Integrated package of electron cyclotron emission imaging data processing and forward modeling in OMFIT.

An Electron Cyclotron Emission Imaging (ECEI) data analysis module has been developed for the OMFIT platform to accommodate the needs of users at the DIII-D tokamak for physics applications. The user can easily access the ECEI spatial observation windows in the plasma that are calculated based on the automatically retrieved hardware setup and available DIII-D equilibria, perform spectral analysis, and obtain 2D electron temperature fluctuation images. The module provides a powerful data post-processing package for extracting important physics parameters from the 2D measurements, including the radial structure and poloidal mode number of Alfven eigenmodes, as well as the frequency-vs-wavenumber dispersion relationship of broadband MHD. The module propagates characterized synthetic fluctuations for the user, so one can perform forward modeling tasks with simple analytical fluctuations.

British Association of Dermatologists National Clinical Audit on the Management of Hidradenitis Suppurativa in the UK.

BACKGROUND: The first UK guidelines for the management of hidradenitis suppurativa (HS) were published by the British Association of Dermatologists (BAD) in 2018. The guidelines contained a set of audit criteria. AIM: To evaluate current HS management against the audit standards in the BAD guidelines. METHODS: BAD members were invited to complete audit questionnaires between January and May 2020 for five consecutive patients with HS per department. RESULTS: In total, 88 centres participated, providing data for 406 patients. Disease staging using the Hurley system and disease severity using a validated tool during follow-ups was documented in 75% and 56% of cases, respectively, while quality of life and pain were documented in 49% and 50% of cases, respectively. Screening for cardiovascular disease risk factors was as follows: smoking 75%, body mass index 27% and others such as lipids and diabetes 57%. Screening for depression and anxiety was performed in 40% and 25% of cases, respectively. Support for smokers or obese patients was documented in 35% and 23% of cases. In total, 182 patients were on adalimumab, of whom 68% had documentation of baseline disease severity, and 76% were reported as having inadequate response or contraindications to systemic treatments; 44% of patients continued on adalimumab despite having < 25% improvement in lesion count. CONCLUSION: UK dermatologists performed well against several audit standards, including documenting disease staging at baseline and smoking status. However, improvements are needed, particularly with regard to screening and management of comorbidities that could reduce the long-term complications associated with HS. A re-audit is required to evaluate changes in practice in the future.

The landscape of psoriasis provision in the UK.

Psoriasis remains one of the commonest conditions seen in dermatological practice, and its treatment is one of the greatest cost burdens for the UK National Health Service. Treatment of psoriasis is complex, with numerous overlapping lines and therapies used in combination. This complexity reflects the underlying pathophysiology of the disease as well as the heterogeneous population that it affects. National Institute for Health and Care Excellence (NICE) guidance for the treatment of psoriasis has been available since 2013, and has been the subject of three national audits conducted by the British Association of Dermatologists. This report synthesizes the results of the most recent of those exercises and places it in the context of the NICE guidance and previous audits. It clearly shows the significant burden of disease, issues with provision of services and long waiting times and the marked shift in therapies towards targeted biologic therapies.

Achievement of Reactor-Relevant Performance in Negative Triangularity Shape in the DIII-D Tokamak.

Plasma discharges with a negative triangularity (δ=-0.4) shape have been created in the DIII-D tokamak with a significant normalized beta (ß_{N}=2.7) and confinement characteristic of the high confinement mode (H_{98y2}=1.2) despite the absence of an edge pressure pedestal and no edge localized modes (ELMs). These inner-wall-limited plasmas have a similar global performance as a positive triangularity (δ=+0.4) ELMing H-mode discharge with the same plasma current, elongation and cross sectional area. For cases both of dominant electron cyclotron heating with T_{e}/T_{i}>1 and dominant neutral beam injection heating with T_{e}/T_{i}=1, turbulent fluctuations over radii 0.5<ρ<0.9 were reduced by 10-50% in the negative triangularity shape compared to the matching positive triangularity shape, depending on the radius and conditions.

The international food unit: a new measurement aid that can improve portion size estimation.

