Creating comics, songs and poems to make sense of decolonising the curriculum: a collaborative autoethnography patchwork.

Decolonising the curriculum is a complex endeavour, with the potential to cause harm as well as benefit. People doing the work might find themselves questioning their personal and political identities and motives, it is common for people to get disillusioned. While surveys and toolkits are important to help us start the work, we are interested in finding out how decolonising practices can be sustained. We believe to practise meaningfully in this area we need to understand ourselves as practitioners, make sense of the work and have deep connections with colleagues and possibly our institutions.This research uses collaborative autoethnography; our personal experiences, reflected through the lenses of each other's point of view; to help us know ourselves and make sense of our practice. We also show how art, in the form of comics, poems and a song, can be used to deepen our research by adding meaning, connection and joy. We present this research as a patchwork text of writing, art and conversations. Our work is underpinned by theory, particularly drawing on Sara Ahmed and bell hooks. It is produced by the three of us to illuminate the process of decolonising a curriculum. We see this paper as part of our collective resistance: resistance to colonialism, to scientism and to inhumanity. We hope you will find resonances with your practice, and perhaps discover new ways to find meaning and connections.

Anomalous Extensor Digiti Minimi with Multiple Slips and Bulbous Appearance.

The extensor digiti minimi is a muscle in the posterior compartment of the forearm that extends the fifth digit. Variations of the extensor tendons of the hand are common and mostly asymptomatic, however, some may impinge and occupy the narrow dorsal compartments of the wrist causing dorsal wrist pain and impairment of digital movement. Orthopedic literature illustrates how frequent anomalies of the extensor indicis proprius, extensor digitorum brevis manus, and extensor medii proprius occur; however, minimal literature documents a bulbous, multi slip extensor digiti minimi. Within this case, a 30-year-old, right-handed woman with no prior hand trauma presented with recurrent snapping localized to her right fifth digit, causing intermittent pain and an audible "click". This study aims to provide a thorough anatomical description of a rare extensor digit minimi anomaly and a viable option to treat successfully an inflamed, symptomatic extensor retinaculum affecting the extensor digiti minimi.

SynWiki: Functional annotation of the first artificial organism Mycoplasma mycoides JCVI-syn3A.

The new field of synthetic biology aims at the creation of artificially designed organisms. A major breakthrough in the field was the generation of the artificial synthetic organism Mycoplasma mycoides JCVI-syn3A. This bacterium possesses only 452 protein-coding genes, the smallest number for any organism that is viable independent of a host cell. However, about one third of the proteins have no known function indicating major gaps in our understanding of simple living cells. To facilitate the investigation of the components of this minimal bacterium, we have generated the database SynWiki (http://synwiki.uni-goettingen.de/). SynWiki is based on a relational database and gives access to published information about the genes and proteins of M. mycoides JCVI-syn3A. To gain a better understanding of the functions of the genes and proteins of the artificial bacteria, protein-protein interactions that may provide clues for the protein functions are included in an interactive manner. SynWiki is an important tool for the synthetic biology community that will support the comprehensive understanding of a minimal cell as well as the functional annotation of so far uncharacterized proteins.

In-cell architecture of an actively transcribing-translating expressome.

Structural biology studies performed inside cells can capture molecular machines in action within their native context. In this work, we developed an integrative in-cell structural approach using the genome-reduced human pathogen Mycoplasma pneumoniae We combined whole-cell cross-linking mass spectrometry, cellular cryo-electron tomography, and integrative modeling to determine an in-cell architecture of a transcribing and translating expressome at subnanometer resolution. The expressome comprises RNA polymerase (RNAP), the ribosome, and the transcription elongation factors NusG and NusA. We pinpointed NusA at the interface between a NusG-bound elongating RNAP and the ribosome and propose that it can mediate transcription-translation coupling. Translation inhibition dissociated the expressome, whereas transcription inhibition stalled and rearranged it. Thus, the active expressome architecture requires both translation and transcription elongation within the cell.

Characterization of an Immunoglobulin Binding Protein (IbpM) From Mycoplasma pneumoniae.

