Clinical versus MRI grading of the medial collateral ligament in acute knee injury

Sensitivity, specificity, and agreement between clinical and magnetic resonance imaging (MRI) gradings of the medial collateral ligament (MCL) after acute knee injury were evaluated in 362 patients. Ninety-seven per cent were injured during sports/recreation. Sensitivity and specificity of MRI for grade II or III MCL injury was 68% (95% CI 58-77%) and 90% (95% CI 86-93%), respectively. Weighted Kappa analysis showed moderate agreement between clinical and MRI grading (0.56 [95% CI 0.48-0.65]). Findings were similar for patients with and without concomitant cruciate ligament rupture (0.57 [95% CI 0.48-0.66] and 0.55 [95% CI 0.35-0.75], respectively) and for specialists in orthopaedics and knee sub-specialists (0.55 [95% CI 0.39-0.70] and 0.57 [95% CI 0.47-0.67], respectively). Agreement between clinical and MRI grading of MCL injuries by orthopaedic specialists in a general hospital is at least moderate regardless of the presence of cruciate ligament injury.

Influenza A subtype H3N2 is associated with an increased risk of hospital dissemination - an observational study over six influenza seasons

BACKGROUND

Previous studies on hospital-acquired influenza (HAI) have not systematically evaluated the possible impact of different influenza subtypes. HAI has historically been associated with high mortality, but clinical consequences may be less severe in a modern hospital setting.

AIMS

To identify and quantify HAI for each season, investigate possible associations with varying influenza subtypes, and to determine HAI-associated mortality.

METHODS

All influenza-PCR-positive adult patients (>18 years old) hospitalized in Skåne County during 2013-2019, were prospectively included in the study. Positive influenza samples were subtyped. Medical records of patients with suspected HAI were examined to confirm a nosocomial origin and to determine 30-day mortality.

RESULTS

Of 4110 hospitalized patients with a positive influenza PCR, 430 (10.5%) were HAI. Influenza A(H3N2) infections were more often HAI (15.1%) than influenza A(H1N1)pdm09, and influenza B (6.3% and 6.8% respectively, P<0.001). The majority of HAI caused by H3N2 were clustered (73.3 %) and were the cause of all 20 hospital outbreaks consisting of ≥4 affected patients. In contrast, the majority of HAI caused by influenza A(H1N1)pdm09 and influenza B were solitary cases (60% and 63.2%, respectively, P<0.001). Mortality associated with HAI was 9.3% and similar between subtypes.

CONCLUSIONS

HAI caused by influenza A(H3N2) was associated with an increased risk of hospital dissemination. Our study is relevant for future seasonal influenza infection control preparedness and shows that subtyping of influenza may help to define relevant infection control measures. Mortality in HAI remains substantial in a modern hospital setting.

Bumblebee flower constancy and pollen diversity over time

Bees often focus their foraging effort on a few or even a single flower species, even if other equally rewarding flower species are present. Although this phenomenon-called flower constancy-has been widely documented during single foraging trips, it is largely unknown if the behavior persists over longer time periods, especially under field conditions with large temporal variations of resources. We studied the pollen diet of individuals from nine different Bombus terrestris colonies for up to 6 weeks, to investigate flower constancy and pollen diversity of individuals and colonies, and how these change over time. We expected high degrees of flower constancy and foraging consistency over time, based on foraging theory and previous studies. Instead, we found that only 23% of the pollen foraging trips were flower constant. The fraction of constant pollen samples did not change over the study period, although repeatedly sampled individuals that were flower constant once often showed different preferences at other sampling occasions. The similarity of pollen composition in samples collected by the same individuals at different occasions dropped with time. This suggests that the flower preferences change in response to shifting floral resources. The average diversity of pollen from single foraging trips was around 2.5 pollen types, while the colony-level pollen diversity was about three times higher. How rapidly preferences change in response to shifting resources, and if this differs between and within bee species depending on factors such as size, should be the focus of future research.

Clinical, patient-reported, radiographic and magnetic resonance imaging findings 11 years after acute posterior cruciate ligament injury treated non-surgically

BACKGROUND

Long-term consequences of posterior cruciate ligament (PCL) injury such as persistent posterior tibial translation and risk of osteoarthritis development are unclear. Additionally, little data is available describing the natural history of structural morphology of the ruptured PCL. The purpose of the study was to determine the long-term outcome after non-operatively treated PCL injury.

