Brachial Plexus Injury Secondary to Spontaneous Upper Limb Haematoma.

Spontaneous upper limb muscle haematomas are rare clinical phenomenons, which often go under- or misdiagnosed. They can present management challenges in the context of anticoagulant therapy, especially in the presence of other medical conditions. We present the case of a 52-year-old male with an initially missed presentation of a spontaneous muscle haematoma that progressed and re-presented to the emergency department (ED) with signs of mixed upper limb neuropathy requiring surgical evacuation and an emergency fasciotomy. This case highlights the importance of prompt diagnosis and intervention. While brachial plexus injuries from haematoma compression are uncommon, in our case, we discuss the need for surgical intervention to relieve pressure and optimise patient outcomes when clinically concerned about compartment syndrome or progressive neuropathy.

A Robotics Experimental Design Method Based on PDCA: A Case Study of Wall-Following Robots.

There is a lack of research that proposes a complete and interoperable robotics experimental design method to improve students' learning outcomes. Therefore, this study proposes a student-oriented method based on the plan-do-check-act (PDCA) concept to design robotics experiments. The proposed method is based on our teaching experience and multiple practical experiences of allowing students to do hands-on experiments. It consists of eight steps, mainly including experimental goals, experimental activities, robot assembly, robot control, in-class evaluation criteria, and after-class report requirements. The after-class report requirements designed in the proposed method can help students improve their report-writing abilities. A wall-following robotics experiment designed using the PDCA method is proposed, and some students' learning outcomes and after-class reports in this experiment are presented to illustrate the effectiveness of the proposed method. This experiment also helps students to understand the fundamental application of multi-sensor fusion technology in designing an autonomous mobile robot. We can see that the proposed reference examples allow students to quickly assemble two-wheeled mobile robots with four different sensors and to design programs to control these assembled robots. In addition, the proposed in-class evaluation criteria stimulate students' creativity in assembling different wall-following robots or designing different programs to achieve this experiment. We present the learning outcomes of three stages of the wall-following robotics experiment. Three groups of 42, 37, and 44 students participated in the experiment in these three stages, respectively. The ratios of the time required for the robots designed by students to complete the wall-following experiment, less than that of the teaching example, are 3/42 = 7.14%, 26/37 = 70.27%, and 44/44 = 100%, respectively. From the comparison of learning outcomes in the three stages, it can be seen that the proposed PDCA-based design method can indeed improve students' learning outcomes and stimulate their active learning and creativity.

Far-Field Petahertz Sampling of Plasmonic Fields.

The response of metal nanostructures to optical excitation leads to localized surface plasmon (LSP) generation with nanoscale field confinement driving applications in, for example, quantum optics and nanophotonics. Field sampling in the terahertz domain has had a tremendous impact on the ability to trace such collective excitations. Here, we extend such capabilities and introduce direct sampling of LSPs in a more relevant petahertz domain. The method allows to measure the LSP field in arbitrary nanostructures with subcycle precision. We demonstrate the technique for colloidal nanoparticles and compare the results to finite-difference time-domain calculations, which show that the build-up and dephasing of the plasmonic excitation can be resolved. Furthermore, we observe a reshaping of the spectral phase of the few-cycle pulse, and we demonstrate ad-hoc pulse shaping by tailoring the plasmonic sample. The methodology can be extended to single nanosystems and applied in exploring subcycle, attosecond phenomena.

Genomics-driven derivatization of the bioactive fungal sesterterpenoid variecolin: Creation of an unnatural analogue with improved anticancer properties.

A biosynthetic gene cluster for the bioactive fungal sesterterpenoids variecolin (1) and variecolactone (2) was identified in Aspergillus aculeatus ATCC 16872. Heterologous production of 1 and 2 was achieved in Aspergillus oryzae by expressing the sesterterpene synthase VrcA and the cytochrome P450 VrcB. Intriguingly, the replacement of VrcB with homologous P450s from other fungal terpenoid pathways yielded three new variecolin analogues (5-7). Analysis of the compounds' anticancer activity in vitro and in vivo revealed that although 5 and 1 had comparable activities, 5 was associated with significantly reduced toxic side effects in cancer-bearing mice, indicating its potentially broader therapeutic window. Our study describes the first tests of variecolin and its analogues in animals and demonstrates the utility of synthetic biology for creating molecules with improved biological activities.

