Subsequent Interruption Research Articles

Engendering Care in the Politics of the East Bengali Refugee Identity: A Reading of Bengal Partition Narratives Through the Lens of Ecological and Culinary Citizenship

The ‘politics of care’ has become an essential dialectical discourse within the field of ecofeminism with the intervention of theorist Sherilyn Macgregor. The engendering of care has politicized the figure and the status of the woman within and beyond the domestic space. Further, this discourse has gone beyond the cultural domain of domesticity to realign itself with the understanding of care work in the light of ecological citizenship. In the light of this my paper proposes to revisit South Asian partition historiography to look at the figure of the refugee. I wish to look at the Bengal Partition of 1947 and discern how the East Bengali refugee maneuvers their identity vis-à-vis their claim of ecological and culinary citizenship. Sunanda Sikdar’s novel A Life Long Ago, translated by Anchita Ghatak for Penguin and the recipient of the Ananda Puraskar 2010 award, is a memoir that reproduces the anxieties that are part of the division of Bengal and the subsequent interruption, creation, preservation of the notion of citizenship and the instituting and the drawing of the national border that separates India from Bangladesh, erstwhile East Pakistan. Meanwhile, the anthology edited by Bashabi Fraser, Bengal Partition Stories: An Unclosed Chapter, contains multiple stories that problematize the notion of national borders specifically by challenging these political lines vis-à-vis the culinary code. Through selective stories from the anthology mentioned and Sikdar’s memoir, the paper seeks to address the issue of citizenship and national borders through the realm of the kitchen, food consumption and domesticity and how the gastronomic experience is informed by the ecofeminist rhetoric of the ‘politics of care’. I would also look at Bhaswati Gosh’s debut novel Victory Colony 1950, and Madhushree Ghosh’s culinary memoir Khabaar: An Immigrant Journey of Food, Memory, and Family, which threaten and dismantle the gender binaries embedded within the discourse of care politics.

Direct current arc quenching performance of a model electric fuse equipped with SiO2 sand and additive silicone resin as an arc quenching medium: the effect of a vaporized silicone decomposition mixture on transient arc resistance

Most high-power electric fuses installed in DC distributions of automobiles employ silica sand (chemical formula SiO2) as arc quenching material to implement the limitation and subsequent interruption of high direct currents. This paper on arc quenching material describes the effects of the addition of silicone resin (chemical formula C2H6SiO) on SiO2 sand, based on the resistance of an arc discharge in SiO2 vapor mixed with silicone resin vapor. The measurement results obtained for the fuse operation of a model electric fuse show that the addition of silicone resin, e.g. an even coating of silicone resin on the surface of a Cu fuse element, attains a shorter arc quenching time. This phenomenon is subsequently explained based on the rise effect of an arc column resistance achieved by mixing with silicone vapor decomposition. The chemical compositions of high-temperature SiO2 vapor mixed with C2H6SiO vapor decomposition are evaluated to show the predominant chemical species at 30 000 K–5000 K for several C2H6SiO vapor concentrations, . The results obtained for of 10%–50% reveal that a H atom originating from C2H6SiO is present at high molar fractions above 0.1 over a wide temperature range of 12 000 K–5000 K. Further evaluations of the electrical resistivity for the high-temperature vapor show that mixing with C2H6SiO vapor contributes to a rise in at temperatures of 10 000 K–6000 K. A contribution analysis of the reveals that the rise effect of the is accomplished chiefly by the presence of a H atom that has dissociated from C2H6SiO.

Increased influenza severity in children in the wake of SARS-CoV-2.

The SARS-CoV-2 pandemic and subsequent interruption of influenza circulation has lowered population immunity to influenza, especially among children with few prepandemic exposures. Using data from a prospective pediatric cohort study based in Managua, Nicaragua, we compared the incidence and severity of influenza A/H3N2 and influenza B/Victoria between 2022 and two prepandemic seasons. We found a higher incidence of A/H3N2 in older children in 2022 compared with pre-2020 and a higher proportion of severe influenza in 2022, primarily among children aged 0-4, suggesting an influence of the SARS-CoV-2 pandemic on influenza incidence and severity in children.

A comprehensive analysis of the hub genes for oxidative stress in ischemic stroke.

