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What happens to conservatively managed chronic subdural haematoma.
No full textBackground: Chronic subdural haematoma (CSDH) is a common neurosurgical problem, increasingly prevalent due to an ageing population. Conservative management is an option for asymptomatic or mild cases, though data on outcomes is limited. Aim/Objective: This study aims to address critical gaps in understanding around conservatively managedCSDH and whether there are features that can predict progression and the longer-term prognosis of these patients. Methods: A retrospective cohort study was performed at a major trauma centre in the UK. All patients with chronic subdural haematoma referred from March 2019 to March 2021 were included and grouped into surgical or conservative management. Demographic, outcome, and radiological data were collected from patient records and compared. Results: Of 289 patients, 90 had surgery and 199 were managed conservatively. Conservative patients were older (84 vs 77 years, p \u3c 0.0001), had more comorbidities (4 vs 2, p \u3c 0.0001), higher frailty (CFS \u3e 6: 45% vs 10%, p \u3c 0.0001), and greater anti-thrombotic use (57% vs 42%, p = 0.0175). Mortality was significantly higher in the conservative group at all time points including one month (16% vs 2%, p \u3c 0.0001), one year (42% vs 12%, p \u3c 0.0001) and two years (55% vs 21%, P \u3c 0.0001). Surgical patients had significantly greater midline shift (10 mm vs 2.6 mm, p \u3c 0.0001), and haematoma depth (24 mm vs 11 mm, p \u3c 0.0001). Only 3% of conservative patients crossed over to surgery. Conclusion: Our study highlights the high mortality rate in conservatively managed CSDH, with frailty as a key indicator for early death. The low crossover to surgery questions the necessity of radiological monitoring in conservatively managed CSDH
The Problem of Being the Problem: creating practice-based fieldworking along climate vulnerable coastlines
No full textFocused on multisensory encounter with local semi-flooded sea caves and their communities in the crowded shores of Torbay’s Marine Conservation Zone, South West UK, this thesis questions how art and writing, made out of art-based practices of fieldworking (Crone et al., 2022), can respond to the threats posed to climate vulnerable coastal habitats from the global phenomenon of sea level rise. It asks, what is response, and how does an approach emerge from bodily encounters with fragile marine cave ecologies . Enquiring how acts of prolonged noticing can bear witness, the research considers what it means to be human in such a place, asking what advantage the disturbance that art making (through performative practices and immersion in the field) brings to the act of witnessing. Drawing on feminist posthumanities and feminist new materialisms, this thesis takes a critical position regarding the idea of ‘witness’ in science and art. Informed by Susan Schuppli’s concept material witness (Schuppli 2020) and Stacy Alaimo’s notion of trans-corporeality (Alaimo, 2018), the work considers matter as archive and carrier. Further, it contends that biota and entities reliably bear witness.In an interweaving of artwork and writing, and drawing on material-discursive practices, this thesis considers sea caves through their various enmeshed relationships as phenomena, following Karen Barad’s writings on agential realism (Barad, 2003). The field work involves regular, repeated approaches to the habitats of very local marine caves, keeping to the rhythms of the tides while being sensitive to ecosystem temporalities. The artworks created are guided, performative field trips, performance lectures and immersive film and sound installations which fold in and through each other in a remixing of field data. This data is gathered using alternative ways of sensing such as ritual, augury, conjuring and incantation, as well as methods designed for extended sensing. These strategies are developed as means of sympathetic attunement to coastal ecologies that have long become compromised by carbon-intense imaginaries. The immersive installations are proposed as ‘remote witnessing technologies’ which transcribe the material conditions of site into sensual atmospheres aimed at generating estranged, affective states that accentuate a radical sympathy designed to nurture sensitivity for emergent intertidal worlds
Unravelling impact of comorbidities on mortality risks in CKD patients during the COVID-19 pandemic: An explainable AI-driven study
