Formation of orogenic gold deposits by progressive movement of a fault-fracture mesh through the upper crustal brittle-ductile transition zone.

Orogenic gold deposits are comprised of complex quartz vein arrays that form as a result of fluid flow along transcrustal fault zones in active orogenic belts. Mineral precipitation in these deposits occurs under variable pressure conditions, but a mechanism explaining how the pressure regimes evolve through time has not previously been proposed. Here we show that extensional quartz veins at the Garrcon deposit in the Abitibi greenstone belt of Canada preserve petrographic characteristics suggesting that the three recognized paragenetic stages formed within different pressure regimes. The first stage involved the growth of interlocking quartz grains competing for space in fractures held open by hydrothermal fluids at supralithostatic pressures. Subsequent fluid flow at fluctuating pressure conditions caused recrystallization of the vein quartz and the precipitation of sulfide minerals through wall-rock sulfidation, with some of the sulfide minerals containing microscopic gold. These pressure fluctuations between supralithostatic to near-hydrostatic conditions resulted in the post-entrapment modification of the fluid inclusion inventory of the quartz. Late fluid flow occurred at near-hydrostatic conditions and resulted in the formation of fluid inclusions that have not been affected by post-entrapment modification as pressure conditions never returned to supralithostatic conditions. This late fluid flow is interpreted to have formed the texturally late, coarse native gold that occurs along quartz grain boundaries and in open spaces. The systematic evolution of the pressure regimes in orogenic gold deposits such as Garrcon can be explained by relative movement of fault-fracture meshes across the base of the upper crustal brittle-ductile transition zone. We conclude that early vein quartz in orogenic deposits is precipitated at near-lithostatic conditions whereas the paragenetically late gold is introduced at distinctly lower pressure.

Source-detector trajectory optimization in cone-beam computed tomography: a comprehensive review on today's state-of-the-art.

Cone-beam computed tomography (CBCT) imaging is becoming increasingly important for a wide range of applications such as image-guided surgery, image-guided radiation therapy as well as diagnostic imaging such as breast and orthopaedic imaging. The potential benefits of non-circular source-detector trajectories was recognized in early work to improve the completeness of CBCT sampling and extend the field of view (FOV). Another important feature of interventional imaging is that prior knowledge of patient anatomy such as a preoperative CBCT or prior CT is commonly available. This provides the opportunity to integrate such prior information into the image acquisition process by customized CBCT source-detector trajectories. Such customized trajectories can be designed in order to optimize task-specific imaging performance, providing intervention or patient-specific imaging settings. The recently developed robotic CBCT C-arms as well as novel multi-source CBCT imaging systems with additional degrees of freedom provide the possibility to largely expand the scanning geometries beyond the conventional circular source-detector trajectory. This recent development has inspired the research community to innovate enhanced image quality by modifying image geometry, as opposed to hardware or algorithms. The recently proposed techniques in this field facilitate image quality improvement, FOV extension, radiation dose reduction, metal artifact reduction as well as 3D imaging under kinematic constraints. Because of the great practical value and the increasing importance of CBCT imaging in image-guided therapy for clinical and preclinical applications as well as in industry, this paper focuses on the review and discussion of the available literature in the CBCT trajectory optimization field. To the best of our knowledge, this paper is the first study that provides an exhaustive literature review regarding customized CBCT algorithms and tries to update the community with the clarification of in-depth information on the current progress and future trends.

Evaluating capacity at three government referral hospital emergency units in the kingdom of Eswatini using the WHO Hospital Emergency Unit Assessment Tool.

BACKGROUND: The Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini. METHODS: We conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT. RESULTS: All sites provided some level of emergency care 24 h a day, 7 days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols). CONCLUSIONS: The HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.

The transport of liquids in softwood: timber as a model porous medium.

