[Utility of topical vancomycin application in the prevention of surgical site infection of the lumbosacral spine]. / Utilidad de la aplicación de vancomicina tópica en la prevención de infección de sitio quirúrgico de la columna lumbosacra.

INTRODUCTION: surgical site infections (SSI) remain a significant cause of morbidity and mortality and one of the most representative causes of nosocomial infections. The use of intrawound vancomycin in lumbar spine surgery is a potential prophylactic measure against SSI; however, evidence regarding its efficacy is contradictory. Our study was designed to research if intrawound vancomycin significantly prevents SSI in lumbar spine surgery. MATERIAL AND METHODS: this is a randomized, double-blinded, controlled clinical trial; 233 patients who underwent lumbar spine surgery, were randomly assigned to a group in which intrawound vancomycin was instilled in the incision before closure (109), or to a control group (114). The main outcome is the presence of SSI; we determined its prevalence and searched for difference between groups for association between SSI and independent variables. RESULTS: global SSI prevalence was 1.8%, in the experimental group was 0.9%, in the control group was 2.6%. There was no significant difference between these values, p = 0.622. The relative risk of SSI in the experimental group was 0.35 (95% CI 0.037-3.30), that of the control group was 2.87 (95% CI 0.30-27.16). The number needed to treat is 58.3. We did not find a significant association between the independent variables studied and the appearance of SSI. CONCLUSIONS: we did not find a significant difference in the prevalence of SSI between groups nor a significant association between SSI and independent variables.

INTRODUCCIÓN: las infecciones postoperatorias del sitio quirúrgico son una importante causa de morbimortalidad y una de las formas más comunes de infecciones nosocomiales. La aplicación de vancomicina al terminar una intervención de columna lumbar es una potencial práctica profiláctica de infecciones del sitio quirúrgico (ISQ). La evidencia que sostiene su uso es controversial. Nuestro estudio investiga si la aplicación de vancomicina disminuye en forma significativa la prevalencia de ISQ. MATERIAL Y MÉTODOS: ensayo clínico aleatorizado, controlado, cegado; 223 pacientes intervenidos de la columna lumbar fueron aleatoriamente asignados a un grupo experimental de 109 pacientes en quienes se colocó vancomicina y a un grupo control de 114 pacientes que no recibió vancomicina. El principal desenlace del estudio es la aparición de ISQ; se estudió la prevalencia de ISQ en ambos grupos y se buscó si existe diferencia significativa. Se analizó la existencia de factores predictores de ISQ. RESULTADOS: la prevalencia global de infección fue 1.8%; en el grupo experimenta 0.09% y en el grupo control 2.6%. No hubo diferencia significativa entre estas cifras, p = 0.622. El riesgo relativo de ISQ en el grupo experimental fue 0.35 (IC95% 0.037-3.30), el del grupo control fue 2.87 (IC95% 0.30-27.16). El número necesario para tratar es 58.3. No encontramos asociación significativa entre las variables independientes estudiadas y la aparición de ISQ. CONCLUSIONES: no encontramos evidencia suficiente de que la aplicación de vancomicina disminuya significativamente la prevalencia de ISQ ni asociación significativa de ISQ con las variables independientes estudiadas.

Peri-operative management and analgesic strategy for a patient undergoing quadruple limb amputation.

Inadequately managed amputation pain can contribute to postoperative morbidity and mortality. However, amputation pain can be challenging to manage due to its complex nature, with both central and peripheral nociceptive and neuropathic elements. Here, we present the case of a 47-year old man who developed irreversible ischaemic injuries to all four limbs following admission to intensive care with sepsis. He required quadruple amputation and we describe our approach to his peri-operative management including anaesthesia, invasive monitoring and the multi-modal approach to his peri-operative management using a combination of intravenous analgesics, bilateral brachial plexus nerve catheters and a combined spinal and epidural. The patient made a good recovery and was able to return home from a rehabilitation facility 12 months after the operation, able to undertake many tasks himself with the aid of prosthetics.

