The Emerging Cloud: a survey of vapers, their health and utilization of healthcare within the UK.

BACKGROUND: Recent work in the UK estimated the prevalence of current cannabinoid-based vaping to be higher than in the USA, a factor previously associated with e-cigarette or vaping-associated lung injury (EVALI). Research in the USA has demonstrated that attendances to emergency departments relating to e-cigarettes began to rise before the EVALI outbreak, suggesting that vapers also experience milder forms of vaping-related illness. AIM: Quantify symptom prevalence and healthcare utilization amongst current UK vapers. DESIGN: Voluntary online survey of individuals aged 16 and over within the UK. METHODS: Anonymized data were collected on demographics, vaping/smoking status and vaping substances used. Current vapers were asked about the presence of 10 prevalent symptoms from previous US EVALI case series, healthcare attendances and diagnoses given. Risk-ratios were calculated to compare the likelihood of symptoms and attendances between substances. RESULTS: A total of 2477 complete responses were analysed. In all, 397 respondents were current vapers. Symptom prevalence within the previous 12 months ranged from 3.8% to 30.5% (bloody sputum, cough). Healthcare attendances per symptomatic respondent ranged from 0.1 to 1.4 (bloody sputum, shortness of breath). Current vapers of cannabinoid-based products (alone/in combination) had the most attendances per symptomatic respondent for 9/10 symptoms and were more likely to report symptoms aside from 'cough' (nicotine-free e-liquids [risk ratio = 1.7]). Clinicians reportedly never diagnosed vaping-related illness. CONCLUSIONS: UK vapers experience symptoms previously reported in EVALI cases for which they also seek healthcare. Users of cannabinoid-based products were more likely to report symptoms and accounted for a higher healthcare burden. UK vapers may also experience vaping-related illness that does not meet EVALI case criteria.

Isotonitazene, a novel psychoactive substance opioid, detected in two cases following a local surge in opioid overdoses.

BACKGROUND: Isotonitazene is a novel opioid that was first reported in Europe in 2019. There have been no reports of the detection of isotonitazene in patients presenting to the emergency department with acute drug toxicity. AIM: There was an increase in presentations to our emergency department with acute opioid toxicity in August 2021. We aim to describe this outbreak and provide detail on two cases in which isotonitazene was quantified in serum samples. METHODS: Serum samples were available for comprehensive toxicological analysis for two presentations. Written consent was obtained and the samples were analysed through a Thermo XRS ultrahigh-performance liquid chromatography system, interfaced to a Thermo Q Exactive high-resolution accurate mass spectrometer, operating in heated positive ion electrospray mode. Acquired data were processed using Toxfinder software (Thermo) against a regularly updated in-house database. RESULTS: There was an increase in acute opioid presentations to our emergency department from a median of 10 per month to 36 in August 2021. Twenty were treated with naloxone, and 23 were admitted to the hospital for observation and treatment. Serum sample analysis from two patients with acute opioid toxicity responsive to naloxone detected the presence of isotonitazene (0.18 and 0.81 ng/ml). CONCLUSION: We report a cluster of acute opioid toxicity presentations to our Emergency Department with detection of isotonitazene in two cases. Analytical screening is important in determining the presence of novel psychoactive substances (NPS) and to help inform the public health of the implications of NPS use, particularly during clusters of acute recreational drug toxicity presentations.

A Micro-computed Tomography Analysis of Marginal and Internal Fit of Endocrowns Fabricated from Three CAD/CAM Materials.

OBJECTIVE: To assess the marginal and internal misfit of endocrowns fabricated from a resin matrix ceramic (CS), a partially crystallized (EMC), and a fully crystallized (ILS) lithium disilicate glass-ceramic. METHODS AND MATERIALS: Thirty human premolar teeth restored with endocrowns were investigated. Three CAD/CAM materials were used (n=10 per group): CS, EMC, and ILS. Two-dimensional (2D) analysis of marginal and internal misfit was performed on micro-computed tomography scans before and after adhesive bonding. Further, three-dimensional (3D) analysis was performed to determine the total internal volume discrepancy. Surface roughness of the fitting surfaces of endocrowns was characterized using optical profilometry and scanning electron microscopy. RESULTS: Adhesive bonding did not significantly affect marginal or internal misfit (p≥0.093). Differences in marginal misfit among the experimental groups were not statistically significant (p≥0.221). However, differences in 2D internal misfit were statistically significant; the CS group exhibited the largest internal misfit (p=0.001), while no significant difference was found between other groups (p=0.123). The largest discrepancies were observed at the pulpal floor and cervical region of all investigated specimens. No statistically significant difference was found in 3D misfit between ILS and EMC groups (p=0.711); however both exhibited statistically lower 3D misfit values compared to the CS group (p≤0.037). ILS endocrowns exhibited the smoothest and most homogenous fitting surface profile (p<0.001). However, there was no significant correlation between 2D internal misfit and the surface roughness (p≥0.082). CONCLUSIONS: The choice of CAD/CAM material may influence the fitting accuracy of endocrowns. The investigated lithium disilicate glass-ceramics conferred superior internal fit for endocrowns compared to resin matrix ceramic.

