Physical Clues Research Articles

Field Presentation of Hyperkalemia and Cardiac Arrest

Unresponsive patients with no family or friends can be particularly challenging for EMS providers, especially if they rapidly deteriorate or arrest on scene. Although the “Hs & Ts” are taught in ACLS, hyperkalemia is an infrequent cause of cardiac arrest and can be easily overlooked in patients not on dialysis. However, recognition is crucial as the standard approach to cardiac arrest will not work and specific medications are indicated. Additionally, and in contrast to many other causes of cardiac arrest, there are specific and readily identifiable ECG changes that take place leading up to the arrest, potentially allowing time to intervene. In this case there were several visual and physical clues on patient assessment to suggest the etiology, all of which could have been easily overlooked had the patient undergone a cursory or hurried evaluation.

Superposition of Substrate Deformation Fields Induced by Molecular Clutches Explains Cell Spatial Sensing of Ligands.

Cells can sense the physical properties of the extracellular matrices (ECMs), such as stiffness and ligand density, through cell adhesions to actively regulate their behaviors. Recent studies have shown that varying ligand spacing of ECMs can influence adhesion size, cell spreading, and even stem cell differentiation, indicating that cells have the spatial sensing ability of ECM ligands. However, the mechanism of the cells' spatial sensing remains unclear. In this study, we have developed a lattice-spring motor-clutch model by integrating cell membrane deformation, the talin unfolding mechanism, and the lattice spring for substrate ligand distribution to explore how the spatial distribution of integrin ligands and substrate stiffness influence cell spreading and adhesion dynamics. By applying the Gillespie algorithm, we found that large ligand spacing reduces the superposition effect of the substrate's displacement fields generated by pulling force from motor-clutch units, increasing the effective stiffness probed by the force-sensitive receptors; this finding explains a series of previous experiments. Furthermore, using the mean-field theory, we obtain the effective stiffness sensed by bound clutches analytically; our analysis shows that the bound clutch number and ligand spacing are the two key factors that affect the superposition effects of deformation fields and, hence, the effective stiffness. Overall, our study reveals the mechanism of cells' spatial sensing, i.e., ligand spacing changes the effective stiffness sensed by cells due to the superposition effect of deformation fields, which provides a physical clue for designing and developing biological materials that effectively control cell behavior and function.

Facial Features of Hereditary Cancer Predisposition.

In the age of telehealth medicine, an individual's facial features may provide the only physical clues signaling the presence of a heritable cancer predisposition syndrome. These syndromes include APC-associated polyposis, Birt-Hogg-Dubé syndrome, CYLD cutaneous syndrome, hereditary leiomyomatosis and renal cell cancer, multiple endocrine neoplasia, neurofibromatosis type 1, Peutz-Jeghers syndrome, PTEN hamartoma tumor syndrome, and tuberous sclerosis complex 1 and 2, among others. Correctly identifying characteristic features is important for genetic and nongenetic specialists as early detection can enable prompt intervention, improving patient outcomes. Advancements in the availability of genetic testing allow patients and their relatives to have more information about their genetic risk profile than before. These changes in clinical pathways, combined with improvements in screening and risk-reducing treatment, highlight the need to outline the cutaneous and morphologic features of high-risk cancer syndromes for clinicians. In this review, we describe the important facial features of hereditary cancer predisposition, with emphasis on diagnosis, cutaneous and extracutaneous manifestations, and screening.

