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Diabetes mellitus (DM) is thought to be associated with poor outcomes in cervicofacial infections (CFI), yet little is known about the prevalence of DM in these cases. Stress hyperglycaemia (SHG), a normal physiological response to inflammation, is distinct from DM, though they overlap and may be conflated. We aimed to establish the prevalence of DM and SHG in CFI, and to determine the effect of each on severity of disease and outcome measures. The Maxillofacial Surgery Trainee Research Collaborative (MTReC) carried out an audit of all patients with CFI admitted to 25 hospitals between May and October 2017. To the best of our knowledge this created the largest prospective database on CFI, with information collected on presentation, source of infection, biological data, and outcomes. We recorded 1002 admissions, of which 78 (7.8%) had DM. Random blood glucose was measured on admission in 401 patients (40%), of which 45 (11%) displayed SHG. Patients diagnosed with DM were more likely to have infections arising from a salivary source (13% vs 4%, p0.00), more returns to theatre (9% vs 2%, p0.00), and a longer hospital stay (median (range) 2 (0-34) vs 1 (0-139) day, p=0.01) than non-DM patients. In contrast, patients with SHG had more severe disease (multiple fascial spaces involved in 59% vs 19%, p=0.01, and systemic inflammatory response syndrome present in 66% vs 45% p=0.03), but did not have significantly more returns to theatre (2% vs 3%, p=0.91) or longer stays in hospital (median (range) 1 (0-63) vs 1 (0-6), p=0.55) than normoglycaemic patients. The prevalence of DM in our cohort was only marginally higher than in the general population, despite previous retrospective case reviews suggesting a significantly higher prevalence. SHG was not associated with poor outcomes in our cohort, but is likely to be associated with a small increased risk of subsequent diagnosis of DM, which can be quantified using a calculator tool. On discharge, it is important to give appropriate advice about diet, lifestyle, exercise, and weight loss to all patients with CFI.

Robot-assisted general surgery has become increasingly common in the Australian public sector since 2003. It provides significant technical advantages compared to laparoscopic surgery. Currently, it is estimated that the learning curve for surgeons starting off with robotic surgery is complete after 15 cases. This is a retrospective case series, following the progress of four surgeons with minimal robotic experience over 5 years. Patients undergoing colorectal procedures and hernia repairs were included. 303 robotic cases were included in this study, 193 colorectal surgeries and 110 hernia repairs. 20.2% of colorectal patients experienced an adverse event and 10.0% of hernia patients had a complication. The learning curve was correlated to the average docking time, and it was found that this was complete after 2 years, or after a minimum of 12 to 15 cases. Patient length of stay decreases as surgeon experience increases. Robotic surgery is a safe approach to colorectal surgery and hernia repairs with some potential benefits in terms of patient outcomes as surgeon experience increases.

A toy model to examine the effect of a heterogeneous edge weight structure on assortative mixing patterns is developed. This model is used as a benchmark to assess assortative mixing patterns in a real military personnel network describing occupation changes among recruits to the Canadian Armed Forces. Mixing patterns on the network suggest a strong tendency for members to transfer between different occupation groups; possible areas on which to focus retention strategies are identified.

Background We assess the effect of Coronavirus disease 2019 (COVID-19) on UK oral and maxillofacial (OMF) trauma services and patient treatment during the first wave of the pandemic. Materials and Methods From April 1st 2020 until July 31st 2020, OMF Surgery units in the UK were invited to prospectively record all patients presenting with OMF trauma. Information gathered included clinical presentation, mechanism of injury, and how it was managed and whether or not treatment included surgery. Participants were also asked to compare the patient’s care with the treatment, which would have usually been given prior to the crisis. Results Twenty-nine units across the UK contributed with 2229 entries. The most common aetiology was mechanical fall (39%). The most common injuries were soft tissue wounds (52%) and mandible fractures (13%) for hard tissues. Of 876 facial fractures, 79 patients had treatment, which differed from that which would be normal pre-COVID and 33 had treatment deferred meaning 112 (14%) patients received care at variance to normal practice because of COVID restrictions. Conclusions The pattern of OMFS injuries changed during the first COVID-19 lockdown period. For the majority, best practice and delivery of quality trauma care continued in spite on-going operational challenges. Changes to treatment affected only a small proportion of patients. The lessons learnt from the first wave combined with adequate resources and pre-operative patient testing should allow those facial injuries in the second wave to receive best practice care.

