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Humans, like many other animals, live in groups and coordinate actions with others in social settings. 1 Such interpersonal coordination may emerge unconsciously and when the goal is not the coordination of movements, as when falling into the same rhythm when walking together. 2 Although one of our closest living relatives, the chimpanzee (Pan troglodytes), shows the ability to succeed in complex joint action tasks where coordination is the goal, 3 little is known about simpler forms of joint action. Here, we examine whether chimpanzees spontaneously synchronize their actions with conspecifics while walking together. We collected data on individual walking behavior of two groups of chimpanzees under semi-natural conditions. In addition, we assessed social relationships to investigate potential effects on the strength of coordination. When walking with a conspecific, individuals walked faster than when alone. The relative phase was symmetrically distributed around 0° with the highest frequencies around 0, indicating a tendency to coordinate actions. Further, coordination was stronger when walking with a partner compared with two individuals walking independently. Although the inter-limb entrainment was more pronounced between individuals of similar age as a proxy for height, it was not affected by the kinship or bonding status of the walkers or the behaviors they engaged in immediately after the walk. We conclude that chimpanzees adapt their individual behavior to temporally coordinate actions with others, which might provide a basis for engaging in other more complex forms of joint action. This spontaneous form of inter-individual coordination, often called entrainment, is thus shared with humans., Competing Interests: Declaration of interests The authors declare no competing interests., (Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.)

Background: Involving patients, service users, carers and members of the public in research has been part of health policy and practice in the UK for the last 15 years. However, low-income communities tend to remain marginalized from the co-design and delivery of mental health research, perpetuating the potential for health inequalities. Greater understanding is therefore needed on how to meaningfully engage low-income communities in mental health research., Objectives: To explore and articulate whether and how an engaged research approach facilitated knowledge coproduction relating to poverty and mental distress., Setting: A reflective evaluation of community and researcher engagement in the DeStress study that took place in two low-income areas of South-west England., Design: Reflective evaluation by the authors through on-going feedback, a focus group and first-person writing and discussion on experiences of working with the DeStress project, and how knowledge coproduction was influenced by an engaged research approach., Results: An engaged research approach influenced the process and delivery of the DeStress project, creating a space where community partners felt empowered to coproduce knowledge relating to poverty-related mental distress, treatment and the training of health professionals that would otherwise have been missed. We examine motivations for involvement, factors sustaining engagement, how coproduction influenced research analysis, findings and dissemination of outputs, and what involvement meant for different stakeholders., Conclusion: Engaged research supported the coproduction of knowledge in mental health research with low-income communities which led to multiple impacts., (© 2020 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Purpose: To describe the technique of J-shaped manipulation of the metallic stent for instrument-free intubation of the nasolacrimal outflow tract after dacryocystorhinostomy., Methods: The internal diameter of the J-shaped curve placed in the intubation stents was measured and the technique of intubation of the nasolacrimal outflow tract and out the external naris is described. In addition, the anatomic relationships of the nasolacrimal system are illustrated and videographed in relation to the described procedure., Results: This technique has been used successfully on 75 consecutive endoscopic dacryocystorhinostomy cases. After completion of bony osteotomy and opening of the nasolacrimal sac, the metallic portion of the stent is bent into a J-shaped curved with an average internal diameter of 4 cm. The punctum is then canulated with the metallic stent and directed 2 mm vertically then 8 mm to 10 mm medially along the path of the canalicular system. On entering the osteotomy, the stent is directed inferior and slightly lateral in the direction of the external naris. Gentle advancement with small angle redirection of the stent as needed allows exit through the external naris without using additional instrumentation in the nose., Conclusion: The authors present a technique of J-shaped manipulation of the intubation stent allowing navigation of the nasolacrimal outflow tract and exit through the external naris without additional instrumentation. This technique offers advantages over instrument-assisted retrieval of the intubation tube. First, the J-Curve technique is faster than multi-instrument retrieval. Second, less damage is incurred to the mucosa of the lateral nasal wall and/or septum secondary to blind placement of a Crawford hook, hemostat, or grooved director.

