The "Crossing Collection Sign": A Diagnostic Tool on Spine Magnetic Resonance Imaging For Localizing Cerebrospinal Fluid Leak.

OBJECTIVE: The aim of the study is to determine whether the site of "cross" between ventral and dorsal spinal longitudinal extradural CSF collections (SLECs) seen on magnetic resonance imaging during initial workup of patients with suspected CSF leaks can predict the subsequently confirmed leakage site on computed tomography myelography or surgical repair. METHODS: This was an institutional review board-approved, retrospective study performed from 2006 to 2021. Patients with SLECs who underwent total spine magnetic resonance imaging at our institution, followed by myelography and/or surgical repair for CSF leak, were included. Patients with incomplete workup including lack of computed tomography myelography and/or surgical repair and patients severely motion degraded imaging were excluded from our study. The site of cross between ventral and dorsal SLECs was defined as the "crossing collection sign" and was compared with the anatomically confirmed site of leak on myelography and/or at surgical repair. RESULTS: Thirthy-eight patients met inclusion criteria with 18 females and 11 males ranging in age from 27 to 60 years (median, 40 years; interquartile range, 14 years). The crossing collection sign was seen in 76% of patients (n = 29). The distributions of confirmed CSF leak were as follows: cervical (n = 9), thoracic (n = 17), and lumbar spine (n = 3). The crossing collection sign predicted the site of CSF leak in 14 of 29 patients (48%) and was within 3-vertebral segments in 26 of 29 cases (90%). CONCLUSIONS: The crossing collection sign can help prospectively identify spinal regions with highest likelihood for CSF leak in patients with SLECs. This can potentially help optimize the more invasive subsequent steps in the workup for these patients, including dynamic myelography and surgical exploration for repair.

Climate change research and action must look beyond 2100.

Anthropogenic activity is changing Earth's climate and ecosystems in ways that are potentially dangerous and disruptive to humans. Greenhouse gas concentrations in the atmosphere continue to rise, ensuring that these changes will be felt for centuries beyond 2100, the current benchmark for projection. Estimating the effects of past, current, and potential future emissions to only 2100 is therefore short-sighted. Critical problems for food production and climate-forced human migration are projected to arise well before 2100, raising questions regarding the habitability of some regions of the Earth after the turn of the century. To highlight the need for more distant horizon scanning, we model climate change to 2500 under a suite of emission scenarios and quantify associated projections of crop viability and heat stress. Together, our projections show global climate impacts increase significantly after 2100 without rapid mitigation. As a result, we argue that projections of climate and its effects on human well-being and associated governance and policy must be framed beyond 2100.

Mitigating the Effects of Electrode Biofouling-Induced Impedance for Improved Long-Term Electrochemical Measurements In Vivo.

Biofouling is a prevalent issue in studies that involve prolonged implantation of electrochemical probes in the brain. In long-term fast-scan cyclic voltammetry (FSCV) studies, biofouling manifests as a shift in the peak oxidative potential of the background signal that worsens over days to weeks, diminishing sensitivity and selectivity to neurotransmitters such as dopamine. Using open circuit potential (OCP) measurements, scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDX), and electrochemical impedance spectroscopy (EIS), we examined the biofouling-induced events that occur due to electrode implantation. We determined that the FSCV background signal shift results from cathodic polarization of the Ag/AgCl-wire reference electrode and increased electrochemical impedance of both the Ag/AgCl-wire reference electrode and carbon-fiber working electrode. These events are likely caused collectively by immune response-induced electrode encapsulation. A headstage utilizing a three-electrode configuration, designed to compensate for the impedance component of biofouling, reduced the FSCV background signal shift in vivo and preserved dopamine sensitivity at artificially increased impedance levels in vitro. In conjunction with a stable reference electrode, this three-electrode configuration will be critical in achieving reliable neurotransmitter detection for the duration of long-term FSCV studies.