Early evaluation of a DBT-informed online intervention for people with eating disorders.

OBJECTIVES: Eating disorders (EDs) have a worldwide prevalence of 7.8%, with towering mortality rates and high healthcare costs. The current recommended treatment for EDs principally works by directly targeting ED thoughts and behaviours, but recovery rates are low. A multifaceted link between difficulties with emotions and EDs is now widely established, and newer third-wave therapies that aim to address these underlying emotion difficulties are promising. The current study piloted an online emotion self-help intervention which was co-developed with clinicians and people with lived experienced of EDs. The intervention aimed to specifically address difficulties with emotion identification and regulation, as well as unhelpful beliefs about emotions, which are believed to give rise to and maintain ED thoughts and behaviours. METHOD: We recruited 39 people with self-reported EDs to test this intervention over a one-week period. Our participants were asked to complete a series of questionnaires measuring emotion processes and psychopathology on Day 1 (T1) before being given access to the intervention. Participants were then asked to practice the newly acquired skills for seven days, before taking the same questionnaires on Day 9 (T2). We also asked participants to qualitatively report on their experience of the intervention. RESULTS: We found significant improvements in ED psychopathology (ED-15), depression (PHQ-9), and anxiety (GAD-7) pre- to post-intervention, with medium to large effect sizes. All our emotion variables namely alexithymia (TAS-20), difficulties regulating emotions (DERS-SF), and unhelpful beliefs about emotions (EBQ) also showed significant changes post-intervention with medium to large effect sizes. Most importantly, changes in emotion regulation processes were linked to improved eating psychopathology. The qualitative analysis corroborated this finding, highlighting how the intervention helped them form new beliefs about emotions, which helped them reduce ED behaviours. DISCUSSION: Significant improvements in emotion processing and regulations, as well as psychopathology, along with positive qualitative feedback, suggest that the intervention effectively met its aims of increasing awareness of the link between emotions and eating psychopathology, providing help to identify and regulate emotions, and normalising emotional experiences. While our results are promising, further research is required to assess its effectiveness longer term and in clinical settings.

About one person dies every hour as a direct result of an eating disorder (ED), in part because of poor treatment outcomes. Current recommended treatments have a limited focus around emotion difficulties, such as the ability to identify emotions and regulate them, which are linked to ED thoughts and behaviours. With the help of clinicians and people with lived experience of EDs, we developed an online intervention that works on these emotion difficulties. We recruited 39 people with EDs to test this intervention over a one-week period and evaluated our results using quantitative and qualitative analyses. Comparing scores before and after the intervention, we found that ED psychopathology, depression and anxiety were significantly lower post-intervention. Beliefs about emotions as well as the ability to identify, describe and regulate emotions were also significantly improved post-intervention. Qualitative analysis showed that our intervention helped people feel better equipped to deal with their feelings in a healthier way, which helped reduce ED behaviours. One person even described the intervention as "life-changing". While our results are promising, further research is required to assess our intervention in a clinical setting.

In Vitro Models Used in the Formation of Root Caries Lesions-A Review of the Literature.

The management of root caries remains a challenge for clinicians due to its unique anatomical location and structure. There is increasing interest in utilising artificial root caries lesions to develop new strategies for remineralisation. An ideal protocol has not yet been agreed upon. The aim of this review is to provide a structured overview of previously reported in vitro root caries models. The literature was screened and mined for information mainly on substrate selection, model systems utilised, and variables used in the models. Human roots (60%) were the most frequently used substrates, followed by bovine roots (40%). Chemical models (69%) were the most frequently utilised model systems, followed by microbiological models (27%), to form root caries lesions. Acetate buffer solution (80%), pH 5.0 or above (40%), and a demineralisation time of five days (25%) were the common variables used in the chemical systems, while mono-species biofilm was most frequently used (73%) in microbiological models and Streptococcus mutans was the most common bacterial strain utilised in these models (80%). This review highlights the variability amongst the experimental approaches, discusses the advantages and limitations of these approaches, and emphasises that standardisation of experimental conditions along with sustained research will benefit root caries research.

