Giant sigmoid diverticulum.

Unlike acute diverticulitis, giant diverticulum larger than 4 cm is a rare entity with few cases described in the literature. We present a case of a 66-year-old male patient diagnosed with colonic diverticulosis. He presented to the emergency department with symptoms of acute abdomen and was diagnosed by CT scan with a 13x14 cm giant diverticulum showing signs of complication. Given the findings, an urgent surgical intervention was decided, and diverticulectomy at the diverticular neck was performed using an endostapler. The etiology of giant diverticula is related to a mechanism of one-way valve at the diverticular neck. Diagnosis poses a challenge as the clinical presentation is nonspecific. The imaging modality of choice is CT scan, which reveals a large cystic image dependent on the sigmoid colon. Definitive treatment is surgical, either by resecting the affected segment including the lesion or by performing a simple diverticulectomy in uncomplicated cases.

Improving perioperative management of surgical sets for trauma surgeries: the 4S approach.

BACKGROUND: The perioperative management of the surgical instruments and implants that comprise sets for trauma surgeries has been identified as a complex and resource-intensive activity due to non-standardized inventories, redundant surgical instruments and unnecessary sterilization cycles. The 4S Intelligent Trauma Care program aims to improve perioperative management and thereby reduce environmental impact by utilizing standardized inventories, a sterile implant portfolio, a barcode that enables a digital safety certification, and a digitized restocking service. OBJECTIVE: The objective of this study was to investigate the impact of the introduction of the 4S program for the management of surgical sets in open reduction internal fixation (ORIF) trauma surgeries. METHODS: This was a single-center, quality improvement study of ORIF trauma surgeries, comparing the current practice (30 procedures) to the procedure following the introduction of the 4S program (30 procedures). The primary outcome was the proportion of procedures requiring only one sterilization cycle. Secondary outcomes were the number of sterilization cycles per procedure, set processing time across departments, total set processing costs, number of missing or damaged implants, number of cleaning cycles per procedure, time taken to assemble containers for sterilization, number of containers entering the autoclave per procedure, environmental impact, number of baskets entering the cleaning machine per procedure, and staff satisfaction. RESULTS: Introduction of the 4S program resulted in a reduction in the mean number of sterilization cycles required from 2.1 to 1.0 (p < 0.001). In the current practice, only 30.0% of procedure sets were sterilized within one cycle, compared to 100.0% following introduction of the 4S program (p < 0.001). A reduction in the mean set processing time of 24.1% in the OR and 35.3% in the sterilization department was observed. Mean set processing costs for the current practice were €81.23, compared to €50.30 following introduction of the 4S program. Furthermore, following the introduction of the 4S program, procedures were associated with significant reductions in water and electricity usage, and increased staff satisfaction. CONCLUSIONS: This quality improvement study demonstrates the substantial time and cost savings, positive environmental impact and staff satisfaction that could be achieved by streamlining surgical set management through the 4S program. To our knowledge, this is the first study of this type and our findings may be instructive to other hospitals and surgical specialties.

Pancreatic lipoma: diagnostic boom of a rare mesenchymal tumor.

Following the incidental finding of a tumor in a 58-year-old female, diagnosed as pancreatic lipoma, histologically confirmed by fine-needle aspiration biopsy (FNAB) with endoscopic ultrasound (EUS), we made a review in our center between 2018 and 2020, with 14 cases diagnosed of pancreatic lipoma by computarized tomography (CT) or magnetic resonance imaging (MRI).

Stimuli-Responsive Solvatochromic Au(I)-Ag(I) Clusters: Reactivity and Photophysical Properties Induced by the Nature of the Solvent.