Bacteria evolved many ways to invade, colonize and survive in the host tissue. Such complex infection strategies of other bacteria are not present in the cell-wall less Mycoplasmas. Due to their strongly reduced genomes, these bacteria have only a minimal metabolism. Mycoplasma pneumoniae is a pathogenic bacterium using its virulence repertoire very efficiently, infecting the human lung. M. pneumoniae can cause a variety of conditions including fever, inflammation, atypical pneumoniae, and even death. Due to its strongly reduced metabolism, M. pneumoniae is dependent on nutrients from the host and aims to persist as long as possible, resulting in chronic diseases. Mycoplasmas evolved strategies to subvert the host immune system which involve proteins fending off immunoglobulins (Igs). In this study, we investigated the role of MPN400 as the putative factor responsible for Ig-binding and host immune evasion. MPN400 is a cell-surface localized protein which binds strongly to human IgG, IgA, and IgM. We therefore named the protein MPN400 immunoglobulin binding protein of Mycoplasma (IbpM). A strain devoid of IbpM is slightly compromised in cytotoxicity. Taken together, our study indicates that M. pneumoniae uses a refined mechanism for immune evasion.

Reconstruction of Traumatic Central Slip Injuries: Technique Using a Slip of Flexor Digitorum Superficialis.

Multiple reconstruction techniques have been described for correction of boutonniere deformities including direct repair, central slip reconstruction, lateral band reconstruction, transverse retinacular ligament reconstruction, staged reconstruction, and extensor tenotomy. Each technique has been reported to have variable results with complications including capsular contracture, loss of proximal interphalangeal flexion, and residual deformity. We describe a surgical technique for central slip reconstruction using a slip of the flexor digitorum superficialis tendon through a bone tunnel.

"There Is Zero Regulation on the Selling of Alcohol": The Voice of the Youth on the Context and Determinants of Alcohol Drinking in Lebanon.

Alcohol-related research from the Arab world has rarely touched on the experiences or views of Arab adolescents. In this article, we present an in-depth analysis of youth alcohol drinking patterns and determinants derived from focus group discussions completed with more than 100 Lebanese high school/vocational students (15-19 years). The social ecology of alcohol use framework guided our research and analysis. Findings reveal that alcohol drinking is perceived as a pervasive and serious public health problem, triggered by a complex web of social relations, and facilitated by lax policies. Recommendations to curb heavy/harmful alcohol drinking among adolescents include regulating the role of alcohol industry, providing alternative recreational spaces/pass-times, educating about alcohol-related harms, and promoting more research on alcohol and its harms. Findings confirm the social ecology of alcohol use framework, and suggest the addition of the macro level of influence to this model, namely, a comprehensive alcohol harm reduction policy.

Isolated Rhabdomyolysis of the Infraspinatus Muscle Following the CrossFit "Sissy Test": A Report of Two Cases.

CASE: Following the completion of a CrossFit-style challenge (the "Sissy Test"), 2 patients presented with severe pain and swelling over the posterior aspect of the scapula. Magnetic resonance imaging demonstrated isolated edema of the infraspinatus muscle in both patients; the compartments were compressible. Neurovascular checks and observation of range of motion were performed. The patients were treated nonoperatively and were discharged with the diagnosis of overuse syndrome with rhabdomyolysis of the infraspinatus muscle. CONCLUSION: With marked increase in the popularity of extreme fitness, monitoring for rhabdomyolysis and potential renal dysfunction is essential.

(Dis)connectivities in wartime: The therapeutic geographies of Iraqi healthcare-seeking in Lebanon.

The proliferation of conflicts across borders of Middle Eastern States has transformed the landscapes of health and healthcare across the region. In the case of Iraq, state healthcare has collapsed under the strain of protracted conflicts. Meanwhile, Lebanon's post-war healthcare system is booming, and becoming more privatised. In this paper, we build on an ethnographic study on the movements and experiences of Iraqi patients in Lebanon to show how one of the consequences of war is the rise of alternative forms of healthcare-seeking practices and survival strategies - a therapeutic geography that is embedded in regional economies and geopolitical relations and reconfigurations. We argue for the need to reimagine the disconnectivity and connectivity of healthcare systems under war and conflict as grounded in the empirical realities and experiences of mobility in the Middle East.

Features of the waterpipe tobacco industry: A qualitative study of the third International Hookah Fair.

