The French 35-hour workweek: a wide-ranging social change.

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Prunier-Poulmaire, S; Gadbois, C

2001-12-01

The reduction of the legal working week to 35 hours in France has generated wide-ranging social change. We examine the resulting changes in working-time patterns as well as their repercussions on the use of the time gained and on the quality of life and health. To compensate the reduction in the length of the working week, companies have modified the working-time patterns, by extending operation time (shiftwork, atypical schedules) and by matching the on-site workforce to production requirements (flexible working hours). They have sought to make more efficient use of working time: job intensification or job compression. The effects on the off-the-job life and health are linked to the shiftwork and atypical schedules designed to increase the company's operating time, and adjustments to the company's need for flexibilization impose working time/free time patterns that are at odds with biological rhythms and social life patterns. Changes to working-time patterns have unexpected consequences for work organization: heightened difficulties for the individual and the crew. These changes may generate a range of health problems related to overwork and stress. The way some companies have adapted may call into question the usefulness of work done by employees, thus damaging their social identity and mental well-being.

The potential effects of climate change on amphibian distribution, range fragmentation and turnover in China.

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Duan, Ren-Yan; Kong, Xiao-Quan; Huang, Min-Yi; Varela, Sara; Ji, Xiang

2016-01-01

Many studies predict that climate change will cause species movement and turnover, but few have considered the effect of climate change on range fragmentation for current species and/or populations. We used MaxEnt to predict suitable habitat, fragmentation and turnover for 134 amphibian species in China under 40 future climate change scenarios spanning four pathways (RCP2.6, RCP4.5, RCP6 and RCP8.5) and two time periods (the 2050s and 2070s). Our results show that climate change may cause a major shift in spatial patterns of amphibian diversity. Amphibians in China would lose 20% of their original ranges on average; the distribution outside current ranges would increase by 15%. Suitable habitats for over 90% of species will be located in the north of their current range, for over 95% of species in higher altitudes (from currently 137-4,124 m to 286-4,396 m in the 2050s or 314-4,448 m in the 2070s), and for over 75% of species in the west of their current range. Also, our results predict two different general responses to the climate change: some species contract their ranges while moving westwards, southwards and to higher altitudes, while others expand their ranges. Finally, our analyses indicate that range dynamics and fragmentation are related, which means that the effects of climate change on Chinese amphibians might be two-folded.

The potential effects of climate change on amphibian distribution, range fragmentation and turnover in China

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Ren-Yan Duan

2016-07-01

Full Text Available Many studies predict that climate change will cause species movement and turnover, but few have considered the effect of climate change on range fragmentation for current species and/or populations. We used MaxEnt to predict suitable habitat, fragmentation and turnover for 134 amphibian species in China under 40 future climate change scenarios spanning four pathways (RCP2.6, RCP4.5, RCP6 and RCP8.5 and two time periods (the 2050s and 2070s. Our results show that climate change may cause a major shift in spatial patterns of amphibian diversity. Amphibians in China would lose 20% of their original ranges on average; the distribution outside current ranges would increase by 15%. Suitable habitats for over 90% of species will be located in the north of their current range, for over 95% of species in higher altitudes (from currently 137–4,124 m to 286–4,396 m in the 2050s or 314–4,448 m in the 2070s, and for over 75% of species in the west of their current range. Also, our results predict two different general responses to the climate change: some species contract their ranges while moving westwards, southwards and to higher altitudes, while others expand their ranges. Finally, our analyses indicate that range dynamics and fragmentation are related, which means that the effects of climate change on Chinese amphibians might be two-folded.

Adult Hematology and Clinical Chemistry Laboratory Reference Ranges in a Zimbabwean Population.

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Samaneka, Wadzanai P; Mandozana, Gibson; Tinago, Willard; Nhando, Nehemiah; Mgodi, Nyaradzo M; Bwakura-Dangarembizi, Mutsawashe F; Munjoma, Marshall W; Gomo, Zvenyika A R; Chirenje, Zvavahera M; Hakim, James G

2016-01-01

Laboratory reference ranges used for clinical care and clinical trials in various laboratories in Zimbabwe were derived from textbooks and research studies conducted more than ten years ago. Periodic verification of these ranges is essential to track changes over time. The purpose of this study was to establish hematology and chemistry laboratory reference ranges using more rigorous methods. A community-based cross-sectional study was carried out in Harare, Chitungwiza, and Mutoko. A multistage sampling technique was used. Samples were transported from the field for analysis at the ISO15189 certified University of Zimbabwe-University of California San Francisco Central Research Laboratory. Hematology and clinical chemistry reference ranges lower and upper reference limits were estimated at the 2.5th and 97.5th percentiles respectively. A total of 769 adults (54% males) aged 18 to 55 years were included in the analysis. Median age was 28 [IQR: 23-35] years. Males had significantly higher red cell counts, hemoglobin, hematocrit, and mean corpuscular hemoglobin compared to females. Females had higher white cell counts, platelets, absolute neutrophil counts, and absolute lymphocyte counts compared to males. There were no gender differences in eosinophils, monocytes, and absolute basophil count. Males had significantly higher levels of urea, sodium, potassium, calcium, creatinine, amylase, total protein, albumin and liver enzymes levels compared to females. Females had higher cholesterol and lipase compared with males. There are notable differences in the white cell counts, neutrophils, cholesterol, and creatinine kinase when compared with the currently used reference ranges. Data from this study provides new country specific reference ranges which should be immediately adopted for routine clinical care and accurate monitoring of adverse events in research studies.

Coherent change detection and interferometric ISAR measurements in the folded compact range

Energy Technology Data Exchange (ETDEWEB)

Sorensen, K.W.

1996-08-01

A folded compact range configuration has been developed ant the Sandia National Laboratories` compact range antenna and radar-cross- section measurement facility as a means of performing indoor, environmentally-controlled, far-field simulations of synthetic aperture radar (SAR) measurements of distributed target samples (i.e. gravel, sand, etc.). The folded compact range configuration has previously been used to perform coherent-change-detection (CCD) measurements, which allow disturbances to distributed targets on the order of fractions of a wavelength to be detected. This report describes follow-on CCD measurements of other distributed target samples, and also investigates the sensitivity of the CCD measurement process to changes in the relative spatial location of the SAR sensor between observations of the target. Additionally, this report describes the theoretical and practical aspects of performing interferometric inverse-synthetic-aperture-radar (IFISAR) measurements in the folded compact range environment. IFISAR measurements provide resolution of the relative heights of targets with accuracies on the order of a wavelength. Several examples are given of digital height maps that have been generated from measurements performed at the folded compact range facility.

Characterization of changes in serum anti-glycan antibodies in Crohn's disease--a longitudinal analysis.

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Florian Rieder

Full Text Available INTRODUCTION: Anti-glycan antibodies are a promising tool for differential diagnosis and disease stratification of patients with Crohn's disease (CD. We longitudinally assessed level and status changes of anti-glycan antibodies over time in individual CD patients as well as determinants of this phenomenon. METHODS: 859 serum samples derived from a cohort of 253 inflammatory bowel disease (IBD patients (207 CD, 46 ulcerative colitis (UC were tested for the presence of anti-laminarin (Anti-L, anti-chitin (Anti-C, anti-chitobioside (ACCA, anti-laminaribioside (ALCA, anti-mannobioside (AMCA and anti-Saccharomyces cerevisiae (gASCA antibodies by ELISA. All patients had at least two and up to eleven serum samples taken during the disease course. RESULTS: Median follow-up time for CD was 17.4 months (Interquartile range (IQR 8.0, 31.6 months and for UC 10.9 months (IQR 4.9, 21.0 months. In a subgroup of CD subjects marked changes in the overall immune response (quartile sum score and levels of individual markers were observed over time. The marker status (positive versus negative remained widely stable. Neither clinical phenotype nor NOD2 genotype was associated with the observed fluctuations. In a longitudinal analysis neither changes in disease activity nor CD behavior led to alterations in the levels of the glycan markers. The ability of the panel to discriminate CD from UC or its association with CD phenotypes remained stable during follow-up. In the serum of UC patients neither significant level nor status changes were observed. CONCLUSIONS: While the levels of anti-glycan antibodies fluctuate in a subgroup of CD patients the antibody status is widely stable over time.

Climate change impacts on tree ranges: model intercomparison facilitates understanding and quantification of uncertainty.

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Cheaib, Alissar; Badeau, Vincent; Boe, Julien; Chuine, Isabelle; Delire, Christine; Dufrêne, Eric; François, Christophe; Gritti, Emmanuel S; Legay, Myriam; Pagé, Christian; Thuiller, Wilfried; Viovy, Nicolas; Leadley, Paul

2012-06-01

Model-based projections of shifts in tree species range due to climate change are becoming an important decision support tool for forest management. However, poorly evaluated sources of uncertainty require more scrutiny before relying heavily on models for decision-making. We evaluated uncertainty arising from differences in model formulations of tree response to climate change based on a rigorous intercomparison of projections of tree distributions in France. We compared eight models ranging from niche-based to process-based models. On average, models project large range contractions of temperate tree species in lowlands due to climate change. There was substantial disagreement between models for temperate broadleaf deciduous tree species, but differences in the capacity of models to account for rising CO(2) impacts explained much of the disagreement. There was good quantitative agreement among models concerning the range contractions for Scots pine. For the dominant Mediterranean tree species, Holm oak, all models foresee substantial range expansion. © 2012 Blackwell Publishing Ltd/CNRS.

Adult Hematology and Clinical Chemistry Laboratory Reference Ranges in a Zimbabwean Population.

Directory of Open Access Journals (Sweden)

Wadzanai P Samaneka

Full Text Available Laboratory reference ranges used for clinical care and clinical trials in various laboratories in Zimbabwe were derived from textbooks and research studies conducted more than ten years ago. Periodic verification of these ranges is essential to track changes over time. The purpose of this study was to establish hematology and chemistry laboratory reference ranges using more rigorous methods.A community-based cross-sectional study was carried out in Harare, Chitungwiza, and Mutoko. A multistage sampling technique was used. Samples were transported from the field for analysis at the ISO15189 certified University of Zimbabwe-University of California San Francisco Central Research Laboratory. Hematology and clinical chemistry reference ranges lower and upper reference limits were estimated at the 2.5th and 97.5th percentiles respectively.A total of 769 adults (54% males aged 18 to 55 years were included in the analysis. Median age was 28 [IQR: 23-35] years. Males had significantly higher red cell counts, hemoglobin, hematocrit, and mean corpuscular hemoglobin compared to females. Females had higher white cell counts, platelets, absolute neutrophil counts, and absolute lymphocyte counts compared to males. There were no gender differences in eosinophils, monocytes, and absolute basophil count. Males had significantly higher levels of urea, sodium, potassium, calcium, creatinine, amylase, total protein, albumin and liver enzymes levels compared to females. Females had higher cholesterol and lipase compared with males. There are notable differences in the white cell counts, neutrophils, cholesterol, and creatinine kinase when compared with the currently used reference ranges.Data from this study provides new country specific reference ranges which should be immediately adopted for routine clinical care and accurate monitoring of adverse events in research studies.

Changes in gene expression following trauma are related to the age of transfused packed red blood cells.

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Torrance, Hew D T; Vivian, Mark E; Brohi, Karim; Prowle, John R; Pearse, Rupert M; Owen, Helen C; Hinds, Charles J; O'Dwyer, Michael J

2015-03-01

Transfusion of packed red blood cells (PRBCs) is associated with an increased incidence of nosocomial infections and an increased risk of death. The duration of storage before transfusion may influence these outcomes. Here, we explore the association between the age of transfused PRBCs and specific patterns of inflammatory gene expression in severely injured trauma patients. Severely injured trauma patients requiring intensive care unit treatment and receiving transfusion of PRBCs within 24 hours of the injury were recruited. Blood samples were obtained within 2 hours of the trauma, at 24 hours, and at 72 hours. Messenger RNA was extracted from whole blood, and gene expression was quantified using quantitative polymerase chain reaction. The median age of the units of PRBCs transfused to each patient was recorded. The primary outcome measure was the change in candidate gene expression over the initial 72 hours. Sixty-four patients were studied. Fifty-three patients (83%) were male, and the median age was 40.5 years (interquartile range [IQR], 31-59). Median Injury Severity Score (ISS) was 31.5 (IQR, 23-43), and 55 patients (86%) experienced a blunt injury. Forty-one patients (64%) developed a nosocomial infection, and 15 patients (23%) died before hospital discharge. Each patient received a median of 5 U of PRBCs (IQR, 4-9.8 U) during the first 24 hours of hospital admission. The median age of the units of PRBCs transfused in each patient was 20 days (IQR, 17-22 days). Older blood was associated with greater decreases in interleukin 12 (IL-12), IL-23, and RORγt (all p's < 0.05) gene expression over the initial 24 hours, greater decreases in IL-12 gene expression over 72 hours, and a rise in transforming growth factor β gene expression over the first 72 hours. A multivariate analysis confirmed the independence of these associations. Increasing the duration of storage of PRBCs before transfusion is associated with a pattern of gene expression consistent with more

Potential climate change favored expansion of a range limited species, Haematostaphis barteri Hook f.

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Jacob Koundouonon Moutouama

2016-12-01

Full Text Available Understanding impact of climate change on range breadth of rare species can improve the ability to anticipate their decline or expension and take appropriate conservation measures. Haematatostaphis barteri is an agroforestry species of the Sudanian centre of endemism in Africa. We investigeted impact of climate change on range of suitable habitats for this species in Benin,using the Maximum Entropy algorithm under R software. Five environmental variables were used with the regional climate model under the new Representation Concentration Pathways (RCP. Moisture Index of the Moist Quarter and Slope variability had the greatest predictive importance for the range of suitable habitats for H. barteri. Its Potential breadth was found to be currently limited to the Atacora Mountain Chain (AMC and covers 0.51% of national territory. Climate change was projected to favor expansion of suitable habitats for H. barteri by 0.12% and 0.05%, respectively for the RCP4.5 and RCP8.5. These habitats were however mostly out of the local protected areas network. Climate change would extend range of habitats for H. barteri. Observed protection gaps suggest need for integrating this species into formal in situ, on-farm or ex situ conservation schemes.

How disturbance, competition, and dispersal interact to prevent tree range boundaries from keeping pace with climate change.

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Liang, Yu; Duveneck, Matthew J; Gustafson, Eric J; Serra-Diaz, Josep M; Thompson, Jonathan R

2018-01-01

Climate change is expected to cause geographic shifts in tree species' ranges, but such shifts may not keep pace with climate changes because seed dispersal distances are often limited and competition-induced changes in community composition can be relatively slow. Disturbances may speed changes in community composition, but the interactions among climate change, disturbance and competitive interactions to produce range shifts are poorly understood. We used a physiologically based mechanistic landscape model to study these interactions in the northeastern United States. We designed a series of disturbance scenarios to represent varied disturbance regimes in terms of both disturbance extent and intensity. We simulated forest succession by incorporating climate change under a high-emissions future, disturbances, seed dispersal, and competition using the landscape model parameterized with forest inventory data. Tree species range boundary shifts in the next century were quantified as the change in the location of the 5th (the trailing edge) and 95th (the leading edge) percentiles of the spatial distribution of simulated species. Simulated tree species range boundary shifts in New England over the next century were far below (usually change (usually more than 110 km over 100 years) under a high-emissions scenario. Simulated species` ranges shifted northward at both the leading edge (northern boundary) and trailing edge (southern boundary). Disturbances may expedite species' recruitment into new sites, but they had little effect on the velocity of simulated range boundary shifts. Range shifts at the trailing edge tended to be associated with photosynthetic capacity, competitive ability for light and seed dispersal ability, whereas shifts at the leading edge were associated only with photosynthetic capacity and competition for light. This study underscores the importance of understanding the role of interspecific competition and disturbance when studying tree range

Histomorphological changes of vessel structure in head and neck vessels following preoperative or postoperative radiotherapy

International Nuclear Information System (INIS)

Schultze-Mosgau, S.; Wehrhan, F.; Wiltfang, J.; Grabenbauer, G.G.; Sauer, R.; Roedel, F.; Radespiel-Troeger, M.

2002-01-01

Patients and Methods: In 348 patients (October 1995-March 2002) receiving primarly or secondarily 356 microvascular hard- and soft tissue reconstruction, a total of 209 vessels were obtained from neck recipient vessels and transplant vessels during anastomosis. Three groups were analysed: group 1 (27 patients) treated with no radiotherapy or chemotherapy; group 2 (29 patients) treated with preoperative irradiation (40-50 Gy) and chemotherapy (800 mg/m 2 /day 5-FU and 20 mg/m 2 /day cisplatin) 1.5 months prior to surgery; group 3 (20 patients) treated with radiotherapy (60-70 Gy) (median interval 78.7 months; IQR: 31.3 months) prior to surgery. From each of the 209 vessel specimens, 3 sections were investigated histomorphometrically, qualitatively and quantitatively (ratio media area/total vessel area) by NIH-Image-digitized measurements. To evaluate these changes as a function of age, radiation dose and chemotherapy, a statistical analysis was performed using an analysis of covariance and χ 2 tests (p > 0.05, SPSS V10). Results: In group 3, qualitative changes (intima dehiscence, hyalinosis) were found in recipient arteries significantly more frequently than in groups 1 and 2. For group 3 recipient arteries, histomorphometry revealed a significant decrease in the ratio media area/total vessel area (median 0.51, IQR 0.10) in comparison with groups 1 (p = 0.02) (median 0.61, IQR 0.29) and 2 (p = 0.046) (median 0.58, IQR 0.19). No significant difference was found between the vessels of groups 1 and 2 (p = 0.48). There were no significant differences in transplant arteries and recipient or transplant veins between the groups. Age and chemotherapy did not appear to have a significant influence on vessel changes in this study (p > 0.05). Conclusions: Following irradiation with 60-70 Gy, significant qualitative and quantitative histological changes to the recipient arteries, but not to the recipient veins, could be observed. In contrast, irradiation at a dose of 40-50 Gy

Feature Optimization for Long-Range Visual Homing in Changing Environments

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Qidan Zhu

2014-02-01

Full Text Available This paper introduces a feature optimization method for robot long-range feature-based visual homing in changing environments. To cope with the changing environmental appearance, the optimization procedure is introduced to distinguish the most relevant features for feature-based visual homing, including the spatial distribution, selection and updating. In the previous research on feature-based visual homing, less effort has been spent on the way to improve the feature distribution to get uniformly distributed features, which are closely related to homing performance. This paper presents a modified feature extraction algorithm to decrease the influence of anisotropic feature distribution. In addition, the feature selection and updating mechanisms, which have hardly drawn any attention in the domain of feature-based visual homing, are crucial in improving homing accuracy and in maintaining the representation of changing environments. To verify the feasibility of the proposal, several comprehensive evaluations are conducted. The results indicate that the feature optimization method can find optimal feature sets for feature-based visual homing, and adapt the appearance representation to the changing environments as well.

How disturbance, competition and dispersal interact to prevent tree range boundaries from keeping pace with climate change

Science.gov (United States)

Liang, Y.; Duveneck, M.; Gustafson, E. J.; Serra-Diaz, J. M.; Thompson, J. R.

2017-12-01

Climate change is expected to cause geographic shifts in tree species' ranges, but such shifts may not keep pace with climate changes because seed dispersal distances are often limited and competition-induced changes in community composition can be relatively slow. Disturbances may speed changes in community composition, but the interactions among climate change, disturbance and competitive interactions to produce range shifts are poorly understood. We used a physiologically-based mechanistic landscape model to study these interactions in the northeastern United States. We designed a series of disturbance scenarios to represent varied disturbance regimes in terms of both disturbance extent and intensity. We simulated forest succession by incorporating climate change under a high emissions future, disturbances, seed dispersal, and competition using the landscape model parameterized with forest inventory data. Tree species range boundary shifts in the next century were quantified as the change in the location of the 5th (the trailing edge) and 95th (the leading edge) percentiles of the spatial distribution of simulated species. Simulated tree species range boundary shifts in New England over the next century were far below (usually Disturbances may expedite species` recruitment into new sites, but they had little effect on the velocity of simulated range boundary shifts. Range shifts at the trailing edge tended to be associated with photosynthetic capacity, competitive ability for light and seed dispersal ability, whereas shifts at the leading edge were associated only with photosynthetic capacity and competition for light. This study underscores the importance of understanding the role of interspecific competition and disturbance when studying tree range shifts.

Structural changes and out-of-sample prediction of realized range-based variance in the stock market

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Gong, Xu; Lin, Boqiang

2018-03-01

This paper aims to examine the effects of structural changes on forecasting the realized range-based variance in the stock market. Considering structural changes in variance in the stock market, we develop the HAR-RRV-SC model on the basis of the HAR-RRV model. Subsequently, the HAR-RRV and HAR-RRV-SC models are used to forecast the realized range-based variance of S&P 500 Index. We find that there are many structural changes in variance in the U.S. stock market, and the period after the financial crisis contains more structural change points than the period before the financial crisis. The out-of-sample results show that the HAR-RRV-SC model significantly outperforms the HAR-BV model when they are employed to forecast the 1-day, 1-week, and 1-month realized range-based variances, which means that structural changes can improve out-of-sample prediction of realized range-based variance. The out-of-sample results remain robust across the alternative rolling fixed-window, the alternative threshold value in ICSS algorithm, and the alternative benchmark models. More importantly, we believe that considering structural changes can help improve the out-of-sample performances of most of other existing HAR-RRV-type models in addition to the models used in this paper.

Impacts of climate change on range expansion by the mountain pine beetle

Energy Technology Data Exchange (ETDEWEB)

Carroll, A.L.; Taylor, S.W. [Canadian Forest Service, Victoria, BC (Canada). Pacific Forestry Centre; Regniere, J. [Canadian Forest Service, Quebec, PQ (Canada). Laurentian Forestry Centre; Logan, J.A.; Bentz, B.J. [United States Dept. of Agriculture, Logan, UT (United States). Logan Forestry Sciences Laboratory; Powell, J.A. [Utah State Univ., Logan, UT (United States). Dept. of Mathematics and Statistics

2006-07-01

The elevational and latitudinal range of mountain pine beetle (MPB) has been limited by climatic conditions that are currently unfavorable for brood development. This study examined the impact of climatic conditions on the establishment and persistence of MPB using a spatially explicit, climate-driven simulation tool. Historic weather records were also used to create maps of past habitats for MPB in British Columbia. Map overlays were then created to determine if MPB has expanded its range due to changes in the province's climate. The distribution of climatically suitable habitats was examined in 10-year increments. Results of the study showed an increase in benign habitats. MPB populations have expanded into new areas as a result of changes in climate. Additional range expansion for MPB was then assessed using a global circulation model along with a conservative forcing scenario that forecast a doubling of carbon dioxide (CO{sub 2}) by 2050. Weather conditions were then combined with a climatic suitability model in order to examine areas of climatically suitable habitats. It was concluded that continued eastward expansion by MPB is probable. 44 refs., 4 tabs., 7 figs.

Winter Precipitation Efficiency of Mountain Ranges in the Colorado Rockies Under Climate Change

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Eidhammer, Trude; Grubišić, Vanda; Rasmussen, Roy; Ikdea, Kyoko

2018-03-01

Orographic precipitation depends on the environmental conditions and the barrier shape. In this study we examine the sensitivity of the precipitation efficiency (i.e., drying ratio (DR)), defined as the ratio of precipitation to incoming water flux, to mountain shape, temperature, stability, and horizontal velocity of the incoming air mass. Furthermore, we explore how the DR of Colorado mountain ranges might change under warmer and moister conditions in the future. For given environmental conditions, we find the DR to be primarily dependent on the upwind slope for mountain ranges wider than about 70 km and on both the slope and width for narrower ranges. Temperature is found to exert an influence on the DR for all Colorado mountain ranges, with DR decreasing with increasing temperature, under both the current and future climate conditions. The decrease of DR with temperature under warmer climate was found to be stronger for wider mountains than the narrower ones. We attribute this asymmetry to the sensitivity of DR to reduced horizontal velocity under warmer conditions. Specifically, while DR for wider mountains shows no sensitivity to changes in horizontal velocity, the DR for narrow ranges increases as the horizontal velocity decreases and more time is provided for precipitation to form. Thus, for narrower ranges, the horizontal velocity appears to offset the temperature effect slightly. The percentagewise decrease of DR for all examined mountain ranges is about 4%K-1. In comparison, the increase in precipitation is about 6%K-1 while the vapor flux increase is about 9%K-1.

Weight Watchers on prescription: An observational study of weight change among adults referred to Weight Watchers by the NHS

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Aston Louise M

2011-06-01

Full Text Available Abstract Background The scale of overweight and obesity in the UK places a considerable burden on the NHS. In some areas the NHS has formed partnerships with commercial companies to offer weight management services, but there has been little evaluation of these schemes. This study is an independent audit of the Weight Watchers NHS Referral scheme and evaluates the weight change of obese and overweight adults referred to Weight Watchers (WW by the NHS. Method Data was obtained from the WW NHS Referral Scheme database for 29,326 referral courses started after 2nd April 2007 and ending before 6th October 2009 [90% female; median age 49 years (IQR 38 - 61 years; median BMI 35.1 kg/m2 (IQR 31.8 - 39.5 kg/m2. Participants received vouchers (funded by the PCT following referral by a healthcare professional to attend 12 WW meetings. Body weight was measured at WW meetings and relayed to the central database. Results Median weight change for all referrals was -2.8 kg [IQR -5.9 - -0.7 kg] representing -3.1% initial weight. 33% of all courses resulted in loss of ≥5% initial weight. 54% of courses were completed. Median weight change for those completing a first course was -5.4 kg [IQR -7.8 - -3.1 kg] or -5.6% of initial weight. 57% lost ≥5% initial weight. Conclusions A third of all patients who were referred to WW through the WW NHS Referral Scheme and started a 12 session course achieved ≥5% weight loss, which is usually associated with clinical benefits. This is the largest audit of NHS referral to a commercial weight loss programme in the UK and results are comparable with other options for weight loss available through primary care.

Competition and facilitation may lead to asymmetric range shift dynamics with climate change.

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Ettinger, Ailene; HilleRisLambers, Janneke

2017-09-01

Forecasts of widespread range shifts with climate change stem from assumptions that climate drives species' distributions. However, local adaptation and biotic interactions also influence range limits and thus may impact range shifts. Despite the potential importance of these factors, few studies have directly tested their effects on performance at range limits. We address how population-level variation and biotic interactions may affect range shifts by transplanting seeds and seedlings of western North American conifers of different origin populations into different competitive neighborhoods within and beyond their elevational ranges and monitoring their performance. We find evidence that competition with neighboring trees limits performance within current ranges, but that interactions between adults and juveniles switch from competitive to facilitative at upper range limits. Local adaptation had weaker effects on performance that did not predictably vary with range position or seed origin. Our findings suggest that competitive interactions may slow species turnover within forests at lower range limits, whereas facilitative interactions may accelerate the pace of tree expansions upward near timberline. © 2017 John Wiley & Sons Ltd.

A new tool for exploring climate change induced range shifts of conifer species in China.

Science.gov (United States)

Kou, Xiaojun; Li, Qin; Beierkuhnlein, Carl; Zhao, Yiheng; Liu, Shirong

2014-01-01

It is inevitable that tree species will undergo considerable range shifts in response to anthropogenic induced climate change, even in the near future. Species Distribution Models (SDMs) are valuable tools in exploring general temporal trends and spatial patterns of potential range shifts. Understanding projections to future climate for tree species will facilitate policy making in forestry. Comparative studies for a large number of tree species require the availability of suitable and standardized indices. A crucial limitation when deriving such indices is the threshold problem in defining ranges, which has made interspecies comparison problematic until now. Here we propose a set of threshold-free indices, which measure range explosion (I), overlapping (O), and range center movement in three dimensions (Dx, Dy, Dz), based on fuzzy set theory (Fuzzy Set based Potential Range Shift Index, F-PRS Index). A graphical tool (PRS_Chart) was developed to visualize these indices. This technique was then applied to 46 Pinaceae species that are widely distributed and partly common in China. The spatial patterns of the modeling results were then statistically tested for significance. Results showed that range overlap was generally low; no trends in range size changes and longitudinal movements could be found, but northward and poleward movement trends were highly significant. Although range shifts seemed to exhibit huge interspecies variation, they were very consistent for certain climate change scenarios. Comparing the IPCC scenarios, we found that scenario A1B would lead to a larger extent of range shifts (less overlapping and more latitudinal movement) than the A2 and the B1 scenarios. It is expected that the newly developed standardized indices and the respective graphical tool will facilitate studies on PRS's for other tree species groups that are important in forestry as well, and thus support climate adaptive forest management.

A new tool for exploring climate change induced range shifts of conifer species in China.

Directory of Open Access Journals (Sweden)

Xiaojun Kou

Full Text Available It is inevitable that tree species will undergo considerable range shifts in response to anthropogenic induced climate change, even in the near future. Species Distribution Models (SDMs are valuable tools in exploring general temporal trends and spatial patterns of potential range shifts. Understanding projections to future climate for tree species will facilitate policy making in forestry. Comparative studies for a large number of tree species require the availability of suitable and standardized indices. A crucial limitation when deriving such indices is the threshold problem in defining ranges, which has made interspecies comparison problematic until now. Here we propose a set of threshold-free indices, which measure range explosion (I, overlapping (O, and range center movement in three dimensions (Dx, Dy, Dz, based on fuzzy set theory (Fuzzy Set based Potential Range Shift Index, F-PRS Index. A graphical tool (PRS_Chart was developed to visualize these indices. This technique was then applied to 46 Pinaceae species that are widely distributed and partly common in China. The spatial patterns of the modeling results were then statistically tested for significance. Results showed that range overlap was generally low; no trends in range size changes and longitudinal movements could be found, but northward and poleward movement trends were highly significant. Although range shifts seemed to exhibit huge interspecies variation, they were very consistent for certain climate change scenarios. Comparing the IPCC scenarios, we found that scenario A1B would lead to a larger extent of range shifts (less overlapping and more latitudinal movement than the A2 and the B1 scenarios. It is expected that the newly developed standardized indices and the respective graphical tool will facilitate studies on PRS's for other tree species groups that are important in forestry as well, and thus support climate adaptive forest management.

The response of big sagebrush (Artemisia tridentata) to interannual climate variation changes across its range.

Science.gov (United States)

Kleinhesselink, Andrew R; Adler, Peter B

2018-05-01

Understanding how annual climate variation affects population growth rates across a species' range may help us anticipate the effects of climate change on species distribution and abundance. We predict that populations in warmer or wetter parts of a species' range should respond negatively to periods of above average temperature or precipitation, respectively, whereas populations in colder or drier areas should respond positively to periods of above average temperature or precipitation. To test this, we estimated the population sensitivity of a common shrub species, big sagebrush (Artemisia tridentata), to annual climate variation across its range. Our analysis includes 8,175 observations of year-to-year change in sagebrush cover or production from 131 monitoring sites in western North America. We coupled these observations with seasonal weather data for each site and analyzed the effects of spring through fall temperatures and fall through spring accumulated precipitation on annual changes in sagebrush abundance. Sensitivity to annual temperature variation supported our hypothesis: years with above average temperatures were beneficial to sagebrush in colder locations and detrimental to sagebrush in hotter locations. In contrast, sensitivity to precipitation did not change significantly across the distribution of sagebrush. This pattern of responses suggests that regional abundance of this species may be more limited by temperature than by precipitation. We also found important differences in how the ecologically distinct subspecies of sagebrush responded to the effects of precipitation and temperature. Our model predicts that a short-term temperature increase could produce an increase in sagebrush cover at the cold edge of its range and a decrease in cover at the warm edge of its range. This prediction is qualitatively consistent with predictions from species distribution models for sagebrush based on spatial occurrence data, but it provides new mechanistic

Switched Memory B Cells Are Increased in Oligoarticular and Polyarticular Juvenile Idiopathic Arthritis and Their Change Over Time Is Related to Response to Tumor Necrosis Factor Inhibitors.

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Marasco, Emiliano; Aquilani, Angela; Cascioli, Simona; Moneta, Gian Marco; Caiello, Ivan; Farroni, Chiara; Giorda, Ezio; D'Oria, Valentina; Marafon, Denise Pires; Magni-Manzoni, Silvia; Carsetti, Rita; De Benedetti, Fabrizio

2018-04-01

To investigate whether abnormalities in B cell subsets in patients with juvenile idiopathic arthritis (JIA) correlate with clinical features and response to treatment. A total of 109 patients diagnosed as having oligoarticular JIA or polyarticular JIA were enrolled in the study. B cell subsets in peripheral blood and synovial fluid were analyzed by flow cytometry. Switched memory B cells were significantly increased in patients compared to age-matched healthy controls (P < 0.0001). When patients were divided according to age at onset of JIA, in patients with early-onset disease (presenting before age 6 years) the expansion in switched memory B cells was more pronounced than that in patients with late-onset disease and persisted throughout the disease course. In longitudinal studies, during methotrexate (MTX) treatment, regardless of the presence or absence of active disease, the number of switched memory B cells increased significantly (median change from baseline 36% [interquartile range {IQR} 15, 66]). During treatment with MTX plus tumor necrosis factor inhibitors (TNFi), in patients maintaining disease remission, the increase in switched memory B cells was significantly lower than that in patients who experienced active disease (median change from baseline 4% [IQR -6, 32] versus 41% [IQR 11, 73]; P = 0.004). The yearly rate of increases in switched memory B cells was 1.5% in healthy controls, 1.2% in patients who maintained remission during treatment with MTX plus TNFi, 4.7% in patients who experienced active disease during treatment with MTX plus TNFi, and ~4% in patients treated with MTX alone. Switched memory B cells expand during the disease course at a faster rate in JIA patients than in healthy children. This increase is more evident in patients with early-onset JIA. TNFi treatment inhibits this increase in patients who achieve and maintain remission, but not in those with active disease. © 2018, American College of Rheumatology.

Early signs of range disjunction of submountainous plant species: an unexplored consequence of future and contemporary climate changes.

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Kuhn, Emilien; Lenoir, Jonathan; Piedallu, Christian; Gégout, Jean-Claude

2016-06-01

Poleward and upward species range shifts are the most commonly anticipated and studied consequences of climate warming. However, these global responses to climate change obscure more complex distribution change patterns. We hypothesize that the spatial arrangement of mountain ranges and, consequently, climatic gradients in Europe, will result in range disjunctions. This hypothesis was investigated for submountainous forest plant species at two temporal and spatial scales: (i) under future climate change (between 1950-2000 and 2061-2080 periods) at the European scale and (ii) under contemporary climate change (between 1914-1987 and 1997-2013 periods) at the French scale. We selected 97 submountainous forest plant species occurring in France, among which distribution data across Europe are available for 25 species. By projecting future distribution changes for the 25 submountainous plant species across Europe, we demonstrated that range disjunction is a likely consequence of future climate change. To assess whether it is already taking place, we used a large forest vegetation-plot database covering the entire French territory over 100 years (1914-2013) and found an average decrease in frequency (-0.01 ± 0.004) in lowland areas for the 97 submountainous species - corresponding to a loss of 6% of their historical frequency - along with southward and upward range shifts, suggesting early signs of range disjunctions. Climate-induced range disjunctions should be considered more carefully since they could have dramatic consequences on population genetics and the ability of species to face future climate changes. © 2016 John Wiley & Sons Ltd.

A network of experimental forests and ranges: Providing soil solutions for a changing world

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Mary Beth. Adams

2010-01-01

The network of experimental forests and ranges of the USDA Forest Service represents significant opportunities to provide soil solutions to critical issues of a changing world. This network of 81 experimental forests and ranges encompasses broad geographic, biological, climatic and physical scales, and includes long-term data sets, and long-term experimental...

Quantifying species' range shifts in relation to climate change: a case study of Abies spp. in China.

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Xiaojun Kou

Full Text Available Predicting species range shifts in response to climatic change is a central aspect of global change studies. An ever growing number of species have been modeled using a variety of species distribution models (SDMs. However, quantitative studies of the characteristics of range shifts are rare, predictions of range changes are hard to interpret, analyze and summarize, and comparisons between the various models are difficult to make when the number of species modeled is large. Maxent was used to model the distribution of 12 Abies spp. in China under current and possible future climate conditions. Two fuzzy set defined indices, range increment index (I and range overlapping index (O, were used to quantify range shifts of the chosen species. Correlation analyses were used to test the relationships between these indices and species distribution characteristics. Our results show that Abies spp. range increments (I were highly correlated with longitude, latitude, and mean roughness of their current distributions. Species overlapping (O was moderately, or not, correlated with these parameters. Neither range increments nor overlapping showed any correlation with species prevalence. These fuzzy sets defined indices provide ideal measures of species range shifts because they are stable and threshold-free. They are reliable indices that allow large numbers of species to be described, modeled, and compared on a variety of taxonomic levels.

Explaining life history variation in a changing climate across a species' range

DEFF Research Database (Denmark)

Neuheimer, Anna B.; MacKenzie, Brian R.

2014-01-01

Timing of reproduction greatly influences offspring success and resulting population production. Explaining and predicting species' dynamics necessitates disentangling the intrinsic (genotypic) and extrinsic (climatic) factors controlling reproductive timing. Here we explore temporal and spatial...... changes in spawning time for 21 populations of Atlantic cod (Gadus morhua) across the species' range (40 degrees to 80 degrees N). We estimate spawning time using a physiologically relevant metric that includes information on fish thermal history (degree-days, DD). First, we estimate spawning DD among...... years (within populations) to show how recent changes in spawning time can be explained by local changes in temperature. Second, we employ spawning DD to identify temperature-independent trends in spawning time among populations that are consistent with parallel adaptive evolution and the evolutionary...

Drivers and uncertainties of forecasted range shifts for warm-water fishes under climate and land cover change

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Bouska, Kristen; Whitledge, Gregory W.; Lant, Christopher; Schoof, Justin

2018-01-01

Land cover is an important determinant of aquatic habitat and is projected to shift with climate changes, yet climate-driven land cover changes are rarely factored into climate assessments. To quantify impacts and uncertainty of coupled climate and land cover change on warm-water fish species’ distributions, we used an ensemble model approach to project distributions of 14 species. For each species, current range projections were compared to 27 scenario-based projections and aggregated to visualize uncertainty. Multiple regression and model selection techniques were used to identify drivers of range change. Novel, or no-analogue, climates were assessed to evaluate transferability of models. Changes in total probability of occurrence ranged widely across species, from a 63% increase to a 65% decrease. Distributional gains and losses were largely driven by temperature and flow variables and underscore the importance of habitat heterogeneity and connectivity to facilitate adaptation to changing conditions. Finally, novel climate conditions were driven by mean annual maximum temperature, which stresses the importance of understanding the role of temperature on fish physiology and the role of temperature-mitigating management practices.

Emergency medicine journal impact factor and change compared to other medical and surgical specialties.

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Reynolds, Joshua C; Menegazzi, James J; Yealy, Donald M

2012-11-01

A journal impact factor represents the mean number of citations per article published. Designed as one tool to measure the relative importance of a journal, impact factors are often incorporated into academic evaluation of investigators. The authors sought to determine how impact factors of emergency medicine (EM) journals compare to journals from other medical and surgical specialties and if any change has taken place over time. The 2010 impact factors and 5-year impact factors for each journal indexed by the Thomson Reuters ISI Web of Knowledge Journal Citation Reports (JCR) were collected, and EM, medical, and surgical specialties were evaluated. The maximum, median, and interquartile range (IQR) of the current impact factor and 5-year impact factor in each journal category were determined, and specialties were ranked according to the summary statistics. The "top three" impact factor journals for each specialty were analyzed, and growth trends from 2001 through 2010 were examined with random effects linear regression. Data from 2,287 journals in 31 specialties were examined. There were 23 EM journals with a current maximum impact factor of 4.177, median of 1.269, and IQR of 0.400 to 2.176. Of 23 EM journals, 57% had a 5-year impact factor available, with a maximum of 4.531, median of 1.325, and IQR of 0.741 to 2.435. The top three EM journals had a mean standard deviation (±SD) impact factor of 3.801 (±0.621) and median of 4.142 and a mean (±SD) 5-year impact factor of 3.788 (±1.091) and median of 4.297, with a growth trend of 0.211 (95% confidence interval [CI] = 0.177 to 0.245; p journals ranked no higher than 24th among 31 specialties. Emergency medicine journals rank low in impact factor summary statistics and growth trends among 31 medical and surgical specialties. © 2012 by the Society for Academic Emergency Medicine.

Probabilistic estimation of future emissions of isoprene and surface oxidant chemistry associated with land-use change in response to growing food needs

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C. J. Hardacre

2013-06-01

Full Text Available We quantify the impact of land-use change, determined by our growing demand for food and biofuel production, on isoprene emissions and subsequent atmospheric oxidant chemistry in 2015 and 2030, relative to 1990, ignoring compound climate change effects over that period. We estimate isoprene emissions from an ensemble (n = 1000 of land-use change realizations from 1990–2050, broadly guided by the IPCC AR4/SRES scenarios A1 and B1. We also superimpose land-use change required to address projected biofuel usage using two scenarios: (1 assuming that world governments make no changes to biofuel policy after 2009, and (2 assuming that world governments develop biofuel policy with the aim of keeping equivalent atmospheric CO2 at 450 ppm. We present the median and interquartile range (IQR statistics of the ensemble and show that land-use change between −1.50 × 1012 m2 to +6.06 × 1012 m2 was found to drive changes in the global isoprene burden of −3.5 to +2.8 Tg yr−1 in 2015 and −7.7 to +6.4 Tg yr−1 in 2030. We use land-use change realizations corresponding to the median and IQR of these emission estimates to drive the GEOS-Chem global 3-D chemistry transport model to investigate the perturbation to global and regional surface concentrations of isoprene, nitrogen oxides (NO+NO2, and the atmospheric concentration and deposition of ozone (O3. We show that across subcontinental regions the monthly surface O3 increases by 0.1–0.8 ppb, relative to a zero land-use change calculation, driven by increases (decreases in surface isoprene in high (low NOx environments. At the local scale (4° × 5° we find that surface O3 increases by 5–12 ppb over temperate North America, China and boreal Eurasia, driven by large increases in isoprene emissions from short-rotation coppice crop cultivation for biofuel production.

