Valley formation aridifies East Africa and elevates Congo Basin rainfall.

East African aridification during the past 8 million years is frequently invoked as a driver of large-scale shifts in vegetation1 and the evolution of new animal lineages, including hominins2-4. However, evidence for increasing aridity is debated5 and, crucially, the mechanisms leading to dry conditions are unclear6. Here, numerical model experiments show that valleys punctuating the 6,000-km-long East African Rift System (EARS) are central to the development of dry conditions in East Africa. These valleys, including the Turkana Basin in Kenya, cause East Africa to dry by channelling water vapour towards Central Africa, a process that simultaneously enhances rainfall in the Congo Basin rainforest. Without the valleys, the uplift of the rift system leads to a wetter climate in East Africa and a drier climate in the Congo Basin. Results from climate model experiments demonstrate that the detailed tectonic development of Africa has shaped the rainfall distribution, with profound implications for the evolution of African plant and animal lineages.

A Review of Petrol Burns in Australia and New Zealand.

Petrol-related thermal burns cause significant morbidity and mortality worldwide and it has been established that they affect young males disproportionately. Beyond this, we sought to identify the difference in the characteristics and outcomes of burns between males and females in an international population. Such differences may highlight areas for future preventative strategies. The Burns Registry of Australia and New Zealand was used. Petrol burns that resulted in a hospital admission in those 16 years or older between January 2010 and December 2019 were included. A total of 2833 patients were included. The median age was 35 years with most patients being male (88%). Burns from a campfire or burnoffs were most common. Females were more likely to suffer burns due to assault or from deliberate self-harm. The total body surface area affected by burns was higher for females than males (10% vs 8%). Furthermore, females more frequently required ICU admission, escharotomies, and had a longer hospital length of stay. The unadjusted mortality rate for females was more than double the rate for males (5.8% vs 2.3%). This international study demonstrates that whilst men more frequently suffer petrol burns, women suffer more severe burns, require more intensive and longer hospitalizations and have a higher mortality rate. These findings may inform changes in preventative health policies globally to mitigate against these concerning findings.

Vascular surgery patients in intensive care: a bi-national cohort study over 15 years.

BACKGROUND: To describe the characteristics and outcomes of patients admitted to Intensive Care following vascular surgery, and their subsequent usage of Intensive Care resources, over a 15-year period in Australia and New Zealand. METHODS: This was a retrospective, bi-national study of 69 676 adult patients admitted to 179 Intensive Care Unit (ICUs) following vascular surgery between January 2005 and December 2019, using the Australian and New Zealand Intensive Care Society Adult Patient Database. RESULTS: The proportion of ICU bed days used by vascular surgery patients decreased during the study period from 3.6% in 2005 to 2.9% in 2019 (P < 0.001). The cohort had a median age of 73 years, and were most frequently admitted after a carotid endarterectomy (22%) or elective open aneurysm repair (20%). A total of 5.2% of patients did not survive to discharge. Mean annual adjusted mortality decreased during the study period from 6.1% in 2005 to 3.7% in 2019 (P < 0.001). Multiple factors were associated with higher mortality, including gender, hospital case volume and hospital type. CONCLUSIONS: Between 2005 and 2019 survival for vascular surgery patients requiring ICU admission in Australia and New Zealand improved. During the same time the proportion of ICU bed days used by these patients decreased.

A systematic review of systematic review methodology in plastic surgery journals.

INTRODUCTION: Systematic reviews (SR) and meta-analyses (MA) are described as the top level of evidence in clinical research and are commonplace in plastic surgery literature. Their quality is limited both by the reliability of primary studies and the method of aggregating data. This study analysed the overall quality of SR's in plastic surgery and identified influencing factors. MATERIALS AND METHODS: The paper critically appraised SR's published in three prominent plastic surgery journals between July 2019 and July 2020. Study selection and appraisal was performed in duplicate. Articles were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR). RESULTS: Seventy-six studies were included. 52 (68%) were SR's only and 24 (32%) included meta-analysis (MA) as well. The most common subspecialty areas included breast, craniofacial and hand. 78% of studies followed the PRISMA guidelines. The median (min, max) AMSTAR score was 3.5 (0-7). SR's with MA had significantly higher AMSTAR scores (p<0.001) than SR's alone, with median scores of 5 and 3 respectively. Papers from China had significantly higher AMSTAR scores than the USA. Craniofacial SR's had significantly higher scores than all other subspecialty areas. Most SR's reviewed concluded that there is currently inadequate primary research to make a conclusion and recommended more research be carried out in that area. CONCLUSIONS: This systematicreview found overall that the quality of research methodology in Plastic Surgery SRs is low, and their conclusions of limited value. Surgeons should be familiar with SR and MA methodology, so they can exercise better judgement in applying findings to clinical practice.

