Virtual reality for acute and chronic pain management in adult patients: a narrative review.

Virtual reality is a computer-generated environment that immerses the user in an interactive artificial world. This ability to distract from reality has been utilised for the purposes of providing pain relief from noxious stimuli. As technology rapidly matures, there is potential for anaesthetists and pain physicians to incorporate virtual reality devices as non-pharmacological therapy in a multimodal pain management strategy. This systematic narrative review evaluates clinical studies that used virtual reality in adult patients for management of acute and chronic pain. A literature search found 690 citations, out of which 18 studies satisfied the inclusion criteria. Studies were assessed for quality using the Jadad and Nottingham-Ottawa Scales. Agreement on scores between independent assessors was 0.87 (95%CI 0.73-0.94). Studies investigated virtual reality use: intra-operatively; for labour analgesia; for wound dressing changes; and in multiple chronic pain conditions. Twelve studies showed reduced pain scores in acute or chronic pain with virtual reality therapy, five studies showed no superiority to control treatment arms and in one study, the virtual reality exposure group had a worsening of acute pain scores. Studies were heterogeneous in: methods; patient population; and type of virtual reality used. These limitations suggest the evidence-base in adult patients is currently immature and more rigorous studies are required to validate the use of virtual reality as a non-pharmacological adjunct in multimodal pain management.

Nutrients cause grassland biomass to outpace herbivory.

Human activities are transforming grassland biomass via changing climate, elemental nutrients, and herbivory. Theory predicts that food-limited herbivores will consume any additional biomass stimulated by nutrient inputs ('consumer-controlled'). Alternatively, nutrient supply is predicted to increase biomass where herbivores alter community composition or are limited by factors other than food ('resource-controlled'). Using an experiment replicated in 58 grasslands spanning six continents, we show that nutrient addition and vertebrate herbivore exclusion each caused sustained increases in aboveground live biomass over a decade, but consumer control was weak. However, at sites with high vertebrate grazing intensity or domestic livestock, herbivores consumed the additional fertilization-induced biomass, supporting the consumer-controlled prediction. Herbivores most effectively reduced the additional live biomass at sites with low precipitation or high ambient soil nitrogen. Overall, these experimental results suggest that grassland biomass will outstrip wild herbivore control as human activities increase elemental nutrient supply, with widespread consequences for grazing and fire risk.

Evaluation of the Laguerre-Gaussian mode purity produced by three-dimensional-printed microwave spiral phase plates.

Computer-aided design software and additive manufacturing provide flexibility for the direct fabrication of multi-material devices. This design and fabrication versatility has been investigated for the manufacture of dielectric spiral phase plates (SPP) that generate electromagnetic waves with helical wavefronts. Three types of SPPs designed to produce an orbital angular momentum (OAM) mode number l = |1| were additively manufactured using material extrusion and polyjet fabrication methods. The OAM mode characteristics of the transformed helical microwaves as a function of the SPP geometrical features were investigated experimentally in the 12-18 GHz frequency range. The SPPs were further combined with an additively manufactured dielectric lens that provided a marked improvement in OAM mode purity. Finally, multiplexing and de-multiplexing of two OAM modes were demonstrated successfully using an optimum SPP geometry and arrangement.

The impact of air pollution on terrestrial managed and natural vegetation.

Although awareness that air pollution can damage vegetation dates back at least to the 1600s, the processes and mechanisms of damage were not rigorously studied until the late twentieth century. In the UK following the Industrial Revolution, urban air quality became very poor, with highly phytotoxic SO2 and NO2 concentrations, and remained that way until the mid-twentieth century. Since then both air quality, and our understanding of pollutants and their impacts, have greatly improved. Air pollutants remain a threat to natural and managed ecosystems. Air pollution imparts impacts through four major threats to vegetation are discussed through in a series of case studies. Gas-phase effects by the primary emissions of SO2 and NO2 are discussed in the context of impacts on lichens in urban areas. The effects of wet and dry deposited acidity from sulfur and nitrogen compounds are considered with a particular focus on forest decline. Ecosystem eutrophication by nitrogen deposition focuses on heathland decline in the Netherlands, and ground-level ozone at phytotoxic concentrations is discussed by considering impacts on semi-natural vegetation. We find that, although air is getting cleaner, there is much room for additional improvement, especially for the effects of eutrophication on managed and natural ecosystems. This article is part of a discussion meeting issue 'Air quality, past present and future'.