Chapter 9.1: The Use of Fluorides in the Control of Coronal Caries.

Fluoride is the main agent used to control dental caries, with a very successful history after its widespread implementation worldwide, resulting in significant caries declines around the globe. In this chapter, the mechanism of action and peculiarities of different methods of fluoride use are revised. Fluoride controls caries progression by interfering with the processes of mineral exchanges (demineralization, remineralization) to which teeth are frequently subjected upon exposure to dental biofilm and a diet rich in fermentable sugars. Because caries is a ubiquitous disease of modern societies, different strategies have been developed to successfully keep fluoride available in oral fluids: (1) community-based approaches, such as water fluoridation, in which fluoride is delivered to communities at very low levels; (2) individual-based approaches, such as fluoride toothpastes, in which fluoride is delivered at higher concentrations, directly into the oral cavity, in a convenient combination with the act of brushing teeth to remove dental biofilm; (3) professionally-delivered approaches, such as fluoride gels and varnishes, in which very-high concentration products react with teeth resulting in local fluoride reservoirs that release the ion for weeks/months; and (4) combinations of these approaches, such as the concomitant use of fluoridated water and toothpaste, or the use of professional fluorides in caries-active patients. In conclusion, this chapter reviews the different modalities of fluoride use for coronal caries control, and summarizes the combined application of these methods according to the best evidence available.

Sex-specific mechanisms for eating disorder risk in men and women with autistic traits: the role of alexithymia.

BACKGROUND: A poorly understood relationship exists between eating disorders (ED) and autism spectrum conditions (ASC: henceforth 'autism'). ED are more prevalent in autistic people and people with high autistic traits, and autistic features are prognostic of longer illness. Aiming to understand what increases the risk of ED in relation to autism and autistic traits, previous research has implicated alexithymia as a causal mechanism in this relationship. These studies could not, however, disentangle whether alexithymia explains the relationship between ED pathology and autistic traits directly or through its impact on anxious/depressive symptoms, which in turn result in higher ED symptomatology. Moreover, despite evidence for sex differences in the aetiology of ED, little research has examined the impact of sex on these relationships. METHODS: Focusing on the association between autistic traits and ED psychopathology, we examined independent mediating effects of alexithymia and anxious/depressive symptoms, as well as sequential mediation effects where alexithymia affects ED psychopathology via its impact on anxious/depressive symptoms. Participants were 198 men and 265 women with formally diagnosed and suspected ED, who completed an online survey of standardised scales. RESULTS: In men, higher autistic traits were associated with ED psychopathology sequentially via greater alexithymia and through that, greater depressive/anxious symptoms. In women, alexithymia mediated the relationship between autistic traits and ED psychopathology both directly and sequentially through its impact on anxious/depressive symptoms. Interestingly, depressive/anxious symptoms also mediated that relationship independently from alexithymia. CONCLUSIONS: While cross-sectional, these findings suggest that the relationship between autistic traits and ED symptomatology is mediated by other variables. In support of its proposed role in the aetiology of ED, alexithymia was directly associated with ED symptoms in women. It also affected ED symptoms indirectly, in all participants, via its effect on depressive/anxious symptoms. Interventions focusing on alexithymia may facilitate recovery not only via their effect on ED, but via their effect on other forms of state psychopathology which contribute to the maintenance and development of ED. Sex differences, however, reflect that alternative therapeutic targets for men and women may be beneficial.

