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Case 339
No full textA 66-year-old male patient with a background history of hypertension and no history of liver disease was found to have mildly deranged liver function test results as part of his annual hypertension review. Clinical examination findings were unremarkable, the patient was afebrile (36.8 °C), and other vital observations were within normal limits. Full blood count and urea and creatinine levels were within normal limits; however, liver function tests revealed a mildly elevated alanine aminotransferase level of 61 IU/L (1.02 µkat/L) (reference range, 0–40 IU/L [0–0.67 µkat/L]), and a mildly elevated γ-glutamyltransferase level of 52 IU/L (0.88 µkat/L) (reference range, 0–50 IU/L [0–0.83 µkat/L]). The patient subsequently underwent US examination of the abdomen, which revealed a large liver lesion in an otherwise normal liver with no imaging features of cirrhosis. MRI of the liver was performed for further characterization (Fig 1). The patient subsequently underwent resection of the large mass and surgical pathology. Surveillance MRI was performed 4 months after surgery (Fig 2)
Shallow seawater oxygenation at ca. 1.44 Ga: A reflection of local seafloor oxygen oases or extensive water-column oxygenation?
No full textIt has been suggested that local marine oxygen oases could have formed during the Archean through the oxygenic photosynthesis of microbial mats residing in stromatolites. The ensuing mid-Proterozoic (ca. 1.8−0.8 Ga) was characterized by overall low atmospheric oxygen levels and pervasive oceanic anoxia below a shallow chemocline, but with increasing evidence for several intervals of transient oxygenation. However, since some of the oxygenation intervals have largely been documented by stromatolites, it remains unclear whether these oxygenation signals represent local seafloor oxygen oases or extensive seawater oxygenation. To address this issue, we have conducted a comparative investigation of the mineralogy and geochemistry of stromatolite-rich and stromatolite-poor sections formed during a prominent oxygenation interval in the ca. 1.44 Ga Tieling Formation of North China. Similar iodine concentration and cerium anomaly characteristics in the stromatolite column and inter-column carbonates suggest that no significant difference existed in terms of redox conditions between the stromatolites and the surrounding water column. Furthermore, the stromatolite-rich interval exhibits lower I/(Ca+Mg) values relative to the contemporaneous stromatolite-poor interval. This indicates that the photosynthetic oxygen production capacity of microbial mats developed in the Tieling Formation was limited and insufficient to significantly elevate seafloor oxygen levels. After considering our high-resolution I/(Ca+Mg) and carbonate-carbon isotope data alongside seawater redox investigations of other contemporary basins, we argue that the ca. 1.44 Ga interval of oxygenation may represent an extensive shallow seawater oxygenation event across multiple basins, but with local redox heterogeneity. Our study therefore provides new insight into the nature of oxygenation events recorded by stromatolites during the mid-Proterozoic
Further development of a patient-reported outcome measure to assess the impact of oral secretion problems in people living with MND
Get PDFObjective: Oral secretion problems are common yet poorly managed in people living with MND (plwMND). A validated patient-reported outcome for measuring saliva symptoms in this patient group would facilitate better monitoring of individuals. This study aimed to assess the validity, reliability and sensitivity to change of a revised version of the clinical saliva score for MND (CSS-MNDr).
Methods: Data were collected as part of a longitudinal, observational saliva management study. The CSS-MNDr, ALS Functional Rating Scale, a Global Rating of Change questionnaire and saliva-specific modified Likert scale were completed at each study visit, each of which probed the severity of saliva symptoms. Construct validity, test-retest reliability and sensitivity of the CSS-MNDr were assessed and the minimal important difference of the instrument was estimated.
Results: The CSS-MNDr showed excellent test-retest reliability (intraclass correlation coefficient >0.9). Construct validity showed the CSS-MNDr performed as expected, with bulbar-onset participants scoring significantly higher than those who reported limb-onset across all visits (group mean scores). Strong correlation of total scores with the ALSFRS-R saliva question was demonstrated (-0.8), with the thick subscore correlating less well (-0.5). A minimal important difference in the range of -2.5 to -3.6 over 3 months was estimated for worsening symptoms.
