Dacryocystography using cone beam CT in patients with lacrimal drainage system obstruction.

PURPOSE To assess the usefulness of cone beam CT (CBCT) for dacryocystography (DCG) using either direct syringing or passive application of contrast medium. METHODS Ten consecutive patients with epiphora who had CBCT-DCG in a sitting position were retrospectively analyzed. CBCT-DCGs were performed using 2 techniques: direct syringing with contrast medium or using the passive technique, where patients received 3 drops of contrast medium into the conjunctival sac before CBCT-DCG. Clinical and radiologic diagnoses were compared for both groups. RESULTS The 10 patients (men = 3) had a mean age of 63.2 years. Both techniques proved to be simple procedures with good delineation of the bone, soft tissue, and the contrast medium in the lacrimal system. No side effects were noted. CONCLUSIONS CBCT-DCG is a useful alternative to determine the localization of stenosis in patients with chronic epiphora.

The Road Not Taken: Enabling and Limiting Mobility in the Eastern Pamirs

Based on fieldwork conducted between 2008 and 2011, this article explores the role of roads in enabling and limiting the movement of people and goods in Tajikistan’s Eastern Pamirs. The article focuses on the Pamir Highway and a newly established trade route linking Tajikistan with China. Besides materially facilitating mobility, both roads serve as trajectories for opportunities, but often also signify the lack of such to those who live along them. This article thus seeks to analyse the shifting roles of roads against the backdrop of past and present state dispensations, shifting ideologies and newly emerging economic practices. By emphasising roads as both enabling and limiting spatial entities shaped by materiality, politics and economics, this article argues, on the one hand, that roads are important factors in directing and accelerating the mobility of people and goods and, on the other, that roads are also symbols of immobility inasmuch as they set limitations on the movement of people.

Infection rate of emergency bolt-kit vs. non-emergency conventional implanted silver bearing external ventricular drainage catheters.

BACKGROUND Bolt-kit systems are increasingly used as an alternative to conventional external cerebrospinal fluid (CSF) drainage systems. Since 2009 we regularly utilize bolt-kit external ventricular drainage (EVD) systems with silver-bearing catheters inserted manually with a hand drill and skull screws for emergency ventriculostomy. For non-emergency situations, we use conventional ventriculostomy with subcutaneous tunneled silver-bearing catheters, performed in the operating room with a pneumatic drill. This retrospective analysis compared the two techniques in terms of infection rates. METHODS 152 patients (aged 17-85 years, mean=55.4 years) were included in the final analysis; 95 received bolt-kit silver-bearing catheters and 57 received conventionally implanted silver-bearing catheters. The primary endpoint combined infection parameters: occurrence of positive CSF culture, colonization of catheter tips, or elevated CSF white blood cell counts (>4/μl). Secondary outcome parameters were presence of microorganisms in CSF or on catheter tips. Incidence of increased CSF cell counts and number of patients with catheter malposition were also compared. RESULTS The primary outcome, defined as analysis of combined infection parameters (occurrence of either positive CSF culture, colonization of the catheter tips or raised CSF white blood cell counts >4/μl)was not significantly different between the groups (58.9% bolt-kit group vs. 63.2% conventionally implanted group, p=0.61, chi-square-test). The bolt-kit group was non-inferior and not superior to the conventional group (relative risk reduction of 6.7%; 90% confidence interval: -19.9% to 25.6%). Secondary outcomes showed no statistically significant difference in the incidence of microorganisms in CSF (2.1% bolt-kit vs. 5.3% conventionally implanted; p=0.30; chi-square-test). CONCLUSIONS This analysis indicates that silver-bearing EVD catheters implanted with a bolt-kit system outside the operating room do not significantly elevate the risk of CSF infection as compared to conventional implant methods.

Injury severity and mortality of adult zebra crosswalk and non-zebra crosswalk road crossing accidents: a cross-sectional analysis

PRINCIPALS Over a million people worldwide die each year from road traffic injuries and more than 10 million sustain permanent disabilities. Many of these victims are pedestrians. The present retrospective study analyzes the severity and mortality of injuries suffered by adult pedestrians, depending on whether they used a zebra crosswalk. METHODS Our retrospective data analysis covered adult patients admitted to our emergency department (ED) between 1 January 2000 and 31 December 2012 after being hit by a vehicle while crossing the road as a pedestrian. Patients were identified by using a string term. Medical, police and ambulance records were reviewed for data extraction. RESULTS A total of 347 patients were eligible for study inclusion. Two hundred and three (203; 58.5%) patients were on a zebra crosswalk and 144 (41.5%) were not. The mean ISS (injury Severity Score) was 12.1 (SD 14.7, range 1-75). The vehicles were faster in non-zebra crosswalk accidents (47.7 km/n, versus 41.4 km/h, p<0.027). The mean ISS score was higher in patients with non-zebra crosswalk accidents; 14.4 (SD 16.5, range 1-75) versus 10.5 (SD13.14, range 1-75) (p<0.019). Zebra crosswalk accidents were associated with less risk of severe injury (OR 0.61, 95% CI 0.38-0.98, p<0.042). Accidents involving a truck were associated with increased risk of severe injury (OR 3.53, 95%CI 1.21-10.26, p<0.02). CONCLUSION Accidents on zebra crosswalks are more common than those not on zebra crosswalks. The injury severity of non-zebra crosswalk accidents is significantly higher than in patients with zebra crosswalk accidents. Accidents involving large vehicles are associated with increased risk of severe injury. Further prospective studies are needed, with detailed assessment of motor vehicle types and speed.

