Tolerance of Landoltia punctata to arsenate: an evaluation of the potential use in phytoremediation programs.

Plants used in phytoremediation should accumulate and tolerate a specific pollutant. Here, we aimed at evaluating a possible arsenic (As) accumulation and mechanisms of tolerance against As-induced damage in Landoltia punctata to explore this species for phytoremediation. Plants were subjected to increasing As levels. As absorption was higher with increasing As levels. The activity of superoxide dismutase and glutathione reductase as well as anthocyanin levels increased with As levels. Catalase and peroxidase activities increased in plants subjected to As levels up to 1.0 mg L-1 and decreased at higher levels. Due to the antioxidant system, higher levels of reactive oxygen species were restrained in plants under low levels of As. However, the levels of superoxide anion, hydrogen peroxide, and lipid peroxidation increased in response to the impaired antioxidant system induced by the highest As levels. Biomass decreased in plants exposed to As and scanning electron microscopy revealed root structural damage in the root cap of plants under 3.0 mg L-1 As. This work highlights that L. punctata can be considered a hyperaccumulator species and has potential for As phytoremediation when levels are lower than 1.0 mg L-1-a concentration 100-fold higher than that recommended for drinking water. Novelty Statement: Landoltia punctata can be considered a hyperaccumulator species and has the potential for arsenic phytoremediation when levels are lower than 1.0 mg L-1.

Systematic Review: The Role of Thrombolysis in Intermediate-Risk Pulmonary Embolism.

BACKGROUND: This systemic review provides practicing emergency physicians updated information about the role of thrombolysis in the treatment of intermediate-risk pulmonary embolism. METHODS: A PubMed literature search from January 1, 2005 to December 31, 2018 was conducted and limited to human clinical trials written in English with relevant keywords. High-quality studies were identified and then underwent a structured review. Recommendations are made based on the literature review. RESULTS: Sixty-three articles met criteria for rigorous review, of which 13 were appropriate for citation in this review. Of these 13, there were 6 prospective studies and 7 retrospective studies. CONCLUSIONS: Thrombolysis, either catheter-directed or systemic, is a treatment option in the management of patients with intermediate-risk pulmonary embolism and a high likelihood of clinical deterioration. Each method of thrombolysis carries risks and benefits. Based on the available evidence, transfer to a facility for the purpose of catheter-directed thrombolysis is not recommended.

Program Visits and Residency Interviews.

Interviews and program visits play a major role in the National Resident Matching Program application process. They are a great opportunity for programs to assess applicants and vice versa. Irrespective of all other elements in the application profile, these can make it or break it for an applicant. In this article, we assist applicants in planning their residency interviews and program visits. We elaborate on the keys to success, including planning of the interviews in a proper and timely fashion, searching programs individually, conducting mock interviews, following interview and program visit etiquette, and carefully scheduling and making travel arrangements. We also guide applicants through what to expect and is expected of them during their interview and visit.

History and physical exam predictors of intracranial injury in the elderly fall patient: A prospective multicenter study.

OBJECTIVES: A prior single-center study demonstrated historical and exam features predicting intracranial injury (ICI) in geriatric patients with low-risk falls. We sought to prospectively validate these findings in a multicenter population. METHODS: This is a prospective observational study of patients ≥65 years presenting after a fall to three EDs. Patients were eligible if they were at baseline mental status and were not triaged to the trauma bay. Fall mechanism, head strike history, headache, loss of consciousness (LOC), anticoagulants/antiplatelet use, dementia, and signs of head trauma were recorded. Radiographic imaging was obtained at the discretion of treating physicians. Patients were called at 30 days to determine outcome in non-imaged patients. RESULTS: 723 patients (median age 83, interquartile range 74-88) were enrolled. Although all patients were at baseline mental status, 76 had GCS <15, and 154 had dementia. 406 patients were on anticoagulation/antiplatelet agents. Fifty-two (7.31%) patients had traumatic ICI. Two study variables were helpful in predicting ICI: LOC (odds ratio (OR) 2.02) and signs of head trauma (OR 2.6). The sensitivity of these items was 86.5% (CI 73.6-94) with a specificity of 38.8% (CI 35.1-42.7). The positive predictive value in this population was 10% (CI 7.5-13.3) with a negative predictive value of 97.3% (CI 94.4-98.8). Had these items been applied as a decision rule, 273 patients would not have undergone CT scanning, but 7 injuries would have been missed. CONCLUSION: In low-risk geriatric fall patients, the best predictors of ICI were physical findings of head trauma and history of LOC.