Ischemic stroke (IS), resulting from the occlusion of the cerebral artery and subsequent interruption of blood flow, represents a major and critical threat to public health. Oxidative stress (OS) has been confirmed to play a role in the IS pathological process and neural death. Understanding the essential role of OS-related genes in ischemic stroke is critical to understanding the current perception of the pathophysiological process in IS. Herein, by integrating three IS datasets (GSE16561, GSE22255, and GSE58294), we divided IS samples into the low- and high-OS groups by calculating the OS score identified by the oxidative stress gene set. The functional enrichment analysis of differentially expressed genes (DEGs) between the low- and high-OS groups indicated that DEGs were associated with hypoxia, the inflammatory response, and oxidative phosphorylation pathways. Furthermore, nine hub genes (namely TLR1, CXCL1, MMP9, TLR4, IL1R2, EGR1, FOS, CXCL10, and DUSP1) were identified through the Girvan-Newman algorithm and cytoHubba algorithms. Nine hub genes were highly expressed in IS samples and positively related to neutrophils and macrophages. Drug-sensitive analysis targeting hub genes defined allopurinol and nickel sulfate as potential candidates for impairing the neural death caused by oxidative stress in IS. Finally, we employed five machine learning methods to check the efficacy of the predictive model identified by nine hub genes. The results showed that our model had superior power for predicting the OS activity of IS patients. TLR4 was found to have excellent diagnostic value and a wide-spectrum interaction with other hub genes. Our research emphasized the impact of oxidative stress on ischemic stroke, which supports the idea that antioxidants hold great promise in ischemic stroke therapy.

1620P Return to work trajectories after early breast cancer diagnosis: A population-based cohort study in the French National Healthcare Insurance database

Return to work (RtW) is important for quality of life after breast cancer (BC), and a difficult challenge for many patients (pts). Current evidence relies mainly on selected populations and limited indicators. We aimed to construct RtW indicators based on sickness leave (SL) and disability pension (DP) benefits, and to explore RtW trajectories. We conducted a retrospective cohort study using data from a random sample of 1/97th beneficiaries of the French National Health System. All women aged 25-55 years with a first early BC diagnosis between 2013 and 2016 were included and followed-up for 3 years. We constructed RtW indicators based on literature review, data availability and stakeholders’ expertise in the national context. Descriptive analyses were performed on sample characteristics and RtW indicators. Longitudinal RtW trajectories were explored using sequence analysis and clustered using optimal matching. Data from 306 pts (56% HR+/HER2-, 24% triple-negative, 14% HER2+, 6% in situ) were extracted. (Neo)adjuvant chemotherapy, trastuzumab and endocrine therapy were administered in 59%, 14% and 66% of pts, respectively. Median time with compensation until full and sustainable (> 28 days) RtW was 242 days. Median cumulative lengths of all-type and full-time sickness absence during follow-up were 450 days and 313 days, respectively. Full-time or partial RtW was achieved by 57% of pts at 1-year, 82% at 2-year and 85% at 3-year after diagnosis. Three RtW trajectories were identified: “RtW within a year” (48% of the population) with pts experiencing RtW during the 1st year and limited subsequent work interruption, “RtW supported by partial SL or DP” (38%) with pts typically returning to work during the 2nd year after a partial SL period or with a partial DP, and “continued compensation” (14%) with pts receiving either complete SL benefit or DP at 3-year. Identification of RtW trajectories based on French medico-administrative databases seems feasible. It revealed large individual variability and identified three distinct groups of RtW trajectories. Further exploration of trajectory determinants and lived experience is needed to develop targeted RtW interventions.

Continuous assessment of ventricular fibrillation prognostic status during CPR: Implications for resuscitation