Partitioning surface wave propagation on reconfigurable porous plane.

This paper introduces a novel reconfigurable technique for partitioning the propagation of surface waves by utilizing a T-shaped structure and pathways established through the introduction of fluid metal or metal pins into evenly spaced cylindrical cavities within a porous surface wave platform. Notably, the co-printing of metal and dielectric materials via 3D printing is employed, resulting in an expedited fabrication process. Extensive 3D electromagnetic simulations and experimental investigations validate the proposed approach's efficacy in achieving surface wave division while minimizing interference. The study encompasses an exploration of diverse power distribution ratios achievable within the distributed surface waves. Critical physical parameters of the T-junction are comprehensively examined, including partition depth, junction geometry, output port symmetry, and asymmetry. Additionally, the research delves into the frequency-dependent behaviours of asymmetric T-junctions and pathways. These findings establish the groundwork for adaptable architectures, facilitating concurrent communication among multiple devices within a unified surface wave communication network. This innovation holds potential to enhance various applications through improved communication capabilities.

Supermicrosurgery: past, present and future.

Supermicrosurgery was popularised in 1997 and is defined as a technique of microvascular anastomosis for single nerve fascicles and vessels 0.3-0.8 mm in diameter. It requires the use of powerful microscopes, ultradelicate microsurgical instruments and specialist dyes. The development of supermicrosurgery has vastly improved the ability of microsurgeons to create true perforator flaps with minimal donor site morbidity for reconstructive surgery and improved the precision of additional microsurgical techniques. This review outlines the origins and history of supermicrosurgery, its current applications in reconstructive surgery (including fingertip reconstructions, true perforator flap surgery, nerve flaps and lymphoedema surgery), supermicrosurgery training and future directions for the field.

Incidence and prevalence, and medication use among adults living with dermatomyositis: an Alberta, Canada population-based cohort study.

Dermatomyositis is a rare disease characterized by progressive muscle weakness and skin rashes. Estimates of incidence and prevalence are fundamental measures in epidemiology, but few studies have been conducted on dermatomyositis. To address this knowledge gap, we conducted a population-based study to determine the contemporary incidence (between 2013 and 2019) and prevalence (2019) of adults living with dermatomyositis using administrative health data in Alberta, Canada. We also described disease-related medication use, as there are very few approved medications for the treatment of dermatomyositis, and no Canadian therapeutic guidelines. The average age- and sex-standardized annual incidence of dermatomyositis was 2.8-3.0 cases per 100,000 adults, and prevalence was 28.6 cases per 100,000 adults, which is greater than reported in other cohorts. Dermatomyositis-related medication use decreased from 73% in the first year to 46% in the eighth year after diagnosis. Glucocorticoids were the most commonly used drug class, often taken concurrently with various immunomodulatory agents; this medication use aligns with empirically-based recommendations and the few therapeutic guidelines for dermatomyositis. Considering that Alberta may have one of the highest rates of dermatomyositis among adults, further research on the burden of disease is warranted for planning within the health care system.

Trajectory of health care resources among adults stopping or reducing treatment frequency of botulinum toxin for chronic migraine treatment in Alberta, Canada.

