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Importance: Reconstructing cosmetically sensitive defects in an aging population undergoing multiple Mohs micrographic surgeries (MMS) may be addressed with alternatives to surgery. Objective: Patients undergoing MMS with defect reconstruction in visually prominent areas receiving placental allograft were compared with traditional autologous tissue-based procedures—flaps and full-thickness skin grafts (FTSG). Design, Setting, and Participants: This retrospective case–control study evaluated patients who underwent MMS for removal of a basal or squamous cell carcinoma with same-day repair. Main Outcomes and Measures: The primary endpoint was the incidence and comparison of postoperative morbidity. Risk for developing medical or cosmetic sequelae was determined through multivariate logistic regression. Results: The study population consisted of 143 propensity score-matched pairs (n = 286) with moderate- to high-risk defects on the face, head, and neck. Compared with autologous tissue, placental allograft cases were associated with significantly lower risk for infection (p = 0.004), poor scar cosmesis (p

In regulatory aquatic toxicology, acute toxicity studies with chemicals are conducted with a species of fish, crustacea, and or alga. The LC50/EC50 obtained from these studies is used for the hazard classification and labeling of the chemicals. The methods like probit or logit analysis and Litchfield and Wilcoxon method are prescribed in the OECD guidelines to determine the LC50. In the present study, LC50s were calculated using probit analysis, Litchfield & Wilcoxon method, and also using the method by Trevan (the inventor of median lethal dose) using three sets of concentration-mortality data of fish acute toxicity tests. The slopes of the concentration-mortality curves, fiducial limits (95% confidence interval) of LC50s, and ‘mode’ of the concentration-mortality curves were compared. Though the methods used in the study resulted in more or less similar LC50s, the LC10 and LC90, slopes and ‘mode’ differed considerably, indicating that LC50 does not reveal the exact toxicity profile of a chemical. The LC50 calculated using Finney’s probit analysis provides better information on the toxicity profile of a chemical than the LC50calculated by Litchfield & Wilcoxon method. While interpreting LC50, the mortality occurred below 16 % (eg.,LC10) and above 84 % (eg.,LC90), slope and ‘mode’ of the concentration-mortality curve may also be considered. It is worth having a relook at the current practice of hazard classification and labeling of the chemicals based only on LC50 in regulatory aquatic toxicology.

ZusammenfassungIm Rahmen des nichttraumatologischen Schockraummanagements zur Versorgung kritisch kranker Patienten werden akute Störungen der Vitalfunktionen rasch detektiert und behandelt. Beim „primary survey“ (Erstversorgung) dient das etablierte ABCDE-Schema der strukturierten Untersuchung aller relevanten Vitalparameter. Akute Störungen werden hierbei unmittelbar detektiert und therapiert. „C-Probleme“ stellen den größten Anteil der ABCDE-Störungen bei nichttraumatologischen Schockraumpatienten dar und zeichnen sich durch eine hämodynamische Instabilität infolge hypovolämischer, obstruktiver, distributiver oder kardiogener Schockformen aus. Abhängig von den lokalen Versorgungsstrukturen umfasst die nichttraumatologische Schockraumversorgung hierbei auch die Stabilisierung von Patienten mit akutem Koronarsyndrom oder nach prähospitaler Reanimation (Cardiac Arrest Center).

Objective The purpose of this study was to determine the impact of prehabilitation exercise intervention with respect to (1) acceptability, feasibility, and safety; and (2) physical function, measured by 6‐minute‐walk test (6MWT). Data sources PRISMA guidelines were used to systematically search PubMed, Embase, and CINAHL databases evaluating prehabilitation exercise interventions. Study selection The inclusion criteria were studies investigating patients who underwent surgery for their cancer and underwent prehabilitation exercise. Data extraction and synthesis Guidelines were applied by independent extraction by multiple observers. Data were pooled using a random‐effects model. Main outcome(s) and measure(s) Acceptability, feasibility, and safety rates were calculated. 6MWT (maximum distance a person can walk at their own pace on a hard, flat surface, measured in meters, with longer distance indicative of better performance status) was compared using two arms using the DerSimonian and Laird method. Results Objective 1. Across 21 studies included in this review, 1564 patients were enrolled, 1371 (87.7%) accepted the trial; of 1371, 1230 (89.7% feasibility) completed the intervention. There was no grade 3+ toxicities. Objective 2. Meta‐analysis of five studies demonstrated a statistically significant decrease in 6MWT distance postoperatively in the control group (mean difference = +27.9 m; 95% confidence interval (CI): 9.3; 46.6) and a significant improvement postoperatively in the prehabilitation group (mean difference = −24.1 m; 95% CI: −45.7; −2.6). Meta‐analysis demonstrated improvements in 6MWT distance 4–8 weeks postoperatively in the prehabilitation group compared to the control group (mean difference = −58.0 m, 95% CI: −92.8; −23.3). Conclusions and relevance Prehabilitation exercise for cancer patients undergoing surgery was found to be safe, acceptable, and feasible with a statistically significant improvement in the 6MWT, indicating that prehabilitation can improve postoperative functional capacity., Prehabilitation exercise for cancer patients undergoing surgery was found to be safe, acceptable, and feasible.In this meta‐analysis, panel A shows that there is a 27.9 m c post operatively in the control group. Panel B shows that there is a 24.1 m increase in distance walked during the 6MWTpostoperatively in the prehab group. Panel C shows that the two groups (control andprehab) have the same 6MWT distance before randomization. Panel D shows that prehab intervention improved the 6MWT by 58.0 m, suggesting that prehabilitation can improve postoperative functional capacity.

ZusammenfassungAbdominelle Beschwerden sind ein häufiges Leitsymptom in der Notfallmedizin. Unter diesem Symptomkomplex sind eine Vielzahl verschiedener Krankheitsbilder zu fassen, die sich in intra- und extraabdominelle bzw. retroperitoneale Pathologien unterscheiden lassen und Patienten aller Altersklassen betreffen können. Ursächlich für abdominelle Beschwerden können dabei banale Erkrankungen bis hin zu vital bedrohlichen Notfällen sein. Das Akute Abdomen ist ein interdisziplinärer Notfall, bei dem eine interdisziplinäre Teamarbeit notwendig ist. Eine rasche Ersteinschätzung und Risikostratifizierung hat zum Ziel, kritisch kranke Patienten mit akutem Interventionsbedarf frühzeitig zu detektieren und einer geeigneten Therapie zuzuführen. Ein strukturiertes Vorgehen ist hierbei zum Ausschluss bzw. zur Bestätigung der wichtigsten Differenzialdiagnosen essenziell.