BackgroundVentricular fibrillation (VF) waveform measures reflect myocardial physiologic status. Continuous assessment of VF prognosis using such measures could guide resuscitation, but has not been possible due to CPR artifact in the ECG. A recently-validated VF measure (termed VitalityScore), which estimates the probability (0–100%) of return-of-rhythm (ROR) after shock, can assess VF during CPR, suggesting potential for continuous application during resuscitation. ObjectiveWe evaluated VF using VitalityScore to characterize VF prognostic status continuously during resuscitation. MethodsWe characterized VF using VitalityScore during 60 seconds of CPR and 10 seconds of subsequent pre-shock CPR interruption in patients with out-of-hospital VF arrest. VitalityScore utility was quantified using area under the receiver operating characteristic curve (AUC). VitalityScore trends over time were estimated using mixed-effects models, and associations between trends and ROR were evaluated using logistic models. A sensitivity analysis characterized VF during protracted (100-second) periods of CPR. ResultsWe evaluated 724 VF episodes among 434 patients. After an initial decline from 0–8 seconds following VF onset, VitalityScore increased slightly during CPR from 8–60 seconds (slope: 0.18%/min). During the first 10 seconds of subsequent pre-shock CPR interruption, VitalityScore declined (slope: −14%/min). VitalityScore predicted ROR throughout CPR with AUCs 0.73–0.75. Individual VitalityScore trends during 8–60 seconds of CPR were marginally associated with subsequent ROR (adjusted odds ratio for interquartile slope change (OR) = 1.10, p = 0.21), and became significant with protracted (100 seconds) CPR duration (OR = 1.28, p = 0.006). ConclusionVF prognostic status can be continuously evaluated during resuscitation, a development that could translate to patient-specific resuscitation strategies.

Testing and isolation to prevent overloaded healthcare facilities and reduce death rates in the SARS-CoV-2 pandemic in Italy

BackgroundDuring the first wave of COVID-19, hospital and intensive care unit beds got overwhelmed in Italy leading to an increased death burden. Based on data from Italian regions, we disentangled the impact of various factors contributing to the bottleneck situation of healthcare facilities, not well addressed in classical SEIR-like models. A particular emphasis was set on the undetected fraction (dark figure), on the dynamically changing hospital capacity, and on different testing, contact tracing, quarantine strategies.MethodsWe first estimated the dark figure for different Italian regions. Using parameter estimates from literature and, alternatively, with parameters derived from a fit to the initial phase of COVID-19 spread, the model was optimized to fit data (infected, hospitalized, ICU, dead) published by the Italian Civil Protection.ResultsWe show that testing influenced the infection dynamics by isolation of newly detected cases and subsequent interruption of infection chains. The time-varying reproduction number (Rt) in high testing regions decreased to <1 earlier compared to the low testing regions. While an early test and isolate (TI) scenario resulted in up to ~31% peak reduction of hospital occupancy, the late TI scenario resulted in an overwhelmed healthcare system.ConclusionsAn early TI strategy would have decreased the overall hospital usage drastically and, hence, death toll (∼34% reduction in Lombardia) and could have mitigated the lack of healthcare facilities in the course of the pandemic, but it would not have kept the hospitalization amount within the pre-pandemic hospital limit.

Automatic Control System for Monitoring Collision, Breakage and Wear of CNC Lathe Tools

Reliable and efficient operation of CNC lathes is possible only if they are equipped with technical diagnostic tools and automatic control systems are created on their basis. At the same time, the purpose of automatic diagnostics of the CNC lathes operation is to quickly identify possible emergency situations during their operation, including unforeseen collisions with obstacles, breakage, and wear of tools, with subsequent interruption of the cutting process. The article describes an automatic system for monitoring the collision, breakage, and wear of a CNC lathe tools, discloses its composition, and when implementing the algorithm for recognizing emergency situations, it is proposed to use binary parameters when forming the event matrix, which made it possible to reduce the time and increase the efficiency of identifying the onset of an emergency. The practical implementation of the system is described.

Mental Status and Feasibility of an Intravitreal Ranibizumab Treat-and-Extend Regimen in Patients with Neovascular Age-Related Macular Degeneration.

Anti-vascular endothelial growth factor (VEGF) therapy is the first-choice treatment for neovascular age-related macular degeneration (nvAMD); however, patients often are burdened physically, financially, and mentally. We investigated the relationship between mental status and feasibility of an intravitreal ranibizumab treat-and-extend (TAE) regimen for nvAMD. In this prospective, multicenter study, 75 patients with nvAMD received ranibizumab intravitreally in a TAE regimen. After two monthly injections, the injection intervals were extended step-by-step to 6, 8, 12, and 16weeks in eyes with dry maculas on optical coherence tomography (OCT) and, if exudation persisted or relapsed, shortened by one step. The best corrected visual acuity (BCVA) measurement and OCT were performed at baseline and on the same days of the scheduled injections. At baseline, all patients completed a survey, the Hospital Anxiety and Depression Scale (HADS), regarding mental burden. At week52, patients on the TAE regimen for 1year completed the HADS and a questionnaire designated to assess treatment-associated mental status. Fifty-one patients (68%) completed the 1-year TAE regimen; 24 eyes (32%) discontinued the TAE regimen because of the rescue treatment, difficulty in completing clinical visits, or financial burden. In 51 eyes on the TAE regimen for 1year, the mean BCVAs improved from 64.3 letters at baseline to 71.6 letters at week52. The mean anxiety and depression scores on HADS decreased significantly (p < 0.01) after the 1-year treatment. Women tended to have higher anxiety scores, possibly associated with fear of injection and recurrence, while some men had higher depression scores potentially associated with financial burden, difficulty in completing clinical visits, and subsequent interruption of the TAE regimen especially in eyes with low treatment efficacy. A TAE regimen of intravitreal ranibizumab injections preserves vision in eyes with nvAMD and reduces mental burden associated with disease relapse. This clinical study was registered retrospectively on December22, 2014 with the ClinicalTrials.gov identifier NCT02321839.