Reaction of the heterometallic polymer [Au2Ag2(C6Cl5)4(OEt2)2] n with 4 equiv of pyridazine leads to the new discrete complex [Au2Ag2(C6Cl5)4(µ2-C4H4N2)2(C4H4N2)2] (1). Complex 1 is solvoluminescent, leading to drastic structural changes, depending on the coordination ability of the chosen solvent. Thus, the reaction of complex 1 with acetonitrile leads to a new Au(I)-Ag(I) complex of stoichiometry [Au2Ag2(C6Cl5)4(µ2-C4H4N2)2(NCMe)2] n·2CH3CN(2), while if the reaction is carried out with a noncoordinating solvent such as dichloromethane, complex [Au2Ag2(C6Cl5)4(C4H4N2)2] n·CH2Cl2 (3) is obtained. Furthermore, when complexes 1, 2, and 3 are exposed to tetrahydrofuran, different results are obtained. In the case of complex 1, the metallic core disposition remains and THF is incorporated as a crystallization solvent in [Au2Ag2(C6Cl5)4(µ2-C4H4N2)2(C4H4N2)2]·2THF (1·THF). On the other hand, reaction of complexes 2 or 3 with THF gives rise to a mixture of the corresponding polymeric complex [Au2Ag2(C6Cl5)4(THF)2] n, in which pyridazine ligands are displaced, together with a polymorph of complex 1·THF. All these complexes are luminescent in solid state displaying different emission energies depending on their structural disposition as well as on the presence of the metallophilic interactions. These subtle changes in the cluster structures, only based on the solvent used, lead to spectacular reversible changes in the emissive behavior of the complexes, allowing the tuning of the luminescent emissions in a wide range. DFT and TD-DFT calculations support the experimental photophysical studies.

The Long-Term Clinical Outcome of Posttraumatic Stress Disorder With Impaired Coronary Distensibility.

OBJECTIVE: Coronary Distensibility Index (CDI) impairments reflect endothelial-dependent process associated with vulnerable-plaque composition. This study investigated the relation of impaired CDI with posttraumatic stress disorder (PTSD) and their predictive value for major adverse cardiovascular events (MACE). METHODS: This study involved 246 patients (age = 63 [10] years, 12% women) with (n = 50) and without (n = 196) PTSD, who underwent computed tomography angiography to determine coronary artery disease and CDI. Extent of coronary artery disease was defined as normal, nonobstructive (<50% luminal stenosis), and obstructive (>50%). Incidence of MACE, defined as myocardial infarction or cardiovascular death, was documented during a mean follow-up of 50 months. Survival regression was employed to assess the longitudinal association of impaired CDI and PTSD with MACE. RESULTS: A significant inverse correlation between CDI and Clinical Global Impression Severity scale of PTSD symptoms was noted (r = .81, p = .001). CDI was significantly lower in patients with PTSD (3.3 [0.2]) compared with those without PTSD (4.5 [0.3]), a finding that was more robust in women (p < .05). Covariate-adjusted analyses revealed that the relative risk of MACE was higher in patients with PTSD (hazard ratio [HR] = 1.56, 95% CI = 1.34-3.14) and those with impaired CDI (HR = 1.95, 95% CI = 1.27-3.01, per standard deviation lower CDI value). There was also a significant interaction between PTSD and impaired CDI (HR = 3.24, 95% CI = 2.02-5.53). CONCLUSIONS: Impaired CDI is strongly associated with the severity of PTSD symptoms. Both impaired CDI and PTSD were independently associated with an increased risk of MACE during follow-up, and evidence indicated an interaction between these two factors. These findings highlight the important role of CDI in identifying individuals with PTSD at risk for MACE.

Faggot! Dyke! Experiences of Lesbian, Gay and Bisexual Physical Education Teachers and their Strategies in the Face of Homophobia.

The growing visibility of the LGBTQ community and the demand for their rights, also in the educational context, have led, among other things, to a higher focus on the experiences of teachers and the role they play when facing homophobia and promoting diversity and respect. In this sense, lesbian, gay and bisexual (LGB) teachers could experience their sexual orientation and its visibility as a problem. However, specific knowledge about these experiences is limited, also in Physical Education (PE). This study explores these experiences through data collected from 24 in-depth interviews with Primary and Secondary LGB PE teachers in Spain. The results align with the international literature, highlighting that disclosing their sexual orientation is a key aspect of participants' experience. Although teachers agree on the advantages of "coming out of the closet," LGB PE teachers define their strategies based on contextual elements such as fear of the families' reaction, the type of school, or the training received. They develop strategies such as ignoring homophobic acts, reacting against them, or using them educationally. Overall, homophobia in the educational context affects them emotionally. As a conclusion, it is essential to improve training, engage allies, and involve the entire educational community in the fight against homophobia.

Coronary sinus aneurysm and left ventricular-coronary sinus fistula. Implantation of CRT device.