METHODS

Over 6-years, all acute knee injuries were documented by subacute MRI (median 8 days [5-15, 25th - 75th percentile] from injury to MRI). Twenty-six patients with acute PCL injury were identified of whom 18 (69%) participated in the long-term follow-up after 11 years. Follow-up included radiographic posterior tibial translation (RPTT) determined using the Puddu axial radiograph. weight-bearing knee radiographs, MRI and KOOS (Knee injury and Osteoarthritis Outcome Score).

RESULTS

On subacute MRI, 11 knees displayed total and 7 partial ruptures. At 11 (SD 1.9) years, the median RPTT was 3.7 mm (1.5-6.3, 25th - 75th percentile). Seven knees displayed radiographic osteoarthritis approximating Kellgren-Lawrence grade ≥ 2. All follow-up MRIs displayed continuity of the PCL. Patients with more severe RPTT (> 3.7 mm), had worse scores in the KOOS subscales for symptoms (mean difference 14.5, 95% CI 7-22), sport/recreation (30, 95% CI 0-65) and quality of life (25, 95% CI 13-57) than those with less severe RPTT (≤ 3.7 mm). This was also the case for the KOOS₄ (22, 95% CI 9-34).

CONCLUSION

Acute PCL injuries treated non-surgically display a high degree of PCL continuity on MR images 11 years after injury. However, there is a large variation of posterior tibial translation with higher values being associated with poorer patient-reported outcomes.

Incidence and concomitant chondral injuries in a consecutive cohort of primary traumatic patellar dislocations examined with sub-acute MRI

PURPOSE

To present age- and sex-specific cumulative annual incidences of primary traumatic lateral patellar dislocation (LPD) and to detail patient characteristics and concomitant chondral injuries including osteochondral fractures, as visualized on magnetic resonance imaging (MRI), in a large consecutive cohort of knee-injured individuals.

METHODS

Data on primary traumatic lateral patellar dislocations were collected from a large consecutive cohort of knee injuries examined with sub-acute MRI in a single centre with a well-defined catchment area. Annual incidences for different age-groups in relation to gender were calculated together with the risk of concomitant chondral and osteochondral injury, during sports and in general.

RESULTS

A total of 184 primary patellar dislocations were identified in the cohort of 1145 acute knee injuries (n=175) and surgical records (n=9). Knee MRI was performed within a median of six days of injury. Median age of patients with primary LPD was 16 years (interquartile range, 14-21; range, 9-47) and 41% were females. Males were significantly older than females at the time of injury (median age 17 vs. 15, P = 0.021) and sustained their primary LPD during sports more often than females (65 vs. 40%, P < 0.001). Primary LPD occurred most frequently at the age of 13 to 15 years where the annual incidence was 125 (95% CI, 96-160) per 100,000 persons. The overall annual incidence of primary LPD was 14 (95% CI, 12-16) per 100,000 persons, with a predominance of males versus females (17 vs. 11, P = 0.01). Concomitant lesions to joint surfaces were displayed on MRI or during surgery in 75 (43%) knees. Osteochondral fractures were seen in 32 knees (18%). We found no statistically significant difference in the risk of osteochondral fracture between those injured during sports or during leisure activity (14 vs. 24%, P = 0.08).

CONCLUSIONS

The annual incidence of first-time patellar dislocation was found to be 14 per 100,000 individuals with the highest incidence found among those aged 13-15 years. Primary LPD was more common among males and was sustained during sports activity in 55% of the cases. Associated injuries to the chondral surfaces should be expected in 43% of knees with primary LPD where 18% represent osteochondral fractures.

Optimizing Species Richness in Mosaic Landscapes: A Probabilistic Model of Species-Area Relationships

Most landscapes are comprised of multiple habitat types differing in the biodiversity they contain. This is certainly true for human modified landscapes, which are often a mix of habitats managed with different intensity, semi-natural habitats and even pristine habitats. To understand fundamental questions of how the composition of such landscapes affects biodiversity conservation, and to evaluate biodiversity consequences of policies that affect the composition of landscapes, there is a need for models able to translate information on biodiversity from individual habitats to landscape-wide predictions. However, this is complicated by species richness not being additive. We constructed a model to help analyze and solve this problem based on two simple assumptions. Firstly, that a habitat can be characterized by the biological community inhabiting it; i.e., which species occur and at what densities. Secondly, that the probability of a species occurring in a particular unit of land is dictated by its average density in the associated habitats, its spatial aggregation, and the size of the land unit. This model leads to a multidimensional species-area relation (one dimension per habitat). If the goal is to maximize species diversity at the landscape scale (γ-diversity), within a fixed area or under a limited budget, the model can be used to find the optimal allocation of the different habitats. In general, the optimal solution depends on the total size of the species pool of the different habitats, but also their similarity (β-diversity). If habitats are complementary (high β), a mix is usually preferred, even if one habitat is poorer (lower α diversity in one habitat). The model lends itself to economic analyses of biodiversity problems, without the need to monetarize biodiversity value, i.e., cost-effectiveness analysis. Land prices and management costs will affect the solution, such that the model can be used to estimate the number of species gained in relation to expenditure on each habitat. We illustrate the utility of the model by applying it to agricultural landscapes in southern Sweden and demonstrate how empirical monitoring data can be used to find the best habitat allocation for biodiversity conservation within and between landscapes.