Timber is the only widely used construction material we can grow. The wood from which it comes has evolved to provide structural support for the tree and to act as a conduit for fluid flow. These flow paths are crucial for engineers to exploit the full potential of timber, by allowing impregnation with liquids that modify the properties or resilience of this natural material. Accurately predicting the transport of these liquids enables more efficient industrial timber treatment processes to be developed, thereby extending the scope to use this sustainable construction material; moreover, it is of fundamental scientific value - as a fluid flow within a natural porous medium. Both structural and transport properties of wood depend on its micro-structure but, while a substantial body of research relates the structural performance of wood to its detailed architecture, no such knowledge exists for the transport properties. We present a model, based on increasingly refined geometric parameters, that accurately predicts the time-dependent ingress of liquids within softwood timber, thereby addressing this long-standing scientific challenge. Moreover, we show that for the minimalistic parameterisation the model predicts ingress with a square-root-of-time behaviour. However, experimental data show a potentially significant departure from this [Formula: see text] behaviour - a departure which is successfully predicted by our more advanced parametrisation. Our parameterisation of the timber microstructure was informed by computed tomographic measurements; model predictions were validated by comparison with experimental data. We show that accurate predictions require statistical representation of the variability in the timber pore space. The collapse of our dimensionless experimental data demonstrates clear potential for our results to be up-scaled to industrial treatment processes.

A dust-enshrouded tidal disruption event with a resolved radio jet in a galaxy merger.

Tidal disruption events (TDEs) are transient flares produced when a star is ripped apart by the gravitational field of a supermassive black hole (SMBH). We have observed a transient source in the western nucleus of the merging galaxy pair Arp 299 that radiated >1.5 × 1052 erg at infrared and radio wavelengths but was not luminous at optical or x-ray wavelengths. We interpret this as a TDE with much of its emission reradiated at infrared wavelengths by dust. Efficient reprocessing by dense gas and dust may explain the difference between theoretical predictions and observed luminosities of TDEs. The radio observations resolve an expanding and decelerating jet, probing the jet formation and evolution around a SMBH.

Cell geometry across the ring structure of Sitka spruce.

For wood to be used to its full potential as an engineering material, it is necessary to quantify links between its cell geometry and the properties it exhibits at bulk scale. Doing so will make it possible to predict timber properties crucial to engineering, such as mechanical strength and stiffness, and the resistance to fluid flow, and to inform strategies to improve those properties as required, as well as to measure the effects of interventions such as genetic manipulation and chemical modification. Strength, stiffness and permeability of timber all derive from the geometry of its cells, and yet current practice is to predict them based on properties, such as bulk density, that do not directly describe the cell structure. This work explores links between micro-computed tomography data for structural-size pieces of wood, which show the variation of porosity across the wood's ring structure, and high-resolution tomography showing the geometry of the cells, from which we measure cell length, lumen area, porosity, cell wall thickness and the number density of cells. High-resolution scans, while informative, are time-consuming and expensive to run on a large number of samples at the scale of building components. By scanning the same volume of timber at both low and high resolutions (high-resolution scans over a near-continuous volume of timber of approx. 20 mm3 at 15 µm3 per voxel), we are able to demonstrate correlations between the measurements at the two different resolutions, reveal the physical basis for these correlations, and demonstrate that the data from the low-resolution scan can be used to estimate the variation in (small-scale) cell geometry throughout a structural-size piece of wood.

A Survey of the Literature on Unintended Consequences Associated with Health Information Technology: 2014-2015.