We describe a 72-year-old man referred for implantation of a cardiac resynchronization therapy device who had previously undergone repeated operations to replace the mitral valve. Retrograde venography of the coronary sinus (CS) to implant the left ventricular (LV) pacing lead revealed aneurysmal dilatation of the CS with LV-CS fistula that hindered-but did not prevent-complete implantation of the system.

Novel Association of Blunt Cerebrovascular Injuries with the San Diego-Mexico Border Wall Height Extension.

BACKGROUND: The San Diego-Mexico border wall height extension is associated with increased traumatic injuries and related costs after wall falls. We report previous trends and a neurological injury type not previously associated with border falls: blunt cerebrovascular injuries (BCVIs). METHODS: In this retrospective cohort study, patients who presented to the UC San Diego Health Trauma Center for injuries from border wall falls from 2016 to 2021 were considered. Patients were included if they were admitted before (January 2016 to May 2018) or after (January 2020 to December 2021) the height extension period. Patient demographics, clinical data, and hospital stay data were compared. RESULTS: We identified 383 patients, 51 (68.6% male; mean age, 33.5 years) in the pre-height extension cohort and 332 (77.1% male; mean age, 31.5 years) in the post-height extension cohort. There were 0 and 5 BCVIs in the pre- and post-height extension groups, respectively. BCVIs were associated with increased injury severity scores (9.16 vs. 31.33; P < 0.001), longer intensive care unit lengths of stay (median, 0 days; [interquartile range (IQR), 0-3 days]; vs. median, 5 days [IQR, 2-21 days]; P = 0.022), and increased total hospital charges (median, $163,490 [IQR, $86,578-$282,036]; vs. median, $835,260 [IQR, $171,049-$1,933,996]; P = 0.048). Poisson modeling found BCVI admissions were 0.21 (95% confidence interval, 0.07-0.41; P = 0.042) per month higher after the height extension. CONCLUSIONS: We review the injuries correlating with the border wall extension and reveal an association with rare, potentially devastating BCVIs that were not seen before the border wall modifications. These BCVIs and associated morbidity shed light on the trauma increasingly found at the southern U.S. border, which could be informative for future infrastructure policy decisions.

Harassment disparities and risk profile within lesbian, gay, bisexual and transgender Spanish adult population: Comparisons by age, gender identity, sexual orientation, and perpetration context.

Lesbian, Gay, Bisexual and Transgender (LGBT) harassment disparities have become a public health issue due to discrimination and the effects on these people's health and wellbeing. The purpose was to compare harassment disparities within the Spanish adult LGBT population according to age, gender identity, sexual orientation and the context of perpetration and to describe the harassment risk profile. A sample of 1,051 LGBT adults participated in a cross-sectional study. Frequencies, percentages and Chi-square tests of independence for stablishing significant differences (p < 0.05) were calculated. The corrected standardized residuals allowed to identify the categories in which significant differences emerged. Binomial logistic regression was used to define the probability of the main LGBT groups of suffering harassment. Results show that 54.4% of the participants had experienced harassment. Young adults presented a higher prevalence than the older group. There were significant harassment differences between transgender (67.2%) and cisgender (52.7%) groups, and also between the subgroup of trans women (75.8%) and the subgroups of cis men (60.2%) and cis women (42.9%). The main disparities according to sexual orientation emerged between lesbian trans and the other LGB groups. Most harassment occurred in educational contexts and public spaces. Trans-women and trans non-binary reported a higher rate of harassment than cis LGB persons in all contexts. Trans people with different orientations (especially lesbian and gay trans) differed in harassment from LGB cis in four of the six contexts analyzed. Harassment is likely to diminish between 2 and 3% each year as LGBTs get older in educational contexts and public spaces but increases 1.07 times in the workplace. Trans women, trans non-binary, lesbian cis and trans-men were more likely to suffer harassment than bisexual cis persons. Trans women present the highest risk of harassment in three contexts (workplace, family and public spaces) and trans non-binary in the other three contexts (education, health and sport). Harassment is a serious problem for LGBT adults in Spain, especially among trans people, which differ in characteristics from those of the sexual minorities mainstream. Programs and policies targeted for improving health should therefore consider the differences that came to light in this study.

Brain dysfunctions during facial discrimination in schizophrenia: selective association to affect decoding.