The development of China’s steel industry has been phenomenal, and in 2018, China’s crude steel production reached 928.3 million tonnes and accounted for 51.3% share of global crude steel productio...

The role of corticosteroids in the management of cervicofacial infections continues to cause controversy. Systemic anti-inflammatory and immunomodulatory effects that reduce swelling and improve symptoms in the head and neck may make these agents an effective addition to the antibiotics used and to surgical management, although this same effect may dull the physiological response to infection, and allow infections to progress. We have systematically reviewed the evidence for the use of corticosteroids in common cervicofacial infections following the PRISMA guidelines. MeSH terms included "head", "neck", "infection", and "glucocorticoid". In total, 31 papers were identified. Eight reported the use of corticosteroids for peritonsillar abscess (PTA), 10 for pharyngitis, four for deep neck space infection (DNSI), four for periorbital cellulitis, and five for supraglottitis. Whilst there is an established evidence base for their use in the treatment of PTA and pharyngitis, other indications need further study, and we highlight the potential pitfalls. The evidence suggests that the use of adjunctive, short-term, high-dose corticosteroids in cervicofacial infections may be safe and effective.

Inguinal ultrasound (US) has a high sensitivity and specificity for the diagnosis of inguinal hernias but is often performed unnecessarily, adding cost and time to treatment. The aim of our study was to assess the rate and necessity of US before clinical examination by a hernia surgeon. Medical records of patients referred for an inguinal hernia from April through July 2017 were reviewed. These cases were analyzed for patient demographics, physical examination (PE) findings, previsit imaging, health-care system of surgeon, and case outcome. Twenty-nine per cent of patients had an inguinal US before visiting a surgeon. Sixty-three per cent of patients who underwent an US had a palpable hernia on PE, and 76 per cent had a positive PE by the surgeon. Patients without a hernia on referring provider's PE underwent US 59 per cent of the time. Inguinal USs are being ordered unnecessarily by referring providers. Physical examination by referring providers and surgeons should be the primary tool for diagnosis of an inguinal hernia.

BACKGROUND The Lyell McEwin Hospital entered into a public-private collaborative agreement in 2019 in order to access Da Vinci® Xi Surgical Systems (Intuitive Surgical, Sunnyvale, CA, USA) in private hospitals. This study aimed to examine the costs associated with usage of robot surgical systems under the agreement, and the potential for acquisition in the public hospital. METHODS Retrospective data on robotic-assisted and equivalent operations performed between 1 May 2019 and 30 April 2020 were collected and formed subsequent model inputs. Cost data were from hospital records and the local Da Vinci® Xi distributor. Clinical workflow of operations was simulated with a decision-analytic model, with output being costs incurred. The model's base case scenario assumed 5% of cases were robotically assisted. RESULTS A total of 35 robotic-assisted, 101 laparoscopic and 34 open operations were performed. Patients were predominantly male and overweight with multiple comorbidities. Length of stay and duration of operation were associated with increased costs (p