Background: Little research has been done to uncover the features of the waterpipe tobacco industry, which makes designing effective interventions and policies to counter this growing trend challenging. The objective of this study is to describe the features of the waterpipe industry. Methods: In 2015, we randomly sampled and conducted semi-structured interviews with representatives of waterpipe companies participating in a trade exhibition in Germany. We used an inductive approach to identify emerging themes. Results: We interviewed 20 representatives and four themes emerged: industry growth, cross-industry overlap, customer-product relationship, and attitude towards policy. The industry was described as transnational, generally decentralized, non-cartelized, with ad hoc relationships between suppliers, distributors and retailers. Ties with the cigarette industry were apparent. The waterpipe industry appeared to be in an early growth phase, encroaching on new markets, and comprising of mainly small family-run businesses. Customer loyalty appears stronger towards the waterpipe apparatus than tobacco. There was a notable absence of trade unionism and evidence of deliberate breaches of tobacco control laws. Conclusion: The waterpipe industry appears fragmented but is slowly growing into a mature, globalized, and customer-focused industry with ties to the cigarette industry. Now is an ideal window of opportunity to strengthen public health policy towards the waterpipe industry, which should include a specific legislative waterpipe framework.

Does published research on non-communicable disease (NCD) in Arab countries reflect NCD disease burden?

OBJECTIVES: To review trends in non-communicable (NCD) research output in the Arab region, in terms of quantity and quality, study design, setting and focus. We also examined differences by time and place, and assessed gaps between research output and NCD burden. METHODS: A scoping review of a total of 3,776 NCD-related reports published between 2000 and 2013 was conducted for seven Arab countries. Countries were selected to represent diverse socio-economic development levels in the region: Regression analyses were used to assess trends in publications over time and by country. Research gaps were assessed by examining the degree of match between proportionate literature coverage of the four main NCDs (CVD, cancer, DM, and COPD) and cause-specific proportional mortality rates (PMR). RESULTS: The annual number of NCD publications rose nearly 5-fold during the study period, with higher income countries having the higher publication rates (per million populations) and the most rapid increases. The increase in the publication rate was particularly prominent for descriptive observational studies, while interventional studies and systematic reviews remained infrequent (slope coefficients = 13.484 and 0.883, respectively). Gap analysis showed a mismatch between cause-specific PMR burden and NCD research output, with a relative surplus of reports on cancer (pooled estimate +38.3%) and a relative deficit of reports on CVDs (pooled estimate -30.3%). CONCLUSION: The widening disparity between higher and lower-income countries and the discordance between research output and disease burden call for the need for ongoing collaboration among Arab academic institutions, funding agencies and researchers to guide country-specific and regional research agendas, support and conduct.

Surgical Technique Utilizing Suture-Button Device for Central Metacarpal Ray Resection.

Certain technical demands must be overcome in order to accomplish the goals of creating a functional hand when performing a central digital ray resection of the hand. One of the biggest challenges is maintaining metacarpal gap closure and in such a way that the metacarpals are balanced and not rotated. Inadequate closure of the defect created between the metacarpals by a central ray resection will produce a persistent gap between the remaining fingers as well as the potential for malalignment. Current techniques are fraught with difficulty and have frequently proven inadequate. We describe a technique for performing a central ray resection without the worry of nonunion, malunion, or increase in gap. With the development of newer fixation devices, we have been able to perform central ray resection while optimally closing the gap, controlling rotation, and providing good hand function.

Delayed sequence intubation: a prospective observational study.

STUDY OBJECTIVE: We investigate a new technique for the emergency airway management of patients with altered mental status preventing adequate preoxygenation. METHODS: This was a prospective, observational, multicenter study of patients whose medical condition led them to impede optimal preintubation preparation because of delirium. A convenience sample of emergency department and ICU patients was enrolled. Patients received a dissociative dose of ketamine, allowing preoxygenation with high-flow nonrebreather mask or noninvasive positive pressure ventilation (NIPPV). After preoxygenation, patients were paralyzed and intubated. The primary outcome of this study was the difference in oxygen saturations after maximal attempts at preoxygenation before delayed sequence intubation compared with saturations just before intubation. Predetermined secondary outcomes and complications were also assessed. RESULTS: A total of 62 patients were enrolled: 19 patients required delayed sequence intubation to allow nonrebreather mask, 39 patients required it to allow NIPPV, and 4 patients required it for nasogastric tube placement. Saturations increased from a mean of 89.9% before delayed sequence intubation to 98.8% afterward, with an increase of 8.9% (95% confidence interval 6.4% to 10.9%). Thirty-two patients were in a predetermined group with high potential for critical desaturation (pre-delayed sequence intubation saturations ≤93%). All of these patients increased their saturations post-delayed sequence intubation; 29 (91%) of these patients increased their post-delayed sequence intubation saturations to greater than 93%. No complications were observed in the patients receiving delayed sequence intubation. CONCLUSION: Delayed sequence intubation could offer an alternative to rapid sequence intubation in patients requiring emergency airway management who will not tolerate preoxygenation or peri-intubation procedures. It is essentially procedural sedation, with the procedure being preoxygenation. Delayed sequence intubation seems safe and effective for use in emergency airway management.