BACKGROUND: Portion size education tools, aids and interventions can be effective in helping prevent weight gain. However consumers have difficulties in estimating food portion sizes and are confused by inconsistencies in measurement units and terminologies currently used. Visual cues are an important mediator of portion size estimation, but standardized measurement units are required. In the current study, we present a new food volume estimation tool and test the ability of young adults to accurately quantify food volumes. The International Food Unit™ (IFU™) is a 4x4x4 cm cube (64cm3), subdivided into eight 2 cm sub-cubes for estimating smaller food volumes. Compared with currently used measures such as cups and spoons, the IFU™ standardizes estimation of food volumes with metric measures. The IFU™ design is based on binary dimensional increments and the cubic shape facilitates portion size education and training, memory and recall, and computer processing which is binary in nature. METHODS: The performance of the IFU™ was tested in a randomized between-subject experiment (n = 128 adults, 66 men) that estimated volumes of 17 foods using four methods; the IFU™ cube, a deformable modelling clay cube, a household measuring cup or no aid (weight estimation). Estimation errors were compared between groups using Kruskall-Wallis tests and post-hoc comparisons. RESULTS: Estimation errors differed significantly between groups (H(3) = 28.48, p < .001). The volume estimations were most accurate in the group using the IFU™ cube (Mdn = 18.9%, IQR = 50.2) and least accurate using the measuring cup (Mdn = 87.7%, IQR = 56.1). The modelling clay cube led to a median error of 44.8% (IQR = 41.9). Compared with the measuring cup, the estimation errors using the IFU™ were significantly smaller for 12 food portions and similar for 5 food portions. Weight estimation was associated with a median error of 23.5% (IQR = 79.8). CONCLUSIONS: The IFU™ improves volume estimation accuracy compared to other methods. The cubic shape was perceived as favourable, with subdivision and multiplication facilitating volume estimation. Further studies should investigate whether the IFU™ can facilitate portion size training and whether portion size education using the IFU™ is effective and sustainable without the aid. A 3-dimensional IFU™ could serve as a reference object for estimating food volume.

Clearance of recalcitrant warts in a patient with idiopathic immune deficiency following administration of the quadrivalent human papillomavirus vaccine.

Human papillomavirus (HPV)-induced cutaneous warts are potentially serious and debilitating. In immunosuppressed patients, these warts may be resistant to standard therapies. We report a case of a young patient with a primary immune deficiency whose recalcitrant cutaneous warts regressed completely following administration of a quadrivalent HPV vaccine.

Observation of a critical gradient threshold for electron temperature fluctuations in the DIII-D Tokamak.

A critical gradient threshold has been observed for the first time in a systematic, controlled experiment for a locally measured turbulent quantity in the core of a confined high-temperature plasma. In an experiment in the DIII-D tokamak where L(T(e))(-1) = |∇T(e)|/T(e) and toroidal rotation were varied, long wavelength (k(θ)ρ(s) ≲ 0.4) electron temperature fluctuations exhibit a threshold in L(T(e))(-1): below, they change little; above, they steadily increase. The increase in δT(e)/T(e) is concurrent with increased electron heat flux and transport stiffness. Observations were insensitive to rotation. Accumulated evidence strongly enforces the identification of the experimentally observed threshold with ∇T(e)-driven trapped electron mode turbulence.

Pedestal structure model.

Predictions are developed for gradients and profiles of the electron density and temperature in tokamak H-mode pedestals that are in transport quasiequilibrium. They are based on assuming paleoclassical processes provide the irreducible minimum radial plasma transport and dominate in the steep gradient regions of pedestals. The predictions agree (within a factor of about two) with properties of a number of pedestal experimental results.

Percutaneous laser photocoagulation of osteoid osteomas under CT guidance.

AIM: The aim was to evaluate laser photocoagulation and the use of the Bonopty needle system in the treatment of osteoid osteoma. MATERIALS AND METHODS: Five patients with osteoid osteomas were treated with computed tomography (CT)-guided, percutaneous laser photocoagulation using the Bonopty biopsy system. RESULTS: Complete pain relief was obtained in four patients. In one patient, pain persisted until the 6 weeks follow-up but resolved within 24 h of repeating the procedure. There were no complications, and patients remained symptom free at follow-up of 4-23 months (mean, 14 months). CONCLUSION: CT-guided laser photocoagulation of osteoid osteoma is a minimally invasive technique that represents a cost-effective alternative to surgical excision. The Bonopty needle system allows successful penetration of the sclerotic bone surrounding the nidus with manual pressure alone.

Septic arthritis of the shoulder in children in Malawi. A randomised, prospective study of aspiration versus arthrotomy and washout.