OBJECTIVE: Understand health resource, medication use, and cost of adults with chronic migraine who received guideline-recommended onabotulinumtoxinA (botulinum toxin) treatment frequency and then continued or reduced/stopped. BACKGROUND: Botulinum toxin may be a beneficial treatment for chronic migraine; the trajectory of health resources utilization among those with continued or reduced/stopped use is unclear. METHODS: A retrospective population-based cohort study utilizing administrative data from Alberta, Canada (2012-2020), was performed. A cohort of adults who received ≥5 botulinum toxin treatment cycles for chronic migraine over 18 months (6-month run-in; 1-year pre-index period) were grouped into those who (1) continued use (≥3 treatments/year), or (2) stopped or reduced use (stopped for 6 months then received 0 or 1-2 treatments/year, respectively) over a 1-year post-index period. Health resources and medication use were described, and pre-post costs were assessed. A second cohort that received ≥3 treatments/year immediately followed by 1 year of stopped or reduced use was considered in sensitivity analysis. RESULTS: Pre-post health resource, medication use, and costs were similar among those with continued use (n = 3336). Among those who stopped or reduced use (n = 1099; 756 stopped, 343 reduced), health resource, medication use, and costs were lower in the post- (total median per-person cost [IQR]: all-cause $4851 [$8090]; migraine-related $835 [$1915]) versus pre- (all-cause $6096 [$7207]; migraine-related $2995 [$1950]) index period (estimated cost ratios [95% CI]: total all-cause 0.86 [0.79, 0.95]; total migraine-related 0.44 [0.40, 0.48]). In the second cohort (n = 3763), return to continued use (≥3 treatments/year) occurred in up to 70.4% in those with reduced use. CONCLUSIONS: Of adults treated with botulinum toxin for chronic migraine, 75.2% had continued use, stable health resource and medication use, and costs over a 2 year period. In those that stopped/reduced use, the observed lower health resource and migraine medication use may indicate improved symptom control, but the resumption of guideline-recommended treatment intervals after reduced use was common.

Implementation of a Real-Time Object Pick-and-Place System Based on a Changing Strategy for Rapidly-Exploring Random Tree.

An object pick-and-place system with a camera, a six-degree-of-freedom (DOF) robot manipulator, and a two-finger gripper is implemented based on the robot operating system (ROS) in this paper. A collision-free path planning method is one of the most fundamental problems that has to be solved before the robot manipulator can autonomously pick-and-place objects in complex environments. In the implementation of the real-time pick-and-place system, the success rate and computing time of path planning by a six-DOF robot manipulator are two essential key factors. Therefore, an improved rapidly-exploring random tree (RRT) algorithm, named changing strategy RRT (CS-RRT), is proposed. Based on the method of gradually changing the sampling area based on RRT (CSA-RRT), two mechanisms are used in the proposed CS-RRT to improve the success rate and computing time. The proposed CS-RRT algorithm adopts a sampling-radius limitation mechanism, which enables the random tree to approach the goal area more efficiently each time the environment is explored. It can avoid spending a lot of time looking for valid points when it is close to the goal point, thus reducing the computing time of the improved RRT algorithm. In addition, the CS-RRT algorithm adopts a node counting mechanism, which enables the algorithm to switch to an appropriate sampling method in complex environments. It can avoid the search path being trapped in some constrained areas due to excessive exploration in the direction of the goal point, thus improving the adaptability of the proposed algorithm to various environments and increasing the success rate. Finally, an environment with four object pick-and-place tasks is established, and four simulation results are given to illustrate that the proposed CS-RRT-based collision-free path planning method has the best performance compared with the other two RRT algorithms. A practical experiment is also provided to verify that the robot manipulator can indeed complete the specified four object pick-and-place tasks successfully and effectively.

Improving plastic surgery care of hand trauma using the lean thinking model.

Plastic surgery trauma care services vary widely between hospitals in the UK. The authors evaluated their plastic surgery trauma service and illustrated the use of lean thinking to successfully implement small interventions to create positive change. The study findings demonstrated an increase in the proportion of patients with trauma being treated in the outpatient clinic rather than in the main theatres. This coincided with an increase in the proportion of patients being treated on the day of presentation to hospital.

Comprehensive Profiling of EBV Gene Expression and Promoter Methylation Reveals Latency II Viral Infection and Sporadic Abortive Lytic Activation in Peripheral T-Cell Lymphomas.