OBJECTIVE: To summarize recent research on unintended consequences associated with implementation and use of health information technology (health IT). Included in the review are original empirical investigations published in English between 2014 and 2015 that reported unintended effects introduced by adoption of digital interventions. Our analysis focuses on the trends of this steam of research, areas in which unintended consequences have continued to be reported, and common themes that emerge from the findings of these studies. METHOD: Most of the papers reviewed were retrieved by searching three literature databases: MEDLINE, Embase, and CINAHL. Two rounds of searches were performed: the first round used more restrictive search terms specific to unintended consequences; the second round lifted the restrictions to include more generic health IT evaluation studies. Each paper was independently screened by at least two authors; differences were resolved through consensus development. RESULTS: The literature search identified 1,538 papers that were potentially relevant; 34 were deemed meeting our inclusion criteria after screening. Studies described in these 34 papers took place in a wide variety of care areas from emergency departments to ophthalmology clinics. Some papers reflected several previously unreported unintended consequences, such as staff attrition and patients' withholding of information due to privacy and security concerns. A majority of these studies (71%) were quantitative investigations based on analysis of objectively recorded data. Several of them employed longitudinal or time series designs to distinguish between unintended consequences that had only transient impact, versus those that had persisting impact. Most of these unintended consequences resulted in adverse outcomes, even though instances of beneficial impact were also noted. While care areas covered were heterogeneous, over half of the studies were conducted at academic medical centers or teaching hospitals. CONCLUSION: Recent studies published in the past two years represent significant advancement of unintended consequences research by seeking to include more types of health IT applications and to quantify the impact using objectively recorded data and longitudinal or time series designs. However, more mixed-methods studies are needed to develop deeper insights into the observed unintended adverse outcomes, including their root causes and remedies. We also encourage future research to go beyond the paradigm of simply describing unintended consequences, and to develop and test solutions that can prevent or minimize their impact.

Road Traffic Related Injury Research and Informatics. New Opportunities for Biomedical and Health Informatics as a Contribution to the United Nations' Sustainable Development Goals?

The United Nations has recently adopted 17 sustainable development goals for 2030, including ensuring healthy lives and promoting well-being for all at all ages, and making cities and human settlements inclusive, safe, resilient and sustainable. Road injuries remain among the ten leading causes of death in the world, and are projected to increase with rapidly increasing motorisation globally. Lack of comprehensive data on road injuries has been identified as one of the barriers for effective implementation of proven road safety interventions. Building, linking and analysing electronic patient records in conjunction with establishing injury event and care registries can substantially contribute to healthy lives and safe transportation. Appropriate use of new technological approaches and health informatics best practices could provide significant added value to WHO's global road safety work and assist Member States in identifying prevention targets, monitoring progress and improving quality of care to reduce injury-related deaths. This paper encourages the initiation of new multidisciplinary research at a global level.

Optimization of whispering gallery resonator design for biosensing applications.

Whispering gallery modes (WGMs) within microsphere cavities enable highly sensitive label-free detection of changes in the surrounding refractive index. This detection modality is of particular interest for biosensing applications. However, the majority of biosensing work utilizing WGMs to date has been conducted with resonators made from either silica or polystyrene, while other materials remain largely uninvestigated. By considering characteristics such as the quality factor and sensitivity of the resonator, the optimal WGM sensor design can be identified for various applications. This work explores the choice of resonator refractive index and size to provide design guidelines for undertaking refractive index biosensing using WGMs.

Morbidity and Mortality following Traditional Uvulectomy among Children Presenting to the Muhimbili National Hospital Emergency Department in Dar es Salaam, Tanzania.

Background. Traditional uvulectomy is performed as a cultural ritual or purported medical remedy. We describe the associated emergency department (ED) presentations and outcomes. Methods. This was a subgroup analysis of a retrospective review of all pediatric visits to our ED in 2012. Trained abstracters recorded demographics, clinical presentations, and outcomes. Results. Complete data were available for 5540/5774 (96%) visits and 56 (1.0%, 95% CI: 0.7-1.3%) were related to recent uvulectomy, median age 1.3 years (interquartile range: 7 months-2 years) and 30 (54%) were male. Presenting complaints included cough (82%), fever (46%), and hematemesis (38%). Clinical findings included fever (54%), tachypnea (30%), and tachycardia (25%). 35 patients (63%, 95% CI: 49-75%) received intravenous antibiotics, 11 (20%, 95% CI: 10-32%) required blood transfusion, and 3 (5%, 95% CI: 1-15%) had surgical intervention. All were admitted to the hospital and 12 (21%, 95% CI: 12-34%) died. By comparison, 498 (9.1%, 95% CI: 8-10%) of the 5484 children presenting for reasons unrelated to uvulectomy died (p = 0.003). Conclusion. In our cohort, traditional uvulectomy was associated with significant morbidity and mortality. Emergency care providers should advocate for legal and public health interventions to eliminate this dangerous practice.