Predictive value of long-term changes of growth differentiation factor-15 over a 27-year-period for heart failure and death due to coronary heart disease.

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Fluschnik, Nina; Ojeda, Francisco; Zeller, Tanja; Jørgensen, Torben; Kuulasmaa, Kari; Becher, Peter Moritz; Sinning, Christoph; Blankenberg, Stefan; Westermann, Dirk

2018-01-01

Growth differentiation factor-15 (GDF-15), Cystatin C and C-reactive protein (CRP) have been discussed as biomarkers for prediction of cardiac diseases. The aim of this study was to investigate the predictive value of single and repeated measurements of GDF-15 compared to Cystatin C and CRP for incidence of heart failure (HF) and death due to coronary heart disease (CHD) in the general population. Levels of GDF-15, CRP and Cystatin C were determined in three repeated measurements collected 5 years apart in the DAN-MONICA (Danish-Multinational MONitoring of trends and determinants in Cardiovascular disease) cohort (participants at baseline n = 3785). Cox regression models adjusted for cardiovascular risk factors revealed significantly increased hazard ratios (HR) for GDF-15 for incident HF 1.36 (HR per interquartile range (IQR) increase, 95% confidence interval (CI): 1.16; 1.59) and for death from CHD 1.51 (HR per IQR increase, 95% CI: 1.31, 1.75) (both with p<0.001). Joint modeling of time-to-event and longitudinal GDF-15 over a median 27-year follow-up period showed that the marker evolution was positively associated with death of CHD (HR per IQR increase 3.02 95% CI: (2.26, 4.04), p < 0.001) and HF (HR per IQR increase 2.12 95% CI: (1.54, 2.92), p<0.001). However using Cox models with follow-up time starting at the time of the third examination, serial measurement of GDF-15, modeled as changes between the measurements, did not improve prediction over that of the most recent measurement. GDF-15 is a promising biomarker for prediction of HF and death due to CHD in the general population, which may provide prognostic information to already established clinical biomarkers. Repeated measurements of GDF-15 displayed only a slight improvement in the prediction of these endpoints compared to a single measurement.

Using the Five Domains Model to Assess the Adverse Impacts of Husbandry, Veterinary, and Equitation Interventions on Horse Welfare.

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McGreevy, Paul; Berger, Jeannine; de Brauwere, Nic; Doherty, Orla; Harrison, Anna; Fiedler, Julie; Jones, Claudia; McDonnell, Sue; McLean, Andrew; Nakonechny, Lindsay; Nicol, Christine; Preshaw, Liane; Thomson, Peter; Tzioumis, Vicky; Webster, John; Wolfensohn, Sarah; Yeates, James; Jones, Bidda

2018-03-18

The aim of this study was to conduct a series of paper-based exercises in order to assess the negative (adverse) welfare impacts, if any, of common interventions on domestic horses across a broad range of different contexts of equine care and training. An international panel (with professional expertise in psychology, equitation science, veterinary science, education, welfare, equestrian coaching, advocacy, and community engagement; n = 16) met over a four-day period to define and assess these interventions, using an adaptation of the domain-based assessment model. The interventions were considered within 14 contexts: C1 Weaning; C2 Diet; C3 Housing; C4 Foundation training; C5 Ill-health and veterinary interventions (chiefly medical); C6 Ill-health and veterinary interventions (chiefly surgical); C7 Elective procedures; C8 Care procedures; C9 Restraint for management procedures; C10 Road transport; C11 Activity-competition; C12 Activity-work; C13 Activity-breeding females; and C14 Activity-breeding males. Scores on a 1-10 scale for Domain 5 (the mental domain) gathered during the workshop were compared with overall impact scores on a 1-10 scale assigned by the same panellists individually before the workshop. The most severe (median and interquartile range, IQR) impacts within each context were identified during the workshop as: C1 abrupt, individual weaning (10 IQR 1); C2 feeding 100% low-energy concentrate (8 IQR 2.5); C3 indoor tie stalls with no social contact (9 IQR 1.5); C4 both (i) dropping horse with ropes (9 IQR 0.5) and forced flexion (9 IQR 0.5); C5 long-term curative medical treatments (8 IQR 3); C6 major deep intracavity surgery (8.5 IQR 1); C7 castration without veterinary supervision (10 IQR 1); C8 both (i) tongue ties (8 IQR 2.5) and (ii) restrictive nosebands (8 IQR 2.5); C9 ear twitch (8 IQR 1); C10 both (i) individual transport (7.00 IQR 1.5) and group transport with unfamiliar companions (7 IQR 1.5); C11 both (i) jumps racing (8 IQR 2.5) and

Using the Five Domains Model to Assess the Adverse Impacts of Husbandry, Veterinary, and Equitation Interventions on Horse Welfare

Directory of Open Access Journals (Sweden)

Paul McGreevy

2018-03-01

Full Text Available The aim of this study was to conduct a series of paper-based exercises in order to assess the negative (adverse welfare impacts, if any, of common interventions on domestic horses across a broad range of different contexts of equine care and training. An international panel (with professional expertise in psychology, equitation science, veterinary science, education, welfare, equestrian coaching, advocacy, and community engagement; n = 16 met over a four-day period to define and assess these interventions, using an adaptation of the domain-based assessment model. The interventions were considered within 14 contexts: C1 Weaning; C2 Diet; C3 Housing; C4 Foundation training; C5 Ill-health and veterinary interventions (chiefly medical; C6 Ill-health and veterinary interventions (chiefly surgical; C7 Elective procedures; C8 Care procedures; C9 Restraint for management procedures; C10 Road transport; C11 Activity—competition; C12 Activity—work; C13 Activity—breeding females; and C14 Activity—breeding males. Scores on a 1–10 scale for Domain 5 (the mental domain gathered during the workshop were compared with overall impact scores on a 1–10 scale assigned by the same panellists individually before the workshop. The most severe (median and interquartile range, IQR impacts within each context were identified during the workshop as: C1 abrupt, individual weaning (10 IQR 1; C2 feeding 100% low-energy concentrate (8 IQR 2.5; C3 indoor tie stalls with no social contact (9 IQR 1.5; C4 both (i dropping horse with ropes (9 IQR 0.5 and forced flexion (9 IQR 0.5; C5 long-term curative medical treatments (8 IQR 3; C6 major deep intracavity surgery (8.5 IQR 1; C7 castration without veterinary supervision (10 IQR 1; C8 both (i tongue ties (8 IQR 2.5 and (ii restrictive nosebands (8 IQR 2.5; C9 ear twitch (8 IQR 1; C10 both (i individual transport (7.00 IQR 1.5 and group transport with unfamiliar companions (7 IQR 1.5; C11 both (i jumps racing (8 IQR 2

Rates and reasons for early change of first HAART in HIV-1-infected patients in 7 sites throughout the Caribbean and Latin America.

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Carina Cesar

Full Text Available BACKGROUND: HAART rollout in Latin America and the Caribbean has increased from approximately 210,000 in 2003 to 390,000 patients in 2007, covering 62% (51%-70% of eligible patients, with considerable variation among countries. No multi-cohort study has examined rates of and reasons for change of initial HAART in this region. METHODOLOGY: Antiretroviral-naïve patients >or= 18 years who started HAART between 1996 and 2007 and had at least one follow-up visit from sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Time from HAART initiation to change (stopping or switching any antiretrovirals was estimated using Kaplan-Meier techniques. Cox proportional hazards modeled the associations between change and demographics, initial regimen, baseline CD4 count, and clinical stage. PRINCIPAL FINDINGS: Of 5026 HIV-infected patients, 35% were female, median age at HAART initiation was 37 years (interquartile range [IQR], 31-44, and median CD4 count was 105 cells/uL (IQR, 38-200. Estimated probabilities of changing within 3 months and one year of HAART initiation were 16% (95% confidence interval (CI 15-17% and 28% (95% CI 27-29%, respectively. Efavirenz-based regimens and no clinical AIDS at HAART initiation were associated with lower risk of change (hazard ratio (HR = 1.7 (95% CI 1.1-2.6 and 2.1 (95% CI 1.7-2.5 comparing neverapine-based regimens and other regimens to efavirenz, respectively; HR = 1.3 (95% CI 1.1-1.5 for clinical AIDS at HAART initiation. The primary reason for change among HAART initiators were adverse events (14%, death (5.7% and failure (1.3% with specific toxicities varying among sites. After change, most patients remained in first line regimens. CONCLUSIONS: Adverse events were the leading cause for changing initial HAART. Predictors for change due to any reason were AIDS at baseline and the use of a non-efavirenz containing regimen. Differences between participant sites were observed and require

Rates and Reasons for Early Change of First HAART in HIV-1-Infected Patients in 7 Sites throughout the Caribbean and Latin America

Science.gov (United States)

Cesar, Carina; Shepherd, Bryan E.; Krolewiecki, Alejandro J.; Fink, Valeria I.; Schechter, Mauro; Tuboi, Suely H.; Wolff, Marcelo; Pape, Jean W.; Leger, Paul; Padgett, Denis; Madero, Juan Sierra; Gotuzzo, Eduardo; Sued, Omar; McGowan, Catherine C.; Masys, Daniel R.; Cahn, Pedro E.

2010-01-01

Background HAART rollout in Latin America and the Caribbean has increased from approximately 210,000 in 2003 to 390,000 patients in 2007, covering 62% (51%–70%) of eligible patients, with considerable variation among countries. No multi-cohort study has examined rates of and reasons for change of initial HAART in this region. Methodology Antiretroviral-naïve patients > = 18 years who started HAART between 1996 and 2007 and had at least one follow-up visit from sites in Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru were included. Time from HAART initiation to change (stopping or switching any antiretrovirals) was estimated using Kaplan-Meier techniques. Cox proportional hazards modeled the associations between change and demographics, initial regimen, baseline CD4 count, and clinical stage. Principal Findings Of 5026 HIV-infected patients, 35% were female, median age at HAART initiation was 37 years (interquartile range [IQR], 31–44), and median CD4 count was 105 cells/uL (IQR, 38–200). Estimated probabilities of changing within 3 months and one year of HAART initiation were 16% (95% confidence interval (CI) 15–17%) and 28% (95% CI 27–29%), respectively. Efavirenz-based regimens and no clinical AIDS at HAART initiation were associated with lower risk of change (hazard ratio (HR) = 1.7 (95% CI 1.1–2.6) and 2.1 (95% CI 1.7–2.5) comparing neverapine-based regimens and other regimens to efavirenz, respectively; HR = 1.3 (95% CI 1.1–1.5) for clinical AIDS at HAART initiation). The primary reason for change among HAART initiators were adverse events (14%), death (5.7%) and failure (1.3%) with specific toxicities varying among sites. After change, most patients remained in first line regimens. Conclusions Adverse events were the leading cause for changing initial HAART. Predictors for change due to any reason were AIDS at baseline and the use of a non-efavirenz containing regimen. Differences between participant sites were observed

How disturbance, competition, and dispersal interact to prevent tree range boundaries from keeping pace with climate change

Science.gov (United States)

Yu Liang; Matthew J. Duveneck; Eric J. Gustafson; Josep M. Serra-Diaz; Jonathan R. Thompson

2018-01-01

Climate change is expected to cause geographic shifts in tree species' ranges, but such shifts may not keep pace with climate changes because seed dispersal distances are often limited and competition-induced changes in community composition can be relatively slow. Disturbances may speed changes in community composition, but the interactions among climate change,...

Spatial and temporal changes in seasonal range attributes in a declining barren-ground caribou herd

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John A. Virgl

2017-05-01

Full Text Available From 1996 to 2015 the Bathurst caribou herd has declined from approximately 349,000 to 20,000 animals. Aboriginal traditional knowledge (TK has recently observed the later arrival of the herd below the treeline, an attribute of the autumn range. Science also predicts that seasonal range attributes (e.g., area, location likely vary with population size, and perhaps climate. We used Aboriginal TK and science to identify several seasonal range attributes that were ex­amined for changes through time (decreasing population abundance. Attributes of seasonal ranges for female Bathurst caribou were calculated using satellite radio-collar data from January 1996 through October 2013. Climate data from CircumArctic Rangifer Monitoring and Assessment Network were analyzed for trends from 1979 to 2009. Analyses showed a significant decrease in the area of post-calving and autumn ranges, but no changes in winter and spring ranges. Results supported Aboriginal TK that female caribou have shifted the autumn range farther from the treeline and moved into the forest later in the year. Analysis of climate variables found no trends at the spatio-temporal scale of the post-calving to autumn ranges. Working hypotheses to explain these patterns, which are not mutually exclusive, include reduced predation risk, increased use of core areas at lower population density, and greater utilization of areas of taiga where arboreal and ground lichen availability and accessibility are relatively higher than in the forest. This analysis demonstrates how including Aboriginal TK can lead to stronger connections and results, with potential to provide new and different insights for further investigations.

Persistence of climate changes due to a range of greenhouse gases.

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Solomon, Susan; Daniel, John S; Sanford, Todd J; Murphy, Daniel M; Plattner, Gian-Kasper; Knutti, Reto; Friedlingstein, Pierre

2010-10-26

Emissions of a broad range of greenhouse gases of varying lifetimes contribute to global climate change. Carbon dioxide displays exceptional persistence that renders its warming nearly irreversible for more than 1,000 y. Here we show that the warming due to non-CO(2) greenhouse gases, although not irreversible, persists notably longer than the anthropogenic changes in the greenhouse gas concentrations themselves. We explore why the persistence of warming depends not just on the decay of a given greenhouse gas concentration but also on climate system behavior, particularly the timescales of heat transfer linked to the ocean. For carbon dioxide and methane, nonlinear optical absorption effects also play a smaller but significant role in prolonging the warming. In effect, dampening factors that slow temperature increase during periods of increasing concentration also slow the loss of energy from the Earth's climate system if radiative forcing is reduced. Approaches to climate change mitigation options through reduction of greenhouse gas or aerosol emissions therefore should not be expected to decrease climate change impacts as rapidly as the gas or aerosol lifetime, even for short-lived species; such actions can have their greatest effect if undertaken soon enough to avoid transfer of heat to the deep ocean.

Mosquitoes and Culicoides biting midges: vector range and the influence of climate change.

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Elbers, A R W; Koenraadt, C J M; Meiswinkel, R

2015-04-01

Vector-borne animal diseases pose a continuous and substantial threat to livestock economies around the globe. Increasing international travel, the globalisation of trade, and climate change are likely to play a progressively more important role in the introduction, establishment and spread of arthropod-borne pathogens worldwide. A review of the literature reveals that many climatic variables, functioning singly or in combination, exert varying effects on the distribution and range of Culicoides vector midges and mosquitoes. For example, higher temperatures may be associated with increased insect abundance--thereby amplifying the risk of disease transmission--but there are no indications yet of dramatic shifts occurring in the geographic range of Culicoides midges. However, the same cannot be said for mosquitoes: over the last few decades, multiple Asian species have established themselves in Europe, spread and are unlikely to ever be eradicated. Research on how insects respond to changes in climate is still in its infancy. The authors argue that we need to grasp how other annectant changes, such as extremes in precipitation (drought and flooding), may affect the dispersal capability of mosquitoes. Models are useful for assessing the interplay between mosquito vectors expanding their range and the native flora and fauna; however, ecological studies employing classical mark-release-recapture techniques remain essential for addressing fundamental questions about the survival and dispersal of mosquito species, with the resulting parameters fed directly into new-generation disease transmission models. Studies on the eventual impact of mosquitoes on animal and human health should be tackled through large-scale integrated research programmes. Such an approach calls for more collaborative efforts, along the lines of the One Health Initiative.

Intramyocardial bone marrow mononuclear cell transplantation in ischemic heart failure: Long-term follow-up.

Science.gov (United States)

Lehtinen, Miia; Pätilä, Tommi; Kankuri, Esko; Lauerma, Kirsi; Sinisalo, Juha; Laine, Mika; Kupari, Markku; Vento, Antti; Harjula, Ari

2015-07-01

Long-term results regarding treatment of chronic ischemic heart failure with bone marrow mononuclear cells (BMMCs) have been few. We received encouraging results at the 1-year follow-up of patients treated with combined coronary artery bypass grafting (CABG) and BMMCs, so we decided to extend the follow-up. The study patients had received injections of BMMCs or vehicle into the myocardial infarction border area during CABG in a randomized and double-blind manner. We could contact 36 of the 39 patients recruited for the original study. Pre-operatively and after an extended follow-up period, we performed magnetic resonance imaging, measured pro-B-type amino-terminal natriuretic peptide, reviewed patient records from the follow-up period, and determined current quality of life with the Medical Outcomes Study Short-Form 36 (SF-36) Health Survey. The median follow-up time was 60.7 months (interquartile range [IQR], 45.1-72.6 months). No statistically significant difference was detected in change of pro-B-type amino-terminal natriuretic peptide values or in quality of life between groups. The median change in left ventricular ejection fraction was 4.9% (IQR, -2.1% to 12.3%) for controls and 3.9% (IQR, -5.2% to 10.2%) for the BMMC group (p = 0.647). Wall thickening in injected segments increased by a median of 17% (IQR, -5% to 30%) for controls and 15% (IQR, -12% to 19%) for BMMC patients (p = 0.434). Scar size in injected segments increased by a median of 2% (IQR, -7% to 19%) for controls but diminished for BMMC patients, with a median change of -17% (IQR, -30% to -6%; p = 0.011). In the treatment of chronic ischemic heart failure, combining intramyocardial BMMC therapy with CABG fails to affect cardiac function but can sustainably reduce scar size, even in the long-term. Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Bony Regeneration of the Sella after Transsphenoidal Pituitary Surgery.

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Yahia-Cherif, Mehdi; Delpierre, Isabelle; Hassid, Sergio; De Witte, Olivier

2016-04-01

The purpose of this study is to demonstrate the possible bony regrowth of the sella after transsphenoidal surgery without any intraoperative sellar reconstruction. Radiologic findings of the sella were reviewed in patients with pituitary tumors treated by transsphenoidal surgery. In 17 patients who had postoperative cranial computed tomography scans, bony regeneration of the sellar floor was evaluated by comparing immediate and late postoperative scans. The bony opening reduction was measured in transverse and sagittal planes. The median bony opening diameter in the transverse plane was 8.8 mm (interquartile range [IQR] 5.7-11.4) on the first scan and 4.2 mm (IQR 0.8-6.8) on the second scan. In the sagittal plane, it was 4.8 mm (IQR 1.8-6.8) on the first scan and 2.9 mm (IQR 1.6-3.9) on the second scan. These changes occurred in a median time of 36 months (IQR 22-42). There was a statistically significant decrease of the bony opening diameters in both the transverse and sagittal planes (P transsphenoidal pituitary surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Using the Five Domains Model to Assess the Adverse Impacts of Husbandry, Veterinary, and Equitation Interventions on Horse Welfare

Science.gov (United States)

McGreevy, Paul; Berger, Jeannine; de Brauwere, Nic; Doherty, Orla; Harrison, Anna; Fiedler, Julie; Jones, Claudia; McDonnell, Sue; McLean, Andrew; Nakonechny, Lindsay; Preshaw, Liane; Tzioumis, Vicky; Webster, John; Wolfensohn, Sarah; Yeates, James; Jones, Bidda

2018-01-01

procedures; C8 Care procedures; C9 Restraint for management procedures; C10 Road transport; C11 Activity—competition; C12 Activity—work; C13 Activity—breeding females; and C14 Activity—breeding males. Scores on a 1–10 scale for Domain 5 (the mental domain) gathered during the workshop were compared with overall impact scores on a 1–10 scale assigned by the same panellists individually before the workshop. The most severe (median and interquartile range, IQR) impacts within each context were identified during the workshop as: C1 abrupt, individual weaning (10 IQR 1); C2 feeding 100% low-energy concentrate (8 IQR 2.5); C3 indoor tie stalls with no social contact (9 IQR 1.5); C4 both (i) dropping horse with ropes (9 IQR 0.5) and forced flexion (9 IQR 0.5); C5 long-term curative medical treatments (8 IQR 3); C6 major deep intracavity surgery (8.5 IQR 1); C7 castration without veterinary supervision (10 IQR 1); C8 both (i) tongue ties (8 IQR 2.5) and (ii) restrictive nosebands (8 IQR 2.5); C9 ear twitch (8 IQR 1); C10 both (i) individual transport (7.00 IQR 1.5) and group transport with unfamiliar companions (7 IQR 1.5); C11 both (i) jumps racing (8 IQR 2.5) and Western performance (8 IQR 1.5); C12 carriage and haulage work (6 IQR 1.5); C13 wet nurse during transition between foals (7.5 IQR 3.75); and C14 teaser horse (7 IQR 8). Associations between pre-workshop and workshop scores were high, but some rankings changed after workshop participation, particularly relating to breeding practices. Domain 1 had the weakest association with Domain 5. The current article discusses the use of the domain-based model in equine welfare assessment, and offers a series of assumptions within each context that future users of the same approach may make when assessing animal welfare under the categories reported here. It also discusses some limitations in the framework that was used to apply the model. PMID:29562654

Care delivery and compensation system changes: a case study of organizational readiness within a large dental care practice organization in the United States.

Science.gov (United States)

Cunha-Cruz, Joana; Milgrom, Peter; Huebner, Colleen E; Scott, JoAnna; Ludwig, Sharity; Dysert, Jeanne; Mitchell, Melissa; Allen, Gary; Shirtcliff, R Mike

2017-12-20

Dental care delivery systems in the United States are consolidating and large practice organizations are becoming more common. At the same time, greater accountability for addressing disparities in access to care is being demanded when public funds are used to pay for care. As change occurs within these new practice structures, attempts to implement change in the delivery system may be hampered by failure to understand the organizational climate or fail to prepare employees to accommodate new goals or processes. Studies of organizational behavior within oral health care are sparse and have not addressed consolidation of current delivery systems. The objective of this case study was to assess organizational readiness for implementing change in a large dental care organization consisting of staff model clinics and affiliated dental practices and test associations of readiness with workforce characteristics and work environment. A dental care organization implemented a multifaceted quality improvement program, called PREDICT, in which community-based mobile and clinic-based dental services were integrated and the team compensated based in part on meeting performance targets. Dental care providers and supporting staff members (N = 181) were surveyed before program implementation and organizational readiness for implementing change (ORIC) was assessed by two 5-point scales: change commitment and efficacy. Providers and staff demonstrated high organizational readiness for change. Median change commitment was 3.8 (Interquartile range [IQR]: 3.3-4.3) and change efficacy was 3.8 (IQR: 3.0-4.2). In the adjusted regression model, change commitment was associated with organizational climate, support for methods to arrest tooth decay and was inversely related to office chaos. Change efficacy was associated with organizational climate, support for the company's mission and was inversely related to burnout. Each unit increase in the organizational climate scale predicted 0

Aerosol Optical Properties at the Lulin Atmospheric Background Station in Taiwan and the Influences of Long-Range Transport of Air Pollutants

Science.gov (United States)

Hsiao, Ta-Chih; Chen, Wei-Nai; Ye, Wei-Cheng; Lin, Neng-Huei; Tsay, Si-Chee; Lin, Tang-Huang; Lee, Chung-Te; Chuang, Ming-Tung; Pantina, Peter; Wang, Sheng-Hsiang

2016-01-01

The Lulin Atmospheric Background Station (LABS, 23.47 deg. N 120.87 deg. E, 2862 m ASL) in Central Taiwan was constructed in 2006 and is the only high-altitude background station in the western Pacific region for studying the influence of continental outflow. In this study, extensive optical properties of aerosols, including the aerosol light scattering coefficient [Sigma(sub s)] and light absorption coefficient [Sigma(sub a)], were collected from 2013 to 2014. The intensive optical properties, including mass scattering efficiency [Sigma(sub s)], mass absorption efficiency [Sigma(sub a)] single scattering albedo (Omega), scattering Angstrom exponent (A), and backscattering fraction (b), were determined and investigated, and the distinct seasonal cycle was observed. The value of [Alpha(sub a)] began to increase in January and reached a maximum in April; the mean in spring was 5.89 m(exp. 2) g(exp. -1) with a standard deviation (SD) of 4.54 m(exp. 2) g(exp. -1) and a 4.48 m(exp. 2) g(exp. -1) interquartile range (IQR: 2.95-7.43 m(exp. 2) g(exp. -1). The trend was similar in [Sigma(sub a)], with a maximum in March and a monthly mean of 0.84 m(exp. 2) g(exp. -1). The peak values of Omega (Mean = 0.92, SD = 0.03, IQR: 0.90 - 0.93) and A (Mean = 2.22, SD = 0.61, IQR: 2.12 = 2.47) occurred in autumn. These annual patterns of optical properties were associated with different long-range transport patterns of air pollutants such as biomass burning (BB) aerosol in spring and potential anthropogenic emissions in autumn. The optical measurements performed at LABS during spring in 2013 were compared with those simultaneously performed at the Doi Ang Kang Meteorology Station, Chiang Mai Province, Thailand (DAK, 19.93 deg. N, 99.05 deg. E, 1536 m a.s.l.), which is located in the Southeast Asia BB source region. Furthermore, the relationships among [Sigma(sub s)], [Sigma(sub a)], and (b) were used to characterize the potential aerosol types transported to LABS during different

Aerosol optical properties at the Lulin Atmospheric Background Station in Taiwan and the influences of long-range transport of air pollutants

Science.gov (United States)

Hsiao, Ta-Chih; Chen, Wei-Nai; Ye, Wei-Cheng; Lin, Neng-Huei; Tsay, Si-Chee; Lin, Tang-Huang; Lee, Chung-Te; Chuang, Ming-Tung; Pantina, Peter; Wang, Sheng-Hsiang

2017-02-01

The Lulin Atmospheric Background Station (LABS, 23.47°N 120.87°E, 2862 m ASL) in Central Taiwan was constructed in 2006 and is the only high-altitude background station in the western Pacific region for studying the influence of continental outflow. In this study, extensive optical properties of aerosols, including the aerosol light scattering coefficient (σs) and light absorption coefficient (σa), were collected from 2013 to 2014. The intensive optical properties, including mass scattering efficiency (αs), mass absorption efficiency (αa), single scattering albedo (ω), scattering Ångstrӧm exponent (Å), and backscattering fraction (b), were determined and investigated, and the distinct seasonal cycle was observed. The value of αs began to increase in January and reached a maximum in April; the mean in spring was 5.89 m2 g-1 with a standard deviation (SD) of 4.54 m2 g-1 and a 4.48 m2 g-1 interquartile range (IQR: 2.95-7.43 m2 g-1). The trend was similar in αa, with a maximum in March and a monthly mean of 0.84 m2 g-1. The peak values of ω (Mean = 0.92, SD = 0.03, IQR: 0.90-0.93) and Å (Mean = 2.22, SD = 0.61, IQR: 2.12-2.47) occurred in autumn. These annual patterns of optical properties were associated with different long-range transport patterns of air pollutants such as biomass burning (BB) aerosol in spring and potential anthropogenic emissions in autumn. The optical measurements performed at LABS during spring in 2013 were compared with those simultaneously performed at the Doi Ang Kang Meteorology Station, Chiang Mai Province, Thailand (DAK, 19.93°N, 99.05°E, 1536 m a.s.l.), which is located in the Southeast Asia BB source region. Furthermore, the relationships among αs, αa, and b were used to characterize the potential aerosol types transported to LABS during different seasons, and the data were inspected according to the HYSPLIT 5-day backward trajectories, which differentiate between different regions of air mass origin.

Inter-generational change in African elephant range use is associated with poaching risk, primary productivity and adult mortality.

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Goldenberg, Shifra Z; Douglas-Hamilton, Iain; Wittemyer, George

2018-05-30

Repeated use of the same areas may benefit animals as they exploit familiar sites, leading to consistent home ranges over time that can span generations. Changing risk landscapes may reduce benefits associated with home range fidelity, however, and philopatric animals may alter movement in response to new pressures. Despite the importance of range changes to ecological and evolutionary processes, little tracking data have been collected over the long-term nor has range change been recorded in response to human pressures across generations. Here, we investigate the relationships between ecological, demographic and human variables and elephant ranging behaviour across generations using 16 years of tracking data from nine distinct female social groups in a population of elephants in northern Kenya that was heavily affected by ivory poaching during the latter half of the study. Nearly all groups-including those that did not experience loss of mature adults-exhibited a shift north over time, apparently in response to increased poaching in the southern extent of the study area. However, loss of mature adults appeared to be the primary indicator of range shifts and expansions, as generational turnover was a significant predictor of range size increases and range centroid shifts. Range expansions and northward shifts were associated with higher primary productivity and lower poached carcass densities, while westward shifts exhibited a trend to areas with higher values of primary productivity and higher poached carcass densities relative to former ranges. Together these results suggest a trade-off between resource access, mobility and safety. We discuss the relevance of these results to elephant conservation efforts and directions meriting further exploration in this disrupted society of a keystone species. © 2018 The Author(s).

Induction of early long-range epigenetic changes by α-irradiation in arabidopsis thaliana plants

International Nuclear Information System (INIS)

Xu Shuyan; Li Fanghua; Wang Ting; Bian Po; Wu Yuejin

2011-01-01

Along the way, the mutagenic mechanism of low-energy ions irradiation is a debatable issue. Recently, the existence of radiation induced long-range (mutagenic) effects in vivo in plants has been performed in a series of studies of our group, which account for the mutagenesis of low-energy ions irradiation in a new perspective. However, numerous distinct biology phenomena remain to be addressed, which bear obvious characteristics to epigenetic.In the present study, using the expression of methylation-related AtDML3 gene and methylation level of specific gene segments as end points, the methylation of cytosine, the most important feature of epigenetic,was investigated. It was shown that, in A. thaliana, root-localized α-irradiation could induce epigenetic changes in aerial parts which avoided the direct irradiation. The radiation induced long-range epigenetic changes were confirmed in this study, which supplied innovative ideas for the further investigation of the mutagenetic mechanism of low-energy ions irradiation. (authors)

Experimental Forests and climate change: views of long-term employees on ecological change and the role of Experimental Forests and Ranges in understanding and adapting to climate change

Science.gov (United States)

Laurie Yung; Mason Bradbury; Daniel R. Williams

2012-01-01

In this project, we examined the views of 21 long-term employees on climate change in 14 Rocky Mountain Research Station Experimental Forests and Ranges (EFRs). EFRs were described by employees as uniquely positioned to advance knowledge of climate change impacts and adaptation strategies due to the research integrity they provide for long-term studies, the ability to...

Preoperative factors and 3-year weight change in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium.

Science.gov (United States)

Courcoulas, Anita P; Christian, Nicholas J; O'Rourke, Robert W; Dakin, Greg; Patchen Dellinger, E; Flum, David R; Melissa Kalarchian, Ph D; Mitchell, James E; Patterson, Emma; Pomp, Alfons; Pories, Walter J; Spaniolas, Konstantinos; Steffen, Kristine; Wolfe, Bruce M; Belle, Steven H

2015-01-01

Limited data guide the prediction of weight loss success or failure after bariatric surgery according to presurgery factors. There is significant variation in weight change after bariatric surgery and much interest in identifying preoperative factors that may contribute to these differences. This report evaluates the associations of a comprehensive set of baseline factors and 3-year weight change. Ten hospitals in 6 geographically diverse clinical centers in the United States. Adults undergoing a first bariatric surgical procedure as part of clinical care by participating surgeons were recruited between 2006 and 2009. Participants completed research assessments utilizing standardized and detailed data collection on over 100 preoperative and operative parameters for individuals undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Weight was measured 3 years after surgery. Percent weight change for RYGB or LAGB from baseline to 3 years was analyzed as both a continuous and dichotomous outcome with cut points at 25% for RYGB and 10% for LAGB. Multivariable linear and logistic regression models were used to identify independent baseline predictors of the continuous and categorical outcomes, respectively. The median weight loss 3 years after surgery for RYGB (n = 1513) participants was 31.5% (IQR: 24.6%-38.4%; range, 59.2% loss to .9% gain) of baseline weight and 16.0% (IQR: 8.1%-23.1%; range, 56.1% loss to 12.5% gain) for LAGB (n = 509) participants. The median age was 46 years for RYGB and 48 years for LAGB; 80% of RYGB participants and 75% of LAGB participants were female; and the median baseline body mass index (BMI) was 46 kg/m(2) for RYGB and 44 kg/m(2) for LAGB. For RYGB, black participants lost 2.7% less weight compared with whites and participants with diabetes at baseline had 3.7% less weight loss at year 3 than those without diabetes at baseline. There were small but statistically significant differences in weight

Preoperative Factors and Three Year Weight Change in the Longitudinal Assessment of Bariatric Surgery (LABS) Consortium

Science.gov (United States)

Courcoulas, Anita P.; Christian, Nicholas J.; O’Rourke, Robert W.; Dakin, Greg; Dellinger, E. Patchen; Flum, David Reed; Kalarchian, Melissa; Mitchell, James E.; Patterson, Emma; Pomp, Alfons; Pories, Walter J.; Spaniolas, Konstantinos; Steffen, Kristine; Wolfe, Bruce M.; Belle, Steven H.

2015-01-01

BACKGROUND Limited data guide the prediction of weight loss success or failure following bariatric surgery according to pre-surgery factors. There is significant variation in weight change following bariatric surgery and much interest in identifying pre-operative factors that may contribute to these differences. OBJECTIVE This report evaluates the associations of a comprehensive set of baseline factors and three-year weight change. SETTING Ten hospitals in six geographically diverse clinical centers in the United States. METHODS: PARTICIPANTS and INTERVENTIONS Adults undergoing a first bariatric surgical procedure as part of clinical care by participating surgeons were recruited between 2006 and 2009. Participants completed research assessments utilizing standardized and detailed data collection on over 100 preoperative and operative parameters for individuals undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Weight was measured 3 years following surgery. METHODS: MAIN OUTCOME MEASURES Percent weight change for RYGB or LAGB from baseline to 3 years was analyzed as both a continuous and dichotomous outcome with cut points at 25% for RYGB and 10% for LAGB. Multivariable linear and logistic regression models were used to identify independent baseline predictors of the continuous and categorical outcomes, respectively. RESULTS The median weight loss 3 years following surgery for RYGB (n=1513) participants was 31.5% (IQR: 24.6%–38.4%; range, 59.2% loss to 0.9% gain) of baseline weight and 16.0% (IQR: 8.1%–23.1%; range, 56.1% loss to 12.5% gain) for LAGB (n=509) participants. The median age was 46 years for RYGB and 48 years for LAGB; 80% of RYGB participants and 75% of LAGB participants were female; and the median baseline Body Mass Index (BMI) was 46 kg/m2 for RYGB and 44 kg/m2 for LAGB. For RYGB, Black participants lost 2.7% less weight compared to Whites and participants with diabetes at baseline had 3.7% less weight

Screening variability and change of soil moisture under wide-ranging climate conditions: Snow dynamics effects.

Science.gov (United States)

Verrot, Lucile; Destouni, Georgia

2015-01-01

Soil moisture influences and is influenced by water, climate, and ecosystem conditions, affecting associated ecosystem services in the landscape. This paper couples snow storage-melting dynamics with an analytical modeling approach to screening basin-scale, long-term soil moisture variability and change in a changing climate. This coupling enables assessment of both spatial differences and temporal changes across a wide range of hydro-climatic conditions. Model application is exemplified for two major Swedish hydrological basins, Norrström and Piteälven. These are located along a steep temperature gradient and have experienced different hydro-climatic changes over the time period of study, 1950-2009. Spatially, average intra-annual variability of soil moisture differs considerably between the basins due to their temperature-related differences in snow dynamics. With regard to temporal change, the long-term average state and intra-annual variability of soil moisture have not changed much, while inter-annual variability has changed considerably in response to hydro-climatic changes experienced so far in each basin.

Liver Stiffness Decreases Rapidly in Response to Successful Hepatitis C Treatment and Then Plateaus.

Directory of Open Access Journals (Sweden)

Sweta Chekuri

Full Text Available To investigate the impact of a sustained virological response (SVR to hepatitis C virus (HCV treatment on liver stiffness (LS.LS, measured by transient elastography (FibroScan, demographic and laboratory data of patients treated with interferon (IFN-containing or IFN-free regimens who had an SVR24 (undetectable HCV viral load 24 weeks after the end of treatment were analyzed using two-tailed paired t-tests, Mann-Whitney Wilcoxon Signed-rank tests and linear regression. Two time intervals were investigated: pre-treatment to SVR24 and SVR24 to the end of follow-up. LS scores ≥ 12.5 kPa indicated LS-defined cirrhosis. A p-value below 0.05 was considered statistically significant.The median age of the patients (n = 100 was 60 years [IQR (interquartile range 54-64; 72% were male; 60% were Caucasian; and 42% had cirrhosis pre-treatment according to the FibroScan measurement. The median LS score dropped from 10.40 kPa (IQR: 7.25-18.60 pre-treatment to 7.60 kPa (IQR: 5.60-12.38 at SVR24, p <0.01. Among the 42 patients with LS-defined cirrhosis pre-treatment, 25 (60% of patients still had LS scores ≥ 12.5 kPa at SVR24, indicating the persistence of cirrhosis. The median change in LS was similar in patients receiving IFN-containing and IFN-free regimens: -1.95 kPa (IQR: -5.75 --0.38 versus -2.40 kPa (IQR: -7.70 --0.23, p = 0.74. Among 56 patients with a post-SVR24 LS measurement, the LS score changed by an additional -0.90 kPa (IQR: -2.98-0.5 during a median follow-up time of 1.17 (IQR: 0.88-1.63 years, which was not a statistically significant decrease (p = 0.99.LS decreased from pre-treatment to SVR24, but did not decrease significantly during additional follow-up. Earlier treatment may be needed to reduce the burden of liver disease.

[Examination of placental three-dimensional power Doppler indices and perinatal outcome in pregnancies complicated by intrauterine growth restriction].

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Molnár, András; Surányi, Andrea; Jakó, Mária; Nyári, Tibor; Németh, Gábor

2017-07-01

Development of intrauterine growth restriction (IUGR) can be traced back to maternal or fetal factors, but in many cases we find placental factors (reduced placental circulation) in the background. Our aim was to examine whether the reduced placental bloodperfusion and vascularity show any correlation with cesarean section frequency and the clinical outcome in IUGR pregnancies. The aim of the present study was also to use a properly calibrated and reproducible method for evaluating placental blood flow, that can later be incorporated into the routine examination. 254 women were recruited in our prospective case-control study. The 3 dimensional power Doppler (3DPD) ultrasound indices; vascularisation index (VI), flow index (FI) and vascularization flow index (VFI) were measured on each participant. Median VI was 3.7% (interquartile range [IQR] 3.2%-4.2%) in the IUGR group and 10.1% (IQR 8.6%-10.9%) in the control group (p = 0.001). Median FI value was 40.0 (IQR 39.7-42.5) in the IUGR group and 45.1 (IQR 44.1-53.1) in the control group (p = 0.012). Median VFI was 2.2 (IQR 2.1-2.4) in the IUGR group and 4.8 (IQR 4.4-5.3) in the control. The 3DPD indices may be useful for examining changes in circulation in IUGR pregnancies to characterize the underlying pathology. Orv Hetil. 2017; 158(26): 1008-1013.

Low acclimation capacity of narrow-ranging thermal specialists exposes susceptibility to global climate change.

Science.gov (United States)

Markle, Tricia M; Kozak, Kenneth H

2018-05-01

, given that narrow-ranging salamanders are found to have both poor acclimation ability and lower tolerance to warm temperatures, they are likely to be more susceptible to environmental warming associated with anthropogenic climate change.

Mechanisms Controlling Species Responses to Climate Change: Thermal Tolerances and Shifting Range Limits. (Invited)

Science.gov (United States)

Sage, R. F.; Bykova, O.; Coiner, H.

2010-12-01

One of the main effects of anthropogenic climate change will be widespread shifts in species distribution, with the common assumption that they will migrate to higher elevation and latitude. While this assumption is supported by migration patterns following climate warming in the past 20,000 years, it has not been rigorously evaluated in terms of physiological mechanism, despite the implication that migration in response to climate warming is controlled by some form of thermal adaptation. We have been evaluating the degree to which species range limits are controlled by physiological patterns of thermal tolerance in bioinvaders of North America. Bioinvaders presumably have few biotic controls over their distribution and thus are more likely to fully exploit their thermal niche. In cheatgrass (Bromus tectorum), the minimum lethal temperature in winter is -32C, which corresponds to the mean winter minimum temperature at its northern range limit. In red brome (Bromus rubens), the minimum lethal temperature is also near -32C, which is well below the minimum winter temperature near -20C that corresponds to its northern distribution limit. In kudzu (Pueraria lobata), the minimum lethal temperature is near -20C, which corresponds to the midwinter minimum at its northern distribution limit; however, overwintering kudzu tissues are insulated by soil and snow cover, and thus do not experience lethal temperatures at kudzu's northern range limit. These results demonstrate that some invasive species can exploit the potential range defined by their low temperature tolerance and thus can be predicted by mechanistic models to migrate to higher latitudes with moderation of winter cold. The distribution of other invaders such as kudzu and red brome are not controlled by tolerance of midwinter cold. Developing mechanistic models of their distributions, and how these might change with climate warming, will require extensive physiological study.