Epstein-Barr virus (EBV) latency patterns are well defined in EBV-associated epithelial, NK/T-cell, and B-cell malignancies, with links between latency stage and tumorigenesis deciphered in various studies. In vitro studies suggest that the oncogenic activity of EBV in T-cells might be somewhat different from that in EBV-tropic B lymphoid cells, prompting us to study this much less investigated viral gene expression pattern and its regulation in nine EBV+ peripheral T-cell lymphoma (PTCL) biopsies. Using frozen specimens, RT-PCR showed 6/7 cases with a latency II pattern of EBV gene expression. Analyses of EBNA1 promoter usage and CpG methylation status in these six cases showed that only Qp was used, while Cp, Wp, and Fp were all silent. However, the remaining case showed an exceptionally unique latency III type with lytic activation, as evidenced by EBV lytic clonality and confirmed by the full usage of Cp and Qp as well as weakly lytic Fp and Wp, fully unmethylated Cp and marginally unmethylated Wp. Further immunostaining of the eight cases revealed a few focally clustered LMP1+ cells in 7/8 cases, with rare isolated LMP1+ cells detected in another case. Double immunostaining confirmed that the LMP1+ cells were of the T-cell phenotype (CD3+). In 6/8 cases, sporadically scattered Zta+ cells were detected. Double staining of EBER-ISH with T-cell (CD45RO/UCHL1) or B-cell (CD20) markers confirmed that the vast majority of EBER+ cells were of the T-cell phenotype. Predominant type-A EBV variant and LMP1 30-bp deletion variant were present, with both F and f variants detected. In summary, the EBV gene expression pattern in PTCL was found to be mainly of latency II (BART+EBNA1(Qp)+LMP1+LMP2A+BZLF1+), similar to that previously reported in EBV-infected nasopharyngeal epithelial, NK/T-cell, and Hodgkin malignancies; however, fully lytic infection could also be detected in occasional cases. Rare cells with sporadic immediate-early gene expression were commonly detected in PTCL. These findings have implications for the future development of EBV-targeting therapeutics for this cancer.

An open automation system for predatory journal detection.

The growing number of online open-access journals promotes academic exchanges, but the prevalence of predatory journals is undermining the scholarly reporting process. Data collection, feature extraction, and model prediction are common steps in tools designed to distinguish between legitimate and predatory academic journals and publisher websites. The authors include them in their proposed academic journal predatory checking (AJPC) system based on machine learning methods. The AJPC data collection process extracts 833 blacklists and 1213 whitelists information from websites to be used for identifying words and phrases that might indicate the presence of predatory journals. Feature extraction is used to identify words and terms that help detect predatory websites, and the system's prediction stage uses eight classification algorithms to distinguish between potentially predatory and legitimate journals. We found that enhancing the classification efficiency of the bag of words model and TF-IDF algorithm with diff scores (a measure of differences in specific word frequencies between journals) can assist in identifying predatory journal feature words. Results from performance tests suggest that our system works as well as or better than those currently being used to identify suspect publishers and publications. The open system only provides reference results rather than absolute opinions and accepts user inquiries and feedback to update the system and optimize performance.

Characteristics-Based Framework of Effective Automated Monitoring Parameters in Construction Projects.

The construction industry is moving toward digitalization, and technologies support various construction processes. In the automated construction progress monitoring domain, several modern progress measurement techniques have been introduced. However, a hesitant attitude has been observed toward its adoption. Researchers have highlighted lack of theoretical understanding of effectual implementation is one of the significant reasons. This study aims to analyze general technological parameters related to automated monitoring technologies and devise a theoretical-based conceptual framework explaining the aspects affecting the adequate operation of automated monitoring. The study has been executed by following a systematic inline process for the identification of effective parameters, which include a structured literature review, semi-structured interviews, pilot survey, questionnaire survey, and structural equation modeling (SEM)-based mathematical model. A refined conceptual framework has been devised with 21 effective parameters under five significant categories, i.e., "Target Object," "Technical," "External Interference," "Occlusions," and "Sensing." A knowledge framework has been established by adopting the SEM technique, which is designed on the characteristics-based theme. This conceptual framework provides the theoretical base for practitioners toward the conceptual understanding of automated monitoring processes related to technological parameters that affect the outcomes. This study is unique as it focused on the general criteria or parameters that affect the performance or outcomes of the digital monitoring process and is easily understandable by the user or operator.

Condensate loss estimation and transient solar-to-vapor conversion efficiency for effective performance evaluation of the inclined solar still.

