A novel anatomo-physiologic high-grade spondylolisthesis model to evaluate L5 nerve stretch injury after spondylolisthesis reduction

L5 nerve palsy is a well-known complication following reduction of high-grade spondylolisthesis. While several mechanisms for its occurrence have been proposed, the hypothesis of L5 nerve root strain or displacement secondary to mechanical reduction remains poorly studied. The aim of this cadaveric study is to determine changes in morphologic parameters of the L5 nerve root during simulated intraoperative reduction of high-grade spondylolisthesis. A standard posterior approach to the lumbosacral junction was performed in eight fresh-frozen cadavers with lumbosacral or lumbopelvic screw fixation. Wide decompressions of the spinal canal and L5 nerve roots with complete facetectomies were accomplished with full exposure of the L5 nerve roots. A 100% translational slip was provoked by release of the iliolumbar ligaments and cutting the disc with the attached anterior longitudinal ligament. To evaluate the path of the L5 nerves during reduction maneuvers, metal bars were inserted bilaterally at the inferomedial aspects of the L5 pedicle at a distance of 10 mm from the midpoint of the L5 pedicle screws. There was no measurable change in length of the L5 nerve roots after 50% and 100% reduction of spondylolisthesis. Mechanical strain or displacement during reduction is an unlikely cause of L5 nerve root injury. Further anatomical or physiological studies are necessary to explore alternative mechanisms of L5 nerve palsy in the setting of high-grade spondylolisthesis correction, and surgeons should favor extensive surgical decompression of the L5 nerve roots when feasible.

Treatment of Dysphagia with Biofeedback and Functional Electrical Stimulation in a Patient with Wallenberg Syndrome: A Prospective Case Report

Biofeedback games and automated functional electrical stimulation (FES) can be used in the treatment of dysphagia. This case study aims to evaluate the effect of the treatment on a 77-year-old man with chronic Wallenberg syndrome and his and the therapist’s experiences when using this therapy form. The participant received intensive treatment for nine days with Facial Oral Tract Therapy, biofeedback games and FES. The Penetration Aspiration Scale was scored using Functional Endoscopic Evaluation of Swallowing at baseline and the end of the intervention period. Swallowing-specific parameters were measured daily, and interviews were conducted with the patient and therapist during the intervention period. The patient and therapist both expressed a positive attitude to the ease of use and usefulness of this technology, despite there being no measurable change in the participant’s swallowing and eating function and only small improvements in swallowing parameters. The experience from this study was that biofeedback games and FES gave only small improvements in swallowing for this participant but were motivating and easy to use. Further research is needed to investigate the effect of this therapy on other participants with a more robust research design.

Clinical Evaluation of a Self-Testing Kit for Vaginal Infection Diagnosis

Vaginitis is a common disorder among women of varying ages that arises from a change in the normal pH balance of vaginal bacteria or an infection. Characteristic symptoms of itching, irritation, and odor cause considerable discomfort and increase the risk of contracting other sexually transmitted infections. Because of the sensitive and personal nature of the condition, some women may be reluctant to seek treatment. This behavior not only fails to solve the problem but may also delay medical treatment and result in additional medical complications. The pH changes associated with vaginitis and vaginosis, which are characterized by the presence or absence of inflammation, respectively, are well known but can vary. For example, bacterial vaginosis and trichomoniasis infection will raise vaginal pH above 4.5, while vulvovaginal candidiasis does not result in any measurable change to pH. Nonetheless, diagnostic tools relying on pH measurement are a valuable approach from which additional testing and treatment may be launched. Here, we focused on the use of a vaginal self-test tool and tested 50 patients, including pregnant women. When used according to the instructions, the Hygeia Touch Self-Testing Kit for Vaginal Infection demonstrated over 88% accuracy compared to a clinical diagnostic workup, with a sensitivity of 87% and a specificity of 89% in the patients where the swab was correctly interpreted. This study demonstrated an effective self-test method with high acceptability among women that provided them with greater autonomy regarding health management.