Conclusions: The CSS-MNDr has been validated as a reliable patient reported outcome for measuring saliva problems in plwMND. With separate scores for thick and thin secretion problems, the CSS-MNDr is the most comprehensive tool for assessing salivary problems in plwMND reported to date
Reframing the relationship between fertility and education in adolescence: 60 Years of evidence from Latin America
Get PDFIt is a demographic puzzle that Latin America and the Caribbean's high levels of adolescent fertility have persisted over the course of its dramatic fertility transitions and schooling expansions. These phenomena usually occur alongside postponements to entry into motherhood.
To tackle the puzzle, this study untangles, in basic mechanical terms, how the region has maintained such high levels of adolescent fertility. It also delves into the broader theoretical underpinnings of the relationship between schooling and the timing of fertility, which it categorizes into enrollment (i.e. incarceration) and aspirational effects.
The study uses 96 nationally representative demographic surveys from 15 countries in the region to produce cohort-based estimates of the magnitude and timing of parity-specific adolescent childbearing for school attainment profiles measured in single years. Changes in the likelihood of experiencing adolescent motherhood or having multiple births in adolescence for different schooling careers interlock with surprising findings regarding the timings of those births.
The results strongly suggest that school enrollment's ability to forestall fertility appears as effective today as it was over half a century ago, while schooling's aspirational influence has been dramatically modified under changing context and reorganized social hierarchies
Nutrient‐induced changes in root respiration in 10 woody plant species
Get PDF1. Nitrogen (N) and phosphorus (P) are soil macronutrients that influence ecosystem productivity through strong impacts on plant metabolism. The influence of nutrient supply on the relationships between leaf respiration rate (R) and leaf N concentration ([N]) has been widely investigated. By contrast, how root R responds to variations in nutrient availability and whether there remains a general response across a wide range of species is less well known.
2. We conducted an experiment assessing the effects of N and P supply on root R in 10 woody plant species, with root R being determined by the in vivo rate of oxygen (O2) consumption. Maximum R (Rmax) was also quantified by O2 uptake in the presence of an exogenous substrate and a respiratory uncoupler
3. Our results showed that high-N and high-P supply significantly stimulated mass-based root R in woody plants, with the effects of N supply significant only when P supply was high. The promoting effect of high-P treatment remained consistent despite N supply. Root R-[N] bivariate relationships were altered by nutrient availability across all species, with higher root R at a given root [N] under low- than high-N supply. Similarly, root R at a given P concentration ([P]) was higher under low- than high-P supply. Root Rmax was significantly higher than in vivo R for all nutrient treatments, showing that in vivo root R was limited by substrate supply and/or adenylates, with no significant difference in R/Rmax ratios among nutrient treatments.
4. These results indicate that ecosystem models should consider different scaling relationships linking root R to root N or P concentrations for woody species when predicting the effects of nutrient availability on carbon cycle dynamics and climate–biosphere feedback
Artificial intelligence–assisted capsule endoscopy versus conventional capsule endoscopy for detection of small bowel lesions: a systematic review and meta‐analysis
Get PDFBackground
Capsule endoscopy (CE) is a valuable tool used in the diagnosis of small intestinal lesions. The study aims to systematically review the literature and provide a meta-analysis of the diagnostic accuracy, specificity, sensitivity, and negative and positive predictive values of AI-assisted CE in the diagnosis of small bowel lesions in comparison to CE.
Methods
Literature searches were performed through PubMed, SCOPUS, and EMBASE to identify studies eligible for inclusion. All publications up to 24 November 2024 were included. Original articles (including observational studies and randomized control trials), systematic reviews, meta-analyses, and case series reporting outcomes on AI-assisted CE in the diagnosis of small bowel lesions were included. The extracted data were pooled, and a meta-analysis was performed for the appropriate variables, considering the clinical and methodological heterogeneity among the included studies. Comprehensive Meta-Analysis v4.0 (Biostat Inc.) was used for the analysis of the data.