The unseen cloud: a survey of vaping practices and the acquisition of vaping products within the UK.

BACKGROUND: Vaping of cannabinoid-based products and informal acquisition of vaping products were associated with the outbreak of E-cigarette or vaping associated lung injury (EVALI) in the USA. Current prevalence of cannabinoid-based vaping within the UK is not known and literature regarding the acquisition of vaping products is limited. AIM: To estimate the prevalence of nicotine-based, nicotine-free and cannabinoid-based product vaping within the UK and to determine where vaping products are acquired. DESIGN AND METHODS: A voluntary online survey of individuals aged 16 and over within the UK was conducted using a convenience sample. Data were collected on respondent demographics, smoking/vaping history and acquisition of e-liquids/products. RESULTS: A total of 2478 responses were included. Median age 45 years (interquartile range 35-57). Prevalence of current vaping of nicotine-based e-liquids, nicotine-free e-liquids and cannabinoid-based products was 14.4%, 11.2% and 5.49%, respectively. Current nicotine-based and nicotine-free vaping was most prevalent in 25-34 years olds (22.4% and 19.2% of respondents). Current cannabinoid-based vaping was most prevalent in 16-24 years olds. The most common 'ever' used cannabinoid-based products were cannabidiol oil/cannabigerol oil and cannabis leaves (4.8%). Specialist vaping stores were the most common source of 'ever' acquisition for all products. 36.8% and 40.5% of respondents who had ever vaped nicotine-based and nicotine-free e-liquids reported prior acquisition from informal sources. CONCLUSION: This survey reported a higher prevalence of current cannabinoid-based vaping within the UK (5.5%) than previously reported in the USA (2.0%). In addition to the informal acquisition of vaping products as demonstrated within the survey, these results highlight potential underestimation of the risk of EVALI within the UK.

Increased Handpiece Speeds without Air Coolant: Aerosols and Thermal Impact.

This study assessed the impact of increased speed of high-speed contra-angle handpieces (HSCAHs) on the aerosolization of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surrogate virus and any concomitant thermal impact on dental pulp. A bacteriophage phantom-head model was used for bioaerosol detection. Crown preparations were performed with an NSK Z95L Contra-Angle 1:5 (HSCAH-A) and a Bien Air Contra-Angle 1:5 Nova Micro Series (HSCAH-B) at speeds of 60,000, 100,000, and 200,000 revolutions per minute (rpm), with no air coolant. Bioaerosol dispersal was measured with Φ6-bacteriophage settle plates, air sampling, and particle counters. Heating of the internal walls of the pulp chambers during crown preparation was assessed with an infrared camera with HSCAH-A and HSCAH-B at 200,000 rpm (water flows ≈15 mL min-1 and ≈30 mL min-1) and an air-turbine control (≈23.5 mL min-1) and correlated with remaining tissue thickness measurements. Minimal bacteriophage was detected on settle or air samples with no notable differences observed between handpieces or speeds (P > 0.05). At all speeds, maximum settled aerosol and average air detection was 1.00 plaque-forming units (pfu) and 0.08 pfu/m3, respectively. Irrespective of water flow rate or handpiece, both maximum temperature (41.5°C) and temperature difference (5.5°C) thresholds for pulpal health were exceeded more frequently with reduced tissue thickness. Moderate and strong negative correlations were observed based on Pearson's correlation coefficient, between remaining dentine thickness and either differential (r = -0.588) or maximum temperature (r = -0.629) measurements, respectively. Overall, HSCAH-B generated more thermal energy and exceeded more temperature thresholds compared to HSCAH-A. HSCAHs without air coolant operating at speeds of 200,000 rpm did not increase bioaerosolization in the dental surgery. Thermal risk is variable, dependent on handpiece design and remaining dentine thickness.

Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys.

BACKGROUND: Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012-13; and EA-V, 2016-17) in Germany. METHODS: The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V). RESULTS: 384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%). CONCLUSION: Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.

The impact of interviewer characteristics on residency candidate scores in Emergency Medicine: a brief report.