Introduction Gender differences have been documented in prevalence and morbidity of caries, gingivitis and oral health, but not previously in cervicofacial infection. Identification and minimisation of gender inequalities is a World Health Organisation priority, and there are physiological, behavioural and cultural reasons to suspect that sex and gender differences may be present.Methods Analysis was carried out of the MTReC National Snapshot audit of cervicofacial infections. This database was created by oral and maxillofacial surgery trainees in 2017 and records over 400 variables in 1,002 individual patients admitted to hospital with severe odontogenic infection.Results Records were available for 1,002 patients with cervicofacial infection (456 females and 546 males). There were significant differences between recorded gender in those presenting with airway compromise (male 7% vs female 2%, p = 0.001), severe inflammatory response syndrome (male 60% vs female 39%, p = 0.007) and requirement for awake fibre-optic intubation on admission (male 4% vs female 1%, p = 0.014).Discussion These results suggest that male patients access healthcare later in their disease than female patients, and with more severe systemic compromise. This may be due to prevalent cultural and behavioural norms. As equality of access is the responsibility of the administrator, we discuss methods which might improve timely presentation in males with cervicofacial infections.

Background: Intestinal stomas are formed for emergency, elective, benign and malignant conditions. They may be temporary or permanent. The complication rates of intestinal stomas are reported as high as 56%. Objective: The aim of this article is to provide an overview of intestinal stomas and common related issues, to inform general practitioners (GPs) and improve stoma-related care. Discussion: There are a variety of early and late complications associated with intestinal stomas. It is important that patients have access to an informed GP, stomal therapy nurse and surgeon to provide optimal ongoing care. Good stoma care contributes to good quality of life for patients.

Mesiodens is the most common type of supernumerary tooth, located between the maxillary central incisors in close relation to the nasopalatine canal. A 20-year-old man presented with right-sided nasal blockage, nasal discharge and collapsed nose without history of trauma. Imaging revealed a calcified mass in the inferior meatus extending into dilated nasopalatine canal. Endoscopic removal of the mass revealed tuberculate appearance of an incompletely developed tooth, consistent with mesiodens. Based on the history of septal cartilage collapse with right-sided mucopurulent discharge, endoscopic findings of the right inferior turbinate being adherent to the septal cartilage and the underlying mesiodens, we believe that the patient developed a septal abscess secondary to infection in nasal mucosa surrounding the mesiodens causing collapse of septal cartilage. While a tooth or tooth-like mass causing nasal passage air-flow obstruction is uncommon, we believe that this is the first reported case of mesiodens presenting with septal cartilage collapse.

In the context of a weeklong summer professional development program focused on climate change education, we conducted a qualitative case study investigating how science educators’ understandings of learning progressions (LPs) informed their ideas about climate change teaching practice. Participants (N = 27) in the Climate Academy were middle school (n = 14), high school (n = 7), higher education (n = 2), and informal (n = 4) science educators from 2 Mid-Atlantic states in the United States. In cooperation with other Climate Academy facilitators, we engaged participants in a variety of professional learning activities, among which were exploring LPs and their potential utility for informing climate change teaching practice. During these activities with LPs, the science educators engaged with LPs on 2 constructs relevant to climate change: carbon cycling and sea level rise. We collected data in the forms of observational field notes and personal interviews to gain insight into participants’ perspec...

Victoria University of Wellington, New Zealand, hosted the thirty-fifth Annual Conference of the Society of Architectural Historians, Australia and New Zealand (SAHANZ) from 4–7 July 2018. Themed a...

The Materials Processing Institute is a UK based research and innovation centre for the global steel industry. The Institute, which will celebrate its 75th anniversary in 2019, prioritises developm...

We present research from an investigation on developing a learning progression (LP) for sea level rise (SLR), a major effect of global climate change. We began our research by drafting a hypothetical LP for sea level rise, informed by extant knowledge of the topic in the scientific community, in science education literature, and in science education policy documents such as the Next Generation Science Standards. Causes and mechanisms, scale and representations, and impacts made up the three components of the LP. Our confidence in our hypothetical LP was greater for the lower and upper anchors than for the levels between them. For all levels, however, we remained tentative due to the limitation of empirical data from learners. We next developed an assessment instrument as well as an online activity as a way to elicit learners’ thinking about sea level rise. These instruments were administered to middle school students (N = 95) and undergraduate pre-service teachers (N = 77). An analysis of the data suggested that our hypothetical LP for sea level rise was a necessary first step, but it underscored the necessity of probing learners’ thinking of the construct to develop a robust understanding of learners’ conceptual understanding overtime of SLR. The assessment data provided essential information about learner understanding of the construct of sea level rise that assisted us in moving our SLR LP from a hypothetical state to a more stable state, which we term as “conditional.” The development of a conditional SLR LP, along with the accompanying assessment instruments, contributes to research and thinking about learning progressions and climate change education. © 2016 Wiley Periodicals, Inc. J Res Sci Teach 53: 1471–1499, 2016