Interactive proteogenomic exploration of response to Fusarium head blight in oat varieties with different resistance

Fusarium species are cereal pathogens that cause the Fusarium Head Blight (FHB) disease. FHB can reduce yield, cause mycotoxin accumulation in the grain and reduce germination efficiency of the harvested seeds. Understanding the biochemical interactions between the host plants and the pathogen is crucial for controlling the disease and for the development of cultivars with improved tolerance to FHB. Here, we studied morphological and proteomic differences between the susceptible oat variety Belinda and the more resistant variety Argamak using variety-specific transcriptome assemblies as references. Measurements of deoxynivalenol toxin levels confirmed the partial resistance in Argamak and the susceptibility in Belinda. To jointly investigate the proteomics- and sequence data, we developed an RShiny-based interface for interactive exploration of the dataset using univariate and multivariate statistics. When applying this interface to the dataset, quantitative protein differences between Belinda and Argamak were detected, and eighteen peptides were found uniquely in Argamak during infection, among them several lipoxygenases. Such proteins can be developed as markers for Fusarium resistance breeding. In conclusion, this study provides the first proteogenomic insight on molecular Fusarium-oat interactions at both morphological and molecular levels and the data are openly available through an interactive interface for further inspection. SIGNIFICANCE: Fusarium head blight causes widespread damage to crops, and chronic and acute toxicity to human and livestock due to the accumulation of toxins during infection. In the present study, two oat varieties with differing resistance were challenged with Fusarium to understand the disease better, and studied both at morphological and molecular levels, identifying proteins which could play a role in the defense mechanism. Furthermore, a proteogenomics approach allows joint profiling of expression and sequence level differences to identify potentially functionally differing mutations. Here such analysis is made openly available through an interactive interface which allows other scientists to draw further findings from the data. This study may both serve as a basis for understanding oat disease response and developing breeding markers for Fusarium resistant oat and future proteogenomic studies using the interactive approach described.

Diversity of avenanthramide content in wild and cultivated oats

Background. Oat grains accumulate substantial amounts of various phenolic compounds that possess biological activity and have a potential to considerably increase health benefits of oats as a food. Avenanthramides (AVA) is an important group of these compounds due to their antioxidant, anti-itching, anti-inflammatory, antiproliferative activities.

Materials and methods. Using combined HPLC and LC-MS analyses, we provide the first comprehensive review of the total avenanthramide content and composition in cultivated and wild oats. The AVA content was measured in 32 wild and 120 cultivated oat accessions obtained from the global collection of the N.I. Vavilov Institute of Plant Genetic Resources (VIR), St. Petersburg, Russia.

Results and conclusion. The wild hexaploid A. sterilis L. had the highest total AVA content, reaching 1825 mg kg–1. Among cultivated accessions, naked oat cv. ‘Numbat’ (Australia) had the highest AVA content, 586 mg kg–1. The AVA composition exhibited a wide diversity among the analyzed samples. Accessions were identified where AVAs A, B and C, which are generally considered as major AVA, had a low percentage, and instead other AVAs prevailed. The AVA content in eight oat cultivars revealed significant annual changes in both the total AVA content and the proportions of individual AVAs. Using HPLC analyses, 22 distinguishable peaks in AVA extracts of oat seeds were detected and quantified. Several of these peaks, which have not been previously documented, presumably represent different AVAs. Further analyses are needed to detail these findings and to determine the specific AVA structures in oat grains.

Acromioclavicular joint dislocations: incidence, injury profile, and patient characteristics from a prospective case series

Background

Acromioclavicular joint (ACJ) dislocations are common but evidence regarding the epidemiology of these injuries is incomplete. This study aims to describe the incidence, injury mechanisms, distribution of classifications, risk factors, and patient characteristics for ACJ dislocations in a general population.