Background: At the conclusion of residency candidate interview days, faculty interviewers commonly meet as a group to reach conclusions about candidate evaluations based on shared information. These conclusions ultimately translate into rank list position for The Residency Match. The primary objective is to determine if the post-interview discussion influences the final scores assigned by each interviewer, and to investigate whether interviewer characteristics are significantly associated with the likelihood of changing their score. Based on Foucault's 'theory of discourse' and Bourdieu's 'social capital theory,' we hypothesized that interviewer characteristics, and the discourse itself, would contribute to score changes after a post-interview discussion regarding emergency medicine residency candidates. Methods: We conducted a cross-sectional observational study of candidate scores for all candidates to a four-year emergency medicine residency program affiliated with Yale University School of Medicine during a single application cycle. The magnitude and direction of score changes, if any, after group discussion were plotted and grouped by interviewer academic rank. We created a logistic regression model to determine the odds that candidate scores changed from pre- and post-discussion ratings related to specific interviewer factors. Results: A total of 24 interviewers and 211 candidates created 471 unique interviewer-candidate scoring interactions, with 216 (45.8%) changing post-discussion. All interviewers ranked junior to professor were significantly more likely to change their score compared to professors. Interviewers who were women had significantly lower odds of changing their individual scores following group discussion (p=0.020; OR 0.49, 95% CI 0.26-0.89). Conclusions: Interviewers with lower academic rank had higher odds of changing their post-discussion scores of residency candidates compared to professors. Future work is needed to further characterize the influencing factors and could help create more equitable decision processes during the residency candidate ranking process.

Do adult patients with congenital colorectal conditions know their diagnosis?

PURPOSE: Limited research exists about the knowledge that adult patients have about their congenital colorectal diagnosis. METHODS: This was an IRB approved, prospective study of patients in the Adult Colorectal Research Registry who completed surveys between October 2019 and March 2022. Surveys were administered through REDCap after patients consented to being contacted for research purposes. Patients provided demographic data, which was linked to surgical records, and the diagnoses provided by patients were compared with diagnoses recorded by the original surgeons. RESULTS: One hundred and thirty-one questionnaires were collected, 115 patients had anorectal malformations (ARM) and 16 had Hirschsprung disease (HD). Seven patients who had ARM were unaware that they had an ARM or HD. The type of ARM recorded by the surgeon was unavailable for comparison with the patient's reported diagnosis in four cases. Of the 111 remaining patients with ARM, only 32 of them (29%) knew what their own type of anomaly was. Female patients recalled their diagnosis more often than male patients (42.4% vs 13.5%). All 16 participants with HD correctly identified their diagnosis severity as HD with or without total colonic aganglionosis. CONCLUSION: The results of this study demonstrate patient's limited understanding of their type of ARM and highlight the urgent need to enhance communication and education strategies, such as issuing patients with medical diagnosis identification cards. It is critical for clinicians to better communicate with patients to ensure that they and their relatives truly understand their precise diagnosis. Adequately informed patients can better advocate for themselves, adhere to treatments and precautionary recommendations and navigate the complexities of transitional care. Consequently they can more effectively manage their lifelong complications.

A retrospective study of antivenom-associated adverse reaction and anaphylaxis at Ngwelezana Hospital, South Africa.

BACKGROUND: Snakebite victims are commonly seen in KwaZulu-Natal Hospitals, with only a minority of patients requiring antivenom. This study reviewed antivenom-associated adverse events at our institution, after administration of the South African Vaccine Producers (SAVP) polyvalent antivenom. METHODS: A retrospective review, over 52 months (January 2016-April 2020), of patients who received antivenom. Demographics, clinical details and clinical course following antivenom administration were analysed. RESULTS: Emergency department doctors treated 758 snakebites; 156 patients were admitted of which 51 (33%) received antivenom. Indications for antivenom included: neurotoxicity (24%), haemotoxicity (18%) and significant cytotoxicity (58%). Antivenom-associated adverse events occurred in 61% of patients; with 47% developing anaphylaxis requiring adrenaline infusion. There was a higher incidence of anaphylaxis in children (57%) than in adults (40%), p = 0.55. There was no association between antivenom dose and anaphylaxis. No benefit was noted with adrenaline premedication (p = 0.64), nor with the addition of antihistamine or steroid pre-medicants to adrenaline (p = 0.61). Multivariable logistic regression identified age as a predictor for anaphylaxis, but not dose or duration of antivenom and not any particular form of premedication. Intubation was required in 29% of patients developing anaphylaxis. There were no deaths and all patients made full recovery. CONCLUSION: Almost half of the patients at Ngwelezana hospital in Kwazulu-Natal receiving the SAVP polyvalent antivenom developed anaphylaxis requiring adrenaline infusion, with children at higher risk. The administration of this antivenom must only be given for valid indications, in a high-care environment by medical personnel ready to manage anaphylactic shock. The addition of antihistamine and corticosteroids to adrenaline for premedication has no added benefit.

Direct observation of ultrafast exciton localization in an organic semiconductor with soft X-ray transient absorption spectroscopy.

The localization dynamics of excitons in organic semiconductors influence the efficiency of charge transfer and separation in these materials. Here we apply time-resolved X-ray absorption spectroscopy to track photoinduced dynamics of a paradigmatic crystalline conjugated polymer: poly(3-hexylthiophene) (P3HT) commonly used in solar cell devices. The π→π* transition, the first step of solar energy conversion, is pumped with a 15 fs optical pulse and the dynamics are probed by an attosecond soft X-ray pulse at the carbon K-edge. We observe X-ray spectroscopic signatures of the initially hot excitonic state, indicating that it is delocalized over multiple polymer chains. This undergoes a rapid evolution on a sub 50 fs timescale which can be directly associated with cooling and localization to form either a localized exciton or polaron pair.