Zusammenfassung Einleitung Jährlich stellen sich bundesweit zahlreiche Patienten in zentralen Notaufnahmen vor. Ziel der vorliegenden Untersuchung war es, alters- und geschlechtsabhängig Zuführung, Ersteinschätzung, Entlassart und Verweildauer an einem universitären Standort zu analysieren. Material und Methodik In dieser retrospektiven Studie wurden alle Patientenkontakte der zentralen Notaufnahme des Universitätsklinikums Düsseldorf des Jahres 2019 erfasst und anhand der Prozesskriterien Zuführung, Ersteinschätzung, Entlassart und Verweildauer kategorisiert und deren Verteilung untersucht. Ergebnisse Vom 01.01. bis 31.12.2019 wurden insgesamt 43.821 Patientenkontakte erfasst. Das durchschnittliche Alter der Patienten betrug 47 ± 24 Jahre (Median: 47, Min.–Max.: 0–106). Der Anteil weiblicher Patienten betrug 48 %. Ein Alter ≤ 17 Jahren wiesen 10 % der Patienten (♀ vs. ♂: 4 vs. 6 %, p p Schlussfolgerung Es finden sich deutliche und vor allem altersabhängige Unterschiede in den Prozesskriterien Zuführung, Ersteinschätzung, Entlassart und Verweildauer. Rund 15 % der Patienten sind kritisch krank oder verletzt („orange“ und „rot“). Mit steigendem Alter nimmt der Anteil dieser Triagekategorien zu. Bei rund 30 % der Patienten besteht eine stationäre Aufnahmeindikation, entsprechende Bettenkapazitäten müssen täglich eingeplant werden.

This paper discusses the analysis of the UHF (401 MHz) plasma-induced communications blackout (and brownout) experienced by the Mars InSight spacecraft during its entry, descent, and landing (EDL) ...

BACKGROUND Different deep brain stimulation (DBS) targets have been suggested as treatment for patients with pharmacologically refractory Holmes tremor (HT). We report the clinical and quality of life (QoL) long-term (up to nine years) outcome in four patients with HT treated with DBS (in thalamic ventral intermediate nucleus-VIM or in dentato-rubro-thalamic tract-DRTT). MATERIALS AND METHODS The patients underwent routine clinical evaluations before and after DBS (typically annually). Tremor severity and activities of daily living (ADL) were quantified by the Fahn-Tolosa-Marin Tremor-Rating-Scale (FTMTRS). QoL was assessed using the RAND SF-36-item Health Survey (RAND SF-36). In addition, we computed, in all four patients, the VTA based on the best stimulation settings using heuristic approaches included in the open source toolbox LEAD-DBS. RESULTS In all patients, tremor and ADL improved significantly at one-year post-DBS follow-up (34-61% improvement in FTMTRS total score compared to baseline). In three out of four patients, the improvement of tremor was sustained no longer than two to three years and only in one patient was sustained up to nine years. In this patient, the largest intersection between VTA and DBS target has been observed. Scores for ADL deteriorated over the course of time, reaching worse levels compared to baseline already during the three-year post-DBS follow-up, in three out of four patients. Physical and mental health component scores of RAND SF-36 had very different outcome between patients and follow-ups and were not associated with tremor-related outcomes. CONCLUSIONS The benefits of DBS in HT might not be always long lasting. Although QoL slightly improved, this change seemed to be independent of the motor outcome following DBS. The estimation of DBS target and VTA proximity could be a useful tool for DBS clinicians in order to facilitate the DBS programming process and optimize DBS treatment.

Critically ill patients are often initially treated by out-of-hospital emergency medicine services. A major challenge-especially at the interface between out-of-hospital and in-hospital care-is to continue patient care without wasting time, while maintaining a high level. These include the stabilization of vital functions (e.g., airway management, noninvasive/invasive ventilation, circulatory stabilization) and implementation of a suitable diagnostic and therapeutic strategy (e.g., laboratory examinations, sonography, radiological imaging). In recent years, therefore, interest and research has focused on the topic of "nontraumatic resuscitation room care". The first monocentric data recently became available and work is ongoing to develop nontraumatic resuscitation room management for optimal care of critically ill patients in the emergency department. Based on initial studies, experiences and expert opinions, this paper describes a structured approach to nontraumatic resuscitation room management.Kritisch kranke Patienten werden regelmäßig in der prähospitalen Notfallmedizin versorgt. Gerade an der Nahtstelle zwischen prähospitaler und innerklinischer Versorgung besteht eine große Herausforderung darin, die Patientenbehandlung ohne Zeitverlust und auf hohem Niveau fortzuführen. Hierzu gehören die Stabilisierung der Vitalfunktionen (inkl. Atemwegsicherung, nichtinvasive/invasive Beatmung, Kreislaufstabilisierung) und Umsetzung einer geeigneten Diagnostik- und Therapiestrategie (inkl. Laboruntersuchungen, Sonographie, radiologischer Bildgebung). In den letzten Jahren hat sich daher ein Interessens- und Forschungsschwerpunkt zum Thema „nichttraumatologische Schockraumversorgung“ entwickelt. Mittlerweile liegen erste monozentrische Daten vor und es wird kontinuierlich an der Entwicklung eines nichttraumatologischen Schockraummanagements zur optimalen Versorgung von kritisch kranken Patienten in der zentralen Notaufnahme gearbeitet. Der vorliegende Beitrag beschreibt auf der Basis von ersten Studien, Erfahrungen und Expertenmeinungen eine strukturierte Vorgehensweise im nichttraumatologischen Schockraummanagement.

ZusammenfassungAtemkalk wird in Kreislauftauchgeräten beim technischen Tauchen („Rebreathern“) verwendet. Vergleichbar mit einem Narkosekreislaufgerät dient bei einem halb- bzw. geschlossenen Atemsystem der Kalk der Kohlendioxidabsorbtion. Der Atemkalk enthält meist Kalziumhydroxid, das unter Wassereinwirkung zu Natronlauge reagieren kann. Bei der Ingestion bzw. Aspiration von Bestandteilen des Atemkalks kann es zu Verätzungen mit der Bildung von Kolliquationsnekrosen kommen. Eine frühzeitige Endo- bzw. ggf. Bronchoskopie ist hier zur Abschätzung von Folgeschäden essenziell.