The effect of range changes on the functional turnover, structure and diversity of bird assemblages under future climate scenarios.

Science.gov (United States)

Barbet-Massin, Morgane; Jetz, Walter

2015-08-01

Animal assemblages fulfill a critical set of ecological functions for ecosystems that may be altered substantially as climate change-induced distribution changes lead to community disaggregation and reassembly. We combine species and community perspectives to assess the consequences of projected geographic range changes for the diverse functional attributes of avian assemblages worldwide. Assemblage functional structure is projected to change highly unevenly across space. These differences arise from both changes in the number of species and changes in species' relative local functional redundancy or distinctness. They sometimes result in substantial losses of functional diversity that could have severe consequences for ecosystem health. Range expansions may counter functional losses in high-latitude regions, but offer little compensation in many tropical and subtropical biomes. Future management of local community function and ecosystem services thus relies on understanding the global dynamics of species distributions and multiscale approaches that include the biogeographic context of species traits. © 2015 John Wiley & Sons Ltd.

Fasting serum insulin and the homeostasis model of insulin resistance (HOMA-IR) in the monitoring of lifestyle interventions in obese persons.

Science.gov (United States)

Vogeser, Michael; König, Daniel; Frey, Ingrid; Predel, Hans-Georg; Parhofer, Klaus Georg; Berg, Aloys

2007-09-01

Lifestyle changes with increased physical activity and balanced energy intake are recognized as the principal interventions in obesity and insulin resistance. Only few prospective studies, however, have so far addressed the potential role of routine biochemical markers of insulin sensitivity in the monitoring of respective interventions. Fasting insulin and glucose was measured in 33 obese individuals undergoing a lifestyle modification program (MOBILIS) at baseline and after 1 year. The HOMA-IR index (homeostasis model of insulin resistance) was calculated as [fasting serum glucose*fasting serum insulin/22.5], with lower values indicating a higher degree of insulin sensitivity. While the median body mass index (BMI) and waist circumference decreased by 10% and 11%, respectively, the HOMA-IR index decreased in an over-proportional manner by 45% within 1 year (BMI baseline, median 35.7, interquartile range (IQR) 33.7-37.7; after 1 year, median 32.2, IQR 29.6-35.1. HOMA-IR baseline, median 2.9, IQR 1.5-4.6; after 1 year 1.6, IQR 0.9-2.7). In contrast to HOMA-IR and fasting serum insulin, no significant changes in fasting serum glucose were observed. Baseline and post-intervention HOMA-IR showed a high degree of inter-individual variation with eight individuals maintaining high HOMA-IR values despite weight loss after 1 year of intervention. Individual changes in the carbohydrate metabolism achieved by a lifestyle intervention program were displayed by fasting serum insulin concentrations and the HOMA-IR but not by fasting glucose measurement alone. Therefore, assessment of the HOMA-IR may help to individualize lifestyle interventions in obesity and to objectify improvements in insulin sensitivity after therapeutic lifestyle changes.

Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV nondisclosure, and paradoxical income effects.

Directory of Open Access Journals (Sweden)

Jessica E Haberer

2011-04-01

Full Text Available A better understanding of pediatric antiretroviral therapy (ART adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence.Adherence among 96 HIV-infected Zambian children (median age 6, interquartile range [IQR] 2,9 initiating fixed-dose combination ART was measured prospectively (median 23 months; IQR 20,26 with caregiver report, clinic and unannounced home-based pill counts, and medication event monitoring systems (MEMS. HIV-1 RNA was determined at 48 weeks. Child and caregiver characteristics, socio-demographic status, and treatment-related factors were assessed as predictors of adherence. Median adherence was 97.4% (IQR 96.1,98.4% by visual analog scale, 94.8% (IQR 86,100% by caregiver-reported last missed dose, 96.9% (IQR 94.5,98.2% by clinic pill count, 93.4% (IQR 90.2,96.7% by unannounced home-based pill count, and 94.8% (IQR 87.8,97.7% by MEMS. At 48 weeks, 72.6% of children had HIV-1 RNA <50 copies/ml. Agreement among adherence measures was poor; only MEMS was significantly associated with viral suppression (p = 0.013. Predictors of poor adherence included changing residence, school attendance, lack of HIV disclosure to children aged nine to 15 years, and increasing household income.Adherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years. However, certain groups are at risk for treatment failure, including children with disrupted routines, no knowledge of their HIV diagnosis among older children, and relatively high household income, possibly reflecting greater social support in the setting of greater poverty.

ASSESSMENT OF RANGES OF POSSIBLE CHANGE OF TEMPORARY RESISTANCE OF CAST IRON WITH LAMELLAR AND FLAKED GRAPHITE ON THEIR HARDNESS

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S. G. Sandomirskii

2017-01-01

Full Text Available The analysis of ranges of possible change of temporary resistance of sB of castings from ductile and gray cast iron is carried out. The analytical description of ranges of change of sВ depending on casting BH hardness is developed. It is shown that the range of change of sВ of pig-iron castings, wider in comparison with steel, with the measured hardness of BH is caused variations of forms and the amount of graphite inclusions at the considered classes of cast iron and influence of thickness of a wall of casting from gray cast iron on dependence of sВ (HB. The result is intended for determination of the guaranteed casting size sВ without her destruction, when there is no information on sВ of check test pieces.

Anvendelse af video som forberedelse til stationsbaseret eksamen i medicin og kirurgi

DEFF Research Database (Denmark)

Subhi, Yousif; Bitsch, Mikael

2014-01-01

aspects. On a Likert scale from 1 to 7 our video was rated 4 (interquartile range (IQR): 4-6). An informatory lecture was rated 4 (IQR: 3-5) and a rehearsal OSCE was rated 6 (IQR: 5-7). Video use peaked in the days up to OSCE. Accessibility should be improved by reaching out using the appropriate tools...

The extending of ranges of some bird species at the north-eastern border of their distribution due to intra-century climate changes

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Oleg V. Glushenkov

2017-10-01

Full Text Available The paper presents an overview of the phenomenon of range expanding of birds located at the northeastern limit of their range. The study area is located in the Volga-Kama Krai in the Chuvash Republic, adjacent to the River Volga. It is situated northwards and southwards of 56° N, and westwards and eastwards of 49° E, in a band of about 400 km. The problem is considered in aspect of the intra-century changes of climatic conditions in the region and in European Russia as a whole. The analysis of the relationship between the range expansion of some bird species and the intra-century climate changes was based on ornithological and climatological material available for the study area. We have used material on climate change in the Chuvashian Republic and Volga-Kama Krai since 1926, taking into account recent data of Roshydromet and Intergovernmental Panel on Climate Change. The idea of this study was based on the theory of climatic cycles of different periodicity, the theory of recent global climate change and the hypothesis of cyclic dynamics of the ranges of waterfowl in the context of centuries-old and intra-century climate change in Northern Eurasia. In the framework of the problem, we have studied ornithological material dated from the late 19th till the early 21st century, authored by Bogdanov, Ruzsky, Zhitkov, Buturlin, Artobolevsky, Volchanetsky, Pershakov, Popov, Glushenkov and others. As shown the intra-century climate changes do quite likely affect the northward and northeastward range expansion of such bird species as Cygnus olor, Anas strepera, Aythya ferina, Hieraaetus pennatus, Aquila heliaca, and Fulica atra. Climate changes can also be judged on the base of the shift in the arrival timing to earlier dates for some birds. It is most clearly manifested for early arriving species (Grus grus, Ardea cinerea, Actitis hypoleucos. It is also true for the later arriving Pernis apivorus and Merops apiaster whose existence depends on the

Pathogen-Host Associations and Predicted Range Shifts of Human Monkeypox in Response to Climate Change in Central Africa

Science.gov (United States)

Thomassen, Henri A.; Fuller, Trevon; Asefi-Najafabady, Salvi; Shiplacoff, Julia A. G.; Mulembakani, Prime M.; Blumberg, Seth; Johnston, Sara C.; Kisalu, Neville K.; Kinkela, Timothée L.; Fair, Joseph N.; Wolfe, Nathan D.; Shongo, Robert L.; LeBreton, Matthew; Meyer, Hermann; Wright, Linda L.; Muyembe, Jean-Jacques; Buermann, Wolfgang; Okitolonda, Emile; Hensley, Lisa E.; Lloyd-Smith, James O.; Smith, Thomas B.; Rimoin, Anne W.

2013-01-01

Climate change is predicted to result in changes in the geographic ranges and local prevalence of infectious diseases, either through direct effects on the pathogen, or indirectly through range shifts in vector and reservoir species. To better understand the occurrence of monkeypox virus (MPXV), an emerging Orthopoxvirus in humans, under contemporary and future climate conditions, we used ecological niche modeling techniques in conjunction with climate and remote-sensing variables. We first created spatially explicit probability distributions of its candidate reservoir species in Africa's Congo Basin. Reservoir species distributions were subsequently used to model current and projected future distributions of human monkeypox (MPX). Results indicate that forest clearing and climate are significant driving factors of the transmission of MPX from wildlife to humans under current climate conditions. Models under contemporary climate conditions performed well, as indicated by high values for the area under the receiver operator curve (AUC), and tests on spatially randomly and non-randomly omitted test data. Future projections were made on IPCC 4th Assessment climate change scenarios for 2050 and 2080, ranging from more conservative to more aggressive, and representing the potential variation within which range shifts can be expected to occur. Future projections showed range shifts into regions where MPX has not been recorded previously. Increased suitability for MPX was predicted in eastern Democratic Republic of Congo. Models developed here are useful for identifying areas where environmental conditions may become more suitable for human MPX; targeting candidate reservoir species for future screening efforts; and prioritizing regions for future MPX surveillance efforts. PMID:23935820

Protein adsorption on tailored substrates: long-range forces and conformational changes

Energy Technology Data Exchange (ETDEWEB)

Bellion, M; Santen, L [Department of Theoretical Physics, Saarland University, 66041 Saarbruecken (Germany); Mantz, H; Haehl, H; Quinn, A; Nagel, A; Gilow, C; Weitenberg, C; Schmitt, Y; Jacobs, K [Department of Experimental Physics, Saarland University, 66041 Saarbruecken (Germany)], E-mail: k.jacobs@physik.uni-saarland.de

2008-10-08

Adsorption of proteins onto solid surfaces is an everyday phenomenon that is not yet fully understood. To further the current understanding, we have performed in situ ellipsometry studies to reveal the adsorption kinetics of three different proteins, lysozyme, {alpha}-amylase and bovine serum albumin. As substrates we offer Si wafers with a controlled Si oxide layer thickness and a hydrophilic or hydrophobic surface functionalization, allowing the tailoring of the influence of short- and long-range interactions. Our studies show that not only the surface chemistry determines the properties of an adsorbed protein layer but also the van der Waals contributions of a composite substrate. We compare the experimental findings to results of a colloidal Monte Carlo approach that includes conformational changes of the adsorbed proteins induced by density fluctuations.

Peripheral tissue oximetry

DEFF Research Database (Denmark)

Hyttel-Sorensen, Simon; Hessel, Trine Witzner; Greisen, Gorm

2014-01-01

Estimation of regional tissue oxygenation (rStO2) by near infrared spectroscopy enables non-invasive end-organ oxygen balance monitoring and could be a valuable tool in intensive care. However, the diverse absolute values and dynamics of different devices, and overall poor repeatability of measur......Estimation of regional tissue oxygenation (rStO2) by near infrared spectroscopy enables non-invasive end-organ oxygen balance monitoring and could be a valuable tool in intensive care. However, the diverse absolute values and dynamics of different devices, and overall poor repeatability......, and response to changing oxygenation by the down slope of rStO2 during vascular occlusion in the respective arm. 10 healthy adults, 21-29 years old, with double skinfolds on the forearm less than 10 mm participated. The median rStO2 was 70.7% (interquartile range (IQR) 7.7%), 68.4% (IQR 8.4%), and 64.6% (IQR 4...

Range-wide latitudinal and elevational temperature gradients for the world's terrestrial birds: implications under global climate change.

Directory of Open Access Journals (Sweden)

Frank A La Sorte

Full Text Available Species' geographical distributions are tracking latitudinal and elevational surface temperature gradients under global climate change. To evaluate the opportunities to track these gradients across space, we provide a first baseline assessment of the steepness of these gradients for the world's terrestrial birds. Within the breeding ranges of 9,014 bird species, we characterized the spatial gradients in temperature along latitude and elevation for all and a subset of bird species, respectively. We summarized these temperature gradients globally for threatened and non-threatened species and determined how their steepness varied based on species' geography (range size, shape, and orientation and projected changes in temperature under climate change. Elevational temperature gradients were steepest for species in Africa, western North and South America, and central Asia and shallowest in Australasia, insular IndoMalaya, and the Neotropical lowlands. Latitudinal temperature gradients were steepest for extratropical species, especially in the Northern Hemisphere. Threatened species had shallower elevational gradients whereas latitudinal gradients differed little between threatened and non-threatened species. The strength of elevational gradients was positively correlated with projected changes in temperature. For latitudinal gradients, this relationship only held for extratropical species. The strength of latitudinal gradients was better predicted by species' geography, but primarily for extratropical species. Our findings suggest threatened species are associated with shallower elevational temperature gradients, whereas steep latitudinal gradients are most prevalent outside the tropics where fewer bird species occur year-round. Future modeling and mitigation efforts would benefit from the development of finer grain distributional data to ascertain how these gradients are structured within species' ranges, how and why these gradients vary among

Resistance to alveolar shape change limits range of force propagation in lung parenchyma.

Science.gov (United States)

Ma, Baoshun; Smith, Bradford J; Bates, Jason H T

2015-06-01

We have recently shown that if the lung parenchyma is modeled in 2 dimensions as a network of springs arranged in a pattern of repeating hexagonal cells, the distortional forces around a contracting airway propagate much further from the airway wall than classic continuum theory predicts. In the present study we tested the hypothesis that this occurs because of the negligible shear modulus of a hexagonal spring network. We simulated the narrowing of an airway embedded in a hexagonal network of elastic alveolar walls when the hexagonal cells of the network offered some resistance to a change in shape. We found that as the forces resisting shape change approach about 10% of the forces resisting length change of an individual spring the range of distortional force propagation in the spring network fell of rapidly as in an elastic continuum. We repeated these investigations in a 3-dimensional spring network composed of space-filling polyhedral cells and found similar results. This suggests that force propagation away from a point of local parenchymal distortion also falls off rapidly in real lung tissue. Copyright © 2015 Elsevier B.V. All rights reserved.

Large-scale range collapse of Hawaiian forest birds under climate change and the need 21st century conservation options

Science.gov (United States)

Fortini, Lucas B.; Vorsino, Adam E.; Amidon, Fred A.; Paxton, Eben H.; Jacobi, James D.

2015-01-01

Hawaiian forest birds serve as an ideal group to explore the extent of climate change impacts on at-risk species. Avian malaria constrains many remaining Hawaiian forest bird species to high elevations where temperatures are too cool for malaria's life cycle and its principal mosquito vector. The impact of climate change on Hawaiian forest birds has been a recent focus of Hawaiian conservation biology, and has centered on the links between climate and avian malaria. To elucidate the differential impacts of projected climate shifts on species with known varying niches, disease resistance and tolerance, we use a comprehensive database of species sightings, regional climate projections and ensemble distribution models to project distribution shifts for all Hawaiian forest bird species. We illustrate that, under a likely scenario of continued disease-driven distribution limitation, all 10 species with highly reliable models (mostly narrow-ranged, single-island endemics) are expected to lose >50% of their range by 2100. Of those, three are expected to lose all range and three others are expected to lose >90% of their range. Projected range loss was smaller for several of the more widespread species; however improved data and models are necessary to refine future projections. Like other at-risk species, Hawaiian forest birds have specific habitat requirements that limit the possibility of range expansion for most species, as projected expansion is frequently in areas where forest habitat is presently not available (such as recent lava flows). Given the large projected range losses for all species, protecting high elevation forest alone is not an adequate long-term strategy for many species under climate change. We describe the types of additional conservation actions practitioners will likely need to consider, while providing results to help with such considerations.

AVALIAÇÃO DA ÁREA DE DISPOSIÇÃO FINAL DE RESÍDUOS SÓLIDOS URBANOS NO MUNICÍPIO DE ARAGUARI UTILIZANDO O ÍNDICE DE QUALIDADE DE ATERROS DE RESÍDUOS - IQR

Directory of Open Access Journals (Sweden)

Luciana Melo Pirete

2014-09-01

Full Text Available A disposição final dos resíduos sólidos urbanos (RSU tem se apresentado como um problema que as prefeituras têm dificuldade de equacionar, pois mesmo havendo incentivo à reutilização e reciclagem ainda existirão os remanescentes, conhecidos como rejeitos, que devem ser enviados aos aterros sanitários. Na maioria dos municípios brasileiros, a administração se limita a recolher os resíduos domiciliares, depositando-os em locais afastados, sem maiores cuidados sanitários. A operação inadequada das áreas para deposição dos resíduos sólidos domiciliares, nos municípios, causa impactos ambientais e compromete a saúde pública. Nesse contexto, o presente trabalho teve como objetivo classificar a qualidade do aterro sanitário de Araguari - MG. Para tal, foi realizada a aplicação do Índice de Qualidade de Aterro de Resíduos - IQR, que avalia os parâmetros referentes às características do local, à infraestrutura implantada e às condições operacionais do aterro, conforme a metodologia estabelecida pela Companhia de Tecnologia de Saneamento Ambiental – CETESB. Para isso foram realizadas inspeções locais, análise documental e entrevistas. Constatou-se que o aterro pode se enquadrar em uma classe controlada, apesar da necessidade de ajustes em alguns itens.

Preventing Excessive Blood Loss During Percutaneous Nephrolithotomy by Using Tranexamic Acid: A Double Blinded Prospective Randomized Controlled Trial

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Adnan Siddiq

2017-12-01

Full Text Available Objective: Percutaneous nephrolithotomy (PCNL is most frequently performed procedure for renal stones 2 cm and larger. Perioperative hemorrhage being most common complication, warrants as important predicting factor of adverse outcomes. Prevention with inexpensive and safe drug like tranexamic acid (TA would ultimately turn out to be cornerstone for establishing future guidelines. Aim of this study is to evaluate whether TA is efficacious in preventing blood loss during PCNL. Materials and Methods: Ethical review board approval taken. Sample size calculation yielded 240 patients, comprising 120 in each group. Group A receiving TA and group B receiving placebo. Age, gender, body mass index (BMI, stone size, volume and location, preoperative blood count, creatinine, urine analysis, coagulation profile and necessary radiological investigations done. Randomization through lottery method. Both patient and investigator were blinded. Hemoglobin (Hb and hematocrit (Hct levels done at 24 hours postoperatively and fall in values recorded. Results: Both groups were equal in characteristics like age, gender, BMI, stone size, volume and location (p>0.05. Operative variables like calyx punctured, position of puncture and operative time were also found to be similar in both groups. Median change in Hb in placebo group was 1.6 interquartile range (IQR 4, while in TA group was 1.3 (IQR 7.8 (p=0.001. Similarly, median change in Hct level in placebo group was 3.6 (IQR 11.8 and in TA group was 2.4 (IQR 13 (p<0.001. Sixteen patients were transfused after surgery; 12 (75% belonged to placebo group while 4 (25% belonged to TA group (p=0.038. Hospital stay was not significantly different in both groups (p=0.177 with median of 4.0 and IQR of 0 in both groups. Conclusion: TA during PCNL reduces blood loss and minimizes blood transfusion rate.

Changes in structure of the short-range order of the InP melt when heated

International Nuclear Information System (INIS)

Glazov, V.M.; Dovletov, K.; Nashel'skij, A.Ya.; Mamedov, M.M.

1977-01-01

An investigation of the temperature dependence of the InP viscosity has indicated an ''after-melting'' effect similar to that observed in other A 3 V 5 compounds having a sphalerite structure. The termodynamic parameters of the viscous flow of indium phosphide melt have been calculated, and a suggestion has been made on the loosening of the short-range order structure of the melt during the period preceding solidification. With the similarity in the behaviour of InP and of A 3 Sb compound melts as a basis, a suggestion has been put forward that the influence of the thermal dissociation upon the character of the changes in the short-range order structure directly after transition from the solid to the liquid phase is negligible

Ranging behavior relates to welfare indicators pre- and post-range access in commercial free-range broilers.

Science.gov (United States)

Taylor, Peta S; Hemsworth, Paul H; Groves, Peter J; Gebhardt-Henrich, Sabine G; Rault, Jean-Loup

2018-06-01

Little is known about the effect of accessing an outdoor range on chicken welfare. We tracked individual ranging behavior of 538 mixed-sex Ross 308 chickens on a commercial farm across 4 flocks in winter and summer. Before range access, at 17 to 19 d of age, and post-range access, at 30 to 33 and 42 to 46 d of age in winter and summer flocks respectively, welfare indicators were measured on chickens (pre-range: winter N = 292; summer N = 280; post-range: winter N = 131; summer N = 140), including weight, gait score, dermatitis and plumage condition. Post-ranging autopsies were performed (winter: N = 170; summer: N = 60) to assess breast burn, leg health, and ascites. Fewer chickens accessed the range in winter flocks (32.5%) than summer flocks (82.1%). Few relationships between welfare and ranging were identified in winter, likely due to minimal ranging and the earlier age of post-ranging data collection compared to summer flocks. In summer flocks prior to range access, chickens that accessed the range weighed 4.9% less (P = 0.03) than chickens that did not access the range. Pre-ranging weight, gait score, and overall plumage cover predicted the amount of range use by ranging chickens in summer flocks (P ranging behavior. In summer flocks post-range access, ranging chickens weighed 12.8% less than non-ranging chickens (P range visits were associated with lower weight (P range was associated with lower weight (P range in summer is partly related to changes in broiler chicken welfare. Further investigations are required to determine causation.

Using satellite laser ranging to measure ice mass change in Greenland and Antarctica

Directory of Open Access Journals (Sweden)

J. A. Bonin

2018-01-01

Full Text Available A least squares inversion of satellite laser ranging (SLR data over Greenland and Antarctica could extend gravimetry-based estimates of mass loss back to the early 1990s and fill any future gap between the current Gravity Recovery and Climate Experiment (GRACE and the future GRACE Follow-On mission. The results of a simulation suggest that, while separating the mass change between Greenland and Antarctica is not possible at the limited spatial resolution of the SLR data, estimating the total combined mass change of the two areas is feasible. When the method is applied to real SLR and GRACE gravity series, we find significantly different estimates of inverted mass loss. There are large, unpredictable, interannual differences between the two inverted data types, making us conclude that the current 5×5 spherical harmonic SLR series cannot be used to stand in for GRACE. However, a comparison with the longer IMBIE time series suggests that on a 20-year time frame, the inverted SLR series' interannual excursions may average out, and the long-term mass loss estimate may be reasonable.

Using satellite laser ranging to measure ice mass change in Greenland and Antarctica

Science.gov (United States)

Bonin, Jennifer A.; Chambers, Don P.; Cheng, Minkang

2018-01-01

A least squares inversion of satellite laser ranging (SLR) data over Greenland and Antarctica could extend gravimetry-based estimates of mass loss back to the early 1990s and fill any future gap between the current Gravity Recovery and Climate Experiment (GRACE) and the future GRACE Follow-On mission. The results of a simulation suggest that, while separating the mass change between Greenland and Antarctica is not possible at the limited spatial resolution of the SLR data, estimating the total combined mass change of the two areas is feasible. When the method is applied to real SLR and GRACE gravity series, we find significantly different estimates of inverted mass loss. There are large, unpredictable, interannual differences between the two inverted data types, making us conclude that the current 5×5 spherical harmonic SLR series cannot be used to stand in for GRACE. However, a comparison with the longer IMBIE time series suggests that on a 20-year time frame, the inverted SLR series' interannual excursions may average out, and the long-term mass loss estimate may be reasonable.

Iodine deficiency in pregnancy is prevalent in vulnerable groups in Denmark

DEFF Research Database (Denmark)

Kirkegaard-Klitbo, Ditte Marie; Perslev, Kathrine; Andersen, Stine Linding

2016-01-01

-containing supplements (86%). The median UIC was 118 (interquartile range (IQR): 79-196) µg/l in iodine supplement users and 82 (IQR: 41-122) µg/l in non-users (p education, non-Danish origin and pre-pregnancy obesity....... CONCLUSIONS: The iodine status in Danish pregnant women was below WHO recommendations. Iodine supplement non-users are at a particular risk of iodine deficiency. Low maternal education, non-Danish origin and pre-pregnancy obesity are predictors of non-iodine supplement use. An increase in iodine fortification......INTRODUCTION: Iodine is essential for the production of thyroid hormones. In pregnancy, physiological changes occur that can lead to iodine deficiency and impairment of fetal neurological development. We aimed to assess the iodine intake in pregnant women in Eastern Denmark, compare iodine levels...

Downstream changes in spring-fed stream invertebrate communities: the effect of increased temperature range?

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Russell G. DEATH

2011-09-01

Full Text Available Reduced thermal amplitude has been highlighted as a limiting factor for aquatic invertebrate diversity in springs. Moving downstream water temperature range increases and invertebrate richness is expected to change accordingly. In the present study temperature patterns were investigated in seven spring-fed streams, between April 2001 and November 2002, and compared to five run-off-fed streams to assess the degree of crenic temperature constancy. Temperature and physico-chemical characteristics of the water, and food resource levels were measured, and the invertebrate fauna collected at 4 distances (0, 100, 500 m and 1 km from seven springs in the North and South Islands of New Zealand. Temperature variability was greater for run-off-fed streams than for springs, and increased in the spring-fed streams with distance from the source. Periphyton and physico-chemical characteristics of the water did not change markedly over the 1 km studied, with the exception of water velocity and organic matter biomass, which increased and decreased, respectively. The rate of increase in temperature amplitude differed greatly for the studied springs, probably being affected by flow, altitude, and the number and type of tributaries (i.e., spring- or run-off-fed joining the spring-fed stream channel. Longitudinal changes in the number and evenness of invertebrate taxa were positively correlated to thermal amplitude (rs = 0.8. Moving downstream, invertebrate communities progressively incorporated taxa with higher mobility and taxa more common in nearby run-off-fed streams. Chironomids and non-insect taxa were denser at the sources. Chironomid larvae also numerically dominated communities 100 and 500 m downstream from the sources, together with Pycnocentria spp. and Zelolessica spp., while taxa such as Hydora sp. and Hydraenidae beetles, the mayflies Deleatidium spp. and Coloburiscus humeralis, and the Trichoptera Pycnocentrodes spp., all had greater abundances 1 km

Are changing emission patterns across the Northern Hemisphere influencing long-range transport contributions to background air pollution?

Science.gov (United States)

Mathur, R.; Kang, D.; Napelenok, S. L.; Xing, J.; Hogrefe, C.

2017-12-01

Air pollution reduction strategies for a region are complicated not only by the interplay of local emissions sources and several complex physical, chemical, dynamical processes in the atmosphere, but also hemispheric background levels of pollutants. Contrasting changes in emission patterns across the globe (e.g. declining emissions in North America and Western Europe in response to implementation of control measures and increasing emissions across Asia due to economic and population growth) are resulting in heterogeneous changes in the tropospheric chemical composition and are likely altering long-range transport impacts and consequently background pollution levels at receptor regions. To quantify these impacts, the WRF-CMAQ model is expanded to hemispheric scales and multi-decadal model simulations are performed for the period spanning 1990-2010 to examine changes in hemispheric air pollution resulting from changes in emissions over this period. Simulated trends in ozone and precursor species concentrations across the U.S. and the Northern Hemisphere over the past two decades are compared with those inferred from available measurements during this period. Additionally, the decoupled direct method (DDM) in CMAQ, a first- and higher-order sensitivity calculation technique, is used to estimate the sensitivity of O3 to emissions from different source regions across the Northern Hemisphere. The seasonal variations in source region contributions to background O3 are then estimated from these sensitivity calculations and will be discussed. These source region sensitivities estimated from DDM are then combined with the multi-decadal simulations of O3 distributions and emissions trends to characterize the changing contributions of different source regions to background O3 levels across North America. This characterization of changing long-range transport contributions is critical for the design and implementation of tighter national air quality standards

Effect of femtosecond laser-assisted cataract surgery (flacs) on endothelial cell count

International Nuclear Information System (INIS)

Khan, M.S.; Habib, A.; Ishaq, M.; Yaqub, A.

2017-01-01

Objective:To compare the change in endothelial cell count after femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification. Study Design:Randomized controlled clinical trial. Place and Duration of Study:Armed Forces Institute of Ophthalmology, Rawalpindi, Pakistan from January 2016 to August 2017. Methodology:Patients with senile cataract and age ranging from 40 to 80 years were included in the study. Patients with any other cause of endothelial cell loss, history of trauma, documented diabetes millitis, hypertention and glaucoma were excluded. Preoperative detailed ocular examination, including both anterior and posterior examination, was carried out. Patients were distributed into two groups. Group GP were planned for conventional phacoemulsification, while group GF underwent FLACS. All the surgeries were performed under local anesthesia by same ophthalmic surgeon. Specular microscope (Topcon specular microscope sp-3000p) was utilized to measure the endothelial cell count (ECC) before and 4 weeks after the surgery. Results:Fifty eyes (25 in each group) of 48 patients underwent cataract surgery by phacoemulsification or FLACS. Twenty-five (52.08%) out of the total were females while 23 (47.91%) were males. Median age of the participants in hacoemulsification group was 55 years (IQR 20.50), while in FLACS group it was 54 years (IQR 8). The median change in endothelial cell count was 228 (IQR 532) in Phaco group, while 23 (IQR 35) in FLACS group. (p<0.05 Mann Whitney U-test). Conclusion:FLACS is a safe and effective modality for cataract treatment and it induces significantly less endothelial cell loss than conventional phacoemulsification. (author)

Changing clinical patterns in rheumatoid arthritis management over two decades: sequential observational studies.

Science.gov (United States)

Mian, Aneela N; Ibrahim, Fowzia; Scott, Ian C; Bahadur, Sardar; Filkova, Maria; Pollard, Louise; Steer, Sophia; Kingsley, Gabrielle H; Scott, David L; Galloway, James

2016-01-27

Rheumatoid arthritis (RA) treatment paradigms have shifted over the last two decades. There has been increasing emphasis on combination disease modifying anti-rheumatic drug (DMARD) therapy, newer biologic therapies have become available and there is a greater focus on achieving remission. We have evaluated the impact of treatment changes on disease activity scores for 28 joints (DAS28) and disability measured by the health assessment questionnaire scores (HAQ). Four cross-sectional surveys between 1996 and 2014 in two adjacent secondary care rheumatology departments in London evaluated changes in drug therapy, DAS28 and its component parts and HAQ scores (in three surveys). Descriptive statistics used means and standard deviations (SD) or medians and interquartile ranges (IQR) to summarise changes. Spearman's correlations assessed relationships between assessments. 1324 patients were studied. Gender ratios, age and mean disease duration were similar across all cohorts. There were temporal increases in the use of any DMARDs (rising from 61% to 87% of patients from 1996-2014), combination DMARDs (1% to 41%) and biologic (0 to 32%). Mean DAS28 fell (5.2 to 3.7), active disease (DAS28 > 5.1) declined (50% to 18%) and DAS28 remission (DAS28 disability measured by HAQ. As a consequence the relationship between DAS28 and HAQ has become weaker over time. Although the reasons for this divergence between disease activity and disability are uncertain, focussing treatment entirely in suppressing synovitis may be insufficient.

Climatic associations of British species distributions show good transferability in time but low predictive accuracy for range change.

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Giovanni Rapacciuolo

Full Text Available Conservation planners often wish to predict how species distributions will change in response to environmental changes. Species distribution models (SDMs are the primary tool for making such predictions. Many methods are widely used; however, they all make simplifying assumptions, and predictions can therefore be subject to high uncertainty. With global change well underway, field records of observed range shifts are increasingly being used for testing SDM transferability. We used an unprecedented distribution dataset documenting recent range changes of British vascular plants, birds, and butterflies to test whether correlative SDMs based on climate change provide useful approximations of potential distribution shifts. We modelled past species distributions from climate using nine single techniques and a consensus approach, and projected the geographical extent of these models to a more recent time period based on climate change; we then compared model predictions with recent observed distributions in order to estimate the temporal transferability and prediction accuracy of our models. We also evaluated the relative effect of methodological and taxonomic variation on the performance of SDMs. Models showed good transferability in time when assessed using widespread metrics of accuracy. However, models had low accuracy to predict where occupancy status changed between time periods, especially for declining species. Model performance varied greatly among species within major taxa, but there was also considerable variation among modelling frameworks. Past climatic associations of British species distributions retain a high explanatory power when transferred to recent time--due to their accuracy to predict large areas retained by species--but fail to capture relevant predictors of change. We strongly emphasize the need for caution when using SDMs to predict shifts in species distributions: high explanatory power on temporally-independent records

Association between changes in lifestyle and all-cause mortality: the Health and Lifestyle Survey.

OpenAIRE

White, J.; Greene, G.; Kivimaki, M.; Batty, G. D.

2018-01-01

BACKGROUND: To examine the combined influence of changes in physical activity, diet, smoking and alcohol consumption on all-cause mortality. METHODS: Health behaviours were assessed in 1984/1985 and 1991/1992 in 8123 adults from the UK (4666 women, median age 41.0 years). An unhealthy lifestyle score was calculated, allocating one point for smoking, fruits and vegetables 21 units of alcohol (men) per week. RESULTS: There were 2003 deaths over a median follow-up of 6.6 years (IQR 5.9-7.2) foll...

Desertification of forest, range and desert in Tehran province, affected by climate change

Science.gov (United States)

Eskandari, Hadi; Borji, Moslem; Khosravi, Hassan; Mesbahzadeh, Tayebeh

2016-06-01

Climate change has been identified as a leading human and environmental crisis of the twenty-first century. Drylands throughout the world have always undergone periods of degradation due to naturally occurring fluctuation in climate. Persistence of widespread degradation in arid and semiarid regions of Iran necessitates monitoring and evaluation. This paper aims to monitor the desertification trend in three types of land use, including range, forest and desert, affected by climate change in Tehran province for the 2000s and 2030s. For assessing climate change at Mehrabad synoptic station, the data of two emission scenarios, including A2 and B2, were used, utilizing statistical downscaling techniques and data generated by the Statistical DownScaling Model (SDSM). The index of net primary production (NPP) resulting from Moderate Resolution Imaging Spectroradiometer (MODIS) satellite images was employed as an indicator of destruction from 2001 to 2010. The results showed that temperature is the most significant driving force which alters the net primary production in rangeland, forest and desert land use in Tehran province. On the basis of monitoring findings under real conditions, in the 2000s, over 60 % of rangelands and 80 % of the forest were below the average production in the province. On the other hand, the long-term average changes of NPP in the rangeland and forests indicated the presence of relatively large areas of these land uses with a production rate lower than the desert. The results also showed that, assuming the existence of circumstances of each emission scenarios, the desertification status will not improve significantly in the rangelands and forests of Tehran province.

Effects of emissions change, climate change and long-range transport on regional modeling of future U.S. particulate matter pollution and speciation

Science.gov (United States)

He, Hao; Liang, Xin-Zhong; Wuebbles, Donald J.

2018-04-01

This study investigates the future U.S. PM2.5 pollution under multiple emissions scenarios, climate states, and long-range transport (LRT) effects using the regional Community Multi-scale Air Quality (CMAQ) model integrated with a regional climate model. CMAQ with fixed chemical lateral boundary conditions (LBCs) successfully reproduces the present-day PM2.5 pollution and its major species in rural and suburban areas, but has some discrepancies in urban areas such as the Los Angeles Basin, where detailed emissions and meteorology conditions cannot be resolved by the 30 km grid. Its performance is slightly worsened when using dynamic chemical LBCs from global chemical transport model (CTM) simulations, which provide cleaner conditions into the CMAQ lateral boundaries. Under future Intergovernmental Panel on Climate Change (IPCC) emission scenarios, CMAQ projects large PM2.5 reductions (∼40% for A1B and ∼20% for A1Fi scenario) in the eastern United States, but slight to moderate increases (∼5% for A1B and ∼10% for A1Fi) in the western United States. The projected increases are particularly large (up to 30%) near the Mexico-U.S. border, suggesting that Mexico is a major source for future U.S. PM2.5 pollution. The effect from climate change alone is estimated to increase PM2.5 levels ubiquitously (∼5% for both A1B and A1Fi) over the United States, except for a small decrease in the Houston, Texas area, where anthropogenic non-methane volatile organic compounds (NMVOCs) emissions dominate. This climate penalty, however, is substantially smaller than effects of emissions change, especially in the eastern United States. Future PM2.5 pollution is affected substantially (up to -20%) by changes in SO2 emissions and moderately (3-5%) by changes in NOx and NH3 emissions. The long-range transport (LRT) effects, which are estimated by comparing CMAQ simulations with fixed and dynamic LBCs, are regional dependent, causing up to 10-20% decrease over the western United

Tree range expansion in eastern North America fails to keep pace with climate warming at northern range limits.

Science.gov (United States)

Sittaro, Fabian; Paquette, Alain; Messier, Christian; Nock, Charles A

2017-08-01

Rising global temperatures are suggested to be drivers of shifts in tree species ranges. The resulting changes in community composition may negatively impact forest ecosystem function. However, long-term shifts in tree species ranges remain poorly documented. We test for shifts in the northern range limits of 16 temperate tree species in Quebec, Canada, using forest inventory data spanning three decades, 15° of longitude and 7° of latitude. Range shifts were correlated with climate warming and dispersal traits to understand potential mechanisms underlying changes. Shifts were calculated as the change in the 95th percentile of latitudinal occurrence between two inventory periods (1970-1978, 2000-2012) and for two life stages: saplings and adults. We also examined sapling and adult range offsets within each inventory, and changes in the offset through time. Tree species ranges shifted predominantly northward, although species responses varied. As expected shifts were greater for tree saplings, 0.34 km yr -1 , than for adults, 0.13 km yr -1 . Range limits were generally further north for adults compared to saplings, but the difference diminished through time, consistent with patterns observed for range shifts within each life stage. This suggests caution should be exercised when interpreting geographic range offsets between life stages as evidence of range shifts in the absence of temporal data. Species latitudinal velocities were on average climate change and were mostly unrelated to dispersal traits. Finally, our results add to the body of evidence suggesting tree species are mostly limited in their capacity to track climate warming, supporting concerns that warming will negatively impact the functioning of forest ecosystems. © 2017 John Wiley & Sons Ltd.

Large-Scale Range Collapse of Hawaiian Forest Birds under Climate Change and the Need for 21st Century Conservation Options [corrected].

Directory of Open Access Journals (Sweden)

Lucas B Fortini

Full Text Available Hawaiian forest birds serve as an ideal group to explore the extent of climate change impacts on at-risk species. Avian malaria constrains many remaining Hawaiian forest bird species to high elevations where temperatures are too cool for malaria's life cycle and its principal mosquito vector. The impact of climate change on Hawaiian forest birds has been a recent focus of Hawaiian conservation biology, and has centered on the links between climate and avian malaria. To elucidate the differential impacts of projected climate shifts on species with known varying niches, disease resistance and tolerance, we use a comprehensive database of species sightings, regional climate projections and ensemble distribution models to project distribution shifts for all Hawaiian forest bird species. We illustrate that, under a likely scenario of continued disease-driven distribution limitation, all 10 species with highly reliable models (mostly narrow-ranged, single-island endemics are expected to lose >50% of their range by 2100. Of those, three are expected to lose all range and three others are expected to lose >90% of their range. Projected range loss was smaller for several of the more widespread species; however improved data and models are necessary to refine future projections. Like other at-risk species, Hawaiian forest birds have specific habitat requirements that limit the possibility of range expansion for most species, as projected expansion is frequently in areas where forest habitat is presently not available (such as recent lava flows. Given the large projected range losses for all species, protecting high elevation forest alone is not an adequate long-term strategy for many species under climate change. We describe the types of additional conservation actions practitioners will likely need to consider, while providing results to help with such considerations.

Quantitative Maximum Shear-Wave Stiffness of Breast Masses as a Predictor of Histopathologic Severity.