Quantifying Impact of Chromosome Copy Number on Recombination in Escherichia coli.

The ability to precisely and efficiently recombineer synthetic DNA into organisms of interest in a quantitative manner is a key requirement in genome engineering. Even though considerable effort has gone into the characterization of recombination in Escherichia coli, there is still substantial variability in reported recombination efficiencies. We hypothesized that this observed variability could, in part, be explained by the variability in chromosome copy number as well as the location of the replication forks relative to the recombination site. During rapid growth, E. coli cells may contain several pairs of open replication forks. While recombineered forks are resolving and segregating within the population, changes in apparent recombineering efficiency should be observed. In the case of dominant phenotypes, we predicted and then experimentally confirmed that the apparent recombination efficiency declined during recovery until complete segregation of recombineered and wild-type genomes had occurred. We observed the reverse trend for recessive phenotypes. The observed changes in apparent recombination efficiency were found to be in agreement with mathematical calculations based on our proposed mechanism. We also provide a model that can be used to estimate the total segregated recombination efficiency based on an initial efficiency and growth rate. These results emphasize the importance of employing quantitative strategies in the design of genome-scale engineering efforts.

Utilisation of focused assessment with sonography for trauma (fast) in a referral hospital in an acute conflict zone

Introduction The role of Focused Assessment with Sonography for Trauma (FAST) is well described in the literature in high-resource general emergency care settings. However; there are limited data on utilisation of FAST by local providers in limited-resource conflict settings. We describe the first experience of a hospital in E-DRC using the FAST exam in triage to evaluate and expedite blunt and penetrating trauma patients during an armed invasion. Methods HEAL Africa Hospital (HEAL) is a tertiary trauma centre located in Goma; Eastern Democratic Republic of Congo. In 2010; ultrasound training was initiated. During subsequent armed fighting and the invasion of Goma; the hospital adopted the FAST exam as triage tool in the emergency centre (EC). Ultrasound scans were prospectively logged and perceived utility for immediate patient management was recorded. At a 1 year follow-up; a cohort of physician and nurses considered downstream patient recipients were also asked perceived utility towards its use. Results 222/243 (91) of ultrasound scans were recorded by physicians as having positive utility for immediate patient management. 61/243 (25) scans were FAST exams; 24 for obstetric evaluation and 158 were scans for pain management with ultrasound regional anaesthesia. 23/61 (41) of the FAST were reported as positive. Patients with + FAST were immediately prioritised and either a chest tube was placed or taken to the operating room for laparotomy. All 23 patients brought for laparotomy or chest tube were shown to have haemoperitoneum or positive output respectively. Discussion : The introduction of FAST training and requisite equipment in resource stressed healthcare settings is both desirable and feasible. In this study; the introduction of FAST by local providers had an important influence on the decision making process and enabled immediate triage of casualties to laparotomy; chest tube or clinical observations. Prospective controlled research is further needed to evaluate the impact

Recombineering to homogeneity: extension of multiplex recombineering to large-scale genome editing.

Recombineering has been an essential tool for genetic engineering in microbes for many years and has enabled faster, more efficient engineering than previous techniques. There have been numerous studies that focus on improving recombineering efficiency, which can be divided into three main areas: (i) optimizing the oligo used for recombineering to enhance replication fork annealing and limit proofreading; (ii) mechanisms to modify the replisome itself, enabling an increased rate of annealing; and (iii) multiplexing recombineering targets and automation. These efforts have increased the efficiency of recombineering several hundred-fold. One area that has received far less attention is the problem of multiple chromosomes, which effectively decrease efficiency on a chromosomal basis, resulting in more sectored colonies, which require longer outgrowth to obtain clonal populations. Herein, we describe the problem of multiple chromosomes, discuss calculations predicting how many generations are needed to obtain a pure colony, and how changes in experimental procedure or genetic background can minimize the effect of multiple chromosomes.

