Douglas and Hartley provide data that indicates that drug courts face budgetary and resource hurd... more Douglas and Hartley provide data that indicates that drug courts face budgetary and resource hurdles in their effort to become institutionalized reforms to courts. Drug courts commonly adopt what the authors call "hodgepodege budgeting" strategies where ingenuity, opportunity, and luck seperate those programs that succeed from those that fail. They also note the challenges that hodgepodge budgeting presents to those who hope to institutionalize drug courts and other court reforms.
While much has been made of the financial crisis affecting state courts in the early 2000s, there... more While much has been made of the financial crisis affecting state courts in the early 2000s, there has been little research on court budgeting and the politics that affect it, especially concerning factors that lead to budgetary success. In this study, we assess the determinants of budget success for state courts by examining the perceptions of key state budget actors. We argue that courts tend to behave conservatively in the budget process and may need to behave more politically. Behaving acquisitively, providing realistic requests, and justifying funding needs will enable courts to increase funding in the short-term. In the long-term, courts should act more aggressively to improve relations with legislative and executive branch officials.
Objectives: The American state of Hawaii presents a tuberculosis (TB) burden more consistent with... more Objectives: The American state of Hawaii presents a tuberculosis (TB) burden more consistent with that of the Philippines and the Pacific Islands than that with the United States (US) or Europe. This study seeks to determine if the genetic families of Mycobacterium tuberculosis (Mtb) that are prevalent in Hawaii display differences in host demographics that may be of use for TB control in Hawaii and the Pacific. Study design: This retrospective study was conducted by analyzing data from the Hawaii State Department of Health to investigate the demographics associated with the Beijing (global lineage 2) and Manila (lineage 1) families of Mtb in Hawaii. Methods: Deidentified records of all culture-positive TB cases reported by the Hawaii State Department of Health Tuberculosis Control Program from 2004 to 2016 were analyzed to identify lineage-specific demographic differences and trends. Patients' countries of origin, age, sex, and time in the US before TB diagnosis were included in this analysis. Results: Manila family isolates were found to predominantly enter Hawaii through Filipino immigrants, whereas Beijing family isolates originated from a diverse set of countries. Both families exhibited significant differences in age and sex demographics. In addition, Manila family cases presented from patients with significantly longer average time of residence in the US than non-Manila cases, whereas Beijing family cases presented from patients with significantly shorter time of residence in the US than non-Beijing cases. Conclusions: Both the Beijing and Manila families of Mtb demonstrated demographic differences in Hawaii that may prove important for improving TB control and surveillance policy in Hawaii and throughout the Pacific. Areas with heavy Filipino immigration may benefit from directing more resources toward screening and education efforts for middle-aged men and those who have resided in the country longer, whereas other areas of the Pacific should consider a younger and more sex-balanced allocation. Specific to the US and Hawaii, effective screening of youths emigrating from the Compact of Free Association states remains vital.
Analysis of the population structure of Mycobacterium tuberculosis strains from the People's ... more Analysis of the population structure of Mycobacterium tuberculosis strains from the People's Republic of China showed that the vast majority belong to a genetically closely related group. These strains shared the majority of their IS6110 DNA-containing restriction fragments, and also, the DNA polymorphism associated with other repetitive DNA elements, like the polymorphic GC-rich sequence and the direct repeat, was very limited. Because the majority of these strains originated from the province of Beijing, we designated this grouping the "Beijing family" of M. tuberculosis strains. Strains of this family were also found to dominate in neighboring countries such as Mongolia, South Korea, and Thailand, whereas a low prevalence of such strains was observed in countries on other continents. These data indicate that strains of the Beijing family recently expanded from a single ancestor which had a selective advantage. It is speculated that long-term Mycobacterium bovis BCG ...
Direct repeat spoligotyping of 85 paraffin-embedded lung biopsies was used to investigated the oc... more Direct repeat spoligotyping of 85 paraffin-embedded lung biopsies was used to investigated the occurrence around Beijing of the Beijing family of Mycobacterium tuberculosis . Samples ranged in time from 1956 to 1990. Hybridization patterns were found with 49 (58%) samples, and 45 (92%) produced typical Beijing family patterns extending over the 34-year period.