Zusammenfassung Einleitung In Notaufnahmen kommen bundesweit nichttraumatologische kritisch kranke Patienten zur Aufnahme. Zur Struktur, Organisation und Ausstattung des nichttraumatologischen Schockraummanagements ist bisher wenig bekannt. Mittels einer Umfrage sollte daher der Ist-Zustand analysiert werden. Methodik Durch die Arbeitsgruppe „Schockraum“ der Deutschen Gesellschaft Interdisziplinäre Notfall- und Akutmedizin (DGINA) wurde mittels E‑Mail den 420 ärztlichen Leiter*Innen des DGINA-Mitgliederregisters eine Onlineumfrage zugesendet. Zwei Wochen nach initialem Anschreiben erfolgte eine Erinnerung. Die Ergebnisse wurden in einer anonymisierten Datenbank extrahiert und ausgewertet. Ergebnisse Insgesamt lag die Rücklaufquote mit 131 verwertbaren Antworten bei 31 %. Die Umfrage erfasste Krankenhäuser der Basis- (24 %), erweiterten (39 %) und umfassenden Notfallversorgung (37 %). Korrespondierend zur Versorgungsstufe stiegen die jährlichen Patientenkontakte (21.000 vs. 31.000 vs. 39.000), die Monitorplätze in den Notaufnahmen (9 ± 4 vs. 13 ± 6 vs. 18 ± 10), die Betten der assoziierten Notaufnahmestationen (4 ± 5 vs. 10 ± 17 vs. 13 ± 12), die verfügbaren Schockräume (1 ± 1 vs. 2 ± 1 vs. 3 ± 1) und deren Größe (31 ± 16 vs. 35 ± 9 vs. 38 ± 14 m2) an. Hinsichtlich verschiedener Ausstattungsmerkmale (z. B. Röntgenlafette: 58 vs. 65 vs. 78 %, Computertomographie im Schockraum: 6 vs. 12 vs. 27 %) zeigten sich deutliche Unterschiede in Abhängigkeit von der Versorgungsstufe. Während Kühlungssysteme in 30 % in allen Versorgungsstufen vorgehalten wurden, fanden sich andere Ausstattungsmerkmale (z. B. Videolaryngoskopie: 65 vs. 80 vs. 86 %, Bronchoskopie: 29 vs. 22 vs. 45 %) und spezielle Notfallprozeduren (z. B. REBOA [„resuscitative endovascular balloon occlusion of the aorta“]: 3 vs. 5 vs. 12 %, ACCD [„automated chest compression device“]: 26 vs. 57 vs. 61 %) häufiger in höheren Versorgungsstufen. Schlussfolgerung Die vorliegenden Ergebnisse zeigen erstmals den Ist-Zustand der nichttraumatologischen Schockraumversorgung in verschiedenen Versorgungsstufen in Deutschland. Empfehlungen zu Ausstattungsmerkmalen für das nichttraumatologische Schockraummanagement müssen zukünftig formuliert werden.

The limited mass and volume available in a CubeSat present a tremendous design challenge. This challenge needed to be solved even before thinking of sending any CubeSat to Deep Space and to enable the first interplanetary CubeSat mission: Mars Cube One (MarCO). This chapter provides detailed information on the antenna development at X‐band and UHF that made this mission possible. In order to fill the needs of deep‐space communications and navigation for CubeSats and small satellites, the Iris V1 Deep‐Space Transponder was developed at the Jet Propulsion Laboratory starting with the interplanetary nanospacecraft pathfinder in relevant environment “first CubeSat to deep space” mission. MarCO essentially communicates at X‐band with the DSN stations and all antennas are optimized across the deep‐space frequency bands. Before presenting the original deployable UHF antenna, a brief state‐of‐the‐art is presented showing all antenna concepts available in the literature at the time MarCO development started.

ZusammenhangIm Einsatzspektrum des professionellen Rettungsdienstes stellen Atemwegsnotfälle („A-Probleme“) einen seltenen, respiratorische Notfälle („B-Probleme“) hingegen einen häufigen Einsatzgrund dar. Die Vorhaltung entsprechenden Materials, Schulung und regelmäßiges Training, die Etablierung von SOPs und gelebtes Teamwork sind wesentliche Aspekte für ein erfolgreiches Atemwegsmanagement, für das die S1-Leitlinie „Prähospitales Atemwegsmanagement“ einen praktischen Leitfaden bietet.

The emergency department (ED) is the main port of entry for patients with infectious diseases, the place where a number of diagnostic procedures are performed and treatment is often initiated. The aim of this retrospective study was to estimate the influence of the establishment and introduction of a blood culture standard operating procedure (BC-SOP) and of the subsequent training of microbial diagnostics in an ED.In a before and after study over a study period of 3 months each (November 2017-January 2018 and November 2018-January 2019), the number of blood cultures taken, the rate of blood cultures per 1000 patients, the number of positive blood cultures and the frequency of typical skin pathogens were evaluated. In the interim time between the two study periods, a BC-SOP was developed in collaboration with the hospital's antibiotic stewardship team and subsequently introduced with staff training in the ED. The study was approved by the local ethics committee of the medical faculty of the Heinrich Heine University (2019-392-RetroDEuA).In total 92% of the nursing personnel and 93% of the medical personnel received training. The total number of blood cultures increased from 1757 to 2872 (64% increase) and the rate of blood cultures per 1000 patients from 287 to 481 (68% increase). The number of positive blood cultures decreased from 18.6% to 13.7% (p 0.05). Typical skin pathogens were found in 34.4% and 26.4% of the cases, respectively (p 0.05).The development, introduction and training of a BC-SOP in the ED can make a relevant contribution to the microbial diagnostics and increase the quantity as well as the quality.EINLEITUNG: Zentrale Notaufnahmen stellen die Eintrittspforte für viele stationär aufzunehmende Patienten in einem Krankenhaus dar und sind häufig der Ausgangspunkt für die antiinfektive Diagnostik und Therapie von Notfallpatienten. In dieser retrospektiven Untersuchung soll der Frage nachgegangen werden, wie die Etablierung einer Standard Operating Procedure (SOP) „Blutkulturen“ und deren Schulung die mikrobielle Diagnostik in einer zentralen Notaufnahme verbessern kann.In einer Vorher-und-nachher-Untersuchung wurde über einen jeweils 3‑monatigen Zeitraum (11/2017 bis 01/2018 und 11/2018 bis 01/2019) die Anzahl der abgenommenen Blutkulturen, die Rate an Blutkulturen/1000 Fälle, die Anzahl positiver Blutkulturen und die Häufigkeit typischer Hautkeime analysiert. Im Zeitraum zwischen den evaluierten Zeitabschnitten wurde eine SOP „Blutkulturen“ in Zusammenarbeit mit dem Antibiotic-Stewardship(ABS)-Teams und der zentrale Notaufnahme entwickelt, implementiert und geschult. Ein positives Votum der Ethikkommission der Heinrich-Heine-Universität (2019-392-RetroDEuA) lag vor.Die pflegerischen und ärztlichen Mitarbeiter wurden zu 92 % bzw. 93 % geschult. Die Anzahl der abgenommenen Blutkulturen stieg von 1757 auf 2872 um 64 % ebenso wie die Anzahl der Blutkulturen/1000 Fälle von 287 auf 481 (68 %). Die Anzahl der positiven Blutkulturen reduzierte sich von 18,6 auf 13,7 % (p 0,05). Typische Hautkeime fanden sich in 34,4 % und 26,4 % der Fälle (p 0,05).Die durch Schulungen begleitete Einführung einer SOP „Blutkulturen“ in der zentralen Notaufnahme kann einen relevanten Beitrag zur antimikrobiellen Diagnostik leisten und sowohl die Quantität als auch die Qualität erhöhen.