Autistic individuals seem to be at higher risk of developing eating disorders (ED)­even just having autistic traits seems to elevate risk of ED, although we do not understand why. One possibility is that autism and autistic traits are closely related to alexithymia, a difficulty identifying and describing your emotions, and it may be this that increases risk of ED. To test this, we explored relationships between autistic traits and ED symptoms in men and women with ED, who completed an online survey. In men, we found that autistic traits were associated with ED symptoms because they were associated with alexithymia, and alexithymia was associated with ED symptoms because it was associated with anxious/depressive symptoms. The same was true in women, but anxious/depressive symptoms were also associated with ED symptoms in their own right. While these findings need to be investigated in more thorough longitudinal approaches, they suggest that pathways to ED differ slightly between men and women, autistic and non-autistic, and that therapeutic interventions should also differ. In both sexes, the fact that alexithymia was associated with ED symptoms and those of other mental illnesses that seemed to contribute to ED, suggests that it should be targeted in interventions.

Utility of Diffusion Modeling of Cogstate Brief Battery Test Performance in Detecting Mild Cognitive Impairment.

Cognitive testing data are essential to the diagnosis of mild cognitive impairment (MCI), and computerized cognitive testing, such as the Cogstate Brief Battery, has proven helpful in efficiently identifying harbingers of dementia. This study provides a side-by-side comparison of traditional Cogstate outcomes and diffusion modeling of these outcomes in predicting MCI diagnosis. Participants included 257 older adults (160 = normal cognition; 97 = MCI). Results showed that both traditional Cogstate and diffusion modeling analyses predicted MCI diagnosis with acceptable accuracy. Cogstate measures of recognition learning and working memory accuracy and diffusion modeling variable of decision-making efficiency (drift rate) and nondecisional time were most predictive of MCI. While participants with normal cognition demonstrated a change in response caution (boundary separation) when transitioning tasks, participants with MCI did not evidence this change.

What about males? Exploring sex differences in the relationship between emotion difficulties and eating disorders.

OBJECTIVE: While eating disorders (EDs) are more commonly diagnosed in females, there is growing awareness that men also experience EDs and may do so in a different way. Difficulties with emotion processing and emotion regulation are believed to be important in EDs, but as studies have involved predominantly female samples, it is unclear whether this is also true for males. METHODS: In a sample of 1604 participants (n = 631 males), we assessed emotion processing and emotion regulation in males with EDs (n = 109) and compared results to both females with EDs (n = 220) and males from the general population (n = 522). We also looked at whether emotion processing and emotion regulation difficulties predicted various aspects of eating psychopathology and whether this was moderated by sex. We assessed emotion processing with the Toronto Alexithymia Scale, emotion regulation with the Difficulties in Emotion Regulation Scale and the Emotion Regulation Questionnaire, and eating psychopathology with the Eating Disorder Examination Questionnaire. RESULTS: We found that males with ED, like their female counterparts, suffered from emotion processing and emotion regulation deficits. We did find some sex differences, in that males with EDs tended to report more difficulties with their emotions as well as a more externally oriented thinking style compared to females with EDs. Difficulties with emotion processing and emotion regulation were strongly predictive of various aspects of eating psychopathology in both sexes. Importantly, we found that sex moderated the relationship between cognitive reappraisal and eating restraint. As such, low use of reappraisal was found to be associated with higher levels of restraint in females but not in males. DISCUSSION: Difficulties with emotion processing and emotion regulation are associated with eating psychopathology in both males and females. Reappraisal was not found to be associated with reduced eating psychopathology in males, suggesting a cautious approach to interventions targeting this strategy. Research around explanatory mechanisms and interventions must adopt a broader viewpoint including those that are traditionally overlooked in EDs.

While eating disorders (EDs) are more common in females, males also suffer from these conditions and are generally neglected in research around EDs. Difficulty identifying and managing emotions is believed to be important in the development and maintenance of EDs, but as studies have been conducted mostly in females, it is unclear whether this is also true for males. We recruited 1604 participants (631 were males, and 329 were diagnosed with EDs comprising 109 males and 220 females) and compared how males and females processed and regulated their emotions. We found that males with EDs, like their female counterparts, suffered from difficulties identifying and regulating their emotions, though they showed a slightly different profile of difficulties. While difficulties with emotions were associated with ED behaviours in both sexes, difficulties using reappraisal, an emotion regulation strategy where one reinterprets an event from a different perspective, were associated with restraint in females but not in males. This suggests that while interventions to help with emotional functioning could be beneficial for both women and men with EDs, the different emotional profiles of men with EDs must be considered, as interventions targeting particular emotional processes (e.g. reappraisal) may be relevant for women but not men.