A dipstick assay for the detection of brucella-specific immunoglobulin M antibodies was evaluated... more A dipstick assay for the detection of brucella-specific immunoglobulin M antibodies was evaluated with 707 sera from 247 laboratory-confirmed brucellosis patients and 342 control sera from brucellosis-free individuals. These sera were collected from six different countries. The assay was found to be highly sensitive and specific. In addition, the test is easy to use and does not require specialized training or equipment, and the components are stable without a requirement for refrigeration. All of these factors make the test ideal for developing countries and rural settings.
Scientific progress often relies on applying published methodological advances to different probl... more Scientific progress often relies on applying published methodological advances to different problems. With the aim of improving both the uptake and reproducibility of chemical transformations, a new assessment tool has now been developed that provides a clear and easy-to-interpret overview of common factors that affect a synthetic method.
Patients with neuromuscular diseases benefit from coordinated multidisciplinary care to achieve b... more Patients with neuromuscular diseases benefit from coordinated multidisciplinary care to achieve best outcomes. The integration of multi-specialty healthcare delivered in a single clinic can be challenging for service providers due to cost and resource limitation. Our cross-sectional survey of 53 adult patients with neuromuscular disease across Queensland revealed only 27% support the introduction of an integrated multidisciplinary clinic. The most cited reason for opposition to a multidisciplinary clinic was a perceived loss of contact with one's usual doctor. Modifying service delivery in neuromuscular disease is a complex undertaking and will need input from numerous stakeholders.
Background: Tuberculosis (TB) caused an estimated 1.4 million deaths and 10.4 million new cases g... more Background: Tuberculosis (TB) caused an estimated 1.4 million deaths and 10.4 million new cases globally in 2015. TB rates in the United States continue to steadily decline, yet rates in the State of Hawaii are perennially among the highest in the nation due to a continuous influx of immigrants from the Western Pacific and Asia. TB in Hawaii is composed of a unique distribution of genetic lineages, with the Beijing and Manila families of Mycobacterium tuberculosis (Mtb) comprising over two-thirds of TB cases. Standard fingerprinting methods (spoligotyping plus 24-loci Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeats [MIRU-VNTR] fingerprinting) perform poorly when used to identify actual transmission clusters composed of isolates from these two families. Those typing methods typically group isolates from these families into large clusters of non-linked isolates with identical fingerprints. Next-generation whole-genome sequencing (WGS) provides a new tool for molecular epidemiology that can resolve clusters of isolates with identical spoligotyping and MIRU-VNTR fingerprints. Methods: We performed WGS and SNP analysis and evaluated epidemiological data to investigate 19 apparent TB transmission clusters in Hawaii from 2003 to 2017 in order to assess WGS' ability to resolve putative Mtb clusters from the Beijing and Manila families. This project additionally investigated MIRU-VNTR allele prevalence to determine why standard Mtb fingerprinting fails to usefully distinguish actual transmission clusters from these two Mtb families. Results: WGS excluded transmission events in seven of these putative clusters, confirmed transmission in eight, and identified both transmission-linked and non-linked isolates in four. For epidemiologically identified clusters, while the sensitivity of MIRU-VNTR fingerprinting for identifying actual transmission clusters was found to be 100%, its specificity was only 28.6% relative to WGS. We identified that the Beijing and Manila families' significantly lower Shannon evenness of MIRU-VNTR allele distributions than lineage 4 was the cause of standard fingerprinting's poor performance when identifying transmission in Beijing and Manila family clusters. Conclusions: This study demonstrated that WGS is necessary for epidemiological investigation of TB in Hawaii and the Pacific.
