Network community structure of substorms using SuperMAG magnetometers

Geomagnetic substorms are a global magnetospheric reconfiguration, during which energy is abruptly transported to the ionosphere. Central to this are the auroral electrojets, large-scale ionospheric currents that are part of a larger three-dimensional system, the substorm current wedge. Many, often conflicting, magnetospheric reconfiguration scenarios have been proposed to describe the substorm current wedge evolution and structure. SuperMAG is a worldwide collaboration providing easy access to ground based magnetometer data. Here we show application of techniques from network science to analyze data from 137 SuperMAG ground-based magnetometers. We calculate a time-varying directed network and perform community detection on the network, identifying locally dense groups of connections. Analysis of 41 substorms exhibit robust structural change from many small, uncorrelated current systems before substorm onset, to a large spatially-extended coherent system, approximately 10 minutes after onset. We interpret this as strong indication that the auroral electrojet system during substorm expansions is inherently a large-scale phenomenon and is not solely due to many meso-scale wedgelets.

A Quasi-Experimental Evaluation of an Education Program for the Use of Electrical Stimulation Therapy to Heal Pressure Injuries

Electrical stimulation (E-Stim) involves applying low levels of electrical current. Despite high-level recommendations for E-stim use in many pressure injury (PrI) best practice treatment guidelines, clinicians seldom use E-Stim.

PURPOSE

This quasi-experimental design study aimed to determine whether an educational program could improve health care providers' knowledge and attitudes regarding the use of E-Stim for treating PrIs in community-dwelling individuals with spinal cord injury living in 1 region of Ontario, Canada.

METHODS

An educational intervention based on a university-level continuing education program was developed as part of a multifaceted knowledge mobilization project. Health care providers (eg, nurses, physicians, and allied health professionals) from multiple agencies were invited to participate. The instructional series included 8 online modules on background theory and knowledge and a hands-on workshop that familiarized participants with the equipment necessary to deliver E-Stim. Knowledge (percentage of correct answers using a knowledge test developed by the research team) and attitudes (assessed using the E-Stim Attitude Survey in which items were scored using a 5-point Likert scale (where 0 indicated a negative attitude and 5 a positive attitude) were evaluated 3 times (pre-education, post-online, and post-workshop). Data were aggregated into unit-weighted averaged composites of 3 attitude subscales (resources, evidence-based practice, and education), which were compared before and after educational sessions using a linear mixed effect model.

RESULTS

Among the 83 participants, a significant increase in knowledge scores was noted from pre-education (55.9%) to post-online (78.4%) and post-workshop (78.0%) (X² [2] = 89.34; P <.001). A significant increase in attitude scores was noted across time points (resources: X² [2] = 27.32, P <.0001; evidence-based practice: X² [2] = 38.93, P <.0001; and education: X² [2] = 92.88, P <.0001). For the evidence-based practice subscale, attitude increased significantly post-online (t[127] = 6.03, P <.0001). For the resources subscale, a significant increase was detected after post-workshop (t[113] = 5.23, P <.001].

CONCLUSIONS

Online education increased health care providers' knowledge about E-Stim; however, hands-on workshops were required to change certain attitudes about the use of E-Stim for wound healing. Further research is required to evaluate 1) whether a change in knowledge and attitude scores translates to a practice change for health care providers and 2) the potential importance of ongoing coaching and mentorship for a sustainable change in the clinical setting.

Military assistance to the civil authority: medical liaison with the Manchester clinicians after the Arena bombing

UK Defence Medical Services’ personnel have experienced an intense exposure to patients injured during war over the last decade and a half. As some bitter lessons of war surgery were relearned and innovative practices introduced, outcomes for patients impr oved consistently as experience accumulated. The repository of many of the enduring lessons learnt at the Role 4 echelon of care remain at the Queen Elizabeth Hospital Birmingham (QEHB), with the National Health Service and Defence Medical Services personnel who treated the returning casualties. On 22 May 2017, a terrorist detonated an improvised explosive device at the Manchester Arena, killing 22 and wounding 159 people. In the aftermath of the event, QEHB was requested to provide support to the Manchester clinicians and teleconferencing and then two clinical visits were arranged. This short report describes the nature of the visits, outlines the principles of Military Aid to the Civil Authority and looks to the future role of the Defence Medical Services in planning and response to UK terrorism events.