Methods

Inclusion was performed prospectively during a 4-year period with the following criteria; age 18-75 years, shoulder trauma within 2 weeks, a clinical suspicion of ACJ dislocation, and radiographs that excluded fracture. The injuries were classified according to the Rockwood system, and epidemiologic variables were obtained. Rockwood types 1-2 were defined as low-grade injuries and types 3-6 as high-grade. Age groups were defined with a young group (18-39 years), an intermediate group (40-59), and an old group (60-75).

Results

A total of 158 patients were included; 139 were male and the mean age was 39 years (range 18-74). There were 73 low-grade and 85 high-grade injuries. The incidence was 2.0 [95% confidence interval (CI) = 1.7-2.4] per 10,000 person-years, gradually decreasing with higher age, groupwise. The incidence rate ratio (IRR) for men vs. women was 7.6 (95% CI = 4.7-12.6) and IRR >1 was seen comparing younger age groups to older. Odds ratio calculations showed that risk factors for high-grade injury were older age and traffic accidents.

Conclusion

The incidence of ACJ dislocations was 2.0 per 10,000 person-years in a general population. Male gender and younger age group were risk factors for injury, whereas the risk for high-grade injuries were greater in older patients and after traffic accidents.

Photolysis of mixtures of UV filters octocrylene and ethylhexyl methoxycinnamate leads to formation of mixed transformation products and different kinetics

The treatment with ultraviolet (UV) light is a well-known technique for water disinfection. Photodegradation by UV light is in discussion as measure for advanced water treatment that could provide a potential removal option for micropollutants. Micropollutants such as ingredients from personal care products are also present in grey water. Grey water gets increasingly attention as a source for water reuse. For that purpose it has to be treated. UV-treatment is an option. However, the knowledge on the fate of micropollutants within such a treatment is little. Therefore, we investigated the fate of the UV filters ethylhexyl methoxycinnamate (EHMC), and octocrylene (OCR) as for both UV filters the presence in grey water was reported. OCR as a single compound was investigated with regard to its degradation kinetics and possible photo-transformation products (photo-TPs). These results were compared with those of EHMC previously reported in literature. The mixture of the two UV filters was also investigated to reveal if mixture effects occur regarding the elimination of the UV filters and the formation of TPs. A medium pressure mercury vapor lamp (200-400 nm) was employed for photolysis. This study shows that OCR itself was eliminated below the limit of detection after 256 min and that photo-TPs were formed. The photolysis of the mixture demonstrated alterations of the degradation rates and patterns. Additional TPs were formed by the reaction of the UV filters or TPs with each other. The study shows that more attention should be paid to mixture-effects and mixture-TPs that may cause further follow-up effects.

The role of irradiation source setups and indirect phototransformation: Kinetic aspects and the formation of transformation products of weakly sunlight-absorbing pesticides

In this study, emission spectra of three different commonly used xenon irradiation sources were analyzed and compared for the first time to ascertain the most suitable setup to simulate natural solar radiation. In order to demonstrate setup differences, absolute photon fluxes of irradiation sources were received by actinometry. Verification was done by measuring quantum yields of the model compounds Penconazole, Terbutryn, and Mecoprop in every setup. Differences regarding kinetic aspects and the formation of transformation products (TPs) was evaluated by analyzing direct phototransformation and additionally photolysis in presence of Nitrate as a photosensitizer in one irradiation setup (optical bench). Results showed that a precise setup characterization is needed to estimate whether irradiation sources are suitable to simulate terrestrial sunlight. This was found to be especially important for weakly sunlight-absorbing substances. In comparison with direct photolysis, indirect photolysis led to an enhancement of degradation rate constants for all substances and in case of Mecoprop to different types of TPs that were formed during irradiation. This study underlined that there are big knowledge gaps regarding irradiation sources setups and conditions. It is therefore absolutely necessary to consider those factors while simulating substance degradation and the TP formation under environmental conditions.

Estimating effects of arable land use intensity on farmland birds using joint species modeling