Reported Weight Change in Older Adults and Presence of Frailty.

OBJECTIVE: A 5% change in weight is a significant predictor for frailty and obesity. We ascertained how self-reported weight change over the lifespan impacts rates of frailty in older adults. METHODS: We identified 4,984 subjects ≥60 years with body composition measures from the National Health and Nutrition Examination Survey. An adapted version of Fried's frailty criteria was used as the primary outcome. Self-reported weight was assessed at time current,1 and 10 years earlier and at age 25. Weight changes between each time point were categorized as ≥ 5%, ≤5% or neutral. Logistic regression assessed the impact of weight change on the outcome of frailty. RESULTS: Among 4,984 participants, 56.5% were female, mean age was 71.1 years, and mean BMI was 28.2kg/m2. A weight loss of ≥ 5% had a higher association with frailty compared to current weight, age 25 (OR 2.94 [1.72,5.02]), 10 years ago (OR 1.68 [1.05,2.69]), and 1 year ago (OR 1.55 [1.02,2.36]). Weight gain in the last year was associated with increased rate of frailty (1.59 [1.09,2.32]). CONCLUSION: There is an association between frailty and reported weight loss over time while only weight gain in the last year has an association with frailty.

Superdirective dimers of coupled self-resonant split ring resonators: Analytical modelling and numerical and experimental validation.

Superdirective antennas developed over the last century have received renewed interest in recent years from the development of metamaterials. These arrays of electromagnetic resonators (or meta-atoms) carrying short wavelength electro- and/or magneto-inductive waves support current distributions with very high spatial frequency as required by the classical conditions for superdirectivity. As meta-atoms can have both electric and magnetic dipole characteristics (and hence radiation properties), developing antennas exploiting these distributions can challenge conventional intuitions regarding the optimal configurations required. In this work we are reporting the development of a genuinely superdirective array using split ring resonators (SRRs). We provide a comprehensive analytical model characterizing the radiation from SRR dimers in which excitation of only one split ring leads to superdirective radiation via mutually coupled modes. Our model exploits simple circuit descriptions of coupled resonant circuits, combined with standard radiation formulae for curvilinear current distributions. Using this simple model we are able to map directivity against possible SRR locations and orientations in two dimensions and identify the unique optimal configuration which meets the requirements for superdirective emission. We validate the theoretical findings by comparison to both full wave simulations and experiments showing that our SRR dimer achieves endfire directivity very close to the maximum theoretical value.

Soil net nitrogen mineralisation across global grasslands.

Soil nitrogen mineralisation (Nmin), the conversion of organic into inorganic N, is important for productivity and nutrient cycling. The balance between mineralisation and immobilisation (net Nmin) varies with soil properties and climate. However, because most global-scale assessments of net Nmin are laboratory-based, its regulation under field-conditions and implications for real-world soil functioning remain uncertain. Here, we explore the drivers of realised (field) and potential (laboratory) soil net Nmin across 30 grasslands worldwide. We find that realised Nmin is largely explained by temperature of the wettest quarter, microbial biomass, clay content and bulk density. Potential Nmin only weakly correlates with realised Nmin, but contributes to explain realised net Nmin when combined with soil and climatic variables. We provide novel insights of global realised soil net Nmin and show that potential soil net Nmin data available in the literature could be parameterised with soil and climate data to better predict realised Nmin.

More salt, please: global patterns, responses and impacts of foliar sodium in grasslands.

Sodium is unique among abundant elemental nutrients, because most plant species do not require it for growth or development, whereas animals physiologically require sodium. Foliar sodium influences consumption rates by animals and can structure herbivores across landscapes. We quantified foliar sodium in 201 locally abundant, herbaceous species representing 32 families and, at 26 sites on four continents, experimentally manipulated vertebrate herbivores and elemental nutrients to determine their effect on foliar sodium. Foliar sodium varied taxonomically and geographically, spanning five orders of magnitude. Site-level foliar sodium increased most strongly with site aridity and soil sodium; nutrient addition weakened the relationship between aridity and mean foliar sodium. Within sites, high sodium plants declined in abundance with fertilisation, whereas low sodium plants increased. Herbivory provided an explanation: herbivores selectively reduced high nutrient, high sodium plants. Thus, interactions among climate, nutrients and the resulting nutritional value for herbivores determine foliar sodium biogeography in herbaceous-dominated systems.