No full textObjectivesThe chronic kidney disease (CKD) patients were at high risk for severe clinical complications during the COVID-19 pandemic. Our objectives were to evaluate comorbidity prevalence; predict mortality risks for CKD patients during the pandemic; assess how various health factors interact to influence mortality; and provide insights for targeted prevention strategies.MethodWe analysed data from 186,396 CKD patients in Mexico during the entire pandemic (Jan 2020- May 2023). Explainable artificial intelligence (XAI) methods with extreme gradient boosting (XGBoost) models and Shapley Additive Explanations (SHAP) were developed to predict mortality for CKD patients with model interpretations. Different metrics were used to comprehensively evaluate model’s generalisation performances.ResultsThe most prevalent comorbidities were hypertension (64.39 %), diabetes (49.79 %), and obesity (16.46 %). Male patients and older individuals showed higher risk for adverse outcomes. The overall mortality rate was 19.33 %, with significantly higher mortality in COVID-19 positive patients (33.9 %) compared to COVID-19 negative patients (10.1 %). Comorbidities with the most significant impact on the mortality included diabetes, hypertension, and obesity, which were more frequent in the COVID-19 positive group and associated with higher rates of intubation, and ICU admission. Pneumonia was identified as a major predictor of negative outcomes in CKD patients with COVID-19. CVD was more common in the COVID-19 negative group. Our machine learning models achieved performances of AUC= 0.76 and F1-score= 0.75 for predicting mortality during the pandemic.ConclusionTargeted management of comorbid conditions, especially respiratory infections, is crucial in CKD patients during pandemics
Headwater drainage evolution in a foreland basin system usingsurfaces and topographic metrics (Zadorra River, Upper Ebro,Spain)
No full textForeland basins are elongate depressions that develop around the flanks of collisional mountain ranges. Rivers are key agents that shape their landscape geomorphology and evolution. Their upstream headwater areas are geomorphologically dynamic locations prone to drainage network reorganisations via headward erosion by the foreland axial river. They are complex areas to investigate due to geological complexity, the absence of fluvial deposits and long timescales over which drainage evolution occurs. In this study, we examined the Zadorra River, a headwater tributary to the Ebro River that preserves a diverse number of different geomorphological features that record long-term drainage evolution. Four key sectors with different surface configurations and topographic characteristics were identified. We have used surfaces (erosional, depositional and composite) in combination with topographic metrics (longitudinal profiles, hypsometry and drainage divide analysis) to understand the patterns and timing of fluvial incision linked to incision wave propagation and headwater drainage integration by the Mediterranean draining Ebro River. The study describes the drainage evolution of the Ebro headwaters, beginning with the trans-formation of internally drained basins into east- and south-directed tributaries. Thepaleo-Arakil River, closer to the advancing Ebro headwaters and Mediterranean divide, was integrated first through headward erosion, while the more distant proto-Zadorra River was integrated later. This spatial and temporal shift focused subsequent drainage evolution on the proto-Zadorra, whose northward erosion captured and beheaded the paleo-Arakil, forming the modern Zadorra-Ebro and Arakil-Ebro tributaries. Geological evidence and fluvial terraces indicate this headwater drainage integration spanned from the Miocene to the Quaternary and will continue northward in the future. The study highlights the geological and geomorphological complexity of foreland basin headwater regions and their interplay for drainage expansion and integration
Plio-Quaternary coastal uplift along the western Iberian Margin: insights from dated marine terraces (Peniche, Portugal)