Novel Use of Ophthalmic pH Paper to Diagnose Malicious Caustic Ingestion in a Pediatric Patient.

Occult caustic ingestion in the pediatric population is a challenging diagnosis to make in the emergency department. Failure to suspect and diagnose a caustic ingestion can lead to potentially life-changing comorbidities. Historically, the diagnosis of caustic ingestion has been clinical without any suitable diagnostic tools to aid in the suspicion of occult cases. In this case, we describe a novel use of ophthalmic pH paper to diagnose caustic ingestion in a three-year-old.

Prospective Validation and Refinement of a Decision Rule to Obtain Chest X-ray in Patients With Nontraumatic Chest Pain in the Emergency Department.

OBJECTIVES: The objective was to prospectively validate and refine previously published criteria to determine the potential utility of chest x-ray (CXR) in the evaluation and management of patients presenting to the emergency department (ED) with nontraumatic chest pain (CP). METHODS: A prospective observational study was performed of patients presenting to three EDs in the United States with a chief complaint of nontraumatic CP. Previously defined high-risk history and examination elements were combined into a refined decision rule and these elements were recorded for each patient by the ED physician. CXR results were reviewed and analyzed to determine the presence of clinically significant findings including pneumonia, pleural effusion, pneumothorax, congestive heart failure, or the presence of a new mass. Odds ratios for each history and examination element were analyzed as well as sensitivity, specificity, and negative predictive value (NPV) of the rule overall. RESULTS: A total of 1,111 patients were enrolled and 1,089 CXRs were analyzed. There were 70 (6.4%) patients with clinically relevant findings on CXR. The refined decision rule had a sensitivity of 92.9% (confidence interval [CI] = 83.4%-97.3%) and specificity of 30.4% (CI = 27.6%-33.4%) to predict clinically relevant findings on CXR, with a NPV of 98.4% (CI = 96.1%-99.4%). Five CXRs with clinically significant findings would have been missed by application of the refined rule (three pneumonias and two pleural effusions). Applying these criteria as a CXR decision rule to this population would have reduced CXR utilization by 28.9%. CONCLUSIONS: This study validates previous research suggesting a low clinical yield for CXR in the setting of nontraumatic CP in the ED. This refined clinical decision rule has a favorable sensitivity and NPV in a patient population with low incidence of disease. Further validation is needed prior to use in practice.

During the Emergency Department Evaluation of a Well-Appearing Neonate with Fever, Should Empiric Acyclovir Be Initiated?

BACKGROUND: Herpes simplex virus (HSV) infection represents significant morbidity and mortality in the neonatal period. Although clear guidelines exist on the evaluation and management of the otherwise well-appearing febrile neonate pertaining to occult serious bacterial infections, there is no standardized approach regarding when to initiate testing and treatment for HSV infection. It is vital we establish a unified guideline based on available clinical research to aid in our decision to evaluate and initiate therapy for this disease. METHODS: A PubMed search was performed using the keywords "neonate AND fever AND HSV" and "neonate AND fever AND acyclovir." The time period for the search was May 1982 to May 2016. Identified articles underwent further selection based on relevance to the clinical question. Selected articles then underwent detailed review and structured analysis. RESULTS: Our search identified 93 articles, of which 18 were found to be relevant to our clinical question. Recommendations were then made based on thorough review and analysis of the selected articles. CONCLUSIONS: Neonatal HSV infection carries significant morbidity and mortality if left untreated. High-quality clinical evidence on when to evaluate and treat for possible HSV infection is lacking. Based on available research, HSV infection in the febrile neonate should be strongly considered if age is < 21 days, or if presenting with concerning clinical features. If testing is performed, empiric treatment with high-dose acyclovir should be initiated. Additional research is needed to further clarify which cases mandate evaluation and treatment for HSV, and to better define treatment protocols.

Spontaneous strategies for psychological control of seizures.