Oral Ferric Maltol Does Not Adversely Affect the Intestinal Microbiome of Patients or Mice, But Ferrous Sulphate Does

Background and Aims: Altering dietary ferrous sulphate (FS) consumption exacerbates a murine model of colitis and alters the intestinal microbiome. We investigated the impact of oral ferric maltol (FM) and FS on mice with dextran sodium sulphate (DSS) induced colitis, and the microbiome of patients with iron deficiency. Methods: Mice had acute colitis induced, with 2% DSS for 5 days, followed by water. During this period, groups of mice were fed standard chow (200 ppm iron, SC, n = 8), or SC with 200ppm FS supplementation (n = 16, FSS), or SC with 200 ppm FM supplementation (n = 16, FMS). Clinical, pathological and microbiome assessments were compared at days 1 and 10. Fecal bacterial gDNA was extracted and the microbiome assessed by sequencing. Statistical inferences were made using MacQIIME. Principal Coordinates Analysis were used to visualize beta-diversity cluster analysis. Ten patients with IDA were treated with FS, and six with inactive inflammatory bowel disease received FM, supplements for four weeks: pre- and mid-treatment fecal samples were collected: the microbiome was assessed (see above). Results: In mice, after DSS treatment, there was a decrease in many genera in the SC and FSS groups: Lactobacillales increased in mice that received FMS. In humans, FS treatment led to an increase in five genera, but FM was not associated with any measurable change. The severity of DSS-induced colitis was greater with FSS than FMS. Conclusions: This study demonstrates differential and unique influences of ferric maltol and ferrous sulphate supplements on intestinal microbiota. These differences might contribute to the different side effects associated with these preparations.

A Comparative Study of Financial Crises: Fractal Dissection of Investor Rationality

Any non-linear dynamic system can be checked for structural properties only at the time of extremes/crises. Hence, in this research article we tried to investigate stock markets for visible patterns or structures in the vicinity of crashes. We used fractal dimension analysis for studying the volatility of prices and presence of noise and patterns in the time series data of NIFTY, SENSEX and gold. We found change in market predictability of the various time series in the surrounding of crash points. There was measurable change in persistence levels around rupture points. It can be concluded that excessive order in stock markets can choke the markets which then witness crashes to relieve this symmetry and resume randomness for normal functioning. We supported the results with behavioural biases and patterns of investors. The repetitive trading psychology, different intensity of emotions of investors towards their gains and losses, and onset of irrationality and fear leads to worsening of any financial crisis. The crashes can have devastating effects on the economy and the investors. We there have tried to find visible patterns that can serve as warning signals of an approaching crisis. This can be of special assistance to the investors, traders and speculators who enjoy playing in the stock market.

Effect of Hypoglycemia on Heart Rate Variability in People with Type 1 Diabetes and Impaired Awareness of Hypoglycemia

Background: People with impaired awareness of hypoglycemia (IAH) are at elevated risk of severe, potentially hazardous, hypoglycemia and would benefit from a device alerting to hypoglycemia. Heart rate variability (HRV) changes with hypoglycemia due to sympathetic activity. Since IAH is associated with suppressed sympathetic activity, we investigated whether hypoglycemia elicits a measurable change in HRV in patients with T1D and IAH. Method: Eligible participants underwent a modified hyperinsulinemic euglycemic hypoglycemic clamp (glucose nadir, 43.1 ± 0.90 mg/dl), while HRV was measured by a VitalConnect HealthPatch. Measurements of HRV included Root Mean Square of the Successive Differences (RMSSD) and low to high frequency (LF:HF) ratio. Wilcoxon rank-sum test was used for testing within-subject HRV changes. Results: We included 12 participants (8 female, mean age 57 ± 12 years, mean HbA1c 57 ± 5 mmol/mol (7.4 ± 0.4%)). Symptoms increased from 4.0 (1.5-7.0) at euglycemia to 7.5 (5.0-11.0) during hypoglycemia ( P = .003). In response to hypoglycemia, the LF:HF ratio and RMSSD increased when normalized for data obtained during euglycemia (both P < .01). The LF:HF ratio increased in 6 participants (50%) and declined in one other participant (8%). The RMSSD decreased in 3 (25%) and increased in 4 (33%) participants. In 2 patients, no change in HRV could be detected in response to hypoglycemia. Conclusions: This study reveals that hypoglycemia-induced changes in HRV are retained in the majority of people with T1D and IAH, and that these changes can be detected by a wearable device. Real-time HRV seems usable for detection of hypoglycemia in patients with IAH.

A Metabolic Mechanism for Anaesthetic Suppression of Cortical Synaptic Function in Mouse Brain Slices—A Pilot Investigation