Head computed tomography utilization and intracranial hemorrhage rates.

Utilization of computed tomography scans (CTs) has increased dramatically in emergency departments in the USA. This study aimed to retrospectively determine the yield of CTs among all patients that received a CT of the head from 2001 to 2007, which is adjusted for patient volume. For secondary endpoints, we examined the yield of CT of the head for the following hemorrhages: (1) intracerebral, (2) subarachnoid, (3) subdural, and (4) epidural. In 2001, 3.3 head CTs were performed per 100 patients seen. This increased by 60 % to 5.2 per 100 in 2007 (p = 0.005, R (2) = 0.82). This correlated with a nonsignificant decrease in the rate of intracranial hemorrhage found by CT from 3.6 per 100 CTs in 2001 (95 % confidence interval (CI) = 2.7-4.5) to 3.0 per 100 in 2007 (95 % CI = 2.5-3.6). There were no significant differences in "positive" rates for each subgroup of intracranial hemorrhage. Our study found that the utilization of head CTs increased dramatically, but there was a corresponding increase in the number of positive findings so that the overall yield of head CTs from 2001 to 2007 remained relatively constant.

Incidence of symptomatic retethering after surgical management of pediatric tethered cord syndrome with or without duraplasty.

BACKGROUND: Cord retethering and other postoperative complications can occur after the surgical untethering of a first-time symptomatic tethered cord. It is unclear if using duraplasty vs. primary dural closure in the initial operation is associated with decreased incidence of either immediate postoperative complications or subsequent symptomatic retethering. It is also unclear if different etiologies are associated with different outcomes after each method of closure. We reviewed our pediatric experience in first-time surgical untethering of symptomatic tethered cord syndrome (TCS) to identify the incidence of postoperative complications and symptomatic retethering after duraplasty vs. primary closure. MATERIALS AND METHODS: We retrospectively reviewed 110 consecutive pediatric (<18 years old) cases of first-time symptomatic spinal cord untethering at our institution over a 10-year period. Incidence of postoperative complications and symptomatic retethering were compared in cases with duraplasty vs. primary dural closure use. RESULTS: Mean age was 5.7 +/- 4.8 years old. "Complex" etiologies included lipomyelomeningocele or prior lipomyelomeningocele repair in 22 (20%) patients, prior myelomeningocele repair in 35 (32%), and concurrent lumbosacral lipoma in 18 (16%). "Noncomplex etiologies" included fatty filum in 26 (24%) and split cord malformation in five (4%). Seventy-five (68%) cases underwent primary dural closure vs. 35 (32%) with duraplasty. Twenty-nine (26%) patients experienced symptomatic retethering at a median [interquartile range (IQR)] of 30.5 [20.75-41.75] months postoperatively. There was no difference in incidence of postoperative cerebrospinal fluid leak, surgical site infection, or median [IQR] length of stay in patients receiving primary dural closure [4 (5%), 7 (9%), and 5 (4-6) days, respectively] vs. duraplasty [3 (9%), 3 (9%), and 6 [5-8] days, respectively], p > 0.05. Complex etiologies were more likely to retether than noncomplex etiologies after primary closure (33.6% vs. 6.6%, p = 0.05) but not after duraplasty (13.7% vs. 5.4%, p = 0.33). Duraplasty graft type (polytetrafluoroethylene vs. bovine pericardium) was not associated with pseudomeningocele or retethering. CONCLUSION: In our experience, the increased rate of symptomatic retethering observed with complex pediatric TCS (pTCS) etiologies after primary dural closures was not observed when duraplasty was instituted. Expansile duraplasty may be valuable specifically in the management of patient subgroups with complex pTCS etiologies.