Get PDFThis study presents a detailed geomorphological and geochronological analysis of a marine terrace staircase developed into the Peniche Peninsula (Portugal), a rocky headland of Jurassic carbonate bedrock located in the central sector of the Western Iberian passive margin. The marine terrace levels are described morphologically and sedimentologically, but also dated using ESR and U-Series methodologies. The marine terrace staircase comprises six emerged levels ranging from 4 m (above mean sea level, asl) (Tm6) to 24–28 m asl (Tm1), inset into a summit wave-cut platform at 29–45 m asl (Pm). The marine terrace sediments are composed of rounded boulders to cobbles and coarse sands. Dating results reveal that the marine terrace staircase spans ∼900 ka across the Middle-Late Pleistocene. The terraces can be assigned to either a single sea-level highstand or a level that has been re-occupied by two sea level highstands. The staircase records very low uplift rates (0.04 to −0.02 m/ka; the longer-term mean rate for the entire Pleistocene staircase is 0.03 m/ka), typical of a passive continental margin. Regionally, coastal terrace staircases are typically found along the Western Iberian passive margin, with their configuration locally influenced by the underlying bedrock geology and tectonic history
Thinning Antarctic glaciers expose high-altitude nunataks delivering more bioavailable iron to the Southern Ocean
No full textGlacial systems entrain and transfer sediment, rich in essential nutrients, from continental sources to the ocean, where they are released by meltwater. In the Southern Ocean, primary producers are limited by the availability of micronutrients, like iron (Fe), so any increase in continental sediment supply could enhance primary productivity and subsequent drawdown of atmospheric CO2. Here we provide a systematic account of labile Fe concentrations in Antarctic continental sediments. Ferrihydrite and crystalline Fe (oxyhydr)oxides were extracted from 27 Antarctic samples collected from nunataks, lateral moraines and blue ice areas in the Sør Rondane Mountains, East Antarctica. We report ascorbate extractable Fe (FeA) in all samples and enhanced precipitation of dithionite extractable Fe (FeD) in subaerially exposed mountain sediments. Our results suggest that as temperatures rise and Antarctic glaciers thin, newly exposed rock surfaces could supply more bioavailable iron to glacier systems, and subsequently the Southern Ocean
Assessing cognitive performance and comfort under simulated MRI noise and its association with autistic like traits
No full textMagnetic Resonance Imaging (MRI) scanners produce noise levels between 65 and 130 decibels. This noise, alongside the broader sensory environment of the MRI, poses challenges for individuals with autism spectrum disorder (ASD). Noise exposure has been shown to impair task performance, increase errors, and affect brain activity. ASD traits are associated with decreased sound tolerance, including hyperacusis, misophonia, and phonophobia. In ASD, noisy environments disrupt inferior frontal gyrus function, impairing task response and brain connectivity. Given this, it’s crucial to understand how these sensory challenges specifically affect ASD experience and performance during MRI procedures. This study assesses cognitive performance and comfort under simulated MRI noise and its association with autistic-like traits. Participants completed the AQ questionnaire before performing a computerised 3-back task under three noise conditions of MRI noise in a within-subjects design. Accuracy, hit rates, false alarm rates and comfort ratings were collected after each condition. A univariate ANOVA was conducted to analyse the effects of noise across different levels on task performance, correlated against AQ scores. The results suggest that individuals with more autistic traits may be less negatively affected by auditory distractions. While this study did not find statistical significance for the hypothesis, it does emphasise the differences in those with high ASD-like traits. These findings challenge assumptions about sensory sensitivity in ASD traits and suggest that cognitive adaptation mechanisms may influence noise tolerance, highlighting the need for individualised accommodations in MRI setting
Analysis of organic compounds extracted from recycled polypropylene via GC-FID/MS and Pyr-GC-MS for future pharmaceutical applications
No full textA mandatory target for 30% of plastic packaging to be recycled has been proposed by 2030, in order to mitigate the problem of plastic waste being incinerated or deposited in landfills. However, during the recycling process additives are added and with polypropylene being used for plastic packaging and surgical masks, these additives need to be analysed for the presence of contaminants. Examples include VOCs, PAHs, phthalates, and brominated diphenyl’s, all of which have health issues. Two samples of recycled polypropylene pellets were obtained from a national recycling company, along with a reference pellet purchased through Sigma-Aldrich. All pellets underwent ultrasound-assisted extraction (UAE) with