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Berg, Wendie A; Mendelson, Ellen B; Cosgrove, David O; Doré, Caroline J; Gay, Joel; Henry, Jean-Pierre; Cohen-Bacrie, Claude

2015-08-01

The objective of our study was to compare quantitative maximum breast mass stiffness on shear-wave elastography (SWE) with histopathologic outcome. From September 2008 through September 2010, at 16 centers in the United States and Europe, 1647 women with a sonographically visible breast mass consented to undergo quantitative SWE in this prospective protocol; 1562 masses in 1562 women had an acceptable reference standard. The quantitative maximum stiffness (termed "Emax") on three acquisitions was recorded for each mass with the range set from 0 (very soft) to 180 kPa (very stiff). The median Emax and interquartile ranges (IQRs) were determined as a function of histopathologic diagnosis and were compared using the Mann-Whitney U test. We considered the impact of mass size on maximum stiffness by performing the same comparisons for masses 9 mm or smaller and those larger than 9 mm in diameter. The median patient age was 50 years (mean, 51.8 years; SD, 14.5 years; range, 21-94 years), and the median lesion diameter was 12 mm (mean, 14 mm; SD, 7.9 mm; range, 1-53 mm). The median Emax of the 1562 masses (32.1% malignant) was 71 kPa (mean, 90 kPa; SD, 65 kPa; IQR, 31-170 kPa). Of 502 malignancies, 23 (4.6%) ductal carcinoma in situ (DCIS) masses had a median Emax of 126 kPa (IQR, 71-180 kPa) and were less stiff than 468 invasive carcinomas (median Emax, 180 kPa [IQR, 138-180 kPa]; p = 0.002). Benign lesions were much softer than malignancies (median Emax, 43 kPa [IQR, 24-83 kPa] vs 180 kPa [IQR, 129-180 kPa]; p masses. Despite overlap in Emax values, maximum stiffness measured by SWE is a highly effective predictor of the histopathologic severity of sonographically depicted breast masses.

Long-range correlations and fractal dynamics in C. elegans: Changes with aging and stress

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Alves, Luiz G. A.; Winter, Peter B.; Ferreira, Leonardo N.; Brielmann, Renée M.; Morimoto, Richard I.; Amaral, Luís A. N.

2017-08-01

Reduced motor control is one of the most frequent features associated with aging and disease. Nonlinear and fractal analyses have proved to be useful in investigating human physiological alterations with age and disease. Similar findings have not been established for any of the model organisms typically studied by biologists, though. If the physiology of a simpler model organism displays the same characteristics, this fact would open a new research window on the control mechanisms that organisms use to regulate physiological processes during aging and stress. Here, we use a recently introduced animal-tracking technology to simultaneously follow tens of Caenorhabdits elegans for several hours and use tools from fractal physiology to quantitatively evaluate the effects of aging and temperature stress on nematode motility. Similar to human physiological signals, scaling analysis reveals long-range correlations in numerous motility variables, fractal properties in behavioral shifts, and fluctuation dynamics over a wide range of timescales. These properties change as a result of a superposition of age and stress-related adaptive mechanisms that regulate motility.

Assessment of Type I Interferon Signaling in Pediatric Inflammatory Disease.

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Rice, Gillian I; Melki, Isabelle; Frémond, Marie-Louise; Briggs, Tracy A; Rodero, Mathieu P; Kitabayashi, Naoki; Oojageer, Anthony; Bader-Meunier, Brigitte; Belot, Alexandre; Bodemer, Christine; Quartier, Pierre; Crow, Yanick J

2017-02-01

Increased type I interferon is considered relevant to the pathology of a number of monogenic and complex disorders spanning pediatric rheumatology, neurology, and dermatology. However, no test exists in routine clinical practice to identify enhanced interferon signaling, thus limiting the ability to diagnose and monitor treatment of these diseases. Here, we set out to investigate the use of an assay measuring the expression of a panel of interferon-stimulated genes (ISGs) in children affected by a range of inflammatory diseases. A cohort study was conducted between 2011 and 2016 at the University of Manchester, UK, and the Institut Imagine, Paris, France. RNA PAXgene blood samples and clinical data were collected from controls and symptomatic patients with a genetically confirmed or clinically well-defined inflammatory phenotype. The expression of six ISGs was measured by quantitative polymerase chain reaction, and the median fold change was used to calculate an interferon score (IS) for each subject compared to a previously derived panel of 29 controls (where +2 SD of the control data, an IS of >2.466, is considered as abnormal). Results were correlated with genetic and clinical data. Nine hundred ninety-two samples were analyzed from 630 individuals comprising symptomatic patients across 24 inflammatory genotypes/phenotypes, unaffected heterozygous carriers, and controls. A consistent upregulation of ISG expression was seen in 13 monogenic conditions (455 samples, 265 patients; median IS 10.73, interquartile range (IQR) 5.90-18.41), juvenile systemic lupus erythematosus (78 samples, 55 patients; median IS 10.60, IQR 3.99-17.27), and juvenile dermatomyositis (101 samples, 59 patients; median IS 9.02, IQR 2.51-21.73) compared to controls (78 samples, 65 subjects; median IS 0.688, IQR 0.427-1.196), heterozygous mutation carriers (89 samples, 76 subjects; median IS 0.862, IQR 0.493-1.942), and individuals with non-molecularly defined autoinflammation (89 samples, 69

Rifaximin Reduces Markers of Inflammation and Bacterial 16S rRNA in Zambian Adults with Hepatosplenic Schistosomiasis: A Randomized Control Trial.

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Sinkala, Edford; Zyambo, Kanekwa; Besa, Ellen; Kaonga, Patrick; Nsokolo, Bright; Kayamba, Violet; Vinikoor, Michael; Zulu, Rabison; Bwalya, Martin; Foster, Graham R; Kelly, Paul

2018-04-01

Cirrhosis is the dominant cause of portal hypertension globally but may be overshadowed by hepatosplenic schistosomiasis (HSS) in the tropics. In Zambia, schistosomiasis seroprevalence can reach 88% in endemic areas. Bacterial translocation (BT) drives portal hypertension in cirrhosis contributing to mortality but remains unexplored in HSS. Rifaximin, a non-absorbable antibiotic may reduce BT. We aimed to explore the influence of rifaximin on BT, inflammation, and fibrosis in HSS. In this phase II open-label trial (ISRCTN67590499), 186 patients with HSS in Zambia were evaluated and 85 were randomized to standard care with or without rifaximin for 42 days. Changes in markers of inflammation, BT, and fibrosis were the primary outcomes. BT was measured using plasma 16S rRNA, lipopolysaccharide-binding protein, and lipopolysaccharide, whereas hyaluronan was used to measure fibrosis. Tumor necrosis factor receptor 1 (TNFR1) and soluble cluster of differentiation 14 (sCD14) assessed inflammation. 16S rRNA reduced from baseline (median 146 copies/µL, interquartile range [IQR] 9, 537) to day 42 in the rifaximin group (median 63 copies/µL, IQR 12, 196), P < 0.01. The rise in sCD14 was lower ( P < 0.01) in the rifaximin group (median rise 122 ng/mL, IQR-184, 783) than in the non-rifaximin group (median rise 832 ng/mL, IQR 530, 967). TNFR1 decreased ( P < 0.01) in the rifaximin group (median -39 ng/mL IQR-306, 563) but increased in the non-rifaximin group (median 166 ng/mL, IQR 3, 337). Other markers remained unaffected. Rifaximin led to a reduction of inflammatory markers and bacterial 16S rRNA which may implicate BT in the inflammation in HSS.

The relationship between post-stent strut apposition and follow-up strut coverage assessed by a contour plot optical coherence tomography analysis.

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Kim, Jung-Sun; Ha, Jinyong; Kim, Byeong-Keuk; Shin, Dong-Ho; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo; Hong, Myeong-Ki

2014-06-01

This study sought to evaluate the relationship between post-stent strut apposition and follow-up strut coverage using contour plot optical coherence tomographic analysis. Tracking the fate of interested regions of struts at different time points has not been investigated. Post-intervention and 6-month follow-up optical coherence tomographic evaluations were performed in 82 patients treated with biolimus- (n = 37) or sirolimus-eluting stents (n = 45). Post-stent apposition was classified as embedded, apposed, or malapposed. For volumetric stent evaluation, the post-intervention strut-artery distance and the neointimal thickness at follow-up were measured as a function of the circumferential arc length and longitudinal stent length. Computer-generated contour plots of the strut-artery distance and neointimal thickness were compared. The percentages of embedded and malapposed struts after intervention were 1.8% (Interquartile range [IQR]: 0.6% to 6.2%) and 2.3% (IQR: 0.5% to 5.2%), respectively. The percentages of uncovered and malapposed struts at 6 months were 16.0% (IQR: 7.4% to 33.3%) and 0% (IQR: 0% to 0.7%), respectively. The percentage of uncovered struts at 6 months varied significantly with post-stent strut apposition (0% [IQR: 0% to 11.4%] in embedded, 16.3% [IQR: 8.1% to 31.3%] in apposed, and 26.8% [IQR: 0% to 56.3%] in malapposed, p < 0.001 for all pairwise comparisons). In lesions without tissue prolapse, embedded struts were all covered (100% covered struts) compared with those with tissue prolapse (76.8% covered, p < 0.001). The optical coherence tomography-guided optimization of stent strut apposition enhances strut coverage at follow-up. This comprehensive method for evaluating strut apposition may provide more useful information to understanding the serial changes in strut coverage. (Neointimal Coverage After Implantation of Biolimus Eluting Stent With Biodegradable Polymer: Optical Coherence Tomographic Assessment According to the Treatment of

Femoral component loosening after hip resurfacing arthroplasty

International Nuclear Information System (INIS)

Zustin, Jozef; Sauter, Guido; Hahn, Michael; Morlock, Michael M.; Ruether, Wolfgang; Amling, Michael

2010-01-01

Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral

Scotoma analysis of 10–2 visual field testing with a red target in screening for hydroxychloroquine retinopathy

Directory of Open Access Journals (Sweden)

Browning DJ

2015-08-01

Full Text Available David J Browning, Chong LeeDepartment of Ophthalmology, Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, NC, USAObjective: To quantify the variability of scotomas detected by 10–2 visual field (VF testing with a red target in patients taking hydroxychloroquine without and with retinopathy.Design: Retrospective review of clinical charts and VFs.Methods: Twenty-four patients taking hydroxychloroquine without retinopathy, and eight patients taking hydroxychloroquine with retinopathy were tested in this study. Retinopathy was defined by annular scotomas on 10–2 VF testing with corroborative spectral domain optical coherence tomographic outer retinal changes and multifocal electroretinographic changes leading to cessation of hydroxychloroquine or chloroquine. Location and depth of scotoma points on 10–2 VF testing were recorded and their fates followed in serial, reliable 10–2 VFs performed with a red target over time. The main outcome measures for this study were the number of scotoma points and locations, percentage of persistent scotoma points, size of scotomas, location of scotomas, and percentage of scotomas deepening. Results: A median of 3, interquartile range (IQR (2, 5, scotoma points per VF occurred in patients without retinopathy. A median of 86%, IQR (77, 100, of these resolved on the subsequent field. For patients with retinopathy, a median of 50%, IQR (46, 79, resolved, a difference compared to patients without retinopathy that was significant (P=0.0158. The median percentage of scotoma points in the zone from 2° to 8° from fixation in eyes with retinopathy was 72%, IQR (54, 100, compared to 49%, IQR (40, 54, in eyes without retinopathy (P=0.0069. The number of persistent scotoma locations at the last visit was higher in eyes with retinopathy: 3, IQR (1, 3, versus 0, IQR (0, 1, in patients without retinopathy, P=0.0156.Conclusion: Point scotomas are common and variable in 10–2 VF testing with a red target for

[Menopause and ultrasonographic measurements of calcaneus].

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López-Caudana, Alma Ethelia; Castillo-Calderón, María Griselda; Ávila-Jiménez, Laura

2014-01-01

In Mexico, calcaneal ultrasound measurements -bone mineral density (BMD), broadband ultrasound attenuation (BUA), speed of sound (SOS), ultrasonic quantitative index (QUI)- and their differences in regards to menopause have not been documented. It was carried out a cross-sectional study in 862 women from 20 to 90 years old, incorporated through consecutive sample, who were users of the Sistema para el Desarrollo Integral de la Familia (DIF) in Morelos. Sociodemographic, reproductive and life style factors were identified. BMD, BUA, SOS and QUI were measured with quantitative ultrasound (QUS), using a Sunlight Omnisense 7000 S device. Adjusted differences in the mean of these measurements were estimated between pre and postmenopausal women through multiple linear regression. The medians were: BMD, 0.455 g/cm² (IQR, interquartile range = 0.378, 0.538); BUA, 66.0 dB/mHz (IQR = 54.3, 78.1); SOS, 1530.7 m/s (IQR = 1509.8, 1551.7); QUI = 83.7 units (IQR = 71.1, 96.6). In postmenopausal women, adjusted mean for BUA was -4.34 dB/mHz (CI 95 % = -8.23,-0.43); for SOS, -4.26 m/s (CI 95 % = -13.82, 5.30) ; for QUI, -4.42 units (CI 95 % = -8.64,-0.19). This report increases information about the clinical applicability of QUS. SOS in calcaneus does not reflect changes related with menopause.

Climate change may alter breeding ground distributions of eastern migratory monarchs (Danaus plexippus) via range expansion of Asclepias host plants.

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Lemoine, Nathan P

2015-01-01

Climate change can profoundly alter species' distributions due to changes in temperature, precipitation, or seasonality. Migratory monarch butterflies (Danaus plexippus) may be particularly susceptible to climate-driven changes in host plant abundance or reduced overwintering habitat. For example, climate change may significantly reduce the availability of overwintering habitat by restricting the amount of area with suitable microclimate conditions. However, potential effects of climate change on monarch northward migrations remain largely unknown, particularly with respect to their milkweed (Asclepias spp.) host plants. Given that monarchs largely depend on the genus Asclepias as larval host plants, the effects of climate change on monarch northward migrations will most likely be mediated by climate change effects on Asclepias. Here, I used MaxEnt species distribution modeling to assess potential changes in Asclepias and monarch distributions under moderate and severe climate change scenarios. First, Asclepias distributions were projected to extend northward throughout much of Canada despite considerable variability in the environmental drivers of each individual species. Second, Asclepias distributions were an important predictor of current monarch distributions, indicating that monarchs may be constrained as much by the availability of Asclepias host plants as environmental variables per se. Accordingly, modeling future distributions of monarchs, and indeed any tightly coupled plant-insect system, should incorporate the effects of climate change on host plant distributions. Finally, MaxEnt predictions of Asclepias and monarch distributions were remarkably consistent among general circulation models. Nearly all models predicted that the current monarch summer breeding range will become slightly less suitable for Asclepias and monarchs in the future. Asclepias, and consequently monarchs, should therefore undergo expanded northern range limits in summer months

Changes in cardiac index and blood pressure on positioning children prone for scoliosis surgery.

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Brown, Z E; Görges, M; Cooke, E; Malherbe, S; Dumont, G A; Ansermino, J M

2013-07-01

In this prospective observational study we investigated the changes in cardiac index and mean arterial pressure in children when positioned prone for scoliosis correction surgery. Thirty children (ASA 1-2, aged 13-18 years) undergoing primary, idiopathic scoliosis repair were recruited. The cardiac index and mean arterial blood pressure (median (IQR [range])) were 2.7 (2.3-3.1 [1.4-3.7]) l.min(-1).m(-2) and 73 (66-80 [54-91]) mmHg, respectively, at baseline; 2.9 (2.5-3.2 [1.7-4.4]) l.min(-1).m(-2) and 73 (63-81 [51-96]) mmHg following a 5-ml.kg(-1) fluid bolus; and 2.5 (2.2-2.7 [1.4-4.8]) l.min(-1).m(-2) and 69 (62-73 [46-85]) mmHg immediately after turning prone. Turning prone resulted in a median reduction in cardiac index of 0.5 l.min(-1).m(-2) (95% CI 0.3-0.7 l.min(-1).m(-2), p=0.001), or 18.5%, with a large degree of inter-subject variability (+10.3% to -40.9%). The changes in mean arterial blood pressure were not significant. Strategies to predict, prevent and treat decreases in cardiac index need to be developed. © 2013 The Association of Anaesthetists of Great Britain and Ireland.

Accuracy of iodine quantification using dual energy CT in latest generation dual source and dual layer CT

Energy Technology Data Exchange (ETDEWEB)

Pelgrim, Gert Jan; Oudkerk, Matthijs [University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, P.O. Box EB44, Groningen (Netherlands); Hamersvelt, Robbert W. van; Willemink, Martin J.; Schilham, Arnold; Leiner, Tim [Utrecht University Medical Center, Department of Radiology, Utrecht (Netherlands); Schmidt, Bernhard T.; Flohr, Thomas [Siemens Healthcare GmbH, Forchheim (Germany); Milles, Julien [Philips Healthcare, Best (Netherlands); Vliegenthart, Rozemarijn [University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, P.O. Box EB44, Groningen (Netherlands); University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen (Netherlands)

2017-09-15

To determine the accuracy of iodine quantification with dual energy computed tomography (DECT) in two high-end CT systems with different spectral imaging techniques. Five tubes with different iodine concentrations (0, 5, 10, 15, 20 mg/ml) were analysed in an anthropomorphic thoracic phantom. Adding two phantom rings simulated increased patient size. For third-generation dual source CT (DSCT), tube voltage combinations of 150Sn and 70, 80, 90, 100 kVp were analysed. For dual layer CT (DLCT), 120 and 140 kVp were used. Scans were repeated three times. Median normalized values and interquartile ranges (IQRs) were calculated for all kVp settings and phantom sizes. Correlation between measured and known iodine concentrations was excellent for both systems (R = 0.999-1.000, p < 0.0001). For DSCT, median measurement errors ranged from -0.5% (IQR -2.0, 2.0%) at 150Sn/70 kVp and -2.3% (IQR -4.0, -0.1%) at 150Sn/80 kVp to -4.0% (IQR -6.0, -2.8%) at 150Sn/90 kVp. For DLCT, median measurement errors ranged from -3.3% (IQR -4.9, -1.5%) at 140 kVp to -4.6% (IQR -6.0, -3.6%) at 120 kVp. Larger phantom sizes increased variability of iodine measurements (p < 0.05). Iodine concentration can be accurately quantified with state-of-the-art DECT systems from two vendors. The lowest absolute errors were found for DSCT using the 150Sn/70 kVp or 150Sn/80 kVp combinations, which was slightly more accurate than 140 kVp in DLCT. (orig.)

Climate driven range divergence among host species affects range-wide patterns of parasitism

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Richard E. Feldman

2017-01-01

Full Text Available Species interactions like parasitism influence the outcome of climate-driven shifts in species ranges. For some host species, parasitism can only occur in that part of its range that overlaps with a second host species. Thus, predicting future parasitism may depend on how the ranges of the two hosts change in relation to each other. In this study, we tested whether the climate driven species range shift of Odocoileus virginianus (white-tailed deer accounts for predicted changes in parasitism of two other species from the family Cervidae, Alces alces (moose and Rangifer tarandus (caribou, in North America. We used MaxEnt models to predict the recent (2000 and future (2050 ranges (probabilities of occurrence of the cervids and a parasite Parelaphostrongylus tenuis (brainworm taking into account range shifts of the parasite’s intermediate gastropod hosts. Our models predicted that range overlap between A. alces/R. tarandus and P. tenuis will decrease between 2000 and 2050, an outcome that reflects decreased overlap between A. alces/R. tarandus and O. virginianus and not the parasites, themselves. Geographically, our models predicted increasing potential occurrence of P. tenuis where A. alces/R. tarandus are likely to decline, but minimal spatial overlap where A. alces/R. tarandus are likely to increase. Thus, parasitism may exacerbate climate-mediated southern contraction of A. alces and R. tarandus ranges but will have limited influence on northward range expansion. Our results suggest that the spatial dynamics of one host species may be the driving force behind future rates of parasitism for another host species.

Dominant forest tree species are potentially vulnerable to climate change over large portions of their range even at high latitudes

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Catherine Périé

2016-07-01

Full Text Available Projecting suitable conditions for a species as a function of future climate provides a reasonable, although admittedly imperfect, spatially explicit estimate of species vulnerability associated with climate change. Projections emphasizing range shifts at continental scale, however, can mask contrasting patterns at local or regional scale where management and policy decisions are made. Moreover, models usually show potential for areas to become climatically unsuitable, remain suitable, or become suitable for a particular species with climate change, but each of these outcomes raises markedly different ecological and management issues. Managing forest decline at sites where climatic stress is projected to increase is likely to be the most immediate challenge resulting from climate change. Here we assess habitat suitability with climate change for five dominant tree species of eastern North American forests, focusing on areas of greatest vulnerability (loss of suitability in the baseline range in Quebec (Canada rather than opportunities (increase in suitability. Results show that these species are at risk of maladaptation over a remarkably large proportion of their baseline range. Depending on species, 5–21% of currently climatically suitable habitats are projected to be at risk of becoming unsuitable. This suggests that species that have traditionally defined whole regional vegetation assemblages could become less adapted to these regions, with significant impact on ecosystems and forest economy. In spite of their well-recognised limitations and the uncertainty that remains, regionally-explicit risk assessment approaches remain one of the best options to convey that message and the need for climate policies and forest management adaptation strategies.

Dominant forest tree species are potentially vulnerable to climate change over large portions of their range even at high latitudes.

Science.gov (United States)

Périé, Catherine; de Blois, Sylvie

2016-01-01

Projecting suitable conditions for a species as a function of future climate provides a reasonable, although admittedly imperfect, spatially explicit estimate of species vulnerability associated with climate change. Projections emphasizing range shifts at continental scale, however, can mask contrasting patterns at local or regional scale where management and policy decisions are made. Moreover, models usually show potential for areas to become climatically unsuitable, remain suitable, or become suitable for a particular species with climate change, but each of these outcomes raises markedly different ecological and management issues. Managing forest decline at sites where climatic stress is projected to increase is likely to be the most immediate challenge resulting from climate change. Here we assess habitat suitability with climate change for five dominant tree species of eastern North American forests, focusing on areas of greatest vulnerability (loss of suitability in the baseline range) in Quebec (Canada) rather than opportunities (increase in suitability). Results show that these species are at risk of maladaptation over a remarkably large proportion of their baseline range. Depending on species, 5-21% of currently climatically suitable habitats are projected to be at risk of becoming unsuitable. This suggests that species that have traditionally defined whole regional vegetation assemblages could become less adapted to these regions, with significant impact on ecosystems and forest economy. In spite of their well-recognised limitations and the uncertainty that remains, regionally-explicit risk assessment approaches remain one of the best options to convey that message and the need for climate policies and forest management adaptation strategies.

Climate Change May Alter Breeding Ground Distributions of Eastern Migratory Monarchs (Danaus plexippus) via Range Expansion of Asclepias Host Plants

Science.gov (United States)

Lemoine, Nathan P.

2015-01-01

Climate change can profoundly alter species’ distributions due to changes in temperature, precipitation, or seasonality. Migratory monarch butterflies (Danaus plexippus) may be particularly susceptible to climate-driven changes in host plant abundance or reduced overwintering habitat. For example, climate change may significantly reduce the availability of overwintering habitat by restricting the amount of area with suitable microclimate conditions. However, potential effects of climate change on monarch northward migrations remain largely unknown, particularly with respect to their milkweed (Asclepias spp.) host plants. Given that monarchs largely depend on the genus Asclepias as larval host plants, the effects of climate change on monarch northward migrations will most likely be mediated by climate change effects on Asclepias. Here, I used MaxEnt species distribution modeling to assess potential changes in Asclepias and monarch distributions under moderate and severe climate change scenarios. First, Asclepias distributions were projected to extend northward throughout much of Canada despite considerable variability in the environmental drivers of each individual species. Second, Asclepias distributions were an important predictor of current monarch distributions, indicating that monarchs may be constrained as much by the availability of Asclepias host plants as environmental variables per se. Accordingly, modeling future distributions of monarchs, and indeed any tightly coupled plant-insect system, should incorporate the effects of climate change on host plant distributions. Finally, MaxEnt predictions of Asclepias and monarch distributions were remarkably consistent among general circulation models. Nearly all models predicted that the current monarch summer breeding range will become slightly less suitable for Asclepias and monarchs in the future. Asclepias, and consequently monarchs, should therefore undergo expanded northern range limits in summer months

Climate change may alter breeding ground distributions of eastern migratory monarchs (Danaus plexippus via range expansion of Asclepias host plants.

Directory of Open Access Journals (Sweden)

Nathan P Lemoine

Full Text Available Climate change can profoundly alter species' distributions due to changes in temperature, precipitation, or seasonality. Migratory monarch butterflies (Danaus plexippus may be particularly susceptible to climate-driven changes in host plant abundance or reduced overwintering habitat. For example, climate change may significantly reduce the availability of overwintering habitat by restricting the amount of area with suitable microclimate conditions. However, potential effects of climate change on monarch northward migrations remain largely unknown, particularly with respect to their milkweed (Asclepias spp. host plants. Given that monarchs largely depend on the genus Asclepias as larval host plants, the effects of climate change on monarch northward migrations will most likely be mediated by climate change effects on Asclepias. Here, I used MaxEnt species distribution modeling to assess potential changes in Asclepias and monarch distributions under moderate and severe climate change scenarios. First, Asclepias distributions were projected to extend northward throughout much of Canada despite considerable variability in the environmental drivers of each individual species. Second, Asclepias distributions were an important predictor of current monarch distributions, indicating that monarchs may be constrained as much by the availability of Asclepias host plants as environmental variables per se. Accordingly, modeling future distributions of monarchs, and indeed any tightly coupled plant-insect system, should incorporate the effects of climate change on host plant distributions. Finally, MaxEnt predictions of Asclepias and monarch distributions were remarkably consistent among general circulation models. Nearly all models predicted that the current monarch summer breeding range will become slightly less suitable for Asclepias and monarchs in the future. Asclepias, and consequently monarchs, should therefore undergo expanded northern range limits in

Thermal conductivity of an organic phase change material/expanded graphite composite across the phase change temperature range and a novel thermal conductivity model

International Nuclear Information System (INIS)

Ling, Ziye; Chen, Jiajie; Xu, Tao; Fang, Xiaoming; Gao, Xuenong; Zhang, Zhengguo

2015-01-01

Highlights: • Expanded graphite can improve thermal conductivity of RT44HC by 20–60 times. • Thermal conductivity of PCM/EG composites keeps constant before/after melting. • Thermal conductivity of PCMs nearly doubled during phase changing. • Thermal conductivity of composite PCM increases with density and percentage of EG. • The simple model predicts thermal conductivity of EG-based composites accurately. - Abstract: This work studies factors that affect the thermal conductivity of an organic phase change material (PCM), RT44HC/expanded graphite (EG) composite, which include: EG mass fraction, composite PCM density and temperature. The increase of EG mass fraction and bulk density will both enhance thermal conductivity of composite PCMs, by up to 60 times. Thermal conductivity of RT44HC/EG composites remains independent on temperature outside the phase change range (40–45 °C), but nearly doubles during the phase change. The narrow temperature change during the phase change allows the maximum heat flux or minimum temperature for heat source if attaching PCMs to a first (constant temperature) or second (constant heat flux) thermal boundary. At last, a simple thermal conductivity model for EG-based composites is put forward, based on only two parameters: mass fraction of EG and bulk density of the composite. This model is validated with experiment data presented in this paper and in literature, showing this model has general applicability to any composite of EG and poor thermal conductive materials

Prevalence and predictors of episiotomy among women at first birth ...

African Journals Online (AJOL)

interquartile range (IQR): 2.9-3.5]) was statistically higher than those of women who did not receive episiotomy (median, 3.1 kg [IQR: 2.7-3.4]), (Z = −3.415, P = 0.001). Proportion of newborns with low 1st min Apgar scores in the episiotomy group ...

Fast-track access to urologic care for patients with macroscopic haematuria is efficient and cost-effective

DEFF Research Database (Denmark)

Liedberg, Fredrik; Gerdtham, Ulf; Gralén, Katarina

2016-01-01

: In all 275 patients who called 'the Red Phone' hotline were investigated, and 47 of them (17%) were diagnosed with cancer and 36 of those had bladder cancer. Median time from patient-reported haematuria to diagnosis was 29 (interquartile range (IQR) 14-104) days and 50 (IQR 27-165) days...

Scotoma analysis of 10-2 visual field testing with a white target in screening for hydroxychloroquine retinopathy

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Browning DJ

2015-05-01

Full Text Available David J Browning, Chong Lee Department of Ophthalmology, Charlotte Eye, Ear, Nose and Throat Associates, Charlotte, NC, USA Objective: To quantify the variability of scotomas detected by 10-2 visual field (VF testing in patients taking hydroxychloroquine without and with retinopathy.Design: Retrospective review of clinical charts and visual fields.Subjects: Twenty-one patients taking hydroxychloroquine without retinopathy, and nine patients taking hydroxychloroquine and one patient taking chloroquine with retinopathy.Methods: Retinopathy was defined by annular scotomas on 10-2 VF testing with corroborative spectral domain optical coherence tomographic outer retinal changes and multifocal electroretinographic changes leading to cessation of hydroxychloroquine or chloroquine. Location and depth of scotoma points on 10-2 VF testing were recorded and their fates followed in serial, reliable 10-2 VFs performed with a white target over time.Main outcome measures: Number of scotoma points and locations, percentage of persistent scotoma points, size of scotomas, location of scotomas, and percentage of scotomas deepening.Results: A median of five, interquartile range (IQR 3–8 scotoma points per VF occurred in patients without retinopathy. A median of 86%, IQR 63%–100% of these points resolve on the subsequent field. For patients with retinopathy, a median of 22%, IQR 10%–59% resolve. The median percentage of scotoma points in the zone 2–8 degrees from fixation in eyes with retinopathy was 79%, IQR 68%–85% compared to 60%, IQR 54%–75% in eyes without retinopathy (P=0.0094. Single-point scotomas were more common in eyes without than with retinopathy. Scotomas consisting of more than four contiguous scotoma points were generally indicative of retinopathy.Conclusion: Point scotomas are common and variable in 10-2 VF testing with a white target for hydroxychloroquine retinopathy in subjects without retinopathy. The annular zone 2 to 8�

Very low calorie diet without aspartame in obese subjects: improved metabolic control after 4 weeks treatment.

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Norén, Erik; Forssell, Henrik

2014-07-28

Very low calorie diet (VLCD) is routinely used in programs for treatment of obesity and before bariatric surgery in order to reduce risk of postoperative complications. Aspartame, an artificial sweetener, is commonly used in VLCD and is well approved as a food additive without any adverse effects. The development of a new fructose containing VLCD formula without aspartame raises questions as to effects on glucose and lipid control. As part of an ongoing study of a novel bariatric surgery procedure, twenty-five obese subjects with mean body mass index (BMI) 39.8 kg/m2 and mean age of 48.8 years enrolled in a single center observational study. Seven subjects presented with type 2 diabetes mellitus. The subjects underwent four weeks dietary treatment with VLCD Slanka (Slanka). Blood samples including fasting plasma glucose, HbA1c, cholesterol and triglycerides were performed at start and after four weeks of diet. Blood pressure and weight were noted. All subjects completed the diet without any adverse events. Mean weight reduction was 8.2 kg with 95% confidence interval 7.1-9.2 kg (p = 0.001). Excess weight (i.e. proportion of weight exceeding BMI 25) loss decreased by median 19.5% (inter quartile range (IQR) 16,8-24,2). Median fasting plasma glucose was at inclusion 5,6 mmol/l (IQR 5,3-6,8) and after diet 4.8 mmol/l (IQR 4,6-5,2) (p = 0.001). Median HbA1c changed from 39 mmol/mol (IQR 37-44) to 37 mmol/mol (IQR 35-43) (p = 0.001). There was also significant reduction in cholesterol and triglyceride levels as well as in systolic blood pressure. Changes in other monitored blood chemistry values were without clinical importance. Four weeks treatment with fructose containing VLCD of obese subjects preparing for bariatric surgery gave a substantial weight reduction without any significant negative metabolic effects.

Projected range contractions of European protected oceanic montane plant communities: focus on climate change impacts is essential for their future conservation.

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Hodd, Rory L; Bourke, David; Skeffington, Micheline Sheehy

2014-01-01

Global climate is rapidly changing and while many studies have investigated the potential impacts of this on the distribution of montane plant species and communities, few have focused on those with oceanic montane affinities. In Europe, highly sensitive bryophyte species reach their optimum occurrence, highest diversity and abundance in the north-west hyperoceanic regions, while a number of montane vascular plant species occur here at the edge of their range. This study evaluates the potential impact of climate change on the distribution of these species and assesses the implications for EU Habitats Directive-protected oceanic montane plant communities. We applied an ensemble of species distribution modelling techniques, using atlas data of 30 vascular plant and bryophyte species, to calculate range changes under projected future climate change. The future effectiveness of the protected area network to conserve these species was evaluated using gap analysis. We found that the majority of these montane species are projected to lose suitable climate space, primarily at lower altitudes, or that areas of suitable climate will principally shift northwards. In particular, rare oceanic montane bryophytes have poor dispersal capacity and are likely to be especially vulnerable to contractions in their current climate space. Significantly different projected range change responses were found between 1) oceanic montane bryophytes and vascular plants; 2) species belonging to different montane plant communities; 3) species categorised according to different biomes and eastern limit classifications. The inclusion of topographical variables in addition to climate, significantly improved the statistical and spatial performance of models. The current protected area network is projected to become less effective, especially for specialised arctic-montane species, posing a challenge to conserving oceanic montane plant communities. Conservation management plans need significantly

Projected range contractions of European protected oceanic montane plant communities: focus on climate change impacts is essential for their future conservation.

Directory of Open Access Journals (Sweden)

Rory L Hodd

Full Text Available Global climate is rapidly changing and while many studies have investigated the potential impacts of this on the distribution of montane plant species and communities, few have focused on those with oceanic montane affinities. In Europe, highly sensitive bryophyte species reach their optimum occurrence, highest diversity and abundance in the north-west hyperoceanic regions, while a number of montane vascular plant species occur here at the edge of their range. This study evaluates the potential impact of climate change on the distribution of these species and assesses the implications for EU Habitats Directive-protected oceanic montane plant communities. We applied an ensemble of species distribution modelling techniques, using atlas data of 30 vascular plant and bryophyte species, to calculate range changes under projected future climate change. The future effectiveness of the protected area network to conserve these species was evaluated using gap analysis. We found that the majority of these montane species are projected to lose suitable climate space, primarily at lower altitudes, or that areas of suitable climate will principally shift northwards. In particular, rare oceanic montane bryophytes have poor dispersal capacity and are likely to be especially vulnerable to contractions in their current climate space. Significantly different projected range change responses were found between 1 oceanic montane bryophytes and vascular plants; 2 species belonging to different montane plant communities; 3 species categorised according to different biomes and eastern limit classifications. The inclusion of topographical variables in addition to climate, significantly improved the statistical and spatial performance of models. The current protected area network is projected to become less effective, especially for specialised arctic-montane species, posing a challenge to conserving oceanic montane plant communities. Conservation management plans need

Changes in estimated glomerular filtration rate over time in South African HIV-1-infected patients receiving tenofovir: a retrospective cohort study

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De Waal, Reneé; Cohen, Karen; Fox, Matthew P; Stinson, Kathryn; Maartens, Gary; Boulle, Andrew; Igumbor, Ehimario U; Davies, Mary-Ann

2017-01-01

Abstract Introduction: Tenofovir has been associated with decline in kidney function, but in patients with low baseline kidney function, improvements over time have been reported. Additionally, the magnitude and trajectory of estimated glomerular filtration rate (eGFR) changes may differ according to how eGFR is calculated. We described changes in eGFR over time, and the incidence of, and risk factors for, kidney toxicity, in a South African cohort. Methods: We included antiretroviral-naïve patients ≥16 years old who started tenofovir-containing antiretroviral therapy (ART) between 2002 and 2013. We calculated eGFR using the Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Cockcroft-Gault equations. We described changes in eGFR from ART initiation using linear mixed effects regression. We described the incidence of eGFR <30 mL/min on treatment, and identified associations with low eGFR using Cox regression. Results: We included 15156 patients with median age of 35.4 years (IQR 29.9–42.0), median CD4 cell count of 168 cells/µL (IQR 83–243), and median eGFR (MDRD) of 98.6 mL/min (IQR 84.4–115.6). Median duration of follow up on tenofovir was 12.9 months (IQR 5.1–23.3). Amongst those with a baseline and subsequent eGFR  available, mean eGFR change from baseline at 12 months was −4.4 mL/min (95% CI −4.9 to −4.0), −2.3 (−2.5 to −2.1), and 0.6 (0.04 to 1.2) in those with baseline eGFR ≥90 mL/min; and 11.9 mL/min (11.0 to 12.7), 14.6 (13.5 to 15.7), and 11.0 (10.3 to 11.7) in those with baseline eGFR <90 mL/min, according to the MDRD, CKD-EPI (n = 11 112), and Cockcroft-Gault (n = 9 283) equations, respectively. Overall, 292 (1.9%) patients developed eGFR <30 mL/min. Significant associations with low eGFR included older age, baseline eGFR <60 mL/min, CD4 count <200 cells/µL, body weight <60 kg, and concomitant protease inhibitor use. Conclusions: Patients on

Associations of day-to-day temperature change and diurnal temperature range with out-of-hospital cardiac arrest.

Science.gov (United States)

Onozuka, Daisuke; Hagihara, Akihito

2017-01-01

Background Although the impacts of temperature on mortality and morbidity have been documented, few studies have investigated whether day-to-day temperature change and diurnal temperature range (DTR) are independent risk factors for out-of-hospital cardiac arrest (OHCA). Design This was a prospective, population-based, observational study. Methods We obtained all OHCA data from 2005-2013 from six major prefectures in Japan: Hokkaido, Tokyo, Kanagawa, Aichi, Kyoto, and Osaka. We used a quasi-Poisson regression analysis with a distributed-lag non-linear model to assess the associations of day-to-day temperature change and DTR with OHCA for each prefecture. Results In total, 271,698 OHCAs of presumed cardiac origin were reported during the study period. There was a significant increase in the risk of OHCA associated with cold temperature in five prefectures, with relative risks (RRs) ranging from 1.298 (95% confidence interval (CI) 1.022-1.649) in Hokkaido to 3.893 (95% CI 1.713-8.845) in Kyoto. DTR was adversely associated with OHCA on hot days in Aichi (RR 1.158; 95% CI 1.028-1.304) and on cold days in Tokyo (RR 1.030; 95% CI 1.000-1.060), Kanagawa (RR 1.042; 95% CI 1.005-1.082), Kyoto (RR 1.060; 95% CI 1.001-1.122), and Osaka (RR 1.050; 95% CI 1.014-1.088), whereas there was no significant association between day-to-day temperature change and OHCA. Conclusion We found that associations between day-to-day temperature change and DTR and OHCA were generally small compared with the association with mean temperature. Our findings suggest that preventative measures for temperature-related OHCA may be more effective when focused on mean temperature and DTR.

Demographic consequences of climate change and land cover help explain a history of extirpations and range contraction in a declining snake species.

Science.gov (United States)

Pomara, Lars Y; LeDee, Olivia E; Martin, Karl J; Zuckerberg, Benjamin

2014-07-01

Developing conservation strategies for threatened species increasingly requires understanding vulnerabilities to climate change, in terms of both demographic sensitivities to climatic and other environmental factors, and exposure to variability in those factors over time and space. We conducted a range-wide, spatially explicit climate change vulnerability assessment for Eastern Massasauga (Sistrurus catenatus), a declining endemic species in a region showing strong environmental change. Using active season and winter adult survival estimates derived from 17 data sets throughout the species' range, we identified demographic sensitivities to winter drought, maximum precipitation during the summer, and the proportion of the surrounding landscape dominated by agricultural and urban land cover. Each of these factors was negatively associated with active season adult survival rates in binomial generalized linear models. We then used these relationships to back-cast adult survival with dynamic climate variables from 1950 to 2008 using spatially explicit demographic models. Demographic models for 189 population locations predicted known extant and extirpated populations well (AUC = 0.75), and models based on climate and land cover variables were superior to models incorporating either of those effects independently. These results suggest that increasing frequencies and severities of extreme events, including drought and flooding, have been important drivers of the long-term spatiotemporal variation in a demographic rate. We provide evidence that this variation reflects nonadaptive sensitivity to climatic stressors, which are contributing to long-term demographic decline and range contraction for a species of high-conservation concern. Range-wide demographic modeling facilitated an understanding of spatial shifts in climatic suitability and exposure, allowing the identification of important climate refugia for a dispersal-limited species. Climate change vulnerability

Non-Seasonal Variation of Airborne Aspergillus Spore Concentration in a Hospital Building

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Michael Oberle

2015-10-01

Full Text Available Nosocomial fungal infections are gaining increased attention from infectiologists. An adequate investigation into the levels of airborne Aspergillus and other fungal spores in hospital settings, under normal conditions, is largely unknown. We monitored airborne spore contamination in a Swiss hospital building in order to establish a seasonally-dependent base-line level. Air was sampled using an impaction technique, twice weekly, at six different locations over one year. Specimens were seeded in duplicate on Sabouraud agar plates. Grown colonies were identified to genus levels. The airborne Aspergillus spore concentration was constantly low throughout the whole year, at a median level of 2 spores/m3 (inter-quartile range = IQR 1–4, and displayed no seasonal dependency. The median concentration of other fungal spores was higher and showed a distinct seasonal variability with the ambient temperature change during the different seasons: 82 spores/m3 (IQR 26–126 in summer and 9 spores/m3 (IQR 6–15 in winter. The spore concentration varied considerably between the six sampling sites in the building (10 to 26 spores/m3. This variability may explain the variability of study results in the literature.

Changes in hip abductor moment 3 or more years after femoral derotation osteotomy among individuals with cerebral palsy.