The latitudinal diversity gradient of tetrapods across the Permo-Triassic mass extinction and recovery interval.

The decline in species richness from the equator to the poles is referred to as the latitudinal diversity gradient (LDG). Higher equatorial diversity has been recognized for over 200 years, but the consistency of this pattern in deep time remains uncertain. Examination of spatial biodiversity patterns in the past across different global climate regimes and continental configurations can reveal how LDGs have varied over Earth history and potentially differentiate between suggested causal mechanisms. The Late Permian-Middle Triassic represents an ideal time interval for study, because it is characterized by large-scale volcanic episodes, extreme greenhouse temperatures and the most severe mass extinction event in Earth history. We examined terrestrial and marine tetrapod spatial biodiversity patterns using a database of global tetrapod occurrences. Terrestrial tetrapods exhibit a bimodal richness distribution throughout the Late Permian-Middle Triassic, with peaks in the northern low latitudes and southern mid-latitudes around 20-40° N and 60° S, respectively. Marine reptile fossils are known almost exclusively from the Northern Hemisphere in the Early and Middle Triassic, with highest diversity around 20° N. Reconstructed terrestrial LDGs contrast strongly with the generally unimodal gradients of today, potentially reflecting high global temperatures and prevailing Pangaean super-monsoonal climate system during the Permo-Triassic.

Assessing Potential Oligomerization Reaction Mechanisms of Isoprene Epoxydiols on Secondary Organic Aerosol.

Extensive studies of secondary organic aerosol (SOA) formation have identified isoprene epoxydiol (IEPOX) intermediates as key species in the formation of isoprene-derived SOA. Recent work has suggested that isoprene-derived dimers and oligomers may constitute a significant fraction of SOA, but a mechanism for the formation of such abundant SOA components has yet to be established. The potential for dimer formation from the nucleophilic addition of 2-methyltetrol to trans-ß-IEPOX was assessed through a series of model epoxide-nucleophile experiments using nuclear magnetic resonance (NMR) spectroscopy. These experiments helped establish a rigorous understanding of structural, stereochemical, and NMR chemical shift trends, which were used along with nucleophilic strength calculations to interpret the results of the trans-ß-IEPOX + 2-methyltetrol reaction and evaluate its relevance in the atmosphere. A preference for less sterically hindered nucleophiles was observed in all model systems. In all addition products, a significant increase in NMR chemical shift was observed directly adjacent to the epoxide-nucleophile linkage, with smaller decreases in chemical shift at all other sites. A partial NMR assignment of a single trans-ß-IEPOX + 2-methyltetrol nucleophilic addition product was obtained, but nucleophilic strength calculations suggest that 2-methyltetrol is a poor nucleophile. Therefore,  this reaction is unlikely to significantly contribute to dimer and oligomer formation on SOA. Nevertheless, the structural and stereochemical considerations, NMR assignments, and NMR chemical shift trends reported here will prove useful in future attempts to synthesize dimer and oligomer analytical standards.

Early detection of cryostorage tank failure using a weight-based monitoring system.

PURPOSE: To study the relationship between liquid nitrogen loss and temperature in cryostorage dewars and develop an early-warning alarm for impending tank failure. METHODS: Cryostorage dewars were placed on custom-engineered scales, and weight and temperature data were continuously monitored in the setting of slow, medium, and fast rate-loss of LN2 to simulate three scenarios of tank failure. RESULTS: LN2 Tank weights and temperatures were continuously monitored and recorded, with a calculated alarm trigger set at 10% weight loss and temperature of - 185 °C. With an intact tank, a 10% loss in LN2 occurred in 4.2-4.9 days. Warming to - 185 °C occurred in 37.8-43.7 days, over 30 days after the weight-based alarm was triggered. Full evaporation of LN2 required ~ 36.8 days. For the medium rate-loss simulation, a 10% loss in LN2 occurred in 0.8 h. Warming to - 185 °C occurred in 3.7-4.8 h, approximately 3 h after the weight-based alarm was triggered. For the fast rate-loss simulation, a 10% weight loss occurred within 15 s, and tanks were depleted in under 3 min. Tank temperatures began to rise immediately and at a relatively constant rate of 43.9 °C/h and 51.6 °C/h. Temperature alarms would have sounded within 0.37 and 0.06 h after the breech. CONCLUSIONS: This study demonstrates that a weight-based alarm system can detect tank failures prior to a temperature-based system. Weight-based monitoring could serve as a redundant safety mechanism for added protection of cryopreserved reproductive tissues.