Declines in European farmland birds over past decades have been attributed to the combined effects of agricultural intensification and abandonment. Consequently, aspirations to stop declines should focus attention on reversing these changes through voluntary or policy-driven interventions. The design of such interventions should ideally be informed by scientific knowledge of which aspects of the transformation of agricultural landscapes have contributed to the farmland bird declines. Declines may be associated with loss of natural habitats or the intensification and homogenization of land use management on production land, and furthermore, these changes may interact. Here, we applied an orthogonal design exploiting spatial variation in land use in a major agricultural region of Sweden to seek evidence for benefits to farmland birds of reversing some of the intensifications on and among arable fields and whether effects are modified by the availability of seminatural habitats (pastures and field borders) in the landscape. We accounted for the potentially confounding effect of interactions between species by using a joint species distribution model explicitly controlling for additional variation and covariation among species. We found that interventions aimed specifically at land in production could provide benefits to farmland birds. Landscapes with a higher proportion leys or fallows and/or with a more diverse set of crops held higher abundances of most farmland birds. However, effects were only apparent in landscapes with low availability of seminatural habitats and were sometimes even negative in landscapes with high amounts of such habitats, demonstrating context dependence. Even if we found little evidence of interactions between species, the joint modeling approach provided several benefits. It allowed information to be shared between species making analyses robust to uncertainty due to low abundances and provided direct information about the mean and variability in effects of studied predictors among species. We also found that care needs to be taken regarding prior and distributional assumptions as the importance of species interactions might otherwise be overstated. We conclude that this approach is well suited for evaluating agricultural policies by providing evidence for or against certain interventions or to be linked to policy scenarios of land use change.

Competition, seed dispersal and hunting: what drives germination and seedling survival in an Afrotropical forest?

Disentangling the contributions of different processes that influence plant recruitment, such as competition and seed dispersal, is important given the increased human-mediated changes in tropical forest ecosystems. Previous studies have shown that seedling communities in an Afrotropical rainforest in southeastern Nigeria are strongly affected by the loss of important seed-dispersing primates, including Cross River gorillas (Gorilla gorilla diehli), chimpanzee (Pan troglodytes elioti) and drill (Mandrillus leucophaeus). Here we study how germination and survival of tree seedlings are affected by competition and reduced seed dispersal in three contiguous forest reserves, in southeastern Nigeria, with similar mature tree species composition and structure. We use an experimental design aimed at manipulating the effect of competition among seedlings in three protected and three hunted sites within the reserves. We use a total of sixty 5 × 5 m plots of three types: plots cleared of all seedlings, plots selectively cleared of all primate-dispersed seedlings and control plots. All seedlings were identified, measured, assigned to dispersal mode and tagged, and after 1 year we evaluated survival, mortality and new recruits. We found that in hunted sites germination of abiotically dispersed species was over four times higher in cleared plots compared to control plots, whereas germination of primate-dispersed species was the same, which indicated that dispersal limitation was the dominant force in seedling recruitment in hunted sites. This was supported by the fact that the germination of all dispersal modes in the selectively cleared plots in protected sites was similar to the control plots in the same sites, but germination of abiotically dispersed species was significantly lower than in cleared plots in hunted sites. Competition among seedlings was mostly evident from the fact that 75 % more seedlings of primate-dispersed species germinated in cleared compared to control plots in protected sites. We conclude that inter-seedling competition may be irrelevant to seedling recruitment in hunted sites, where dispersal limitation appears to be a much stronger force shaping the seedling plant community, and thus hunting indirectly reverses the importance of competition and dispersal limitation in structuring seedling communities.

The gracilis tendon autograft is a safe choice for orthopedic reconstructive procedures: a consecutive case series studying the effects of tendon harvesting

Background

The gracilis tendon is commonly used as an autograft to reconstruct torn tendons or ligaments in many parts of the body. Little is known about the subjective and functional outcome after gracilis tendon harvest. The aim of this study was to evaluate the outcome of the donor leg in patients undergoing such surgery.

Methods

Patients with chronic acromioclavicular joint dislocations undergoing coracoclavicular ligament reconstructions using autogenous gracilis tendon grafts were eligible for this study. The graft harvesting procedure was carried out in a standard fashion using a tendon stripper. Knee injury and Osteoarthritis Outcome Score (KOOS) were collected preoperatively and after 12 months. The first 5 patients were included retrospectively and lacked preoperative data, for these patients age- and gender matched normative KOOS scores were used as baseline values. Isometric knee flexor strength in 60° and 90° degrees of flexion was measured at final follow up at a median of 26 (14–56) months postoperatively with the non-operated leg used as reference.

Results

Twenty four patients were eligible for the study and 2 were excluded. The 22 patients available for analysis had a mean age of 44 (22–62) years at the time of surgery and 4 were women. There was no statistically significant change in KOOS 12 months postoperatively compared to baseline values but the patients were weaker in knee flexion in the operated leg compared to the non-operated one.

Conclusions

Gracilis tendon harvesting results in a weakness of knee flexion but does not impair subjective knee function and is a procedure that can be recommended when an autogenous tendon graft is needed.