We undertook a prospective study of 61 children in Malawi with septic arthritis of the shoulder. They were randomised into two groups, treated by aspiration (group 1, 31 patients) or arthrotomy (group 2, 30 patients). Both received antibiotics for six weeks. We studied the results of blood tests, microbiology, and the clinical and radiological outcome one year after diagnosis. Only one patient was sickle-cell positive and three were HIV-positive. Non-typhoidal Salmonella species accounted for 86% (19/22) of the positive joint cultures in group 1 and 73% (16/22) in group 2. Of the 33 radiographs available for review at follow-up at six months, 23 (70%) showed evidence of glenohumeral damage. There was no statistical difference in radiological outcome for the two groups. We devised and validated a scoring system, the Blantyre Septic Joint Score, for the assessment of joints based upon swelling, tenderness, function and range of movement. Despite the radiological changes only one of the 24 joints examined at one year had any deficit in these parameters. There was no statistical difference in the clinical outcome for the two treatment groups at any stage during the period of follow-up.

The use of a carbon fiber plate for periprosthetic supracondylar femoral fractures.

Operative management of periprosthetic supracondylar femoral fractures in poor-quality bone presents a challenging task for the orthopaedic surgeon. We report our experience with the use of a semirigid carbon fiber-reinforced plate in the treatment of 5 patients, all of whom were elderly women with severe osteoporosis and highly restricted mobility. All 5 of the fractures were sustained after low-energy trauma at least 2 years after primary knee arthroplasty. Except for 1 patient who died of pulmonary embolism, all 4 surviving patients progressed uneventfully to fracture union with good mobility and no residual pain. The use of this method for the treatment of periprosthetic femoral fractures has not been reported previously, and we believe it provides a successful and technically undemanding solution to this difficult problem.

Case study: incorporating project management skills in the design of a clinical research patient management system.

Faced with the problem of managing over 3,000 records with no systematic location and retrieval mechanism, a project management team relied on health information management skills, including those of project management, data modeling, and records management, to plan and implement an effective system for managing patient data.

Primary glenoid dysplasia. A review of 12 patients.

We reviewed 12 patients with primary glenoid dysplasia. Ten were assessed clinically and two from case notes and radiographs. We identified two groups according to the age at onset of symptoms. The first (seven patients) consisted of boys and younger men, all of whom developed symptoms before the age of 40 years. All four children were free from pain, whereas the three adults in this group had varying degrees of this. Four patients had symptoms of instability. The second group consisted of older men (five patients) all of whom had noted the onset of symptoms, in the form of pain and stiffness, after the age of 40 years. All five had radiological evidence of osteoarthritis. Although the four children in our study had minimal symptoms, all eight adults had ongoing shoulder pain and dysfunction, despite a specific rehabilitation programme. Four patients required surgery; one had posterior stabilisation for instability and three arthroplasties of the shoulder for osteoarthritis.

A comparison of tracheal tube tip designs on the passage of an endotracheal tube during oral fiberoptic intubation.

BACKGROUND: The design of an endotracheal tube has been shown to influence the passage of the tube through the glottis during fiberoptic intubation. Difficulty in passing the endotracheal tube can occur if the aryepiglottic folds obstruct the passage of the bevel. The relevant aspects of endotracheal tube design include the shape of the bevel, the material used by the manufacturer, and the ability of the tube to conform to the shape of the fiberscope. The aim of the current study was to compare the ease of passage through the glottis of two different tubes. One tube was a wire reinforced polyvinyl chloride tube with a standard bevel and the other was a newly designed tube with a bevel of different shape and made of silicone rubber. The new design is for use with the a commerical intubating laryngeal mask. METHODS: The authors studied a population of 30 patients who received a standard anesthetic. In all cases, oral fiberoptic intubation was attempted. Anesthetic was administered to each patient using both tubes, and before the study the order of the tubes was randomized. The difficulty in passing the tube was assessed by a blinded observer and graded using a three-point scale (grade 1: no difficulty passing the tube; grade 2: obstruction to passing the tube relieved by withdrawal and a 90 degrees anticlockwise rotation; grade 3: obstruction necessitating more than one manipulation or external laryngeal manipulation). RESULTS: In 27 patients, no difficulty was shown by use of the silicone-tipped tube. In only three patients was there difficulty that necessitated a 90 degrees anticlockwise twist. With the wire-reinforced tube, no difficulty was experienced on 14 occasions. Grade 1 difficulty was experienced eight times and difficulty necessitating more than one maneuver, head movement, or external laryngeal manipulation was seen on eight occasions. Statistical significance was achieved at P = 0.0002 (Wilcoxon signed rank test). CONCLUSIONS: The authors conclude that the use of the silicone-tipped tube with the new bevel design may provide an advantage in the clinical situation of fiberoptic intubation.

Using goal setting as a strategy for dietary behavior change.