BACKGROUND: Psychotherapy is the gold standard treatment for posttraumatic stress disorder (PTSD), yet psychotherapy utilization and retention among veterans is low. Little is known about the barriers to care and factors associated with women veterans’ PTSD psychotherapy utilization and retention. OBJECTIVES: Using a nationally-representative sample of 986 women Veterans Health Administration (VHA) Primary Care users with PTSD and a perceived need for mental health care, we examined (1) the proportion of women who utilized psychotherapy; (2) retention in psychotherapy among women who used any psychotherapy; and (3) individual factors related to psychotherapy utilization and retention. METHODS: Women completed a survey on their mental health care experiences. Outpatient mental health care utilization in the year prior to survey was obtained from VHA administrative data. RESULTS: Most women (79.1%) utilized psychotherapy, and 41.7% of those women had a minimal therapeutic dose of psychotherapy (≥ 8 visits). Mental health diagnostic comorbidity and being African American/Black or identifying as neither African American/Black nor White were significantly associated with higher psychotherapy utilization. Mental health diagnostic comorbidity, exposure to military sexual trauma, and receiving treatment aligned with gender-related and group-related preferences were associated with higher psychotherapy retention. Being a parent was associated with lower retention. CONCLUSION: Although a significant proportion of women veterans with PTSD are utilizing psychotherapy, retention is enhanced when women are able to obtain treatment aligned with their preferences. Thus, efforts to promote patient-centered, shared decisions regarding mental health treatment options could increase the efficacy and efficiency of treatment for PTSD among women.

Grundlage fur alle metabolischen Prozesse im menschlichen Korper ist die Gewinnung und Verstoffwechselung von Energietragern. Als Endprodukt der anaeroben Glykolyse entsteht Lactat. Dieses dient dem Korper als Substrat fur die Gluconeogenese und als oxidierbares Substrat. Infolge einer Vielzahl an Akutereignissen (z. B. Schock, Sepsis, Herz-Kreislauf-Stillstand, Trauma, Krampfanfall, Ischamie, diabetische Ketoacidose, Thiaminmangel, Leberfunktionsstorungen, Intoxikationen) kann eine Hyperlactatamie nachgewiesen werden. Da eine Hyperlactatamie mit erhohter Mortalitat einhergehen kann, ist in der Notfallmedizin einerseits die Fahndung nach der Ursache der Hyperlactatamie ebenso wichtig wie andererseits eine effektive kausale Therapie. Wiederholte Lactatmessungen sind Bestandteil vieler Behandlungsalgorithmen, da die Betrachtung der dynamischen Entwicklung der Blutlactatkonzentrationen helfen kann, den Akutzustand des Patienten und die Effektivitat der getroffenen Masnahmen besser abzuschatzen.

ZusammenfassungIntoxikationen stellen einen häufigen Grund der Notfallbehandlung im Rettungs- und Notarztdienst und in der zentralen Notaufnahme dar. An erster Stelle stehen hierbei Alkohol- gefolgt von Medikamentenintoxikationen (z. B. mit Benzodiazepinen). Der Gebrauch von Lachgas und daraus resultierende Intoxikationen sind in den letzten Jahren vermehrt berichtet worden. Auch Mischintoxikationen in Kombination mit Lachgas sind beschrieben. Der vorliegende Fallbericht stellt eine Mischintoxikation mit zunächst unklarer Vigilanzminderung vor und beleuchtet die systematische Abarbeitung wesentlicher Differenzialdiagnosen.

BACKGROUND AND PURPOSE: Total brain volume and total intracranial volume are important measures for assessing whole-brain atrophy in Alzheimer disease, dementia, and other neurodegenerative diseases. Unlike MR imaging, which has a number of well-validated fully-automated methods, only a handful of methods segment CT images. Available methods either use enhanced CT, do not estimate both volumes, or require formal validation. Reliable computation of total brain volume and total intracranial volume from CT is needed because head CTs are more widely used than head MRIs in the clinical setting. We present an automated head CT segmentation method (CTseg) to estimate total brain volume and total intracranial volume. MATERIALS AND METHODS: CTseg adapts a widely used brain MR imaging segmentation method from the Statistical Parametric Mapping toolbox using a CT-based template for initial registration. CTseg was tested and validated using head CT images from a clinical archive. RESULTS: CTseg showed excellent agreement with 20 manually segmented head CTs. The intraclass correlation was 0.97 (P < .001) for total intracranial volume and 0.94 (P < .001) for total brain volume. When CTseg was applied to a cross-sectional Alzheimer disease dataset (58 with Alzheimer disease patients and 58 matched controls), CTseg detected a loss in percentage total brain volume (as a percentage of total intracranial volume) with age (P

Goals We aimed to establish the epidemiological characteristics and documentation of diagnostic workup for gastroparesis (GP). Background No study has used a national database to evaluate the prevalence, demographics, and associated comorbid conditions of GP, and document rates of proper diagnosis. Materials and methods This was a cross-sectional population-based study using the Explorys Platform to determine the prevalence of GP in a large and diverse population highly representative of the US population and to examine the diagnostic approach of GP. Data collected were individual characteristics from electronic medical records (EMRs) included age, ethnicity/race, sex, diagnostic report for esophagogastroduodenoscopy (EGD) and gastric emptying study (GES). Results A total of 43,827,910 medical records were surveyed (1999 to 2014), of which 69,950 had a diagnosis of GP, yielding an overall prevalence of 0.16%. We identified 249,930 EMRs with type 1 diabetes mellitus (T1DM), and 2,940,280 EMR's with type 2 diabetes mellitus (T2DM), of which 11,470 (4.59%) and 38,670 (1.31%) EMR's had concurrent GP, respectively. The remainder 19,810 EMRs with a diagnosis of GP were classified as having idiopathic GP. In all three subgroups, women and Caucasians had the highest prevalence of GP. The diagnosis of GP was confirmed by both GES and EGD in 9,950 of patients (14.22%). For patients with T1DM, T2DM, or idiopathic GP, GP was confirmed by both diagnostic tests in 16.8%, 14.0%, and 13.2%, respectively. Conclusions Our estimated rates of prevalence of GP in T1DM and T2DM indicate that GP is not a common clinical complication in these populations. Majority of EMRs that indicated a diagnosis of GP did not include any documentation of definitive diagnostic testing (EGD and/or GES).

This study compared the Macintosh blade direct laryngoscope, Glidescope, C-Mac d-Blade, and McGrath MAC X-blade video laryngoscopes in 2 cadaveric models with severe cervical spinal instability. We hypothesized that the Glidescope video laryngoscope would allow for intubation with the least amount of cervical spine movement. Our secondary endpoints were glottic visualization and intubation success.In total, 2 fresh cadavers underwent maximal surgical destabilization from the craniocervical junction to the cervicothoracic junction by a neurosurgical spine specialist, with subsequent neutral positioning of the heads with surgical head fixation devices. On each cadaver, 8 experienced anesthesiologists performed four intubations with the 4 laryngoscopes in random order. Lateral radiographic measurements determined vertebral displacement during intubation.Cervical spine displacements were not significantly different amongst video laryngoscopes. Cormack-Lehane Grade 1 views were achieved with all attempts with each of the 3 video laryngoscopes; intubation attempts with the Macintosh blade achieved only grade 3 or grade 4 views. Intubation was successful every time with a video laryngoscope but only during 1 of 16 intubation attempts with the Macintosh blade.In a cadaveric model with maximally destabilized cervical spines, cervical spine movement was observed during attempted laryngoscopy using each of 3 video laryngoscopes, although there was no significant difference between the laryngoscopes. Given cervical spine displacement occurred, these video laryngoscopes do not prevent cervical spine motion during laryngoscopy. However, with improved glottic visualization and intubation success, video laryngoscopes are superior to the Macintosh blade in both cervical spine safety and intubation efficacy in the model studied.