Missed training, collateral damage from COVID 19?

during the COVID-19 pandemic a total lockdown was enforced all over Italy starting on March 9th. This resulted in the shrinking of economic activities. In addition, all formal occupational security-training courses were halted, among them the 81/08 law lectures and Basic Life Support-Defibrillation (BLS-D) laymen training courses. The aim of the study was to evaluate the impact of the pandemic on BLS-D laymen training courses in the Lombardy region. BLS-D training courses records for the Lombardy region were analysed. The analysis was conducted from 2016 to 2020 as part of the Hippo project. between 2017 and 2019 BLS-D trained laymen kept increasing, moving from 53,500 trained individuals up to 74,700. In 2020 a stark reduction was observed with only 22,160 individuals trained. Formal courses were not halted completely during 2020. Still, in the months available for training, the number of individuals enrolled showed a sharp 50% reduction. laymen training courses for emergency management are a fundamental component of primary prevention practice. The 81/08 and 158/12 Italian laws have decreed this practice mandatory on the workplace. Following the enforcement of the lockdown and the subsequent interruption of emergency management courses, efforts will be necessary to re-establish and guarantee the high quality training of the pre-pandemic period.

Pain Management Optimisation by an Ultrasound-Guided Analgesic Technique in Outpatients with Plantar Fasciitis during High-Energy Extracorporeal Shock Wave Therapy.

Several studies have demonstrated the efficacy of high-energy extracorporeal shock wave therapy (HESWT) for the treatment of painful foot diseases. A crucial complication of HESWT is the appearance of pain with the subsequent interruption of the procedure. The aim of this study was the evaluation of ultrasound (US)-guided posterior tibial nerve block (PTNB) efficacy in outpatients who discontinued the first application of HESWT due to surge of moderate-severe pain. Twenty-one patients, scheduled for HESWT due to plantar fasciitis, who interrupted the treatment for surge of pain (numeric rating scale [NRS] 5), were enrolled. After interruption of the first treatment, the patients received US-guided PTNB for every subsequent HESWT session. The same skilled anaesthesiologist performed an US-guided PTNB all the times. Once the nerve was identified, the needle was inserted and 5ml mepivacaine 1% were injected. Intensity of pain during each procedure by NRS and evaluation of patient's adherence to the treatment were detected. The HESWT was split into only three applications giving in average about 0.25 mJ mm-2, and all patients completed the treatment sessions. US-guided PTNB showed a significant reduction of NRS (P < 0.01) between the first HEWST without anaesthesia and the three subsequent treatments under peripheral block. US-guided PTNB resulted a valid support for the HEWST in outpatients with plantar fasciitis because it reduced the pain during the procedure, allowing to minimise the patient discomfort and to give the therapeutic doses just in three sessions.

Avascular Necrosis in Patients with Chronic Myeloid Leukemia: A Systematic Literature Review