A STUDY OF CONSUMER BUYING TRUST ON E- COMMERCE

One of the reasons that customers do not make purchases from online merchants is because they do not trust them, which is a response that is frequently given by customers. It is more difficult to build reliability with clients in the setting of the online environment since there are no physical clues and there is no physical link between the parties involved. Therefore, it is crucial for businesses to obtain the information necessary to effectively manage the confidence that customers have in online buying. This trust is essential for businesses to maintain. In spite of this, it might be challenging for online vendors to acquire the trust of customers through the utilization of the internet. In order to acquire a more in-depth knowledge of the amount of confidence that clients have in online buying, this dissertation was created with the purpose of attaining that comprehension. The identification of major factors that lead to the growth of customer trust in online commerce was something that we were interested in. We carried out an empirical study with the purpose of evaluating how customers perceive the significance of several aspects that were chosen in order to make them feel trustworthy enough to make transactions online. The research investigation that we conducted revolved around these aspects as its foundation. The fundamental information was acquired by means of a questionnaire, and we made the decision to carry out our investigation by means of a survey as our method of inquiry. When we made our discovery, we found that there are a great many factors that contribute to the construction of trust. These factors are essential for clients to take into consideration when they are making purchases utilizing the internet. It is crucial to provide clients with a sense of security and privacy features in order to assure them that they will be able to make transactions online with complete assurance. Companies are unable to directly alter the level of trust that their customers have in them since there is no opportunity for them to do so. To accomplish this, all that is required of them is to fashion circumstances that motivate individuals to feel trusting of one another. A marketplace has the potential to be trustworthy; yet, in order for the marketplace to be trusted, the participants on the marketplace must first feel trust in order for the marketplace to be trusted. Keywords: consumer trust, e-commerce, online shopping, website security, social proof, transparency, customer service.

An Investigation of the Loop Oscillations after a Solar Flare

We study the loop oscillations after a solar flare on 19 January 2023, in the active region N11E40 3196, which is well observed by the SDO/AIA. After tracing the loop position and fitting, we find that the loop oscillations have a period between 3 and 9 min at various locations, such as from the leg to the top or from the inner to the outer loop. Their oscillating amplitudes decrease with time. Two loops display the position oscillation simultaneously with their brightness oscillation. After the analysis of the differential emission measure (DEM), we find that two of their loop position oscillations resulted from the plasma density fluctuation. Meanwhile, it is interesting that the brightness of these two position oscillations displays a typical period of about 4 min, similar to that of the position oscillation. This is possible due to both the plasma density and temperature fluctuation there. Our findings provide the physical clues for studying and understanding the mechanism of the loop position and brightness oscillations.

Dying at home for people experiencing financial hardship and deprivation: How health and social care professionals recognise and reflect on patients' circumstances.

International palliative care policy often views home as the most desirable location for end-of-life care. However, people living in more deprived areas can worry about dying in poor material circumstances and report more benefits from hospital admission at the end of life. There is increasing recognition of inequities in the experience of palliative care, particularly for people living in more deprived areas. Promoting an equity agenda in palliative care means building healthcare professionals' capacity to respond to the social determinants of health when working with patients near the end of their life. The purpose of this article is to present data which reveal how some health and social care professionals view home dying for people experiencing financial hardship and deprivation. This work was framed by social constructionist epistemology. Semi-structured qualitative interviews (n = 12) were conducted with health and social care professionals who support people at the end of life. Participants were recruited from one rural and one urban health board area in Scotland, UK. Data collection occurred between February and October 2021. Thematic analysis was used to analyse the interview data. Our findings suggest that healthcare staff relied on physical clues in the home environment to identify if people were experiencing financial hardship, found discussions around poverty challenging and lacked awareness of how inequities intersect at the end of life. Health professionals undertook 'placing' work to try and make the home environment a suitable space for dying, but some barriers were seen as insurmountable. There was recognition that increased partnership working and education could improve patient experiences. We argue further research is needed to capture the perspectives of individuals with direct lived experience of end-of-life care and financial hardship.

The Many Lives of the Getty Bayard Album

This essay looks at the J. Paul Getty Museum’s Bayard Album, a book filled with 167 photographs predominantly taken by pioneering French photographer Hippolyte Bayard (1801–87). It brings to the fore questions about Bayard’s processes, subjects, and network of British colleagues. The uncertainty surrounding the album’s compiler offers an opportunity to explore Bayard’s own role. While the album is undated, physical clues present evidence that it was one of the earliest photographic albums ever made. Thus, the compiler had to turn to non-photographic precedents for the presentation and sequencing of imagery. The various notations and twentieth-century alterations found in the Getty album reveal its mutability, raising questions about whose hands this album passed through and how the various owners changed its meaning over the course of 180 years. This study demonstrates how the album genre complicates our understanding of cultural artifacts and the artists associated with them.