Previously, freshwater yields of the solar still were quantified only based on the actual distillate recovery, not considering condensate losses by any means. Likewise, solar-to-vapor conversion efficiencies of the solar still were conventionally considered and evaluated as one-off -rigid values- based on the latent heat of the average water temperature. In most cases, these approaches do not give a comprehensive performance details of the solar still. Thus, we suggest two considerations for effective performance evaluation of the inclined solar still. The first consideration is theoretical estimation of the condensate loss due to the condensate collection channel slope, while the other is the use of a transient method to evaluate the solar-to-vapor conversion efficiency. We demonstrated, geometrically, that the condensate loss on the inclined solar still can be significant-hence the need to consider it alongside the overall yield. We formulated a model to estimate the condensate loss and validated the model by comparing an estimated condensate loss with experimental loss. Similarly, we demonstrated a transient approach to evaluate the solar-to-vapor conversion efficiency by using the latent heat of the hourly water temperature. Accordingly, the optimum hourly efficiency of the investigated solar still prototype was 161.4%, with a daily average of 113.4% versus 108.4% from the conventional method. Overall, no study on the solar still had previously accounted for condensate losses by any means whatsoever, making our current study a reference and a pioneer in this concept and suggesting an advancement in the approach to report the performance productivity of the solar still.•Condensate loss on the inclined solar still due condensate collection channel slope was estimated geometrically and demonstrated to be significant.•Solar-to-vapor conversion efficiency was evaluated using an hourly transient approach.

Inferring the true number of SARS-CoV-2 infections in Japan.

INTRODUCTION: In Japan, as of December 31, 2021, more than 1.73 million laboratory-confirmed cases have been reported. However, the actual number of infections is likely to be under-ascertained due to the epidemiological characteristics such as mild and subclinical infections and limited testing availability in the early days of the pandemic. In this study, we infer the true number of infections in Japan between January 16, 2020, and December 31, 2021, using a statistical modelling framework that combines data on reported cases and fatalities. METHODS: We used reported COVID-19 deaths and age-specific infection fatality ratios (IFR) to impute the true number of infections. Estimates of IFR were informed from published studies and were adjusted to reflect the effects of pharmaceutical interventions, mass vaccination, and evolving variants. To account for the uncertainty in IFR, we sampled values from relevant distributions. RESULTS: We estimated that as of December 31, 2021, 3.07 million (CrI: 2.05-4.24 million) people had been infected in Japan, which is 1.77 times higher than the 1.73 million reported cases. Our meta-analysis confirmed that these findings were consistent with the intermittent seroprevalence studies conducted in Japan. CONCLUSIONS: We have estimated that a substantial number of COVID-19 infections in Japan were unreported, particularly in adults. Our approach provides a more realistic assessment of the true underlying burden of COVID-19. The results of this study can be used as fundamental components to strengthen population health control and surveillance measures.

Chronic Medication Use and Factors Associated With Polypharmacy Among Outpatient Pediatric Patients.

OBJECTIVE: This study aimed to determine the prevalence and predictors of chronic polypharmacy among pediatric patients in an outpatient setting. METHODS: We conducted a review of medications dispensed to patients from an outpatient pediatric facility during a 12-month period. Patients who received chronic medications (≥30 days' supply), which contained at least 1 active pharmaceutical ingredient were included in the study. Descriptive analysis was used to determine prevalence of polypharmacy while predictive factors for polypharmacy were evaluated using logistic regression. RESULTS: Our study included 3920 patients (median age, 9.9 years; IQR, 9.4) and 16,401 medications. The median number of chronic medications used among our study cohort was 2.0 (IQR, 1) with polypharmacy identified in 309 (7.9%) patients. Predictors for polypharmacy were age and the use of certain therapeutic class of medications. Patients 12 to <19 years old (OR, 6.95; 95% CI, 4.1-10.1) were more likely to require ≥5 concurrent medications compared with patients younger than 2 years of age. Use of calcium supplements (OR, 21.2; 95% CI, 11.3-39.6), Vitamin D analogues (OR, 14.3; 95% CI, 8.0-25.8), and systemic glucocorticoids (OR, 18.8; 95% CI, 10.7-33.2) were also highly associated with polypharmacy. CONCLUSIONS: Adolescents and children with chronic medical conditions who require prolonged systemic glucocorticoids, calcium, and Vitamin D supplements are at higher risk of incurring long-term polypharmacy. This subgroup of pediatric patients may be more vulnerable to the occurrence of negative outcomes resulting from the use of multiple chronic medications.

