Atlanto-occipital Dissociation: A Review on Epidemiology, Recognition and Diagnosis, Management Options, Outcomes, and Future Directions.

Atlanto-occipital dissociation (AOD) is an extremely common injury but often fatal. In a systematic review from 2010, AODs were present in almost 20% of blunt trauma fatalities. It is an injury many patients do not survive; therefore, few are treated, even at high volume trauma centers. In survivors, his injury is often missed or the diagnosis is often delayed. Mortality rates commonly reach beyond 60% when injury patterns go unrecognized. Approximately 50% of patients with AOD sustain blunt cerebrovascular injury and nearly 20% of patients present with traumatic brain injury (TBI) or stroke. This pathology was once considered uniformly fatal. However, over the last 20 years, significant advancements have been made both clinically and radiographically, to better identify and manage this injury pattern. Despite improvements in clinical comprehension and improved time to diagnosis, less than 75% of cases are currently recognized within 24 hours. Less than 40% of patients who suffer AOD are independent with functionality, without neurological impairment. This article reviews current literature regarding AOD in hopes to improve timing to diagnosis, subsequent prognosis, timing to fixation or stabilization, and postoperative recovery.

Using telehealth for people at the end of life with chronic illness in Australia.

BACKGROUND: Traditional models of palliative care have been tested by the challenges of caring for increasing numbers of people at the end stages of a chronic non-malignant illness. The COVID-19 pandemic and consequent reliance on telehealth services, has enabled the development of creative models of care. AIMS: To improve home-based palliative care for people with chronic illness using telehealth, and this was demonstrated using quality-of-life measures. METHODS: A total of 35 non-cancer referrals to a community palliative care service were recommended for the pilot project, with one specialist palliative care nurse as their contact. All were offered a telehealth service with a specially designed app to self-monitor their symptoms, a session on advance care directives, and self-rated quality-of-life measures using the RAND 36-Item Health Survey (Version 1.0), consisting of 36 items that cover nine domains. Statistical analysis was performed using SPSS software. FINDINGS: Over the 21 months of the pilot study, 13 people chose to participate in the pilot. For participants, telehealth meant more control over their symptoms, fewer emergency presentations and appointment travel time was alleviated. Quality-of-life surveys highlighted physical impairments, which did not change over time. CONCLUSION: This pilot programme demonstrated an innovative approach to addressing the demands of people dying of chronic illness, with further work required to explore the place of telehealth consultations in the overall healthcare system.

Beyond the usual suspects: methanogenic communities in eastern North American peatlands are also influenced by nickel and copper concentrations.

Peatlands both accumulate carbon and release methane, but their broad range in environmental conditions means that the diversity of microorganisms responsible for carbon cycling is still uncertain. Here, we describe a community analysis of methanogenic archaea responsible for methane production in 17 peatlands from 36 to 53 N latitude across the eastern half of North America, including three metal-contaminated sites. Methanogenic community structure was analysed through Illumina amplicon sequencing of the mcrA gene. Whether metal-contaminated sites were included or not, metal concentrations in peat were a primary driver of methanogenic community composition, particularly nickel, a trace element required in the F430 cofactor in methyl-coenzyme M reductase that is also toxic at high concentrations. Copper was also a strong predictor, likely due to inhibition at toxic levels and/or to cooccurrence with nickel, since copper enzymes are not known to be present in anaerobic archaea. The methanogenic groups Methanocellales and Methanosarcinales were prevalent in peatlands with low nickel concentrations, while Methanomicrobiales and Methanomassiliicoccales were abundant in peatlands with higher nickel concentrations. Results suggest that peat-associated trace metals are predictors of methanogenic communities in peatlands.

A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery.

INTRODUCTION: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.

A service evaluation of specialist nurse telephone follow-up of bowel cancer patients after surgery.

INTRODUCTION: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.

Controls on bacterial and archaeal community structure and greenhouse gas production in natural, mined, and restored Canadian peatlands.

Northern peatlands are important global C reservoirs, largely because of their slow rates of microbial C mineralization. Particularly in sites that are heavily influenced by anthropogenic disturbances, there is scant information about microbial ecology and whether or not microbial community structure influences greenhouse gas production. This work characterized communities of bacteria and archaea using terminal restriction fragment length polymorphism (T-RFLP) and sequence analysis of 16S rRNA and functional genes across eight natural, mined, or restored peatlands in two locations in eastern Canada. Correlations were explored among chemical properties of peat, bacterial and archaeal community structure, and carbon dioxide (CO2) and methane (CH4) production rates under oxic and anoxic conditions. Bacteria and archaea similar to those found in other peat soil environments were detected. In contrast to other reports, methanogen diversity was low in our study, with only 2 groups of known or suspected methanogens. Although mining and restoration affected substrate availability and microbial activity, these land-uses did not consistently affect bacterial or archaeal community composition. In fact, larger differences were observed between the two locations and between oxic and anoxic peat samples than between natural, mined, and restored sites, with anoxic samples characterized by less detectable bacterial diversity and stronger dominance by members of the phylum Acidobacteria. There were also no apparent strong linkages between prokaryote community structure and CH4 or CO2 production, suggesting that different organisms exhibit functional redundancy and/or that the same taxa function at very different rates when exposed to different peat substrates. In contrast to other earlier work focusing on fungal communities across similar mined and restored peatlands, bacterial and archaeal communities appeared to be more resistant or resilient to peat substrate changes brought about by these land uses.