Natural interface guiding cell: Directly using waste fish scales with rich micro/nano structures for control of cell behaviors

Extracellular matrix (ECM) with various micro/nano features is an important chemical and physical clue to control cell behaviors. Fish scale surface has rich structures and similar components to ECM, but there are no reports on directly using the natural surface of fish scales to guide cell behavior. Herein, natural interface of waste fish scales can be directly, simply, green, and low-costly used to regulate cell behavior. A series of characterization showed that the natural surface of fish scales is rich in micro/nano structures (groove, short ridge, fibers), contain collagen and hydroxyapatite, has suitable wettability and no cytotoxicity. These natural structures on waste fish scales have adjustable cell guidance abilities, which are consistent with the anisotropy levels of these structures (ordered fibers > grooves > damaged fibers > short ridges). Moreover, cell contact interaction with micro/nano topographies on the fish scale surface is dynamically adjustable with growth time, and also increased the chemoresistance of cancer cells to drug (irinotecan and cisplatin). Due to its advantages of wide material sources, waste recycling, patterning-free, and pretreatment-free, directly using biowastes (fish scales) not only provides a new opportunity for the development of in vitro anisotropic culture platform, but also helps to deepen the understanding and application of natural materials.

Oriented nanofibrous P(MMD-co-LA)/Deferoxamine nerve scaffold facilitates peripheral nerve regeneration by regulating macrophage phenotype and revascularization

Delayed injured nerve regeneration remains a clinical problem, partly ascribing to the lack of regulation of regenerative microenvironment, topographical cues, and blood nourishment. Functional electrospun conduits have been established as an efficacious strategy to facilitate nerve regeneration by providing structural guidance, regulating the regenerative immune microenvironment, and improving vascular regeneration. However, the synthetic polymers conventionally used to fabricate electrospinning scaffolds, such as poly(L-lactic acid), poly(glycolic acid), and poly(lactic-co-glycolic acid), can cause aseptic inflammation due to acidic degradation products. Therefore, a poly[3(S)-methyl-morpholine-2,5-dione-co-lactic] [P(MMD-co-LA)] containing alanine units with good mechanical properties and reduced acid degradation products, was obtained by melt ring-opening polymerization (ROP). Here, we aimed to explore the effect of oriented nanofiber/Deferoxamine (DFO, a hydrophilic angiogenic drug) scaffold in the rapid construction of a favorable regenerative microenvironment, including cell bridge, polarized vascular system, and immune microenvironment. In vitro studies have shown that the scaffold can sustainably release DFO, which accelerates the migration and tube formation of human umbilical vein endothelial cells (HUVECs), as well as the expression of genes related to angiogenesis. The physical clues provided by the arranged nanofibers can regulate the polarization of macrophages and reduce the expression of inflammatory factors. Furthermore, the in vivo results demonstrated a higher M2 polarization level of the oriented nanofibrous scaffold treatment group with reducedinflammation reaction in the injured nerve. Moreover, the in-situ release of DFO up-regulated the expression of HIF1-α and SDF-1α genes, as well as the expression of HIF1-α′s target gene VEGF, further promoting revascularization and enhancing nerve regeneration at the defect site. The obtained results provide essential insights on accelerating the creation of the nerve regeneration microenvironment by combining the physiological processes of nerve regeneration with topographical cues and chemical signal induction.