Sensitivity of global soil carbon stocks to combined nutrient enrichment.

Soil stores approximately twice as much carbon as the atmosphere and fluctuations in the size of the soil carbon pool directly influence climate conditions. We used the Nutrient Network global change experiment to examine how anthropogenic nutrient enrichment might influence grassland soil carbon storage at a global scale. In isolation, enrichment of nitrogen and phosphorous had minimal impacts on soil carbon storage. However, when these nutrients were added in combination with potassium and micronutrients, soil carbon stocks changed considerably, with an average increase of 0.04 KgCm-2  year-1 (standard deviation 0.18 KgCm-2  year-1 ). These effects did not correlate with changes in primary productivity, suggesting that soil carbon decomposition may have been restricted. Although nutrient enrichment caused soil carbon gains most dry, sandy regions, considerable absolute losses of soil carbon may occur in high-latitude regions that store the majority of the world's soil carbon. These mechanistic insights into the sensitivity of grassland carbon stocks to nutrient enrichment can facilitate biochemical modelling efforts to project carbon cycling under future climate scenarios.

Experimental evaluation of 3D printed spiral phase plates for enabling an orbital angular momentum multiplexed radio system.

This paper evaluates the performance of three-dimensionally (3D) printed spiral phase plates (SPPs) for enabling an orbital angular momentum (OAM) multiplexed radio system. The design and realization of the SPPs by means of additive manufacturing exploiting a high-permittivity material is described. Modes 1 and 2 SPPs are then evaluated at 15 GHz in terms of 3D complex radiation pattern, mode purity and beam collimation by means of a 3D printed dielectric lens. The results with the lens yield a crosstalk of -8 dB for between modes 1 and -1, and -11.4 dB for between modes 2 and -2. We suggest a mode multiplexer architecture that is expected to further reduce the crosstalk for each mode. An additional loss of 4.2 dB is incurred with the SPPs inserted into the communication link, which is undesirable for obtaining reliable LTE-based communications. Thus, we suggest: using lower loss materials, seeking ways to reduce material interface reflections or alternative ways of OAM multiplexing to realize a viable OAM multiplexed radio system.

Sex differences in amino acids lost via sweating could lead to differential susceptibilities to disturbances in nitrogen balance and collagen turnover.

Fluid collected during sweating is enriched with amino acids derived from the skin's natural moisturising factors and has been termed "faux" sweat. Little is known about sex differences in sweat amino acid composition or whether faux sweat amino acid losses affect nitrogen balance. Faux sweat collected by healthy adults (n = 47) after exercise, and at rest by chronic fatigue patients, was analysed for amino acid composition. Healthy females had higher total amino acid concentrations in sweat (10.5 ± 1.2 mM) compared with healthy males (6.9 ± 0.9 mM). Females had higher levels of 13 amino acids in sweat including serine, alanine and glycine. Higher hydroxyproline and proline levels suggested greater collagen turnover in females. Modelling indicated that with conservative levels of exercise, amino acid losses in females via faux sweat were triple than those predicted for urine, whereas in males they were double. It was concluded that females were more susceptible to key amino acid loss during exercise and/or hot conditions. Females reporting chronic fatigue had higher levels of methionine in faux sweat than healthy females. Males reporting chronic fatigue had higher levels of numerous amino acids in faux sweat compared to healthy males. Higher amino acid loss in faux sweat associated with chronic fatigue could contribute to a hypometabolic state. Depending on activity levels, climatic conditions and gender, amino acid losses in sweat and skin leachate could influence daily protein turnover where periods of continuously high turnover could lead to a negative net nitrogen balance.

Implicit learning of between-group intervals in auditory temporal structures.

Implicit learning of temporal structure has primarily been reported when events within a sequence (e.g., visual-spatial locations, tones) are systematically ordered and correlated with the temporal structure. An auditory serial reaction time task was used to investigate implicit learning of temporal intervals between pseudorandomly ordered syllables. Over exposure, participants identified syllables presented in sequences with weakly metrical temporal structures. In a test block, the temporal structure differed from exposure only in the duration of the interonset intervals (IOIs) between groups. It was hypothesized that reaction time (RT) to syllables following between-group IOIs would decrease with exposure and increase at test. In Experiments 1 and 2, the sequences presented over exposure and test were counterbalanced across participants (Pattern 1 and Pattern 2 conditions). An RT increase at test to syllables following between-group IOIs was only evident in the condition that presented an exposure structure with a slightly stronger meter (Pattern 1 condition). The Pattern 1 condition also elicited a global expectancy effect: Test block RT slowed to earlier-than-expected syllables (i.e., syllables shifted to an earlier beat) but not to later-than-expected syllables. Learning of between-group IOIs and the global expectancy effect extended to the Pattern 2 condition when meter was strengthened with an external pulse (Experiment 2). Experiment 3 further demonstrated implicit learning of a new weakly metrical structure with only earlier-than-expected violations at test. Overall findings demonstrate learning of weakly metrical rhythms without correlated event structures (i.e., sequential syllable orders). They further suggest the presence of a global expectancy effect mediated by metrical strength.