Climate warming and land-use changes drive broad-scale floristic changes in Southern Sweden

Land-use changes, pollution and climate warming during the 20th century have caused changes in biodiversity across the world. However, in many cases, the environmental drivers are poorly understood. To identify and rank the drivers currently causing broad-scale floristic changes in N Europe, we analysed data from two vascular plant surveys of 200 randomly selected 2.5 × 2.5 km grid-squares in Scania, southernmost Sweden, conducted 1989-2006 and 2008-2015, respectively, and related the change in frequency (performance) of the species to a wide range of species-specific plant traits. We chose traits representing all plausible drivers of recent floristic changes: climatic change (northern distribution limit, flowering time), land-use change (light requirement, response to grazing/mowing, response to soil disturbance), drainage (water requirement), acidification (pH optimum), nitrogen deposition and eutrophication (N requirement, N fixation ability, carnivory, parasitism, mycorrhizal associations), pollinator decline (mode of reproduction) and changes in CO₂ levels (photosynthetic pathway). Our results suggest that climate warming and changes in land-use were the main drivers of changes in the flora during the last decades. Climate warming appeared as the most influential driver, with northern distribution limit explaining 30%-60% of the variance in the GLMM models. However, the relative importance of the drivers differed among habitat types, with grassland species being affected the most by cessation of grazing/mowing and species of ruderal habitats by on-going concentration of both agriculture and human population to the most productive soils. For wetland species, only pH optimum was significantly related to species performance, possibly an effect of the increasing humification of acidic water bodies. An observed relative decline of mycorrhizal species may possibly be explained by decreasing nitrogen deposition resulting in less competition for phosphorus. We found no effect of shortage or decline of pollinating lepidopterans and bees.

High rate of latent tuberculosis treatment completion in immigrants seeking asylum in Sweden

BACKGROUND/AIM

Treatment of latently infected individuals at increased risk of reactivation is a cornerstone in tuberculosis control. Although asylum seekers without residence permit in Sweden are offered screening for both active tuberculosis and latent tuberculosis infection (LTBI), treatment for LTBI is often not initiated due to anticipated low rates of treatment completion. We aimed to compare completion rates for LTBI treatment between asylum seekers and other patients, and between asylum seekers with and without residence permit.

METHODS

Data were collected retrospectively from tuberculosis clinic registers and medical records. For comparison of treatment completion rates, relative risks (RR) and confidence intervals (CI) were calculated. Predictors of completion were assessed by logistic regression multivariate analysis.

RESULTS

Treatment completion was achieved in 506/606 subjects (83%). RR of non-completion for asylum seekers (n = 297) compared to other subjects (n = 309) was 1.13 (95% CI: 0.79-1.61; p = .51), and 0.91 (95% CI: 0.53-1.56; p = .72) for asylum seekers without residence permit (n = 217) compared to asylum seekers with residence permit (n = 80). Completion rates increased from 53% in 2008 to 92% in 2015-2016. The following factors were associated with completion: scheduled interpreter-assisted appointments throughout the course of therapy, shorter treatment duration (6 vs. 9 months), and being treated in connection with immunosuppressive therapy.

CONCLUSION

Treatment completion rates were similar between asylum seekers and other subjects, supporting initiation of latent tuberculosis treatment in immigrants with recent arrival to low-endemic countries.

Comparison and analysis of reoperations in two different treatment protocols for trochanteric hip fractures - postoperative technical complications with dynamic hip screw, intramedullary nail and Medoff sliding plate

Background

In treatment of unstable trochanteric fractures dynamic hip screw and Medoff sliding plate devices are designed to allow secondary fracture impaction, whereas intramedullary nails aim to maintain fracture alignment. Different treatment protocols are used by two similar Swedish regional emergency care hospitals. Dynamic hip screw is used for fractures considered as stable within the respective treatment protocol, whereas one treatment protocol (Medoff sliding plate/dynamic hip screw) uses biaxial Medoff sliding plate for unstable pertrochanteric fractures and uniaxial Medoff sliding plate for subtrochanteric fractures, the second (intramedullary nail/dynamic hip screw) uses intramedullary nail for subtrochanteric fractures and for pertrochanteric fractures with intertrochanteric comminution or subtrochanteric extension. All orthopedic surgeries are registered in a regional database.

Methods

All consecutive trochanteric fracture operations during 2011–2012 (n = 856) and subsequent technical reoperations (n = 40) were derived from the database. Reoperations were analysed and classified into the categories adjustment (percutaneous removal of the locking screw of the Medoff sliding plate or the intramedullary nail, followed by fracture healing) or minor, intermediate (reosteosynthesis) or major (hip joint replacement, Girdlestone or persistent nonunion) technical complications.