Topological structure of electrospun membrane regulates immune response, angiogenesis and bone regeneration

The fate of biomaterials is orchestrated by biocompatibility and bioregulation characteristics, reported to be closely related to topographical structures. For the purpose to investigate the topography of fibrous membranes on the guided bone regeneration performance, we successfully fabricated poly (lactate-co-glycolate)/fish collagen/nano-hydroxyapatite (PFCH) fibrous membranes with random, aligned and latticed topography by electrospinning. The physical, chemical and biological properties of the three topographical PFCH membranes were systematically investigated by in vitro and in vivo experiments. The subcutaneous implantation of C57BL6 mice showed an acceptable mild foreign body reaction of all three topological membranes. Interestingly, the latticed PFCH membrane exhibited superior abilities to recruit macrophage/monocyte and induce angiogenesis. We further investigated the osteogenesis of the three topographical PFCH membranes via the critical-size calvarial bone defect model of rats and mice and the results suggested that latticed PFCH membrane manifested promising performance to promote angiogenesis through upregulation of the HIF-1α signaling pathway; thereby enhancing bone regeneration. Our research illustrated that the topological structure of fibrous membranes, as one of the characteristics of biomaterials, could regulate its biological functions, and the fibrous structure of latticed topography could serve as a favorable surface design of biomaterials for bone regeneration. Statement of significanceIn material-mediated regeneration medicine, the interaction between the biomaterial and the host is key to successful tissue regeneration. The micro-and nano-structure becomes one of the most critical physical clues for designing biomaterials. In this study, we fabricated three topological electrospun membranes (Random, Aligned and Latticed) to understand how topological structural clues mediate bone tissue regeneration. Interestingly, we found that the Latticed topographical PFCH membrane promotes macrophage recruitment, angiogenesis, and osteogenesis in vivo, indicating the fibrous structure of latticed topography could serve as a favorable surface design of biomaterials for bone regeneration.

Visual Control System Based on Nociception-Analgesia Index for Patients in a Vegetative State/Unresponsive Wakefulness Syndrome and Minimally Conscious State

Considering people who are in a coma, doctors have to rely on physical clues and information provided by monitoring systems. It is commonly used for patients in a vegetative state, as contact with them is difficult. Taking into account the typical workload of the doctor, they require several tools to monitor the coma depth, since it is hard to perform a clinical evaluation hourly. Therefore, visual perception and monitoring of physical state for coma personnel proved to be more convenient for prompt decision-making. In a number of cases, it would be possible to make a prognosis for their recovery and monitor effectiveness of treatment courses. Visual control system based on RGB led strips according to the ANI range of values was created. In conclusion, the connecting scheme of ANI monitor with the implementation of visual object was presented.

Cold Weather Viruses.

1. Asif Noor, MD* 2. Theresa Fiorito, MD* 3. Leonard R. Krilov, MD*,† 1. *Department of Pediatrics, Children's Medical Center, NYU Winthrop Hospital, Mineola, NY 2. †Department of Pediatrics, State University of New York, Stony Brook School of Medicine, Stony Brook, NY * Abbreviations: AAP: : American Academy of Pediatrics Adv: : adenovirus CDC: : Centers for Disease Control and Prevention FDA: : Food and Drug Administration hMPV: : human metapneumovirus PCR: : polymerase chain reaction PIV: : parainfluenza virus RSV: : respiratory syncytial virus RV: : rhinovirus Clinicians must learn to identify viral infections in children during the winter months and must practice caution with the use of unnecessary medications in such cases. Recognition of the clinical pattern of viral infection (eg, bronchiolitis) in conjunction with judicious use of viral tests (either office-based immunoassays or newer molecular tests) may assist in epidemiological monitoring, cohorting patients in the hospital, withholding unnecessary therapies, and providing a definitive diagnosis. After completing this article, readers should be able to: 1. Review the epidemiological aspects and clinical signs and symptoms of common cold weather viruses. 2. Recognize situations in which viral testing is indicated. 3. Recognize situations in which treatment is indicated. In early November you are evaluating a 9-month-old boy born at 33 weeks of gestation. The infant presents with 2 days of fevers (101°F–102°F [38.3°C–38.8°C]), copious rhinorrhea, and 1 day of coughing with difficulty breathing. He is otherwise feeding well and has had adequate urination. His 4-year-older sister has an upper respiratory tract infection. On physical examination, the infant has a respiratory rate of 45 breaths/min without chest wall retractions. On auscultation there is good air entry with scattered rhonchi bilaterally. What is the most appropriate next step in management? 1. Obtain respiratory syncytial virus (RSV) and influenza antigen testing. 2. Obtain a chest radiograph to look for focal infiltrate. 3. Provide supportive care with nasal …