Results
A total of 14 studies were included in the present study. The mean age of participants across the studies was 54.3 years (SD 17.7), with 55.4% men and 44.6% women. The pooled accuracy for conventional CE was 0.966 (95% CI: 0.925–0.988), whereas for AI-assisted CE, it was 0.9185 (95% CI: 0.9138–0.9233). Conventional CE exhibited a pooled sensitivity of 0.860 (95% CI: 0.786–0.934) compared with AI-assisted CE at 0.9239 (95% CI: 0.8648–0.9870). The positive predictive value for conventional CE was 0.982 (95% CI: 0.976–0.987), whereas AI-assisted CE had a PPV of 0.8928 (95% CI: 0.7554–0.999). The pooled specificity for conventional CE was 0.998 (95% CI: 0.996–0.999) compared with 0.5367 (95% CI: 0.5244–0.5492) for AI-assisted CE. Negative predictive values were higher in AI-assisted CE at 0.9425 (95% CI: 0.9389–0.9462) versus 0.760 (95% CI: 0.577–0.943) for conventional CE.
Conclusion
AI-assisted CE displays superior diagnostic accuracy, sensitivity, and positive predictive values albeit the lower pooled specificity in comparison with conventional CE. Its use would ensure accurate detection of small bowel lesions and further enhance their management
Participatory transitional justice as anticipatory project: North Korea, diasporas and uncertain futures
Get PDFThis article examines how insights from the transitional justice literature can be applied to North Korea, where the political system prevents grassroots, participatory approaches to accountability, truth-telling, commemoration and reconciliation. The North Korean diaspora, while a potential grassroots community, largely consists of escapees with tenuous or secretive ties to their home country. We argue that the participatory elements of the anticipatory transitional justice efforts are necessarily transnational and must be focused on enabling conditions for a future transition scenario. Political opportunity structures, particularly those shaped by the South Korean state, are critical in facilitating victim engagement. Our findings contextualize the purpose of anticipatory efforts and highlight ways to better address challenges faced by victim constituencies. Additionally, we provide insight into how broader political and structural environments can enable or restrain meaningful action, offering strategies for advancing transitional justice in anticipation of change in North Korea
Intersectionality and the Role of Place in Ethnographic Research on Informal Recyclers' Livelihoods
Get PDFHow social structures such as gender, race, and class shape informal recyclers’ livelihoods and how they actively create and navigate space in their everyday lives remain understudied in the Global North. In this article I highlight how the diverse social identities of informal recyclers intersect to influence their livelihood activities, focusing on football tailgates as emblematic sites of consumption and discard. Football tailgates are social events where football fans socialise and party before a football game, and tailgaters are the fans who attend football tailgates. I investigated how the intersectionality of informal recyclers’ self- and externally perceived social identities shape their livelihood activity and explored how the identity of place determines it as a site of collection of recyclable material. The findings indicate that informal recyclers are self-conscious of the stereotyping, stigma, and discrimination associated with their self and externally perceived social identities. Low social class has the most impact on how informal recyclers engage in their livelihood. Their activities tend to be more acceptable at football tailgates than other places. I argue that the intersection of informal recyclers’ social identities with place and social capital unravels the dynamics that shape their participation in discard practices
Trespass to the ‘person' in the metaverse
Get PDFThe term ‘metaverse’ refers to a varied collection of internet-based virtual reality worlds in which, amongst other things, users across the globe can collaborate, socialise, trade, play games, access entertainment, or even work. Increasingly, technological innovations, such as high-resolution headsets and sensory (or ‘haptic’) clothing, are closing the experiential gap between such virtual environments and the ‘actual’ world, and broadening the scope of daily activities that the former can accommodate. Whilst this clearly presents opportunities, it also raises questions about the suitability and efficacy of existing legal rules for regulating user conduct within these platforms. Using English law as a case study, this paper specifically considers the various torts commonly referred to under the umbrella term of ‘trespass to the person’, evaluating the extent of their applicability within this novel context, and thereby illuminating issues that might, in time, require intervention from law and policy makers both within the case study context and beyond. It is argued that, as the qualitative difference between physical contact in the actual world and virtual contact in the metaverse becomes smaller, it will become increasingly difficult to justify applying the torts of trespass to the person differently in each context
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