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"Edwards, M. J."
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Life in extreme environments : insights in biological capability
\"From deep ocean trenches and the geographical poles to outer space, organisms can be found living in remarkably extreme conditions. This book provides a captivating account of these systems and their extraordinary inhabitants, 'extremophiles'. A diverse, multidisciplinary group of experts discuss responses and adaptations to change; biodiversity, bioenergetic processes, and biotic and abiotic interactions; polar environments; and life and habitability, including searching for biosignatures in the extraterrestrial environment. The editors emphasize that understanding these systems is important for increasing our knowledge and utilizing their potential, but this remains an understudied area. Given the threat to these environments and their biota caused by climate change and human impact, this timely book also addresses the urgency to document these systems. It will help graduate students and researchers in conservation, marine biology, evolutionary biology, environmental change and astrobiology better understand how life exists in these environments and their susceptibility or resilience to change\"-- Provided by publisher.
Book
Randomised feasibility study of physiotherapy for patients with functional motor symptoms
ObjectiveTo determine the feasibility of conducting a randomised controlled trial of a specialist physiotherapy intervention for functional motor symptoms (FMS).MethodsA randomised feasibility study was conducted recruiting patients with a clinically established diagnosis of FMS from a tertiary neurology clinic in London, UK. Participants were randomised to the intervention or a treatment as usual control. Measures of feasibility and clinical outcome were collected and assessed at 6 months.Results60 individuals were recruited over a 9-month period. Three withdrew, leaving 29 intervention and 28 controls participants in the final analysis. 32% of patients with FMS met the inclusion criteria, of which 90% enrolled. Acceptability of the intervention was high and there were no adverse events. At 6 months, 72% of the intervention group rated their symptoms as improved, compared to 18% in the control group. There was a moderate to large treatment effect across a range of outcomes, including three of eight Short Form 36 (SF36) domains (d=0.46–0.79). The SF36 Physical function was found to be a suitable primary outcome measure for a future trial; adjusted mean difference 19.8 (95% CI 10.2 to 29.5). The additional quality adjusted life years (QALY) with intervention was 0.08 (95% CI 0.03 to 0.13), the mean incremental cost per QALY gained was £12 087.ConclusionsThis feasibility study demonstrated high rates of recruitment, retention and acceptability. Clinical effect size was moderate to large with high probability of being cost-effective. A randomised controlled trial is needed.Trial registration numberNCT02275000; Results.
Journal Article
The Joint UK Land Environment Simulator (JULES), model description - Part 1: Energy and water fluxes
This manuscript describes the energy and water components of a new community land surface model called the Joint UK Land Environment Simulator (JULES). This is developed from the Met Office Surface Exchange Scheme (MOSES). It can be used as a stand alone land surface model driven by observed forcing data, or coupled to an atmospheric global circulation model. The JULES model has been coupled to the Met Office Unified Model (UM) and as such provides a unique opportunity for the research community to contribute their research to improve both world-leading operational weather forecasting and climate change prediction systems. In addition JULES, and its forerunner MOSES, have been the basis for a number of very high-profile papers concerning the land-surface and climate over the last decade. JULES has a modular structure aligned to physical processes, providing the basis for a flexible modelling platform.
Journal Article
Symmetric Inertial Confinement Fusion Implosions at Ultra-High Laser Energies
Indirect-drive hohlraum experiments at the National Ignition Facility have demonstrated symmetric capsule implosions at unprecedented laser drive energies of 0.7 megajoule. One hundred and ninety-two simultaneously fired laser beams heat ignition-emulate hohlraums to radiation temperatures of 3.3 million kelvin, compressing 1.8-millimeter-diameter capsules by the soft x-rays produced by the hohlraum. Self-generated plasma optics gratings on either end of the hohlraum tune the laser power distribution in the hohlraum, which produces a symmetric x-ray drive as inferred from the shape of the capsule self-emission. These experiments indicate that the conditions are suitable for compressing deuterium-tritium-filled capsules, with the goal of achieving burning fusion plasmas and energy gain in the laboratory.