Many common prescription and over-the-counter medications have antimuscarinic effects. Antimuscarinics are a well recognized cause of dry mouth, with potential to cause other physical and cognitive adverse effects. A comprehensive medication review in a patient presenting with dry mouth can lead to overall health improvements. Scoring systems can be helpful in identifying antimuscarinic drugs and their adverse effects. CPD/Clinical Relevance: Antimuscarinic drug use is prevalent and a common cause of dry mouth. Older people are particularly susceptible to antimuscarinic adverse effects.

We experimentally investigated the self-assembly of chemically active colloidal Janus spheres into dimers. The trans-dimer conformation, in which the two active sites are oriented roughly in opposite directions and the particles are osculated at their equators, becomes dominant as the hydrogen peroxide fuel concentration increases. Our observations suggest high spinning frequency combined with little translational motion is at least partially responsible for the stabilization of the trans-dimer as activity increases.

This chapter reports contributions of new and fresh thinking in climate change education from our Maryland and Delaware Climate Change Education, Assessment, and Research learning sciences team, as supported by two grants from the National Science Foundation's Climate Change Education Program. Delaware context with coastal areas along both states influenced to a large extent our decision to select SLR for this next step of our learning progressions research in climate change education. Learning progressions support this achievement because LPs describe the way in which learners' ideas about a topic become more sophisticated over the years through sustained learning opportunities and targeted instruction. The chapter focuses on development of a limited subset of hypothetical LPs for the consequences of climate change that were selected to align with the geographical regions represented in our context has resulted in tangible progress in our quest to include climate change in science teacher education and in the science curriculum.

An external fixator is an essential tool for treating unstable pelvic ring injuries but its use carries risks, including pin-site infections and injury to the lateral femoral cutaneous nerve (LFCN). Surgeons currently lack data regarding these risks for patient counseling. This study aimed to identify the incidence of and risk factors for superficial and deep pin-site infection and LFCN damage. Fifty-two patients who underwent pelvic external fixation with anterior pin placement as part of definitive treatment for unstable pelvic ring disruption were retrospectively evaluated to identify factors associated with the development of infection. Ten (19%) patients developed superficial pin-site infections, with none developing a deep infection. Five were treated with oral antibiotics alone, 5 with additional intravenous antibiotics, and 1 underwent superficial surgical debridement at the time of external fixator removal. Three (6%) patients had temporary symptoms consistent with irritation to their LFCN that all resolved by 3 months. One (2%) patient had residual mild and intermittent LFCN dysesthesias at the 6-month follow-up. Adjusted logistic regression models identified no specific factors that were associated with increased risk of infection. The incidence of superficial infections related to pelvic external fixation was 19%, which can usually be treated with antibiotics with low risk of deep infection. In addition, there remains a low risk of long-term LFCN damage. Patients should be counseled on these risks during the perioperative period. [ Orthopedics. 2017; 40(6):e959–e963.]

The Next Generation Science Standards (NGSS) are the first set of U.S. national science standards to explicitly include the topic of global climate change. With this new emphasis in K–12 sc...