A systematic review of interventions to prevent work-related musculoskeletal disorders in ENT surgeons.

OBJECTIVE: Work-related musculoskeletal disorders in ENT surgeons are common and detrimental, yet few are aware of preventative measures. We evaluate the evidence for interventions to prevent work-related musculoskeletal disorders in ENT surgeons. METHOD: A systematic search of databases up to 8 June 2021 was performed using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and predetermined inclusion criteria. RESULTS: Seven prospective cohort studies and 2 case series were identified (51 participants). Interventions included novel equipment (n = 3), patient positioning (n = 2), clinician positioning (n = 3) and operative technique (n = 1). Five studies reported Rapid Upper Limb Assessment scores as outcome measures of strain. Strain decreased when adopting a favourable operating posture, using a supportive chair and keeping patients supine for clinic procedures. CONCLUSION: A small number of low-quality studies were identified. Modifiable risk factors exist, and ergonomic education may help prevent work-related musculoskeletal disorders. Further studies with longer term follow up are required.

The burden of end-stage osteoarthritis in Australia: a population-based study on the incidence of total knee replacement attributable to overweight/obesity.

OBJECTIVES: To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population. METHODS: This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association National Joint Registry and population data from the Australian Bureau of Statistics. The time-trend change in incidence of TKR relating to BMI was assessed between 2015 and 2018. The influence of obesity on the incidence of TKR in different age and gender groups was determined. The population attributable fraction (PAF) was then calculated to estimate the effect of obesity reduction on TKR incidence. RESULTS: The greatest increase in incidence of TKR was seen in patients from obese class III. The incidence rate ratio for having a TKR for obesity class III was 28.683 at those aged 18-54 years but was 2.029 at those aged >75 years. Females in obesity class III were 1.7 times more likely to undergo TKR compared to similarly classified males. The PAFs of TKR associated with overweight or obesity was 35%, estimating 14,287 cases of TKR attributable to obesity in 2018. The proportion of TKRs could be reduced by 20% if overweight and obese population move down one category. CONCLUSIONS: Obesity has resulted in a significant increase in the incidence of TKR in the youngest population in Australia. The impact of obesity is greatest in the young and the female population. Effective strategies to reduce the national obese population could potentially reduce 35% of the TKR, with over 10,000 cases being avoided.

Annotated catalogue of the Tachinidae (Insecta, Diptera) of Chile.