IntroductionAvascular necrosis (AVN) has been associated with hematological malignancies; nonetheless, it is extremely uncommon in patients with chronic myeloid leukemia (CML). AVN has been described as a presenting manifestation in few CML patients. In other cases, it has been linked to CML treatment, specifically interferon-alpha (IFN-α) and tyrosine kinase inhibitors (TKI). This article reviews the available published literature to shed light on the existing evidence focusing on the pathogenesis, clinical characteristics, and outcomes of AVN in patients with CML.Resultsafter an extensive search in the literature, we found 17 cases of AVN of the femoral head (AVNFH) and four cases of osteonecrosis of the jaw (ONJ) in CML patients. We did not find any reported case of AVN with CML in other sites apart from the femoral head and jaw. They were reported in 18 published articles between 1984 and 2021. There was an almost equal distribution between male and female patients with approximately a 1:1 ratio and a median age of 39 years (ranging from 7 to 71 years).A total of ten patients had AVNFH as the initial presentation of CML. Hip pain was the presenting symptom in all cases. The outcomes among these patients were variable. Almost all of them achieved symptomatic improvement after starting CML treatment, with some of them showing complete resolution of pain. However, in three cases, persistent gait problems were reported, three patients underwent hip replacement surgeries, and one patient developed another AVNFH after the initiation of Interferon-alpha.Five patients developed AVNFH after interferon therapy. Of note, all of them were on hydroxyurea therapy, in addition to interferon-alpha. Among patients who received TKIs for CML, we found only three cases of AVNFH associated with different TKI (Table 5). Notably, blood counts were within the normal range at the time of diagnosis with TKI-related AVNFH.ONJ was reported in four cases between 2018 and 2021(Table 6), and all of them were linked to TKI therapy. One patient had a recurrence of ONJ a year after healing (patient 1), and two patients required surgical intervention (patients 3 and 4).Discussionleukostasis and thrombocytosis that usually accompanied CML is the main predisposing factor for AVN. Leukemic cells and platelet aggregations in the microvascular circulation can lead to the microthrombi formation and subsequent interruption of blood supply to the areas with poor collateral circulation, especially femoral heads.We found that AVN in CML patients is exclusively affected the femoral head and jaw. Also, there was an almost equal distribution between males and females with a 1:1 ratio. The most common presenting symptom was unilateral hip pain, even in the cases found to have bilateral AVN on MRI. The patients with AVNFH as a presenting manifestation of CML were children and young adults. In addition, WBC counts were strikingly elevated in patients who initially presented with AVNFH (above 90,000). In contrast, platelet counts were variable which might support that leukostasis plays a significant role in the development of AVN. As evidenced by our data, there was no reported case of AVN with Pegylated IFN-α use, indicating that pegylated Interferon is safer than standard Interferon, especially in patients at high risk for AVN.Concerning the three cases that developed AVNFH after TKI therapy, we noted that all of them were in complete hematological response (CHR). Regarding OJN in CML, it occurred after prolonged use of TKI (more than two years in all cases). Seven patients with AVNFH underwent hip surgery (six patients required hip replacement), and only one patient (out of 17) had a recurrence of AVNFH at the same site. Given the lack of sufficient data, we could not conclude whether AVN in CML has an adverse prognostic effect. Nevertheless, we can conclude that the clinical outcomes of AVN in CML were not worse than AVN associated with other conditions.ConclusionAVN in CML is a rare condition that carries a high morbidity rate and long-term sequela. Therefore, it should be highly considered in the patient with CML who presents with either hip or jaw pain. Early detection and proper management of AVNFH in CML patients are essential to prevent longstanding disability. Based on our review, we can conclude that the prognosis of AVNFH in CML is considered good. However, further research is required to clarify the effect of AVN on the prognosis of CML. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Withdrawal from Negotiations as the Basis for Pre-Contractual Liability under Russian and Foreign Law

The paper analyzes the criteria for unfair termination of negotiations as a basis for pre-contractual liability. There are 3 components of unfair interruption of negotiations: 1) entry into negotiations without the intent to conclude an agreement and their subsequent interruption; 2) arbitrary termination of negotiations if the counterparty has confidence in the conclusion of the contract; 3) untimely notification of the counterparty about withdrawing from the negotiation process. The author analizes the criteria for unfair breakdown of negotiations. They include the following: the counterparty has reasonable confidence in the conclusion of the contract and the absence of a valid reason for terminating business contacts. These criteria are relevant only for the second composition of the elements of unfair termination of negotiations. To be held liable for entering into negotiations without intending to conclude an agreement and for the subsequent withdrawal from them, it is not required to establish such criteria, and in case of untimely notification of the severance of business contacts, it is necessary to establish only one criterion, namely, the counterparty can reasonably believe in conclusion of the agreement. As a general rule, participants in pre-contractual relations have the right to conduct parallel negotiations with other persons. This possibility may be limited by entering into an exclusivity agreement. At the same time, in some cases, entering into parallel negotiations can be qualified as unfair behavior even without the conclusion of such an agreement.