Schizophrenia patients exhibit impaired facial affect perception, yet the exact nature of this impairment remains unclear. We investigated neural activity related to processing facial emotional and non-emotional information and complex images in 12 schizophrenia patients and 15 healthy controls using functional magnetic resonance imaging. All subjects performed a facial information processing task with three conditions: matching facial emotion, matching facial identity, and matching complex visual patterns. Patients and controls showed comparable behavioral performance in all task conditions. The neural activation patterns in schizophrenia patients and healthy controls were distinctly different while processing affect-related facial information but not other non-emotional facial features. During emotion matching, orbital frontal cortex and left amydala activations were found in controls but not in patients. When comparing emotion versus identity matching, controls activated the fusiform and middle temporal gyri, left superior temporal gyrus, and right inferior and middle frontal gyrus, whereas schizophrenia patients only activated the middle and inferior frontal gyri, the frontal operculi and the right insular cortex. Our findings suggest that schizophrenia patients and healthy controls may utilize different neural networks when processing facial emotional information.

Single-step assembly of gold nanoparticles into plasmonic colloidosomes at the interface of oleic acid nanodroplets.

Plasmonic gold colloidosomes (Au CSs) of sub-200 nm size are formed by the self-assembly of spherical gold nanoparticles (Au NPs) of ca. 4 nm size at the interface of oleic acid (OA) nanodroplets formed in n-hexane. Au NPs are prepared through the mild decomposition of [Au(C6F5)(tht)] (tht = tetrahydrothiophene). These Au CSs display tunable surface, size and shape-dependent collective plasmonic absorptions, leading to interesting photothermal and stimuli-responsive properties.

Digital citizens' feelings in national #Covid 19 campaigns in Spain.

BACKGROUND: In 2020 Spain launched an official campaign, #EsteVirusLoParamosUnidos, aimed at uniting the entire country through citizen cooperation, in order to combat Covid-19. The objective of this research has been to analyse how this Twitter campaign revealed the feelings expressed by Spanish citizens. METHODS: The research is based on a composite design that triangulates, from a theoretical model, a quantitative analysis and a qualitative analysis. RESULTS: Of the 7,357 tweets in the sample, 72.32% were found to be retweets. Four content families were extracted which relate to politics, education, messages to society and the defence of occupational groups. The feelings expressed ranged from those of unity, admiration and support to those of discontent and criticism of issues regarding the health situation. CONCLUSIONS: The development of networked socio-political and technical measures, which enabled citizen participation, facilitated the development of new patterns of interaction between national or regional governments and digital citizens. This increased citizens' possibilities of influencing the public agenda and, therefore, strengthening citizen engagement regarding specific situations.

Malnutrition in paediatric patients with leukaemia and lymphoma: a retrospective cohort study.

INTRODUCTION: Paediatric cancer is a potentially curable disease and its prognosis has been linked to several factors, such as nutritional status. The impact of malnutrition on these patients, either by overnutrition or undernutrition, varies and its relationship with outcomes is inconsistent. This study was conducted in order to determine the frequency of malnutrition in children with haematolymphoid malignancies at the time of diagnosis, as well as during treatment and to also investigate its relationship with the development of infections and death. MATERIALS AND METHODS: A retrospective cohort study of 191 children with a recent diagnosis of a haematolymphoid malignancy. The risks and nutritional classification were determined using anthropometry, follow-ups were conducted for up to 24 months and the presentation and frequency of infections and/or death were also recorded. Bivariate and multivariate analyses were conducted using binomial logistic regressions, for death and infection outcomes during follow-up. Survival analysis was conducted for various factors and types of cancer. RESULTS: 83.7% of children had a sufficient nutritional classification at diagnosis, 6.8% had malnutrition by undernutrition and 9.4% by overnutrition. 83.8% had at least one infectious complication during follow-up and 47.1% had ≥ 3. This percentage increased to 69.2% when configuring it in the malnutrition by undernutrition group. 18.3% of patients died. When configuring the mortality, the percentage was greater in patients with Acute Myeloid Leukaemia (AML) (57.1%) and malnutrition by undernutrition (30.7%). The multivariate analysis for the outcome of death, only showed a statistically significant variable (AML odds ratio = 26.52; confidence interval = 1.09-643.24; p = 0.04). CONCLUSION: No statistically significant relationship was found between the nutritional status of children with haematolymphoid neoplasms, and outcomes such as infections or death. The differences in the results obtained in these investigations may be related to the varied nutritional status definitions and the ways of measuring them, thus limiting comparisons between them.