BACKGROUND The significance of discrepant findings between histology (BMB) and flow cytometry (FC) in bone marrow (BM) examination at diffuse large B-cell lymphoma (DLBCL) diagnosis is uncertain. METHODS We performed a 5-year retrospective single-center study of patients diagnosed by DLBCL not otherwise specified (n = 82), divided into three groups according to BM infiltration at diagnosis: BMB-/FC- (75.6%), BMB+/FC+ (13.4%), and BMB-/FC+ (11%). RESULTS Median infiltration by FC analysis of the BMB-/FC+ group was 0.8% and if we considered BM infiltration as positive in all cases, 4/9 would be upstaged. Median follow was 33 months. Event-free survival (EFS) after 18 months was 82, 23, and 27% for BMB-/FC-, BMB-/FC+, and BMB+/FC+, respectively (p

Background While there are clear national resuscitation room admission guidelines for major trauma patients, there are no comparable alarm criteria for critically ill nontrauma (CINT) patients in the emergency department (ED). The aim of this study was to define and validate specific trigger factor cut-offs for identification of CINT patients in need of a structured resuscitation management protocol. Methods All CINT patients at a German university hospital ED for whom structured resuscitation management would have been deemed desirable were prospectively enrolled over a 6-week period (derivation cohort, n = 108). The performance of different thresholds and/or combinations of trigger factors immediately available during triage were compared with the National Early Warning Score (NEWS) and Quick Sequential Organ Failure Assessment (qSOFA) score. Identified combinations were then tested in a retrospective sample of consecutive nontrauma patients presenting at the ED during a 4-week period (n = 996), and two large external datasets of CINT patients treated in two German university hospital EDs (validation cohorts 1 [n = 357] and 2 [n = 187]). Results The any-of-the-following trigger factor iteration with the best performance in the derivation cohort included: systolic blood pressure 80% of patients in the derivation cohort and performed better than NEWS and qSOFA scores in the internal validation cohort (sensitivity = 98.5%, specificity = 98.6%). When applied to the external validation cohorts, need for advanced resuscitation measures and hospital mortality (6.7 vs. 28.6%, p p Conclusion Our simple, any-of-the-following decision rule can serve as an objective trigger for initiating resuscitation room management of CINT patients in the ED.

Introduction Many patients with epistaxis are seen in the A&E department. A significant number are discharged without need for inpatient admission due to minor bleeds. Many are given limited information on management of further bleeds and even fewer are advised on the prevention of bleeds. Aim To evaluate the advice given to patients with epistaxis who are seen and discharged from A+E, to instigate an improvement in advice and to examine the subsequent effect on re-attendance rates Method Epistaxis patients discharged from A+E were audited over a 6-week period looking at advice given on discharge. A questionnaire was distributed to all A&E and ENT doctors probing current practice. A presentation on the management and prevention of epistaxis and the appropriate verbal/written advice to give was delivered and epistaxis advice sheets were made available. The practice regarding advice and the re-attendance rates were re-audited. Results 53 patients presented to the A&E department with epistaxis. 31 patients presenting with epistaxis were seen and discharged by A&E doctors. The remaining seen by ENT. Only 9 patients received verbal advice and 1 received written advice. There were 13 re-attenders. After re-audit showed a significant increase in the proportion of patients receiving advice by A&E doctors. Verbal and written advice increased from 18% to 61% and 1% to 60% respectively. The number of re-attenders was reduced to 13 to 6.

Background: Polychaetes are an important component of the estuarine and mangrove ecosystem especially in fisheries perspective. The polychaete fauna of the Manakkudy estuary barmouth and mangrove was examined for species composition and taxonomic classification. A total of 27 species belonging to 16 genera under 12 families were collected. Results: Of these 27 species, 16 are new records to Manakudy estuary. Out of which, those coming under the group Errantia were dominant (9 species) when compared to Sedentaria group (7 species). Among the 12 families identified, the species diversity of Nereidae and Capitellidae were found to be high. Conclusions: Salinity and nature of substrata, two main factors which govern the distribution of polychaetes, are also given along with species description.

Communications and navigation are fundamental to robotic spacecraft exploration. NASA spacecraft communicates via radio links with antennas in the deep space network (DSN) located in California, Australia, and Spain. Measurements of range between the DSN and spacecraft are an important and sometimes critical contribution to navigation. For a given pair of uplink and downlink carriers, ranging must generally be accompanied by telemetering, in order to allow for efficient use of spacecraft and ground resources. Regenerative ranging, which is compatible with the simultaneous presence of telemetry, is more efficient in the use of link power than is the current standard (nonregenerative) ranging. This improved efficiency arises because regenerative ranging replaces the wideband filter found in a nonregenerative transponder's ranging channel with a narrowband loop that tracks the range code, so the signal-to-noise ratio in the transponder's ranging channel is large and there is essentially no noise modulated onto the downlink carrier. This paper offers a comparison of pseudonoise (PN) regenerative ranging versus the nonregenerative method of ranging. This paper also describes the implementation of PN regenerative ranging on the Iris transponder, which is a low-power, 0.5U size, DSN-compatible, software-defined radio based on various JPL flight transponder designs. Iris is baselined to be used on 7 out of 13 of the CubeSats flying as secondary payloads on the Space Launch System Exploration Mission-1 launch of the Orion spacecraft.

The Jet Propulsion Laboratory (JPL) is supporting several deep-space CubeSat missions selected as secondary payloads on the Space Launch System Exploration Mission One (SLS EM-1) launch of the Orion spacecraft. Seven secondary payload CubeSat missions (Lunar Flashlight, Near-Earth Asteroid Scout, BioSentinel, Lunar IceCube, CubeSat for Solar Particles, Lunar Polar Hydrogen Mapper, and ArgoMoon) have baselined the Iris deep space transponder as the main telecommunications and navigation transponder for their missions. Iris, first developed for JPL's interplanetary nanospacecraft pathfinder in relevant environment mission, and further developed for JPL's Mars Cube One mission, is a software-defined radio based on various JPL flight heritage designs. The transponder operates at X-band frequencies (7.2-GHz uplink, 8.4-GHz downlink) for compatibility with NASA's Deep Space Network, but the modular hardware design allows for further expanded capabilities into other frequency bands such as UHF, S-, and Ka-band. The transponder has a maximum power consumption of 35 W at 4-W radio frequency output, with uplink sensitivities down to −150 dBm. Various encoding schemes are available for the user to choose, from traditional convolutional coding with Reed Solomon concatenation to Turbo codes, and support for low-density parity-check coding is in the plan for future support. This paper will discuss the current capabilities and specifications of the Iris deep space transponder, as well as current hardware, firmware, and software implementations, and provide a short overview of future capabilities currently in the works.