Results

The relative risk of intermediate or major technical complications was 4.2 (1.2–14) times higher in unstable pertrochanteric fractures and 4.6 (1.1–19) times higher in subtrochanteric fractures with treatment protocol: intramedullary nail/dynamic hip screw, compared to treatment protocol: Medoff sliding plate/dynamic hip screw. Overall rates of intermediate and major technical complications in unstable pertrochanteric and subtrochanteric fractures were with biaxial Medoff sliding plate 0.68%, with uniaxial Medoff sliding plate 1.4%, with dynamic hip screw 3.4% and with intramedullary nail 7.2%.

Conclusions

The treatment protocol based on use of biaxial Medoff sliding plate for unstable pertrochanteric and uniaxial Medoff sliding plate for subtrochanteric fractures reduced the risk of severe technical complications compared to using the treatment protocol based on dynamic hip screw and intramedullary nail.

Photodegradation of the UV filter ethylhexyl methoxycinnamate under ultraviolet light: Identification and in silico assessment of photo-transformation products in the context of grey water reuse

To prevent water shortages in the future and to reduce domestic water consumption, decentralized grey water (GW) reuse has become increasingly important. This water has, however, to be free of pollutants. Conventional treatment of GW does not fully eliminate micropollutants such as the UV filter substance ethylhexyl methoxycinnamate (EHMC). EHMC, which is commonly used in sunscreens and personal care products, is an endocrine disruptor and shows potential to bioaccumulation, which is also reflected in its low water solubility. Photolysis has been proposed as an alternative treatment method for other micropollutants, but it is not clear yet whether it can also be used to eliminate EHMC. One goal of this study was to better understand the basic pathways involved in this process. It aimed to identify photo-transformation products (photo-TPs) by using, in the test conditions, an initial concentration of EHMC higher than those expected in the environment. Acetonitrile (ACN) was added in low concentrations to the aqueous solution to overcome the low aquatic solubility of EHMC. The influence of this co-solvent on the degradation kinetics was studied. The photolysis experiments were carried out using a medium pressure mercury lamp, which emits UV light in the range of 200-400nm. The quantum yield of the photolysis of EHMC was 0.0042 and 0.0023mol·Einstein^-1 (for 0.2 and 0.5% ACN (v/v), respectively), and the relative and absolute UV photon fluxes were determined. HPLC was used to monitor the elimination kinetics of EHMC, which followed first-order kinetics. The results of LC-MSⁿ analyses revealed that beside others, several oxidized and hydroxylized EHMC isomers were formed as photo-TPs in aqueous solution. Using a set of in silico quantitative structure-activity relationship (QSAR) models, this study also offered new insights concerning the environmental fate and toxicity of the TPs of EHMC.

Body Temperature Regulation in Hot Environments

Organisms in hot environments will not be able to passively dissipate metabolically generated heat. Instead, they have to revert to evaporative cooling, a process that is energetically expensive and promotes excessive water loss. To alleviate these costs, birds in captivity let their body temperature increase, thereby entering a state of hyperthermia. Here we explore the use of hyperthermia in wild birds captured during the hot and dry season in central Nigeria. We found pronounced hyperthermia in several species with the highest body temperatures close to predicted lethal levels. Furthermore, birds let their body temperature increase in direct relation to ambient temperatures, increasing body temperature by 0.22°C for each degree of increased ambient temperature. Thus to offset the costs of thermoregulation in ambient temperatures above the upper critical temperature, birds are willing to let their body temperatures increase by up to 5°C above normal temperatures. This flexibility in body temperature may be an important mechanism for birds to adjust to predicted increasing ambient temperatures in the future.

Physico-chemical characteristics affect the spatial distribution of pesticide and transformation product loss to an agricultural brook

Diffuse entry of pesticide residues from agriculture into rivers is spatially unevenly distributed. Therefore, the identification of critical source areas (CSAs) may support water quality management in agricultural catchments. In contrast to former studies, we followed the hypothesis that not only hydrological and topographical characteristics but also physico-chemical properties of pesticide residues have a major influence on their loss to rivers and on corresponding formation of CSAs. We designed a virtual experiment, i.e. a numerical experiment as close as possible to environmental conditions, in a headwater catchment where pronounced spatial differences in hydrological transport processes were identified in the past. 144 scenarios with different combinations of adsorption coefficients (KOC = 10-1000 ml/g) and transformation half-lives (DT50 = 3-60 days) for pesticide parent compounds (PCs) and their transformation products (TPs) were simulated using the catchment-scale spatially distributed reactive transport model ZIN-AgriTra. Export fractions of substances in the virtual experiment ranged from 0.001-15% for pesticides and 0.001-1.8% for TPs. The results of the scenario investigations suggest that more of the calculated export mass variability could be attributed to KOC than to DT50 for both PCs and TPs. CSAs for TPs were spatially more equally distributed in the catchment than for PC export which was likely an effect of changing physico-chemical properties during transformation. The ranking of highest export fields was different between PCs and TPs for most of the investigated scenarios but six fields appeared among the top ten export fields in 95% of the scenarios, which shows the influence of site characteristics such as tile drains or soil properties in the catchment. Thus, the highest export fields were determined by a combination of site characteristics and substance characteristics. Therefore, despite the challenge of widely differing physico-chemical characteristics of pesticides on the market, these characteristics are an important consideration when delineating pesticide residue CSAs.