Three-phase Technetium-99m bone scanning in patients with pain in the knee region after cemented total knee arthroplasty.

INTRODUCTION: Our aim was to question the usefulness of a three-phase bone scan in the evaluation of pain in the knee region after TKR. Our hypothesis was that an abnormal investigation had a poor association with the presence of infection or loosening, and did not provide any additional diagnostic information above that already available through other standard investigations. METHODS: A retrospective study over a 24-month period was performed comprising 118 patients investigated with a TPBS. Investigations were summarised and analysed, and were classified as entirely normal, possibly abnormal, and definitely abnormal. RESULTS: Thirty-three per cent (39/118) of TPBSs were reported as being entirely normal, 59% (69/118) as possibly abnormal, and 8% (10/118) as definitely abnormal. During the 24-month study period, 131 revision TKR procedures were performed at our institution; 9% (12/131) were investigated with TPBS and 91% (119/131) were not. No patient with an entirely normal pre-operative TPBS underwent revision TKR surgery. Eighty-five per cent (67/79) with an abnormal TPBS were managed conservatively. In our series, a TPBS had a positive predictive value of 2.53%, a negative predictive value of 100%, with an overall accuracy of 34.75% with 100% sensitivity (97.5% one-sided confidence interval 0-24.71%), and 33.62% specificity (95% confidence interval 53.29-72.37%), in the diagnosis of infection, or loosening with concurrent infection in determining the indication for revision surgery. CONCLUSION: A TPBS should only be considered following clinical evaluation, serological investigation, diagnostic imaging, and microbiological analysis of fluid obtained from arthrocentesis by a specialist revision arthroplasty surgeon. A TPBS may be useful in the situation where abnormal serology is present, but where repeated joint aspirations samples are inconclusive.

Spin-Torque-Biased Magnetic Strip: Nonequilibrium Phase Diagram and Relation to Long Josephson Junctions.

Spin-torque-biased magnetic dynamics in an easy-plane ferromagnet (EPF) is theoretically studied in the presence of a weak in-plane anisotropy. While this anisotropy spoils U(1) symmetry, thereby quenching the conventional spin superfluidity, we show that the system instead realizes a close analog of a long Josephson junction (LJJ) model. The traditional magnetic-field and electric-current controls of the latter map, respectively, onto the symmetric and antisymmetric combinations of the out-of-plane spin torques applied at the ends of the magnetic strip. This suggests an alternative route towards realizations of superfluidlike transport phenomena in insulating magnetic systems. We study a spin-torque-biased phase diagram, providing an analytical solution for static multidomain phases in the EPF. We adapt an existing self-consistency method for the LJJ to develop an approximate solution for the EPF dynamics. The LJJ-EPF mapping has the potential for producing applications with superconductor-based circuit functionality at elevated temperatures. The results apply equally to antiferromagnets with suitable effective free energy in terms of the Néel order instead of in-plane magnetization.

Assessing the Potential for Oligomer Formation from the Reactions of Lactones in Secondary Organic Aerosols.