This case report describes a patient with known acute lymphoblastic leukemia (ALL) presenting with a rapidly enlarging and vision-threatening orbital mass. Orbital disease is rare in patients with ALL, and to our knowledge only six cases have been previously described, five of which are in children. We describe a 36-year-old Caucasian female with known acute lymphoblastic leukemia who developed markedly decreased visual acuity, proptosis, and elevated intraocular pressure over the course of 12 h. She was treated with emergent surgical intervention followed by intrathecal chemotherapy and intravenous steroids. Following medical and surgical intervention, the patient demonstrated rapid resolution of symptoms and a return to baseline visual acuity. The initial presentation of acute onset proptosis with optic nerve compromise can be suggestive of infectious etiologies, however, this case suggests caution in evaluation of patients with known systemic malignancy, particularly ALL, as early intervention with systemic steroids and surgery may result in return of visual function.

Evaluation of neurological status is imperative to patient assessment. Multiple assessment tools are readily available for clinicians to diagnose and report changes in neurological condition. Some of these tools include the Glasgow Coma Scale, the National Institutes of Health Stroke Scale, the Canadian Neurological Scale, and the Four Score. Although assessment tools are beneficial to help standardize the assessment and communication of findings, they are at times cumbersome, leaving bedside clinicians with questions concerning which tool is appropriate for a given patient population. This initiative began as a means to standardize assessments and communication for neuroscience patients. As success was met, the project was moved forward locally at our hospital campus and later extended to the entire health system. With the support of the chief of neurology, the neuroscience patient care services director, the stroke coordinator, and the neuroscience clinical educator, three different neurological examinations were developed. They were defined as the Basic Neurological Check, the Coma Neurological Check, and the National Institutes of Health Stroke Scale/Stroke Neurological Check. The neurological examinations would address the assessment needs of patients with acute stroke, general neurosurgery/neurology patients, and patients in coma.

Although venous thromboembolism is an important cause of morbidity and mortality within the hospital, a significant proportion of at-risk inpatients do not receive measures known to reduce the risk of deep vein thrombosis and pulmonary embolism. The objective of the present study was to determine whether a pharmacy-driven alert system would, compared to usual care, be associated with a higher rate of adequate venous thromboembolism prevention measures among at-risk inpatients on a general internal medicine service. The study was a prospective, controlled trial set at a university-based teaching hospital. The participants were adults who were admitted (Monday through Friday) to the general internal medicine inpatient service from 19 June to 21 September 2006. Their treatment included a pharmacist assessment of venous thromboembolism risk and a pharmacist-driven alert to the treating physician. The Proportion of at-risk patients receiving adequate thromboprophylaxis within 36 h of admission was recorded. Overall, 140 patients were at sufficient risk for venous thromboembolism to be included. In the usual care group, prophylactic measures were ordered for 49 (61%) of the 80 patients at moderate to high risk. In the pharmacist-alert group, 44 (73%) of the 60 moderate to high venous thromboembolism-risk patients received adequate thromboprophylaxis (P = 0.15). Although we did not observe a statistically significant difference between the groups, our results are consistent with previous reports suggesting that alert systems can increase the proportion of hospitalized patients who receive adequate measures to prevent venous thromboembolism.