Science.gov (United States)

Boyer, Elizabeth R; Novacheck, Tom F; Schwartz, Michael H

2017-09-01

To examine the effect of femoral derotation osteotomy (FDO) on dimensionless hip abductor moment during gait in children with cerebral palsy. We retrospectively analyzed data from independent ambulators within our database. Postoperative visits 1 year (short-term) and at least 3 years (mid-term) were analyzed. We estimated the coronal plane hip abductor moment arm based on musculoskeletal modeling that accounted for anteversion and hip rotation. There were 140 individuals with a short-term analysis (77 males, 63 females; age at surgery 9y 11mo [range 4y 5mo-17y 5mo]) and 29 with mid-term analysis (15 males, 14 females; age at surgery 8y 7mo [range 4y 5mo-13y 1mo]). At short-term, anteversion and internal hip rotation decreased 35° and 13° respectively, which increased median (IQR) moment arms from 20 (23) per cent below normal to 2 (12) per cent above normal. Dimensionless mean hip abductor moment remained unchanged at short-term. Mid-term anteversion did not change but hip rotation increased 8° and hip abductor moment increased to 0.040 (0.029). There was no change in pelvic and trunk obliquity, although hip abductor strength increased and walking velocity decreased at mid-term. The unexpected lack of improvement in hip abductor moment from pre- to short-term may be caused by gait compensations that unload the hip. The increase in hip abductor moment beyond 3 years postoperatively underscores the benefits of an FDO into adolescence for independent ambulating individuals with cerebral palsy. © 2017 Mac Keith Press.

Changes in Rectal Dose Due to Alterations in Beam Angles for Setup Uncertainty and Range Uncertainty in Carbon-Ion Radiotherapy for Prostate Cancer.

Directory of Open Access Journals (Sweden)

Yoshiki Kubota

Full Text Available Carbon-ion radiotherapy of prostate cancer is challenging in patients with metal implants in one or both hips. Problems can be circumvented by using fields at oblique angles. To evaluate the influence of setup and range uncertainties accompanying oblique field angles, we calculated rectal dose changes with oblique orthogonal field angles, using a device with fixed fields at 0° and 90° and a rotating patient couch.Dose distributions were calculated at the standard angles of 0° and 90°, and then at 30° and 60°. Setup uncertainty was simulated with changes from -2 mm to +2 mm for fields in the anterior-posterior, left-right, and cranial-caudal directions, and dose changes from range uncertainty were calculated with a 1 mm water-equivalent path length added to the target isocenter in each angle. The dose distributions regarding the passive irradiation method were calculated using the K2 dose algorithm.The rectal volumes with 0°, 30°, 60°, and 90° field angles at 95% of the prescription dose were 3.4±0.9 cm3, 2.8±1.1 cm3, 2.2±0.8 cm3, and 3.8±1.1 cm3, respectively. As compared with 90° fields, 30° and 60° fields had significant advantages regarding setup uncertainty and significant disadvantages regarding range uncertainty, but were not significantly different from the 90° field setup and range uncertainties.The setup and range uncertainties calculated at 30° and 60° field angles were not associated with a significant change in rectal dose relative to those at 90°.

Safety and efficacy of cryopreserved autologous platelet concentrates in HLA-alloimmunized patients with hematologic malignancies.

Science.gov (United States)

Gerber, Bernhard; Alberio, Lorenzo; Rochat, Sophie; Stenner, Frank; Manz, Markus G; Buser, Andy; Schanz, Urs; Stussi, Georg

2016-10-01

Curative chemotherapy approaches in patients with malignancies and platelet (PLT) transfusion refractoriness due to alloimmunization may be hampered by the lack of suitable PLT donors. For these patients, transfusion of cryopreserved autologous PLTs is an option, but is time- and resource-consuming. We aimed at further simplifying this process. A retrospective single-center analysis was conducted on the transfusion of cryopreserved autologous PLTs in nine female alloimmunized, PLT transfusion-refractory patients treated for acute leukemia (n = 8) and non-Hodgkin's lymphoma (n = 1). No additional processing was used before transfusion, and most notably, washing and centrifugation steps were omitted. Clinical efficacy and safety, as well as a flow cytometric assessment of structural and functional PLT changes, were analyzed. A total of 40 autologous PLT concentrates were thawed at bedside and transfused a median of 32 (range, 9 to 994) days after cryopreservation. No major bleeds and no severe dimethyl sulfoxide toxicity were observed. The median PLT count increments did not differ 1 and 18 to 24 hours after transfusion and reached 6 × 10 9 /L (interquartile range [IQR], 3 × 10 9 -7.5 × 10 9 /L) and 6 × 10 9 /L (IQR, 2.5 × 10 9 -9.5 × 10 9 /L), respectively. Cryopreservation resulted in partial activation of one-third of the PLTs. In vitro stimulation with strong agonists induced additional full activation of cryopreserved PLTs: median, 55% (IQR, 42%-60%) after thrombin and 39% (IQR, 36%-39%) after convulxin. The transfusion of cryopreserved autologous PLTs is feasible and safe. Despite the cryopreservation process, PLT functionality is partially maintained. © 2016 AABB.

Sub-dissociative-dose intranasal ketamine for moderate to severe pain in adult emergency department patients.

Science.gov (United States)

Yeaman, Fiona; Meek, Robert; Egerton-Warburton, Diana; Rosengarten, Pamela; Graudins, Andis

2014-06-01

There are currently no studies assessing effectiveness of sub-dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED. The study aims to examine the effectiveness of sub-dissociative IN ketamine as a primary analgesic agent for adult patients in the ED. This is a prospective, observational study of adult ED patients presenting with severe pain (≥6 on 11-point scale at triage). IN ketamine dose was 0.7 mg/kg, with secondary dose of 0.5 mg/kg at 15 min if pain did not improve. After 6 months, initial dose was increased to 1.0 mg/kg with the same optional secondary dose. The primary outcomes are change in VAS rating at 30 min; percentage of patients reporting clinically significant reduction in VAS (≥20 mm) at 30 min; dose resulting in clinically significant pain reduction. Of the 72 patients available for analysis, median age was 34.5 years and 64% were men. Median initial VAS rating was 76 mm (interquartile range [IQR]: 65-82). Median total dose of IN ketamine for all patients was 0.98 mg/kg (IQR: 0.75-1.15, range: 0.59-1.57). Median reduction in VAS rating at 30 min was 24 mm (IQR: 2-45). Forty (56%, 95% CI: 44.0-66.7) reported VAS reduction ≥20 mm, these patients having had a total median ketamine dose of 0.94 mg/kg (IQR: 0.72-1.04). IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56% of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Accuracy of iodine quantification using dual energy CT in latest generation dual source and dual layer CT.

Science.gov (United States)

Pelgrim, Gert Jan; van Hamersvelt, Robbert W; Willemink, Martin J; Schmidt, Bernhard T; Flohr, Thomas; Schilham, Arnold; Milles, Julien; Oudkerk, Matthijs; Leiner, Tim; Vliegenthart, Rozemarijn

2017-09-01

To determine the accuracy of iodine quantification with dual energy computed tomography (DECT) in two high-end CT systems with different spectral imaging techniques. Five tubes with different iodine concentrations (0, 5, 10, 15, 20 mg/ml) were analysed in an anthropomorphic thoracic phantom. Adding two phantom rings simulated increased patient size. For third-generation dual source CT (DSCT), tube voltage combinations of 150Sn and 70, 80, 90, 100 kVp were analysed. For dual layer CT (DLCT), 120 and 140 kVp were used. Scans were repeated three times. Median normalized values and interquartile ranges (IQRs) were calculated for all kVp settings and phantom sizes. Correlation between measured and known iodine concentrations was excellent for both systems (R = 0.999-1.000, p < 0.0001). For DSCT, median measurement errors ranged from -0.5% (IQR -2.0, 2.0%) at 150Sn/70 kVp and -2.3% (IQR -4.0, -0.1%) at 150Sn/80 kVp to -4.0% (IQR -6.0, -2.8%) at 150Sn/90 kVp. For DLCT, median measurement errors ranged from -3.3% (IQR -4.9, -1.5%) at 140 kVp to -4.6% (IQR -6.0, -3.6%) at 120 kVp. Larger phantom sizes increased variability of iodine measurements (p < 0.05). Iodine concentration can be accurately quantified with state-of-the-art DECT systems from two vendors. The lowest absolute errors were found for DSCT using the 150Sn/70 kVp or 150Sn/80 kVp combinations, which was slightly more accurate than 140 kVp in DLCT. • High-end CT scanners allow accurate iodine quantification using different DECT techniques. • Lowest measurement error was found in scans with largest photon energy separation. • Dual-source CT quantified iodine slightly more accurately than dual layer CT.

Range of motion and isometric strength of shoulder joints of team handball athletes during the playing season, Part II: changes after midseason.

Science.gov (United States)

Fieseler, Georg; Jungermann, Philipp; Koke, Alexander; Irlenbusch, Lars; Delank, Karl-Stefan; Schwesig, Rene

2015-03-01

Our objective was to investigate the influence of workload and consecutive changes on active range of motion and isometric strength of team handball athletes' throwing shoulders (TSs) because the available data are insufficient. In a longitudinal investigation, 31 professional male handball athletes underwent a clinical shoulder examination. Athletes were examined at the beginning (week 0), at the end (week 6) of the preseasonal training, and at the end of the half-season (week 22) on both shoulders to determine isometric rotational strength (hand held dynamometer) and active range of motion (goniometer). This analysis demonstrates the results subsequently from week 6 to week 22 and from week 0 to week 22. The glenohumeral internal rotation (IR) deficit (GIRD), external rotation (ER) gain, and ER at the TS increased significantly (P 0.10, d > 0.30) in the first sequence (week 6 to week 22) but not significantly from week 0 to week 22. The total range of motion remained stable, and IR changed but not significantly. There was no influence on IR, ER, and total range of motion at the non-TS. The isometric strength of the TS and non-TS IR did not change. The isometric strength in ER significantly increased bilaterally during the investigation period. Our data verify changes and influences, such as an increasing GIRD, at the overhead TS joint in accordance with the workload during team handball season. ER gain did improve after the half-season period but did not fully compensate the GIRD at the TS. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Weight loss and weight loss maintenance efficacy of a novel weight loss program: The retrospective RNPC® cohort

DEFF Research Database (Denmark)

Thorning, Tanja Kongerslev; Fabre, Odile; Legrand, Rémy

2018-01-01

or obese patients treated in 54 RNPC® weight loss clinics in France. Results: A total of 10,809 (89%) patients completed the initial weight loss phase and 2996 (25%) completed the full program. Median weight loss percentage was 10.7% (Interquartile range [IQR]: 5.8; 16.5) after a median of 105 days (IQR...

Is nelfinavir exposure associated with cancer incidence in HIV-positive individuals?

DEFF Research Database (Denmark)

Boettiger, David C; Sabin, Caroline A; Grulich, Andrew

2016-01-01

(50% white, 73% male) contributed 303 005 person-years of follow-up between 1 January 2004 and 1 February 2014. At study enrolment, median age was 40 [interquartile range (IQR) 33-46] years and 8305 individuals had a history of nelfinavir use [median duration 1.7 (IQR 0.7-3.4) years]. During follow...

Asymmetric changes of growth and reproductive investment herald altitudinal and latitudinal range shifts of two woody species.

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Matías, Luis; Jump, Alistair S

2015-02-01

Ongoing changes in global climate are altering ecological conditions for many species. The consequences of such changes are typically most evident at the edge of the geographical distribution of a species, where range expansions or contractions may occur. Current demographical status at geographical range limits can help us to predict population trends and their implications for the future distribution of the species. Thus, understanding the comparability of demographical patterns occurring along both altitudinal and latitudinal gradients would be highly informative. In this study, we analyse the differences in the demography of two woody species through altitudinal gradients at their southernmost distribution limit and the consistency of demographical patterns at the treeline across a latitudinal gradient covering the complete distribution range. We focus on Pinus sylvestris and Juniperus communis, assessing their demographical structure (density, age and mortality rate), growth, reproduction investment and damage from herbivory on 53 populations covering the upper, central and lower altitudes as well as the treeline at central latitude and northernmost and southernmost latitudinal distribution limits. For both species, populations at the lowermost altitude presented older age structure, higher mortality, decreased growth and lower reproduction when compared to the upper limit, indicating higher fitness at the treeline. This trend at the treeline was generally maintained through the latitudinal gradient, but with a decreased growth at the northern edge for both species and lower reproduction for P. sylvestris. However, altitudinal and latitudinal transects are not directly comparable as factors other than climate, including herbivore pressure or human management, must be taken into account if we are to understand how to infer latitudinal processes from altitudinal data. © 2014 John Wiley & Sons Ltd.

Species-specific ecological niche modelling predicts different range contractions for Lutzomyia intermedia and a related vector of Leishmania braziliensis following climate change in South America.

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McIntyre, Shannon; Rangel, Elizabeth F; Ready, Paul D; Carvalho, Bruno M

2017-03-24

Before 1996 the phlebotomine sand fly Lutzomyia neivai was usually treated as a synonym of the morphologically similar Lutzomyia intermedia, which has long been considered a vector of Leishmania braziliensis, the causative agent of much cutaneous leishmaniasis in South America. This report investigates the likely range changes of both sand fly species in response to a stabilisation climate change scenario (RCP4.5) and a high greenhouse gas emissions one (RCP8.5). Ecological niche modelling was used to identify areas of South America with climates currently suitable for each species, and then the future distributions of these climates were predicted based on climate change scenarios. Compared with the previous ecological niche model of L. intermedia (sensu lato) produced using the GARP algorithm in 2003, the current investigation modelled the two species separately, making use of verified presence records and additional records after 2001. Also, the new ensemble approach employed ecological niche modelling algorithms (including Maximum Entropy, Random Forests and Support Vector Machines) that have been widely adopted since 2003 and perform better than GARP, as well as using a more recent climate change model (HadGEM2) considered to have better performance at higher resolution than the earlier one (HadCM2). Lutzomyia intermedia was shown to be the more tropical of the two species, with its climatic niche defined by higher annual mean temperatures and lower temperature seasonality, in contrast to the more subtropical L. neivai. These different latitudinal ranges explain the two species' predicted responses to climate change by 2050, with L. intermedia mostly contracting its range (except perhaps in northeast Brazil) and L. neivai mostly shifting its range southwards in Brazil and Argentina. This contradicts the findings of the 2003 report, which predicted more range expansion. The different findings can be explained by the improved data sets and modelling methods. Our

Fitness declines towards range limits and local adaptation to climate affect dispersal evolution during climate‐induced range shifts

DEFF Research Database (Denmark)

Hargreaves, Anna; Bailey, Susan; Laird, Robert

2015-01-01

Dispersal ability will largely determine whether species track their climatic niches during climate change, a process especially important for populations at contracting (low-latitude/low-elevation) range limits that otherwise risk extinction. We investigate whether dispersal evolution....... We simulate a species distributed continuously along a temperature gradient using a spatially explicit, individual-based model. We compare range-wide dispersal evolution during climate stability vs. directional climate change, with uniform fitness vs. fitness that declines towards range limits (RLs...... at contracting range limits is facilitated by two processes that potentially enable edge populations to experience and adjust to the effects of climate deterioration before they cause extinction: (i) climate-induced fitness declines towards range limits and (ii) local adaptation to a shifting climate gradient...

Climate change impacts on agriculture in 2050 under a range of plausible socioeconomic and emissions scenarios

International Nuclear Information System (INIS)

Wiebe, Keith; Islam, Shahnila; Mason-D’Croz, Daniel; Robertson, Richard; Robinson, Sherman; Lotze-Campen, Hermann; Biewald, Anne; Bodirsky, Benjamin; Müller, Christoph; Popp, Alexander; Sands, Ronald; Tabeau, Andrzej; Van Meijl, Hans; Van der Mensbrugghe, Dominique; Kavallari, Aikaterini; Willenbockel, Dirk

2015-01-01

Previous studies have combined climate, crop and economic models to examine the impact of climate change on agricultural production and food security, but results have varied widely due to differences in models, scenarios and input data. Recent work has examined (and narrowed) these differences through systematic model intercomparison using a high-emissions pathway to highlight the differences. This paper extends that analysis to explore a range of plausible socioeconomic scenarios and emission pathways. Results from multiple climate and economic models are combined to examine the global and regional impacts of climate change on agricultural yields, area, production, consumption, prices and trade for coarse grains, rice, wheat, oilseeds and sugar crops to 2050. We find that climate impacts on global average yields, area, production and consumption are similar across shared socioeconomic pathways (SSP 1, 2 and 3, as we implement them based on population, income and productivity drivers), except when changes in trade policies are included. Impacts on trade and prices are higher for SSP 3 than SSP 2, and higher for SSP 2 than for SSP 1. Climate impacts for all variables are similar across low to moderate emissions pathways (RCP 4.5 and RCP 6.0), but increase for a higher emissions pathway (RCP 8.5). It is important to note that these global averages may hide regional variations. Projected reductions in agricultural yields due to climate change by 2050 are larger for some crops than those estimated for the past half century, but smaller than projected increases to 2050 due to rising demand and intrinsic productivity growth. Results illustrate the sensitivity of climate change impacts to differences in socioeconomic and emissions pathways. Yield impacts increase at high emissions levels and vary with changes in population, income and technology, but are reduced in all cases by endogenous changes in prices and other variables. (paper)

Climate change velocity since the Last Glacial Maximum and its importance for patterns of species richness and range size

DEFF Research Database (Denmark)

Sandel, Brody Steven; Arge, Lars Allan; Svenning, J.-C.

to fully occupy suitable habitat, or when local diversification rates are depressed by local population extinctions and changing selective regimes. Locations with long-term climate instability should therefore show reduced species richness with small-ranged species particularly missing from the community...... these predictions using global data on mammal and amphibian distributions. Consistent with our predictions, richness of small-ranged species of both groups was negatively associated with velocity. Velocity generally explained more variation in richness than did the simple climate anomaly. Climate velocity appears...... to capture an important historical signal on current mammal and amphibian distributions....

Flight range, fuel load and the impact of climate change on the journeys of migrant birds

Science.gov (United States)

Sheard, Catherine; Butchart, Stuart H. M.

2018-01-01

Climate change is predicted to increase migration distances for many migratory species, but the physiological and temporal implications of longer migratory journeys have not been explored. Here, we combine information about species' flight range potential and migratory refuelling requirements to simulate the number of stopovers required and the duration of current migratory journeys for 77 bird species breeding in Europe. Using tracking data, we show that our estimates accord with recorded journey times and stopovers for most species. We then combine projections of altered migratory distances under climate change with models of avian flight to predict future migratory journeys. We find that 37% of migratory journeys undertaken by long-distance migrants will necessitate an additional stopover in future. These greater distances and the increased number of stops will substantially increase overall journey durations of many long-distance migratory species, a factor not currently considered in climate impact studies. PMID:29467262

Histopathological changes in kidneys of free ranging animals in relation to lead and cadmium residues

International Nuclear Information System (INIS)

Beiglboeck, C.

2000-05-01

Kidney samples of 234 roe deer and 45 wild boars were collected in Lower Austria and Vienna, and were analyzed for lead and cadmium contents. Samples of the organs were examined histologically, considering 12 different morphological parameters. Influences of age, sex and origin of the animals on heavy metal burdens were assessed, and the possible correlation between histopathological changes and age, sex, origin and heavy metal concentrations in the kidneys was tested. Lead concentrations were low with medians (mg/kg wet tissue) being 0,062 in roe deer and 0,044 in wild boars. Neither age nor sex nor origin influenced the lead contents of the kidneys. Cadmium burden was fairly high, both in roe deer (median: 0,954) and wild boars (median: 3,009). It increased with age in both species, while female roe deer showed higher contents as well. No influence of the animals' origin was found. The correlation between histopathological changes and age, sex, origin and heavy metal concentrations in the kidneys was tested in 208 roe deer and 44 wild boars which showed no signs of kidney related diseases. In roe deer, the frequency of vacuolic degeneration, pycnotic nuclei, caryolysis and necrosis was related with increased cadmium concentrations. Increasing age correlated with lymphohistiocytic infiltration, interstitial fibrosis and swelling of glomeruli. Pigment deposits and thickening of the Bowman's capsule could be related to both cadmium and age. Furthermore, roe deer from Vienna more frequently showed alterations as observed in animals from Lower Austria. No correlation existed between morphological changes and lead concentrations or sex. In wild boars, there was no obvious relationship between all parameters tested and the frequency of histopathologic changes, except changes in pigmentation. Possible nephrotoxic agents in free ranging animals and the demonstrated influence of cadmium on severe kidney damage are discussed. (author)

Catheter Ablation of Focal Atrial Tachycardia Using Remote Magnetic Navigation

DEFF Research Database (Denmark)

Liu, Xiao-Yu; Jacobsen, Peter Karl; Pehrson, Steen

2018-01-01

, a total of 56 atrial foci were found. Acute success of the primary ablation was obtained in 52 patients (98%). Mean procedure duration was 109 ± 35 min, ablation duration was 401 sec (interquartile range [IQR], 332 sec), and fluoroscopy time was 5.0 min (IQR, 3.0 min). After a mean follow-up of 31 ± 18...

Longevity of Cane Corso Italiano dog breed and its relationship with ...

African Journals Online (AJOL)

The median lifespan of the whole examined group is 9.29 years (IQR 6.98-11.12, IQR = Interquartile Range). This paper is the first to describe the possible relationship between median lifespan and hair colour within one breed. The longest living group is formed by black brindle coloured dogs, with a median of 10.30 years ...

Localised treatment and 6-month outcomes in patients with ...

African Journals Online (AJOL)

Treatment was per clinic protocols and patients were followed up with structured data collection for up to 6 months. Results. Eight individuals, all HIV infected and 50% female, were identified and enrolled. At enrolment, median age was 38 years (interquartile range (IQR) 32 - 39 years), median CD4 count 20 cells/ìl (IQR 13 ...

Integration of TB and ART services fails to improve TB treatment ...

African Journals Online (AJOL)

The median CD4+ count of HIV-positive patients was 152 cells/μl (interquartile range (IQR) 71 - 277) for integrated facilities and 148 cells/μl (IQR 67 - 260) for single-service facilities. There was no statistical difference in the TB treatment outcome profile between integrated and single-service facilities for all TB patients (p=0.

Reasons for Failure of Prevention of Mother-To-Child HIV ...

African Journals Online (AJOL)

Median gestation at first antenatal consultation (ANC) was 22.5 (interquartile range [IQR] 19.25–24). Eleven (57.9%) mothers were HIV positive at first ANC, whilst eight tested negative and later positive (2 antepartum, 6 postpartum). Median maternal CD4 was 408 cells/μL (IQR 318–531). Six (31.6%) received no antenatal ...

Sub-dissociative dose intranasal ketamine for limb injury pain in children in the emergency department: a pilot study.

Science.gov (United States)

Yeaman, Fiona; Oakley, Ed; Meek, Robert; Graudins, Andis

2013-04-01

The present study aims to conduct a pilot study examining the effectiveness of intranasal (IN) ketamine as an analgesic for children in the ED. The present study used an observational study on a convenience sample of paediatric ED patients aged 3-13 years, with moderate to severe (≥6/10) pain from isolated limb injury. IN ketamine was administered at enrolment, with a supplementary dose after 15 min, if required. Primary outcome was change in median pain rating at 30 min. Secondary outcomes included change in median pain rating at 60 min, patient/parent satisfaction, need for additional analgesia and adverse events being reported. For the 28 children included in the primary analysis, median age was 9 years (interquartile range [IQR] 6-10). Twenty-three (82.1%) were male. Eighteen (64%) received only one dose of IN ketamine (mean dose 0.84 mg/kg), whereas 10 (36%) required a second dose at 15 min (mean for second dose 0.54 mg/kg). The total mean dose for all patients was 1.0 mg/kg (95% CI: 0.92-1.14). The median pain rating decreased from 74.5 mm (IQR 60-85) to 30 mm (IQR 12-51.5) at 30 min (P pain rating was 25 mm (IQR 4-44). Twenty (83%) subjects were satisfied with their analgesia. Eight (33%) were given additional opioid analgesia and the 28 reported adverse events were all transient and mild. In this population, an average dose of 1.0 mg/kg IN ketamine provided adequate analgesia by 30 min for most patients. © 2013 The Authors. EMA © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

In vivo evaluation of axial integrity of coronary stents using intravascular ultrasound: Insights on longitudinal stent deformation.

Science.gov (United States)

Dvir, Danny; Kitabata, Hironori; Barbash, Israel M; Minha, Sa'ar; Badr, Salem; Loh, Joshua P; Chen, Fang; Torguson, Rebecca; Waksman, Ron

2014-09-01

To evaluate the axial integrity of different coronary stents using intravascular ultrasound (IVUS). Longitudinal stent deformation was recently reported. Consecutive patients who underwent IVUS analysis after drug-eluting stent (DES) implantation for de novo coronary lesions were evaluated. Stent length was compared with label length for calculation of absolute change and relative difference (absolute change divided by label length). A total of 233 DES utilizing five different platforms were included. The median absolute change in stent length was 0.90 mm (interquartile range [IQR] 0.48-1.39) and the relative difference was 5.24% (IQR 2.55-8.29). There was no significant difference among the groups in median absolute or relative change: Cypher 0.89 mm/3.89%, Taxus 0.88 mm/5.39%, Endeavor 1.16 mm/6.77%, Xience V 0.86 mm/5.80%, and PROMUS Element 0.79 mm/5.34% (P = 0.085, P = 0.072, respectively). Multivariate logistic regression revealed that the Cypher stent was independently correlated with a lower change in length, whereas stent label length and deployment pressure were correlated with higher absolute change. The axial integrity of DES platforms examined in vivo was high, with only mild changes in stent length after implantation. While there are differences between first- and second-generation DES, axial integrity among second-generation DES was similar. © 2013 Wiley Periodicals, Inc.

Global climate change: impact of diurnal temperature range on mortality in Guangzhou, China.

Science.gov (United States)

Yang, Jun; Liu, Hua-Zhang; Ou, Chun-Quan; Lin, Guo-Zhen; Zhou, Qin; Shen, Gi-Chuan; Chen, Ping-Yan; Guo, Yuming

2013-04-01

Diurnal temperature range (DTR) is an important meteorological indicator associated with global climate change, but little is known about the effects of DTR on mortality. We examined the effects of DTR on cause-/age-/education-specific mortality in Guangzhou, a subtropical city in China during 2003-2010. A quasi-Poisson regression model combined with distributed lag non-linear model was used to examine the effects of DTR, after controlling for daily mean temperature, air pollutants, season and day of the week. A 1 °C increase in DTR at lag 0-4 days was associated with a 0.47% (95% confidence interval: 0.01%-0.93%) increase in non-accidental mortality. Stroke mortality was most sensitive to DTR. Female, the elderly and those with low education were more susceptible to DTR than male, the youth and those with high education, respectively. Our findings suggest that vulnerable subpopulations should pay more attention to protect themselves from unstable daily weather. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessment of the biomass related indoor air pollution in Kwale district in Kenya using short term monitoring.

Science.gov (United States)

Majdan, Marek; Svaro, Miroslav; Bodo, Jan; Taylor, Mark; Muendo, Redempta Malinda

2015-09-01

Indoor air pollution remains an important health problem in some countries. Although research data on this issue is available, routine monitoring in affected areas is limited. The aims of this study were to quantify exposure to biomass-related indoor air pollution; assess the respiratory health of subjects; and explore the feasibility of routine monitoring in Kwale district, Kenya. We sampled 125 rural houses using short-term monitoring for levels of CO, CO2 and TSP. Additional exposure information was obtained using a checklist. Respiratory health was also assessed using a questionnaire, and electronic spirometer in 172 inhabitants. The overall median levels of CO in the sampled houses on all study sites ranged from 5.9 (IQR 3-14.5) to 10 (5.5-21.2) mg/m3, levels of CO2 ranged from 774 (IQR 724-846) to 839 (IQR 749-961) mg/m3) and the levels of TSP ranged from 295 (IQR 79-853 to 1384 (IQR 557-3110) µg/m(3) which indicates that safe levels recommended by WHO and USEPA could be exceeded. Relatively high incidences of respiratory illness or symptoms were reported and the spirometry readings suggested impaired lung function in over 80% of respondents. Our results quantify that the use of biomass fuel can give rise to high levels of indoor air pollution. Given that poor lung function contributes to public health problems in rural regions of East Africa, such as Kwale in Kenya, our findings create grounds for more detailed investigations of the problem and may provide motivation for community based interventions.

Constipation-Related Health Care Utilization in Children Before and After Hospitalization for Constipation.

Science.gov (United States)

Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G

2018-01-01

We studied constipation-related health care among children before and after constipation admission. Index admissions for constipation in 2010-2011 were identified in the Truven Marketscan Database, which includes children receiving Medicaid in 10 states. We measured number of and spending for outpatient constipation visits 12 months before and after index hospitalizations. We also measured spending for constipation hospitalizations and rehospitalization rate. There were 780 index constipation admissions. The median number of outpatient constipation visits was 1 (interquartile range [IQR] = 0, 3) in the 12 months before and 2 (IQR [0, 4]) after admission ( P = .001). Median outpatient spending for constipation was $110 (IQR [0, 429]) before and $132 (IQR [0, 431]) after admission ( P = .2). Median spending for index constipation admissions was $5295 (IQR [2756, 8267]); 78 children (10%) were rehospitalized for constipation within 12 months. Constipation-related health care utilization increased after constipation admission. Median spending for one constipation admission was 50 times the median spending for 12 months of outpatient constipation visits.

The influence of ApoE genotype on the lipid profile and lipoproteins ...

African Journals Online (AJOL)

median=4.1, IQR 3.6-4.7 vs median 3.5, IQR 3.1-3.5, respectively p=0.0167). The median LDL cholesterol and HDL cholesterol did not change. Higher proportions of small density LDL species were seen during pregnancy compared to after ...

The effects of phenotypic plasticity and local adaptation on forecasts of species range shifts under climate change.

Science.gov (United States)

Valladares, Fernando; Matesanz, Silvia; Guilhaumon, François; Araújo, Miguel B; Balaguer, Luis; Benito-Garzón, Marta; Cornwell, Will; Gianoli, Ernesto; van Kleunen, Mark; Naya, Daniel E; Nicotra, Adrienne B; Poorter, Hendrik; Zavala, Miguel A

2014-11-01

Species are the unit of analysis in many global change and conservation biology studies; however, species are not uniform entities but are composed of different, sometimes locally adapted, populations differing in plasticity. We examined how intraspecific variation in thermal niches and phenotypic plasticity will affect species distributions in a warming climate. We first developed a conceptual model linking plasticity and niche breadth, providing five alternative intraspecific scenarios that are consistent with existing literature. Secondly, we used ecological niche-modeling techniques to quantify the impact of each intraspecific scenario on the distribution of a virtual species across a geographically realistic setting. Finally, we performed an analogous modeling exercise using real data on the climatic niches of different tree provenances. We show that when population differentiation is accounted for and dispersal is restricted, forecasts of species range shifts under climate change are even more pessimistic than those using the conventional assumption of homogeneously high plasticity across a species' range. Suitable population-level data are not available for most species so identifying general patterns of population differentiation could fill this gap. However, the literature review revealed contrasting patterns among species, urging greater levels of integration among empirical, modeling and theoretical research on intraspecific phenotypic variation. © 2014 The Authors. Ecology Letters published by John Wiley & Sons Ltd and CNRS.

Armodafinil for fatigue associated with menopause: an open-label trial.

Science.gov (United States)

Meyer, Fremonta; Freeman, Marlene P; Petrillo, Laura; Barsky, Maria; Galvan, Thania; Kim, Semmie; Cohen, Lee; Joffe, Hadine

2016-02-01

This study aims to obtain preliminary data on the efficacy of armodafinil for improving menopause-related fatigue and quality of life. Women (aged 40-65 y) experiencing menopause-related fatigue received open-label armodafinil therapy (up to 150 mg/d) for 4 weeks. Changes from baseline in Brief Fatigue Inventory score and Menopause-Specific Quality of Life (MENQOL) physical domain score were examined using the Wilcoxon signed rank test. Exploratory analyses examined the effects of armodafinil on hot flashes, overall quality of life, insomnia, depression, anxiety, and perceived cognitive performance. After open-label treatment, participants were randomized to double-blind continuation of armodafinil versus placebo for 2 weeks to examine whether treatment discontinuation would precipitate symptom recurrence. Of 29 eligible participants, 20 women (69.0%) completed the trial. During treatment with armodafinil (mean dose, 120 mg/d), median Brief Fatigue Inventory scores decreased by 57.7% from 5.2 (interquartile range [IQR], 4.6-6.2) to 2.2 (IQR, 1.1-4.4; P = 0.0002), and median MENQOL physical domain scores decreased by 51.3% from 3.9 (IQR, 2.3-4.8) to 1.9 (IQR, 1.3-2.7; P = 0.0001). Median hot flashes for 24 hours decreased by 48.3% from 2.9 (IQR, 1.1-4.6) to 1.5 (IQR, 0.4-2.4; P = 0.0005). Improvements in MENQOL total score (49%; P = 0.0001), cognitive function (59.2%; P = 0.0002), depressive symptoms (64.7%; P = 0.0006), insomnia (72.7%; P = 0.0012), and excessive sleepiness (57.1%; P = 0.0006) were noted. Randomized continuation (n = 10) or discontinuation (n = 10) did not indicate group differences. Armodafinil was well-tolerated; three women (12%) were withdrawn for adverse events. These preliminary results suggest a therapeutic effect of armodafinil on fatigue affecting quality of life during menopause, and a potential benefit for other menopause-related symptoms.

Flight range, fuel load and the impact of climate change on the journeys of migrant birds.

Science.gov (United States)

Howard, Christine; Stephens, Philip A; Tobias, Joseph A; Sheard, Catherine; Butchart, Stuart H M; Willis, Stephen G

2018-02-28

Climate change is predicted to increase migration distances for many migratory species, but the physiological and temporal implications of longer migratory journeys have not been explored. Here, we combine information about species' flight range potential and migratory refuelling requirements to simulate the number of stopovers required and the duration of current migratory journeys for 77 bird species breeding in Europe. Using tracking data, we show that our estimates accord with recorded journey times and stopovers for most species. We then combine projections of altered migratory distances under climate change with models of avian flight to predict future migratory journeys. We find that 37% of migratory journeys undertaken by long-distance migrants will necessitate an additional stopover in future. These greater distances and the increased number of stops will substantially increase overall journey durations of many long-distance migratory species, a factor not currently considered in climate impact studies. © 2018 The Authors.

Propionyl-L-carnitine hydrochloride for treatment of mild to moderate colonic inflammatory bowel diseases.

Science.gov (United States)

Merra, Giuseppe; Gasbarrini, Giovanni; Laterza, Lucrezia; Pizzoferrato, Marco; Poscia, Andrea; Scaldaferri, Franco; Arena, Vincenzo; Fiore, Francesca; Cittadini, Achille; Sgambato, Alessandro; Franceschi, Francesco; Gasbarrini, Antonio

2012-09-28

To assess clinical and endoscopic response to propionyl-L-carnitine hydrochloride (PLC) in colonic inflammatory bowel disease. Patients suffering from mild to moderate ulcerative colitis (UC) or Crohn's disease (CD) colitis, with disease activity index (DAI) between 3 and 10 and under stable therapy with oral aminosalicylates, mercaptopurine or azathioprine, for at least 8 wk prior to baseline assessments, were considered suitable for enrollment. Fourteen patients were enrolled to assume PLC 2 g/d (two active tablets twice daily) orally. Clinical-endoscopic and histological activity were assessed by DAI and histological index (HI), respectively, following a colonoscopy performed immediately before and after 4 wk treatment. Clinical response was defined as a lowering of at least 3 points in DAI and clinical remission as a DAI score ≤ 2. Histological response was defined as an improvement of HI of at least 1 point. We used median values for the analysis. Differences pre- and post-treatment were analyzed by Wilcoxon signed rank test. All patients enrolled completed the study. One patient, despite medical advice, took deflazacort 5 d before follow-up colonoscopy examination. No side effects were reported by patients during the trial. After treatment, 71% (SE 12%) of patients achieved clinical response, while 64% (SE 13%) obtained remission. Separating UC from CD patients, we observed a clinical response in 60% (SE 16%) and 100%, respectively. Furthermore 60% (SE 16%) of UC patients and 75% (SE 25%) of CD patients were in clinical remission after therapy. The median DAI was 7 [interquartile range (IQR): 4-8] before treatment and decreased to 2 (IQR: 1-3) (P stability; none showed HI worsening. Median HI decreased from 1 (IQR: 1-2), to 0.5 (IQR: 0-1) at the endoscopic control in the whole population (P < 0.01), while it changed from 1 (IQR: 1-2) to 0.5 (IQR: 0-1) in UC patients (P < 0.01) and from 1.5 (IQR: 1-2) to 0.5 (IQR: 0-1) in CD patients (P = not significant

Color Change for Thermoregulation versus Camouflage in Free-Ranging Lizards.

Science.gov (United States)

Smith, Kathleen R; Cadena, Viviana; Endler, John A; Kearney, Michael R; Porter, Warren P; Stuart-Fox, Devi

2016-12-01

Animal coloration has multiple functions including thermoregulation, camouflage, and social signaling, and the requirements of each function may sometimes conflict. Many terrestrial ectotherms accommodate the multiple functions of color through color change. However, the relative importance of these functions and how color-changing species accommodate them when they do conflict are poorly understood because we lack data on color change in the wild. Here, we show that the color of individual radio-tracked bearded dragon lizards, Pogona vitticeps, correlates strongly with background color and less strongly, but significantly, with temperature. We found no evidence that individuals simultaneously optimize camouflage and thermoregulation by choosing light backgrounds when hot or dark backgrounds when cold. In laboratory experiments, lizards showed both UV-visible (300-700 nm) and near-infrared (700-2,100 nm) reflectance changes in response to different background and temperature treatments, consistent with camouflage and thermoregulatory functions, respectively, but with no interaction between the two. Overall, our results suggest that wild bearded dragons change color to improve both thermoregulation and camouflage but predominantly adjust for camouflage, suggesting that compromising camouflage may entail a greater potential immediate survival cost.

Reassessing changes in diurnal temperature range: A new data set and characterization of data biases

Science.gov (United States)

Thorne, P. W.; Menne, M. J.; Williams, C. N.; Rennie, J. J.; Lawrimore, J. H.; Vose, R. S.; Peterson, T. C.; Durre, I.; Davy, R.; Esau, I.; Klein-Tank, A. M. G.; Merlone, A.

2016-05-01

It has been a decade since changes in diurnal temperature range (DTR) globally have been assessed in a stand-alone data analysis. The present study takes advantage of substantively improved basic data holdings arising from the International Surface Temperature Initiative's databank effort and applies the National Centers for Environmental Information's automated pairwise homogeneity assessment algorithm to reassess DTR records. It is found that breakpoints are more prevalent in DTR than other temperature elements and that the resulting adjustments have a broader distribution. This strongly implies that there is an overarching tendency, across the global meteorological networks, for nonclimatic artifacts to impart either random or anticorrelated rather than correlated biases in maximum and minimum temperature series. Future homogenization efforts would likely benefit from simultaneous consideration of DTR and maximum and minimum temperatures, in addition to average temperatures. Estimates of change in DTR are relatively insensitive to whether adjustments are calculated directly or inferred from adjustments returned for the maximum and minimum temperature series. The homogenized series exhibit a reduction in DTR since the midtwentieth century globally (-0.044 K/decade). Adjustments serve to approximately halve the long-term global reduction in DTR in the basic "raw" data. Most of the estimated DTR reduction occurred over 1960-1980. In several regions DTR has apparently increased over 1979-2012, while globally it has exhibited very little change (-0.016 K/decade). Estimated changes in DTR are an order of magnitude smaller than in maximum and minimum temperatures, which have both been increasing rapidly on multidecadal timescales (0.186 K/decade and 0.236 K/decade, respectively, since the midtwentieth century).

Climate-induced seasonal changes in smallmouth bass growth rate potential at the southern range extent

Science.gov (United States)

Middaugh, Christopher R.; Kessinger, Brin; Magoulick, Daniel D.

2018-01-01

Temperature increases due to climate change over the coming century will likely affect smallmouth bass (Micropterus dolomieu) growth in lotic systems at the southern extent of their native range. However, the thermal response of a stream to warming climate conditions could be affected by the flow regime of each stream, mitigating the effects on smallmouth bass populations. We developed bioenergetics models to compare change in smallmouth bass growth rate potential (GRP) from present to future projected monthly stream temperatures across two flow regimes: runoff and groundwater-dominated. Seasonal differences in GRP between stream types were then compared. The models were developed for fourteen streams within the Ozark–Ouachita Interior Highlands in Arkansas, Oklahoma and Missouri, USA, which contain smallmouth bass. In our simulations, smallmouth bass mean GRP during summer months decreased by 0.005 g g−1 day−1 in runoff streams and 0.002 g g−1 day−1 in groundwater streams by the end of century. Mean GRP during winter, fall and early spring increased under future climate conditions within both stream types (e.g., 0.00019 g g−1 day−1 in runoff and 0.0014 g g−1 day−1 in groundwater streams in spring months). We found significant differences in change in GRP between runoff and groundwater streams in three seasons in end-of-century simulations (spring, summer and fall). Potential differences in stream temperature across flow regimes could be an important habitat component to consider when investigating effects of climate change as fishes from various flow regimes that are relatively close geographically could be affected differently by warming climate conditions.