Background: Though virtual screening methods have proven to be potent in various instances, the technique is practically incomplete to quench the need of drug discovery process. Thus, the quest for novel designing approaches and chemotypes for improved efficacy of lead compounds has been intensified and logistic approaches such as scaffold hopping and hierarchical virtual screening methods were evolved. Till now, in all the previous attempts these two approaches were applied separately. Objective: In the current work, we made a novel attempt in terms of blending scaffold hopping and hierarchical virtual screening. The prime objective is to assess the hybrid method for its efficacy in identifying active lead molecules for emerging PPI target Bcl-2 (B-cell Lymphoma 2). Method: We designed novel scaffolds from the reported cores and screened a set of 8270 compounds using both scaffold hopping and hierarchical virtual screening for Bcl-2 protein. Also, we enumerated the libraries using clustering, PAINS filtering, physicochemical characterization and SAR matching. Results: We generated a focused library of compounds towards Bcl-2 interface, screened the 8270 compounds and identified top hits for seven families upon fine filtering with PAINS algorithm, features, SAR mapping, synthetic accessibility and similarity search. Our approach retrieved a set of 50 lead compounds. Conclusions: Finding rational approach meeting the needs of drug discovery process for PPI targets is the need of the hour which can be fulfilled by an extended scaffold hopping approach resulting in focused PPI targeting by providing novel leads with better potency.

InCoB, one of the largest annual bioinformatics conferences in the Asia-Pacific region since its launch in 2002, returned to New Delhi, India after 12 years, with a conference attendance of 314 delegates. The 2018 conference had sessions on Big Data and Algorithms, Next Generation Sequencing and Omics Science, Structure, Function and Interactions, Disease and Drug Discovery and Plant and Agricultural Bioinformatics. The conference also featured an industry track as well as panel discussions on Women in Bioinformatics and Democratization vs. Quality control in academic publishing. Asia Pacific Bioinformatics Interaction & Networking Society (APbians) was launched as an APBionet Special Interest Group. Of the 52 oral presentations made, 22 were accepted in supplemental issues of BMC Bioinformatics, BMC Genomics or BMC Medical Genomics and are briefly reviewed here. Next year’s InCoB will be held in Jakarta, Indonesia from September 10–12, 2019.

As part of its comprehensive journey toward high reliability, Memorial Hermann Health System has implemented multiple patient safety initiatives. An instance of actual patient harm due to staff unfamiliarity with a medical device triggered a project to ensure the competence of clinical staff in the operation of all approved new and updated medical devices. Medical devices are classified by level of risk to patients if caregivers are not reliably educated. Educational rigor, with tracking and accountability management, is then scaled to that risk assessment. The objective is to decrease safety events related to use of medical devices by ensuring failure-free medical device use. An interdisciplinary team was created to design a “fail-safe” process to analyze and scale training for use of medical devices, with a risk assessment tool predicting the potential severity and frequency of harm to patients. The fail-safe process became an approved procedure and practice standard at the institution.

OBJECTIVES. Premature activation of the digestive protease trypsin within the pancreatic parenchyma is a critical factor in the pathogenesis of pancreatitis. Alterations in genes that affect intra-pancreatic trypsin activity are associated with chronic pancreatitis (CP). Recently, carboxyl ester lipase (CEL) emerged as a trypsin-independent risk gene. Here, we evaluated PNLIP encoding pancreatic lipase as a potential novel susceptibility gene for CP. METHODS. We analyzed all 13 PNLIP exons in 429 German non-alcoholic CP patients and in 600 German control subjects, in 632 patients and 957 controls from France, and in 223 patients and 1070 controls from Japan by DNA sequencing. Additionally, we analyzed selected exons in further 545 CP patients and 1849 controls originating from Germany, USA and India. We assessed the cellular secretion, lipase activity and proteolytic stability of recombinant PNLIP variants. RESULTS. In the German discovery cohort, 8/429 (1.9%) patients and 2/600 (0.3%) controls carried a PNLIP missense variant (P=0.02, OR=5.7, 95% CI=1.1–38.9). Variants detected in patients were prone to proteolytic degradation by trypsin and chymotrypsin. In the French replication cohort, protease-sensitive variants were also enriched in patients with early-onset CP (5/632 [0.8%]) versus controls (1/957 [0.1%]) (P=0.04, OR=7.6, 95% CI=0.9–172.9). In contrast, we detected no protease-sensitive variants in the non-European populations. In the combined European data, protease-sensitive variants were found in 13/1163 cases (1.1%) and in 3/3000 controls (0.1%) (OR=11.3, 95% CI=3.0–49.9, P

Schockraume in zentralen Notaufnahmen sind die ersten Anlaufstellen fur potenziell schwer bzw. mehrfach verletzte Patienten. Hier steht die interdisziplinare Versorgung dieser Patienten im Vordergrund, die die strukturierte und standardisierte Krankenhausaufnahme sowie die entsprechende Initialdiagnostik und Therapie potenziell lebensbedrohlicher Zustande umfasst. Der Schockraum stellt ein zentrales Bindeglied zwischen der prahospitalen und der innerklinischen Versorgungskette dar. Der vorliegende Beitrag beschreibt die Kernaufgaben des Schockraumteams sowie Konzepte und Strategien der Erstversorgung schwer verletzter und polytraumatisierter Patienten.

While static functional connectivity (sFC) of resting state fMRI (rfMRI) measures the average functional connectivity (FC) over the entire rfMRI scan, dynamic FC (dFC) captures the temporal variations of FC at shorter time windows. Although numerous studies have implemented dFC analyses, only a few studies have investigated the reliability of dFC and this limits the biological interpretation of dFC. Here, we used a large cohort (N = 820) of subjects and four rfMRI scans from the Human Connectome Project to systematically explore the relationship between sFC, dFC and their test-retest reliabilities through intra-class correlation (ICC). dFC ICC was explored through the sliding window approach with three dFC statistics (standard deviation, ALFF, and excursion). Excursion demonstrated the highest dFC ICC and the highest age prediction accuracy. dFC ICC was generally higher at window sizes less than 40 s. sFC and dFC were negatively correlated. Compared to sFC, dFC was less reliable. While sFC and sFC ICC were positively correlated, dFC and dFC ICC were negatively correlated, indicating that FC that was more dynamic was less reliable. Intra-network FCs in the frontal-parietal, default mode, sensorimotor and visual networks demonstrated high sFC and low dFC. Moreover, ICCs of both sFC and dFC in these regions were higher. The above results were consistent across two brain atlases and independent component analysis-based networks, multiple window sizes and all three dFC statistics. In summary, dFC is less reliable than sFC and additional experiments are required to better understand the neurophysiological relevance of dFC.