While tuberculosis (TB) remains a global disease, the WHO estimates that 62% of the incident TB c... more While tuberculosis (TB) remains a global disease, the WHO estimates that 62% of the incident TB cases in 2016 occurred in the WHO South-East Asia and Western Pacific regions. TB in the Pacific is composed predominantly of two genetic families of Mycobacterium tuberculosis (Mtb): Beijing and Manila. The Manila family is historically under-studied relative to the families that comprise the majority of TB in Europe and North America (e.g. lineage 4), and it remains unclear why this lineage has persisted in Filipino populations despite the predominance of more globally successful Mtb lineages in most of the world. The Beijing family is of particular interest as it is increasingly associated with drug resistance throughout the world. Both of these lineages are important to the State of Hawaii, where they comprise over two-thirds of TB cases. Here, we performed whole genome sequencing on 82 Beijing family, Manila family, and outgroup clinical Mtb isolates from Hawaii to identify lineage-s...
involves alterations in specific patterns of gene expression. In order to screen for brain region... more involves alterations in specific patterns of gene expression. In order to screen for brain region specific mRNAs which are transcriptionally regulated by acute cocaine and amphetamine, PCR differential display was employed. This approach identified a previously uncharacterized mRNA whose relative levels in the striatum are induced four- to fivefold by acute psychomotor stimulant administration. Isolation and characterization of corresponding cDNA clones resulted in complete nucleotide sequence analysis, including prediction of the encoded protein product. Alternate polyA site utilization in the predicted 3′ noncoding region results in the appearance of an RNA doublet, approximately 700 and 900 bases in length, following Northern analysis. A presumed alternate splicing event further generates diversity within the transcripts, and results in the presence or absence of an in-frame 39 base insert within the putative protein coding region. As a result, the predicted translation products ...
The local electrode atom probe (LEAP) has become the primary instrument used for atom probe tomog... more The local electrode atom probe (LEAP) has become the primary instrument used for atom probe tomography measurements. Recent advances in detector and laser design, together with updated hit detection algorithms, have been incorporated into the latest LEAP 5000 instrument, but the implications of these changes on measurements, particularly the size and chemistry of small clusters and elemental segregations, have not been explored. In this study, we compare data sets from a variety of materials with small-scale chemical heterogeneity using both a LEAP 3000 instrument with 37% detector efficiency and a 532-nm green laser and a new LEAP 5000 instrument with a manufacturer estimated increase to 52% detector efficiency, and a 355-nm ultraviolet laser. In general, it was found that the number of atoms within small clusters or surface segregation increased in the LEAP 5000, as would be expected by the reported increase in detector efficiency from the LEAP 3000 architecture, but subtle differ...
With its airborne transmission and prolonged latency period, Mycobacterium tuberculosis spreads w... more With its airborne transmission and prolonged latency period, Mycobacterium tuberculosis spreads worldwide as one of the most successful bacterial pathogens and continues to kill millions of people every year. M. tuberculosis lineage 1 is inferred to originate ancestrally based on the presence of the 52-bp TbD1 sequence and analysis of single nucleotide polymorphisms. Previously, we briefly reported the complete genome sequencing of M. tuberculosis strains 96121 and 96075, which belong to the ancient Manila family and modern Beijing family respectively. Here we present the comprehensive genomic analyses of the Manila family in lineage 1 compared to complete genomes in lineages 2-4. Principal component analysis of the presence and absence of CRISPR spacers suggests that Manila isolate 96121 is distinctly distant from lineages 2-4. We further identify a truncated whiB5 gene and a putative operon consisting of genes encoding a putative serine/threonine kinase PknH and a putative ABC transporter, which are only found in the genomes of Manila family isolates. Six single nucleotide polymorphisms are uniquely conserved in 38 Manila strains. Moreover, when compared to M. tuberculosis H37Rv, 59 proteins are under positive selection in Manila family isolate 96121 but not in Beijing family isolate 96075. The unique features further serve as biomarkers for Manila strains and may shed light on the limited transmission of this ancestral lineage outside of its Filipino host population.