Realfooders Influencers on Instagram: From Followers to Consumers.

(1) Background: Realfooders have positioned themselves in social networks such as Instagram by posting photographs of recipes, advises, habits and nutritional behaviours which are advertised as reliable nutritional patterns and by their self-promotion as highly trained people in the field of nutrition which sometimes jeopardises the health of digital citizenry. (2) Methods: In this article, we develop a quantitative study for analysing the influence of selected Realfooders on 2,866,980 followers on Instagram, taking into account channel variables (gender, location, interests and motivations), followers' variables (engagement, interaction and consumption) and some variables related to the message of 54 posts about breakfast. (3) Results: Selected Realfooders concentrate their followers in Spain, mostly women between 18 and 24 and between 35 and 44 years old who link their interests on food to the cult of the body and recreational areas. On the other hand, the content generated by Realfooders has been increasing its impact using advertising and marketing techniques for awaking consumer's interest. (4) Conclusions: Educational and social agents are facing the challenge of low health literacy in young population. Therefore, it is necessary to design and implement strategies for developing critical thinking that allow them to assess the content generated by Realfooders and identify which recommendations can be harmful or beneficial to their health.

Classification of spatially unaligned fMRI scans.

The analysis of fMRI data is challenging because they consist generally of a relatively modest signal contained in a high-dimensional space: a single scan can contain millions of voxel recordings over space and time. We present a method for classification and discrimination among fMRI that is based on modeling the scans as distance matrices, where each matrix measures the divergence of spatial network signals that fluctuate over time. We used single-subject independent components analysis (ICA), decomposing an fMRI scan into a set of statistically independent spatial networks, to extract spatial networks and time courses from each subject that have unique relationship with the other components within that subject. Mathematical properties of these relationships reveal information about the infrastructure of the brain by measuring the interaction between and strength of the components. Our technique is unique, in that it does not require spatial alignment of the scans across subjects. Instead, the classifications are made solely on the temporal activity taken by the subject's unique ICs. Multiple scans are not required and multivariate classification is implementable, and the algorithm is effectively blind to the subject-uniform underlying task paradigm. Classification accuracy of up to 90% was realized on a resting-scanned schizophrenia/normal dataset and a tasked multivariate Alzheimer's/old/young dataset. We propose that the ICs represent a plausible set of imaging basis functions consistent with network-driven theories of neural activity in which the observed signal is an aggregate of independent spatial networks having possibly dependent temporal activity.

Risk factors for pediatric cerebral sinovenous thrombosis: A case-control study with case validation.

INTRODUCTION: Cerebral sinovenous thrombosis (CSVT) represents the second most common type of venous thromboembolism (VTE) in children. Current literature includes limited evidence on risk factors for CSVT, particularly in the pediatric population. We sought to determine risk factors for CSVT in pediatric patients through a single-institutional case-control study. In addition, we evaluated thrombophilias, treatments and outcomes in CSVT among cases. METHODS: A case-control study was performed at Johns Hopkins All Children's Hospital on patients admitted from March 31, 2006 through April 1, 2018. Cases were identified using diagnostic codes and confirmed based on electronic health record (EHR) and neuroimaging review. Controls were matched in a 2:1 fashion accounting for the month and year of admission. RESULTS: A total of 60 CSVT cases and 120 controls were identified. Median (range) age was 4.8 years (0-21.3 years) for cases and 5.6 years (0-20.0 years) for controls. Factors putatively associated with CSVT in unadjusted analyses were: corticosteroid use, presence of a central venous catheter, mechanical ventilation, systemic infection, head/neck infection, head/neck trauma, and chronic inflammatory disease. In the multivariable model, head/neck infection (OR: 13.8, 95% CI: 4.87-38.7; P < 0.01), head/neck trauma (OR: 12.7, 95% CI: 2.88-56.2; P < 0.01), and mechanical ventilation (OR: 9.32, 95% CI: 2.35-36.9; P = 0.01) remained independent, statistically-significant risk factors. 61% of patients were subacutely treated with anticoagulants and of those, only two developed relevant bleeding after initiation of therapy. CONCLUSIONS: This single-institutional case-control study reveals that head/neck infection, head/neck trauma, and mechanical ventilation are independent risk factors for pediatric CSVT. These findings will be further investigated via a cooperative registry of pediatric hospital-acquired VTE, by which a risk model for pediatric CSVT will be developed and validated, in order to inform future preventive strategies in at-risk pediatric patients.

sMOOC: A pedagogical model for social inclusion.