Variants of SLC2A10 may be Linked to Poor Response to Metformin.

Purpose: A study among Filipinos revealed that only 15% of patients with diabetes achieved glycemic control, and poor response to metformin could be one of the possible reasons. Recent studies demonstrate how genetic variations influence response to metformin. Hence, the present study aimed to determine genetic variants associated with poor response to metformin. Methods: Using a candidate variant approach, 195 adult Filipino participants with newly diagnosed type 2 diabetes mellitus (T2DM) were enrolled in a case-control study. Genomic DNA from blood samples were collected. Allelic and genotypic associations of variants with poor response to metformin were determined using exact statistical methods. Results: Several polymorphisms were nominally associated with poor response to metformin (P uncorr < 0.05). The most notable is the association of multiple variants in the SLC2A10 gene-rs2425911, rs3092412, and rs2425904-with common additive genetic mode of inheritance. Other variants that have possible associations with poor drug response include rs340874 (PROX-AS1), rs815815 (CALM2), rs1333049 (CDKN2B-AS1), rs2010963 (VEGFA), rs1535435 and rs9494266 (AHI1), rs11128347 (PDZRN3), rs1805081 (NPC1), and rs13266634 (SLC30A8). Conclusion: In Filipinos, a trend for the association for several variants was noted, with further observation that several mechanisms may be involved. The results may serve as pilot data for further validation of candidate variants for T2DM pharmacotherapy.

Free flap for soft palate reconstruction: long-term functional evaluation of a new technique.

PURPOSE: The soft palate (SP) has a complex anatomy and physiology. Reconstruction after tumour resection is a challenge, and procedures that only restore bulk don't give good results. We aim to present a new technique for the in-setting and the functional outcomes. METHODS: We retrospectively included in a monocentric retrospective cohort study every patient with a first diagnosis of a soft palate squamous cell carcinoma (SPSCC), who underwent a tumoral resection with a free flap reconstruction, from February 2013 to July 2017. For the in-setting, a special care is given for the flap in-setting: we suture the flap more caudally than usual under the tongue base, creating a neo-posterior pilar. The primary outcome was the deglutition function, assessed by the M. D Anderson Dysphagia Inventory (MDADI). We also analyzed the patient's quality of life with the FOSS score and the occurrence of nasal regurgitation or larynx aspiration. RESULTS: We included twenty patients, with a median follow-up of 26.5 months. The median MDADI score was 89, and the mode was 93. A Fisher test shows a significant improvement of MDADI scores for unilateral vs bilateral reconstructions (p = 0.03). The median FOSS score was 2, and the mode was 2. Seven (35%) patients complained of nasal regurgitation, three (15%) reported episodic laryngeal aspiration.

Surface chemistry in Ti-6Al-4V feedstock as influenced by powder reuse in electron beam additive manufacturing.

X-ray photoelectron spectroscopy (XPS) as well as scanning and transmission electron microscopy (SEM/TEM) analysis was carried out on four Ti-6Al-4V powders used in electron beam powder-bed fusion (PBF-EB) production environments: virgin low oxygen (0.080 wt% O), reused medium oxygen (0.140 wt% O), reused high oxygen (0.186 wt% O), and virgin high oxygen (0.180 wt% O). The two objectives of this comparative analyses were to (1) investigate high oxygen containing Grade 23 Ti-6Al-4V powders which were further oxidized as a function of reuse and (2) comparing the two virgin Grade 23 and Grade 5 powders of similar oxygen content. The microstructure of the low oxygen virgin Grade 23 powder was consistent with martensitic α' microstructure, whereas the reused powder displayed tempered α/ß Widmänstatten microstructure. XPS revealed a decrease in TiO2 at the surface of the reused powders with an increase in Al2O3. This trend is energetically favorable at the temperatures and pressures in PBF-EB machines, and it is consistent with the thermodynamics of Al2O3 vs. TiO2 reactions. An unexpected amount of nitrogen was measured on the titanium powder, with a general increase in nitride on the surface of the particles as a function of reuse in the Grade 23 powder.