The Tachinidae (Diptera) of Chile are catalogued and information is given on distributions, name-bearing types, synonyms, nomenclatural issues, and pertinent literature. The history of tachinid collectors in Chile and authors who have contributed to the systematic knowledge of Chilean tachinids is extensively reviewed. The classification has been updated and 122 genera and 264 species are recognised in Chile. There is a significant amount of endemism with 28 genera and 100 species known only from Chile. There are also 113 species with distributions shared only between Chile and Argentina, particularly in the southern portions of these countries comprising Patagonia. The catalogue is based on examination of the original descriptions of all nominal species and all other references known to us containing relevant taxonomic and distributional information, for a total of approximately 450 references. Many of the name-bearing types and other Chilean specimens housed in collections were examined. Taxa are arranged hierarchically and alphabetically under the categories of subfamily, tribe, genus, subgenus (where recognised), and species. Nomenclatural information is provided for genus-group and species-group names, including lists of synonyms (mostly restricted to Neotropical taxa) and name-bearing type data. Species distributions are recorded by country within the New World and by larger geographical divisions in the Old World. Additional information is given in the form of notes and references under valid names at the level of tribe, genus, and species. Two genera are newly recorded from Chile: Chaetoepalpus Vimmer & Soukup, 1940 (Tachinini) (also newly recorded from Argentina) and Patelloa Townsend, 1916 (Goniini). Four species are newly recorded from Chile or other countries: Lyphaornata Aldrich, 1934 (Chile); Chaetoepalpuscoquilleti Vimmer & Soukup, 1940 (Argentina and Chile); Phytomypteraevanescens (Cortés, 1967) (Argentina); and Xanthobasisunicolor Aldrich, 1934 (Chile). Eight species previously recorded from Chile are deemed to have been misidentified or misrecorded from Chile (known distributions in parentheses): Archytasincertus (Macquart, 1851) (Argentina, Brazil, Paraguay, Uruguay); Archytasseminiger (Wiedemann, 1830) (Brazil, Colombia); Goniacrassicornis (Fabricius, 1794) (Brazil, Peru, Venezuela, Middle America, West Indies, Nearctic); Lespesiaandina (Bigot, 1888) (Cuba); Lespesiaarchippivora (Riley, 1871) (widespread Nearctic and most of Neotropical); Neoethillaignobilis (van der Wulp, 1890) (Mexico, United States); Siphona (Siphona) geniculata (De Geer, 1776) (Palaearctic, Nearctic [introduced]); and Winthemiaquadripustulata (Fabricius, 1794) (Palaearctic, Nearctic, Oriental]. As First Reviser we fix Paratheresiarufiventris Townsend, 1929 as the senior homonym and Sarcoprosenarufiventris Townsend, 1929 as the junior homonym when the two are placed together in Billaea Robineau-Desvoidy, 1830; and we fix Mayophoriniaangusta Townsend, 1927 as the senior homonym and Metarrhinomyiaangusta Townsend, 1927 as the junior homonym when the two are placed together in Myiopharus Brauer & Bergenstamm, 1889. New replacement names are proposed for eight preoccupied names of Neotropical species (country of type locality in parentheses): Billaearufescens O'Hara & Wood for Sarcoprosenarufiventris Townsend, 1929, preoccupied in the genus Billaea Robineau-Desvoidy, 1830 by Paratheresiarufiventris Townsend, 1929 (Peru), nom. nov.; Billaeatriquetrus O'Hara & Wood for Sarcoprosenatriangulifera Townsend, 1927, preoccupied in the genus Billaea Robineau-Desvoidy, 1830 by Dexiatriangulifera Zetterstedt, 1844 (Peru), nom. nov.; Eucelatorianudioculata O'Hara & Wood for Eucelatorioideanigripalpis Thompson, 1968, preoccupied in the genus Eucelatoria Townsend, 1909 by Chetolyganigripalpis Bigot, 1889 (Trinidad), nom. nov.; Eucelatoriaoblonga O'Hara & Wood for Urodexodeselongatum Cortés & Campos, 1974, preoccupied in the genus Eucelatoria Townsend, 1909 by Exoristaelongata van der Wulp, 1890 (Chile), nom. nov.; Lespesiathompsoni O'Hara & Wood for Sturmiopsoideaobscura Thompson, 1966, preoccupied in the genus Lespesia Robineau-Desvoidy, 1863 by Eurigasterobscurus Bigot, 1857 (Cuba), nom. nov.; Myiopharuscharapensis O'Hara & Wood for Metarrhinomyiaangusta Townsend, 1927, preoccupied in the genus Myiopharus Brauer & Bergenstamm, 1889 by Mayophoriniaangusta Townsend, 1927 (Peru), nom. nov.; Myiopharusincognitus O'Hara & Wood for Stenochaetaclaripalpis Thompson, 1968, preoccupied in the genus Myiopharus Brauer & Bergenstamm, 1889 by Neoxynopsoideaclaripalpis Thompson, 1968 (Trinidad), nom. nov.; and Myiopharusrufopalpus O'Hara & Wood for Paralispepalpalis Townsend, 1929, preoccupied in the genus Myiopharus Brauer & Bergenstamm, 1889 by Myioxynopspalpalis Townsend, 1927 (Peru), nom. nov. New type species fixations are made under the provisions of Article 70.3.2 of the ICZNCode for three genus-group names: Parafabricia Brauer & Bergenstamm, 1894 (synonym of Archytas Jaennicke, 1867), type species newly fixed as Parafabriciaperplexa Townsend, 1931; Tachinodes Brauer & Bergenstamm, 1889 (synonym of Archytas Jaennicke, 1867), type species newly fixed as Juriniametallica