Enigma of Bowel Angina: Unraveling Celiac Trunk Stenosis.

The celiac axis is commonly involved in conditions that cause the narrowing or blockage of a celiac artery atherosclerosis and other vascular disease. Celiac artery compression syndrome is defined as chronic abdominal pain occurring because of compression of the celiac artery commonly in middle-aged (40 to 60 years) females. Various etiologies include atherosclerosis of mesenteries vessels, pancreatitis, median arcuate ligament syndrome, and tumor invasion. It is an uncommon condition, and symptoms include post-prandial abdominal pain mostly in the epigastrium, weight loss, nausea, diarrhea, anorexia, and bloating. Patients are asymptomatic for a prolonged duration due to collateral blood supply to the bowel from the patent superior mesenteric and inferior mesenteric arteries. We present a case of a 67-year-old female who initially presented with signs and symptoms suggestive of small bowel obstruction, however, due to persistent abdominal pain, she underwent a CT scan suggestive of severe celiac trunk stenosis causing abdominal angina. The patient was managed conservatively and responded well with close follow-up.

Unveiling the Truth: Diagnosing Bacterial Meningitis Through Repeat Lumbar Punctures.

Bacterial meningitis is a cause of global concern given its associated high rates of mortality and complications. Timely diagnosis and management are crucial in improving outcomes in patients. Lumbar puncture and radiological investigations form the crux of diagnosis. However, the clinical course becomes complicated if lumbar puncture results are unrevealing and equivocal for bacterial meningitis. We present a case of a 60-year-old female who was diagnosed with bacterial meningitis on repeated lumbar puncture. Clinical vigilance and a high degree of suspicion is needed to ensure that patients with bacterial meningitis are diagnosed and managed appropriately, especially in cases with inconclusive lumbar puncture or radiological investigations.

Single-Use Surgilube® Packets as an Alternative to Ultrasound Gel Bottles.

Point-of-care ultrasound is widely used in hospitalized patients. Hospital-acquired infections attributed to contaminated multiuse ultrasound gel bottles have been increasingly reported, including Burkholderia, Pseudomonas, and Acinetobacter species. Surgilube's chemical properties and sterile single-use packaging make it an appealing alternative to multi-use ultrasound gel bottles.

Identifying community-level disparities in access to driver education and training: Toward a definition of driver training deserts.

OBJECTIVE: Obtaining a license may be challenging for teens due to access to driving instruction; in some states, behind-the-wheel (BTW) instruction is required to secure a license before age 18. We investigate spatial accessibility to BTW centers, and how this geographic distribution intersects with metrics of social disparity at the metropolitan level, toward identifying Driver Training Deserts (DTDs): geographic areas of disconnection to driver training. METHODS: For the Columbus OH region, we collect socioeconomic variables at the Census tract unit of analysis and geocoded locations of public and private BTW training centers and estimate travel time to the nearest BTW training center. We define travel time as either the mean or the maximum travel time to BTW centers across all 1 km × 1 km grid cells within a Census tract. We employ spatial statistical approaches, including homogeneous/inhomogeneous K functions, to determine whether BTW training centers are clustered. Next, we define DTDs as Census tracts with a poverty rate and travel time to BTW centers larger than the 75th percentile values across the region. RESULTS: BTW training centers are spatially clustered across the region; the magnitude of this clustering is so great that BTW centers exhibit statistically significant patterns of clustering, even when considering the underlying spatial distribution of socio-economic characteristics. We find that 11-27 Census tracts are identified as DTDs depending on the definition of travel time. DTDs contain a disproportionate percent of the high poverty population (8.7-23.5%) and, depending on the definition of travel time, a disproportionately large African American population. CONCLUSIONS: Methodologically, defining DTDs necessitates a fine-grained spatial approach as suburban and rural Census tracts tend to be large and thus can be poorly represented by travel times averaged over the Census tract. Defining DTDs as a measure of individual-specific variables - income and impedance - allows DTDs to be addressed with policy interventions. The findings motivate future research correlating DTDs with licensure rates, enrollment in driver training, and safe driving outcomes to understand if DTDs can help explain health equity outcomes related to young driver safety.

Hospital Practices for Respiratory Isolation for Patients With Suspected Tuberculosis and Potential Application of Prediction Models.

