A new method to compile global multi-hazard event sets.

This study presents a new method, the MYRIAD-Hazard Event Sets Algorithm (MYRIAD-HESA), that compiles historically-based multi-hazard event sets. MYRIAD-HESA is a fully open-access method that can create multi-hazard event sets from any hazard events that occur on varying time, space, and intensity scales. In the past, multi-hazards have predominately been studied on a local or continental scale, or have been limited to specific hazard combinations, such as the combination between droughts and heatwaves. Therefore, we exemplify our approach by compiling a global multi-hazard event set database, spanning from 2004 to 2017, which includes eleven hazards from varying hazard classes (e.g. meteorological, geophysical, hydrological and climatological). This global database provides new scientific insights on the frequency of different multi-hazard events and their hotspots. Additionally, we explicitly incorporate a temporal dimension in MYRIAD-HESA, the time-lag. The time-lag, or time between the occurrence of hazards, is used to determine potentially impactful events that occurred in close succession. Varying time-lags have been tested in MYRIAD-HESA, and are analysed using North America as a case study. Alongside the MYRIAD-HESA, the multi-hazard event sets, MYRIAD-HES, is openly available to further increase the understanding of multi-hazard events in the disaster risk community. The open-source nature of MYRIAD-HESA provides flexibility to conduct multi-risk assessments by, for example, incorporating higher resolution data for an area of interest.

Carbon-negative production of acetone and isopropanol by gas fermentation at industrial pilot scale.

Many industrial chemicals that are produced from fossil resources could be manufactured more sustainably through fermentation. Here we describe the development of a carbon-negative fermentation route to producing the industrially important chemicals acetone and isopropanol from abundant, low-cost waste gas feedstocks, such as industrial emissions and syngas. Using a combinatorial pathway library approach, we first mined a historical industrial strain collection for superior enzymes that we used to engineer the autotrophic acetogen Clostridium autoethanogenum. Next, we used omics analysis, kinetic modeling and cell-free prototyping to optimize flux. Finally, we scaled-up our optimized strains for continuous production at rates of up to ~3 g/L/h and ~90% selectivity. Life cycle analysis confirmed a negative carbon footprint for the products. Unlike traditional production processes, which result in release of greenhouse gases, our process fixes carbon. These results show that engineered acetogens enable sustainable, high-efficiency, high-selectivity chemicals production. We expect that our approach can be readily adapted to a wide range of commodity chemicals.

Contralateral neck failure in oral tongue cancer: Outcomes from two centers using predefined treatment criteria.

BACKGROUND: The objective was to determine the incidence of, and factors associated with contralateral neck failure (CNF) in oral tongue squamous cell carcinoma (OTSCC). METHODS: Consecutive patients with OTSCC between 2007 and 2016 were included. The predefined policy of the contralateral neck included neck dissection (ND) where the primary tumor extended/crossed midline or the contralateral neck was involved; and elective nodal irradiation (ENI) where the primary tumor was ≤1 cm from midline/2 cm from tip. RESULTS: This study included 258 patients. ND was ipsilateral 169 (66%) and bilateral 33 (13%). Fifty-five patients (21%) received ENI to the undissected contralateral neck. CNF occurred in 19 patients (7%) and was similar by treatment received. Utilizing this approach, we observed higher rates of CNF with increasing N classification, perineural invasion, extracapsular extension, and depth of invasion ≥6 mm. CONCLUSIONS: Using our institutional policy of treatment to the contralateral neck, a low rate of CNF (≤10%) was observed.

Impact of histological Oral Tongue Cancer margins on locoregional recurrence: A multi-centre retrospective analysis.

OBJECTIVES: To assess the effect of the histological margins (HM) upon locoregional failure (LRF) and overall survival (OS) for oral tongue squamous cell carcinoma (OTSCC). MATERIALS AND METHODS: We undertook a retrospective review of 258 patients, across two institutions, treated for OTSCC between 2007 and 2016. A Cox-proportional hazards model was used to compare the relative hazard ratio of HM to the accepted standard of 5 mm margins for LRF and OS. RESULTS: The median follow up period was 4.8 years. The 5 year OS and freedom from LRF were 69% and 75% respectively. The Cox-proportional hazards model adjusted for age, DOI and LVI showed increasing risk of mortality and LRF with decreasing HM widths of <5 mm. CONCLUSION: HM >5 mm were associated with a risk reduction of both LRF and mortality in OTSCC. This study supports >5 mm HM being the oncologic goal of surgery.

Failed Back Surgery Syndrome: A Review Article.