Phase II study of weekly docetaxel and capecitabine in patients with metastatic breast cancer.

PURPOSE: This phase II study evaluated the safety and efficacy of weekly docetaxel and capecitabine in patients with metastatic breast cancer. PATIENTS AND METHODS: Thirty-nine patients with metastatic breast cancer received 30 mg/m2 of docetaxel on days 1, 8, and 15 in combination with capecitabine 800 mg/m2 twice daily on days 1-21, repeated every 28 days. RESULTS: The median number of treatment cycles was 4 (range, 1-20 cycles). Grade 3 toxicities per patient were asthenia (n = 7; 18%), diarrhea (n = 7; 18%), nausea/vomiting (n = 5; 13%), stomatitis (n = 5; 13%), neutropenia (n = 5; 13%), and hand-foot syndrome (n = 4; 10%). There were only 2 grade 4 toxicities, febrile neutropenia and pulmonary embolism. The overall response rate was 44% (95% confidence interval (CI), 28%-60%), median duration of response was 9.1 months (95% CI, 6.2-12 months), and median time to progression was 5.5 months (95% CI, 3.7-7.3 months). CONCLUSION: Weekly docetaxel with capecitabine was active with acceptable toxicities. Additional trials to define the optimal schedule of docetaxel and capecitabine are justified.

Greenhouse gas emissions from Canadian peat extraction, 1990-2000: a life-cycle analysis.

This study uses life-cycle analysis to examine the net greenhouse gas (GHG) emissions from the Canadian peat industry for the period 1990-2000. GHG exchange is estimated for land-use change, peat extraction and processing, transport to market, and the in situ decomposition of extracted peat. The estimates, based on an additive GHG accounting model, show that the peat extraction life cycle emitted 0.54 x 10(6) t of GHG in 1990, increasing to 0.89 x 10(6) t in 2000 (expressed as CO2 equivalents using a 100-y time horizon). Peat decomposition associated with end use was the largest source of GHGs, comprising 71% of total emissions during this 11-y period. Land use change resulted in a switch of the peatlands from a GHG sink to a source and contributed an additional 15%. Peat transportation was responsible for 10% of total GHG emissions, and extraction and processing contributed 4%. It would take approximately 2000 y to restore the carbon pool to its original size if peatland restoration is successful and the cutover peatland once again becomes a net carbon sink.

The neurobehavioral effects of phytoestrogens in male Syrian hamsters.

We used a phytoestrogen (PE) and a phytoestrogen-free (PE-Free) diet to determine whether or not diet can have neurobehavioral effects on intermale aggression in Syrian hamsters (Mesocricetus auratus). In Experiment 1, 20 adult male hamsters were pre-tested for aggression and then placed on a PE (n=10) or a PE-Free diet (n=10) for 4 weeks in isolation. During week 5, experimental hamsters were exposed to a group-housed, nonaggressive opponent (NAO) for 5 min in a neutral cage arena. PE-fed hamsters exhibited more attacks (33.4+/-6.1) toward the NAO compared to the PE-Free-fed hamsters (18.1+/-4) (p<0.05). Interestingly, testosterone in the blood serum was higher in the PE-fed group (11.01+/-1.48 ng/ml) compared to the PE-Free group (6.5+/-0.87 ng/ml). In Experiment 2, 16 juvenile hamsters were weaned onto a PE (n=8) or a PE-Free diet (n=8). After 7 weeks on the diet, experimental hamsters were exposed to a NAO for 5 min in a neutral cage arena. Although the PE group exhibited higher levels of aggressive behavior, there were no statistically significant differences between groups. However, the PE group had higher levels of testosterone (9.0+/-0.95 ng/ml) compared to the PE-Free group (4.6+/-0.98 ng/ml) (p<0.05). In addition, analysis of the brains from both experiments revealed differences in binding for vasopressin 1A (V1A) receptors. Optical densities were converted to disintegrating units per min/mg. The PE-Free group had higher levels of V1A receptor binding (2689.93+/-254.8 dpm/mg) compared to the PE group (1907.32+/-136.3 dpm/mg) in the lateral septum (p<0.05). In addition, there were differences in the lateral hypothalamus, but the PE group had higher receptor binding (2550.9+/-63.59 dpm/mg) when compared to the PE-Free group (2011.9+/-174.14 dpm/mg) (p<0.05). In sum, these data present the first evidence that phytoestrogens can affect aggressive behavior and, concurrently, alter hormonal status and stimulate changes in the brain of male hamsters.