Journal Article
Non-invasive Cerebellar Stimulation—a Consensus Paper
The field of neurostimulation of the cerebellum either with transcranial magnetic stimulation (TMS; single pulse or repetitive (rTMS)) or transcranial direct current stimulation (tDCS; anodal or cathodal) is gaining popularity in the scientific community, in particular because these stimulation techniques are non-invasive and provide novel information on cerebellar functions. There is a consensus amongst the panel of experts that both TMS and tDCS can effectively influence cerebellar functions, not only in the motor domain, with effects on visually guided tracking tasks, motor surround inhibition, motor adaptation and learning, but also for the cognitive and affective operations handled by the cerebro-cerebellar circuits. Verbal working memory, semantic associations and predictive language processing are amongst these operations. Both TMS and tDCS modulate the connectivity between the cerebellum and the primary motor cortex, tuning cerebellar excitability. Cerebellar TMS is an effective and valuable method to evaluate the cerebello-thalamo-cortical loop functions and for the study of the pathophysiology of ataxia. In most circumstances, DCS induces a polarity-dependent site-specific modulation of cerebellar activity. Paired associative stimulation of the cerebello-dentato-thalamo-M1 pathway can induce bidirectional long-term spike-timing-dependent plasticity-like changes of corticospinal excitability. However, the panel of experts considers that several important issues still remain unresolved and require further research. In particular, the role of TMS in promoting cerebellar plasticity is not established. Moreover, the exact positioning of electrode stimulation and the duration of the after effects of tDCS remain unclear. Future studies are required to better define how DCS over particular regions of the cerebellum affects individual cerebellar symptoms, given the topographical organization of cerebellar symptoms. The long-term neural consequences of non-invasive cerebellar modulation are also unclear. Although there is an agreement that the clinical applications in cerebellar disorders are likely numerous, it is emphasized that rigorous large-scale clinical trials are missing. Further studies should be encouraged to better clarify the role of using non-invasive neurostimulation techniques over the cerebellum in motor, cognitive and psychiatric rehabilitation strategies.
Journal Article
Is there an association between female gender and outcome in severe trauma? A multi-center analysis in the Netherlands
Introduction
Little evidence suggest that female gender is associated with a lower risk of mortality in severely injured patients, especially in premenopausal women. Previous clinical studies have shown contradictory results regarding protective effects of gender on outcome after severe trauma. The objective of this study was to determine the association between gender and outcome (mortality and Intensive Care Unit (ICU) admission) among severely injured patients in the Netherlands.
Methods
A retrospective multicentre study was performed including all polytrauma patients (Injury Severity Score (ISS) ≥16) admitted to the ED of three level 1 trauma centres, between January 1st, 2006 and December 31st, 2014. Data on age, gender, mechanism of injury, ISS, Abbreviated Injury Scale (AIS), prehospital intubation, Revised Trauma Score (RTS), systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) upon admission at the Emergency Department was collected from three Regional Trauma Registries. To determine whether gender was an independent predictor of mortality and ICU admission, logistic regression analysis was performed.
Results
Among 6865 trauma patients, male patients had a significantly higher ISS compared to female patients (26.3 ± 10.2 vs 25.3 ± 9.7,
P =
< 0.0001). Blunt trauma was significantly more common in the female group (95.2% vs 92.3%,
P
= < 0.0001). Males aged 16- to 44-years had a significant higher in-hospital mortality rate (10.4% vs 13.4%,
P
= 0.046). ICU admission rate was significantly lower in females (49.3% vs 54.5%,
P
= < 0.0001). In the overall group, logistic regression did not show gender as an independent predictor for in-hospital mortality (OR 1.020 (95% CI 0.865–1.204),
P
= 0.811) or mortality within 24 h (OR 1.049 (95% CI 0.829–1.327),
P
= 0.693). However, male gender was associated with an increased likelihood for ICU admission in the overall group (OR 1.205 (95% CI 1.046–1.388),
P
= 0.010).
Conclusion
The current study shows that in this population of severely injured patients, female sex is associated with a lower in-hospital mortality rate among those aged 16- to 44-years. Furthermore, female sex is independently associated with an overall decreased likelihood for ICU admission. More research is needed to examine the physiologic background of this protective effect of female sex in severe trauma.