Facial Nerve Palsy After Ear Infection: A Case Report

<strong>Introduction:</strong> The incidence of acute mastoiditis, a common complication of otitis media, has significantly decreased with the emergence of antibiotic therapy [1]. Classical symptoms of acute mastoiditis include fever, irritability, otalgia, swelling of the mastoid area, and retroauricular erythema [2]. Delay in appropriate antibiotic treatment of mastoiditis may lead to intracranial and extracranial complications. Facial nerve paralysis is a rare complication of otomastoiditis with different pathophysiologic mechanisms postulated [3]. Extensive literature search showed cases of lower motor neuron involvement of the facial nerve in affected patients. We report an unusual case of mastoiditis without fever complicated by epidural abscess and upper motor neuron facial nerve palsy in a previously healthy adolescent. <strong>Case Presentation:</strong> A 13-year-old male presented with painful progressive swelling behind his left ear of 5 days duration. Symptoms had started 2 weeks prior with complaints of left ear pain, and he was diagnosed with impacted cerumen and prescribed topical hydrogen peroxide. There was no history of fever, ear discharge, hearing loss or change in neurologic status. On admission, physical examination showed 4x4 cm tender swelling over the left mastoid region with forward displacement of the pinna and cerumen impaction. Neurological assessment was normal. Laboratory investigations showed peripheral leukocytosis (12,200 cells/uL) with neutrophilia (74%), and elevated c-reactive protein (87 mg/L). Head CT scan showed acute coalescent left mastoiditis with small left epidural abscess formation, displacing the left sigmoid sinus medially, and a developing left mastoid subperiosteal abscess (see <em><strong>Figure 1</strong></em>). A diagnosis of acute mastoiditis was made, and he was commenced on intravenous ceftriaxone and vancomycin with resultant decrease in size of the swelling and normalization of inflammatory markers. On the third day of admission, the patient developed mild right-sided facial asymmetry with sparing of the upper part of the face. Ceftriaxone was changed to piperacillin-tazobactam for broader-spectrum anerobic and gram-negative coverage. Otolaryngology evaluation revealed Bezold’s abscess requiring mastoidectomy. The father initially declined, given improvement in the patient’s symptoms, but consented to wide myringotomy and placement of a short-term myringotomy tube for further drainage and middle ear irrigation. Samples of pus collected were sent for aerobic, anaerobic, mycobacterial, and fungal cultures which all came back negative except for scant growth of Staphylococcus epidermidis. MRI done on the second post-operative day showed severe coalescent left otomastoiditis, mild meningeal enhancement compatible with meningitis along the left lateral temporal lobe, and a small sliver of epidural abscess along the left infratemporal fossa (see <em><strong>Figure 2</strong></em>). Antibiotic treatment was escalated from Piperacillin-tazobactam to meropenem to provide a broader gram-negative and anaerobic coverage. At this point, father consented, and patient underwent mastoidectomy with craniotomy and epidural abscess drainage. Patient received 14 days of parenteral antibiotics. He showed clinical and radiological improvement on repeat MRI, facial asymmetry resolved and patient was discharged home in stable condition to complete 1-month of oral antibiotics (levofloxacin + amoxicillin-clavulanate) with subsequent outpatient follow-up. <strong>Conclusion:</strong> Mastoiditis is a complication of otitis media that can lead to potentially life-threatening intracranial complications. Interestingly, the patient developed rightsided facial asymmetry sparing the upper part of the face suggesting a left upper motor neuron facial nerve palsy with involvement of the contralateral face. This finding is unique to our case, and to our knowledge has not been described in literature. A plausible anatomic explanation is the involvement of ipsilateral corticobulbar tract with subsequent interruption of the main input to the lower portion of contralateral facial nerve nucleus which controls the muscles of the lower face [4]. This results in sparing of the upper facial muscles characteristic of upper motor neuron lesion. Appropriate antibiotic treatment with surgical intervention led to complete resolution of symptoms.