ObjectiveCortical thickness changes dramatically during development and is influenced by adolescent drinking. However, previous findings have been inconsistent and limited by region-of-interest approaches that are underpowered because they do not conform to the underlying heterogeneity from the effects of alcohol.MethodsAdolescents (n=657; 12-22 years at baseline) from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) who endorsed little to no alcohol use at baseline were assessed with structural MRI and followed longitudinally at four yearly intervals. Seven unique spatially covarying patterns of cortical thickness were obtained from the baseline scans by applying a novel data-driven method called non-negative matrix factorization (NMF). The cortical thickness maps of all participants’ longitudinal scans were projected onto vertex-level cortical patterns to obtain participant-specific coefficients for each pattern. Linear mixed-effects models were fit to each pattern to investigate longitudinal effects of alcohol consumption on cortical thickness.ResultsIn most NMF-derived cortical thickness patterns, the longitudinal rate of decline in no/low drinkers was similar for all age cohorts, among moderate drinkers the decline was faster in the younger cohort and slower in the older cohort, among heavy drinkers the decline was fastest in the younger cohort and slowest in the older cohort (FDR corrected p-values < 0.01).ConclusionsThe NMF method can delineate spatially coordinated patterns of cortical thickness at the vertex level that are unconstrained by anatomical features. Age-appropriate cortical thinning is more rapid in younger adolescent drinkers and slower in older adolescent drinkers.

The urgent need for a treatment of COVID-19 has left researchers with limited choice of either developing an effective vaccine or identifying approved/investigational drugs developed for other medical conditions for potential repurposing, thus bypassing long clinical trials. In this work, we compared the sequences of experimentally verified SARS-CoV-2 neutralizing antibodies and sequentially/structurally similar commercialized therapeutic monoclonal antibodies. We have identified three therapeutic antibodies, Tremelimumab, Ipilimumab and Afasevikumab. Interestingly, these antibodies target CTLA4 and IL17A, levels of which have been shown to be elevated during severe SARS-CoV-2 infection. The candidate antibodies were evaluated further for epitope restriction, interaction energy and interaction surface to gauge their repurposability to tackle SARS-CoV-2 infection. Our work provides candidate antibody scaffolds with dual activities of plausible viral neutralization and immunosuppression. Further, these candidate antibodies can also be explored in diagnostic test kits for SARS-CoV-2 infection. We opine that this in silico workflow to screen and analyze antibodies for repurposing would have widespread applications.

We research effects on the electricity market of countries surrounding the North Sea after a proposed offshore wind park in the Dogger Bank area of the North Sea has been constructed. Interconnection and generation distribution are analysed separately. The supply price of electricity for each country is calculated by a linear regression analysis to simulate the supply price for higher or lower supply. The model uses the coupling of one supply with one receiver country. Linear modelling of the electricity market combines the results for each objective to find a final state for the market. Using the historic market and weather data for 2016, the results from interconnection show an average generated value of 0.275 [M€/hour] and 82.1 [GW] of average energy flow through the hub. The results of this interconnection between the countries bring between −26% and +11% change on average electricity prices. For hub generation added in, we found an average generated value of 0.573 [M€/hour] and an average price drop of 5% for each country for an average wind power generation of 6.3 [GW] at the hub. The results show that interconnecting the similarly sized electricity markets i.e. Great Britain and Germany & the Netherlands and Denmark, where one has a higher renewable share, would bring the most price stabilization between the two as well as generate the most financial return.

Background A utility value is a health-related quality of life metric (HRQoL) metric used in a cost-effectiveness analysis. While utilities as outcomes in the treatment of advanced Parkinson’s disease (PD) with deep brain stimulation (DBS) are available, they do not currently exist for PD with early motor complications. The objectives of this study were to predict utilities from observed disease-specific HRQoL data using two mapping algorithms, and investigate their performance in terms of longitudinal changes within and between treatment groups, and distribution by PD severity. Methods This is a post hoc analysis of data from the EARLYSTIM trial of DBS compared with best medical therapy (BMT) in PD patients with early motor complications We used two published algorithms comprising ordinal and multinomial regression models to map EQ-5D-3L utilities from observed PD-specific 39 item Questionnaire (PDQ-39) scores in EARLYSTIM. Utilities were calculated using the predicted functioning levels of EQ-5D-3L dimensions and the established EQ-5D-3L UK tariffs. Statistical analyses (analysis of variance, two-tailed Student’s t-test) were used to test the change from baseline within groups and difference in change from baseline between groups in utilities. Boxplots were developed to investigate the distribution of predicted utilities by PD severity, measured using the Hoehn and Yahr scale. Results The change from baseline in predicted mean utilities was statistically significant at all visits up to 24 months for the DBS group (p p = 0.04) for the BMT group with one algorithm. With both algorithms, the between-groups difference in change from baseline in predicted mean utilities favored DBS at all follow-up visits (p Conclusions Among PD patients with early motor complications, utilities predicted by both mapping algorithms using PDQ-39 data demonstrated a statistically and clinically meaningful improvement with DBS compared with BMT. It was not possible to conclude if one algorithm was more responsive than other. In the absence of utilities collected directly from patients, mapping is an acceptable option permitting economic evaluations to be undertaken.

Mono-allelic germline pathogenic variants in the Partner And Localizer of BRCA2 (PALB2) gene predispose to a high-risk of breast cancer development, consistent with the role of PALB2 in homologous recombination (HR) DNA repair. Here, we sought to define the repertoire of somatic genetic alterations in PALB2-associated breast cancers (BCs), and whether PALB2-associated BCs display bi-allelic inactivation of PALB2 and/or genomic features of HR-deficiency (HRD). Twenty-four breast cancer patients with pathogenic PALB2 germline mutations were analyzed by whole-exome sequencing (WES, n = 16) or targeted capture massively parallel sequencing (410 cancer genes, n = 8). Somatic genetic alterations, loss of heterozygosity (LOH) of the PALB2 wild-type allele, large-scale state transitions (LSTs) and mutational signatures were defined. PALB2-associated BCs were found to be heterogeneous at the genetic level, with PIK3CA (29%), PALB2 (21%), TP53 (21%), and NOTCH3 (17%) being the genes most frequently affected by somatic mutations. Bi-allelic PALB2 inactivation was found in 16 of the 24 cases (67%), either through LOH (n = 11) or second somatic mutations (n = 5) of the wild-type allele. High LST scores were found in all 12 PALB2-associated BCs with bi-allelic PALB2 inactivation sequenced by WES, of which eight displayed the HRD-related mutational signature 3. In addition, bi-allelic inactivation of PALB2 was significantly associated with high LST scores. Our findings suggest that the identification of bi-allelic PALB2 inactivation in PALB2-associated BCs is required for the personalization of HR-directed therapies, such as platinum salts and/or PARP inhibitors, as the vast majority of PALB2-associated BCs without PALB2 bi-allelic inactivation lack genomic features of HRD.