Hospitalized persons with suspected pulmonary tuberculosis (PTB) are placed in airborne isolation to prevent nosocomial infection, as recommended by the Centers for Disease Control and Prevention (CDC). There is significant evidence that clinicians overuse this resource due to an abundance of caution when confronted with a patient with possible PTB. Many researchers have developed predictive tools based on clinical and radiographic data to assist clinicians in deciding which patients to place in respiratory isolation. We assessed the isolation practices for an urban hospital serving a large immigrant population and then retrospectively applied seven previously derived prediction models of isolation of PTB to our population. Our current clinical practice results in 76% of patients with PTB being placed in isolation on admission. However, 208 patients without PTB were placed in isolation unnecessarily for a total of 584 days. Four models had sensitivities greater than 90%, and two models had sensitivities of 100%. The use of these models would have potentially saved more than 150 days of patient isolation per year.

A Rare Case of Arterial and Venous Thromboembolism in a Patient With Severe Clostridium difficile Infection.

Most cases of Clostridium difficile infection are hospital acquired; but in recent times, the incidence of community-acquired infections has increased. Patients with Clostridium difficile infections are at an increased risk for thrombosis. We report a case of an 82-year-old female who was admitted to the intensive care unit for acute hypoxic respiratory failure and septic shock. She was found to have Clostridium difficile infection at presentation. During the hospitalization, we discovered bilateral lower extremity venous thromboembolism, bilateral pulmonary embolism, multifocal thromboembolic brain infarctions, and acute arterial thromboembolic occlusion of right upper and lower extremities. This patient adds to the list of cases of venous thromboembolism associated with Clostridium difficile infections and is the first case of associated arterial embolic phenomenon. There is a need to further investigate the association of Clostridium difficile infections and thromboembolism.

Evaluating cyclist biometrics to develop urban transportation safety metrics.

The transportation safety paradigm for urban transportation - particularly safety for those walking and cycling - relies on counting crashes to parameterize safety. These objective measures of safety are spatially static and reflective of past events: they can be enriched by including the human response to risk at diverse infrastructure designs. This perceived risk has been well captured qualitatively in the transportation safety literature; in the following study, we seek to develop a quantitative methodology that captures perceived risk as a continuous measure of human biometrics. Building on diverse safety-critical fields, we hypothesize that the perception of safety can be measured proactively with traveler biometrics, including eye and head movements, such that high readings of biometric indicators correlate with less safe areas. We collect biometric data from cyclists traversing an urban corridor with a protected, yet not continuously, cycle lane. By isolating and correlating peaks in cyclist biometric measures with infrastructure design, we develop a set of continuous variables - lateral head movements, gaze velocity, and off-mean gaze distance, both independently and as a vector - that allow for the evaluation of urban infrastructure based on perceived risk. The results reflect that higher biometric readings correspond to less safe (i.e., unprotected) areas, indicating that perceived risk can be measured proactively with biometric data.

Genome-wide Diversity and Association Mapping for Capsaicinoids and Fruit Weight in Capsicum annuum L.

Accumulated capsaicinoid content and increased fruit size are traits resulting from Capsicum annuum domestication. In this study, we used a diverse collection of C. annuum to generate 66,960 SNPs using genotyping by sequencing. The study identified 1189 haplotypes containing 3413 SNPs. Length of individual linkage disequilibrium (LD) blocks varied along chromosomes, with regions of high and low LD interspersed with an average LD of 139 kb. Principal component analysis (PCA), Bayesian model based population structure analysis and an Euclidean tree built based on identity by state (IBS) indices revealed that the clustering pattern of diverse accessions are in agreement with capsaicin content (CA) and fruit weight (FW) classifications indicating the importance of these traits in shaping modern pepper genome. PCA and IBS were used in a mixed linear model of capsaicin and dihydrocapsaicin content and fruit weight to reduce spurious associations because of confounding effects of subpopulations in genome-wide association study (GWAS). Our GWAS results showed SNPs in Ankyrin-like protein, IKI3 family protein, ABC transporter G family and pentatricopeptide repeat protein are the major markers for capsaicinoids and of 16 SNPs strongly associated with FW in both years of the study, 7 are located in known fruit weight controlling genes.

Genome-Wide Divergence and Linkage Disequilibrium Analyses for Capsicum baccatum Revealed by Genome-Anchored Single Nucleotide Polymorphisms.