More Efficient Virtual Shadow Maps for Many Lights

Recently, several algorithms have been introduced that enable real-time performance for many lights in applications such as games. In this paper, we explore the use of hardware-supported virtual cube-map shadows to efficiently implement high-quality shadows from hundreds of light sources in real time and within a bounded memory footprint. In addition, we explore the utility of ray tracing for shadows from many lights and present a hybrid algorithm combining ray tracing with cube maps to exploit their respective strengths. Our solution supports real-time performance with hundreds of lights in fully dynamic high-detail scenes.

Phosphorus and carbon availability regulate structural composition and complexity of AM fungal mycelium

The regulation of the structural composition and complexity of the mycelium of arbuscular mycorrhizal (AM) fungi is not well understood due to their obligate biotrophic nature. The aim of this study was to investigate the structure of extraradical mycelium at high and low availability of carbon (C) to the roots and phosphorus (P) to the fungus. We used monoxenic cultures of the AM fungus Rhizophagus irregularis (formerly Glomus intraradices) with transformed carrot roots as the host in a cultivation system including a root-free compartment into which the extraradical mycelium could grow. We found that high C availability increased hyphal length and spore production and anastomosis formation within individual mycelia. High P availability increased the formation of branched absorbing structures and reduced spore production and the overall length of runner hyphae. The complexity of the mycelium, as indicated by its fractal dimensions, increased with both high C and P availability. The results indicate that low P availability induces a growth pattern that reflects foraging for both P and C. Low C availability to AM roots could still support the explorative development of the mycelium when P availability was low. These findings help us to better understand the development of AM fungi in ecosystems with high P input and/or when plants are subjected to shading, grazing or any management practice that reduces the photosynthetic ability of the plant.

A model for habitat selection and species distribution derived from central place foraging theory

We have developed a habitat selection model based on central place foraging theory. An individual's decision to include a patch in its habitat depends on the marginal fitness contribution of that patch, which is characterized by its quality and distance to the central place. The essence of the model we have developed is a fitness isocline which is a function of patch quality and travel time to the patch. It has two parameters: the maximum travel distance to a patch of infinite quality and a coefficient that appropriately scales quality by travel time. Patches falling below the isocline will have positive marginal fitness values and should be included in the habitat. The maximum travel distance depends on the availability and quality of patches, as well as on the forager's life history, whereas the scaling parameter mostly depends on life history properties. Using the model, we derived a landscape quality metric (which can be thought of as a connectivity measure) that sums the values of available habitat in the landscape around a central place. We then fitted the two parameters to foraging data on breeding white storks (Ciconia ciconia) and estimated landscape quality, which correlated strongly with reproductive success. Landscape quality was then calculated for a larger region where re-introduction of the species is currently going on in order to demonstrate how this model can also be regarded as a species distribution model. In conclusion, we have built a general habitat selection model for central place foragers and a novel way of estimating landscape quality based on a behaviorally scaled connectivity metric.

Is population structure in the European white stork determined by flyway permeability rather than translocation history?

European white stork are long considered to diverge to eastern and western migration pools as a result of independent overwintering flyways. In relatively recent times, the western and northern distribution has been subject to dramatic population declines and country-specific extirpations. A number of independent reintroduction programs were started in the mid 1950s to bring storks back to historical ranges. Founder individuals were sourced opportunistically from the Eastern and Western European distributions and Algeria, leading to significant artificial mixing between eastern and western flyways. Here we use mitochondrial and microsatellite DNA to test the contention that prior to translocation, eastern and western flyways were genetically distinct. The data show a surprising lack of structure at any spatial or temporal scale suggesting that even though birds were moved between flyways, there is evidence of natural mixing prior to the onset of translocation activities. Overall a high retention of genetic diversity, high N_ef, and an apparent absence of recent genetic bottleneck associated with early 20th century declines suggest that the species is well equipped to respond to future environmental pressures.