Journal Article
Multistep redirection by cross-beam power transfer of ultrahigh-power lasers in a plasma
Laser redirection by cross-beam power transfer in a plasma is an important example of a nonlinear optics process which uses laser–plasma instabilities to one’s advantage. We have demonstrated this in a hohlraum plasma at the National Ignition Facility (NIF) at Lawrence Livermore National Laboratory. A four-wave mixing process causes laser power in multiple beams to change direction and add to the laser power of a selected beam. The process is controlled by setting the wavelength separation of the interacting laser beams. This technique provides a method to remotely re-point or combine high-powered laser beams without the need of local optical apparatus.
A demonstration of the ability to control the flow of laser energy in a dense plasma by tuning the colour of multiple laser beams injected into it could be useful in the development of laser-driven fusion.
Journal Article
Autosomal-dominant GTPCH1-deficient DRD: clinical characteristics and long-term outcome of 34 patients
Background:An autosomal dominantly inherited defect in the GCH1 gene that encodes guanosine triphosphate cyclohydrolase 1 (GTPCH1) is the most common cause of dopa-responsive dystonia (DRD). A classic phenotype of young-onset lower-limb dystonia, diurnal fluctuations and excellent response to levodopa has been well recognised in association with GCH1 mutations, and rare atypical presentations have been reported. However, a number of clinical issues remain unresolved including phenotypic variability, long-term response to levodopa and associated non-motor symptoms, and there are limited data on long-term follow-up of genetically proven cases.Methods:A detailed clinical evaluation of 34 patients (19 women, 15 men), with confirmed mutations in the GCH1 gene, is presented.Results and conclusions:The classic phenotype was most frequent (n = 23), with female predominance (F:M = 16:7), and early onset (mean 4.5 years) with involvement of legs. However, a surprisingly large number of patients developed craniocervical dystonia, with spasmodic dysphonia being the predominant symptom in two subjects. A subset of patients, mainly men, presented with either a young-onset (mean 6.8 years) mild DRD variant not requiring treatment (n = 4), or with an adult-onset (mean 37 years) Parkinson disease-like phenotype (n = 4). Two siblings were severely affected with early hypotonia and delay in motor development, associated with compound heterozygous GCH1 gene mutations. The study also describes a number of supplementary features including restless-legs-like symptoms, influence of female sex hormones, predominance of tremor or parkinsonism in adult-onset cases, initial reverse reaction to levodopa, recurrent episodes of depressive disorder and specific levodopa-resistant symptoms (writer’s cramp, dysphonia, truncal dystonia). Levodopa was used effectively and safely in 20 pregnancies, and did not cause any fetal abnormalities.
Journal Article
Is there a difference between the incidence of subtypes of tibial plateau fractures between six different level 1, level 2 and level 3 trauma centers in the Netherlands?
Purposes
Tibial plateau fractures can present as different subtypes due to variation in patient characteristics and trauma mechanisms. Insight in the fracture pattern and classification is critical for adequate treatment.This study aims to assess the incidence of tibial plateau fracture subtypes among various levels of trauma centers in the Netherlands, to explore potential variations in fracture patterns and fracture classifications between these centers.
Methods
Over a one-year period data was collected from six Dutch trauma centers representing different levels of trauma care. Fractures were classified using both Schatzker and Luo’s systems. Interobserver agreement was calculated to evaluate the consistency of fracture classification among surgeons.
Results
We included 115 patients treated for a tibial plateau fracture across six different hospitals. The mean patient age was 54 years, ranging from 17 to 85 years. Differences in fracture incidence and mechanisms of injury across trauma centers were revealed; Level 1 trauma centers treated a higher proportion of high-energy trauma cases, predominantly Schatzker 6 fractures, while level 2 and 3 centers dealt with more low-energy traumas, particularly Schatzker 2 fractures. Interobserver agreement for both classification systems was moderate, indicating challenges in classifying tibial plateau fractures accurately.
Conclusion
This study sheds light on the diverse distribution of subtypes of tibial plateau fractures in Dutch trauma centers. Level 1 centers are treating younger, high-energy trauma patients, whereas level 2 and 3 centers handle more low-energy traumas, predominantly Schatzker 2 fractures.
Trial registration
METC Oost-Nederland: 2021–13,184.
Journal Article