Principal component analysis (PCA) with 36,621 polymorphic genome-anchored single nucleotide polymorphisms (SNPs) identified collectively for Capsicum annuum and Capsicum baccatum was used to characterize population structure and species domestication of these two important incompatible cultivated pepper species. Estimated mean nucleotide diversity (π) and Tajima's D across various chromosomes revealed biased distribution toward negative values on all chromosomes (except for chromosome 4) in cultivated C. baccatum, indicating a population bottleneck during domestication of C. baccatum. In contrast, C. annuum chromosomes showed positive π and Tajima's D on all chromosomes except chromosome 8, which may be because of domestication at multiple sites contributing to wider genetic diversity. For C. baccatum, 13,129 SNPs were available, with minor allele frequency (MAF) ≥0.05; PCA of the SNPs revealed 283 C. baccatum accessions grouped into 3 distinct clusters, for strong population structure. The fixation index (FST ) between domesticated C. annuum and C. baccatum was 0.78, which indicates genome-wide divergence. We conducted extensive linkage disequilibrium (LD) analysis of C. baccatum var. pendulum cultivars on all adjacent SNP pairs within a chromosome to identify regions of high and low LD interspersed with a genome-wide average LD block size of 99.1 kb. We characterized 1742 haplotypes containing 4420 SNPs (range 9-2 SNPs per haplotype). Genome-wide association study (GWAS) of peduncle length, a trait that differentiates wild and domesticated C. baccatum types, revealed 36 significantly associated genome-wide SNPs. Population structure, identity by state (IBS) and LD patterns across the genome will be of potential use for future GWAS of economically important traits in C. baccatum peppers.

Design Paradigm Utilizing Reversible Diels-Alder Reactions to Enhance the Mechanical Properties of 3D Printed Materials.

A design paradigm is demonstrated that enables new functional 3D printed materials made by fused filament fabrication (FFF) utilizing a thermally reversible dynamic covalent Diels-Alder reaction to dramatically improve both strength and toughness via self-healing mechanisms. To achieve this, we used as a mending agent a partially cross-linked terpolymer consisting of furan-maleimide Diels-Alder (fmDA) adducts that exhibit reversibility at temperatures typically used for FFF printing. When this mending agent is blended with commercially available polylactic acid (PLA) and printed, the resulting materials demonstrate an increase in the interfilament adhesion strength along the z-axis of up to 130%, with ultimate tensile strength increasing from 10 MPa in neat PLA to 24 MPa in fmDA-enhanced PLA. Toughness in the z-axis aligned prints increases by up to 460% from 0.05 MJ/m(3) for unmodified PLA to 0.28 MJ/m(3) for the remendable PLA. Importantly, it is demonstrated that a thermally reversible cross-linking paradigm based on the furan-maleimide Diels-Alder (fmDA) reaction can be more broadly applied to engineer property enhancements and remending abilities to a host of other 3D printable materials with superior mechanical properties.

Cervical & thoracic manipulations: Acute effects upon pain pressure threshold and self-reported pain in experimentally induced shoulder pain.

BACKGROUND: Emerging evidence suggests that cervical and thoracic joint manipulations may be advocated in treating patients with shoulder pain. OBJECTIVES: To determine the acute effects of cervical, cervicothoracic, and thoracic joint manipulations on outcomes of self-reported pain and pain pressure threshold in experimentally induced shoulder pain. DESIGN: Repeated measures. METHODS: Twenty (20) healthy volunteers were tested on two sessions. Session 1 consisted on baseline assessment of pain pressure threshold testing over the infraspinatus bilaterally and self-reported shoulder pain using the shoulder pain and disability index (SPADI) pain scale. An isokinetic exercise protocol was used to induce delayed onset muscle soreness. In session 2 (24-48 h later), all variables were reassessed before and immediately after a combination of cervical, cervicothoracic and thoracic manipulations. RESULTS: SPADI pain scale scores were significantly different between time points (p < 0.001): the exercise protocol significantly increased reported pain [mean increase 14.1, p < 0.001] while the manipulation significantly decreased reported pain (mean decrease 5.60, p < 0.001)) although pain remained higher than baseline levels. Pain pressure threshold differences were also found between time points (p = 0.001): manipulation significantly increased pain threshold bilaterally (p < 0.001) similar to baseline levels. CONCLUSIONS: Cervical, cervicothoracic, and thoracic joint manipulations acutely increased pain pressure threshold and decreased self-reported shoulder pain in participants with experimentally induced shoulder pain. Physiotherapists may consider the combination of such techniques to achieve short-term hypoalgesic effects and facilitate the application of more active interventions.