Coronary ischemic events increase significantly following a "bad air" day. Ambient particulate matter (PM10) is the pollutant most strongly associated with these events. PM10 produces inflammatory injury to the lower airways. It is not clear, however, whether pulmonary inflammation translates to a systemic response. Lipopolysaccharide (LPS) is a proinflammatory molecule often associated with the coarse fraction of PM. It was hypothesized that PM>2.5 from coal plus LPS induce pulmonary inflammation leading to a systemic inflammatory response. Mice were intratracheally instilled with saline, PM (200 microg), PM + LPS10 (PM + 10 microg LPS), or PM + LPS100 (PM + 100 microg LPS). Eighteen hours later, histologic analysis was performed on lungs from each group. Pulmonary and systemic inflammation were assessed by measuring the proinflammatory cytokines tumor necrosis factor (TNF)-alpha and interleukin (IL)-6 in the pulmonary supernatant and plasma. In a follow-up study, the effects of LPS alone were assessed. Histologic analysis revealed a dose-dependent elevation in pulmonary inflammation with all treatments. Pulmonary TNF-alpha and IL-6 both increased significantly with PM + LPS100 treatment. Regarding plasma, TNF-alpha significantly increased in both PM + LPS10 and PM + LPS100 treatments. For plasma IL-6, all groups tended to rise with a significant increase in the PM + LPS100 group. The results of the follow-up study indicate that the responses to PM + LPS were not due to LPS alone. These results suggest that coarse coal fly ash PM>2.5 combined with LPS produced pulmonary and systemic inflammatory responses. The resulting low-level systemic inflammation may contribute to the increased severity of ischemic heart disease observed immediately following a bad air day.

Objective: To evaluate the relationship between Staphylococcus aureus nasal and tracheal colonization and infection in medical intensive care unit (MICU) patients. The primary outcome was the incidence of S. aureus infection in colonized versus non-colonized patients., Design: Prospective, observational cohort study. Patients admitted to the MICU during the study period were screened for S. aureus nasal and tracheal colonization by culture and a PCR assay twice weekly. Demographic, clinical, and microbiologic data were collected in the MICU and for 30 days after discharge. PFGE and antibiotic susceptibility testing were performed on all S. aureus nasal, tracheal, and clinical isolates., Results: Twenty-three percent of patients (47 of 208) were nasally colonized with S. aureus. Twenty-four percent of these patients developed S. aureus infections versus 2% of non-colonized patients (P < .01). Nine of 11 patients with both nasal colonization and infection were infected by their colonizing strain. Two of 47 nasally colonized patients developed an infection with a different strain of S. aureus. Fifty-three percent of intubated patients with nasal colonization (10 of 19) had tracheal colonization with S. aureus as opposed to 4.9% of intubated, non-colonized patients (3 of 61) (P < .01). Parenteral antibiotics were ineffective at clearing nasal colonization. PCR detected S. aureus colonization (nasal and tracheal) within 6.5 hours with a sensitivity of 83% and a specificity of 99%., Conclusions: The incidence of S. aureus infection was significantly elevated in nasally colonized MICU patients. Techniques to rapidly detect colonization in this population may make targeted topical prevention strategies feasible.

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The objective of this study was to determine if acute and chronic changes in circulating metabolic hormone and metabolite concentrations are associated with beta-agonist-induced nutrient repartitioning in young growing lambs. Two groups of 12 Dorset and Dorset-Finn cross ram lambs weighing 36 or 33 kg live weight were assigned to 3- or 6-week treatment intervals, respectively, to achieve similar slaughter weights. Six lambs within each treatment interval were fed ad libitum a complete mixed high-concentrate diet containing either 0 or 10 ppm cimaterol. During the first 12 hr of cimaterol administration plasma somatotropin (ST), thyroxine (T4), and triiodothyronine (T3) concentrations were not altered by treatment, but plasma insulin, glucose, non-esterified fatty acids (NEFA) and glycerol concentrations were elevated 2 hr after ingestion. These acute responses suggest direct stimulation of glycogenolysis and lipolysis by cimaterol, which is characteristic of beta-adrenergic alteration of carbohydrate and lipid metabolism. Chronic administration of cimaterol significantly decreased insulin concentrations by 36% and 52% at 3 and 6 weeks, respectively, while glucose concentrations remained unchanged. Serum IGF-I concentrations were not significantly altered by cimaterol. T4 levels were reduced 22.1% after 3 weeks of cimaterol treatment. Although plasma NEFA concentrations were chronically elevated 56% to 65% in lambs fed cimaterol, plasma glycerol concentrations remained at baseline levels. The relative changes in plasma NEFA and glycerol concentrations are consistent with a decreased rate of lipogenesis, rather than an increase in lipolysis.