Tropical cyclone simulations over Bangladesh at convection permitting 4.4 km & 1.5 km resolution.

High resolution simulations at 4.4 km and 1.5 km resolution have been performed for 12 historical tropical cyclones impacting Bangladesh. We use the European Centre for Medium-Range Weather Forecasting 5th generation Re-Analysis (ERA5) to provide a 9-member ensemble of initial and boundary conditions for the regional configuration of the Met Office Unified Model. The simulations are compared to the original ERA5 data and the International Best Track Archive for Climate Stewardship (IBTrACS) tropical cyclone database for wind speed, gust speed and mean sea-level pressure. The 4.4 km simulations show a typical increase in peak gust speed of 41 to 118 knots relative to ERA5, and a deepening of minimum mean sea-level pressure of up to -27 hPa, relative to ERA5 and IBTrACS data. The downscaled simulations compare more favourably with IBTrACS data than the ERA5 data suggesting tropical cyclone hazards in the ERA5 deterministic output may be underestimated. The dataset is freely available from https://doi.org/10.5281/zenodo.3600201 .

Effects of COVID-19 lockdown measures on emergency plastic and reconstructive surgery presentations.

BACKGROUND: In Australia, the COVID-19 pandemic has caused severe social disruptions, including restrictions to the movement of people. Healthcare centres around the world have seen changes in the nature of injuries acquired during the COVID-19 pandemic; we therefore hypothesize that social isolation measures have changed the pattern of plastic and reconstructive surgery presentations. METHODS: A prospective cohort study was designed comparing patient presentations during the enforced COVID-19 lockdown to two previous periods. All emergency referrals requiring operative intervention by the plastic and reconstructive surgery unit of our institution were included. Patient demographics, place and mechanism of injury, drug and alcohol involvement, delays to presentation, length of admission and complication rates were collected. RESULTS: Demographics and complication rates were similar across all groups. A 31.8% reduction in total number of emergency cases was seen during the lockdown period. Increase in do-it-yourself injuries (P = 0.001), bicycle injuries (P = 0.001) and injuries acquired via substance abuse (P = 0.041) was observed. Head and neck injuries, mostly due to animal bites and falls, were also more prevalent compared to the same period the previous year (P = 0.007). As expected, over 80% of plastic surgery operations during the COVID-19 period were due to injuries acquired at home, a significant increase compared to previous periods. CONCLUSION: Despite changes in the pattern of presentations requiring plastic and reconstructive emergency surgery, traumatic injuries continued to occur during the pandemic. Thus, planning will be essential to ensure resource allocation for emergency procedures is sustained as second and third waves of COVID-19 cases emerge worldwide.

A 3-Dimensional Quantitative Analysis of Volume Loss Following Submental Cryolipolysis.

BACKGROUND: Cryolipolysis is a proven and effective means of fat reduction; however, there are no standardized means of measuring volume reduction. OBJECTIVES: We aim to assess the volume loss using a 3-dimensional (3D) analysis following submental cryolipolysis. METHODS: A retrospective cohort study between April 2016 and August 2018 was performed. Thirty-five patients underwent a single 45-minute cycle of cryolipolysis to the submental region using the CoolSculpting System. A 3-fold analysis was performed employing an independent observer assessment of 2-dimensional photographs and 3D volumetric analysis utilizing the Vectra XT system, and patient satisfaction was measured with the FACE-Q questionnaire. RESULTS: Our results suggested the mean (standard deviation) pretreatment volume (n = 35) was 104.12 cm3 (28.78). The 6-week mean posttreatment volume (n = 26) was 81.55 cm3 (21.29). The mean volume reduction found at 6 weeks posttreatment showed a reduction of 22.46 cm3 (19.10) (95% CI 14.74 to 30.17, P < 0.0001). The 12-week mean posttreatment volume (n = 24) was 82.24 cm3 (23.97). The 12-week posttreatment demonstrated a reduction of 22.30 cm3 (14.04) (95% CI 16.37 to 28.23, P < 0.0001). The mean percentage correct for each reviewer correctly identifying the pretreatment and posttreatment photograph was 76.33% (7.14). Patient satisfaction showed a mean FACE-Q score of 54.10 (20.41). CONCLUSIONS: The study further affirms that submental cryolipolysis is an efficacious and safe, noninvasive method for reducing submental adiposity resulting in notable patient satisfaction rates. Furthermore, results suggest that patients can have a volume loss of about 20% on average, allowing them to be more confident and comfortable with their appearance.