Postsurgical spine syndrome is becoming an increasingly common challenge for clinicians who deal with spinal disorders owing to the expanding indications for spinal surgery and the aging world population. A multidisciplinary approach is most appropriate for patients who are unlikely to benefit from further formal surgical intervention. Anticonvulsant medications are effective in managing neuropathic pain after surgery, whereas opioids are rarely beneficial. Neuromodulation via a surgically implanted dorsal column neurostimulator is gaining popularity owing to its substantial superiority over conventional medical management and/or further surgical intervention. However, considering that prevention is always better than cure, spinal surgeons need to be well aware of the many poor prognostic indicators for spinal surgery, particularly psychosocial overlay.

Metabolite secretion in microorganisms: the theory of metabolic overflow put to the test.

INTRODUCTION: Microbial cells secrete many metabolites during growth, including important intermediates of the central carbon metabolism. This has not been taken into account by researchers when modeling microbial metabolism for metabolic engineering and systems biology studies. MATERIALS AND METHODS: The uptake of metabolites by microorganisms is well studied, but our knowledge of how and why they secrete different intracellular compounds is poor. The secretion of metabolites by microbial cells has traditionally been regarded as a consequence of intracellular metabolic overflow. CONCLUSIONS: Here, we provide evidence based on time-series metabolomics data that microbial cells eliminate some metabolites in response to environmental cues, independent of metabolic overflow. Moreover, we review the different mechanisms of metabolite secretion and explore how this knowledge can benefit metabolic modeling and engineering.

Evidence of extensive reef development and high coral cover in nearshore environments: implications for understanding coral adaptation in turbid settings.

Mean coral cover has reportedly declined by over 15% during the last 30 years across the central Great Barrier Reef (GBR). Here, we present new data that documents widespread reef development within the more poorly studied turbid nearshore areas (<10 m depth), and show that coral cover on these reefs averages 38% (twice that reported on mid- and outer-shelf reefs). Of the surveyed seafloor area, 11% had distinct reef or coral community cover. Although the survey area represents a small subset of the nearshore zone (15.5 km(2)), this reef density is comparable to that measured across the wider GBR shelf (9%). We also show that cross-shelf coral cover declines with distance from the coast (R(2) = 0.596). Identified coral taxa (21 genera) exhibited clear depth-stratification, corresponding closely to light attenuation and seafloor topography, with reefal development restricted to submarine antecedent bedforms. Data from this first assessment of nearshore reef occurrence and ecology measured across meaningful spatial scales suggests that these coral communities may exhibit an unexpected capacity to tolerate documented declines in water quality. Indeed, these shallow-water nearshore reefs may share many characteristics with their deep-water (>30 m) mesophotic equivalents and may have similar potential as refugia from large-scale disturbances.

Low-Carbon Fuel and Chemical Production by Anaerobic Gas Fermentation.

World energy demand is expected to increase by up to 40% by 2035. Over this period, the global population is also expected to increase by a billion people. A challenge facing the global community is not only to increase the supply of fuel, but also to minimize fossil carbon emissions to safeguard the environment, at the same time as ensuring that food production and supply is not detrimentally impacted. Gas fermentation is a rapidly maturing technology which allows low carbon fuel and commodity chemical synthesis. Unlike traditional biofuel technologies, gas fermentation avoids the use of sugars, relying instead on gas streams rich in carbon monoxide and/or hydrogen and carbon dioxide as sources of carbon and energy for product synthesis by specialized bacteria collectively known as acetogens. Thus, gas fermentation enables access to a diverse array of novel, large volume, and globally available feedstocks including industrial waste gases and syngas produced, for example, via the gasification of municipal waste and biomass. Through the efforts of academic labs and early stage ventures, process scale-up challenges have been surmounted through the development of specialized bioreactors. Furthermore, tools for the genetic improvement of the acetogenic bacteria have been reported, paving the way for the production of a spectrum of ever-more valuable products via this process. As a result of these developments, interest in gas fermentation among both researchers and legislators has grown significantly in the past 5 years to the point that this approach is now considered amongst the mainstream of emerging technology solutions for near-term low-carbon fuel and chemical synthesis.

Coste/efectividad y seguridad de la laparoscopia en Venezuela (reflexiones de un norteamericano) / Cost/effectiveness and security of the laparoscopy in Venezuela (reflection of the north-american)

En la actualidad hay mucho interés en los ginecólogos de todo el mundo en la laparoscopia operatoria. Como profesor de cursos avanzados de laparoscopia, tengo la oportunidad de evaluar muchos nuevos instrumentos con anterioridad a otros ginecólogos. En este artículo revisamos y damos nuestra opinió sobre algunos de estos instrumentos y equipos para cirugía ginecológica laparoscópica que han sido desarrollados recientemente en Norteamérica. También incluyo algunos comentarios sobre certificación de credenciales y normas de seguridad en cirugía laparoscópica