ProThermDB is an updated version of the thermodynamic database for proteins and mutants (ProTherm), which has ∼31 500 data on protein stability, an increase of 84% from the previous version. It contains several thermodynamic parameters such as melting temperature, free energy obtained with thermal and denaturant denaturation, enthalpy change and heat capacity change along with experimental methods and conditions, sequence, structure and literature information. Besides, the current version of the database includes about 120 000 thermodynamic data obtained for different organisms and cell lines, which are determined by recent high throughput proteomics techniques using whole-cell approaches. In addition, we provided a graphical interface for visualization of mutations at sequence and structure levels. ProThermDB is cross-linked with other relevant databases, PDB, UniProt, PubMed etc. It is freely available at https://web.iitm.ac.in/bioinfo2/prothermdb/index.html without any login requirements. It is implemented in Python, HTML and JavaScript, and supports the latest versions of major browsers, such as Firefox, Chrome and Safari.

Background, aim, and objectives The purpose of the review is to assess the cultural practices and its influence on food waste in South Africa. Furthermore, it explores the reasons for food waste by looking at different cultural practice of various ethnic groups in South Africa. The growing concern of the challenges of waste on human health and the environment has pressured the world to come up with drastic measures on how to manage waste to reduce both environmental and public health impacts. One of the concerns is that food waste has become one of the main contributors to increased greenhouse gas emissions. However, South Africa does not have stringent measures to control or reduce food waste in its communities. Methods An extensive online search was conducted to assess the influence of culture on food waste in South Africa and explore how other countries’ cultural practices contribute to food waste. Information was retrieved from online reports, journals, and books. Results and conclusions The studies showed a diversity of cultures and practices in South Africa compared to other countries. For example, in affluent countries where food is available in large quantities, cultural practices have a major influence on food waste. Moreover, some studies highlighted the fact that even though most developing countries are overwhelmed by poor people, many of whom live below the poverty line, food waste is also a challenge. In South Africa, food waste generated during social activities that are related to cultural practices remains a serious challenge. This is because during the cultural and social events, food is prepared in large quantities, which ends up not being wholly consumed and resulting in an increase in food waste that gets disposed of at the landfill sites. The government of South Africa must institute awareness raising measures to inform communities to avoid or reduce the generation of food waste. This would reduce the emission of greenhouse gases and environmental impact, and to protect human health.

SARS-CoV-2 has ushered a global pandemic with no effective drug being available at present. Although several FDA-approved drugs are currently under clinical trials for drug repositioning, there is an on-going global effort for new drug identification. In this paper, using multi-omics (interactome, proteome, transcriptome, and bibliome) data and subsequent integrated analysis, we present the biological events associated with SARS-CoV-2 infection and identify several candidate drugs against this viral disease. We found that: (i) Interactome-based infection pathways differ from the other three omics-based profiles. (ii) Viral process, mRNA splicing, cytokine and interferon signaling, and ubiquitin mediated proteolysis are important pathways in SARS-CoV-2 infection. (iii) SARS-CoV-2 infection also shares pathways with Influenza A, Epstein-Barr virus, HTLV-I, Measles, and Hepatitis virus. (iv) Further, bacterial, parasitic, and protozoan infection pathways such as Tuberculosis, Malaria, and Leishmaniasis are also shared by this virus. (v) A total of 50 candidate drugs including the prophylaxis agents and pathway specific inhibitors are identified against COVID-19. (vi) Betamethasone, Estrogen, Simvastatin, Hydrocortisone, Tositumomab, Cyclosporin A etc. are among the important drugs. (vii) Ozone, Nitric oxide, and photosensitizer drugs are also identified as possible therapeutic candidates. (viii) Curcumin, Retinoic acids, Vitamin D, Arsenic, Copper, and Zinc may be the candidate prophylaxis agents. Nearly 70% of our identified agents are previously suggested to have anti-COVID-19 effects or under clinical trials. Among our identified drugs, the ones that are not yet tested, need validation with caution while an appropriate drug combination from these candidate drugs along with a SARS-CoV-2 specific antiviral agent is needed for effective COVID-19 management., Graphical abstract Image 1, Highlights • SARS-CoV-2 shares Influenza, EBV, HTLV-I, Measles, and Hepatitis virus infection pathways. • SARS-CoV-2 also shares Tuberculosis, Malaria, and Leishmaniasis infection pathways. • mRNA splicing, cytokine and IFN signaling, and ubiquitin are important pathways. • Anticancer, antipsychotic, anti-inflammatory, antibiotic, immunosuppressant, corticosteroid, and lipid-lowering drugs are important. • Tunicamycin, Betamethasone, Estrogen, Statin, Tositumomab, Cyclosporin A are top candidate drugs. • Ozone, Nitric oxide, and photosensitizer drugs are also important against COVID-19. • Curcumin, Retinoic acids, Vit-D, Arsenic, Copper, and Zinc are candidate prophylaxis agents. • ∼70% of our identified drugs are previously suggested or under clinical trial for COVID-19. • Our newly identified candidate drugs need validation with caution.

The hazard pointer method [4] for safe reclamation is capable of protecting individual dynamic objects, including individual nodes of linked structures. However, on its own, it does not protect the descendants of protected nodes for unconditional traversal. We present a new algorithm that extends the hazard pointer algorithm to support unconditional traversal though immutable links of acyclic structures. It has an important added advantage of allowing the reclamation of nodes at any depth with their ancestors in the same pass over hazard pointers. Achieving these advantages does not incur any extra computing cost in protection operations, which are the common case. A counter is added to each object for holding the number of inbound immutable links. Such counters are updated when setting and clearing immutable links, which can happen at most once per link in the lifetime of an object. The algorithm is implemented and used in the Facebook Folly open-source C++ library [1].

The design of the surgical and support areas should be such that all aspects of providing appropriate medical and surgical practices are facilitated. Facilities and equipment should be suitable for the species of animals utilized and the complexity of the procedures performed. Regulatory and legal guidelines must also be met. This chapter provides an overview of the issues related to animal anesthesia and surgery. Preoperative care procedures and health monitoring will vary with the species utilized and the requirements of the experiment. All protocols should require the use of healthy and relatively young animals. Orthopaedic procedures are generally invasive major surgeries requiring deep surgical anesthesia. The anesthetic protocol should provide anesthesia, analgesia and muscle relaxation while maintaining homeostasis. Postoperative analgesia should be required for all orthopaedic protocols unless a specific scientific justification exists for witholding them. The postoperative period can be divided into two important phases, recovery from anesthesia and the period of tissue healing.

This chapter briefly describes some of the ethical issues involved in animal research and to summarize the current regulatory standards under which biomedical research using animals, including orthopaedic research, is conducted. The Public Health Service Policy on Humane Care and Use of Laboratory Animals of 1986 was published by the Public Health Service to implement The Health Research Extension Act of 1985. The United States Department of Agriculture regulations require veterinary consultation during protocol planning for any procedures that may cause more than momentary or slight pain or distress. Animal facility design must assure separation of species or test systems, separate individual projects, provide for quarantine of animals, and accommodate routine or specialized housing. Standard operating procedures must be in place to assure the quality and integrity of the data collected during the course of a study, and any deviation from the written protocol must be documented as part of the raw data.

A novel coronavirus, formally named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused coronavirus disease 2019 (COVID-19) worldwide, and it is the latest pandemic in the se...