Robineau-Desvoidy, 1830; and Willistonia Brauer & Bergenstamm, 1889 (synonym of Belvosia Robineau-Desvoidy, 1830), type species newly fixed as Willistoniaaldrichi Townsend, 1931. Lectotypes are designated for the following four nominal species, all described or possibly described from Chile: Echinomyiapygmaea Macquart, 1851 (a valid name in the genus Peleteria Robineau-Desvoidy, 1830); Goniachilensis Macquart, 1844 (a junior synonym of Goniapallens Wiedemann, 1830); Masiceraauriceps Macquart, 1844 (a valid name in the genus Lespesia Robineau-Desvoidy, 1863); and Prosopochoetanitidiventris Macquart, 1851 (a valid name in the genus Prosopochaeta Macquart, 1851). The following 27 new or revived combinations are proposed (distributions in parentheses): Blepharipezaandina Bigot, 1888 is moved to Lespesia Robineau-Desvoidy, 1863 as L.andina, nomen dubium (Cuba), comb. nov.; Camposodesevanescens Cortés, 1967 is moved to Phytomyptera Rondani, 1845 as P.evanescens (Argentina, Chile), comb. nov.; Ectophasiopsisypiranga Dios & Nihei, 2017 is moved to Trichopoda Berthold, 1827 and assigned to subgenus Galactomyia Townsend, 1908 as T. (G.) ypiranga (Argentina, Brazil), comb. nov.; Embiomyiaaustralis Aldrich, 1934 is moved to Steleoneura Stein, 1924 as S.australis (Argentina, Chile), comb. nov.; Eurigastermodestus Bigot, 1857 is moved to Lespesia as L.modesta (Cuba), comb. nov.; Eurigasterobscurus Bigot, 1857 is moved to Lespesia as L.obscura (Cuba), comb. nov.; Macropatelloatanumeana Townsend, 1931 is moved to Patelloa Townsend, 1916 as P.tanumeana (Argentina, Chile), comb. nov.; Masicerainsignis van der Wulp, 1882 is moved to Drino Robineau-Desvoidy, 1863 as D.insignis (Argentina, Chile), comb. nov.; Parasetigenahichinsi Cortés, 1967 is moved to Chetogena Rondani, 1856 as C.hichinsi (Chile), comb. nov.; Parasetigenaporteri Brèthes, 1920 and junior synonym Stomatotachinasplendida Townsend, 1931 are moved to Chetogena as C.porteri (Chile), both comb. nov.; Phoroceracalyptrata Aldrich, 1934 is moved to Admontia Brauer & Bergenstamm, 1889 as A.calyptrata (Argentina, Chile), comb. nov.; Poliopsauratus Campos, 1953 is moved to Admontia Brauer & Bergenstamm, 1889 as A.aurata (Chile), comb. nov.; Poliopsstriatus Aldrich, 1934 is moved to Admontia as A.striata (Argentina, Chile), comb. nov.; Ruiziellafrontosa Cortés, 1951 is moved to Chaetoepalpus Vimmer & Soukup, 1940 and placed in synonymy with C.coquilleti Vimmer & Soukup, 1940 (Argentina, Chile, Peru), comb. nov.; Ruiziellaluctuosa Cortés, 1951 is moved to Chaetoepalpus as C.luctuosus (Argentina, Chile), comb. nov.; Sarcoprosenaluteola Cortés & Campos, 1974 is moved to Billaea Robineau-Desvoidy, 1830 as B.luteola (Chile), comb. nov.; Sarcoprosenarufiventris Townsend, 1929 is moved to Billaea where it is a junior secondary homonym and is renamed B.rufescens O'Hara & Wood (Peru), comb. nov.; Sarcoprosenatriangulifera Townsend, 1927 is moved to Billaea where it is a junior secondary homonym and is renamed B.triquetrus O'Hara & Wood (Peru),comb. nov.; Saundersiaaurea Giglio-Tos, 1893 is moved to "Unplaced species of Tachinini" (Mexico), comb. nov.; Schistostephanaaurifrons Townsend, 1919 is moved to Billaea as B.aurifrons (Peru), comb. nov.; Siphoactiacharapensis Townsend, 1927 is moved to Clausicella Rondani, 1856 as C.charapensis (Peru), comb. nov.; Siphoactiaperegrina Cortés & Campos, 1971 is moved to Clausicella as C. peregrina (Chile), comb. nov.; Sturmiafestiva Cortés, 1944 is moved to Drino as D.festiva (Argentina, Chile), comb. nov.; Sturmiopsoideaobscura Thompson, 1966 is moved to Lespesia Robineau-Desvoidy, 1863, where it is a junior secondary homonym and is renamed L.thompsoni O'Hara & Wood (Trinidad), comb. nov.; Trichopodaarcuata Bigot, 1876 is returned to Trichopoda from Ectophasiopsis Townsend, 1915 and assigned to subgenus Galactomyia (Argentina, Chile), comb. revived; and Trichopodagradata Wiedemann, 1830 is returned to Trichopoda from Ectophasiopsis and assigned to subgenus Galactomyia (Argentina, Brazil, Uruguay), comb. revived. New or revived generic and specific synonymies are proposed for the following 14 names: Camposodes Cortés, 1967 with Phytomyptera Rondani, 1845, syn. nov.; Ectophasiopsis Townsend, 1915 with Trichopoda Berthold, 1827, subgenus Galactomyia Townsend, 1908, syn. nov.; Embiomyia Aldrich, 1934 with Steleoneura Stein, 1924, syn. nov.; Fabriciaandicola Bigot, 1888 with Peleteriarobusta (Wiedemann, 1830), syn. revived; Macropatelloa Townsend, 1931 with Patelloa Townsend, 1916, syn. nov.; Peleteriainca Curran, 1925 with Peleteriarobusta (Wiedemann, 1830), syn. revived;Poliops Aldrich, 1934 with Admontia Brauer & Bergenstamm, 1889, syn. nov.; Ruiziella Cortés, 1951 with Chaetoepalpus Vimmer & Soukup, 1940, syn. nov.; Ruiziellafrontosa Cortés, 1951 with Chaetoepalpuscoquilleti Vimmer & Soukup, 1940, syn. nov.; Sarcoprosena Townsend, 1927 with Billaea Robineau-Desvoidy, 1830, syn. nov.; Schistostephana Townsend, 1919 with Billaea, syn. nov.; Siphoactia Townsend, 1927 with Clausicella Rondani, 1856, syn. nov.; Stomatotachina Townsend, 1931 with Chetogena Rondani, 1856, syn. nov.; and Sturmiopsoidea Thompson, 1966 with Lespesia Robineau-Desvoidy, 1863, syn. nov.