We describe the case of a gall bladder torsion in an elderly female patient, which was discovered during laparoscopic exploration for presumed acute cholecystitis. The rising incidence of this relatively uncommon process can be attributed to increasing life expectancy. Gall bladder torsion typically manifests in septuagenarians and octogenarians of the female gender, as seen in the presented case. It is thought that local mesenteric redundancy predisposes to the development of mechanical organoaxial torsion along the gall bladder’s longitudinal axis involving the cystic duct and artery. Clinicians must have a high index of suspicion for gall bladder torsion, as a mimicker of acute cholecystitis, in the described patient demographic. Preoperative diagnosis is challenging with the vast majority of reported cases being diagnosed intraoperatively, and only five cases preoperatively. Prompt surgical intervention results in an overall mortality rate of approximately 5%, while a delay in diagnosis can lead to catastrophic patient outcomes.

The phage shock protein (Psp) response maintains integrity of the inner membrane (IM) in response to extracytoplasmic stress conditions and is widely distributed amongst enterobacteria. Its central component PspA, a member of the IM30 peripheral membrane protein family, acts as a major effector of the system through its direct association with the IM. Under non-stress conditions PspA also negatively regulates its own expression via direct interaction with the AAA+ ATPase PspF. PspA has a counterpart in cyanobacteria called Vipp1, which is implicated in protection of the thylakoid membranes. PspA's and Vipp1's conserved N-terminal regions contain a putative amphipathic helix a (AHa) required for membrane binding. An adjacent amphipathic helix b (AHb) in PspA is required for imposing negative control upon PspF. Here, purified peptides derived from the putative AH regions of PspA and Vipp1 were used to directly probe their effector and regulatory functions. We observed direct membrane-binding of AHa derived peptides and an accompanying change in secondary structure from unstructured to alpha-helical establishing them as bona fide membrane-sensing AH's. The peptide-binding specificities and their effects on membrane stability depend on membrane anionic lipid content and stored curvature elastic stress, in agreement with full length PspA and Vipp1 protein functionalities. AHb of PspA inhibited the ATPase activity of PspF demonstrating its direct regulatory role. These findings provide new insight into the membrane binding and function of PspA and Vipp1 and establish that synthetic peptides can be used to probe the structure-function of the IM30 protein family.

Transcription regulation in a temporal and conditional manner underpins the lifecycle of enterobacterial pathogens. Upon exposure to a wide array of environmental cues, these pathogens modulate their gene expression via the RNA polymerase and associated sigma factors. Different sigma factors, either involved in general 'house-keeping' or specific responses, guide the RNA polymerase to their cognate promoter DNAs. The major alternative sigma54 factor when activated helps pathogens manage stresses and proliferate in their ecological niches. In this chapter, we review the function and regulation of the sigma54-dependent Phage shock protein (Psp) system-a major stress response when Gram-negative pathogens encounter damages to their inner membranes. We discuss the recent development on mechanisms of gene regulation, signal transduction and stress mitigation in light of different biophysical and biochemical approaches.

The current scholarly consensus argues that business failure results from the misalignment of a company's strategy and its environment. The case of Western Union, however, suggests that a third element—momentum—is also part of the explanation for companies' failures. The weight of historically accumulated systems, skills, and workers constrains the speed with which managers can adapt their strategy to the environment. Momentum stood in the way of Western Union's attempt to place itself at the center of the growing world of computer communications systems.

Imiquimod 5% (Aldara, 3M Healthcare Ltd.) is a topically applied immune response modifier used in the treatment of superficial basal cell carcinoma, actinic keratosis, and genital warts. We reviewed the casenotes of 5 patients with histologically confirmed dysplastic lower lips who had been treated with topical imiquimod. Each patient was provided with a specially designed lower lip retractor to prevent spread of the cream. Treatment was stopped after 6 weeks or if an acute inflammatory reaction developed. The lower lip was biopsied 4 weeks later, and histologically the dysplastic changes had been reversed in all 5 patients. The lip retractor was well-tolerated, and prevented spread of the cream. Imiquimod 5% cream offers an alternative method to manage dysplastic lips. Our lip retractor is a simple and cost-effective method of isolating the lower lip and allowing application of topical agents. The method could equally well be used for agents other than imiquimod.