Assessment and Management of Pain in the Intensive Care Unit

Background: Management and assessment of pain in patients in critical care unit is a daily challenge for the health care professionals, particularly in the intubated patients, patients on mechanical ventilation, or patients who are on analgesia as such patients are unable to self-assess existence and intensity of pain. It is crucial for physicians to follow guidelines that help in pain assessment and management effectively. Aim of the work: Our aim in this study was to study how to evaluate and manage pain in an intensive care unit patient, predominantly those patients who are unable to self- report or assess. Materials and methods: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1994, through March 2017. The following search terms were used: pain in ICU, pain management in ICU, pain assessment methods, pain assessment in intubated patients. Conclusion: Physical clues, which are given by comatose and intubated patients in critical care unit, should be taken in consideration, as they can be used as a method to identify existence of pain, and must be followed by effective management to decrease discomfort and prevent acute and chronic adverse effects.

Assessment and Management of Pain in the Intensive Care Unit

Background: Management and assessment of pain in patients in critical care unit is a daily challenge for the health care professionals, particularly in the intubated patients, patients on mechanical ventilation, or patients who are on analgesia as such patients are unable to self-assess existence and intensity of pain. It is crucial for physicians to follow guidelines that help in pain assessment and management effectively. Aim of the work: Our aim in this study was to study how to evaluate and manage pain in an intensive care unit patient, predominantly those patients who are unable to self- report or assess. Materials and methods: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1994, through March 2017. The following search terms were used: pain in ICU, pain management in ICU, pain assessment methods, pain assessment in intubated patients. Conclusion: Physical clues, which are given by comatose and intubated patients in critical care unit, should be taken in consideration, as they can be used as a method to identify existence of pain, and must be followed by effective management to decrease discomfort and prevent acute and chronic adverse effects.

Forensic Afterlives

AbstractThe practices involved in forensic investigation center on a search for physical clues and traces that may be used to reconstruct past events. The forensic corpse is therefore involved in a materially grounded semiotics, which provides the basis for making claims about the past. Using the examples of forensic pattern matching (such as craniofacial mapping and fingerprints) and forensic entomology, I explore the different life worlds that emerge after a person’s death and how they are mobilized by forensic investigators. In this form of inquiry, claims to the real are articulated through the signs that different beings—whether human, insect, or microbe—perceive inhering in the corpse. Such forms of forensic investigation offer a productive site for thinking about the ontological status of fact and of the corpse in the context of posthumanism. Forensic signs stretch across our divided categories of the living and the dead, human and animal, nature and culture, providing alternate ways to conceptualize the relationships at play in such assemblages.

A Piece of Wooden Stick as a Crime Scene Evidence to Solve The Murder Mystery

Forensic botany is defined as the use of plant evidence in court. Forensic botany encompasses many sub-disciplines, including plant anatomy, plant ecology, plant systematic, plant molecular biology, palynology, and limnology. Although the field of forensic botany has been recognized, the use of trace plant material as physical evidence in criminal casework is still novel. Plant anatomy uses tree growth ring patterns, to aid in species identification and in performing physical matches of evidence. The physical clues left at the crime scene can assist in determining what transpired at the scene and who was (and was not) involved. The forensic clues challenge experts to analyze evidence from crime scenes.