Effects of Performing Applied Muscle Tension during Recovery after Phlebotomy in Young, First-Time Donors: A Pilot Study.

Vasovagal reaction (VVR) compromises donor safety and reduces the subsequent return rates. Performing applied muscle tension (AMT) during phlebotomy may reduce the incidence of VVR. However, the effectiveness of performing AMT after phlebotomy to reduce delayed VVR remains unclear. With ethics approval, 12 young, first-time donors (YFTD) were recruited to study the effects on stroke volume (SV), cardiac output (CO) and systemic vascular resistance (SVR) while performing AMT from needle insertion to end of recovery. Measurements from 12 matched control YFTD were used for comparison. Pre-donation anxiety and VVR severity were assessed. Compared to controls, donors who performed AMT had higher SV (Control: 57 mL vs. AMT: 69 mL, p = 0.045), higher CO (Control: 3.7 L·min-1 vs. AMT: 5.2 L·min-1, p = 0.006) and lower SVR (Control: 1962 dyn·s·cm-5 vs. AMT: 1569 dyn·s·cm-5, p = 0.032) during mid-phlebotomy. During recovery, the AMT group retained higher SV, higher CO and lower SVR than the control, but not reaching statistical significance. Practicing AMT during recovery resulted in sustained haemodynamic improvements beyond the donation period, despite the reduction in delayed VVR was insignificant compared to the control group. A larger sample size is needed to validate the effectiveness of performing AMT after donation to mitigate delayed VVR.

Elastic-plastic properties of mesoscale electrodeposited LIGA nickel alloy films: microscopy and mechanics.

The elastic-plastic properties of mesoscale electrodeposited LIGA Ni alloy specimens are investigated as a function of specimen size, strain rate, and material composition. Two material compositions are studied: a high-strength fine-grained Ni-Fe alloy and a high-ductility coarse-grained Ni-Co alloy. The specimens have thicknesses of approximately 200 µm and gauge widths ranging from 75 µm to 700 µm. Tensile tests are conducted at strain rates of 0.001/s and 1/s using tabletop loading apparatuses and digital image correlation (DIC) for strain measurement. For each test condition, the apparent Young's modulus, yield strength, ultimate tensile strength, and strain hardening exponent and strength coefficient are extracted from the tensile tests. The true strains to failure are also assessed from fractography. Size, rate, and composition effects are discussed. For most properties, the statistical scatter represented by the standard deviation exceeds the measurement uncertainty; the notable exceptions to these observations are the apparent Young's modulus and yield strength, where large measurement uncertainties are ascribed to common experimental factors and material microplasticity.

Methane monooxygenases: central enzymes in methanotrophy with promising biotechnological applications.

Worldwide, the use of methane is limited to generating power, electricity, heating, and for production of chemicals. We believe this valuable gas can be employed more widely. Here we review the possibility of using methane as a feedstock for biotechnological processes based on the application of synthetic methanotrophs. Methane monooxygenase (MMO) enables aerobic methanotrophs to utilize methane as a sole carbon and energy source, in contrast to industrial microorganisms that grow on carbon sources, such as sugar cane, which directly compete with the food market. However, naturally occurring methanotrophs have proven to be difficult to manipulate genetically and their current industrial use is limited to generating animal feed biomass. Shifting the focus from genetic engineering of methanotrophs, towards introducing metabolic pathways for methane utilization in familiar industrial microorganisms, may lead to construction of efficient and economically feasible microbial cell factories. The applications of a technology for MMO production are not limited to methane-based industrial synthesis of fuels and value-added products, but are also of interest in bioremediation where mitigating anthropogenic pollution is an increasingly relevant issue. Published research on successful functional expression of MMO does not exist, but several attempts provide promising future perspectives and a few recent patents indicate that there is an ongoing research in this field. Combining the knowledge on genetics and metabolism of methanotrophy with tools for functional heterologous expression of MMO-encoding genes in non-methanotrophic bacterial species, is a key step for construction of synthetic methanotrophs that holds a great biotechnological potential.