Influence of the valine zipper region on the structure and aggregation of the basic leucine zipper (bZIP) domain of activating transcription factor 5 (ATF5).

Protein aggregation is a major problem for biopharmaceuticals. While the control of aggregation is critically important for the future of protein pharmaceuticals, mechanisms of aggregate assembly, particularly the role that structure plays, are still poorly understood. Increasing evidence indicates that partially folded intermediates critically influence the aggregation pathway. We have previously reported the use of the basic leucine zipper (bZIP) domain of activating transcription factor 5 (ATF5) as a partially folded model system to investigate protein aggregation. This domain contains three regions with differing structural propensity: a N-terminal polybasic region, a central helical leucine zipper region, and a C-terminal extended valine zipper region. Additionally, a centrally positioned cysteine residue readily forms an intermolecular disulfide bond that reduces aggregation. Computational analysis of ATF5 predicts that the valine zipper region facilitates self-association. Here we test this hypothesis using a truncated mutant lacking the C-terminal valine zipper region. We compare the structure and aggregation of this mutant to the wild-type (WT) form under both reducing and nonreducing conditions. Our data indicate that removal of this region results in a loss of α-helical structure in the leucine zipper and a change in the mechanism of self-association. The mutant form displays increased association at low temperature but improved resistance to thermally induced aggregation.

Raised serum cardiac troponin I concentrations predict hospital mortality in intensive care unit patients.

BACKGROUND: Recent work suggests that increased plasma concentrations of cardiac troponin I (cTnI) are common in critically ill patients and are associated with poor outcome. We measured the frequency of increased plasma cTnI concentrations during patients' stay in a mixed medical/surgical intensive care unit (ICU) and compared our findings with hospital mortality. METHODS: Basic details, organ support, and hospital mortality were recorded for all patients treated in ICU during a 6 month period. cTnI concentrations were sampled daily for all patients, using 0.04 µg litre(-1) as the upper limit of normal, and 0.12 µg litre(-1) as an additional stratification point. RESULTS: Of 663 patients, 54% were male, with a mean (sd) age of 60 (18) yr, 65% were surgical patients, and the median Acute Physiology and Chronic Ill Health II (APACHE II) score was 15 (inter-quartile range 12-20). Increased cTnI concentrations were found in 345 patients (52%) while in ICU. One hundred and twenty patients (18%) died in hospital. cTnI concentration >0.04 µg litre(-1) was associated with reduced odds of hospital survival, independent of age, medical admission, unplanned admission, APACHE II score, mechanical ventilation, and haemofiltration (adjusted odds ratio 0.25, 95% confidence interval 0.08-0.75, P=0.014). Stratification by the degree of cTnI increase revealed an incremental trend towards a lower odds of hospital survival, including for patients with 'minor' elevations of cTnI (0.05-0.12 µg litre(-1)). CONCLUSIONS: Increased serum cTnI concentrations during ICU stay independently predicts hospital mortality, even when the threshold is low. We found a trend towards an association between 'minor' elevations in cTnI and higher in-hospital mortality.

Is a lateral view essential in management of hip fracture?

INTRODUCTION: Neck of femur accounts to about 86,000 cases per annum in UK. AP and lateral radiographs form an essential investigation in planning the management of these fractures. Recently it has been suggested that lateral view does not provide any additional information in majority of the cases. MATERIALS AND METHODS: We looked retrospectively at 25 consecutive radiographs with intracapsular and extracapsular fracture neck of femur each presenting to our department between May 2010 and January 2011. These radiographs were put on the CD in 2 folders as AP and lateral. It was reviewed by 2 observers who suggested their preferred treatment. The results were compared for the intra observer agreement to assess the necessity of the lateral view of the radiographs. We also compared the treatment options with the gold standard. RESULTS: Our results showed that lateral view did not make any difference in the management in majority of the cases with excellent agreement based on kappa statistics. CONCLUSION: We feel that the lateral view does not make any difference in most of the cases as shown by a good intraobserver agreement.