Laboratory and field measurements have demonstrated that 2-methyl glyceric acid (2-MG) is the base component of a wide range of chemical species found in methacrolein-derived secondary organic aerosol (SOA). In order to explore the recently proposed hypothesis that a lactone oxidation intermediate is the origin of 2-MG and its derivatives in SOA, nuclear magnetic resonance techniques were used to study kinetics and reaction products of the aqueous phase reactions of a model lactone, ß-propiolactone (BPL). BPL was found to react with a lifetime of 4-10 h (depending on solution conditions) via a general acid catalyzed mechanism, which suggests that lactones similar to BPL are reactive on an atmospherically relevant time scale. BPL was also shown to form a variety of nucleophilic addition products (organosulfates and nitrates and oligomers) similar to the 2-MG-based species observed in previous experiments involving the photooxidation and SOA processing of methacrolein. While many of the BPL reaction products could be rationalized via an epoxide-like nucleophilic addition mechanism, evidence for ester-like nucleophilic addition was suggested through the observation of inorganic ion-catalyzed oligomer formation. The formation of oligomers was found to depend strongly on the proportion of organic acid nucleophile present in its deprotonated form. Therefore, due to the nature of the general acid catalysis and importance of deprotonated acids for efficient BPL oligomerization, it is suggested that oligomerization from lactone intermediates will be more efficient at higher SOA pH values. This result may help explain why overall isoprene-derived SOA formation has been observed to be largely pH-independent. Overall, the results strongly support the previous conclusion that a lactone intermediate is responsible for the formation of 2-MG-related species found in methacrolein-derived SOA.

Management of symptomatic knee osteoarthritis in obesity: a survey of general practitioners' opinions and practice.

INTRODUCTION: The aim of this survey was to explore general practitioners' opinions and practices regarding the management of symptomatic knee osteoarthritis in obesity. METHODS: Questionnaires were sent electronically to members of the Royal College of General Practitioners specialty interest groups: GPs with an Interest in Nutrition Group and the Physical Activity and Life Style group. RESULTS: The response rate was 75% (142/190). The majority stated weight loss should be the first-line treatment. Half stated that community interventions were effective, and three quarters stated that bariatric surgery should be available to these patients. Two-thirds reported that their knowledge and training around obesity management was insufficient. CONCLUSION: Our survey has shown a variation in the opinions and practices amongst respondents on the management of symptomatic knee osteoarthritis in obesity. Given the projected obesity epidemic, greater training and resources are required in the community setting to enable effective management. There is support for the creation of combined ortho-bariatric services.

Management of symptomatic knee osteoarthritis in obesity: a survey of orthopaedic surgeons' opinions and practice.

INTRODUCTION: The aim of this survey was to explore knee surgeons' opinions and practices regarding the management of symptomatic knee osteoarthritis in obesity. METHODS: Questionnaires were sent electronically to all consultant members of the British Association for Surgery of the Knee. RESULTS: The response rate was 52%. The survey showed considerable practice variation and divided opinion on the evidence base. The majority stated that weight loss should be the first-line treatment. 53% (91/172) stated that such cases should ideally be assessed by a specialist multidisciplinary service; however, only 24% (41/169) would be interested in being the orthopaedic surgeon in such a service. DISCUSSION: The optimal pathway of care for the obese patient with symptomatic knee osteoarthritis remains unclear. Given recent debate around the rationing of knee arthroplasty surgery in obesity, we felt it was timely to survey knee surgeons' current practice. CONCLUSION: Our survey has shown considerable variation in the opinions and practice of surgeons on the management of symptomatic knee osteoarthritis in obesity, together with divided views on current literature.

Correction to: Management of symptomatic knee osteoarthritis in obesity: a survey of orthopaedic surgeons' opinions and practice.

The corresponding author would like to state a different e-mail address: drdanielhill@icloud.com.

Platform to Enable Combined Measurement of Dopamine and Neural Activity.