Health resource utilization and cost before versus after initiation of second-generation long-acting injectable antipsychotics among adults with schizophrenia in Alberta, Canada: a retrospective, observational single-arm study.

BACKGROUND: Long-acting injectable (LAI) antipsychotics, along with community treatment orders (CTOs), are used to improve treatment effectiveness through adherence among individuals with schizophrenia. Understanding real-world medication adherence, and healthcare resource utilization (HRU) and costs in individuals with schizophrenia overall and by CTO status before and after second generation antipsychotic (SGA)-LAI initiation may guide strategies to optimize treatment among those with schizophrenia. METHODS: This retrospective observational single-arm study utilized administrative health data from Alberta, Canada. Adults (≥ 18 years) with schizophrenia who initiated a SGA-LAI (no use in the previous 2-years) between April 1, 2014 and March 31, 2016, and had ≥ 1 additional dispensation of a SGA-LAI were included; index date was the date of SGA-LAI initiation. Medication possession ratio (MPR) was determined, and paired t-tests were used to examine mean differences in all-cause and mental health-related HRU and costs (Canadian dollars), comprised of hospitalizations, physician visits, emergency department visits, and total visits, over the 2-year post-index and 2-year pre-index periods. Analyses were stratified by presence or absence of an active CTO during the pre-index and/or post-index periods. RESULTS: Among 1,211 adults with schizophrenia who initiated SGA-LAIs, 64% were males with a mean age of 38 (standard deviation [SD] 14) years. The mean overall antipsychotic MPR was 0.39 (95% confidence interval [CI] 0.36, 0.41) greater during the 2-year post-index period (0.84 [SD 0.26]) compared with the 2-year pre-index period (0.45 [SD 0.40]). All-cause and mental health-related HRU and costs were lower post-index versus pre-index (p < 0.001) for hospitalizations, physician visits, emergency department visits, and total visits; mean total all-cause HRU costs were $33,788 (95% CI -$38,993, -$28,583) lower post- versus pre-index ($40,343 [SD $68,887] versus $74,131 [SD $75,941]), and total mental health-related HRU costs were $34,198 (95%CI -$39,098, -$29,297) lower post- versus pre-index ($34,205 [SD $63,428] versus $68,403 [SD $72,088]) per-patient. Forty-three percent had ≥ 1 active CTO during the study period; HRU and costs varied according to CTO status. CONCLUSIONS: SGA-LAIs are associated with greater medication adherence, and lower HRU and costs however the latter vary according to CTO status.

The application of technology to improve cognition in older adults: A review and suggestions for future directions.

The rapidly increasing worldwide population of older adults, along with the increasing prevalence of cognitive impairment and dementia in this population, is a growing health-care problem. As such, advances in technology-based cognitive interventions and games are playing an increasingly key role in preserving and improving older adults' cognitive function, especially during the COVID-19 pandemic when opportunities for face-to-face activities or training are few. In this paper, we summarize from previous studies systematic reviews and meta-analyses on the various types of technology used in cognitive interventions (namely, computerized cognitive training, virtual-reality interventions and robot-assisted interventions) and the empirical evidence on the effects of these technologies on global and specific cognitive functions in healthy and clinical populations of older adults (e.g., older adults with mild cognitive impairment or dementia). We also describe older adults' perceptions, experiences and acceptance of these technologies. Finally, we discuss the limitations, challenges and future avenues of research in this field.

Erratum: Epigenomic characterization of a p53-regulated 3p22.2 tumor suppressor that inhibits STAT3 phosphorylation via protein docking and is frequently methylated in esophageal and other carcinomas: Erratum.

[This corrects the article DOI: 10.7150/thno.20893.].