three solvents; methanol (MeOH), acetonitrile:methanol (ACN:MeOH 2:1 v/v) and hexane (Hx). The methods used included multiphase (MPE), where all solvents were added to the same vial, and sequential (SE) involved each solvent in separate vials. The analytes were reconstituted with dichloromethane (DCM) before being analysed via gas chromatography-flame ionisation and mass spectrometry (GC-FID/MS) in full scan mode alongside 11 known plastic contaminants, e.g. diethyl phthalate and naphthalene. All three pellets were also analysed via Fourier Transform Infrared Spectroscopy (FTIR), to determine the chemical and physical properties. This confirmed that the pellets were polypropylene due to similar characteristic peaks to the reference pellet. All GC-FID data underwent retention time matching to the standards and confirmed through the GC-MS analysis. The results contained matches from C18-C20 n-alkanes, whilst Hx extracted from C14 onwards. This showed that by using hexane as a sequential solvent it removed all available analytes, whilst MPE did not due to hexane being immiscible in ACN. Main peak differences between all pellets were analysed through the NIST database to find many differences, e.g. 2,6,10,15-tetra-methyl-heptadecane was only present in the recycled pellets and not the reference pellet, meaning it is a by-product of the recycling process. All pellets also underwent analysis through pyrolysis gas chromatography mass spectrometry (Pyr-GC-MS), the thermal degradation of the solid pellet samples resulted in small chain polymer fragments. All differences were analysed through the NIST database to show that VOCs and phthalates were abundant in all, and through statistical analysis of three known peaks present in all, it was found that the reference pellet was significantly different, thus proving the formation of by-products through the recycling process. Only VOCs and dibutyl phthalate was found throughout, therefore, further analysis is needed to obtain the inorganic contaminants present through ICP-MS analysis, to analyse whether or not recycled plastics can be used as packaging for pharmaceutical products
Vacuum-Assisted Resin Transfer Moulding (VARTM): Can ultrasonic vibration decrease fill time, increase composite properties, and reduce void formation
No full textThis study investigated the potential of ultrasonic vibration (28 kHz) to optimize the Vacuum-Assisted Resin Transfer Moulding (VARTM) process. The aim was to assess whether introducing ultrasonic vibration during the resin infusion phase could reduce fill time, improve mechanical properties, and minimize void formation in glass fibre-reinforced polyester composites. Two flexible tooling systems were compared: a reusable silicone membrane and a traditional vacuum bag. Composite plates were manufactured with and without ultrasonic vibration for both systems. Fill time was observed, and post-cured samples were subjected to mechanical testing for flexural modulus, flexural strength, and interlaminar shear strength (ILSS). Void content and morphology were analysed using X-ray micro-CT scanning.
Results showed that ultrasonic vibration reduced fill time by approximately 15% when using the silicone membrane, but inconsistent resin flow patterns hindered precise measurement. In contrast, no significant change in fill time was observed with the vacuum bag. Mechanical testing revealed a consistent decrease in all key properties for samples manufactured with the silicone membrane under vibration, with reductions in modulus, flexural strength, and ILSS. Void content remained similar across all samples; however, void morphology worsened in silicone membrane samples, with increased clustering, larger void sizes, and decreased sphericity. For vacuum bagged samples, ultrasonic vibration improved mechanical properties for tri-axial composites, with increases of 4.2% in modulus, 200-240% in flexural strength, and 4-9% in ILSS. Void morphology also improved, with smaller and more evenly distributed voids.
The study concludes that while the silicone membrane offers environmental benefits due to its reusability, it is unsuitable for vibration-assisted VARTM due to its inability to effectively transmit ultrasonic vibrations. The vacuum bag demonstrated significant potential for vibration-enhanced composite manufacturing but requires further testing with larger sample sets to achieve statistical significance
Using evidenced-based practice to remove hyperkeratosis to improve wound healing in venous leg ulcer patients: a case study
No full text#400WORDS: NATIONAL NURSING ASSOCIATE SPECIAL EDITIO