An analysis of paediatric snakebites in north-eastern South Africa.

BACKGROUND: Snakebites are an underappreciated health concern in middle- and lower-income countries. The lack of national data vastly impacts funding for this health crisis, as well as strategies for treatment and prevention. Children are particularly vulnerable to snakebite and data in this group is limited. METHODS: This study included paediatric patients, aged 13 years old or younger, admitted to Ngwelezana Tertiary Hospital, Department of Surgery with a snakebite or snakebite related complication, from 1 September 2008 to 31 December 2013. Data captured included demographics, time of presentation, syndromic symptoms, blood results and patient management. RESULTS: A total of 274 patients were included in this study. The median age at presentation was 8 years, with approximately 70% of the patients aged between 6 and 13 years, with a male predominance (56%). The median time of presentation after sustaining a snakebite was 7 hours (interquartile range 4-13 hours). The majority of patients (71%) presented with cytotoxic manifestations. A total of 53 patients received antivenom of whom 25% suffered adverse reactions. Fifty-six patients underwent one or more procedures on their affected limbs. Three patients required admission to the intensive care unit; all were part of the cytotoxic group and received antivenom. There were no recorded mortalities. CONCLUSION: The majority of snakebites are cytotoxic in nature. One-fifth of the paediatric population require antivenom and one-fifth require a surgical procedure post envenomation. Adverse effects post antivenom use are common but manageable. Prevention programmes are needed to help reduce this burden of disease and a nationwide snakebite registry is long overdue.

Dental Mitigation Strategies to Reduce Aerosolization of SARS-CoV-2.

Limiting infection transmission is central to the safety of all in dentistry, particularly during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Aerosol-generating procedures (AGPs) are crucial to the practice of dentistry; it is imperative to understand the inherent risks of viral dispersion associated with AGPs and the efficacy of available mitigation strategies. In a dental surgery setting, crown preparation and root canal access procedures were performed with an air turbine or high-speed contra-angle handpiece (HSCAH), with mitigation via rubber dam or high-volume aspiration and a no-mitigation control. A phantom head was used with a 1.5-mL min-1 flow of artificial saliva infected with Φ6-bacteriophage (a surrogate virus for SARS-CoV-2) at ~108 plaque-forming units mL-1, reflecting the upper limits of reported salivary SARS-CoV-2 levels. Bioaerosol dispersal was measured using agar settle plates lawned with the Φ6-bacteriophage host, Pseudomonas syringae. Viral air concentrations were assessed using MicroBio MB2 air sampling and particle quantities using Kanomax 3889 GEOα counters. Compared to an air turbine, the HSCAH reduced settled bioaerosols by 99.72%, 100.00%, and 100.00% for no mitigation, aspiration, and rubber dam, respectively. Bacteriophage concentrations in the air were reduced by 99.98%, 100.00%, and 100.00% with the same mitigations. Use of the HSCAH with high-volume aspiration resulted in no detectable bacteriophage, both on nonsplatter settle plates and in air samples taken 6 to 10 min postprocedure. To our knowledge, this study is the first to report the aerosolization in a dental clinic of active virus as a marker for risk determination. While this model represents a worst-case scenario for possible SARS-CoV-2 dispersal, these data showed that the use of HSCAHs can vastly reduce the risk of viral aerosolization and therefore remove the need for clinic fallow time. Furthermore, our findings indicate that the use of particle analysis alone cannot provide sufficient insight to understand bioaerosol infection risk.

An Evaluation of the Efficacy of LED Light Curing Units in Primary and Secondary Dental Settings in the United Kingdom.