A 29 year old man presented with isolated injury to both lower limbs after accidental spillage of... more A 29 year old man presented with isolated injury to both lower limbs after accidental spillage of caustic soda 20 hours earlier at the metal cleaning factory where he worked. Despite removing soaked protective clothing at the time of exposure, a lack of irrigation of the area resulted in progressive development of skin changes (figs 1 and 2⇓) and associated pain to the affected limbs. This prompted him to attend his local emergency department. Fig 1 Patient’s right leg Fig 2 Patient’s left leg 1. What type of injury is this? 2. What is the size and depth of the burn? 3. What are the different types of burns? 4. How would you manage this patient? ### 1. What type of injury is this? #### Short answer Bilateral lower limb alkali chemical burns caused by exposure to caustic soda. The injury is circumferential and of heterogeneous depth. #### Discussion This injury is consistent with chemical burns caused by caustic soda (sodium hydroxide), which can occur in industrial and domestic settings. Other chemicals that cause such burns include: Although exposure mainly causes cutaneous and ocular burns, some chemicals can have systemic effects if absorbed or inhaled. Chemical burns account for about 13% of all burns related mortality and 3.3% of all burns in the United Kingdom.1 An important feature of chemical burns is the tendency for the burning process to persist despite macroscopic source removal and resuscitation. Chemicals continue to denature proteins and damage tissues for as long as traces of …
Cerebellopontine angle (CPA) tumours are the most common neoplasms in the posterior fossa, accoun... more Cerebellopontine angle (CPA) tumours are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumours. Most CPA tumours are benign, with most being vestibular schwannomas. Meningiomas arising from the jugular foramen are among the rarest of all with very few being described in the literature. Treatment options vary considerably as experience with these tumours is limited. One option is a skull base approach, but this depends on size, location and ability to preserve lower cranial nerve function. This can be extremely challenging and is accompanied by high mortality risk; therefore, a more conservative option must be considered. This case report highlights the difficulty in management of patients with jugular fossa meningiomas, including appropriate investigations, analysis of surgical versus conservative treatment and associated complications. Furthermore, we elaborate the decision-making process pertaining to the tailoring of the surgical route use...
Douglas and Hartley provide data that indicates that drug courts face budgetary and resource hurd... more Douglas and Hartley provide data that indicates that drug courts face budgetary and resource hurdles in their effort to become institutionalized reforms to courts. Drug courts commonly adopt what the authors call "hodgepodege budgeting" strategies where ingenuity, opportunity, and luck seperate those programs that succeed from those that fail. They also note the challenges that hodgepodge budgeting presents to those who hope to institutionalize drug courts and other court reforms.
While much has been made of the financial crisis affecting state courts in the early 2000s, there... more While much has been made of the financial crisis affecting state courts in the early 2000s, there has been little research on court budgeting and the politics that affect it, especially concerning factors that lead to budgetary success. In this study, we assess the determinants of budget success for state courts by examining the perceptions of key state budget actors. We argue that courts tend to behave conservatively in the budget process and may need to behave more politically. Behaving acquisitively, providing realistic requests, and justifying funding needs will enable courts to increase funding in the short-term. In the long-term, courts should act more aggressively to improve relations with legislative and executive branch officials.
Objectives: The American state of Hawaii presents a tuberculosis (TB) burden more consistent with... more Objectives: The American state of Hawaii presents a tuberculosis (TB) burden more consistent with that of the Philippines and the Pacific Islands than that with the United States (US) or Europe. This study seeks to determine if the genetic families of Mycobacterium tuberculosis (Mtb) that are prevalent in Hawaii display differences in host demographics that may be of use for TB control in Hawaii and the Pacific. Study design: This retrospective study was conducted by analyzing data from the Hawaii State Department of Health to investigate the demographics associated with the Beijing (global lineage 2) and Manila (lineage 1) families of Mtb in Hawaii. Methods: Deidentified records of all culture-positive TB cases reported by the Hawaii State Department of Health Tuberculosis Control Program from 2004 to 2016 were analyzed to identify lineage-specific demographic differences and trends. Patients' countries of origin, age, sex, and time in the US before TB diagnosis were included in this analysis. Results: Manila family isolates were found to predominantly enter Hawaii through Filipino immigrants, whereas Beijing family isolates originated from a diverse set of countries. Both families exhibited significant differences in age and sex demographics. In addition, Manila family cases presented from patients with significantly longer average time of residence in the US than non-Manila cases, whereas Beijing family cases presented from patients with significantly shorter time of residence in the US than non-Beijing cases. Conclusions: Both the Beijing and Manila families of Mtb demonstrated demographic differences in Hawaii that may prove important for improving TB control and surveillance policy in Hawaii and throughout the Pacific. Areas with heavy Filipino immigration may benefit from directing more resources toward screening and education efforts for middle-aged men and those who have resided in the country longer, whereas other areas of the Pacific should consider a younger and more sex-balanced allocation. Specific to the US and Hawaii, effective screening of youths emigrating from the Compact of Free Association states remains vital.