A Systematic Review and Meta-analysis of Exercise Intervention for the Treatment of Calf Muscle Pump Impairment in Individuals with Chronic Venous Insufficiency

Exercise intervention for individuals with chronic venous insufficiency (CVI) and venous leg ulcers (VLUs) is recommended to improve function of the calf muscle pump (CMP). A systematic review with meta-analysis was conducted to measure the effects of exercise (including function of the CMP, ankle strength, range of motion [ROM], and healing rates) for VLUs. Four (4) databases (Cumulative Index to Nursing and Applied Health Literature, 1981; MEDLINE, 1964; Scopus, 1966; and EMBASE, 1947) were searched for relevant articles from the date of index inception to January 2016. All study types that evaluated the effect of exercise on the function of the CMP in patients with CVI were included; narrative and systematic studies were excluded. All data were extracted by 1 reviewer onto a predetermined form and verified by a second reviewer. Data extracted included number of patients, primary diagnosis, patient demographics, study location, wound characteristics, inclusion/exclusion criteria, exercise group details, control group details, co-interventions, primary outcome measures, secondary outcome measures, wound healing measures, blinding, intention to treat, and study design. A total of 1325 articles was screened; 14 met the inclusion criteria (total study participants = 519). CMP hemodynamics were assessed using air plethysmography measurement results from the included studies. A meta-analysis of 8 articles was distilled to 3 with relevant data (83 participants) that found a significant increase on CMP ejection fraction in favor of the exercise group (Hedge's g = 0.83; 95% CI 0.35-1.30, P <.001) compared to control. CMP residual venous fraction also favored the exercise group (Hedge's g = 0.42; 95% CI -0.03-0.862, P = .066). Ankle ROM was higher in the exercise group (116 participants; Hedge's g = 0.62; 95% CI -0.15-1.39, P = .116); however, these differences were not significantly different from controls. Exercise directed at improving calf muscle strength and ankle ROM for individuals with or at risk for VLUs improves CMP hemodynamics and function. Additional research using larger sample sizes to confirm the role of exercise in healing VLUs is warranted.

Mitigating noise-induced hearing loss after blast injury

Introduction

Whilst hearing injuries are not life threatening they may have a profound impact on the victim’s ability to understand and interact with the world around them. Noise-induced hearing loss is a common occupational injury and hearing impairment as a consequence of noise and blast exposure remains the most common injury in both war and peace for military personnel. Health and Safety legislation has made an impact and in the future innovative approaches to mitigate against acoustic injury sustained in the work place will be fundamental. For the Armed Forces, noise exposure during conflict is unpredictable. Furthermore, recent events in the UK and elsewhere have highlighted the potential civilian impact of blast injuries on hearing in the acute setting. No well-established protocol for the management of acute, blast-induced hearing injury currently exists.

Methods

Narrative review is supported by electronic literature searches of PubMed, Embase and the Cochrane Library. Synthesis of published literature and production of flow charts for the acute setting are part of the Emergency Preparedness, Resilience and Response programme.

Results

Whilst there is a lack of high-quality randomised controlled trials, there are a number of studies that may inform our choice of acute management. Animal studies of acute acoustic trauma have shown the potential protective effects of corticosteroids. Human data may be extrapolated from sudden onset sensorineural hearing loss where again there is evidence for the use of corticosteroids. Less certainty exists around the use of other treatments including antioxidants. Intratympanic administration of corticosteroids may be superior to oral administration, particularly in the salvage setting. No evidence exists specifically pertaining to the paediatric population.

Conclusion

Prompt identification of any hearing deficit followed by administration of glucocorticoids either orally or via intratympanic preparations is the mainstay of management. Further research is needed to identify the optimum acute management.