Complex behaviors depend on the coordination of the activities of ensembles of neurons and the release of neuromodulators such as dopamine. The mechanisms underlying such coordination are not well-understood due to a lack of instrumentation for combined and real-time monitoring of neuromodulator release and the activities of large ensembles of neurons. Here we describe a measurement platform that allows for the combined monitoring of electrophysiology from a high-density electrode array and dopamine dynamics from a carbon-fiber microelectrode. Integration of these two measurement systems was achieved through modification of the existing instrumentation. A shared grounded reference electrode was used in both systems to minimize electrical interference. Further, an optional solid-state-relay array positioned between the electrophysiological electrode array and amplifiers was added to provide additional electrical isolation. The capacity of the integrated measurement platform, termed DANA (Dopamine And Neural Activity), to measure action potentials (high frequency) and local-field oscillations (low frequency) was characterized in vitro using an artificial cerebral spinal fluid gelatin. In vivo recordings from the DANA platform in anesthetized rats demonstrated the ability of the system for near-simultaneous measurement of dopamine release and activity from multiple neurons both in distant brain regions (striatum and hippocampus) and within the same brain region (striatum). Furthermore, this system was shown to be sufficiently compact to measure activity in freely moving animals through recording of single-neuron activity, high-frequency local-field oscillations, and dopamine release.

Mechanical Actuation of Magnetic Domain-Wall Motion.

We theoretically study the motion of a magnetic domain wall induced by transverse elastic waves in a one-dimensional magnetic wire, which respects both rotational and translational symmetries. By invoking the conservation of the associated total angular and linear momenta, we are able to derive the torque and the force on the domain wall exerted by the waves. We then show how ferromagnetic and antiferromagnetic domain walls can be driven by circularly and linearly polarized waves, respectively. We envision that elastic waves may provide effective means to drive the dynamics of magnetic solitons in insulators.

Multibranch activity in basal and tuft dendrites during firing of layer 5 cortical neurons in vivo.

Layer 5 pyramidal neurons process information from multiple cortical layers to provide a major output of cortex. Because of technical limitations it has remained unclear how these cells integrate widespread synaptic inputs located in distantly separated basal and tuft dendrites. Here, we obtained in vivo two-photon calcium imaging recordings from the entire dendritic field of layer 5 motor cortex neurons. We demonstrate that during subthreshold activity, basal and tuft dendrites exhibit spatially localized, small-amplitude calcium transients reflecting afferent synaptic inputs. During action potential firing, calcium signals in basal dendrites are linearly related to spike activity, whereas calcium signals in the tuft occur unreliably. However, in both dendritic compartments, spike-associated calcium signals were uniformly distributed throughout all branches. Thus, our data support a model of widespread, multibranch integration with a direct impact by basal dendrites and only a partial contribution on output signaling by the tuft.

Image processing and supervised machine learning for retinal microglia characterization in senescence.

The process of senescence impairs the function of cells and can ultimately be a key factor in the development of disease. With an aging population, senescence-related diseases are increasing in prevalence. Therefore, understanding the mechanisms of cellular senescence within the central nervous system (CNS), including the retina, may yield new therapeutic pathways to slow or even prevent the development of neuro- and retinal degenerative diseases. One method of probing the changing functions of senescent retinal cells is to observe retinal microglial cells. Their morphological structure may change in response to their surrounding cellular environment. In this chapter, we show how microglial cells in the retina, which are implicated in aging and diseases of the CNS, can be identified, quantified, and classified into five distinct morphotypes using image processing and supervised machine learning algorithms. The process involves dissecting, staining, and mounting mouse retinas, before image capture via fluorescence microscopy. The resulting images can then be classified by morphotype using a support vector machine (SVM) we have recently described showing high accuracy. This SVM model uses shape metrics found to correspond with qualitative descriptions of the shape of each morphotype taken from existing literature. We encourage more objective and widespread use of methods of quantification such as this. We believe automatic delineation of the population of microglial cells in the retina, could potentially lead to their use as retinal imaging biomarkers for disease prediction in the future.

Projected future climatic forcing on the global distribution of vegetation types.