Changes in Plasma Copeptin Levels during Hemodialysis: Are the Physiological Stimuli Active in Hemodialysis Patients?

Directory of Open Access Journals (Sweden)

Esmée M Ettema

Full Text Available Plasma levels of copeptin, a surrogate marker for the vasoconstrictor hormone arginine vasopressin (AVP, are increased in hemodialysis patients. Presently, it is unknown what drives copeptin levels in hemodialysis patients. We investigated whether the established physiological stimuli for copeptin release, i.e. plasma osmolality, blood volume and mean arterial pressure (MAP, are operational in hemodialysis patients.One hundred and eight prevalent, stable hemodialysis patients on a thrice-weekly dialysis schedule were studied during hemodialysis with constant ultrafiltration rate and dialysate conductivity in this observational study. Plasma levels of copeptin, sodium, MAP, and blood volume were measured before, during and after hemodialysis. Multivariate analysis was used to determine the association between copeptin (dependent variable and the physiological stimuli plasma sodium, MAP, excess weight as well as NT-pro-BNP immediately prior to dialysis and between copeptin and changes of plasma sodium, MAP and blood volume with correction for age, sex and diabetes during dialysis treatment.Patients were 63 ± 15.6 years old and 65% were male. Median dialysis vintage was 1.6 years (IQR 0.7-4.0. Twenty-three percent of the patients had diabetes and 82% had hypertension. Median predialysis copeptin levels were 141.5 pmol/L (IQR 91.0-244.8 pmol/L. Neither predialysis plasma sodium levels, nor NT-proBNP levels, nor MAP were associated with predialysis copeptin levels. During hemodialysis, copeptin levels rose significantly (p<0.01 to 163.0 pmol/L (96.0-296.0 pmol/L. Decreases in blood volume and MAP were associated with increases in copeptin levels during dialysis, whereas there was no significant association between the change in plasma sodium levels and the change in copeptin levels.Plasma copeptin levels are elevated predialysis and increase further during hemodialysis. Volume stimuli, i.e. decreases in MAP and blood volume, rather than osmotic

Anvendelse af video som forberedelse til stationsbaseret eksamen i medicin og kirurgi

DEFF Research Database (Denmark)

Subhi, Yousif; Bitsch, Mikael

2014-01-01

The objective structured clinical examination (OSCE) is a tool for measuring the dimensions of clinical competences. OSCE differs from traditional oral or written examination and results should not be influenced by lack of knowledge of the testing type. We prepared a video describing the practical...... aspects. On a Likert scale from 1 to 7 our video was rated 4 (interquartile range (IQR): 4-6). An informatory lecture was rated 4 (IQR: 3-5) and a rehearsal OSCE was rated 6 (IQR: 5-7). Video use peaked in the days up to OSCE. Accessibility should be improved by reaching out using the appropriate tools...

Cryoablation of Renal Angiomyolipoma

DEFF Research Database (Denmark)

Makki, Ahmad; Graumann, Ole; Hoyer, Soren

2017-01-01

BACKGROUND: Small series have reported that cryoablation (CA) is a safe and feasible minimally invasive nephron-sparing alternative for the treatment of renal angiomyolipomas (renal AMLs). The aim of the present study was to investigate the safety and efficacy of CA in patients with renal AML......-guided CA. The mean patient age was 46 years [interquartile range (IQR) 30] and the mean tumor volume was 50.1 cm(3) (IQR 53.3). In all cases, the procedure was effectively conducted with no conversion to open surgery, and no major complications were experienced. The mean follow-up time was 25 months (IQR...

Decreasing troponin turnaround time in the emergency department using the central laboratory: A process improvement study.

Science.gov (United States)

Boelstler, Arlene M; Rowland, Ralph; Theoret, Jennifer; Takla, Robert B; Szpunar, Susan; Patel, Shraddha P; Lowry, Andrew M; Pena, Margarita E

2015-03-01

To implement collaborative process improvement measures to reduce emergency department (ED) troponin turnaround time (TAT) to less than 60min using central laboratory. This was an observational, retrospective data study. A multidisciplinary team from the ED and laboratory identified opportunities and developed a new workflow model. Process changes were implemented in ED patient triage, staffing, lab collection and processing. Data collected included TAT of door-to-order, order-to-collect, collect-to-received, received-to-result, door-to-result, ED length of stay, and hemolysis rate before (January-August, 2011) and after (September 2011-June 2013) process improvement. After process improvement and implementation of the new workflow model, decreased median TAT (in min) was seen in door-to-order (54 [IQR43] vs. 11 [IQR20]), order-to-collect (15 [IQR 23] vs. 10 [IQR12]), collect-to-received (6 [IQR8] vs. 5 [IQR5]), received-to-result (30 [IQR12] vs. 24 [IQR11]), and overall door-to-result (117 [IQR60] vs. 60 [IQR40]). A troponin TAT of <60min was realized beginning in May 2012 (59 [IQR39]). Hemolysis rates decreased (14.63±0.74 vs. 3.36±1.99, p<0.0001), as did ED length of stay (5.87±2.73h vs. 5.15±2.34h, p<0.0001). Conclusion Troponin TAT of <60min using a central laboratory was achieved with collaboration between the ED and the laboratory; additional findings include a decreased ED length of stay. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Home range and travels

Science.gov (United States)

Stickel, L.F.; King, John A.

1968-01-01

The concept of home range was expressed by Seton (1909) in the term 'home region,' which Burr (1940, 1943) clarified with a definition of home range and exemplified in a definitive study of Peromyscus in the field. Burt pointed out the ever-changing characteristics of home-range area and the consequent absence of boundaries in the usual sense--a finding verified by investigators thereafter. In the studies summarized in this paper, sizes of home ranges of Peromyscus varied within two magnitudes, approximately from 0.1 acre to ten acres, in 34 studies conducted in a variety of habitats from the seaside dunes of Florida to the Alaskan forests. Variation in sizes of home ranges was correlated with both environmental and physiological factors; with habitat it was conspicuous, both in the same and different regions. Food supply also was related to size of home range, both seasonally and in relation to habitat. Home ranges generally were smallest in winter and largest in spring, at the onset of the breeding season. Activity and size also were affected by changes in weather. Activity was least when temperatures were low and nights were bright. Effects of rainfall were variable. Sizes varied according to sex and age; young mice remained in the parents' range until they approached maturity, when they began to travel more widely. Adult males commonly had larger home ranges than females, although there were a number of exceptions. An inverse relationship between population density and size of home range was shown in several studies and probably is the usual relationship. A basic need for activity and exploration also appeared to influence size of home range. Behavior within the home range was discussed in terms of travel patterns, travels in relation to home sites and refuges, territory, and stability of size of home range. Travels within the home range consisted of repeated use of well-worn trails to sites of food, shelter, and refuge, plus more random exploratory travels

Metabolic changes in summer active and anuric hibernating free-ranging brown bears (Ursus arctos.

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Peter Stenvinkel

Full Text Available The brown bear (Ursus arctos hibernates for 5 to 6 months each winter and during this time ingests no food or water and remains anuric and inactive. Despite these extreme conditions, bears do not develop azotemia and preserve their muscle and bone strength. To date most renal studies have been limited to small numbers of bears, often in captive environments. Sixteen free-ranging bears were darted and had blood drawn both during hibernation in winter and summer. Samples were collected for measurement of creatinine and urea, markers of inflammation, the calcium-phosphate axis, and nutritional parameters including amino acids. In winter the bear serum creatinine increased 2.5 fold despite a 2-fold decrease in urea, indicating a remarkable ability to recycle urea nitrogen during hibernation. During hibernation serum calcium remained constant despite a decrease in serum phosphate and a rise in FGF23 levels. Despite prolonged inactivity and reduced renal function, inflammation does not ensue and bears seem to have enhanced antioxidant defense mechanisms during hibernation. Nutrition parameters showed high fat stores, preserved amino acids and mild hyperglycemia during hibernation. While total, essential, non-essential and branched chain amino acids concentrations do not change during hibernation anorexia, changes in individual amino acids ornithine, citrulline and arginine indicate an active, although reduced urea cycle and nitrogen recycling to proteins. Serum uric acid and serum fructose levels were elevated in summer and changes between seasons were positively correlated. Further studies to understand how bears can prevent the development of uremia despite minimal renal function during hibernation could provide new therapeutic avenues for the treatment of human kidney disease.

Metabolic Changes in Summer Active and Anuric Hibernating Free-Ranging Brown Bears (Ursus arctos)

Science.gov (United States)

Stenvinkel, Peter; Fröbert, Ole; Anderstam, Björn; Palm, Fredrik; Eriksson, Monica; Bragfors-Helin, Ann-Christin; Qureshi, Abdul Rashid; Larsson, Tobias; Friebe, Andrea; Zedrosser, Andreas; Josefsson, Johan; Svensson, My; Sahdo, Berolla; Bankir, Lise; Johnson, Richard J.

2013-01-01

The brown bear (Ursus arctos) hibernates for 5 to 6 months each winter and during this time ingests no food or water and remains anuric and inactive. Despite these extreme conditions, bears do not develop azotemia and preserve their muscle and bone strength. To date most renal studies have been limited to small numbers of bears, often in captive environments. Sixteen free-ranging bears were darted and had blood drawn both during hibernation in winter and summer. Samples were collected for measurement of creatinine and urea, markers of inflammation, the calcium-phosphate axis, and nutritional parameters including amino acids. In winter the bear serum creatinine increased 2.5 fold despite a 2-fold decrease in urea, indicating a remarkable ability to recycle urea nitrogen during hibernation. During hibernation serum calcium remained constant despite a decrease in serum phosphate and a rise in FGF23 levels. Despite prolonged inactivity and reduced renal function, inflammation does not ensue and bears seem to have enhanced antioxidant defense mechanisms during hibernation. Nutrition parameters showed high fat stores, preserved amino acids and mild hyperglycemia during hibernation. While total, essential, non-essential and branched chain amino acids concentrations do not change during hibernation anorexia, changes in individual amino acids ornithine, citrulline and arginine indicate an active, although reduced urea cycle and nitrogen recycling to proteins. Serum uric acid and serum fructose levels were elevated in summer and changes between seasons were positively correlated. Further studies to understand how bears can prevent the development of uremia despite minimal renal function during hibernation could provide new therapeutic avenues for the treatment of human kidney disease. PMID:24039826

Consumer Preferences, Product Characteristics, and Potentially Allergenic Ingredients in Best-selling Moisturizers.

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Xu, Shuai; Kwa, Michael; Lohman, Mary E; Evers-Meltzer, Rachel; Silverberg, Jonathan I

2017-11-01

Because moisturizer use is critical for the prevention and treatment of numerous dermatological conditions, patients frequently request product recommendations from dermatologists. To determine the product performance characteristics and ingredients of best-selling moisturizers. This cohort study involved publicly available data of the top 100 best-selling whole-body moisturizing products at 3 major online retailers (Amazon, Target, and Walmart). Products marketed for use on a specific body part (eg, face, hands, eyelids) were excluded. Pairwise comparisons of median price per ounce on the basis of marketing claims (eg, dermatologist recommended, fragrance free, hypoallergenic) and presence of ingredients represented in the North American Contact Dermatitis Group (NACDG) series were conducted using Wilcoxon rank sum tests. The effect of vehicle type (eg, ointment, lotion, cream, butter) was assessed using the Kruskal-Wallis test. Cross-reactors and botanicals for fragrances were derived from the American Contact Dermatitis Society's Contact Allergen Management Program database. A total of 174 unique best-selling moisturizer products were identified, constituting 109 713 reviews as of August 2016. The median price per ounce was $0.59 (range, $0.10-$9.51 per ounce) with a wide range (9400%). The most popular vehicles were lotions (102 [59%]), followed by creams (22 [13%]), oils (21 [12%]), butters (14 [8%]), and ointments (3 [2%]). Only 12% (n = 21) of best-selling moisturizer products were free of NACDG allergens. The 3 most common allergens were fragrance mix (n = 87), paraben mix (n = 75), and tocopherol (n = 74). Products with the claim "dermatologist recommended" had higher median price per ounce ($0.79; interquartile range [IQR], $0.56-$1.27) than products without the claim ($0.59; IQR, $0.34-$0.92). Products with the claim "phthalate free" had higher median price per ounce ($1.38; IQR, $0.86-$1.63) than products without the claim ($0.59; IQR

Interrater reliability and accuracy of clinicians and trained research assistants performing prospective data collection in emergency department patients with potential acute coronary syndrome.

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Cruz, Carlos O; Meshberg, Emily B; Shofer, Frances S; McCusker, Christine M; Chang, Anna Marie; Hollander, Judd E

2009-07-01

Clinical research requires high-quality data collection. Data collected at the emergency department evaluation is generally considered more precise than data collected through chart abstraction but is cumbersome and time consuming. We test whether trained research assistants without a medical background can obtain clinical research data as accurately as physicians. We hypothesize that they would be at least as accurate because they would not be distracted by clinical requirements. We conducted a prospective comparative study of 33 trained research assistants and 39 physicians (35 residents) to assess interrater reliability with respect to guideline-recommended clinical research data. Immediately after the research assistant and clinician evaluation, the data were compared by a tiebreaker third person who forced the patient to choose one of the 2 answers as the correct one when responses were discordant. Crude percentage agreement and interrater reliability were assessed (kappa statistic). One hundred forty-three patients were recruited (mean age 50.7 years; 47% female patients). Overall, the median agreement was 81% (interquartile range [IQR] 73% to 92%) and interrater reliability was fair (kappa value 0.36 [IQR 0.26 to 0.52]) but varied across categories of data: cardiac risk factors (median 86% [IQR 81% to 93%]; median 0.69 [IQR 0.62 to 0.83]), other cardiac history (median 93% [IQR 79% to 95%]; median 0.56 [IQR 0.29 to 0.77]), pain location (median 92% [IR 86% to 94%]; median 0.37 [IQR 0.25 to 0.29]), radiation (median 86% [IQR 85% to 87%]; median 0.37 [IQR 0.26 to 0.42]), quality (median 85% [IQR 75% to 94%]; median 0.29 [IQR 0.23 to 0.40]), and associated symptoms (median 74% [IQR 65% to 78%]; median 0.28 [IQR 0.20 to 0.40]). When discordant information was obtained, the research assistant was more often correct (median 64% [IQR 53% to 72%]). The relatively fair interrater reliability observed in our study is consistent with previous studies evaluating

How much does it cost to care for survivors of colorectal cancer? Caregiver's time, travel and out-of-pocket costs.

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Hanly, Paul; Céilleachair, Alan Ó; Skally, Mairead; O'Leary, Eamonn; Kapur, Kanika; Fitzpatrick, Patricia; Staines, Anthony; Sharp, Linda

2013-09-01

Cancer treatment is increasingly delivered in an outpatient setting. This may entail a considerable economic burden for family members and friends who support patients/survivors. We estimated financial and time costs associated with informal care for colorectal cancer. Two hundred twenty-eight carers of colorectal cancer survivors diagnosed on October 2007-September 2009 were sent a questionnaire. Informal care costs included hospital- and domestic-based foregone caregiver time, travel expenses and out-of-pocket (OOP) costs during two phases: diagnosis and treatment and ongoing care (previous 30 days). Multiple regression was used to determine cost predictors. One hundred fifty-four completed questionnaires were received (response rate = 68%). In the diagnosis and treatment phase, weekly informal care costs per person were: hospital-based costs, incurred by 99% of carers, mean = €393 (interquartile range (IQR), €131-€541); domestic-based time costs, incurred by 85%, mean = €609 (IQR, €170-€976); and domestic-based OOP costs, incurred by 68%, mean = €69 (IQR, €0-€110). Ongoing costs included domestic-based time costs incurred by 66% (mean = €66; IQR, €0-€594) and domestic-based OOP costs incurred by 52% (mean = €52; IQR, €0-€64). The approximate average first year informal care cost was €29,842, of which 85 % was time costs, 13% OOP costs and 2% travel costs. Significant cost predictors included carer age, disease stage, and survivor age. Informal caregiving associated with colorectal cancer entails considerable time and OOP costs. This burden is largely unrecognised by policymakers, service providers and society in general. These types of studies may facilitate health decision-makers in better assessing the consequences of changes in cancer care organisation and delivery.

Restoration of continence following rectopexy for rectal prolapse and recovery of the internal anal sphincter electromyogram.

Science.gov (United States)

Farouk, R; Duthie, G S; Bartolo, D C; MacGregor, A B

1992-05-01

Twenty-two patients with full-thickness rectal prolapse underwent ambulatory fine wire electromyography of the internal and sphincter (IAS), external and sphincter and puborectalis, together with anorectal manometry, using a computerized system. Examinations were performed both before and 3 to 4 months after rectopexy. The median (interquartile range (i.q.r.)) preoperative IAS electromyogram (EMG) frequency was 0.18 (0.05-0.31) Hz and the median (i.q.r.) preoperative resting anal pressure was 28 (15-64) cmH2O. An improvement in the IAS EMG frequency, median (i.q.r.) 0.29 (0.19-0.38) Hz (P less than 0.03), and resting anal pressure, median (i.q.r.) 41 (20-72) cmH2O (P less than 0.05), was recorded after operation, but these variables remained significantly lower than those found in normal controls: median (i.q.r.) IAS EMG frequency 0.44 (0.36-0.48) Hz and median (i.q.r.) resting anal pressure 92 (74-98) cmH2O. We suggest that repair of the prolapse allows the IAS to recover by removing the cause of persistent rectoanal inhibition.

Are fish outside their usual ranges early indicators of climate-driven range shifts?

Science.gov (United States)

Fogarty, Hannah E; Burrows, Michael T; Pecl, Gretta T; Robinson, Lucy M; Poloczanska, Elvira S

2017-05-01

Shifts in species ranges are a global phenomenon, well known to occur in response to a changing climate. New species arriving in an area may become pest species, modify ecosystem structure, or represent challenges or opportunities for fisheries and recreation. Early detection of range shifts and prompt implementation of any appropriate management strategies is therefore crucial. This study investigates whether 'first sightings' of marine species outside their normal ranges could provide an early warning of impending climate-driven range shifts. We examine the relationships between first sightings and marine regions defined by patterns of local climate velocities (calculated on a 50-year timescale), while also considering the distribution of observational effort (i.e. number of sampling days recorded with biological observations in global databases). The marine trajectory regions include climate 'source' regions (areas lacking connections to warmer areas), 'corridor' regions (areas where moving isotherms converge), and 'sink' regions (areas where isotherms locally disappear). Additionally, we investigate the latitudinal band in which first sightings were recorded, and species' thermal affiliations. We found that first sightings are more likely to occur in climate sink and 'divergent' regions (areas where many rapid and diverging climate trajectories pass through) indicating a role of temperature in driving changes in marine species distributions. The majority of our fish first sightings appear to be tropical and subtropical species moving towards high latitudes, as would be expected in climate warming. Our results indicate that first sightings are likely related to longer-term climatic processes, and therefore have potential use to indicate likely climate-driven range shifts. The development of an approach to detect impending range shifts at an early stage will allow resource managers and researchers to better manage opportunities resulting from range

Measurement of surface roughness changes of unpolished and polished enamel following erosion.

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Francesca Mullan

Full Text Available To determine if Sa roughness data from measuring one central location of unpolished and polished enamel were representative of the overall surfaces before and after erosion.Twenty human enamel sections (4x4 mm were embedded in bis-acryl composite and randomised to either a native or polishing enamel preparation protocol. Enamel samples were subjected to an acid challenge (15 minutes 100 mL orange juice, pH 3.2, titratable acidity 41.3mmol OH/L, 62.5 rpm agitation, repeated for three cycles. Median (IQR surface roughness [Sa] was measured at baseline and after erosion from both a centralised cluster and four peripheral clusters. Within each cluster, five smaller areas (0.04 mm2 provided the Sa roughness data.For both unpolished and polished enamel samples there were no significant differences between measuring one central cluster or four peripheral clusters, before and after erosion. For unpolished enamel the single central cluster had a median (IQR Sa roughness of 1.45 (2.58 μm and the four peripheral clusters had a median (IQR of 1.32 (4.86 μm before erosion; after erosion there were statistically significant reductions to 0.38 (0.35 μm and 0.34 (0.49 μm respectively (p<0.0001. Polished enamel had a median (IQR Sa roughness 0.04 (0.17 μm for the single central cluster and 0.05 (0.15 μm for the four peripheral clusters which statistically significantly increased after erosion to 0.27 (0.08 μm for both (p<0.0001.Measuring one central cluster of unpolished and polished enamel was representative of the overall enamel surface roughness, before and after erosion.

Carbon dots with strong excitation-dependent fluorescence changes towards pH. Application as nanosensors for a broad range of pH

Energy Technology Data Exchange (ETDEWEB)

Barati, Ali [Faculty of Chemistry, Institute for Advanced Studies in Basic Sciences, Zanjan (Iran, Islamic Republic of); Department of Chemistry, Razi University, Kermanshah (Iran, Islamic Republic of); Shamsipur, Mojtaba, E-mail: mshamsipur@yahoo.com [Department of Chemistry, Razi University, Kermanshah (Iran, Islamic Republic of); Abdollahi, Hamid, E-mail: abd@iasbs.ac.ir [Faculty of Chemistry, Institute for Advanced Studies in Basic Sciences, Zanjan (Iran, Islamic Republic of)

2016-08-10

In this study, preparation of novel pH-sensitive N-doped carbon dots (NCDs) using glucose and urea is reported. The prepared NCDs present strong excitation-dependent fluorescence changes towards the pH that is a new behavior from these nanomaterials. By taking advantage of this unique behavior, two separated ratiometric pH sensors using emission spectra of the NCDs for both acidic (pH 2.0 to 8.0) and basic (pH 7.0 to 14.0) ranges of pH are constructed. Additionally, by considering the entire Excitation–Emission Matrix (EEM) of NCDs as analytical signal and using a suitable multivariate calibration method, a broad range of pH from 2.0 to 14.0 was well calibrated. The multivariate calibration method was independent from the concentration of NCDs and resulted in a very low average prediction error of 0.067 pH units. No changes in the predicted pH under UV irradiation (for 3 h) and at high ionic strength (up to 2 M NaCl) indicated the high stability of this pH nanosensor. The practicality of this pH nanosensor for pH determination in real water samples was validated with good accuracy and repeatability. - Highlights: • Novel pH-sensitive carbon dots with strong FL changes towards pH are reported. • Ratiometric FL pH-sensors for both acidic and basic ranges of pH are constructed. • Multivariate calibration methods were used to calibrate a broad range of pH. • Using EEM of carbon dots and ANN, pH from 2.0 to 14.0 was well calibrated. • The pH prediction is stable even at high ionic strength up to 2 M NaCl.

Carbon dots with strong excitation-dependent fluorescence changes towards pH. Application as nanosensors for a broad range of pH

International Nuclear Information System (INIS)

Barati, Ali; Shamsipur, Mojtaba; Abdollahi, Hamid

2016-01-01

In this study, preparation of novel pH-sensitive N-doped carbon dots (NCDs) using glucose and urea is reported. The prepared NCDs present strong excitation-dependent fluorescence changes towards the pH that is a new behavior from these nanomaterials. By taking advantage of this unique behavior, two separated ratiometric pH sensors using emission spectra of the NCDs for both acidic (pH 2.0 to 8.0) and basic (pH 7.0 to 14.0) ranges of pH are constructed. Additionally, by considering the entire Excitation–Emission Matrix (EEM) of NCDs as analytical signal and using a suitable multivariate calibration method, a broad range of pH from 2.0 to 14.0 was well calibrated. The multivariate calibration method was independent from the concentration of NCDs and resulted in a very low average prediction error of 0.067 pH units. No changes in the predicted pH under UV irradiation (for 3 h) and at high ionic strength (up to 2 M NaCl) indicated the high stability of this pH nanosensor. The practicality of this pH nanosensor for pH determination in real water samples was validated with good accuracy and repeatability. - Highlights: • Novel pH-sensitive carbon dots with strong FL changes towards pH are reported. • Ratiometric FL pH-sensors for both acidic and basic ranges of pH are constructed. • Multivariate calibration methods were used to calibrate a broad range of pH. • Using EEM of carbon dots and ANN, pH from 2.0 to 14.0 was well calibrated. • The pH prediction is stable even at high ionic strength up to 2 M NaCl.

Determination of Gastrointestinal Transit Times in Barred Owls ( Strix varia ) by Contrast Fluoroscopy.

Science.gov (United States)

Doss, Grayson A; Williams, Jackie M; Mans, Christoph

2017-06-01

Contrast imaging studies are routinely performed in avian patients when an underlying abnormality of the gastrointestinal (GI) tract is suspected. Fluoroscopy offers several advantages over traditional radiography and can be performed in conscious animals with minimal stress and restraint. Although birds of prey are commonly encountered as patients, little is known about GI transit times and contrast imaging studies in these species, especially owls. Owls are commonly encountered in zoological, educational, and wildlife settings. In this study, 12 adult barred owls ( Strix varia ) were gavage fed a 30% weight-by-volume barium suspension (25 mL/kg body weight). Fluoroscopic exposures were recorded at 5, 15, 30, 60, 120, 180, 240, and 300 minutes after administration. Overall GI transit time and transit times of various GI organs were recorded. Median (interquartile range [IQR]) overall GI transit time was 60 minutes (IQR: 19-60 minutes) and ranged from 5-120 minutes. Ventricular and small intestinal contrast filling was rapid. Ventricular emptying was complete by a median of 60 minutes (IQR: 30-120 minutes; range: 30-240 minutes), whereas small intestinal emptying was not complete in 9/12 birds by 300 minutes. Median small intestinal contraction rate was 15 per minute (IQR: 13-16 minutes; range: 10-19 minutes). Median overall GI transit time in barred owls is more rapid than mean transit times reported for psittacine birds and red-tailed hawks ( Buteo jamaicensis ). Fluoroscopy is a safe, suitable method for investigating GI motility and transit in this species.

Higher Order Analysis of Turbulent Changes Found in the ELF Range Electric Field Plasma Before Major Earthquakes

Science.gov (United States)

Kosciesza, M.; Blecki, J. S.; Parrot, M.

2014-12-01

We report the structure function analysis of changes found in electric field in the ELF range plasma turbulence registered in the ionosphere over epicenter region of major earthquakes with depth less than 40 km that took place during 6.5 years of the scientific mission of the DEMETER satellite. We compare the data for the earthquakes for which we found turbulence with events without any turbulent changes. The structure functions were calculated also for the Polar CUSP region and equatorial spread F region. Basic studies of the turbulent processes were conducted with use of higher order spectra and higher order statistics. The structure function analysis was performed to locate and check if there are intermittent behaviors in the ionospheres plasma over epicenter region of the earthquakes. These registrations are correlated with the plasma parameters measured onboard DEMETER satellite and with geomagnetic indices.

When and where to move: Dynamic occupancy models explain the range dynamics of a food nomadic bird under climate and land cover change.

Science.gov (United States)

Kalle, Riddhika; Ramesh, Tharmalingam; Downs, Colleen T

2018-01-01

Globally, long-term research is critical to monitor the responses of tropical species to climate and land cover change at the range scale. Citizen science surveys can reveal the long-term persistence of poorly known nomadic tropical birds occupying fragmented forest patches. We applied dynamic occupancy models to 13 years (2002-2014) of citizen science-driven presence/absence data on Cape parrot (Poicephalus robustus), a food nomadic bird endemic to South Africa. We modeled its underlying range dynamics as a function of resource distribution, and change in climate and land cover through the estimation of colonization and extinction patterns. The range occupancy of Cape parrot changed little over time (ψ = 0.75-0.83) because extinction was balanced by recolonization. Yet, there was considerable regional variability in occupancy and detection probability increased over the years. Colonizations increased with warmer temperature and area of orchards, thus explaining their range shifts southeastwards in recent years. Although colonizations were higher in the presence of nests and yellowwood trees (Afrocarpus and Podocarpus spp.), the extinctions in small forest patches (≤227 ha) and during low precipitation (≤41 mm) are attributed to resource constraints and unsuitable climatic conditions. Loss of indigenous forest cover and artificial lake/water bodies increased extinction probabilities of Cape parrot. The land use matrix (fruit farms, gardens, and cultivations) surrounding forest patches provides alternative food sources, thereby facilitating spatiotemporal colonization and extinction in the human-modified matrix. Our models show that Cape parrots are vulnerable to extreme climatic conditions such as drought which is predicted to increase under climate change. Therefore, management of optimum sized high-quality forest patches is essential for long-term survival of Cape parrot populations. Our novel application of dynamic occupancy models to long-term citizen

Allied Health Professional Support in Pediatric Inflammatory Bowel Disease: A Survey from the Canadian Children Inflammatory Bowel Disease Network—A Joint Partnership of CIHR and the CH.I.L.D. Foundation

Directory of Open Access Journals (Sweden)

Wael El-Matary

2017-01-01

Full Text Available Objectives. The current number of healthcare providers (HCP caring for children with inflammatory bowel disease (IBD across Canadian tertiary-care centres is underinvestigated. The aim of this survey was to assess the number of healthcare providers (HCP in ambulatory pediatric IBD care across Canadian tertiary-care centres. Methods. Using a self-administered questionnaire, we examined available resources in academic pediatric centres within the Canadian Children IBD Network. The survey evaluated the number of HCP providing ambulatory care for children with IBD. Results. All 12 tertiary pediatric gastroenterology centres participating in the network responded. Median full-time equivalent (FTE of allied health professionals providing IBD care at each site was 1.0 (interquartile range (IQR 0.6–1.0 nurse, 0.5 (IQR 0.2–0.8 dietitian, 0.3 (IQR 0.2–0.8 social worker, and 0.1 (IQR 0.02–0.3 clinical psychologists. The ratio of IBD patients to IBD physicians was 114 : 1 (range 31 : 1–537 : 1, patients to nurses/physician assistants 324 : 1 (range 150 : 1–900 : 1, dieticians 670 : 1 (range 250 : 1–4500 : 1, social workers 1558 : 1 (range 250 : 1–16000 : 1, and clinical psychologists 2910 : 1 (range 626 : 1–3200 : 1. Conclusions. There was a wide variation in HCP support among Canadian centres. Future work will examine variation in care including patients’ outcomes and satisfaction across Canadian centres.

Engaging western landowners in climate change mitigation: a guide to carbon-oriented forest and range management and carbon market opportunities

Science.gov (United States)

David D. Diaz; Susan Charnley; Hannah Gosnell

2009-01-01

There are opportunities for forest owners and ranchers to participate in emerging carbon markets and contribute to climate change mitigation through carbon oriented forest and range management activities. These activities often promote sutainable forestry and ranching and broader conservation goals while having the potential to provide a new income stream for...

Technology-assisted title and abstract screening for systematic reviews: a retrospective evaluation of the Abstrackr machine learning tool.

Science.gov (United States)

Gates, Allison; Johnson, Cydney; Hartling, Lisa

2018-03-12

Machine learning tools can expedite systematic review (SR) processes by semi-automating citation screening. Abstrackr semi-automates citation screening by predicting relevant records. We evaluated its performance for four screening projects. We used a convenience sample of screening projects completed at the Alberta Research Centre for Health Evidence, Edmonton, Canada: three SRs and one descriptive analysis for which we had used SR screening methods. The projects were heterogeneous with respect to search yield (median 9328; range 5243 to 47,385 records; interquartile range (IQR) 15,688 records), topic (Antipsychotics, Bronchiolitis, Diabetes, Child Health SRs), and screening complexity. We uploaded the records to Abstrackr and screened until it made predictions about the relevance of the remaining records. Across three trials for each project, we compared the predictions to human reviewer decisions and calculated the sensitivity, specificity, precision, false negative rate, proportion missed, and workload savings. Abstrackr's sensitivity was > 0.75 for all projects and the mean specificity ranged from 0.69 to 0.90 with the exception of Child Health SRs, for which it was 0.19. The precision (proportion of records correctly predicted as relevant) varied by screening task (median 26.6%; range 14.8 to 64.7%; IQR 29.7%). The median false negative rate (proportion of records incorrectly predicted as irrelevant) was 12.6% (range 3.5 to 21.2%; IQR 12.3%). The workload savings were often large (median 67.2%, range 9.5 to 88.4%; IQR 23.9%). The proportion missed (proportion of records predicted as irrelevant that were included in the final report, out of the total number predicted as irrelevant) was 0.1% for all SRs and 6.4% for the descriptive analysis. This equated to 4.2% (range 0 to 12.2%; IQR 7.8%) of the records in the final reports. Abstrackr's reliability and the workload savings varied by screening task. Workload savings came at the expense of potentially missing

Mapping Patterns and Trends in the Spatial Availability of Alcohol Using Low-Level Geographic Data: A Case Study in England 2003-2013.

Science.gov (United States)

Angus, Colin; Holmes, John; Maheswaran, Ravi; Green, Mark A; Meier, Petra; Brennan, Alan

2017-04-12

Much literature examines the relationship between the spatial availability of alcohol and alcohol-related harm. This study aims to address an important gap in this evidence by using detailed outlet data to examine recent temporal trends in the sociodemographic distribution of spatial availability for different types of alcohol outlet in England. Descriptive analysis of measures of alcohol outlet density and proximity using extremely high resolution market research data stratified by outlet type and quintiles of area-level deprivation from 2003, 2007, 2010 and 2013 was undertaken and hierarchical linear growth models fitted to explore the significance of socioeconomic differences. We find that overall availability of alcohol changed very little from 2003 to 2013 (density +1.6%), but this conceals conflicting trends by outlet type and area-level deprivation. Mean on-trade density has decreased substantially (-2.2 outlets within 1 km (Inter-Quartile Range (IQR) -3-0), although access to restaurants has increased (+1.0 outlets (IQR 0-1)), while off-trade access has risen substantially (+2.4 outlets (IQR 0-3)). Availability is highest in the most deprived areas ( p trends in the spatial availability of alcohol. There are significant variations in these trends by outlet type and deprivation level which may have important implications for health inequalities and public health policy.

Long-term ecological data for conservation: Range change in the black-billed capercaillie (Tetrao urogalloides) in northeast China (1970s-2070s).

Science.gov (United States)

Yang, Li; Zhang, Chao; Chen, Minhao; Li, Jingxin; Yang, Lei; Huo, Zhaomin; Ahmad, Shahid; Luan, Xiaofeng

2018-04-01

Long-term ecological data can be an effective tool to help ecologists integrate future projections with historical contexts and provide unique insights into the long-term dynamics of endangered species. However, hampered by data limitations, including incomplete and spatially biased data, relatively few studies have used multidecadal datasets or have examined changes in biogeography from a historical perspective. The black-billed capercaillie ( Tetrao urogalloides ) is a large capercaillie (classified as Least Concern [LC] on the IUCN red list) that has undergone a dramatic decline in population during the late 20th century and is considered endangered. Its conservation status is pessimistic, and the species requires immediate protection. Therefore, we supplemented a historical dataset to identify changes in this bird's range and population in northeast China over the long term. The study area spanned Heilongjiang Province, Jilin Province, and the northeast corner of Inner Mongolia in northeast China. We integrated an ecological niche model (BIOMOD2) with long-term ecological data on this species to estimate the magnitude of change in distribution over time. Our results revealed a 35.25% reduction in the current distribution of this species compared to their potential distribution in the 1970s. This decline is expected to continue under climate change. For example, the future range loss was estimated to be 38.79 ± 0.22% (8.64-90.19%), and the actual state could be worse, because the baseline range of the model was greater than the real range in the 2000s, showing a 12.39% overestimation. To overcome this poor outlook, a conservation strategy should be established in sensitive areas, including the southwestern Greater Khingan Mountains and northern Lesser Khingan Mountains. Actions that should be considered include field investigations, establishing a monitor network, designing ecological corridors, and cooperating with local inhabitants, governments, and

Mother and Infant Body Mass Index, Breast Milk Leptin and Their Serum Leptin Values.

Science.gov (United States)

Savino, Francesco; Sardo, Allegra; Rossi, Lorenza; Benetti, Stefania; Savino, Andrea; Silvestro, Leandra

2016-06-21

This study investigates correlations between mother and infant Body Mass Index (BMI), their serum leptin values and breast milk leptin concentration in early infancy. We determined serum leptin values in 58 healthy infants and leptin values in their mothers' breast milk, using radioimmunoassay (RIA). Infant and maternal anthropometrics were measured. Median leptin concentration was 3.9 ng/mL (interquartile range (IQR): 2.75) in infant serum, 4.27 ng/mL (IQR: 5.62) in maternal serum and 0.89 ng/mL (IQR: 1.32) in breast milk. Median maternal BMI and weight were 24 kg/m² (IQR: 4.41) and 64 kg (IQR: 15). Median infant BMI was 15.80 kg/cm² (IQR: 4.02), while average weight was 5.130 kg (IQR: 1.627). Infants serum leptin values positively correlated with infants' BMI (p = 0.001; r = 0.213) and breast milk leptin (p = 0.03; r = 0.285). Maternal serum leptin values positively correlated with maternal BMI (p = 0.000, r = 0.449) and breast milk leptin ones (p = 0.026; r = 0.322). Breast milk leptin and maternal BMI could influence infant serum leptin values. Further studies are needed to better elucidate the role of genetics and environment on infant leptin production and risk of obesity later in life.

Predictors of survival among adult Ethiopian patients in the national ...

African Journals Online (AJOL)

The median CD4 count at start of ART was 144 cells/μl (interquartile range (IQR) 78-205), and 34.2% (330/965) had CD4 < 100. Sixty-three percent (536/851) had viral load greater than 5 log copies/ml (IQR 4.7-5.7) at base line. One hundred and one deaths were recorded during follow-up period, all-cause mortality rate ...

Evidence of recent climate change within the historic range of Rio Grande cutthroat trout: implications for management and future persistence

Science.gov (United States)

Zeigler, Matthew P.; Todd, Andrew S.; Caldwell, Colleen A.

2012-01-01

Evidence of anthropogenically influenced climate change has motivated natural resource managers to incorporate adaptive measures to minimize risks to sensitive and threatened species. Detecting trends in climate variables (i.e., air temperature and hydrology) can serve as a valuable management tool for protecting vulnerable species by increasing our understanding of localized conditions and trends. The Rio Grande cutthroat trout Oncorhynchus clarkii virginalis has suffered a severe decline in its historical distribution, with the majority of current populations persisting in isolated headwater streams. To evaluate recent climate change within the subspecies' historical range, we examined trends in average air temperatures, biologically important hydrological variables (timing of snowmelt and seasonal flows), and the April 1 snow water equivalent over the last 45 years (1963–2007). While rates of change in all three metrics were variable across sites, rangewide patterns were evident. Across the subspecies' historical range, average annual air temperatures increased (0.29°C per decade) and the timing of snowmelt shifted 10.6 d earlier in the year (2.3 d/decade). Flows increased during biologically important periods, including winter (January 1–March 31; 6.6% increase per decade), prespawning (April 1–May 14; 6.9% increase per decade), and spawning (May 15–June 15; 4.2% increase per decade) and decreased in summer (June 16–September 15; 1.9% decrease per decade). Evidence of decreasing April 1 snow water equivalent (5.3% per decade) was also observed. While the impacts of these changes at the population level are equivocal, it is likely that negative effects would influence the subspecies by altering its distribution, decreasing available habitat, and altering the timing of important life history components. Continued monitoring and proactive management will be required to increase the resiliency of remaining populations to ensure long-term persistence and

Pelvic floor function following ventral rectopexy versus STARR in the treatment of obstructed defecation.

Science.gov (United States)

Altomare, D F; Picciariello, A; Memeo, R; Fanelli, M; Digennaro, R; Chetta, N; De Fazio, M

2018-04-01

Obstructed defecation syndrome (ODS), most commonly found in females, can be treated by a transanal or abdominal approach with good success rate. Nevertheless, patients may experience de novo or persisting pelvic floor dysfunctions after surgery. The aim of this study was to compare the functional outcome of stapled transanal rectal resection (STARR) and ventral rectopexy (VRP) in a series of ODS patients. Forty-nine female patients who had surgery for ODS between 2006 and 2016 were retrospectively evaluated: 28 (median age 60 years, IQR 54-69 years) had VRP and 21 (median age 58 years, IQR 51-66 years) had STARR. ODS was scored with the ODS score while the overall pelvic floor function was assessed with the three axial perineal evaluation (TAPE) score. Quality-of-life was evaluated by the patient assessment of constipation quality-of-life (PAC-Qol) questionnaire administered preoperatively and after 1 year of follow-up. The preoperative median ODS score and TAPE score were comparable in both groups. After a median follow-up of 12 months (range 12-18 months), the median ODS score was 12 (range 10-20) in the STARR group and 9 (range 3-15) in the VRP one (p = 0.02), while the median TAPE score was 70.5 (IQR 60.6-77.3) in the former and 76.8 (IQR 70.2-89.7) in the latter (p = 0.01). Postoperatively the physical domain of the PAC-QoL score had a median value of 2.74 (IQR 1.7-3.75) in the STARR group compared to 1.5 (IQR 1-2.5) in the VRP group (p = 0.03). No major complications were recorded in either group. VRP and STARR can improve defecation in patients with ODS with minimal complications, but the overall pelvic wellness evaluated by the TAPE score improves significantly only after VRP, suggesting a better performance of VRP than STARR when overall pelvic floor function is concerned.