The chitinase-like protein YKL-40 is not a useful biomarker for severe persistent asthma in children.

BACKGROUND: The chitinase-like protein YKL-40 is thought to play a role in inflammation and tissue remodeling. In adults with severe asthma, YKL-40 is expressed in the airway and YKL-40 levels are elevated in the serum. OBJECTIVE: To compare YKL-40 levels in children with severe persistent asthma with those in adults with severe persistent asthma and to determine whether YKL-40 levels correlate with increasing asthma severity in childhood asthma. METHODS: In this prospective, cross-sectional study, 23 adults and 19 children with severe persistent asthma, 23 children with moderate persistent asthma, and 19 children with mild persistent asthma were enrolled. The following data were collected on each patient: spirometry, exhaled nitric oxide, percutaneous skin testing results to aeroallergens, peripheral eosinophils, serum IgE levels, and serum YKL-40 levels. RESULTS: Compared with adults, children with severe persistent asthma had significantly lower YKL-40 levels, higher values for forced vital capacity and forced expiration volume in 1 second, higher serum IgE levels, and higher exhaled nitric oxide levels. YKL-40 levels did not correlate with increasing asthma severity in the pediatric cohort. CONCLUSION: Severe persistent asthma in childhood is not associated with elevated YKL-40 levels, unlike in adults with severe persistent asthma. YKL-40 is not a useful biomarker for asthma severity in childhood asthma.

Recovery of nickel from aqueous solutions by complexation-ultrafiltration process with sodium polyacrylate and polyethylenimine.

The recovery of nickel from aqueous dilute solutions by complexation-ultrafiltration process with sodium polyacrylate (PAAS) and polyethylenimine (PEI) was studied. Experiments were performed as a function of aqueous pH, polymer/Ni(2+) ratio and background electrolyte concentration. At optimum experimental conditions, the nickel removal rate reaches 99.5% using PAAS and 93.0% using PEI as the complexation agent. The nickel removal rate was found to decrease as the adding salt NaCl concentration increases for both complexation agents. A series of experiments implied that the mechanism could be the compressing electric double layer other than the competitive complexation. Diafiltration technique was further performed to regenerate complexation agents and recover nickel. The nickel removal rates were found to be close to those obtained with the original PEI and PAAS. Finally, Langmuir-type binding isotherm equation was employed to evaluate the extent of nickel bound to PAAS and PEI. The overall results from the two-step process of complexation-UF and decomplexation-UF separation showed that it could be a promising method for nickel removal and recovery from aqueous solutions.

Energy Options for Wireless Sensor Nodes.

Reduction in size and power consumption of consumer electronics has opened up many opportunities for low power wireless sensor networks. One of the major challenges is in supporting battery operated devices as the number of nodes in a network grows. The two main alternatives are to utilize higher energy density sources of stored energy, or to generate power at the node from local forms of energy. This paper reviews the state-of-the art technology in the field of both energy storage and energy harvesting for sensor nodes. The options discussed for energy storage include batteries, capacitors, fuel cells, heat engines and betavoltaic systems. The field of energy harvesting is discussed with reference to photovoltaics, temperature gradients, fluid flow, pressure variations and vibration harvesting.

Lengthening the hamstring muscles without stretching using "awareness through movement".

BACKGROUND AND PURPOSE: Passive stretching is widely used to increase muscle flexibility, but it has been shown that this process does not produce long-term changes in the viscoelastic properties of muscle as originally thought. The authors tested a method of lengthening hamstring muscles called "Awareness Through Movement" (ATM) that does not use passive stretching. SUBJECTS: Thirty-three subjects who were randomly assigned to ATM and control groups met the screening criteria and completed the intervention phase of the study. METHODS: The ATM group went through a process of learning complex active movements designed to increase length in the hamstring muscles. Hamstring muscle length was measured before and after intervention using the Active Knee Extension Test. RESULTS: The ATM group gained significantly more hamstring muscle length (+7.04 degrees ) compared with the control group (+1.15 degrees ). DISCUSSION AND CONCLUSION: The results suggest that muscle length can be increased through a process of active movement that does not involve stretching. Further research is needed to investigate this finding.