Explaining car drivers' intention to prevent road-traffic noise: An application of the Norm Activation Model

Strengthening car drivers’ intention to prevent road-traffic noise is a first step toward noise abatement through voluntary change of behavior. We analyzed predictors of this intention based on the norm activation model (i.e., personal norm, problem awareness, awareness of consequences, social norm, and value orientations). Moreover, we studied the effects of noise exposure, noise sensitivity, and noise annoyance on problem awareness. Data came from 1,002 car drivers who participated in a two-wave longitudinal survey over 4 months. Personal norm had a large prospective effect on intention, even when the previous level of intention was controlled for, and mediated the effect of all other variables on intention. Almost 60% of variance in personal norm was explained by problem awareness, social norm, and biospheric value orientation. The effects of noise sensitivity and noise exposure on problem awareness were small and mediated by noise annoyance. We propose four communication strategies for strengthening the intention to prevent road-traffic noise in car drivers.

Car Design and Road Crossing Behaviour

Humans possess a highly developed sensitivity for facial features. This sensitivity is also deployed to non-human beings and inanimate objects such as cars. In the present study we aimed to investigate whether car design has a bearing on the behaviour of pedestrians. Methods: An immersive virtual reality environment with a zebra crossing was used to determine a) whether the minimum accepted distance for crossing the street is bigger for cars with dominant appearance than for cars with friendly appearance (Block 1) and b) whether the speed of dominant cars are overestimated compared to friendly cars (Block 2). In Block 1, the participant's task was to cross the road in front of an approaching car at the latest moment. The point of time when entering and leaving the street was measured. In Block 2 they were asked to estimate the speed of each passing car. An independent sample rated dominant cars as being more dominant, angry and hostile than friendly cars. Results: None of the predictions regarding the car design was confirmed. Instead, there was an effect of starting position: From the centre island, participants entered the road significantly later (smaller accepted distance) and left the road later than when starting from the pavement. Consistently, the speed of the cars was estimated significantly lower when standing on the centre island compared to the pavement. When entering the visual size of the cars as factor (instead of dominance), we found that participants started to cross the road significantly later in front of small cars compared to big cars and that the speed of smaller cars was overestimated compared to big cars (size-speed bias). Conclusions: Car size and starting position, not car design seem to have an influence on road crossing behaviour.

When the prey gets too big: an uncommon road accident involving a motorcyclist, a car and a bird

We present the postmortem findings of a fatal road accident involving a motorcyclist, a car, and a common buzzard. Both the motorcyclist and the bird died on the scene of the accident and were examined by postmortem full-body CT and autopsy. In addition, a facial injury of the motorcyclist was compared with the dimensions of the buzzard’s beak and claws by 3D scan technologies. Blood splatters collected on the bird’s beak, feet, and tail were examined by DNA analysis. The overall findings suggested a collision of a common buzzard with a motorcyclist in full speed, causing the motorcyclist to lose control of his vehicle and crash with an approaching car on the oncoming lane.

Phyllotaxis involves auxin drainage through leaf primordia

The spatial arrangement of leaves and flowers around the stem, known as phyllotaxis, is controlled by an auxin-dependent reiterative mechanism that leads to regular spacing of the organs and thereby to remarkably precise phyllotactic patterns. The mechanism is based on the active cellular transport of the phytohormone auxin by cellular influx and efflux carriers, such as AUX1 and PIN1. Their important role in phyllotaxis is evident from mutant phenotypes, but their exact roles in space and time are difficult to address due to the strong pleiotropic phenotypes of most mutants in phyllotaxis. Models of phyllotaxis invoke the accumulation of auxin at leaf initials and removal of auxin through their developing vascular strand, the midvein. We have developed a precise microsurgical tool to ablate the midvein at high spatial and temporal resolution in order to test its function in leaf formation and phyllotaxis. Using amplified femtosecond laser pulses, we ablated the internal tissues in young leaf primordia of tomato (Solanum lycopersicum) without damaging the overlying L1 and L2 layers. Our results show that ablation of the future midvein leads to a transient accumulation of auxin in the primordia and to an increase in their width. Phyllotaxis was transiently affected after midvein ablations, but readjusted after two plastochrons. These results indicate that the developing midvein is involved in the basipetal transport of auxin through young primordia, which contributes to phyllotactic spacing and stability.

A high-resolution map of direct and indirect connectivity of erosion risk areas to surface waters in Switzerland: A risk assessment tool for planning and policy-making

Off-site effects of soil erosion are becoming increasingly important, particularly the pollution of surface waters. In order to develop environmentally efficient and cost effective mitigation options it is essential to identify areas that bear both a high erosion risk and high connectivity to surface waters. This paper introduces a simple risk assessment tool that allows the delineation of potential critical source areas (CSA) of sediment input into surface waters concerning the agricultural areas of Switzerland. The basis are the erosion risk map with a 2 m resolution (ERM2) and the drainage network, which is extended by drained roads, farm tracks, and slope depressions. The probability of hydrological and sedimentological connectivity is assessed by combining soil erosion risk and extended drainage network with flow distance calculation. A GIS-environment with multiple-flow accumulation algorithms is used for routing runoff generation and flow pathways. The result is a high resolution connectivity map of the agricultural area of Switzerland (888,050 ha). Fifty-five percent of the computed agricultural area is potentially connected with surface waters, 45% is not connected. Surprisingly, the larger part of 34% (62% of the connected area) is indirectly connected with surface waters through drained roads, and only 21% are directly connected. The reason is the topographic complexity and patchiness of the landscape due to a dense road and drainage network. A total of 24% of the connected area and 13% of the computed agricultural area, respectively, are rated with a high connectivity probability. On these CSA an adapted land use is recommended, supported by vegetated buffer strips preventing sediment load. Even areas that are far away from open water bodies can be indirectly connected and need to be included in planning of mitigation measures. Thus, the connectivity map presented is an important decision-making tool for policy-makers and extension services. The map is published on the web and thus available for application.