Variability of Diurnal Temperature Range During Winter Over Western Himalaya: Range- and Altitude-Wise Study

Science.gov (United States)

Shekhar, M. S.; Devi, Usha; Dash, S. K.; Singh, G. P.; Singh, Amreek

2018-04-01

The current trends in diurnal temperature range, maximum temperature, minimum temperature, mean temperature, and sun shine hours over different ranges and altitudes of Western Himalaya during winter have been studied. Analysis of 25 years of data shows an increasing trend in diurnal temperature range over all the ranges and altitudes of Western Himalaya during winter, thereby confirming regional warming of the region due to present climate change and global warming. Statistical studies show significant increasing trend in maximum temperature over all the ranges and altitudes of Western Himalaya. Minimum temperature shows significant decreasing trend over Pir Panjal and Shamshawari range and significant increasing trend over higher altitude of Western Himalaya. Similarly, sunshine hours show significant decreasing trend over Karakoram range. There exists strong positive correlation between diurnal temperature range and maximum temperature for all the ranges and altitudes of Western Himalaya. Strong negative correlation exists between diurnal temperature range and minimum temperature over Shamshawari and Great Himalaya range and lower altitude of Western Himalaya. Sunshine hours show strong positive correlation with diurnal temperature range over Pir Panjal and Great Himalaya range and lower and higher altitudes.

Impact of the severity of trauma on early retirement

DEFF Research Database (Denmark)

Kuhlman, Michael Bilde; Lohse, Nicolai; Sørensen, Anne Marie

2014-01-01

. SETTING: Level-one urban trauma centre. PARTICIPANTS: Patients aged 18-64 years entering the trauma centre in Copenhagen during 1999-2007 who were alive after three days were followed until early retirement, death or emigration. MAIN OUTCOME MEASURES: Primary outcome was early retirement, defined...... and gender. RESULTS: Of all 6687 patients admitted to the trauma centre, a total of 1722 trauma patients were included and followed for a median of 6.2 years (interquartile range (IQR) 3.7-9.1). Of these, 1305 (75.8%) were males, median age was 35.0 years (IQR 25.4-46.5), and median ISS was 16 (IQR 9...

Automated FiO2-SpO2 control system in neonates requiring respiratory support: a comparison of a standard to a narrow SpO2 control range.

Science.gov (United States)

Wilinska, Maria; Bachman, Thomas; Swietlinski, Janusz; Kostro, Maria; Twardoch-Drozd, Marta

2014-05-28

Managing the oxygen saturation of preterm infants to a target range has been the standard of care for a decade. Changes in target ranges have been shown to significantly impact mortality and morbidity. Selecting and implementing the optimal target range are complicated not only by issues of training, but also the realities of staffing levels and demands. The potential for automatic control is becoming a reality. Results from the evaluation of different systems have been promising and our own experience encouraging. This study was conducted in two tertiary level newborn nurseries, routinely using an automated FiO2-SpO2 control system (Avea-CLiO2, Yorba Linda CA, USA). The aim of this study was to compare the performance of the system as used routinely (set control range of 87-93% SpO2), to a narrower higher range (90-93%). We employed a 12-hour cross-over design with the order of control ranges randomly assigned for each of up to three days. The primary prospectively identified end points were time in the 87-93% SpO2 target range, time at SpO2 extremes and the distribution of the SpO2 exposure. Twenty-one infants completed the study. The infants were born with a median EGA of 27 weeks and studied at a median age of 17 days and weight of 1.08 kg. Their median FiO2 was 0.32; 8 were intubated, and the rest noninvasively supported (7 positive pressure ventilation and 6 CPAP). The control in both arms was excellent, and required less than 2 manual FiO2 adjustments per day. There were no differences in the three primary endpoints. The narrower/higher set control range resulted in tighter control (IQR 3.0 vs. 4.3 p < 0.001), and less time with the SpO2 between 80-86 (6.2% vs. 8.4%, p = 0.006). We found that a shift in the median of the set control range of an automated FiO2-SpO2 control system had a proportional effect on the median and distribution of SpO2 exposure. We found that a dramatic narrowing of the set control range had a disproportionally smaller impact. Our

Population dynamics of sugar maple through the southern portion of its range: implications for range migration

Science.gov (United States)

Justin L. Hart; Christopher M. Oswalt; Craig M. Turberville

2014-01-01

The range of sugar maple (Acer saccharum Marsh.) is expected to shift northward in accord with changing climate. However, a pattern of increased sugar maple abundance has been reported from sites throughout the eastern US. The goal of our study was to examine the stability of the sugar maple southern range boundary by analyzing its demography through...

Sport concussion assessment tool-Third edition normative reference values for professional Rugby Union players.

Science.gov (United States)

Fuller, G W; Govind, O; Tucker, R; Raftery, M

2018-04-01

To establish normative reference data for the SCAT3 in professional Rugby Union players. A cross sectional study in professional Rugby Union players competing in national and international professional competitions between 2015 and 2016. The SCAT3 was administered pre-season or prior to tournaments. Data was collected electronically using a custom tablet application. SCAT3 subcomponents distributions were described and normative ranges determined using percentile cut-offs for average, unusually low/high, and extremely low/high scores. The association between player characteristics and performance in SCAT3 subcomponents was also investigated in exploratory analyses. A total of 3611 professional Rugby Union players were included. The most common baseline symptom was fatigue (14%). The symptom score median (md) was 0 (interquartile range (IQR)=0-1). Symptom severity md was 0 (IQR=0-1). The md of the SAC score was 28 (IQR=26-29). The md of the MBESS was 2 (IQR=0-4). The Tandem gait md was 11.1s (IQR=10.0-12.7s). Upper limb coordination was normal in 98.4%. Younger age and lower educational level were associated with worse performance on delayed recall and reverse month sub-components of the SCAT3 (pRugby Union players are provided. Baseline performance on concentration and delayed recall tests may be lower in younger athletes or in those with lower educational level. Copyright © 2017. Published by Elsevier Ltd.

Fluoride salts as phase change materials for thermal energy storage in the temperature range 1000-1400 K

Science.gov (United States)

Misra, Ajay K.

1988-01-01

Eutectic compositions and congruently melting intermediate compounds in binary and ternary fluoride salt systems were characterized for potential use as latent heat of fusion phase change materials to store thermal energy in the temperature range 1000-1400 K. The melting points and eutectic compositions for many systems with published phase diagrams were experimentally verified and new eutectic compositions having melting points between 1000 and 1400 K were identified. Heats of fusion of several binary and ternary eutectics and congruently melting compounds were experimentally measured by differential scanning calorimetry. For a few systems in which heats of mixing in the melts have been measured, heats of fusion of the eutectics were calculated from thermodynamic considerations and good agreement was obtained between the measured and calculated values. Several combinations of salts with high heats of fusion per unit mass (greater than 0.7 kJ/g) have been identified for possible use as phase change materials in advanced solar dynamic space power applications.

Present, past and future of the European rock fern Asplenium fontanum: combining distribution modelling and population genetics to study the effect of climate change on geographic range and genetic diversity.

Science.gov (United States)

Bystriakova, Nadia; Ansell, Stephen W; Russell, Stephen J; Grundmann, Michael; Vogel, Johannes C; Schneider, Harald

2014-02-01

Climate change is expected to alter the geographic range of many plant species dramatically. Predicting this response will be critical to managing the conservation of plant resources and the effects of invasive species. The aim of this study was to predict the response of temperate homosporous ferns to climate change. Genetic diversity and changes in distribution range were inferred for the diploid rock fern Asplenium fontanum along a South-North transect, extending from its putative last glacial maximum (LGM) refugia in southern France towards southern Germany and eastern-central France. This study reconciles observations from distribution models and phylogeographic analyses derived from plastid and nuclear diversity. Genetic diversity distribution and niche modelling propose that genetic diversity accumulates in the LGM climate refugium in southern France with the formation of a diversity gradient reflecting a slow, post-LGM range expansion towards the current distribution range. Evidence supports the fern's preference for outcrossing, contradicting the expectation that homosporous ferns would populate new sites by single-spore colonization. Prediction of climate and distribution range change suggests that a dramatic loss of range and genetic diversity in this fern is possible. The observed migration is best described by the phalanx expansion model. The results suggest that homosporous ferns reproducing preferentially by outcrossing accumulate genetic diversity primarily in LGM climate refugia and may be threatened if these areas disappear due to global climate change.

Plasma natriuretic peptides in children and adolescents with obstructive sleep apnoea and their changes following intervention

Directory of Open Access Journals (Sweden)

Albert Martin Li

2014-03-01

Full Text Available Objective: This study aimed to evaluate circulating natriuretic peptides (NP concentration in obese and non-obese children and adolescents with and without OSA, and their levels following OSA treatment.Methods: Subjects with habitual snoring and symptoms suggestive of OSA were recruited. They underwent physical examination and overnight polysomnography (PSG. OSA was diagnosed if obstructive apnea hypopnea index (OAHI ≥1/h. Fasting serum atrial natriuretic peptide (ANP and brain natriuretic peptide (BNP were taken after overnight PSG. The subjects were divided into obese, non-obese, with and without OSA groups for comparisons.Results: 114 children (77 were boys with a median (IQR age of 10.8 (8.3-12.7 years (range: 2.4-11.8 years were recruited. Sixty-eight subjects were found to have OSA. Natriuretic peptide levels did not differ between subjects with and without OSA in both obese and non-obese groups. . Stepwise multiple linear regressions revealed that body mass index (BMI z-score was the only independent factor associated with NP concentrations. Fifteen children with moderate-to-severe OSA (OAHI >5/h underwent treatment and there were no significant changes in both ANP and BNP levels after intervention.Conclusion: BMI rather than OSA was the main determinant of natriuretic peptide levels in school-aged children and adolescents.

Repeatability of junctional zone measurements using three-dimensional transvaginal ultrasound in healthy, fertile women

DEFF Research Database (Denmark)

Rasmussen, Christina Kjærgaard; Glavind, Julie; Madsen, Lene Duch

2016-01-01

-observer repeatability was evaluated according to the Bland-Altman method and expressed as coefficient of repeatability (CoR). Results: Using 3D-TVS we visualised a thin and regular JZ in most women. The posterior uterine wall had the largest median (interquartile range; iqr) value of JZmax (5.2 (iqr 3.8-6.5)mm. Ten out....... Correlations between measurements were poor in the narrow range of JZ thickness. Conclusions: The JZ has an indistinct outline by 3D-TVS resulting in an error of JZ measurement within a broad range of ±2-4 mm, but reduced by average measurements. The thickness of JZ varied within a narrow range of this healthy......, fertile population and reliability measurements of JZ thickness has to be evaluated in women with a wider range of JZ thickness....

The changing relationship between HbA1c and FPG according to different FPG ranges.

Science.gov (United States)

Guan, X; Zheng, L; Sun, G; Guo, X; Li, Y; Song, H; Tian, F; Sun, Y

2016-05-01

Since the American Diabetes Association included hemoglobin A1c (HbA1c) in the diagnostic criteria for diabetes in 2010, the clinical use of HbA1c has remained controversial. We explored the use of HbA1c for diagnosing diabetes and intermediate hyperglycemia in comparison with fasting plasma glucose (FPG). We screened 3710 adult subjects (mean age = 55.24 years) comprising 1704 males and 2006 females. We drew an receiver operating characteristic (ROC) curve to evaluate the ability of HbA1c to diagnose diabetes and intermediate hyperglycemia according to FPG. We used Kappa coefficient and Pearson's correlation coefficient to evaluate the relationship between HbA1c and FPG in different FPG ranges. The areas under ROC curve to diagnose diabetes and intermediate hyperglycemia were 0.859 (95 % CI 0.827-0.892) and 0.633 (95 % CI 0.615-0.651). The kappa coefficients between FPG and HbA1c for diagnosis of diabetes and intermediate hyperglycemia were 0.601 (P HbA1c was 0.640 (P HbA1c and FPG changed according to the different FPG ranges. When FPG was higher, the relationship was stronger. HbA1c and FPG were highly consistent in diagnosing diabetes, but they were not in predicting intermediate hyperglycemia.

Short-term Effects of Air Pollution on Oxygen Saturation in a Cohort of Senior Adults in Steubenville, OH

Science.gov (United States)

Luttmann-Gibson, Heike; Sarnat, Stefanie Ebelt; Suh, Helen H.; Coull, Brent A.; Schwartz, Joel; Zanobetti, Antonella; Gold, Diane R.

2014-01-01

Objective We examine whether ambient air pollution is associated with oxygen saturation in 32 elderly subjects in Steubenville. Methods We used linear mixed models to examine the effects of fine particles (PM2.5), sulfate (SO42-), elemental carbon (EC), and gases on median oxygen saturation. Results An interquartile range (IQR) increase of 13.4 μg/m3 in PM2.5 on the previous day was associated with a decrease of -0.18% (95% CI: -0.31 to -0.06), and a 5.1 μg/m3 IQR increase in SO42- on the previous day was associated with a decrease of -0.16% (95% CI: -0.27 to -0.04) in oxygen saturation during the initial 5-min rest period of the protocol. Conclusions Increased exposure to air pollution, including the non-traffic pollutant SO42- from industrial sources, led to changes in oxygen saturation that may reflect particle-induced pulmonary inflammatory or vascular responses. PMID:24451609

Mental and motor development before and during growth hormone treatment in infants and toddlers with Prader-Willi syndrome.

Science.gov (United States)

Festen, D A M; Wevers, M; Lindgren, A C; Böhm, B; Otten, B J; Wit, J M; Duivenvoorden, H J; Hokken-Koelega, A C S

2008-06-01

Prader-Willi syndrome (PWS) is a neurogenetic disorder characterized by muscular hypotonia, psychomotor delay, feeding difficulties and failure to thrive in infancy. GH treatment improves growth velocity and body composition. Research on the effects of GH on psychomotor development in infants with PWS is limited. To evaluate psychomotor development in PWS infants and toddlers during GH treatment compared to randomized controls. Forty-three PWS infants were evaluated at baseline. Twenty-nine of them were randomized into a GH group (n = 15) receiving 1 mg/m(2)/day GH or a non-GH-treated control group (n = 14). At baseline and after 12 months of follow-up, analysis with Bayley Scales of Infant Development II (BSID-II) was performed. Data were converted to percentage of expected development for age (%ed), and changes during follow-up were calculated. Infants in the GH group had a median age of 2.3 years [interquartile range (IQR) 1.7-3.0] and in the control group of 1.5 years (IQR 1.2-2.7) (P = 0.17). Both mental and motor development improved significantly during the first year of study in the GH group vs. the control group: median (IQR) change was +9.3% (-5.3 to 13.3) vs.-2.9% (-8.1 to 4.9) (P development and +11.2% (-4.9 to 22.5) vs.-18.5% (-27.9 to 1.8) (P development, respectively. One year of GH treatment significantly improved mental and motor development in PWS infants compared to randomized controls.

The role of pioneers as indicators of biogeographic range expansion caused by global change in southern African coastal waters

Science.gov (United States)

Whitfield, Alan K.; James, Nicola C.; Lamberth, Stephen J.; Adams, Janine B.; Perissinotto, Renzo; Rajkaran, Anusha; Bornman, Thomas G.

2016-04-01

The South African coastline is just over 3000 km in length yet it covers three major biogeographic regions, namely subtropical, warm temperate and cool temperate. In this review we examine published information to assess the possible role of climate change in driving distributional changes of a wide variety of organisms around the subcontinent. In particular we focus on harmful algal blooms, seaweeds, eelgrass, mangroves, salt marsh plants, foraminiferans, stromatolites, corals, squid, zooplankton, zoobenthos, fish, birds, crocodiles and hippopotamus, but also refer to biota such as pathogens, coralline algae, jellyfish and otters. The role of pioneers or propagules as indicators of an incipient range expansion are discussed, with mangroves, zoobenthos, fishes and birds providing the best examples of actual and imminent distributional changes. The contraction of the warm temperate biogeographic region, arising from the intrusion of cool upwelled waters along the Western Cape shores, and increasingly warm Agulhas Current waters penetrating along the eastern parts of the subcontinent, are highlighted. The above features provide an ideal setting for the monitoring of biotic drivers and responses to global climate change over different spatial and temporal scales, and have direct relevance to similar studies being conducted elsewhere in the world. We conclude that, although this review focuses mainly on the impact of global climate change on South African coastal biodiversity, other anthropogenic drivers of change such as introduced alien invasive species may act synergistically with climate change, thereby compounding both short and long-term changes in the distribution and abundance of indigenous species.

Risk Factors Associated with Discordant Ki-67 Levels between Preoperative Biopsy and Postoperative Surgical Specimens in Breast Cancers.

Directory of Open Access Journals (Sweden)

Hyung Sun Kim

Full Text Available The Ki-67 labelling index is significant for the management of breast cancer. However, the concordance of Ki-67 expression between preoperative biopsy and postoperative surgical specimens has not been well evaluated. This study aimed to find the correlation in Ki-67 expression between biopsy and surgical specimens and to determine the clinicopathological risk factors associated with discordant values.Ki-67 levels were immunohistochemically measured using paired biopsy and surgical specimens in 310 breast cancer patients between 2008 and 2013. ΔKi-67 was calculated by postoperative Ki-67 minus preoperative levels. The outliers of ΔKi-67 were defined as [lower quartile of ΔKi-67-1.5 × interquartile range (IQR] or (upper quartile + 1.5 × IQR and were evaluated according to clinicopathological parameters by logistic regression analysis.The median preoperative and postoperative Ki-67 levels were 10 (IQR, 15 and 10 (IQR, 25, respectively. Correlation of Ki-67 levels between the two specimens indicated a moderately positive relationship (coefficient = 0.676. Of 310 patients, 44 (14.2% showed outliers of ΔKi-67 (range, ≤-20 or ≥28. A significant association with poor prognostic factors was found among these patients. Multivariate analysis determined that significant risk factors for outliers of ΔKi-67 were tumor size >1 cm, negative progesterone receptor (PR expression, grade III cancer, and age ≤35 years. Among 171 patients with luminal human epidermal growth factor receptor 2-negative tumors, breast cancer subtype according to preoperative or postoperative Ki-67 levels discordantly changed in 46 (26.9% patients and a significant proportion of patients with discordant cases had ≥1 risk factor.Ki-67 expression showed a substantial concordance between biopsy and surgical specimens. Extremely discordant Ki-67 levels may be associated with aggressive tumor biology. In patients with luminal subtype disease, clinical application of Ki-67

All that glitters is not gold: A projected distribution of the endemic Indian Golden Gecko Calodactylodes aureus (Reptilia: Squamata: Gekkonidae indicates a major range shrinkage due to future climate change.

Directory of Open Access Journals (Sweden)

Aditya Srinivasulu

2016-06-01

Full Text Available Climate change has a perceived threat on biodiversity due to its effect on species range.  Species with narrow ranges and highly specific climatic and habitat requirements are at higher risk.  To understand the influence of climate change on the Indian endemic gekkonid, the Indian Golden Gecko Calodactylodes aureus (Beddome, 1870 we model the present and future predicted distribution (2050 and 2070 under the CMIP5 RCP4.5 and RCP8.5 scenarios using MaxEnt under the HadGEM3-ES Model.  Our analysis revealed the negative impact of climate change on the Indian Golden Gecko with a decrease in the amount of climatically suitable areas in the future, and an almost total range shrinkage by 2070.  Despite its wide distribution in the eastern Deccan Peninsula, according to our predictions, the species is threatened by a shrinkage in the future range due to climate change. 

Recent state of stress change in the Walker Lane zone, western Basin and Range province, United States

Science.gov (United States)

Bellier, Olivier; Zoback, Mary Lou

1995-06-01

The NW to north-trending Walker Lane zone (WLZ) is located along the western boundary of the northern Basin and Range province with the Sierra Nevada. This zone is distinguished from the surrounding Basin and Range province on the basis of irregular topography and evidence for both normal and strike-slip Holocene faulting. Inversion of slip vectors from active faults, historic fault offsets, and earthquake focal mechanisms indicate two distinct Quaternary stress regimes within the WLZ, both of which are characterized by a consistent WNW σ3 axis; these are a normal faulting regime with a mean σ3 axis of N85°±9°W and a mean stress ratio (R value) (R=(σ2-σ1)/(σ3-σ1)) of 0.63-0.74 and a younger strike-slip faulting regime with a similar mean σ3 axis (N65° - 70°W) and R values ranging between ˜ 0.1 and 0.2. This younger regime is compatible with historic fault offsets and earthquake focal mechanisms. Both the extensional and strike-slip stress regimes reactivated inherited Mesozoic and Cenozoic structures and also produced new faults. The present-day strike-slip stress regime has produced strike-slip, normal oblique-slip, and normal dip-slip historic faulting. Previous workers have explained the complex interaction of active strike-slip, oblique, and normal faulting in the WLZ as a simple consequence of a single stress state with a consistent WNW σ3 axis and transitional between strike-slip and normal faulting (maximum horizontal stress approximately equal to vertical stress, or R ≈ 0 in both regimes) with minor local fluctuations. The slip data reported here support previous results from Owens Valley that suggest deformation within temporally distinct normal and strike-slip faulting stress regimes with a roughly constant WNW trending σ3 axis (Zoback, 1989). A recent change from a normal faulting to a strike-slip faulting stress regime is indicated by the crosscutting striae on faults in basalts the dominantly strike-slip earthquake focal mechanisms and

Superior Oblique Anterior Transposition with Horizontal Recti Recession-Resection for Total Third-Nerve Palsy

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Muhsin Eraslan

2015-01-01

Full Text Available Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination. Results. A total of 6 patients (age range, 14–45 years were included. The median preoperative horizontal deviation was 67.5 Prism Diopter (PD (interquartile range [IQR] 57.5–70 and vertical deviation was 13.5 PD (IQR 10–20. The median postoperative horizontal residual exodeviation was 8.0 PD (IQR 1–16, and the vertical deviation was 0 PD (IQR 0–4. The median correction of hypotropia following superior oblique transposition was 13.5 ± 2.9 PD (range, 10–16. All cases were vertically aligned within 5 PD. Four of the six cases were aligned within 10 PD of the horizontal deviation. Adduction and head posture were improved in all patients. All patients gained new area of binocular single vision in the primary position after the operation. Conclusion. Lateral rectus recession, medial rectus resection, and superior oblique transposition may be used to achieve satisfactory cosmetic and functional results in total third-nerve palsy.

Clinical Trial of Acolbifene in Premenopausal Women at High Risk for Breast Cancer.

Science.gov (United States)

Fabian, Carol J; Kimler, Bruce F; Zalles, Carola M; Phillips, Teresa A; Metheny, Trina; Petroff, Brian K; Havighurst, Thomas C; Kim, KyungMann; Bailey, Howard H; Heckman-Stoddard, Brandy M

2015-12-01

The purpose of this study was to assess the feasibility of using the selective estrogen receptor modulator (SERM) acolbifene as a breast cancer prevention agent in premenopausal women. To do so, we assessed change in proliferation in benign breast tissue sampled by random periareolar fine-needle aspiration (RPFNA) as a primary endpoint, along with changes in other risk biomarkers and objective and subjective side effects as secondary endpoints. Twenty-five women with cytologic hyperplasia ± atypia and ≥2% of breast epithelial cells staining positive for Ki-67, received 20 mg acolbifene daily for 6-8 months, and then had benign breast tissue and blood risk biomarkers reassessed. Ki-67 decreased from a median of 4.6% [interquartile range (IQR), 3.1%-8.5%] at baseline to 1.4% (IQR, 0.6%-3.5%) after acolbifene (P breast density. Subjective side effects were minimal with no significant increase in hot flashes, muscle cramps, arthralgias, or fatigue. Objective measures showed a clinically insignificant decrease in lumbar spine bone density (DEXA) and an increase in ovarian cysts but no change in endometrial thickness (sonography). In summary, acolbifene was associated with favorable changes in benign breast epithelial cell proliferation and estrogen-inducible gene expression but minimal side effects, suggesting a phase IIB placebo-controlled trial evaluating it further for breast cancer prevention. ©2015 American Association for Cancer Research.

Quality of life of obese children in Malaysia.

Science.gov (United States)

Hamzaid, Hana; Talib, Ruzita Abd; Azizi, Nor Hidayah; Maamor, Nathirah; Reilly, John J; Wafa, Sharifah Wajihah

2011-10-01

Quality of life (QoL) is impaired in childhood obesity, but the literature on this is all from Western countries. Aim. To test for impairment of QoL in obese children in Malaysia, using parent-reported and child-reported QoL. Health-related Quality of Life was measured using the Paediatric Quality of Life Inventory version 4.0. Comparison of QoL between a community sample of 90 obese children (as defined by US CDC and Cole-IOTF definitions), median age 9.5 y (interquartile range [IQR] 8.6, 10.5 y) and 90 control children of healthy weight (BMI less than the 85th centile of US reference data), median age 10.0 y (IQR 9.6, 10.5 y). Children were matched pair-wise for age, gender, and ethnic group, and controls were recruited from schools in the same area as obese participants. For child self-report, the healthy weight group had significantly higher QoL for the physical (median 82.9, IQR 65.7, 90.6), and psychosocial domains (median, 73.3, IQR 64.4, 83.3), and total QoL (median 76.1, IQR 64.1, 84.8) compared to the obese group (median 67.2, IQR 59.4, 81.3; median 62.5, IQR 53.3, 75.4; median 60.9, IQR 50.8, 73.9; all p obese and healthy weight group for parent-reported physical health, psychosocial health, or total QoL. Obese children in Malaysia have markedly poorer QoL than their peers, but this is not evident when parent reports of QoL are used.

Poleward shifts in winter ranges of North American birds

Science.gov (United States)

Frank A. La Sorte; Frank R., III Thompson

2007-01-01

Climate change is thought to promote the poleward movement of geographic ranges; however, the spatial dynamics, mechanisms, and regional anthropogenic drivers associated with these trends have not been fully explored. We estimated changes in latitude of northern range boundaries, center of occurrence, and center of abundance for 254 species of winter avifauna in North...

The Joint Front Range Climate Change Vulnerability Study: Closing the Gap between Science and Water Management Decisions

Science.gov (United States)

Kaatz, L.; Yates, D.; Woodbury, M.

2008-12-01

There is increasing concern among metropolitan water providers in Colorado's Front Range about the possible impacts of global and regional climate changes on their future water supply. This is of particular worry given that recent studies indicate global warming may lead to unprecedented drought conditions in the Southwest U.S. (IPCC 2007). The City of Aurora, City of Boulder, Colorado Springs Utilities, Denver Water, City of Ft. Collins, and Northern Colorado Water Conservancy District, along with additional water agencies including the Colorado Water Conservation Board, the Water Research Foundation (formerly AwwaRF), and the NOAA-CIRES Western Water Assessment, have come together to participate in a study intended to provide the education, tools, and methodology necessary to examine possible effects of climate change on several common watersheds. The central objective of this project is to assess possible changes in the timing and volume of hydrologic runoff from selected climate change scenarios centered about the years 2040 and 2070. Two hydrologic models will be calibrated and implemented in the study for this purpose. The future temperature and precipitation scenarios used to generate corresponding future streamflow are based on regionally downscaled temperature and precipitation projections. The projected streamflow obtained by running varied sequences of temperature and precipitation through the hydrologic models, will be compared to historic streamflow to estimate the sensitivity of water supplies to climate change. This regional unified approach is intended to help Colorado water providers communicate with their customers and the media cohesively, by working with the same historic and projected hydrometeorological data, historic natural streamflow, and methodology. Lessons learned from this collaborative approach can be used to encourage and establish other regional efforts throughout the country. Furthermore, this study will set the stage for future

Initiation of sulfonylureas versus metformin is associated with higher blood pressure at one year.

Science.gov (United States)

Roumie, Christianne L; Liu, Xulei; Choma, Neesha N; Greevy, Robert A; Hung, Adriana M; Grijalva, Carlos G; Griffin, Marie R

2012-05-01

To determine if incident oral antidiabetic drug (OAD) use was associated with 12-month systolic blood pressure (BP) and if this was mediated through body mass index (BMI) changes. A retrospective cohort of veterans with hypertension who initiated metformin (n = 2057) or sulfonylurea (n = 1494) between 1 January 2000 and 31 December 2007 in the Veterans Administration Mid-South Network was assembled. Patients were included if they had complete covariates, including 12-month BP and BMI, and persisted on therapy for 12 months. Linear regression was conducted to investigate the effect of OADs on 12-month systolic BP adjusting for demographics, glycated hemoglobin, creatinine, BMI, health care utilization, and comorbidities, including cardiovascular disease (CVD). A second analysis examined if these effects were mediated by BMI change. The secondary outcome was the proportion of patients who had a controlled BP (≤ 140/90 mmHg) at 12 months adjusted for baseline BP and covariates. Patients were white (82%) males (97%) with median age of 64 years (interquartile range [IQR] 57, 72), and 27% had history of CVD. Sulfonylurea users had a 1.33 mmHg (0.16, 2.50, p = 0.03) higher 12-month systolic BP than metformin users. The median change in BMI from OAD initiation to 12 months was -0.76 (IQR -1.78, 0.07) and 0.21 (IQR -0.57, 1.03) among metformin and sulfonylurea users, respectively. In a model adjusting for BMI change, the difference in 12-month systolic BP between sulfonylurea and metformin users became insignificant (0.23 (-1.00, 1.45), p = 0.72), while one BMI unit change was associated with an increase in 12-month systolic BP of 1.07 mmHg (0.74, 1.40, p metformin patients had controlled BP versus 64.2% of sulfonylurea patients (p = 0.01). Compared with metformin, sulfonylurea initiation was associated with increased systolic BP at 12 months, which appears to be mediated by the differential effects of these drugs on BMI. Copyright © 2012 John Wiley & Sons, Ltd.

A framework for examining climate-driven changes to the seasonality and geographical range of coastal pathogens and harmful algae

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John Jacobs

2015-01-01

Full Text Available Climate change is expected to alter coastal ecosystems in ways which may have predictable consequences for the seasonality and geographical distribution of human pathogens and harmful algae. Here we demonstrate relatively simple approaches for evaluating the risk of occurrence of pathogenic bacteria in the genus Vibrio and outbreaks of toxin-producing harmful algae in the genus Alexandrium, with estimates of uncertainty, in U.S. coastal waters under future climate change scenarios through the end of the 21st century. One approach forces empirical models of growth, abundance and the probability of occurrence of the pathogens and algae at specific locations in the Chesapeake Bay and Puget Sound with ensembles of statistically downscaled climate model projections to produce first order assessments of changes in seasonality. In all of the case studies examined, the seasonal window of occurrence for Vibrio and Alexandrium broadened, indicating longer annual periods of time when there is increased risk for outbreaks. A second approach uses climate model projections coupled with GIS to identify the potential for geographic range shifts for Vibrio spp. in the coastal waters of Alaska. These two approaches could be applied to other coastal pathogens that have climate sensitive drivers to investigate potential changes to the risk of outbreaks in both time (seasonality and space (geographical distribution under future climate change scenarios.

An evaluation of the indications for caesarean sections at Chris Hani Baragwanath Academic Hospital

Directory of Open Access Journals (Sweden)

Yasmin Adam

2018-05-01

Full Text Available Abstract:Background:A systematic review concluded that a caesarean section that is performed for medical indications will save lives, but is associated with short and long term complications. The caesarean section rate at CHBAH was 39.78% in 2015. Objectives:To evaluate the indications for caesarean section.Methods:This was a cross-sectional study  in the week 23rd June to the 29th June 2015. Each file was  evaluated for the  correctness of the decision by at least two researchers. Each reviewer could state that he/she absolutely agreed, partially agreed, did not agree or could not make an assessmen.Results:The mean age was 27.01 (6.35; range- 15-44. The median parity was 1(IQR=0-2; range=0-4. No co-morbdities was found in 20 (13.61%. Complications occurred in 25 (17.01% women. The median gestational age at delivery was 38.14 (IQR=36.39-40.14; range-28.0-42.4. The median Apgar (5 min was 10 (IQR=9-10; range- 0-10. The median birth weight was 3040 g (IQR=2530-3440; range- 825-4575 g. The most common indications were fetal distress (n=73; 49.66% and dystocia (n=42; 28.57%. There was absolute agreement between the 2 reviewers in the following; retained 2nd twin, APH of unknown origin, placenta previa, severe IUGR, multiple pregnancy, abnormal presentation, eclampsia, two caesarean sections. When the indication was fetal distress, dystocia, 2nd stage caesarean section, or with 1 previous caesarean the absolute agreement was between 73.85% and 90.24%.Conclusion:There were  few absolute disagreements with the indication. There needs to be an evaluation of methods to diagnose fetal distress and dystocia.  

Self-learning basic life support: A randomised controlled trial on learning conditions.

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Pedersen, Tina Heidi; Kasper, Nina; Roman, Hari; Egloff, Mike; Marx, David; Abegglen, Sandra; Greif, Robert

2018-05-01

To investigate whether pure self-learning without instructor support, resulted in the same BLS-competencies as facilitator-led learning, when using the same commercially available video BLS teaching kit. First-year medical students were randomised to either BLS self-learning without supervision or facilitator-led BLS-teaching. Both groups used the MiniAnne kit (Laerdal Medical, Stavanger, Norway) in the students' local language. Directly after the teaching and three months later, all participants were tested on their BLS-competencies in a simulated scenario, using the Resusci Anne SkillReporter™ (Laerdal Medical, Stavanger, Norway). The primary outcome was percentage of correct cardiac compressions three months after the teaching. Secondary outcomes were all other BLS parameters recorded by the SkillReporter and parameters from a BLS-competence rating form. 240 students were assessed at baseline and 152 students participated in the 3-month follow-up. For our primary outcome, the percentage of correct compressions, we found a median of 48% (interquartile range (IQR) 10-83) for facilitator-led learning vs. 42% (IQR 14-81) for self-learning (p = 0.770) directly after the teaching. In the 3-month follow-up, the rate of correct compressions dropped to 28% (IQR 6-59) for facilitator-led learning (p = 0.043) and did not change significantly in the self-learning group (47% (IQR 12-78), p = 0.729). Self-learning is not inferior to facilitator-led learning in the short term. Self-learning resulted in a better retention of BLS-skills three months after training compared to facilitator-led training. Copyright © 2018 Elsevier B.V. All rights reserved.

Red wine polyphenols do not improve obesity-associated insulin resistance: A randomized controlled trial.

Science.gov (United States)

Woerdeman, Jorn; Del Rio, Daniele; Calani, Luca; Eringa, Etto C; Smulders, Yvo M; Serné, Erik H

2018-01-01

Preclinical studies have suggested that polyphenols extracted from red wine (RWPs) favourably affect insulin sensitivity, but there is controversy over whether RWPs exert similar effects in humans. The aim of the present study was to determine whether RWPs improve insulin sensitivity in obese volunteers. Obese (body mass index >30 kg/m 2 ) volunteers were randomly allocated to RWPs 600 mg/d (n = 14) or matched placebo (n = 15) in a double-blind parallel-arm study for 8 weeks. The participants were investigated at baseline and at the end of the study. Insulin sensitivity was determined using a hyperinsulinaemic-euglycaemic clamp (M-value), a mixed-meal test (Matsuda index), and homeostatic model assessment of insulin resistance (HOMA-IR). RWPs elicited no significant changes in M-value (RWP group: median [interquartile range; IQR] baseline 3.0 [2.4; 3.6]; end of study 3.3 [2.4; 4.8] vs placebo group: median [IQR] baseline 3.4 [2.8; 4.4]; end of study 2.9 [2.8; 5.9] mg/kg/min; P = .65), in Matsuda index (RWP group: median [IQR] baseline 3.3 [2.2; 4.8]; end of study 3.6 [2.4; 4.8] vs placebo group: median [IQR] baseline 4.0 [3.0; 6.0]; end of study 4.0 [3.0; 5.2]; P = .88), or in HOMA-IR. This study showed that 8 weeks of RWP supplementation did not improve insulin sensitivity in 29 obese volunteers. Our findings were not consistent with the hypothesis that RWPs ameliorate insulin resistance in human obesity. © 2017 John Wiley & Sons Ltd.

New regulations regarding Postgraduate Medical Training in Spain: perception of the tutor's role in the Murcia Region

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Saura-Llamas José

2010-06-01

Full Text Available Abstract Background Recently introduced regulatory changes have expanded the Tutor role to include their primary responsibility for Postgraduate Medical Training (PMT. However, accreditation and recognition of that role has been devolved to the autonomic regions. The opinions of the RT may be relevant to future decisions; Methods A comprehensive questionnaire, including demographic characteristics, academic and research achievement and personal views about their role, was sent to 201 RTs in the Murcia Region of Spain. The responses are described using median and interquartile ranges (IQR; Results There were 147 replies (response rate 73%, 69% male, mean age 45 ± 7 yrs. RTs perception of the residents' initial knowledge and commitment throughout the program was 5 (IQR 4-6 and 7 (IQR 5-8, respectively. As regards their impact on the PMT program, RTs considered that their own contribution was similar to that of senior residents. RTs perception of how their role was recognised was 5 (IQR 3-6. Only 16% did not encounter difficulties in accessing specific RT training programs. Regarding the RTs view of their various duties, supervision of patient care was accorded the greatest importance (64% while the satisfactory completion of the PMT program and supervision of day-to-day activities were also considered important (61% and 59% respectively. The main RT requirements were: a greater professional recognition (97%, protected time (95%, specific RT training programs (95% and financial recognition (86%; Conclusions This comprehensive study, reflecting the feelings of our RTs, provides a useful insight into the reality of their work and the findings ought to be taken into consideration in the imminent definitive regulatory document on PMT.

Risk of brain injury during diagnostic coronary angiography: comparison between right and left radial approach.

Science.gov (United States)

Pacchioni, Andrea; Versaci, Francesco; Mugnolo, Antonio; Penzo, Carlo; Nikas, Dimitrios; Saccà, Salvatore; Favero, Luca; Agostoni, Pier Francesco; Garami, Zsolt; Prati, Francesco; Reimers, Bernhard

2013-09-10

To assess the incidence of silent cerebral embolization when using the transradial approach for diagnostic coronary angiography (DCA). Compared to other vascular access sites, the right transradial approach (RTA) could reduce the amount of brain emboli by avoiding mechanical trauma to the aortic wall caused by catheters and wire, whereas it increases manipulation of catheters in the ascending aorta and has a higher risk of direct embolization into the right common carotid artery. A recent study showed an increased incidence of microembolic signals (MES) in RTA compared to femoral. However, left transradial approach (LTA) has never been assessed. 40 patients with suspected coronary artery disease were randomized to DCA via RTA (n=20) or LTA (n=20) with contemporaneous bilateral transcranial Doppler monitoring. MES were detected in all patients, with a significantly higher rate in the RTA group (median 61, interquartile range (IQR) 47-105, vs 48, IQR 31-60, p=0.035). MES generated during procedures needing >2 catheters (n=8), are higher than those detected during procedures performed with 2 catheters (n=32, 102, IQR 70-108, vs 48, IQR 33-60, p=0.001). At multivariate analysis increasing number of catheters was the only independent predictor of high incidence of MES (OR 16.4, 95% CI 1.23-219.9, p=0.034, -2LL=26.7). LTA has a lower risk of brain embolization because of the lower number of catheter exchange maneuvers. Since the degree of brain embolism depends on the magnitude of mechanical manipulation, catheter changes should be minimized to reduce the risk of cerebral embolization. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Prospective pilot study of CT-guided microwave ablation in the treatment of osteoid osteomas

Energy Technology Data Exchange (ETDEWEB)

Prud' homme, Clara; Nueffer, Jean-Philippe; Runge, Michel; Dubut, Jonathan [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); Kastler, Bruno [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); I4S Laboratory, INSERM EA4268, University of Franche-Comte, Besancon (France); Aubry, Sebastien [University Hospital of Besancon, Department of Musculoskeletal Imaging, Besancon (France); Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, Besancon (France)

2017-03-15

The aims of this work were to assess the feasibility and efficacy of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OOs). Thirteen consecutive patients (range 11-31 years old) presenting with OO were prospectively included and treated by CT-guided MWA. Power and duration of MWA were both recorded. The patient's pain was assessed using a numeric pain rating scale (NRS), and side effects were recorded during procedures, after 1 day, 7 days and 1 month. The nidus vascularization and the volume of necrosis induced by MWA were assessed using contrast-enhanced MRI. Success was defined as the complete relief of the patient's pain 1 month after the first procedure, associated with necrosis of the nidus on follow-up MRI. The success rate was up to 92.3% (12/13). At 1 day, 7 days and 1 month, the median NRSs were respectively 5 [interquartile range (IQR) 2-5], 0 (IQR 0-1) and 0 (IQR 0-0). Side effects observed were one partial and self-resolving lesion of a sensory branch of the radial nerve and two skin burns. The median power of the MWA used was 60 W (IQR 50-60) with a 1.5-min duration (IQR 1-2), leading to MWA-induced necrosis measuring on average 23 x 15 x 16 mm. CT-guided MWA of OO has a success rate that appears to be almost similar to that of laser or radiofrequency ablation, but care must be taken to prevent nerve or skin lesions. (orig.)