OBJECTIVE: This study aimed to evaluate the irradiance and the quality of LED light curing units (LCUs) in primary and secondary clinics in the UK and to assess the effect of damage, contamination, use of protective sleeves, and distance of light tips to target on the irradiance and performance of LCUs. METHODS: The irradiance levels (mW/cm2) of 26 LED LCUs from general dental practices and 207 LED LCUs from two dental hospitals were measured using a digital radiometer (Blue Phase II, Ivoclar, Vivadent, Amherst, NY). Ten LED light guide tips (Satelec Mini, Acteon, Merignac, France) were selected to evaluate the effect of chipping, contamination (tip debris), and use of protective sleeves and tips to sensor distance on irradiance (mW/cm2) using a MARC Resin Calibrator (Blue Light Analytics, Halifax, Canada). Homogeneity of the light output was evaluated using a laser beam profiler (SP620; Ophir-Spiricon, North Longan, UT, USA). Statistical analysis was conducted using a one-way analysis of variance (ANOVA) with post hoc Tukey test (α=0.05) and linear regression with stepwise correlation tests. RESULTS: Thirty-three percent of the LCUs delivered irradiance output less than 500 mW/cm2. The condition of the light curing tips was poor, with 16% contaminated with resin debris, 26% damaged, and 10% both contaminated and damaged. The irradiance output was significantly reduced in contaminated (62%) and chipped (50%) light curing tips and when using protective sleeves (24%) (p<0.05). Irradiance was also reduced when increasing the distance with 25% and 34% reduction at 7 mm and 10 mm, respectively (p<0.05). CONCLUSION: There remains a lack of awareness of the need for regular monitoring and maintenance of dental LCUs. Damaged and contaminated light curing tips, use of protective sleeves, and increasing the distance from the restoration significantly reduced the irradiance output and the performance of the LCUs.

Revison of Metaplagia Coquillett (Diptera: Tachinidae) with description of five new species from Area de Conservación Guanacaste in northwestern Costa Rica.

BACKGROUND: We revise the genus Metaplagia Coquillett, 1895 and describe five new species from Area de Conservación Guanacaste (ACG) in northwestern Costa Rica. All new species were reared from an ongoing inventory of wild-caught caterpillars spanning a variety of species within the family Sphingidae (Lepidoptera: Sphingidae). Our study provides a concise description of each new species using morphology, life history, molecular data and photographic documentation. In addition to the new species, the authors provide a re-description of the genus and a revised key to the species of Metaplagia. NEW INFORMATION: The following five new species of Metaplagia are described: Metaplagia leahdennisae Fleming & Wood sp. n., Metaplagia lindarobinsonae Fleming & Wood sp. n., Metaplagia paulinesaribasae Fleming & Wood sp. n., Metaplagia robinsherwoodae Fleming & Wood sp. n. and Metaplagia svetlanakozikae Fleming & Wood sp. n.The following is proposed by Fleming & Wood as new combination of Plagiomima Brauer & Bergenstamm, 1891: Plagiomima latifrons (Reinhard, 1956) comb. n.

Effect of porcine plasma on growth and health of Holstein calves.

The objective of this trial was to compare the health and performance of calves provided high feeding rates of a whey-based all-milk-protein calf milk replacer (MR) with those fed an MR containing either 5% or 10% porcine plasma, which replaced, respectively, either 15% or 30% of the whey-based proteins in the MR formula. A total of 320 male Holstein calves weighing a mean (± SD) of 47.8 ± 4.1 kg were sourced from local dairy farms, auction facilities, and local order buyers. Calves arrived at the research facility in 4 batches of 80 animals each and were randomly assigned to 1 of 3 groups: (1) MR composed of whey-based milk proteins (control group); (2) whey replacement of 5% spray-dried porcine plasma (replacing 15% of protein); or (3) whey replacement of 10% spray-dried porcine plasma (replacing 30% of protein). Calves were housed in individual pens for the first 56 d of the experiment and offered, twice daily, a 26% crude protein (CP), 20% fat MR standardized using synthetic amino acids to 2.4% lysine, 0.8% methionine, and 1.6% threonine. Amounts of MR offered from wk 1 to 8 were 0.65, 0.78, 0.91, 1.04, 1.04, 0.78, 0.52, and 0.325 kg/d, respectively. Calves were also offered a 20% CP texturized calf starter from d 0 to 56 and then transitioned over 7 d (d 56-62) of a 50% calf starter and 50% corn and pellet ration with 2% straw to a corn and pellet ration with 2% straw (18.1% CP) for the remainder of the experiment (d 63-77). Calves were individually weighed upon arrival, weekly through d 56, and at d 77. Grain was fed ad libitum, and remaining grain was weighed weekly to determine weekly consumption. Remaining grain was discarded and was replaced with fresh grain that was weighed and recorded. All milk was offered individually via bucket twice daily, and refusals were recorded following milk feeding by weighing back the remaining unconsumed milk solution. Calves were health scored twice daily, and any medical treatments or mortality were recorded. Time to mortality and medical treatments were analyzed using survival analysis, health scoring data were analyzed using a generalized linear model, and growth was evaluated using a mixed repeated-measures linear regression model. No differences in mortality or incidence of diarrhea were noted between groups. Although there was a high incidence of respiratory disease (65%), no differences were found between groups. Over the entire experimental period, calves gained 67.0 ± 14.9 kg; however, no differences in growth among groups were noted, with the exception that, on d 77, BW was greater for calves in the control group (115.8 ± 15.5 kg) compared with those fed a MR with 5% porcine plasma (113.4 ± 17.8 kg). No differences were found between groups with respect to feed conversion. In this study, an MR composed of either 5% or 10% spray-dried porcine plasma performed comparably to a whey protein-based MR.