Follow-up observations for the Asteroid Catalog using AKARI Spectroscopic Observations

Abstract In the 1–2.5 μm range, spectroscopic observations are made on the AcuA-spec asteroids, the spectra of which were obtained in a continuous covered mode between 2.5–5.0 μm by AKARI. Based on the Bus–DeMeo taxonomy (DeMeo et al. 2009, Icarus, 202, 160), all the AcuA-spec asteroids are classified, using both published and our observational data. Additionally, taking advantage of the Bus–DeMeo taxonomy characteristics, we constrain the characteristic of each spectral type by combining the taxonomy results with the other physical observational data from colorimetry, polarimetry, radar, and radiometry. As a result, it is suggested that certain C-, Cb-, B-type, dark X-, and D-complex asteroids have spectral properties compatible with those of anhydrous interplanetary dust particles with tiny bright material, such as water ice. This supports the proposal regarding the C-complex asteroids (Vernazza et al. 2015, ApJ, 806, 204; 2017, AJ, 153, 72). A combination of the Bus–DeMeo taxonomy for AcuA-spec asteroids with other physical clues, such as the polarimetric inversion angle, radar albedo, and mid-infrared spectroscopic spectra, will be beneficial for surface material constraints from the AcuA-spec asteroid observations.

Management of Pain in the Intensive Care Unit

Background: Pain assessment in ICU patients turns out to be a daily challenge for the attending teams, particularly in those patients who are intubated endotracheally; on mechanical ventilation or analgosedated as such patients are unable to self-assess existence and intensity of pain. Guidelines to identify pain in these patients are crucial for physicians for effective management. Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE, January 1994, through March 2017. The following search terms were used: pain management in ICU, pain in ICU, pain assessment by behavior, pain assessment in intubated patients. Aim: Our aim in this study was to understand how to assess and manage pain in an intensive care unit patient, particularly those patients who are unable to self-report or assess. Conclusion: Physical clues given by comatose or intubated patients in critical care unit must be used as a method to identify existence of pain, and must be managed effectively to decrease discomfort and prevent short and long term adverse effects.

Supervised learning in voice type discrimination using neck-skin vibration signals: Preliminary results on single vowels

Discrimination between normal and pathological voice is a critical component in laryngeal pathology diagnosis and vocal rehabilitative treatment. In the present study, a portable miniature glottal notch accelerometer (GNA) device with supervised machine learning techniques was proposed to discriminate between three human voice types: normal, breathy, and pressed voice. Fourteen native American English speakers who were wearing a GNA device produced five different English single vowels in each of the three voice types. Acoustic features of the GNA signals were extracted using spectral analysis. Preliminary assessments of feature discrepancy among different voice types were made to present physical clues of discrimination. The linear discriminant analysis technique was applied to reduce the dimensionality of the raw-feature vector of the GNA signals. Maximization of between-class distance and minimization of within-class distance were synchronously achieved. The voice types were then classified using several supervised learning techniques, such as Linear Discriminant, Decision Tree, Support Vector Machine, and K-Nearest Neighbors. A classification accuracy of up to 91.0% was achieved. One mapping model from voice input to type output was eventually obtained based on the training set, so as to make predictions with new data in the future work.

Hair and Nail Manifestations of Systemic Disease

The hair and nails provide valuable clues for physical diagnosis of systemic disease. This review provides an organ system-based framework to categorize hair and nail manifestations of systemic disease, and highlights recent discoveries in the pathobiology of appendageal disease. Endocrine disorders such as polycystic ovarian syndrome can present with hirsutism and female pattern hair thinning. Autoimmune thyroid disease is associated with other autoimmune disorders like atopy, alopecia areata, and vitiligo. Cytotoxic chemotherapeutic agents result in anagen or telogen effluvium and nail changes mediated by p53, while molecular-targeted therapies like EGFR inhibitors commonly cause folliculitis and paronychia. The hair and nails are appendageal structures of the skin that provide important physical diagnostic clues. Systemic diseases may affect their texture, color, shape, and growth. Physicians should be aware of certain pathognomonic findings that can trigger further diagnostic workup for systemic disease.