Recent reviews have noted that behavioral theory-based nutrition education programs are more successful at achieving food behavior change than knowledge-based programs and that a clear understanding of the mechanisms of behavior change procedures enable dietetics professionals to more effectively promote change. Successful dietary behavior change programs target 1 or more of the personal, behavioral, or environmental factors that influence the behavior of interest and apply theory-based strategies to influence or change those factors. Goal setting is a strategy that is frequently used to help people change. A 4-step goal-setting process has been identified: recognizing a need for change; establishing a goal; adopting a goal-directed activity and self-monitoring it; and self-rewarding goal attainment. The applications of goal setting in dietary interventions for adults and children are reviewed here. Because interventions using goal setting appear to promote dietary change, dietitians should consider incorporating the goal-setting strategies to enhance the behavior change process in nutrition education programs.

The association between frozen shoulder and Dupuytren's disease.

Fifty-eight patients with the diagnosis of primary frozen shoulder were independently examined by 3 surgeons for evidence of Dupuytren's disease. The disease was found in 52% (30/58) of the patients reviewed. These figures were compared with previously reported figures for a population of similar age. This showed that Dupuytren's disease is 8.27 (95% CI, 6.25-11.2) times more common in patients with frozen shoulder than in the general population; the difference between the two was highly statistically significant (P < .001, chi(2) test). We discuss the literature on the association between frozen shoulder and Dupuytren's disease and the implications of such a high proportion of patients sharing these two conditions.

The hairpin structure of the (6)F1(1)F2(2)F2 fragment from human fibronectin enhances gelatin binding.

The solution structure of the (6)F1(1)F2(2)F2 fragment from the gelatin-binding region of fibronectin has been determined (Protein Data Bank entry codes 1e88 and 1e8b). The structure reveals an extensive hydrophobic interface between the non-contiguous (6)F1 and (2)F2 modules. The buried surface area between (6)F1 and (2)F2 ( approximately 870 A(2)) is the largest intermodule interface seen in fibronectin to date. The dissection of (6)F1(1)F2(2)F2 into the (6)F1(1)F2 pair and (2)F2 results in near-complete loss of gelatin-binding activity. The hairpin topology of (6)F1(1)F2(2)F2 may facilitate intramolecular contact between the matrix assembly regions flanking the gelatin-binding domain. This is the first high-resolution study to reveal a compact, globular arrangement of modules in fibronectin. This arrangement is not consistent with the view that fibronectin is simply a linear 'string of beads'.

Measuring the forces involved in polyvalent adhesion of uropathogenic Escherichia coli to mannose-presenting surfaces.

Mechanisms of bacterial pathogenesis have become an increasingly important subject as pathogens have become increasingly resistant to current antibiotics. The adhesion of microorganisms to the surface of host tissue is often a first step in pathogenesis and is a plausible target for new antiinfective agents. Examination of bacterial adhesion has been difficult both because it is polyvalent and because bacterial adhesins often recognize more than one type of cell-surface molecule. This paper describes an experimental procedure that measures the forces of adhesion resulting from the interaction of uropathogenic Escherichia coli to molecularly well defined models of cellular surfaces. This procedure uses self-assembled monolayers (SAMs) to model the surface of epithelial cells and optical tweezers to manipulate the bacteria. Optical tweezers orient the bacteria relative to the surface and, thus, limit the number of points of attachment (that is, the valency of attachment). Using this combination, it was possible to quantify the force required to break a single interaction between pilus and mannose groups linked to the SAM. These results demonstrate the deconvolution and characterization of complicated events in microbial adhesion in terms of specific molecular interactions. They also suggest that the combination of optical tweezers and appropriately functionalized SAMs is a uniquely synergistic system with which to study polyvalent adhesion of bacteria to biologically relevant surfaces and with which to screen for inhibitors of this adhesion.

The relative orientation of the fibronectin 6F1(1)F2 module pair: a 15N NMR relaxation study.

The structure of a pair of modules (6F1(1)F2), that forms part of the collagen-binding region of fibronectin, is refined using heteronuclear relaxation data. A structure of the pair was previously derived from 1H-1H NOE and 3J(HalphaHN) data [Bocquier et al. (1999) Structure, 7, 1451-1460] and a weak module-module interface, comprising Leu19 and Leu28, in 6F1, and Tyr68 in 2F1, was identified. In this study, the definition of the average relative orientation of the two modules is improved using the dependence of 15N relaxation on rotational diffusion anisotropy. This structure refinement is based on the selection of a subset of structures from sets calculated with NOE and 3J(HalphaHN) data alone, using the quality of the fits to the relaxation data as the selection criterion. This simple approach is compared to a refinement strategy where 15N relaxation data are included in the force field as additional restraints [Tjandra et al. (1997) Nat. Struct. Biol., 4, 443-449].