Running performance and thermal sensation in the heat are improved with menthol mouth rinse but not ice slurry ingestion.

The purpose of this study was to compare the effects of a cooling strategy designed to predominately lower thermal state with a strategy designed to lower thermal sensation on endurance running performance and physiology in the heat. Eleven moderately trained male runners completed familiarization and three randomized, crossover 5-km running time trials on a non-motorized treadmill in hot conditions (33 °C). The trials included ice slurry ingestion before exercise (ICE), menthol mouth rinse during exercise (MEN), and no intervention (CON). Running performance was significantly improved with MEN (25.3 ± 3.5 min; P = 0.01), but not ICE (26.3 ± 3.2 min; P = 0.45) when compared with CON (26.0 ± 3.4 min). Rectal temperature was significantly decreased with ICE (by 0.3 ± 0.2 °C; P < 0.01), which persisted for 2 km of the run and MEN significantly decreased perceived thermal sensation (between 4 and 5 km) and ventilation (between 1 and 2 km) during the time trial. End-exercise blood prolactin concentration was elevated with MEN compared with CON (by 25.1 ± 24.4 ng/mL; P = 0.02). The data demonstrate that a change in the perception of thermal sensation during exercise from menthol mouth rinse was associated with improved endurance running performance in the heat. Ice slurry ingestion reduced core temperature but did not decrease thermal sensation during exercise or improve running performance.

The Reliability of Running Performance in a 5 km Time Trial on a Non-motorized Treadmill.

The purpose of the study was to establish the reliability of performance and physiological responses during a self-paced 5 km running time trial on a non-motorized treadmill. 17 male runners (age: 32±13 years, height: 177±7 cm, body mass: 71±9 kg, sum of 7 skinfolds: 55±21 mm) performed familiarization then 2 separate maximal 5 km running time trials on a non-motorized treadmill. Physiological responses measured included heart rate, oxygen uptake, expired air volume, blood lactate concentration, tissue saturation index and integrated electromyography. Running time (1,522±163 s vs. 1,519±162 s for trials 1 and 2, respectively) demonstrated a low CV of 1.2% and high ICC of 0.99. All physiological variables had CVs of less than 4% and ICCs of >0.92, with the exception of blood lactate concentration (7.0±2 mmol·L(-1) vs. 6.5±1.5 mmol·L(-1) for trials 1 and 2, respectively; CV: 12%, ICC: 0.83) and the electromyography measures (CV: 8-27%, ICC: 0.71-0.91). The data demonstrate that performance time in a 5 km running time trial on a non-motorized treadmill is a highly reliable test. Most physiological responses measured across the 5 km run also demonstrated good reliability.

Spatial gradient in nitrogen deposition affects plant species frequency in acidic grasslands.

Anthropogenic eutrophication impacts ecosystems worldwide. Here, we use a vegetation dataset from semi-natural grasslands on acidic soils sampled along a gradient in north-western Europe to examine the response of species frequency to nitrogen (N) deposition, controlling for the effects of other environmental variables. A second dataset of acidic grasslands from Germany and the Netherlands containing plots from different time periods was analysed to examine whether the results of the spatial gradient approach coincided with temporal changes in the abundance of species. Out of 44 studied species, 16 were affected by N deposition, 12 of them negatively. Soil pH and phosphorus (P) influenced 24 and 14 species, respectively, predominantly positively. Fewer species were related to the soil contents of NO3(-) or NH4(+), with no significant differences between the number of positive and negative effects. Whereas the temporal change of species was unrelated to their responses to pH, species responding negatively to N deposition, soil P and NO3(-) showed a significant decline over time in both countries. Species that were negatively affected by high N deposition and/or high soil P also showed a negative temporal trend and could be characterised by short stature and slow growth. The results confirm the negative role of N deposition for many plant species in semi-natural acidic grasslands. The negative temporal trends of species sensitive to high N deposition and soil P values clearly show a need for maintaining low soil nutrient status and for restoring the formerly infertile conditions in nutrient-enriched grasslands.