Regulation of synaptically located ionotropic receptors is thought to be the main mechanism by which anaesthetics cause unconsciousness. An alternative explanation, which has received much less attention, is that of primary anaesthetic disruption of brain metabolism via suppression of mitochondrial proteins. In this pilot study in mouse cortical slices, we investigated the effect of disrupting cellular metabolism on tissue oxygen handling and cortical population seizure-like event (SLE) activity, using the mitochondrial complex I inhibitor rotenone, and compared this to the effects of the general anaesthetics sevoflurane, propofol and ketamine. Rotenone caused an increase in tissue oxygen (98 mmHg to 157 mmHg (p < 0.01)) before any measurable change in SLE activity. Thereafter, tissue oxygen continued to increase and was accompanied by a significant and prolonged reduction in SLE root mean square (RMS) activity (baseline RMS of 1.7 to 0.7 µV, p < 0.001) and SLE frequency (baseline 4.2 to 0.4 events/min, p = 0.001). This temporal sequence of effects was replicated by all three anaesthetic drugs. In conclusion, anaesthetics with differing synaptic receptor mechanisms all effect changes in tissue oxygen handling and cortical network activity, consistent with a common inhibitory effect on mitochondrial function. The temporal sequence suggests that the observed synaptic depression—as seen in anaesthesia—may be secondary to a reduction in cellular metabolic capacity.

56 Quality Improvement Project on the Bowel Charts in An Elderly Care Ward in Basildon University Hospital

Background To improve the rate of documentation on bowel charts on an elderly care ward with a significant percentage of patients suffering from dementia. Importance As a junior doctor working on an elderly care ward with patients who often had memory problems and were unable to recall their bowel patterns, it was extremely challenging to establish whether a particular patient has constipation or diarrhoea. Constipation in an elderly patient can lead to multiple complications like urinary retention, intestinal obstruction and often decreased oral intake. Methods An audit was carried out to see the rate of completion of the Bowel charts on the ward. Only about 23% of the bowel charts on the ward were complete in the initial survey. Then interventions were introduced in steps and three more audits were done. At each step, we were able to show how the interventions introduced changed the degree of completion of the bowel charts. Outcome We have seen a marked improvement of 37% since the start of the project 5 months ago. From 23% to 60% completion of bowel charts. There appeared to be a sustained change only falling short at the weekends (due to staffing issues) Overall awareness had increased vastly. We were able to make a measurable change and improvement in the quality of care provided.

Refractive change in children with accommodative esotropia

ObjectiveTo determine whether there is a measurable change in hyperopia in children with accommodative esotropia over time.Methods and analysisA retrospective cohort of children with fully or partially accommodative esotropia diagnosed by age 7 years, followed to age 10 or older, and with at least two cycloplegic refractions, one before age 7 years and one after age 10 years. The annual change was calculated from linear mixed-effect models, overall and during two age periods with subgroup analysis by baseline refractive error (<4D, ≥4D) and type (partial, full) of accommodative esotropia.Results405 subjects were studied. Mean age at first and last visit was 3.2 and 12.1 years, respectively, with mean 7.6 cycloplegic refractions. The annual change (95% CI) in refractive error was −0.071 (−0.087 to –0.055) D/yr. Between ages 3 and 7, hyperopia among children with baseline hyperopia <4D increased by 0.12 (0.08 to 0.16) D/yr, while hyperopia among those with baseline 4D or greater was stable (0.0D/yr, −0.03 to 0.04) (p<0.001). Hyperopia decreased from age 7 to 15 years in both subgroups: <4D subgroup −0.17 (−0.20 to –0.14) D/yr, ≥4D subgroup −0.18 (−0.21 to –0.15) D/yr (p=0.58). There was no significant difference in refractive change between fully (n=274) and partially (n=131) accommodative esotropia (p≥0.10).ConclusionHyperopia in children with accommodative esotropia is stable or increases up to age 7 years, depending on baseline hyperopia, but decreases gradually between ages 7 and 15 years regardless of baseline refractive error.

Nursing and Sustainable Development: Furthering the Global Agenda in Uncertain Times

These are fragile and uncertain times for the health and survival of both humanity and the planet at large. The outlook may appear bleak, but there is hope. The rapidly evolving field of global health calls for wisdom and advocacy firmly rooted in a nursing perspective and integrative lens. Global nurses have long been leaders and agents of measurable change in the advancement of physiologic, social, environmental, and economic health determinants. It has been noted that nurses have the potential to make vital contributions toward achieving the United Nations (UN) 2030 Agenda 17 Sustainable Development Goals (SDGs) across settings. The purpose of this article is to make explicit the multifaceted links between nursing and the SDGs. The article first discusses the background and significance of current challenges and the UN 2030 Agenda for Sustainable Development. The authors explain the importance of good health and partnerships, and note the legacy of Nightingale and the Agenda. Finally, they review both opportunities and challenges and ethical considerations related to the SDGs and offer implications for nurses to take action. In its highest form, the UN 2030 Agenda is a holistic framework to eradicate inequity, preserve the well-being of all species, and engage health from whole-system and whole-planet perspectives – work so desperately needed in this era of future uncertainties.