Analysis of the population structure of Mycobacterium tuberculosis strains from the People's ... more Analysis of the population structure of Mycobacterium tuberculosis strains from the People's Republic of China showed that the vast majority belong to a genetically closely related group. These strains shared the majority of their IS6110 DNA-containing restriction fragments, and also, the DNA polymorphism associated with other repetitive DNA elements, like the polymorphic GC-rich sequence and the direct repeat, was very limited. Because the majority of these strains originated from the province of Beijing, we designated this grouping the "Beijing family" of M. tuberculosis strains. Strains of this family were also found to dominate in neighboring countries such as Mongolia, South Korea, and Thailand, whereas a low prevalence of such strains was observed in countries on other continents. These data indicate that strains of the Beijing family recently expanded from a single ancestor which had a selective advantage. It is speculated that long-term Mycobacterium bovis BCG ...
Direct repeat spoligotyping of 85 paraffin-embedded lung biopsies was used to investigated the oc... more Direct repeat spoligotyping of 85 paraffin-embedded lung biopsies was used to investigated the occurrence around Beijing of the Beijing family of Mycobacterium tuberculosis . Samples ranged in time from 1956 to 1990. Hybridization patterns were found with 49 (58%) samples, and 45 (92%) produced typical Beijing family patterns extending over the 34-year period.
A dipstick assay for the detection of brucella-specific immunoglobulin M antibodies was evaluated... more A dipstick assay for the detection of brucella-specific immunoglobulin M antibodies was evaluated with 707 sera from 247 laboratory-confirmed brucellosis patients and 342 control sera from brucellosis-free individuals. These sera were collected from six different countries. The assay was found to be highly sensitive and specific. In addition, the test is easy to use and does not require specialized training or equipment, and the components are stable without a requirement for refrigeration. All of these factors make the test ideal for developing countries and rural settings.
Scientific progress often relies on applying published methodological advances to different probl... more Scientific progress often relies on applying published methodological advances to different problems. With the aim of improving both the uptake and reproducibility of chemical transformations, a new assessment tool has now been developed that provides a clear and easy-to-interpret overview of common factors that affect a synthetic method.
Patients with neuromuscular diseases benefit from coordinated multidisciplinary care to achieve b... more Patients with neuromuscular diseases benefit from coordinated multidisciplinary care to achieve best outcomes. The integration of multi-specialty healthcare delivered in a single clinic can be challenging for service providers due to cost and resource limitation. Our cross-sectional survey of 53 adult patients with neuromuscular disease across Queensland revealed only 27% support the introduction of an integrated multidisciplinary clinic. The most cited reason for opposition to a multidisciplinary clinic was a perceived loss of contact with one's usual doctor. Modifying service delivery in neuromuscular disease is a complex undertaking and will need input from numerous stakeholders.