Most emissions scenarios suggest temperature and precipitation regimes will change dramatically across the globe over the next 500 years. These changes will have large impacts on the biosphere, with species forced to migrate to follow their preferred environmental conditions, therefore moving and fragmenting ecosystems. However, most projections of the impacts of climate change only reach 2100, limiting our understanding of the temporal scope of climate impacts, and potentially impeding suitable adaptive action. To address this data gap, we model future climate change every 20 years from 2000 to 2500 CE, under different CO2 emissions scenarios, using a general circulation model. We then apply a biome model to these modelled climate futures, to investigate shifts in climatic forcing on vegetation worldwide, the feasibility of the migration required to enact these modelled vegetation changes, and potential overlap with human land use based on modern-day anthromes. Under a business-as-usual scenario, up to 40% of terrestrial area is expected to be suited to a different biome by 2500. Cold-adapted biomes, particularly boreal forest and dry tundra, are predicted to experience the greatest losses of suitable area. Without mitigation, these changes could have severe consequences both for global biodiversity and the provision of ecosystem services. This article is part of the theme issue 'Ecological novelty and planetary stewardship: biodiversity dynamics in a transforming biosphere'.

Real-time polarimetric optical sensor using macroporous alumina membranes.

We report on the demonstration of real-time refractive index sensing within 60 µm thick free-standing macroporous alumina membranes with pore diameters of 200 nm. The free-standing macroporous alumina membranes allow the analytes to flow through the pores for targeted delivery, resulting in fast sensing responses. The polarimetric measurement platform exploits the optical anisotropy of the membranes in monitoring the refractive index variations of the analytes that fill the pores, providing highly sensitive and real-time measurements. The experimental characterization of the membranes' birefringence at wavelengths of 808, 980, and 1500 nm showed a decrease in birefringence for shorter wavelengths caused by the depolarization process that takes place when polarized light passes through a porous medium. Volumetric sensing experiments performed at the same wavelengths demonstrated detection limits of 8.1×10(-6), 5.2×10(-6), and 6×10(-6) refractive index units at wavelengths of 808, 980, and 1500 nm, respectively.

Fossil proxies of near-shore sea surface temperatures and seasonality from the late Neogene Antarctic shelf.

We evaluate the available palaeontological and geochemical proxy data from bivalves, bryozoans, silicoflagellates, diatoms and cetaceans for sea surface temperature (SST) regimes around the nearshore Antarctic coast during the late Neogene. These fossils can be found in a number of shallow marine sedimentary settings from three regions of the Antarctic continent, the northern Antarctic Peninsula, the Prydz Bay region and the western Ross Sea. Many of the proxies suggest maximum spring-summer SSTs that are warmer than present by up to 5 °C, which would result in reduced seasonal sea ice. The evidence suggests that the summers on the Antarctic shelf during the late Neogene experienced most of the warming, while winter SSTs were little changed from present. Feedbacks from changes in summer sea ice cover may have driven much of the late Neogene ocean warming seen in stratigraphic records. Synthesized late Neogene and earliest Quaternary Antarctic shelf proxy data are compared to the multi-model SST estimates of the Pliocene Model Intercomparison Project (PlioMIP) Experiment 2. Despite the fragmentary geographical and temporal context for the SST data, comparisons between the SST warming in each of the three regions represented in the marine palaeontological record of the Antarctic shelf and the PlioMIP climate simulations show a good concordance.

ED, email, emess!

Email has transformed communication in the National Health Service. Handling a torrent of unfocused communication is a potential burden on the clinician's time and a source of stress at work. A prospective study of the number of emails, links and attachments received during a 14-day period by four doctors of an emergency department has revealed the large number of emails received, with consultants receiving more emails than registrars. The time required to merely read this mass communication is substantial. It is suggested that time needs to be allocated to handle emails and that doctors may benefit from training on how to handle them.