Exploring pregnant individuals' counseling needs regarding urgent imaging to rule out pulmonary embolism.

Background: Computed tomography pulmonary angiogram and lung scintigraphy with ventilation/perfusion scan are needed to diagnose pulmonary embolism (PE) in pregnancy. Their associated ionizing radiation doses are considered safe in pregnancy. A standardized patient information tool may improve patient counseling and reduce testing hesitancy. Objectives: In this context, we sought to address 1) what patients want to know before undergoing these tests and 2) how they want the information to be provided to them. Methods: We used a qualitative descriptive methodology. We recruited pregnant participants at the McGill University Health Center in Montreal, Canada. Structured interviews explored information needs about PE and diagnostic imaging for PE. The interview transcripts' themes were analyzed with a hybrid deductive and inductive approach. Results: Of 21 individuals approached, 20 consented to participate. Four had been previously investigated for PE. Participants requested information about the risks associated with PE and radiation and their effects on maternal and fetal health. They preferred for radiation doses to be presented in comparison with known radiation thresholds for fetal harm. They suggested that a written tool should be developed using an accessible language. Participants also indicated that the tool would be integrated into their decision-making process, emphasizing a lower risk tolerance for their fetus than for themselves. Conclusion: This single-center group of pregnant patients wished to be informed about the risks of PE and radiation associated with imaging. A written tool could help put information into context and facilitate decision making. These new insights may be used to inform counseling.

Gross Negligence: Impacts of Microplastics and Plastic Leachates on Phytoplankton Community and Ecosystem Dynamics.

Plastic debris is an established environmental menace affecting aquatic systems globally. Recently, microplastics (MP) and plastic leachates (PL) have been detected in vital human organs, the vascular system, and in vitro animal studies positing severe health hazards. MP and PL have been found in every conceivable aquatic ecosystem─from open oceans and deep sea floors to supposedly pristine glacier lakes and snow covered mountain catchment sites. Many studies have documented the MP and PL impacts on a variety of aquatic organisms, whereby some exclusively focus on aquatic microorganisms. Yet, the specific MP and PL impacts on primary producers have not been systematically analyzed. Therefore, this review focuses on the threats posed by MP, PL, and associated chemicals on phytoplankton, their comprehensive impacts at organismal, community, and ecosystem scales, and their endogenous amelioration. Studies on MP- and PL-impacted individual phytoplankton species reveal the production of reactive oxygen species, lipid peroxidation, physical damage of thylakoids, and other physiological and metabolic changes, followed by homo- and heteroaggregations, ultimately eventuating in decreased photosynthesis and primary productivity. Likewise, analyses of the microbial community in the plastisphere show a radically different profile compared to the surrounding planktonic diversity. The plastisphere also enriches multidrug-resistant bacteria, cyanotoxins, and pollutants, accelerating microbial succession, changing the microbiome, and thus, affecting phytoplankton diversity and evolution. These impacts on cellular and community scales manifest in changed ecosystem dynamics with widespread bottom-up and top-down effects on aquatic biodiversity and food web interactions. These adverse effects─through altered nutrient cycling─have "knock-on" impacts on biogeochemical cycles and greenhouse gases. Consequently, these impacts affect provisioning and regulating ecosystem services. Our citation network analyses (CNA) further demonstrate dire effects of MP and PL on all trophic levels, thereby unsettling ecosystem stability and services. CNA points to several emerging nodes indicating combined toxicity of MP, PL, and their associated hazards on phytoplankton. Taken together, our study shows that ecotoxicity of plastic particles and their leachates have placed primary producers and some aquatic ecosystems in peril.

Algal biopolymers as sustainable resources for a net-zero carbon bioeconomy.

The era for eco-friendly polymers was ushered by the marine plastic menace and with the discovery of emerging pollutants such as micro-, nano-plastics, and plastic leachates from fossil fuel-based polymers. This review investigates algae-derived natural, carbon neutral polysaccharides and polyesters, their structure, biosynthetic mechanisms, biopolymers and biocomposites production process, followed by biodegradability of the polymers. The review proposes acceleration of research in this promising area to address the need for eco-friendly polymers and to increase the cost-effectiveness of algal biorefineries by coupling biofuel, high-value products, and biopolymer production using waste and wastewater-grown algal biomass. Such a strategy improves overall sustainability by lowering costs and carbon emissions in algal biorefineries, eventually contributing towards the much touted circular, net-zero carbon future economies. Finally, this review analyses the evolution of citation networks, which in turn highlight the emergence of a new frontier of sustainable polymers from algae.

A New In-Skates Balance Error Scoring System for Ice Hockey Players.