A prospective, multicenter study to validate use of the PUSH in patients with diabetic, venous, and pressure ulcers

Monitoring wound progress is essential for evaluating and documenting treatment outcomes. The Pressure Ulcer Scale for Healing (PUSH) was developed to track pressure ulcer (PU) progress but information about its utility for other types of chronic wounds is limited. A 10-month, descriptive, multicenter study was conducted to examine the responsiveness and concurrent validity of the PUSH when used to monitor wound changes in diabetic foot (DFU), venous leg (VLU), and PU. Using a convenience sample of participants (n = 98, mean age 60 [range 20 to 89] years, the majority [85%] male), PUSH score and acetate wound surface area tracings were obtained at baseline and approximately 4 weeks later from 47 Stage II to Stage IV PU, 23 VLU, and 28 patients with a DFU. After an average of 32 days, wound surface area, total PUSH scores, and individual PUSH component scores decreased significantly between baseline and follow-up (P = 0.000). The mean PUSH score change was significantly different between healing and nonhealing wounds (P = 0.000). A strong relationship (r = .66) was found between total PUSH score and surface area. Results suggest the PUSH tool is a valid, responsive, evaluative tool to monitor and document wound progress of PU, VLU, and DFU. Additional studies to assess use of this tool for DFU and to ascertain the predictive validity of the PUSH tool are warranted.

Use of the skeletal survey in the evaluation of child maltreatment

The radiologic skeletal survey is an important tool for evaluating occult trauma in suspected child abuse. The purposes of this study were: (1) to determine the incidence of clinically unsuspected fractures detected by skeletal survey, and (2) to identify high-risk groups of children who would benefit from skeletal surveys. We retrospectively reviewed the medical records of 203 children admitted over a 30-month period to Children's National Medical Center for alleged physical abuse. Skeletal surveys were ordered based on the treating physicians' clinical suspicions. Patients in whom skeletal surveys were positive for an occult fracture were studied in more detail. There were 96 skeletal surveys performed; of these, 25 were positive for at least 1 clinically unsuspected fracture. Eighty percent of occult fractures were found in children younger than 1 year old. Presenting with a new fracture or an intracranial injury placed the child at higher risk of occult fracture. In contrast, patients with burn injuries had a very low yield of occult fractures. The patient's age and type of suspicious injury can help guide the physician as to when to obtain a skeletal survey.

Photosynthesis and the web: 2001

First, a brief history of the Internet and the World Wide Web is presented. This is followed by relevant information on photosynthesis-related web sites grouped into several categories: (1) large group sites, (2) comprehensive overview sites, (3) specific subject sites, (4) individual researcher sites, (5) kindergarten through high school (K-12) educational sites, (6) books and journals, and, 7) other useful sites. A section on searching the Web is also included. Finally, we have included an appendix with all of the web sites discussed herein as well as other web sites that space did not allow. Readers are requested to send comments, corrections and additions to gov@uiuc.edu.

Externalization of membrane-bound activities during sheep reticulocyte maturation is temperature and ATP dependent

During the maturation of sheep reticulocytes in vitro, there is release of material that can be pelleted from the cell-free incubation medium by centrifugation at 100,000 X g. This pellet contains activities that are derived from both the plasma membrane and lysosomes. No evidence was obtained for the presence of mitochondrial activities or cytosolic enzyme activities. The release of these activities is ATP and temperature dependent, since reduction of either results in a greater retention of the activities by the cells and a lesser amount in the 100,000 X g pellet. The pelleted material is vesicular in nature, and the production and (or) release of the material are reduced upon ATP depletion or lowering of the temperature. It is concluded that the externalization of specific membrane components is a normal metabolic process that occurs during reticulocyte maturation and represents a means by which reticulocytes shed specific types of membrane-associated functions that are known to decrease during reticulocytes maturation.

Vesicle formation during reticulocyte maturation. Association of plasma membrane activities with released vesicles (exosomes)

Vesicles are released during the in vitro culture of sheep reticulocytes which can be harvested by centrifugation at 100,000 X g for 90 min. These vesicles contain a number of activities, characteristic of the reticulocyte plasma membrane, which are known to diminish or disappear upon reticulocyte maturation. The activities include acetylcholinesterase, cytochalasin B binding (glucose transporter) nucleoside binding (i.e. nucleoside transporter), Na+-independent amino acid transport, and the transferrin receptor. Enzymes of cytosolic origin are not detectable or are present at low activity in the vesicles. Cultures of whole blood, mature red cells, or white cells do not yield comparable levels of these activities, supporting the conclusion that the activities arise from the reticulocytes. In addition, the lipid composition of the vesicles shows the high sphingomyelin content characteristic of sheep red cell plasma membranes, but not white cell or platelet membranes, also consistent with the conclusion that the vesicles are of reticulocyte origin. It is suggested that vesicle externalization may be a mechanism for shedding of specific membrane functions which are known to diminish during maturation of reticulocytes to erythrocytes.