Nematic phases and elastoresistivity from a multiorbital non-Fermi liquid.

We propose and study a two-orbital lattice extension of the Sachdev-Ye-Kitaev model in the large-N limit. The phase diagram of this model features a high-temperature isotropic non-Fermi liquid which undergoes first-order thermal transition into a nematic insulator or continuous thermal transition into a nematic metal phase, separated by a tunable tricritical point. These phases arise from spontaneous partial orbital polarization of the multiorbital non-Fermi liquid. We explore the spectral and transport properties of this model, including d.c. elastoresistivity, which exhibits a peak near nematic transition, as well as nonzero frequency elastoconductivity. Our work offers a useful perspective on nematic phases and transport in correlated multiorbital systems.

Audit of vaccination status of health-care workers who tested positive for SARS-CoV-2.

Multiple SARS-CoV-2 vaccinations have shown excellent efficacy during clinical trials. However, post vaccine surveillance is important to confirm 'real-world' findings of vaccine efficacy and safety. It is therefore imperative to identify individuals that become infected with SARS-CoV-2 post vaccination. We investigated the vaccination status of staff that had tested positive in a cohort of healthcare workers in one large tertiary hospital in the UK. At the time of the investigation, 8th December 2020 to 13th March 2021, 11,871 staff had been vaccinated and 225 staff tested positive for SARS-CoV-2. This period coincided with the second wave of SARS-CoV-2 infections in the UK which was driven by the Alpha variant. No healthcare workers who were double vaccinated had a positive PCR test for SARS-CoV-2 during this study period confirming vaccination with Pfizer BioNTec BNT162b2 gives excellent protection against infection of this variant.

Fast camera spatial characterization of photonic polarization entanglement.

Scalable technologies to characterize the performance of quantum devices are crucial to creating large quantum networks and quantum processing units. Chief among the resources of quantum information processing is entanglement. Here we describe the full temporal and spatial characterization of polarization-entangled photons produced by Spontaneous Parametric Down Conversions using an intensified high-speed optical camera, Tpx3Cam. This novel technique allows for precise determination of Bell inequality parameters with minimal technical overhead, and for new characterization methods for the spatial distribution of entangled quantum information. The fast-optical camera could lead to multiple applications in Quantum Information Science, opening new perspectives for the scalability of quantum experiments.

The compliance and cost-effectiveness of smartphone urinalysis albumin screening for people with diabetes in England.

BACKGROUND: People with diabetes are at increased risk of developing chronic kidney disease (CKD) and should undergo annual screening, but adherence is poor. A home urinalysis self-test has been developed to improve compliance with screening. The objective of this paper is to report on a clinical evaluation and economic analysis of home urinalysis self-testing. RESEARCH DESIGN AND METHODS: People with diabetes who had not undergone screening within the previous 18 months were recruited to a single-arm clinical evaluation to assess the uptake and compliance of home urinalysis self-testing. An economic evaluation assessed the likely cost-consequences of the use of home urinalysis self-testing over a lifetime time horizon. RESULTS: A total of 2,196 people with diabetes were contacted as part of the clinical evaluation. Of these, 695 people agreed to be sent a home urinalysis self-testing kit and 499 people completed and returned the test. Cost savings of £2,008 per person were estimated over a lifetime due to increased CKD diagnosis and reduced progression to end stage renal disease. CONCLUSIONS: Home urinalysis self-testing of ACR in people with diabetes is estimated to be a cost-effective use of NHS resources in England in people who would otherwise not comply with standard care.

The Impact of a Newly Established Multidisciplinary Team on the Interventional Treatment of Patients With Emphysema.

BACKGROUND: The emphysema interventional treatment involves mainly lung volume reduction surgery (LVRS) and endobronchial valve (EBV) implantation. Few institutes discuss these cases at a dedicated emphysema multidisciplinary team (MDT) meeting. OBJECTIVES: To investigate the impact of a newly established dedicated emphysema MDT meeting on the interventional treatment of such patients. METHODS: During a study period of 4 years, the outcome of 44 patients who underwent intervention according to the proposal of the emphysema MDT (group A) was compared with the outcome of 44 propensity score matched patients (group B) treated without the emphysema MDT proposal. RESULTS: More LVRS and less EBV insertions were performed in group A (P = .009). In group B, the interventions were performed sooner than in group A (P = .003). Postoperative overall morbidity and length of in-hospital stay were similar in the 2 groups (P = .918 and .758, respectively). Improvement of breathing ability was reported in more patients from group A (P = .012). In group B, the total number of re-interventions was higher (P = .001) and the time to re-intervention had the tendency to be less (P = .069). Survival was similar between the 2 groups (P = .884). Intervention without discussion at the MDT and EBV as initial intervention was an independent predictor of re-intervention. CONCLUSIONS: Interventional treatment for patients with chronic obstructive pulmonary disease (COPD) after discussion at a dedicated MDT involved more LVRS performed, required fewer interventions for their disease, and had longer re-intervention-free intervals and better breathing improvement.

Survey of procedural and resuscitation requirements for paediatricians working in a non-tertiary centre: Implications for training.