OBJECTIVE: Evaluate a new in-skates balance error scoring system (SBESS) for ice hockey players wearing their equipment. DESIGN: Prospective, randomized, single blinded study. SETTING: Sport Medicine Clinic. PARTICIPANTS: Eighty university hockey players. INTERVENTION: A control group performed the SBESS assessment at rest on 2 separate occasions and an experimental group performed the assessment at rest and after exertion. The SBESS consists of maintaining different stances on ice skates for 20 seconds each, while wearing full equipment (no stick, gloves and helmet) and standing on a hard rubber surface. Three independent reviewers scored the video recorded assessments. MAIN OUTCOMES MEASURES: Primary outcome was the number of balance errors and the secondary outcome was the number of falls. RESULTS: The control group's median SBESS scores were 2 and 3 on the first and second attempts at rest, respectively. The experimental group's median SBESS scores were 2 at rest and 2 after exertion. There was no fatigue effect and no athletes fell while performing the test. Of the 4 stances tested, the tandem stance had the highest variability in error scores between athletes and when repeated by the same athlete. The intraclass correlation coefficient (ICC) for interrater reliability was above 0.82, and the intrarater reliability ICC was above 0.86 for all SBESS scores. There was no concordance between the SBESS and the modified BESS. CONCLUSIONS: The SBESS, omitting the tandem stance, is a safe and reproducible sideline balance assessment of ice hockey players wearing full equipment.

Investigation of biodegradation potentials of high density polyethylene degrading marine bacteria isolated from the coastal regions of Tamil Nadu, India.

Plastics constitute an important part of our life for many decades. All the wastes produced from human activities finally enters into the aquatic ecosystem. Microbial degradation of plastic is a promising eco-friendly strategy which represents a great opportunity to manage waste plastic materials with minimum adverse impacts. In this present study, totally 248 bacterial isolates were isolated from the plastic waste dumped sites in the coastal region districts of Tamil Nadu, India and screened for HDPE degradation. Based on the results obtained from the weight loss, viability and FT-IR, 10 bacterial isolates were considered to be potent HDPE degraders. The identification of efficient HDPE degrading isolates confirms that most of the bacterial isolates belong to the genus Bacillus spp. and Pseudomonas spp. The present study suggests that the isolated efficient bacterial strains can be used as cost-effective, eco-friendly and safe approach for the elimination of plastic wastes from the environment.

Icatibant Compared to Steroids and Antihistamines for ACE-Inhibitor-Induced Angioedema.

Article chosen Bas M, Greve J, Stelter K, et al. A Randomized Trial of Icatibant in ACE-Inhibitor-Induced Angioedema. N Engl J Med 2015;372:418-25. doi:10.1056/NEJMoa1312524.

Epidural Hematoma Treated Conservatively: When to Expect the Worst.

BACKGROUND: The Brain Trauma Foundation's 2006 surgical guidelines have objectively defined the epidural hematoma (EDH) patients who can be treated conservatively. Since then, the literature has not provided adequate clues to identify patients who are at higher risk for EDH progression (EDHP) and conversion to surgical therapy. The goal of our study was to identify those patients. METHODS: We carried a retrospective review over a 5-year period of all EDH who were initially triaged for conservative management. Demographic data, injury severity and history, neurological status, use of anticoagulants or anti-platelets, radiological parameters, conversion to surgery and its timing, and Glasgow Outcome Scale were analyzed. Bivariate association and further logistic regression were used to point out the significant predictors of EDHP and conversion to surgery. RESULTS: 125 patients (75% of all EDH) were included. The mean age was 39.1 years. The brain injury was mild in 62.4% of our sample and severe in 14.4%. Only 11.2% of the patients required surgery. Statistical comparison showed that younger age (p< 0.0001) and coagulopathy (p=0.009) were the only significant factors for conversion to surgery. There was no difference in outcomes between patients who had EDHP and those who did not. CONCLUSIONS: Most traumatic EDH are not surgical at presentation. The rate of conversion to surgery is low. Significant predictors of EDHP are coagulopathy and younger age. These patients need closer observation because of a higher risk of EDHP. Outcome of surgical conversion was similar to successful conservative management.

Biodegradation of HDPE by Aspergillus spp. from marine ecosystem of Gulf of Mannar, India.

High density polyethylene (HDPE) is the most commonly found non-degradable solid waste among the polyethylene. In this present study, HDPE degrading various fungal strains were isolated from the polyethylene waste dumped marine coastal area and screened under in vitro condition. Based on weight loss and FT-IR Spectrophotometric analysis, two fungal strains designated as VRKPT1 and VRKPT2 were found to be efficient in HDPE degradation. Through the sequence analysis of ITS region homology, the isolated fungi were identified as Aspergillus tubingensis VRKPT1 and Aspergillus flavus VRKPT2. The biofilm formation observed under epifluorescent microscope had shown the viability of fungal strains even after one month of incubation. The biodegradation of HDPE film nature was further investigated through SEM analysis. HDPE poses severe environmental threats and hence the ability of fungal isolates was proved to utilize virgin polyethylene as the carbon source without any pre-treatment and pro-oxidant additives.