In this article, the results of analysing the sMOOC launched by European project E-learning, Communication, Open Data (ECO) are displayed, from the perspective of social inclusion. Firstly, it considers people excluded from the system and, on a second stage, attention is brought towards those agents acting as social mediators. A quantitative methodology of analysis was applied to the interactions occurred in a sample of 1,361 participants at ECO Portal's course "Education Innovation and Professional Development. Possibilities and Limits of the ICTs". Results show that ECO has massively promoted sMOOC-based training and has become present, not only in Europe, but also in a wider geographical spread, particularly in developing countries. Such training offering has been highly valued by participants in aspects related to the knowledge acquired and them feeling active role-players in the education process, which increases their commitment towards sharing that training in diverse social environments and, as a result, makes a significant impact on social inclusion processes.

Child with small bowel obstruction and perforation secondary to ileal bezoar.

Bezoars are a rare cause of intestinal obstruction, but morbidity and mortality of late diagnosis and complication are high. Generally, bezoars remain in the region of the stomach; however, infrequently, they will pass to the small bowel. The clinical diagnosis of bezoar is challenging, and initial radiographs are frequently nondiagnostic. Early recognition of this entity on plain film or by computed tomography is important to prevent late complications. In addition, bezoar formation can indicate underlying psychiatric disorder that requires evaluation and therapy. We present a child with classic radiographic trichobezoar that had passed to the distal ileum and resulted in subsequent perforation.

Unequal coordination environment in complexes of the type [Au2Ag2(R)4(L)2]n. An immiscible solvent mixture as a key point in the control of ligand replacement.

Following an acid-base strategy, based on the reaction between gold(i) basic fragments and acid silver salts, it is possible to obtain heterometallic polymers of the general formula [Au2Ag2(R)4(L)2]n (R = C6Cl2F3; L = pyrimidine). Using this new heterometallic complex [Au2Ag2(C6Cl2F3)4(pym)2]n (1) as a starting material, and a good coordinating solvent such as acetonitrile, it is possible to modify the arrangement of the ligands connected to the silver centres and to obtain three different tetranuclear Au2Ag2 building blocks leading to the new polymer [Au6Ag6(C6Cl2F3)12(µ2-pym)2(NCMe)6]n (2). Both complexes display very intense luminescence emission. Structural, experimental and computational studies have been carried out in order to identify the origin of these properties and the factors that can affect them, such as, the presence of metallophilic interactions as well as different coordination environments for the metallic centres.

Exposure to mercury in the mine of Almaden.

OBJECTIVES: To describe the process for obtaining mercury and the historical exposure of Almadén miners to mercury. METHODS: Information on every workplace and historical data on production, technological changes in the productive process and biological and environmental values of mercury was collected. A job-exposure matrix was built with these values and the exposure to inorganic mercury was estimated quantitatively as mug/l of urine mercury. A cumulative exposure index was calculated for every worker by adding the estimates for every year in the different workplaces. RESULTS: In the mine, the highest exposures occurred during drilling, with values up to 2.26 mg/m3 in air, 2194 microg/l in urine and 374 microg/l in blood. Furnace operation and cleaning were the tasks with the highest values in metallurgy, peaking up to 3.37 mg/m3. The filling of bottles with mercury by free fall gave values within a range of 1.13-2.43 mg/m3 in air; these values dropped to 0.32-0.83 mg/m3 after introducing a new ventilation system. The toxicity effects of high doses of inorganic mercury on the central nervous and urinary systems have been known for decades. CONCLUSIONS: The exposure of the workers in Almadén mines to mercury has been very high. The extremely high content cinnabar ore of the mine explains the increased concentrations of mercury in air at the work places. This, together with inadequate working conditions, explains the high mercury levels found in blood and urine during the study period.