Suture Needle Injuries During Wound Closure: Examining Sources of Distraction in the OR

Despite focus on prevention of needlestick injuries, intraoperative injuries involving suture needles have increased in the past two decades. When interruptions occur during surgery, a practitioner's focus is disengaged, creating an "error space;" re-engagement of the practitioner takes exponentially longer as each subsequent interruption occurs during the procedure. Human factors studies focus on the interaction between individuals and the environment in which they work (eg, processes, equipment). Researchers use a human factors approach to understand distractions during surgery. Using this methodology, wound closure is viewed as a standalone process and the effect of distractions and interruptions on suture needle injuries is examined. Competing priorities combined with interruptions present opportunities for altered situational awareness, which can lead to injury. This article redefines wound closure as a vulnerable time with great potential for error-a time during which distractions and interruptions can lead to suture needle injuries and other unexpected outcomes.

Cortical structural changes related to early antiretroviral therapy (ART) interruption in perinatally HIV-infected children at 5 years of age.

ART interruption in children can occur especially in resource-limited settings for reasons including poor adherence, stock-outs, ART intolerance of non-pediatric formulas and pill size, as well as ultimately to test for HIV remission. Although early ART initiation is now standard of care in pediatric HIV management, very little is known on the effect of early ART initiation or subsequent interruption on brain development. This study aimed to investigate the effect of ART interruption on brain cortical thickness (CT) and folding in a subset of children from the Children with HIV Early antiRetroviral therapy (CHER) trial cohort who all started ART before 18 months of age. CHER participants in the neuroimaging follow-up study had magnetic resonance (MRI) scans on a 3T Siemens Allegra brain scanner at age 5.44 ± 0.37 years. MR images were processed using the automated cross-sectional stream in FreeSurfer v6.0 and vertex wise comparisons of CT and local gyrification indices (LGIs) were performed between HIV+ children and HIV- controls, as well as between HIV+ children on interrupted or continuous ART and controls. HIV+ children (n = 46) showed thicker cortex than HIV- children (n = 29) in bilateral frontal and left temporo-insular regions but lower LGIs in left superior and bilateral medial orbitofrontal cortex extending into rostral anterior cingulate. Children on interrupted ART (n = 21) had thicker cortex than HIV- controls in left frontal and right insular regions, but children on continuous treatment (n = 25) showed no difference from controls. Children on both interrupted and continuous ART showed region-specific alterations in LGI relative to controls. Cortical folding appears more sensitive than CT to early life events including early ART and interruption. However, immune health resilience in children can translate to long term preservation of morphometric brain development, especially for those on early and continuous treatment.

Select neurotrophins promote oligodendrocyte progenitor cell process outgrowth in the presence of chondroitin sulfate proteoglycans.

Axonal damage and the subsequent interruption of intact neuronal pathways in the spinal cord are largely responsible for the loss of motor function after injury. Further exacerbating this loss is the demyelination of neighboring uninjured axons. The post‐injury environment is hostile to repair, with inflammation, a high expression of chondroitin sulfate proteoglycans (CSPGs) around the glial scar, and myelin breakdown. Numerous studies have demonstrated that treatment with the enzyme chondroitinase ABC (cABC) creates a permissive environment around a spinal lesion that permits axonal regeneration. Neurotrophic factors like brain‐derived neurotrophic factor (BDNF), glial cell line‐derived neurotrophic factor (GDNF), neurotrophic factor‐3 (NT‐3), and ciliary neurotrophic factor (CNTF) have been used to promote neuronal survival and stimulate axonal growth. CSPGs expressed near a lesion also inhibit migration and differentiation of endogenous oligodendrocyte progenitor cells (OPCs) in the spinal cord, and cABC treatment can neutralize this inhibition. This study examined the neurotrophins commonly used to stimulate axonal regeneration after injury and their potential effects on OPCs cultured in the presence of CSPGs. The results reveal differential effects on OPCs, with BDNF and GDNF promoting process outgrowth and NT‐3 stimulating differentiation of OPCs, while CNTF appears to have no observable effect. This finding suggests that certain neurotrophic agents commonly utilized to stimulate axonal regeneration after a spinal injury may also have a beneficial effect on the endogenous oligodendroglial cells as well.