The present research explored the strategies individuals with epilepsy use to manage seizure activity by using a survey method (n=105). Analysis suggests that participants' strategies are more likely cognitive or behavioral in nature, rather than emotional. Furthermore, strategy usage varied by whether participants experienced a global perception or an immediate perception of seizure susceptibility. Cognitive strategies were more likely used in response to immediate awareness of seizure risk (p<.01), whereas behavioral strategies corresponded to a global awareness of risk, though this finding did not quite reach significance (p=.06). The present research 1) provides new information regarding the relationship between awareness of seizure susceptibility and strategy use by individuals with epilepsy to manage seizure activity and 2) developed two new scales (Cognitive, Behavior, & Emotional Strategies for Seizure Control Scale and Perception of Seizure Control Scale) for future research and clinical use.

Advanced medical simulation applications for emergency medicine microsystems evaluation and training.

Participants in the 2008 Academic Emergency Medicine Consensus Conference "The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise" morning workshop session on developing systems expertise were tasked with evaluating best applications of simulation techniques and technologies to small-scale systems in emergency medicine (EM). We collaborated to achieve several objectives: 1) describe relevant theories and terminology for discussion of health care systems and medical simulation, 2) review prior and ongoing efforts employing systems thinking and simulation programs in general medical sectors and acute care medicine, 3) develop a framework for discussion of systems thinking for EM, and 4) explore the rational application of advanced medical simulation methods to a defined framework of EM microsystems (EMMs) to promote a "quality-by-design" approach. This article details the materials compiled and questions raised during the consensus process, and the resulting simulation application framework, with proposed solutions as well as their limitations for EM systems education and improvement.

Design of multimodal dissimilarity spaces for retrieval of video documents.

This paper proposes a novel representation space for multimodal information, enabling fast and efficient retrieval of video data. We suggest describing the documents not directly by selected multimodal features (audio, visual or text), but rather by considering cross-document similarities relatively to their multimodal characteristics. This idea leads us to propose a particular form of dissimilarity space that is adapted to the asymmetric classification problem, and in turn to the query-by-example and relevance feedback paradigm, widely used in information retrieval. Based on the proposed dissimilarity space, we then define various strategies to fuse modalities through a kernel-based learning approach. The problem of automatic kernel setting to adapt the learning process to the queries is also discussed. The properties of our strategies are studied and validated on artificial data. In a second phase, a large annotated video corpus, (ie TRECVID-05), indexed by visual, audio and text features is considered to evaluate the overall performance of the dissimilarity space and fusion strategies. The obtained results confirm the validity of the proposed approach for the representation and retrieval of multimodal information in a real-time framework.

Accuracy of emergency medicine ultrasound in the evaluation of abdominal aortic aneurysm.

This study assesses the accuracy of Emergency Medicine (EM) residents in detecting the size and presence of abdominal aortic aneurysms (AAAs) using EM ultrasound (EUS) compared to radiology measurement (RAD) by computed tomography (CT) scan, magnetic resonance imaging (MRI), angiography, or operative findings. There were 238 aortic EUS performed from 1999-2000; 36 were positive for AAA. The EUS finding of "AAA" had a sensitivity of 0.94 (0.86-1.0 95% confidence interval [CI]) and specificity of 1 (0.98-1.0 95% CI). Mean aortic diameter among patients with AAA identified by EUS was 5.43+/-1.95 cm and by RAD was 5.35+/-1.83 cm. The mean absolute difference between EUS and RAD diameters was 4.4 mm (95% CI 3.7-5.5 mm). Regression of EUS on RAD diameters is strongly correlated, with R(2)=0.92. EM residents with appropriate training can accurately determine the presence of AAA as well as the maximal aortic diameter.

A robust multiscale B-spline function decomposition for estimating motion transparency.

Motion transparency phenomena in image sequences are frequent, but classical methods of motion estimation are unable to deal with them. This paper describes a method for estimating optical flow by a generalization of the brightness constancy assumption to additive transparencies. The brightness constancy assumption is obtained by setting constant velocity fields during three images of a sequence. Thus, by a Taylor development to its second order, we reach an extension of the optical flow constraint equation. Since the equation is nonlinear, the Levenberg-Marquardt algorithm is used. In order to suppress the unavoidable aperture problem, a global model based on B-spline basis functions is applied with the aim of constraining optical flows. This description of motion allows us to work on a coarse to fine estimation of artificial image sequences that shows good convergence properties. It is also applied to natural image sequences.