Lesson of the month 1: Neurosyphilis mimicking viral encephalitis and ischaemic stroke.

With the incidence of syphilis more than doubling over the last decade, knowledge of its manifestations is of increasing importance. Yet, today's clinicians are less experienced in the recognition of syphilis than the physicians of Osler's day.In this case, a 56-year-old man presented with acute confusion and a history suggestive of encephalitis. Neuroimaging revealed cystic infarcts. He was subsequently tested for HIV and syphilis and found to be positive for both. HIV co-infection had accelerated the rate of neurosyphilis progression. After timely diagnosis and treatment of both conditions, cognitive testing returned to baseline.This case highlights that neuroimaging can often show non-specific infarcts and haemorrhages instead of characteristic syphilitic gummae. This variability adds to the challenge of diagnosis. Thus syphilis serology screening should be sent in those presenting with acute confusion and neuroimaging abnormalities. In cases of cryptogenic stroke, syphilis serology should be added to the screening tests.

Study on Lithium Monitoring amongst Patients in a Community Mental Health and Primary Care Setting in Rural England.

BACKGROUND: Lithium is widely used as a mood stabilizer in managing Bipolar Disorder. It is also licensed as an augmenting agent for recurrent depression and treatment resistant depression. However, it has a narrow therapeutic index with potentially significant side effects and adverse drug interactions. Toxicity is one of the main concerns for prescribers and serum levels should be checked regularly. Also, due to the adverse effects on Kidneys and Thyroid, there are strict guidelines to monitor the kidney as well as thyroid functions periodically. Whilst the need to monitor blood biochemistry is well established, less well recognized is the need to monitor patients' physical health by means of annual checks of Body Mass Index (BMI) and waist circumference. AIM: The purpose of this study was to investigate compliance against the NICE CG185 guidelines. Hereford is a rural town in England with a population of about 180000. Currently, the Herefordshire part of 2gether Mental Health NHS Foundation Trust does not have clearly agreed shared care protocols for Lithium monitoring. Lithium monitoring is done by GPs as part of QOF targets. As Psychiatrists recommend treatment with lithium, they have the responsibility to have an updated results and act on these appropriately. Therefore, an important aspect of this audit was to identify monitoring gaps that may result from the dual ownership of patient care. RESULTS: We found that 80% of cases complied with NICE guidance as regards blood monitoring however, only 40% of cases were compliant as regards checks on the physical health parameters of BMI and weight. CONCLUSION: The blood biochemistry of patients on lithium is generally well monitored however, physical health assessment is rarely completed with the required annual frequency and, waist circumference is almost never measured; either on initiation of lithium therapy or, on an on-going basis. More needs to be done to promote awareness of the need to monitor the physical health of patients on lithium and, in particular, to ensure that these checks include measurement of waist circumference. We believe that to improve monitoring of patients on lithium, shared care protocols should be developed between mental health services and GP services.

Synthesis and Luminescence Properties of Transparent Nanocrystalline GdF3:Tb Glass-Ceramic Scintillator.

Transparent glass-ceramic containing rare-earth doped halide nanocrystals exhibits enhanced luminescence performance. In this study, a glass-ceramic with Tb doped gadolinium fluoride nanocrystals embedded in an aluminosilicate glass matrix is investigated for X-ray imaging applications. The nanocrystalline glass-ceramic scintillator was prepared by a melt-quench method followed by an anneal. The GdF3:Tb nanocrystals precipitated within the oxide glass matrix during the processing and their luminescence and scintillation properties were investigated. In this nanocomposite scintillator system, the incorporation of high atomic number Gd compound into the glass matrix increases the X-ray stopping power of the glass scintillator, and effective energy transfer between Gd3+ and Tb3+ ions in the nanocrystals enhances the scintillation efficiency.