A randomized trial of vorinostat with treatment interruption after initiating antiretroviral therapy during acute HIV-1 infection

Objective and DesignA randomized, open-label pilot study in individuals treated with antiretroviral therapy (ART) since acute HIV infection (AHI) with a regimen including a histone deacetylase inhibitor to induce HIV from latency and control HIV replication during subsequent treatment interruption (TI). MethodsFifteen participants who initiated ART at AHI were randomized to vorinostat/hydroxychloroquine/maraviroc (VHM) plus ART (n ​= ​10) or ART alone (n ​= ​5). The VHM arm received three 14-day vorinostat cycles within 10 weeks before TI. ART was resumed for plasma viral load (VL) ​> ​1,000 HIV RNA copies/mL. Primary outcome was proportion of participants on VHM ​+ ​ART versus ART only with VL ​< ​50 copies/mL for 24 weeks after TI. ResultsFifteen participants on ART (median: 178 weeks: range 79–295) enrolled. Two on VHM ​+ ​ART experienced serious adverse events. Fourteen participants underwent TI; all experienced VL rebound with no difference in time between arms: VHM ​+ ​ART (n ​= ​9) median: 4 weeks and ART only (n ​= ​5) median: 5 weeks. VHM induced a 2.2-fold increase in VL (p ​= ​0.008) by single-copy HIV RNA assay after the first cycle. Neopterin levels increased significantly following the first two cycles. After VHM treatment, the frequencies of peripheral blood mononuclear cells harboring total HIV DNA and cell-associated RNA were unchanged. All participants achieved VL suppression following ART re-initiation. ConclusionsAdministration of VHM increased HIV VL in plasma, but this was not sustained. VHM did not impact time to viral rebound following TI and had no impact on the size of the HIV reservoir, suggesting that HIV reservoir elimination will require alternative treatment strategies.

Subsurface transport potential of perfluoroalkyl acids (PFAAs): Column experiments and modeling

Transport of ten perfluoroalkyl acids (PFAAs) was studied with one-dimensional (1-D) saturated column experiments using four soil types with an organic carbon fraction (foc) range of ~0–0.045. Columns were operated under conditions relevant to aqueous film-forming foam (AFFF)-impacted fire protection training areas to determine the ability of equilibrium transport parameters to describe 1-D PFAA transport, if rate-limited sorption influences PFAA transport, and if kinetic parameters can be used to evaluate factors causing rate-limited sorption. Results of initial screening of PFAA breakthrough found that over half of the breakthrough curves deviated from equilibrium transport and merited further investigation. Subsequent analysis showed that, in many cases, these deviations could be accounted for by considering the range of applicable equilibrium Kd values (i.e. based on standard deviation) applicable to the solid phase. Thus, transport of the majority of PFAAs in 3 soils with foc of 0–0.017 was not impacted by rate-limited sorption. Further, low sorption led to transport that was essentially simultaneous for the majority of PFAAs in these porous media. Exceptions were observed for long-chain PFAAs, and also in a fourth soil with foc of 0.045, which indicated the potential for rate-limited sorption to impact transport in some scenarios. Subsequent flow interruption experiments isolating kinetic behavior confirmed rate-limited sorption caused nonequilibrium transport. Linear free energy relationships (LFERs) developed in previous work to predict the inverse relationship between mass transfer coefficients (k) and sorption parameters (i.e., Kd) were used to estimate values of k for PFAAs in this study. Resulting k values were 10−3 to 10−8 h−1, consistent with previously measured kinetic parameters for other polar and anionic compounds. Models incorporating estimated k values resulted in improved predictions of breakthrough observed in nonequilibrium scenarios (R2 0.83–0.98), but k values will require further validation prior to broader application. This work illustrates rate-limited sorption considerations are needed to describe 1-D column saturated transport for some PFAAs and solid phases. At field scales, subsurface heterogeneity and PFAA precursor transformation may be equally or even more important in determining saturated PFAA transport, but kinetic parameters in this study may help to determine relative contributions of rate-limited sorption to overall transport.

The Remonstrance of the Army and the Execution of Charles I

AbstractHenry Ireton's Remonstrance of the Army has an assured place in the rich historiography of the English Civil War as a text that promises insights into the most revolutionary months of England's history. The document savagely criticizes the prospective settlement that the majority in Parliament, conservative in their constitutional and religious preferences, were discussing with Charles at Newport, and provides a justification for the army's subsequent interruption of those negotiations with Pride's Purge. It provides some outlines of a new republican constitution, which became the focus of subsequent debates between the army and the Levellers at Whitehall. Traditionally it has been read as requiring the trial and execution of the king. Recent studies have challenged such arguments: the Remonstrance suggested a route by which the king might be reintegrated into the government with a limited, figure‐head, role. This article argues that the army, inspired by the Remonstrance and by Ireton's emphasis within it on the need for the expiation of blood guilt, intended the trial to end with the capital punishment of the king.