The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences.

OBJECTIVE: The Covid-19 pandemic has wrought disruption to everyday life and services, and emerging evidence suggests that those with eating disorders (EDs) are likely to experience marked distress and exacerbation of their symptoms. However, little is known around the most relevant factors to symptom change; whether certain emotion regulation and coping strategies are linked to better outcomes; and how people with EDs are adjusting to psychological interventions moving online. METHOD: In a mixed-method design, we collected qualitative and quantitative data from 207 (76 males) self-selected UK residents with self-reported ED, who described and ranked impacts of the pandemic on their symptoms. Regression analysis examined whether emotion regulation strategies were associated with self-reported symptom change, ED symptomatology, and negative emotional states. Thematic analysis explored participants' experiences of the pandemic, particularly factors affecting their ED, coping strategies used, and experiences of psychological intervention. RESULTS: Most participants (83.1%) reported worsening of ED symptomatology, though factors affecting symptom change differed between specific EDs. Emotion regulation, such as having fewer strategies, poorer emotional clarity, and non-acceptance of emotions, explained nearly half of the variance in emotional distress during the pandemic. Qualitative findings indicated that difficult emotions (such as fear and uncertainty), changes to routine, and unhelpful social messages were triggering for participants during the pandemic. While some participants described employing positive coping strategies (such as limiting social media exposure), many reported using ED behaviours (among other maladaptive strategies, like alcohol use) to cope with the pandemic. Finally, loss of treatment support, feeling underserving of support and experiencing a 'detached connection' online were further exacerbating factors for these participants. DISCUSSION: While our sample was self-selected and may not represent all people with EDs, our results suggest that people with EDs have been strongly affected by the pandemic. Some aspects of online treatment were found to be beneficial but our findings suggest it also needs some improvement. Our paper discusses implications for online treatment such as taking into account personal circumstances and, in a time where people have limited control over the antecedents of negative emotion, the need to develop skills to manage emotions when they arise.

Rapid diagnostic tests for infectious diseases in the emergency department.

BACKGROUND: Rapid diagnostic tests (RDTs) for infectious diseases, with a turnaround time of less than 2 hours, are promising tools that could improve patient care, antimicrobial stewardship and infection prevention in the emergency department (ED) setting. Numerous RDTs have been developed, although not necessarily for the ED environment. Their successful implementation in the ED relies on their performance and impact on patient management. OBJECTIVES: The aim of this narrative review was to provide an overview of currently available RDTs for infectious diseases in the ED. SOURCES: PubMed was searched through August 2019 for available studies on RDTs for infectious diseases. Inclusion criteria included: commercial tests approved by the US Food and Drug Administration (FDA) or Conformité Européenne (CE) in vitro diagnostic devices with data on clinical samples, ability to run on fully automated systems and result delivery within 2 hours. CONTENT: A nonexhaustive list of representative commercially available FDA- or CE-approved assays was categorized by clinical syndrome: pharyngitis and upper respiratory tract infection, lower respiratory tract infection, gastrointestinal infection, meningitis and encephalitis, fever in returning travellers and sexually transmitted infection, including HIV. The performance of tests was described on the basis of clinical validation studies. Further, their impact on clinical outcomes and anti-infective use was discussed with a focus on ED-based studies. IMPLICATIONS: Clinicians should be familiar with the distinctive features of each RDT and individual performance characteristics for each target. Their integration into ED work flow should be preplanned considering local constraints of given settings. Additional clinical studies are needed to further evaluate their clinical effectiveness and cost-effectiveness.