AIM: There are minimal data to guide the continuing medical education (CME) of general paediatricians working in non-tertiary hospitals. The aim of this study was to determine the procedural and resuscitation skills required by non-tertiary paediatricians and the frequency with which these skills are utilised. METHODS: Over a 12-month period (December 2012 to December 2013), each of the 11 paediatricians involved in acute inpatient care at University Hospital Geelong (UHG) completed a weekly online survey regarding their inpatient clinical experience. This included procedures performed or directly supervised as well as their resuscitation involvement. RESULTS: Each of the 11 paediatricians who managed inpatients on a regular or semi-regular basis during the study period agreed to participate, and each completed all of the weekly surveys. There were seven UHG paediatricians with an inpatient appointment (each with a 0.27 full-time equivalent (FTE) paediatrician workload) and four paediatricians providing inpatient cover on a locum basis. Over the course of 12 months, each 0.27 FTE paediatrician was, on average, involved in 11.3 neonatal, 1.7 infant and 2.4 child resuscitations and performed 0.9 intubations. CONCLUSIONS: Paediatricians working at non-tertiary hospitals are required to perform and supervise critical procedural and resuscitation skills but have limited opportunities to maintain proficiency in such skills. General paediatric training and consultant paediatrician CME programmes should ensure the acquisition and maintenance of the procedural and resuscitation skills required for the management of seriously ill children in non-tertiary acute care settings.

Dual-balloon infusion microcatheter for selective drug-eluting bead transarterial chemoembolization: initial feasibility study.

PURPOSE: We aimed to demonstrate feasibility of the use of a dual-balloon infusion microcatheter for segmental/subsegmental drug-eluting bead transarterial chemoembolization (DEB-TACE). METHODS: Over a 16-month period, 15 segmental and 21 subsegmental DEB-TACE procedures were attempted using a dual-balloon anti-reflux microcatheter (IsoFlow™ microcatheter, Vascular Designs Inc.) in 21 patients (15 males; median age, 61 years; range, 49-82 years) with hepatocellular carcinoma (Barcelona clinic liver cancer stage A [n=4]; B [n=12]; C [n=5]) with one to three tumors, median size of 3.4 cm (1.2-9 cm). Follow-up enhanced computed tomography or magnetic resonance imaging was obtained at one month then subsequently every three months for one year. Technical success was evaluated. Modified RECIST criteria was used for target tumor response assessment. Safety was evaluated by assessing for arterial injury and hepatic injury at the time of the procedure and subsequent evidence of complications and liver toxicity. RESULTS: In 26 of the procedures, the segmental/subsegmental arteries were thought not to be easily selected with standard microcatheters due to the arterial branches being severely tortuous/angulated or atretic from prior TACE or anti-angiogenic therapy or could not be catheterized. Radiologic response assessment of treated tumors demonstrated 32% complete response, 19% partial response, 34% stable disease, and 15% progressive disease. No complications occurred. The median time to progression for the targeted tumors was 7 months (range, 3-12 months). CONCLUSION: DEB-TACE, using this dual-balloon anti-reflux infusion microcatheter is feasible and safe.

Distribution and drivers of global mangrove forest change, 1996-2010.

For the period 1996-2010, we provide the first indication of the drivers behind mangrove land cover and land use change across the (pan-)tropics using time-series Japanese Earth Resources Satellite (JERS-1) Synthetic Aperture Radar (SAR) and Advanced Land Observing Satellite (ALOS) Phased Array-type L-band SAR (PALSAR) data. Multi-temporal radar mosaics were manually interpreted for evidence of loss and gain in forest extent and its associated driver. Mangrove loss as a consequence of human activities was observed across their entire range. Between 1996-2010 12% of the 1168 1°x1° radar mosaic tiles examined contained evidence of mangrove loss, as a consequence of anthropogenic degradation, with this increasing to 38% when combined with evidence of anthropogenic activity prior to 1996. The greatest proportion of loss was observed in Southeast Asia, whereby approximately 50% of the tiles in the region contained evidence of mangrove loss, corresponding to 18.4% of the global mangrove forest tiles. Southeast Asia contained the greatest proportion (33.8%) of global mangrove forest. The primary driver of anthropogenic mangrove loss was found to be the conversion of mangrove to aquaculture/agriculture, although substantial advance of mangroves was also evident in many regions.

Brain penetrant liver X receptor (LXR) modulators based on a 2,4,5,6-tetrahydropyrrolo[3,4-c]pyrazole core.

Liver X receptor (LXR) agonists have been reported to lower brain amyloid beta (Aß) and thus to have potential for the treatment of Alzheimer's disease. Structure and property based design led to the discovery of a series of orally bioavailable, brain penetrant LXR agonists. Oral administration of compound 18 to rats resulted in significant upregulation of the expression of the LXR target gene ABCA1 in brain tissue, but no significant effect on Aß levels was detected.

Per capita increase in hospital presentations and admissions among children since the 1990s.