Background: Tuberculosis (TB) caused an estimated 1.4 million deaths and 10.4 million new cases g... more Background: Tuberculosis (TB) caused an estimated 1.4 million deaths and 10.4 million new cases globally in 2015. TB rates in the United States continue to steadily decline, yet rates in the State of Hawaii are perennially among the highest in the nation due to a continuous influx of immigrants from the Western Pacific and Asia. TB in Hawaii is composed of a unique distribution of genetic lineages, with the Beijing and Manila families of Mycobacterium tuberculosis (Mtb) comprising over two-thirds of TB cases. Standard fingerprinting methods (spoligotyping plus 24-loci Mycobacterial Interspersed Repetitive Units-Variable Number Tandem Repeats [MIRU-VNTR] fingerprinting) perform poorly when used to identify actual transmission clusters composed of isolates from these two families. Those typing methods typically group isolates from these families into large clusters of non-linked isolates with identical fingerprints. Next-generation whole-genome sequencing (WGS) provides a new tool for molecular epidemiology that can resolve clusters of isolates with identical spoligotyping and MIRU-VNTR fingerprints. Methods: We performed WGS and SNP analysis and evaluated epidemiological data to investigate 19 apparent TB transmission clusters in Hawaii from 2003 to 2017 in order to assess WGS' ability to resolve putative Mtb clusters from the Beijing and Manila families. This project additionally investigated MIRU-VNTR allele prevalence to determine why standard Mtb fingerprinting fails to usefully distinguish actual transmission clusters from these two Mtb families. Results: WGS excluded transmission events in seven of these putative clusters, confirmed transmission in eight, and identified both transmission-linked and non-linked isolates in four. For epidemiologically identified clusters, while the sensitivity of MIRU-VNTR fingerprinting for identifying actual transmission clusters was found to be 100%, its specificity was only 28.6% relative to WGS. We identified that the Beijing and Manila families' significantly lower Shannon evenness of MIRU-VNTR allele distributions than lineage 4 was the cause of standard fingerprinting's poor performance when identifying transmission in Beijing and Manila family clusters. Conclusions: This study demonstrated that WGS is necessary for epidemiological investigation of TB in Hawaii and the Pacific.
While tuberculosis (TB) remains a global disease, the WHO estimates that 62% of the incident TB c... more While tuberculosis (TB) remains a global disease, the WHO estimates that 62% of the incident TB cases in 2016 occurred in the WHO South-East Asia and Western Pacific regions. TB in the Pacific is composed predominantly of two genetic families of Mycobacterium tuberculosis (Mtb): Beijing and Manila. The Manila family is historically under-studied relative to the families that comprise the majority of TB in Europe and North America (e.g. lineage 4), and it remains unclear why this lineage has persisted in Filipino populations despite the predominance of more globally successful Mtb lineages in most of the world. The Beijing family is of particular interest as it is increasingly associated with drug resistance throughout the world. Both of these lineages are important to the State of Hawaii, where they comprise over two-thirds of TB cases. Here, we performed whole genome sequencing on 82 Beijing family, Manila family, and outgroup clinical Mtb isolates from Hawaii to identify lineage-s...
involves alterations in specific patterns of gene expression. In order to screen for brain region... more involves alterations in specific patterns of gene expression. In order to screen for brain region specific mRNAs which are transcriptionally regulated by acute cocaine and amphetamine, PCR differential display was employed. This approach identified a previously uncharacterized mRNA whose relative levels in the striatum are induced four- to fivefold by acute psychomotor stimulant administration. Isolation and characterization of corresponding cDNA clones resulted in complete nucleotide sequence analysis, including prediction of the encoded protein product. Alternate polyA site utilization in the predicted 3′ noncoding region results in the appearance of an RNA doublet, approximately 700 and 900 bases in length, following Northern analysis. A presumed alternate splicing event further generates diversity within the transcripts, and results in the presence or absence of an in-frame 39 base insert within the putative protein coding region. As a result, the predicted translation products ...