Microfabricated fiducial markers for digital image correlation-based micromechanical testing of LIGA Ni alloys.

Photolithographically defined thin film Au dots were used as micro fiducial markers for digital image correlation (DIC), to enable two-dimensional strain measurement of 200 µm-thick LIGA (Lithographie, Galvanformung, Abformung) nickel alloys. Due to the sensitivity of electrodeposited films' microstructure and properties on the processing conditions, characterization of LIGA mechanical properties continues to be necessary for microsystems commercialization. DIC offers advantages over laser-based strain measurement techniques but creating suitable speckle patterns on specimens with dimensions under a millimeter is challenging. The material surface roughness itself is often used as the speckle pattern, or micro- or nanoparticles are applied to the surface. But for materials with highly polished surfaces, such as commercial LIGA alloys, the surface roughness is not always suitable, while application of particles still poses technical challenges in uniformity and reproducibility. We fabricated freestanding tensile specimens, with gauge sections 700 µm wide × 3 mm long × 200 µm thick, from electrodeposited Ni-10% Co using a commercial LIGA process, and conducted microtensile tests at strain rate 0.001 s-1. Designing and fabricating arrays of randomly oriented 1.5 µm-thick Au dots on the specimens provided a suitable way to obtain full-field surface strains over the entire gauge lengths and was reproducible from one specimen to another. Microfabricated fiducial markers therefore can be a useful surface-preparation approach for investigating micromechanical behavior, particularly plasticity and fracture, of LIGA films using DIC.

Performance evaluation of a portable bioimpedance cardiac output monitor for measuring hemodynamic changes in athletes during a head-up tilt test.

Cardiac output (CO) monitoring is useful for sports performance training, but most methods are unsuitable as they are invasive or hinder performance. The performance of PhysioFlow (PF), a portable noninvasive transthoracic bioimpedance CO monitor, was evaluated and compared with a reference Doppler CO monitor, USCOM, using a head-up tilt (HUT) test. With ethics committee approval, 20 healthy well-trained athletes were subjected to HUT in a fixed order of 0°, 70°, 30°, and 0° for 3 min each. Simultaneous hemodynamic measurements using PF and USCOM were made 30 s after a change in HUT and analyzed using t tests, ANOVA, and mountain plots. Heart rate (HR) and stroke volume (SV) from both monitors changed according to physiological expectation of tilt, but PF measurements of SV were higher with a positive bias (PF vs. USCOM, 0°: 87.3 vs. 54.0 mL, P < 0.001; 70°: 76.5 vs. 39.5 mL, P < 0.001; 30°: 81.4 vs. 50.1 mL, P < 0.001; 0°: 88.3 vs. 57.1 mL, P < 0.001). Relative changes in SV (∆SV) after each tilt measured using PF were lower with a negative bias (PF vs. USCOM, 0° to 70°: -12.3% vs. -26.3%, P = 0.002; 70° to 30°: +6.4% vs. +31.2%, P < 0.001; 30° to 0°: +9.2% vs. +15.8%, P = 0.280). CO measurements using PF at 70° were erroneous. Compared with USCOM, PF overestimated SV measurements but underestimated the ∆SV between HUT. Accuracy of the PF deteriorated at 70°, implying a gravitational influence on its performance. These findings suggested that the suitability of PF for sports use is questionable.NEW & NOTEWORTHY The use of impedance cardiography to monitor physiological changes in sports is rarely reported. Using head-up tilt test, we evaluated a portable noninvasive impedance cardiography device (PhysioFlow) by comparing it with a reference Doppler monitor (USCOM). Accuracy in tracking hemodynamic changes deteriorated with higher tilt, implying a gravitational influence on its performance. Stroke volume measurements were overestimated, but the changes were underestimated. Despite its convenient physical features, the suitability of PhysioFlow for sports use is questionable.

Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol.

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007-2015) or TNCs (2015-2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.