The many faces of posterior reversible encephalopathy syndrome.

The classic imaging findings of posterior reversible encephalopathy syndrome (PRES) are of bilateral parietal and occipital subcortical vasogenic oedema, and are well established in the literature. As experience with PRES grows, varied and atypical presentations are being increasingly described. This pictorial review illustrates the variable presentations of PRES, including cases with atypical imaging findings. We illustrate cases of PRES with varying distributions of vasogenic oedema as well as cases with atypical imaging findings, such as variations of haemorrhage and restricted diffusion. Atypical imaging findings should not dissuade the diagnosis of PRES in the appropriate clinical situation, and knowledge of the varied appearance and atypical findings of PRES allows the radiologist to make this diagnosis.

Addressing the Impact of Atmospheric Nitrogen Deposition on Western European Grasslands.

There is a growing evidence base demonstrating that atmospheric nitrogen deposition presents a threat to biodiversity and ecosystem function in acid grasslands in Western Europe. Here, we report the findings of a workshop held for European policy makers to assess the perceived importance of reactive nitrogen deposition for grassland conservation, identify areas for policy development in Europe and assess the potential for managing and mitigating the impacts of nitrogen deposition. The importance of nitrogen as a pollutant is already recognized in European legislation, but there is little emphasis in policy on the evaluation of changes in biodiversity due to nitrogen. We assess the potential value of using typical species, as defined in the European Union Habitats Directive, for determining the impact of nitrogen deposition on acid grasslands. Although some species could potentially be used as indicators of nitrogen deposition, many of the typical species do not respond strongly to nitrogen deposition and are unlikely to be useful for identifying impact on an individual site. We also discuss potential mitigation measures and novel ways in which emissions from agriculture could be reduced.

The timing of face selectivity and attentional modulation in visual processing.

Despite the complete imprint of a visual scene on the retina, the brain selects particular items for further processing. However, there is considerable debate about when and where the first attentional effects take hold in the cortex. We examined the timing of face specificity and attentional influences in the primary/secondary visual cortex (V1/V2) and in the fusiform gyrus (FG) in two experiments using magnetoencephalography (MEG). In experiment 1, using a passive viewing task, we identified three components in response to "Face," "Hand," and "Shoe" stimuli bilaterally in the FG: M(FG)100, M(FG)170, and M(FG)200-all showing a stronger preference for faces. The timing of these three activations of the FG is consistent with earlier studies claiming distinct stages of processing of visual stimuli in the first 300 ms. In experiment 2, subjects performed a gender-discrimination task on either faces or hands, drawing attention to only one of the two object categories. In addition to the previously identified three components in FG, here we found object-selective attentional enhancement first appearing in V1/V2 at around 170 ms, and then in FG at around 200 ms, i.e. concurrent with the third component. No attentional effects were evident on the first or second magnetoencephalography components. These findings may indicate that the visual input for an object is first encoded and matched to an attended "cue" object held in mind. When the attended and encoded objects match, a third stage involving attentive processing is enhanced.

Blastomeres and cells with mesendodermal fates of carp embryos express cth1, a member of the TIS11 family of primary response genes.

The carp cth1 gene, related to the mammalian TIS11 family of primary response genes, encodes a novel fish protein with two putative CCCH zinc fingers. This report describes the RNA expression of this gene during cleavage, blastula and gastrula stages of carp embryos. Cth1 mRNA is present in all cleavage stage blastomeres as a maternal message. After the late blastula stage, the maternal expression decreases, revealing a spot of higher expression at the margin of the blastoderm of the dome stage embryo. Further decrease of the maternal message reveals a ring of cth1 expressing cells at the blastoderm margin from the stage of 40% epiboly onwards. By alpha-amanitin treatment we established that this local cth1 expression is of zygotic origin. At the onset of gastrulation the cells of the cth1 ring involute, starting with those in the shield region, and at approximately 60% epiboly the ring is fully involuted and occupies the hypoblast layer. All cth1 transcripts have disappeared at completion of epiboly. We discuss a possible role for the putative cth1 protein during cleavage and gastrulation.