AIM: Data regarding temporal trends in per capita paediatric hospital presentations and admissions are required to inform health system and workforce planning. METHODS: Emergency Department (ED) presentations and admissions to the University Hospital Geelong among patients aged 0 to 16 years over a 12-month period (2012-2013) were determined by review of hospital records and then compared with similar data collected during 1996/1997.1 During each period, the Geelong region was serviced by a single ED, enabling us to estimate per capita presentation and admission rates. RESULTS: Since 1996/1997, per capita paediatric presentations to the ED increased from 643 to 1837 per 10 000 (186%; 95% confidence interval 181% to 191%). Moreover, the proportion of paediatric ED presentations resulting in hospital admission increased from 12.3% to 18.3% (49%; 95% confidence interval 39% to 59%). CONCLUSIONS: There has been a substantial absolute and per capita increase in paediatric ED presentations and hospital admissions since the 1990s. These trends place an increasing burden on the public hospital system, and strategies are required to promote paediatric acute care in the ambulatory setting.

Discovery of a Novel, Orally Efficacious Liver X Receptor (LXR) ß Agonist.

This article describes the application of Contour to the design and discovery of a novel, potent, orally efficacious liver X receptor ß (LXRß) agonist (17). Contour technology is a structure-based drug design platform that generates molecules using a context perceptive growth algorithm guided by a contact sensitive scoring function. The growth engine uses binding site perception and programmable growth capability to create drug-like molecules by assembling fragments that naturally complement hydrophilic and hydrophobic features of the protein binding site. Starting with a crystal structure of LXRß and a docked 2-(methylsulfonyl)benzyl alcohol fragment (6), Contour was used to design agonists containing a piperazine core. Compound 17 binds to LXRß with high affinity and to LXRα to a lesser extent, and induces the expression of LXR target genes in vitro and in vivo. This molecule served as a starting point for further optimization and generation of a candidate which is currently in human clinical trials for treating atopic dermatitis.

Mapping hotspots of malaria transmission from pre-existing hydrology, geology and geomorphology data in the pre-elimination context of Zanzibar, United Republic of Tanzania.

BACKGROUND: Larval source management strategies can play an important role in malaria elimination programmes, especially for tackling outdoor biting species and for eliminating parasite and vector populations when they are most vulnerable during the dry season. Effective larval source management requires tools for identifying geographic foci of vector proliferation and malaria transmission where these efforts may be concentrated. Previous studies have relied on surface topographic wetness to indicate hydrological potential for vector breeding sites, but this is unsuitable for karst (limestone) landscapes such as Zanzibar where water flow, especially in the dry season, is subterranean and not controlled by surface topography. METHODS: We examine the relationship between dry and wet season spatial patterns of diagnostic positivity rates of malaria infection amongst patients reporting to health facilities on Unguja, Zanzibar, with the physical geography of the island, including land cover, elevation, slope angle, hydrology, geology and geomorphology in order to identify transmission hot spots using Boosted Regression Trees (BRT) analysis. RESULTS: The distribution of both wet and dry season malaria infection rates can be predicted using freely available static data, such as elevation and geology. Specifically, high infection rates in the central and southeast regions of the island coincide with outcrops of hard dense limestone which cause locally elevated water tables and the location of dolines (shallow depressions plugged with fine-grained material promoting the persistence of shallow water bodies). CONCLUSIONS: This analysis provides a tractable tool for the identification of malaria hotspots which incorporates subterranean hydrology, which can be used to target larval source management strategies.

Habitat hydrology and geomorphology control the distribution of malaria vector larvae in rural Africa.

BACKGROUND: Larval source management is a promising component of integrated malaria control and elimination. This requires development of a framework to target productive locations through process-based understanding of habitat hydrology and geomorphology. METHODS: We conducted the first catchment scale study of fine resolution spatial and temporal variation in Anopheles habitat and productivity in relation to rainfall, hydrology and geomorphology for a high malaria transmission area of Tanzania. RESULTS: Monthly aggregates of rainfall, river stage and water table were not significantly related to the abundance of vector larvae. However, these metrics showed strong explanatory power to predict mosquito larval abundances after stratification by water body type, with a clear seasonal trend for each, defined on the basis of its geomorphological setting and origin. CONCLUSION: Hydrological and geomorphological processes governing the availability and productivity of Anopheles breeding habitat need to be understood at the local scale for which larval source management is implemented in order to effectively target larval source interventions. Mapping and monitoring these processes is a well-established practice providing a tractable way forward for developing important malaria management tools.

Multidisciplinary management of blunt pelvic trauma.

Pelvic fractures account for ∼3% of all fractures and usually occur in patients with polytrauma. Pelvic fractures usually indicate high energy transfer and a significant mechanism of injury, and they can involve massive hemorrhage. For this reason, mortality from pelvic trauma is high, ranging from 40% to 60% among patients in shock, and up to 90% in patients considered to be in extremis. Multidisciplinary approaches in the treatment of patients with pelvic fractures have resulted in improved outcomes for these complex and challenging injuries. In this article, we describe a case of a pediatric patient who suffered severe pelvic fracture with massive hemorrhage, requiring a multidisciplinary approach for control of hemorrhage and definitive repair of injuries.