The local electrode atom probe (LEAP) has become the primary instrument used for atom probe tomog... more The local electrode atom probe (LEAP) has become the primary instrument used for atom probe tomography measurements. Recent advances in detector and laser design, together with updated hit detection algorithms, have been incorporated into the latest LEAP 5000 instrument, but the implications of these changes on measurements, particularly the size and chemistry of small clusters and elemental segregations, have not been explored. In this study, we compare data sets from a variety of materials with small-scale chemical heterogeneity using both a LEAP 3000 instrument with 37% detector efficiency and a 532-nm green laser and a new LEAP 5000 instrument with a manufacturer estimated increase to 52% detector efficiency, and a 355-nm ultraviolet laser. In general, it was found that the number of atoms within small clusters or surface segregation increased in the LEAP 5000, as would be expected by the reported increase in detector efficiency from the LEAP 3000 architecture, but subtle differ...
With its airborne transmission and prolonged latency period, Mycobacterium tuberculosis spreads w... more With its airborne transmission and prolonged latency period, Mycobacterium tuberculosis spreads worldwide as one of the most successful bacterial pathogens and continues to kill millions of people every year. M. tuberculosis lineage 1 is inferred to originate ancestrally based on the presence of the 52-bp TbD1 sequence and analysis of single nucleotide polymorphisms. Previously, we briefly reported the complete genome sequencing of M. tuberculosis strains 96121 and 96075, which belong to the ancient Manila family and modern Beijing family respectively. Here we present the comprehensive genomic analyses of the Manila family in lineage 1 compared to complete genomes in lineages 2-4. Principal component analysis of the presence and absence of CRISPR spacers suggests that Manila isolate 96121 is distinctly distant from lineages 2-4. We further identify a truncated whiB5 gene and a putative operon consisting of genes encoding a putative serine/threonine kinase PknH and a putative ABC transporter, which are only found in the genomes of Manila family isolates. Six single nucleotide polymorphisms are uniquely conserved in 38 Manila strains. Moreover, when compared to M. tuberculosis H37Rv, 59 proteins are under positive selection in Manila family isolate 96121 but not in Beijing family isolate 96075. The unique features further serve as biomarkers for Manila strains and may shed light on the limited transmission of this ancestral lineage outside of its Filipino host population.
A 29 year old man presented with isolated injury to both lower limbs after accidental spillage of... more A 29 year old man presented with isolated injury to both lower limbs after accidental spillage of caustic soda 20 hours earlier at the metal cleaning factory where he worked. Despite removing soaked protective clothing at the time of exposure, a lack of irrigation of the area resulted in progressive development of skin changes (figs 1 and 2⇓) and associated pain to the affected limbs. This prompted him to attend his local emergency department. Fig 1 Patient’s right leg Fig 2 Patient’s left leg 1. What type of injury is this? 2. What is the size and depth of the burn? 3. What are the different types of burns? 4. How would you manage this patient? ### 1. What type of injury is this? #### Short answer Bilateral lower limb alkali chemical burns caused by exposure to caustic soda. The injury is circumferential and of heterogeneous depth. #### Discussion This injury is consistent with chemical burns caused by caustic soda (sodium hydroxide), which can occur in industrial and domestic settings. Other chemicals that cause such burns include: Although exposure mainly causes cutaneous and ocular burns, some chemicals can have systemic effects if absorbed or inhaled. Chemical burns account for about 13% of all burns related mortality and 3.3% of all burns in the United Kingdom.1 An important feature of chemical burns is the tendency for the burning process to persist despite macroscopic source removal and resuscitation. Chemicals continue to denature proteins and damage tissues for as long as traces of …
Cerebellopontine angle (CPA) tumours are the most common neoplasms in the posterior fossa, accoun... more Cerebellopontine angle (CPA) tumours are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumours. Most CPA tumours are benign, with most being vestibular schwannomas. Meningiomas arising from the jugular foramen are among the rarest of all with very few being described in the literature. Treatment options vary considerably as experience with these tumours is limited. One option is a skull base approach, but this depends on size, location and ability to preserve lower cranial nerve function. This can be extremely challenging and is accompanied by high mortality risk; therefore, a more conservative option must be considered. This case report highlights the difficulty in management of patients with jugular fossa meningiomas, including appropriate investigations, analysis of surgical versus conservative treatment and associated complications. Furthermore, we elaborate the decision-making process pertaining to the tailoring of the surgical route use...
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