Prospective pilot study of CT-guided microwave ablation in the treatment of osteoid osteomas

International Nuclear Information System (INIS)

Prud'homme, Clara; Nueffer, Jean-Philippe; Runge, Michel; Dubut, Jonathan; Kastler, Bruno; Aubry, Sebastien

2017-01-01

The aims of this work were to assess the feasibility and efficacy of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OOs). Thirteen consecutive patients (range 11-31 years old) presenting with OO were prospectively included and treated by CT-guided MWA. Power and duration of MWA were both recorded. The patient's pain was assessed using a numeric pain rating scale (NRS), and side effects were recorded during procedures, after 1 day, 7 days and 1 month. The nidus vascularization and the volume of necrosis induced by MWA were assessed using contrast-enhanced MRI. Success was defined as the complete relief of the patient's pain 1 month after the first procedure, associated with necrosis of the nidus on follow-up MRI. The success rate was up to 92.3% (12/13). At 1 day, 7 days and 1 month, the median NRSs were respectively 5 [interquartile range (IQR) 2-5], 0 (IQR 0-1) and 0 (IQR 0-0). Side effects observed were one partial and self-resolving lesion of a sensory branch of the radial nerve and two skin burns. The median power of the MWA used was 60 W (IQR 50-60) with a 1.5-min duration (IQR 1-2), leading to MWA-induced necrosis measuring on average 23 x 15 x 16 mm. CT-guided MWA of OO has a success rate that appears to be almost similar to that of laser or radiofrequency ablation, but care must be taken to prevent nerve or skin lesions. (orig.)

Life stage, not climate change, explains observed tree range shifts

Czech Academy of Sciences Publication Activity Database

Máliš, F.; Kopecký, Martin; Petřík, Petr; Vladovič, J.; Merganič, J.; Vida, T.

2016-01-01

Roč. 22, č. 5 (2016), s. 1904-1914 ISSN 1354-1013 R&D Projects: GA MŠk(CZ) EE2.3.20.0267; GA ČR GPP505/10/P173 EU Projects: European Commission(XE) 278065 - LONGWOOD Institutional support: RVO:67985939 Keywords : elevational range shift * vegetation resurvey * temperate forests Subject RIV: EH - Ecology, Behaviour Impact factor: 8.502, year: 2016

Adolescents' Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms.

Science.gov (United States)

Kemigisha, Elizabeth; Nyakato, Viola N; Bruce, Katharine; Ndaruhutse Ruzaaza, Gad; Mlahagwa, Wendo; Ninsiima, Anna B; Coene, Gily; Leye, Els; Michielsen, Kristien

2018-02-22

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense-i.e., body image, self-esteem, and gender equitable norms-and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10-14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7-28) and median 22 (IQR: 19, 24, possible range: 5-25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11-44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended.

Forty month follow-up of persistent and difficultly controlled acromegalic patients treated with depot long acting somatostatin analog octreotide

International Nuclear Information System (INIS)

Yetkin, D.O.; Boysan, S.N.; Tiryakioglu, O.; Yalin, A.S.; Kadioglu, P.

2007-01-01

The objective of the present study was to investigate the effects of octreotide long acting release (S-LAR) preparation on growth hormone (GH) and insulin-like growth factor (IGF)-1 serum concentrations and pituitary tumor size in patients with persistent and difficultly controlled acromegaly even after adjuvant irradiation and/or dopamine agonists. Thirty-three patients with active acromegaly (26 female and 7 male, mean age; 43.94±14.01 standard deviation (SD) years) were included in this study. Patients were evaluated at baseline and at 6, 12, 30 and 40 months for GH, IGF-1, and GH response to oral glucose tolerance test (OGTT) and biliary ultrasonography. Sella MRI was performed at initial and at 40 months. All patients received 20 mg S-LAR. Afterwards, the dosage was titrated to improve individual GH response and reduction of IGF-1 into normal ranges. Basal serum IGF-1 levels decreased from median: 530 μg/l [IQR: 420-600] to 340 μg/l [IQR: 230-460] at 6 months (p=0.01), to 400 μg/l [IQR: 222.4-600] at 12 months (p=0.48), to 396 μg/l [IQR: 318-468] at 30 months (p=0.49), to 482 μg/l [308-580] at 40 months (p=0.47). Nadir GH levels in OGTT fell from 2.70 ng/ml [IQR: 1.35-6.90] to 1.60 ng/ml [IQR: 0.36-4.10] at 6 months (p=0.03), to 0.31 ng/ml [IQR: 0.18-0.65] at 12 months (p<0.0001), to 1.50 ng/ml [IQR: 0.83-4.00] at 30 months (p=0.398) and to 0.89 ng/ml [IQR: 0.58-1.35] at 40 months (p<0.0001). Initially, pituitary adenoma volume was median: 1.18 ml [IQR: 0.08-3.50] and it shrank to 0.21 ml [IQR: 0-2.1] at 40 months (p=0.08). Gallstones were detected in 12 patients and six of them underwent cholecystectomy. S-LAR is an effective treatment regimen in reducing GH and IGF-1 concentrations and as well as in shrinking tumor volume in persistent and difficultly controlled acromegalic patients. (author)

New measures of upper esophageal sphincter distensibility and opening patterns during swallowing in healthy subjects using EndoFLIP®

LENUS (Irish Health Repository)

Regan, J

2013-01-01

Background  This paper aims to measure upper esophageal sphincter (UES) distensibility and extent and duration of UES opening during swallowing in healthy subjects using EndoFLIP(®) . Methods  Fourteen healthy subjects (20-50 years) were recruited. An EndoFLIP(®) probe was passed trans-orally and the probe balloon was positioned across the UES. Two 20-mL ramp distensions were completed and UES cross-sectional area (CSA) and intra-balloon pressure (IBP) were evaluated. At 12-mL balloon volume, subjects completed dry, 5- and 10-mL liquid swallows and extent (mm) and duration (s) of UES opening and minimum IBP (mmHg) were analyzed across swallows. Key Results  Thirteen subjects completed the study protocol. A significant change in UES CSA (P < .001) and IBP (P < .000) was observed during 20-mL distension. UES CSA increased up to 10-mL distension (P < .001), from which point IBP raised significantly (P = 0.004). There were significant changes in UES diameter (mm) (P < .000) and minimum IBP (mmHg) (P < .000) during swallowing events. Resting UES diameter (4.9 mm; IQR 0.02) and minimum IBP (18.8 mmHg; IQR 2.64) changed significantly during dry (9.6 mm; IQR 1.3: P < .001) (3.6 mmHg; IQR 4.1: P = 0.002); 5 mL (8.61 mm; IQR 2.7: P < .001) (4.8 mmHg; IQR 5.7: P < .001) and 10-mL swallows (8.3 mm; IQR 1.6: P < 0.001) (3 mmHg; 4.6: P < .001). Median duration of UES opening was 0.5 s across dry and liquid swallows (P = 0.91). Color contour plots of EndoFLIP(®) data capture novel information regarding pharyngo-esophageal events during swallowing. Conclusions & Inferences  Authors obtained three different types of quantitative data (CSA, IBP, and timing) regarding UES distensibility and UES opening patterns during swallowing in healthy adults using only one device (EndoFLIP(®) ). This new measure of swallowing offers fresh information regarding UES dynamics which may ultimately improve patient

Reference curves for CD4 T-cell count response to combination antiretroviral therapy in HIV-1-infected treatment-naïve patients

DEFF Research Database (Denmark)

Bouteloup, V; Sabin, C; Mocroft, A

2017-01-01

OBJECTIVES: The aim of this work was to provide a reference for the CD4 T-cell count response in the early months after the initiation of combination antiretroviral therapy (cART) in HIV-1-infected patients. METHODS: All patients in the Collaboration of Observational HIV Epidemiological Research....... Unadjusted and adjusted references curves and predictions were obtained using quantile regressions. RESULTS: A total of 28 992 patients were included in the study. The median CD4 T-cell count at treatment initiation was 249 [interquartile range (IQR) 150, 336] cells/μL. The median observed CD4 counts at 6, 9...... and 12 months were 382 (IQR 256, 515), 402 (IQR 274, 543) and 420 (IQR 293, 565) cells/μL. The two main factors explaining the variation of CD4 count at 6 months were AIDS stage and CD4 count at cART initiation. A CD4 count increase of ≥ 100 cells/mL is generally required in order that patients stay 'on...

Remnant Cholesterol and Myocardial Infarction in Normal Weight, Overweight, and Obese Individuals from the Copenhagen General Population Study

DEFF Research Database (Denmark)

Varbo, Anette; Freiberg, Jacob J; Nordestgaard, Børge G

2018-01-01

BACKGROUND: We tested whether high remnant cholesterol is associated with high myocardial infarction risk, independent of whether an individual is normal weight, overweight, or obese. METHODS: A total of 106216 individuals from the Copenhagen General Population Study were followed for up to 11......) of obese). RESULTS: Median calculated remnant cholesterol was 0.40 mmol/L [interquartile range (IQR), 0.30-0.55 mmol/L] [15 mg/dL (12-21 mg/dL)] for underweight, 0.50 mmol/L (IQR, 0.37-0.71 mmol....../L) [19 mg/dL (14-27 mg/dL)] for normal weight, 0.70 mmol/L (IQR, 0.49-1.00 mmol/L) [27 mg/dL (19-39 mg/dL)] for overweight, and 0.85 mmol/L (IQR, 0.61-1.20 mmol/L) [(33 mg/dL (24-46 mg/dL)] for obese individuals. On continuous scales, remnant cholesterol was positively correlated with BMI until reaching...

GPS Tracking of Free-Ranging Pigs to Evaluate Ring Strategies for the Control of Cysticercosis/Taeniasis in Peru.

Directory of Open Access Journals (Sweden)

Ian W Pray

2016-04-01

Full Text Available Taenia solium, a parasitic cestode that affects humans and pigs, is the leading cause of preventable epilepsy in the developing world. T. solium eggs are released into the environment through the stool of humans infected with an adult intestinal tapeworm (a condition called taeniasis, and cause cysticercosis when ingested by pigs or other humans. A control strategy to intervene within high-risk foci in endemic communities has been proposed as an alternative to mass antihelminthic treatment. In this ring strategy, antihelminthic treatment is targeted to humans and pigs residing within a 100 meter radius of a pig heavily-infected with cysticercosis. Our aim was to describe the roaming ranges of pigs in this region, and to evaluate whether the 100 meter radius rings encompass areas where risk factors for T. solium transmission, such as open human defecation and dense pig activity, are concentrated.In this study, we used Global Positioning System (GPS devices to track pig roaming ranges in two rural villages of northern Peru. We selected 41 pigs from two villages to participate in a 48-hour tracking period. Additionally, we surveyed all households to record the locations of open human defecation areas. We found that pigs spent a median of 82.8% (IQR: 73.5, 94.4 of their time roaming within 100 meters of their homes. The size of home ranges varied significantly by pig age, and 93% of the total time spent interacting with open human defecation areas occurred within 100 meters of pig residences.These results indicate that 100 meter radius rings around heavily-infected pigs adequately capture the average pig's roaming area (i.e., home range and represent an area where the great majority of exposure to human feces occurs.

GPS Tracking of Free-Ranging Pigs to Evaluate Ring Strategies for the Control of Cysticercosis/Taeniasis in Peru.

Science.gov (United States)

Pray, Ian W; Swanson, Dallas J; Ayvar, Viterbo; Muro, Claudio; Moyano, Luz M; Gonzalez, Armando E; Garcia, Hector H; O'Neal, Seth E

2016-04-01

Taenia solium, a parasitic cestode that affects humans and pigs, is the leading cause of preventable epilepsy in the developing world. T. solium eggs are released into the environment through the stool of humans infected with an adult intestinal tapeworm (a condition called taeniasis), and cause cysticercosis when ingested by pigs or other humans. A control strategy to intervene within high-risk foci in endemic communities has been proposed as an alternative to mass antihelminthic treatment. In this ring strategy, antihelminthic treatment is targeted to humans and pigs residing within a 100 meter radius of a pig heavily-infected with cysticercosis. Our aim was to describe the roaming ranges of pigs in this region, and to evaluate whether the 100 meter radius rings encompass areas where risk factors for T. solium transmission, such as open human defecation and dense pig activity, are concentrated. In this study, we used Global Positioning System (GPS) devices to track pig roaming ranges in two rural villages of northern Peru. We selected 41 pigs from two villages to participate in a 48-hour tracking period. Additionally, we surveyed all households to record the locations of open human defecation areas. We found that pigs spent a median of 82.8% (IQR: 73.5, 94.4) of their time roaming within 100 meters of their homes. The size of home ranges varied significantly by pig age, and 93% of the total time spent interacting with open human defecation areas occurred within 100 meters of pig residences. These results indicate that 100 meter radius rings around heavily-infected pigs adequately capture the average pig's roaming area (i.e., home range) and represent an area where the great majority of exposure to human feces occurs.

Time-resolved magnetic resonance angiography (MRA) at 3.0 Tesla for evaluation of hemodynamic characteristics of vascular malformations: description of distinct subgroups

Energy Technology Data Exchange (ETDEWEB)

Hammer, Simone; Fellner, Claudia; Wohlgemuth, Walter A. [University Hospital Regensburg, Department of Radiology, Regensburg (Germany); Uller, Wibke [Boston Children' s Hospital and Harvard Medical School, Division of Vascular and Interventional Radiology, Boston, MA (United States); University Hospital Regensburg, Department of Radiology, Regensburg (Germany); Manger, Florentine [University Hospital Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Zeman, Florian [University Hospital Regensburg, Center for Clinical Trials, Regensburg (Germany)

2017-01-15

Quantitative evaluation of hemodynamic characteristics of arteriovenous and venous malformations using time-resolved magnetic resonance angiography (MRA) at 3.0 Tesla. Time-resolved MRA with interleaved stochastic trajectories (TWIST) at 3.0 Tesla was studied in 83 consecutive patients with venous malformations (VM) and arteriovenous malformations (AVM). Enhancement characteristics were calculated as percentage increase of signal intensity above baseline over time. Maximum percentage signal intensity increase (signal{sub max}), time intervals between onset of arterial enhancement and lesion enhancement (t{sub onset}), and time intervals between beginning of lesion enhancement and maximum percentage of lesion enhancement (t{sub max}) were analyzed. All AVMs showed a high-flow hemodynamic pattern. Two significantly different (p < 0.001) types of venous malformations emerged: VMs with arteriovenous fistulas (AVF) (median signal{sub max} 737 %, IQR [interquartile range] = 511 - 1182 %; median t{sub onset} 5 s, IQR = 5 - 10 s; median t{sub max} 35 s, IQR = 26 - 40 s) and without AVFs (median signal{sub max} 284 %, IQR = 177-432 %; median t{sub onset} 23 s, IQR = 15 - 30 s; median t{sub max} 60 s, IQR = 55 - 75 s). Quantitative evaluation of time-resolved MRA at 3.0 Tesla provides hemodynamic characterization of vascular malformations. VMs can be subclassified into two hemodynamic subgroups due to presence or absence of AVFs. (orig.)

The BRACELET Study: surveys of mortality in UK neonatal and paediatric intensive care trials

Directory of Open Access Journals (Sweden)

Platt Martin

2010-05-01

Full Text Available Abstract Background The subject of death and bereavement in the context of randomised controlled trials in neonatal or paediatric intensive care is under-researched. The objectives of this phase of the Bereavement and RAndomised ControlLEd Trials (BRACELET Study were to determine trial activity in UK neonatal and paediatric intensive care (2002-06; numbers of deaths before hospital discharge; and variation in mortality across intensive care units and trials and to determine whether bereavement support policies were available within trials. These are essential prerequisites to considering the implications of future policies and practice subsequent to bereavement following a child's enrolment in a trial. Methods The units survey involved neonatal units providing level 2 or 3 care, and paediatric units providing level II care or above; the trials survey involved trials where allocation was randomized and interventions were delivered to intensive care patients, or to parents but designed to affect patient outcomes. Results Information was available from 191/220 (87% neonatal units (149 level 2 or 3 care; and 28/32 (88% paediatric units. 90/177 (51% eligible responding units participated in one or more trial (76 neonatal, 14 paediatric and 54 neonatal units and 6 paediatric units witnessed at least one death. 50 trials were identified (36 neonatal, 14 paediatric. 3,137 babies were enrolled in neonatal trials, 210 children in paediatric trials. Deaths ranged 0-278 (median [IQR interquartile range] 2 [1, 14.5] per neonatal trial, 0-4 (median [IQR] 1 [0, 2.5] per paediatric trial. 534 (16% participants died post-enrolment: 522 (17% in neonatal trials, 12 (6% in paediatric trials. Trial participants ranged 1-236 (median [IQR] 21.5 [8, 39.8] per neonatal unit, 1-53 (median [IQR] 11.5 [2.3, 33.8] per paediatric unit. Deaths ranged 0-37 (median [IQR] 3.5 [0.3, 8.8] per neonatal unit, 0-7 (median [IQR] 0.5 [0, 1.8] per paediatric unit. Three trials had a

Distributional changes and range predictions of downy brome (Bromus tectorum) in Rocky Mountain National Park

Science.gov (United States)

Bromberg, J.E.; Kumar, S.; Brown, C.S.; Stohlgren, T.J.

2011-01-01

Downy brome (Bromus tectorum L.), an invasive winter annual grass, may be increasing in extent and abundance at high elevations in the western United States. This would pose a great threat to high-elevation plant communities and resources. However, data to track this species in high-elevation environments are limited. To address changes in the distribution and abundance of downy brome and the factors most associated with its occurrence, we used field sampling and statistical methods, and niche modeling. In 2007, we resampled plots from two vegetation surveys in Rocky Mountain National Park for presence and cover of downy brome. One survey was established in 1993 and had been resampled in 1999. The other survey was established in 1996 and had not been resampled until our study. Although not all comparisons between years demonstrated significant changes in downy brome abundance, its mean cover increased nearly fivefold from 1993 (0.7%) to 2007 (3.6%) in one of the two vegetation surveys (P = 0.06). Although the average cover of downy brome within the second survey appeared to be increasing from 1996 to 2007, this slight change from 0.5% to 1.2% was not statistically significant (P = 0.24). Downy brome was present in 50% more plots in 1999 than in 1993 (P = 0.02) in the first survey. In the second survey, downy brome was present in 30% more plots in 2007 than in 1996 (P = 0.08). Maxent, a species-environmental matching model, was generally able to predict occurrences of downy brome, as new locations were in the ranges predicted by earlier generated models. The model found that distance to roads, elevation, and vegetation community influenced the predictions most. The strong response of downy brome to interannual environmental variability makes detecting change challenging, especially with small sample sizes. However, our results suggest that the area in which downy brome occurs is likely increasing in Rocky Mountain National Park through increased frequency and cover

Myeloid malignancies in the real-world: Occurrence, progression and survival in the UK's population-based Haematological Malignancy Research Network 2004-15.

Science.gov (United States)

Roman, Eve; Smith, Alex; Appleton, Simon; Crouch, Simon; Kelly, Richard; Kinsey, Sally; Cargo, Catherine; Patmore, Russell

2016-06-01

Population-based information on cancer incidence, prevalence and outcome are required to inform clinical practice and research; but contemporary data are lacking for many myeloid malignancy subtypes. Set within a socio-demographically representative UK population of ∼4 million, myeloid malignancy data (N=5231 diagnoses) are from an established patient cohort. Information on incidence, survival (relative & overall), transformation/progression, and prevalence is presented for >20 subtypes. The median diagnostic age was 72.4years (InterQuartile Range 61.6-80.2), but there was considerable subtype heterogeneity, particularly among the acute myeloid leukaemias (AML) where medians ranged from 20.3 (IQR 13.9-43.8) for AML 11q23 through to 73.7 (IQR 57.3-79.1) for AML with no recurrent genetic changes. Five-year Relative Survival (RS) estimates varied hugely; from 85% for indolent/treatable conditions like chronic myeloid leukaemia (89.8%, 95% CI 84.0-93.6). With a couple of notable exceptions, males experienced higher rates and worse survival than females: the age-standardized incidence rates of several conditions was 2-4 higher in males than females, and the 5-year RS for all subtypes combined was 48.8% (95% CI 46.5-51.2) and 60.4% (95% CI 57.7-62.9) for males and females respectively. During follow-up (potential minimum 2 years and maximum 11years) myelodysplastic syndrome (MDS) progression to AML ranged from 25% for refractory anaemia with excess blasts through to 5% for refractory anaemia with ring sideroblasts: the median interval between MDS and AML diagnosis was 9.0 months (IQR 4.8-17.4months). The marked incidence and outcome variations seen by subtype, sex and age, confirm the requirement for "real-world" longitudinal data to inform aetiological hypotheses, healthcare planning, and future monitoring of therapeutic change. Several challenges for routine cancer registration were identified, including the need to link more effectively to diagnostic and clinical

SCAT3 changes from baseline and associations with X2 Patch measured head acceleration in amateur Australian football players.

Science.gov (United States)

Willmott, Catherine; McIntosh, Andrew S; Howard, Teresa; Mitra, Biswadev; Dimech-Betancourt, Bleydy; Donovan, Jarrod; Rosenfeld, Jeffrey V

2018-05-01

To investigate changes from baseline on SCAT3 as a result of football game exposure, and association with X2 Patch measured head acceleration events in amateur Australian footballers. Prospective cohort. Peak linear acceleration (PLA) of the head (>10 g) was measured by wearable head acceleration sensor X2 Biosystems X-Patch in male (n=34) and female (n=19) Australian footballers. SCAT3 was administered at baseline (B) and post-game (PG). 1394 head acceleration events (HEA) >10 g were measured. Mean and median HEA PLA were recorded as 15.2 g (SD=9.2, range=10.0-115.8) and 12.4 g (IQR=11.0-15.6) respectively. No significant difference in median HEA PLA (g) was detected across gender (p=0.55), however, more HEAs were recorded in males (p=0.03). A greater number (p=0.004) and severity (p0.05 for all), was identified for either gender. Increase in symptom severity post game was not associated with X2 measured HEA. Males sustained more HEA, however HEA PLA magnitude did not differ across gender. Further work on the validation of head acceleration sensors is required and their role in sports concussion research and medical management. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

A mass-wasting dominated Quaternary mountain range, the Coastal Range in eastern Taiwan

Science.gov (United States)

Hsieh, Meng-Long; Hogg, Alan; Song, Sheng-Rong; Kang, Su-Chen; Chou, Chun-Yen

2017-12-01

Fluvial bedrock incision, which creates topographic relief and controls hillslope development, has been considered the key medium linking denudation and tectonic uplift of unglaciated mountains. This article, however, shows a different scenario from the Coastal Range in eastern Taiwan. This range, with the steepness inherited from pre-orogenic volcanoes, has been subject to mass wasting even before its emergence above sea level no earlier than Middle Pleistocene. Numerous terraced alluvial fans/fan deltas record the ancient mass movements of the range, including rock avalanches. Multiple radiocarbon dates sequences not clearly related to the known climate-change events, and are believed to have been triggered mainly by severe rainfall events, large earthquakes, or their combinations. The resulting fluctuation of sediment yield has episodically changed river behavior, forming river terraces in catchments >1 km2. Alluvial terraces are typically exhibited close to the source ridges of mass movements, and strath terraces along the downstream parts of rivers. Both were created when enormous sediment supply had exceeded or matched the prevailing river transport capacity. This process, along with the protection by giant boulders from mass movement, disturbed the long-term incision trend of rivers in response to tectonic uplift. As a result, the observed Holocene bedrock incision at most sites has not kept pace with the tectonic uplift. The spatial contrast in mass-wasting histories further accounts for the great diversity of the terrace sequences, even in areas with similar tectonic and base-level conditions.

Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe

DEFF Research Database (Denmark)

Judd, A; Lodwick, R; Noguera-Julian, A

2017-01-01

OBJECTIVES: The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. METHODS...... compared with participants with heterosexually acquired HIV infection overall [17 (interquartile range (IQR) 4-111) vs. 8 (IQR 2-38) weeks, respectively], and highest in perinatally infected participants aged 10-14 years [49 (IQR 9-267) weeks]. The cumulative proportion with TCVF 5 years after starting ART......: We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged

Evolutionary responses to climate change in a range expanding plant

Czech Academy of Sciences Publication Activity Database

Macel, M.; Dostálek, Tomáš; Esch, S.; Bucharová, A.; Van Dam, N. M.; Tielbörger, K.; Verhoeven, K. J. F.; Münzbergová, Zuzana

2017-01-01

Roč. 184, č. 2 (2017), s. 543-554 ISSN 0029-8549 Institutional support: RVO:67985939 Keywords : gflobal change * herbivory * biotic interactions Subject RIV: EH - Ecology, Behaviour OBOR OECD: Ecology Impact factor: 3.130, year: 2016

The impact of airway management on quality of cardiopulmonary resuscitation: an observational study in patients during cardiac arrest.

Science.gov (United States)

Yeung, Joyce; Chilwan, Mehboob; Field, Richard; Davies, Robin; Gao, Fang; Perkins, Gavin D

2014-07-01

Minimising interruptions in chest compressions is associated with improved survival from cardiac arrest. Current in-hospital guidelines recommend continuous chest compressions after the airway is secured on the premise that this will reduce no flow time. The aim of this study was to determine the effect of advanced airway use on the no flow ratio and other measures of CPR quality. Consecutive adult patients who sustained an in-hospital cardiac arrest were enrolled in this prospective observational study. The quality of CPR was measured using the Q-CPR device (Phillips, UK) before and after an advanced airway device (endotracheal tube [ET] or laryngeal mask airway [LMA]) was inserted. Patients receiving only bag-mask ventilation were used as the control cohort. The primary outcome was no flow ratio (NFR). Secondary outcomes were chest compression rate, depth, compressions too shallow, compressions with leaning, ventilation rate, inflation time, change in impedance and time required to successfully insert airway device. One hundred patients were enrolled in the study (2008-2011). Endotracheal tube and LMA placement took similar durations (median 15.8 s (IQR 6.8-19.4) vs. LMA median 8.0s (IQR 5.5-15.9), p=0.1). The use of an advanced airway was associated with improved no flow ratios (endotracheal tube placement (n=50) improved NFR from baseline median 0.24 IQR 0.17-0.40) to 0.15 to (IQR 0.09-0.28), p=0.012; LMA (n=25) from median 0.28 (IQR 0.23-0.40) to 0.13 (IQR 0.11- 0.19), p=0.0001). There was no change in NFR in patients managed solely with bag valve mask (BVM) (n=25) (median 0.29 (IQR 0.18-0.59) vs. median 0.26 (IQR 0.12-0.37), p=0.888). There was no significant difference in time taken to successfully insert the airway device between the two groups. The use of an advanced airway (ETT or LMA) during in-hospital cardiac arrest was associated with improved no flow ratio. Further studies are required to determine the effect of airway devices on overall patient

Interfacility transfers for US ischemic stroke and TIA, 2006-2014.

Science.gov (United States)

George, Benjamin P; Doyle, Sara J; Albert, George P; Busza, Ania; Holloway, Robert G; Sheth, Kevin N; Kelly, Adam G

2018-05-01

To investigate changes in emergency department (ED) transfers for ischemic stroke (IS) and TIA. We performed a retrospective observational study using the US Nationwide Emergency Department Sample to identify changes in interfacility ED transfers for IS and TIA from the perspective of the transferring ED (2006-2014). We calculated nationwide transfer rates and individual ED transfer rates for IS/TIA by diagnosis and hospital characteristics. Hospital-level fractional logistic regression examined changes in transfer rates over time. The population-estimated number of transfers for IS/TIA increased from 22,576 patient visits in 2006 to 54,485 patient visits in 2014 ( p trend TIA transfer increased from 3.4 (95% confidence interval [CI] 3.0-3.8) in 2006 to 7.6 (95% CI 7.2-7.9) in 2014 per 100 ED visits. Among individual EDs, mean transfer rates for IS/TIA increased from 8.2 per 100 ED visits (median 2.0, interquartile range [IQR] 0-10.2) to 19.4 per 100 ED visits (median 8.1, IQR 1.1-33.3) (2006-2014) ( p trend TIA increased threefold (2006-2014). Interfacility ED transfers for IS/TIA more than doubled from 2006 to 2014. Further work should determine the necessity of IS/TIA transfers and seek to optimize the US stroke care system. © 2018 American Academy of Neurology.

Evolution of density-dependent movement during experimental range expansions.

Science.gov (United States)

Fronhofer, E A; Gut, S; Altermatt, F

2017-12-01

Range expansions and biological invasions are prime examples of transient processes that are likely impacted by rapid evolutionary changes. As a spatial process, range expansions are driven by dispersal and movement behaviour. Although it is widely accepted that dispersal and movement may be context-dependent, for instance density-dependent, and best represented by reaction norms, the evolution of density-dependent movement during range expansions has received little experimental attention. We therefore tested current theory predicting the evolution of increased movement at low densities at range margins using highly replicated and controlled range expansion experiments across multiple genotypes of the protist model system Tetrahymena thermophila. Although rare, we found evolutionary changes during range expansions even in the absence of initial standing genetic variation. Range expansions led to the evolution of negatively density-dependent movement at range margins. In addition, we report the evolution of increased intrastrain competitive ability and concurrently decreased population growth rates in range cores. Our findings highlight the importance of understanding movement and dispersal as evolving reaction norms and plastic life-history traits of central relevance for range expansions, biological invasions and the dynamics of spatially structured systems in general. © 2017 European Society For Evolutionary Biology. Journal of Evolutionary Biology © 2017 European Society For Evolutionary Biology.

Urology Residents' Experience and Attitude Toward Surgical Simulation: Presenting our 4-Year Experience With a Multi-institutional, Multi-modality Simulation Model.

Science.gov (United States)

Chow, Alexander K; Sherer, Benjamin A; Yura, Emily; Kielb, Stephanie; Kocjancic, Ervin; Eggener, Scott; Turk, Thomas; Park, Sangtae; Psutka, Sarah; Abern, Michael; Latchamsetty, Kalyan C; Coogan, Christopher L

2017-11-01

To evaluate the Urological resident's attitude and experience with surgical simulation in residency education using a multi-institutional, multi-modality model. Residents from 6 area urology training programs rotated through simulation stations in 4 consecutive sessions from 2014 to 2017. Workshops included GreenLight photovaporization of the prostate, ureteroscopic stone extraction, laparoscopic peg transfer, 3-dimensional laparoscopy rope pass, transobturator sling placement, intravesical injection, high definition video system trainer, vasectomy, and Urolift. Faculty members provided teaching assistance, objective scoring, and verbal feedback. Participants completed a nonvalidated questionnaire evaluating utility of the workshop and soliciting suggestions for improvement. Sixty-three of 75 participants (84%) (postgraduate years 1-6) completed the exit questionnaire. Median rating of exercise usefulness on a scale of 1-10 ranged from 7.5 to 9. On a scale of 0-10, cumulative median scores of the course remained high over 4 years: time limit per station (9; interquartile range [IQR] 2), faculty instruction (9, IQR 2), ease of use (9, IQR 2), face validity (8, IQR 3), and overall course (9, IQR 2). On multivariate analysis, there was no difference in rating of domains between postgraduate years. Sixty-seven percent (42/63) believe that simulation training should be a requirement of Urology residency. Ninety-seven percent (63/65) viewed the laboratory as beneficial to their education. This workshop model is a valuable training experience for residents. Most participants believe that surgical simulation is beneficial and should be a requirement for Urology residency. High ratings of usefulness for each exercise demonstrated excellent face validity provided by the course. Copyright © 2017 Elsevier Inc. All rights reserved.

Large diurnal temperature range increases bird sensitivity to climate change

NARCIS (Netherlands)

Briga, Michael; Verhulst, Simon

2015-01-01

Climate variability is changing on multiple temporal scales, and little is known of the consequences of increases in short-term variability, particularly in endotherms. Using mortality data with high temporal resolution of zebra finches living in large outdoor aviaries (5 years, 359.220 bird-days),

Temporal Variability of Upper-level Winds at the Eastern Range, Western Range and Wallops Flight Facility

Science.gov (United States)

Decker, Ryan; Barbre, Robert E.

2014-01-01

Space launch vehicles incorporate upper-level wind profiles to determine wind effects on the vehicle and for a commit to launch decision. These assessments incorporate wind profiles measured hours prior to launch and may not represent the actual wind the vehicle will fly through. Uncertainty in the upper-level winds over the time period between the assessment and launch can be mitigated by a statistical analysis of wind change over time periods of interest using historical data from the launch range. Five sets of temporal wind pairs at various times (.75, 1.5, 2, 3 and 4-hrs) at the Eastern Range, Western Range and Wallops Flight Facility were developed for use in upper-level wind assessments. Database development procedures as well as statistical analysis of temporal wind variability at each launch range will be presented.

An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis.

Science.gov (United States)

Kulaylat, Afif N; Moore, Michael M; Engbrecht, Brett W; Brian, James M; Khaku, Aliasgher; Hollenbeak, Christopher S; Rocourt, Dorothy V; Hulse, Michael A; Olympia, Robert P; Santos, Mary C; Methratta, Sosamma T; Dillon, Peter W; Cilley, Robert E

2015-08-01

Recent efforts have been directed at reducing ionizing radiation delivered by CT scans to children in the evaluation of appendicitis. MRI has emerged as an alternative diagnostic modality. The clinical outcomes associated with MRI in this setting are not well-described. Review of a 30-month institutional experience with MRI as the primary diagnostic evaluation for suspected appendicitis (n=510). No intravenous contrast, oral contrast, or sedation was administered. Radiologic and clinical outcomes were abstracted. MRI diagnostic characteristics were: sensitivity 96.8% (95% CI: 92.1%-99.1%), specificity 97.4% (95% CI: 95.3-98.7), positive predictive value 92.4% (95% CI: 86.5-96.3), and negative predictive value 98.9% (95% CI: 97.3%-99.7%). Radiologic time parameters included: median time from request to scan, 71 minutes (IQR: 51-102), imaging duration, 11 minutes (IQR: 8-17), and request to interpretation, 2.0 hours (IQR: 1.6-2.6). Clinical time parameters included: median time from initial assessment to admit order, 4.1 hours (IQR: 3.1-5.1), assessment to antibiotic administration 4.7 hours (IQR: 3.9-6.7), and assessment to operating room 9.1 hours (IQR: 5.8-12.7). Median length of stay was 1.2 days (range: 0.2-19.5). Given the diagnostic accuracy and favorable clinical outcomes, without the potential risks of ionizing radiation, MRI may supplant the role of CT scans in pediatric appendicitis imaging. Copyright © 2015 Elsevier Inc. All rights reserved.

A higher volume of fibrotic tissue on virtual histology prior to coronary stent implantation predisposes to more pronounced neointima proliferation.

Science.gov (United States)

Haine, Steven; Wouters, Kristien; Miljoen, Hielko; Vandendriessche, Tom; Claeys, Marc; Bosmans, Johan; Vrints, Christiaan

2018-04-01

Since neointima smooth muscle cells (SMC) mainly originate from the vessel wall, we investigated whether atherosclerotic plaque composition influences subsequent in-stent neointima proliferation and restenosis. We performed intravascular ultrasound (IVUS) with virtual histology in 98 patients prior to elective bare-metal stent (BMS) implantation in de novo coronary artery lesions. Virtual histology variables pre-percutaneous coronary intervention (PCI) were related to in-stent neointima proliferation six months after implantation assessed as late luminal loss of 0.88 mm (interquartile range (IQR) 0.37-1.23 mm) on angiography and as maximal percentage area stenosis of 42% (IQR 33-59%) and percentage volume intima hyperplasia of 27% (IQR 20-36%) on IVUS. A ridge-trace based multiple linear regression model was constructed to account for multicollinearity of the virtual histology variables and was corrected for implanted stent length (18 mm, IQR 15-23 mm), stent diameter (3.0 mm, IQR 2.75-3.5 mm) and lesion volume (146 mm³, IQR 80-201 mm³) prior to PCI. Fibrous tissue volume prior to PCI (49 mm³, IQR 30-77 mm³) was significantly and independently related to late luminal loss (p = .038), maximal percentage area stenosis (p = .041) and percentage volume intima hyperplasia (p = .004). Neither absolute nor relative amounts of fibrofatty, calcified or necrotic core tissue appeared related to any of the restenosis parameters. Subgroup analysis after exclusion of acute coronary syndrome (ACS) patients yielded similar results. Lesions with more voluminous fibrotic tissue pre-PCI show more pronounced in-stent neointima proliferation, even after correction for lesion plaque volume.

Podocyte Number in Children and Adults: Associations with Glomerular Size and Numbers of Other Glomerular Resident Cells

Science.gov (United States)

Puelles, Victor G.; Douglas-Denton, Rebecca N.; Cullen-McEwen, Luise A.; Li, Jinhua; Hughson, Michael D.; Hoy, Wendy E.; Kerr, Peter G.

2015-01-01

Increases in glomerular size occur with normal body growth and in many pathologic conditions. In this study, we determined associations between glomerular size and numbers of glomerular resident cells, with a particular focus on podocytes. Kidneys from 16 male Caucasian-Americans without overt renal disease, including 4 children (≤3 years old) to define baseline values of early life and 12 adults (≥18 years old), were collected at autopsy in Jackson, Mississippi. We used a combination of immunohistochemistry, confocal microscopy, and design-based stereology to estimate individual glomerular volume (IGV) and numbers of podocytes, nonepithelial cells (NECs; tuft cells other than podocytes), and parietal epithelial cells (PECs). Podocyte density was calculated. Data are reported as medians and interquartile ranges (IQRs). Glomeruli from children were small and contained 452 podocytes (IQR=335–502), 389 NECs (IQR=265–498), and 146 PECs (IQR=111–206). Adult glomeruli contained significantly more cells than glomeruli from children, including 558 podocytes (IQR=431–746; P<0.01), 1383 NECs (IQR=998–2042; P<0.001), and 367 PECs (IQR=309–673; P<0.001). However, large adult glomeruli showed markedly lower podocyte density (183 podocytes per 106 µm3) than small glomeruli from adults and children (932 podocytes per 106 µm3; P<0.001). In conclusion, large adult glomeruli contained more podocytes than small glomeruli from children and adults, raising questions about the origin of these podocytes. The increased number of podocytes in large glomeruli does not match the increase in glomerular size observed in adults, resulting in relative podocyte depletion. This may render hypertrophic glomeruli susceptible to pathology. PMID:25568174

A national survey of emergency pharmacy practice in the United States.

Science.gov (United States)

Thomas, Michael C; Acquisto, Nicole M; Shirk, Mary Beth; Patanwala, Asad E

2016-03-15

The results of a survey to characterize pharmacy practice in emergency department (ED) settings are reported. An electronic survey was sent to all members of the American Society of Health-System Pharmacists' Emergency Medicine Connect group and the American College of Clinical Pharmacy's Emergency Medicine Practice and Research Network. Approximately 400 nontrainee pharmacy practitioners were invited to participate in the survey, which was open for 30 days. Descriptive statistics were used for all analyses. Two hundred thirty-three responses to the survey that were at least partially completed were received. After the removal of duplicate responses and null records, 187 survey responses were retained. The majority of respondents were from community hospitals (59.6%) or academic medical centers (36.1%). A pharmacist's presence in the ED of more than eight hours per day on weekdays and weekends was commonly reported (68.7% of respondents); 49.4% of institutions provided more than eight hours of coverage daily. Nearly one in three institutions (34.8%) provided no weekend ED staffing. The most frequently reported hours of coverage were during the 1 p.m.-midnight time frame. The distribution of ED pharmacist activities, by category, was as follows (data are median reported time commitments): clinical, 25% (interquartile range [IQR], 15-40%); emergency response, 15% (IQR, 10-20%); order processing, 15% (IQR, 5-25%); medication reconciliation/history-taking, 10% (IQR, 5-25%); teaching, 10% (IQR, 5-15%); administrative, 5% (IQR, 3-10%); and scholarly endeavors, 0% (IQR, 0-5%). Pharmacists from academic and community EDs perform a variety of clinical, educational, and administrative activities. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Change of the spectral sensitivity range of thin-film AlGaAs/GaAs -photoreceivers under influence of ultrasonic waves

International Nuclear Information System (INIS)

Zaveryukhina, N. N.; Zaveryukhin, B. N.; Zaveryukhina, E. B.

2007-01-01

Full text: The task of controlled variation of the physical properties of semiconductor materials under the action of external factors is an important problem in the physics of semiconductors. As is well known, one such factor is ultrasonic radiation: propagating in a semiconductor crystal, acoustic (ultrasonic) waves change its properties, in particular, the optical characteristics. In the context of solving the above task, it is expedient to continue investigations of the effect of ultrasonic waves on the characteristics of semiconductor devices. This report presents the results of experimental investigations of the influence of ultrasonic waves on the spectral characteristics of photoreceivers based on AlGaAs/GaAs- heterostructures. The study showed that an exposure to ultrasonic radiation leads to a change, depending on the ultrasonic treatment (UST) parameters, in the spectral characteristics of gallium arsenide crystals, the base materials of modern semiconductor photoelectronics. Some results showed evidence of the positive character of changes in the characteristics of A 3 B 5 -based photoreceivers under the action of ultrasonic waves. The effect of ultrasonic waves on the spectral sensitivity of photoreceivers based on AlGaAs/GaAs- heterostructures has been studied. Ultrasonic treatment of a zinc-doped graded-gap Al x Ga 1-x As- film leads to the formation of a surface layer sensitive to electromagnetic radiation in the wavelength range < 0,55m. It is established that this layer is formed as a result of the acoustostimulated inward diffusion of zinc from the surface to the bulk of the graded-gap layer. The observed expansion of the short-wavelength sensitivity range and an increase in the efficiency of nonequilibrium charge carrier collection in AlGaAs/GaAs- photoreceivers are due to improvement of the crystal defect structure and the dopant redistribution under the action of ultrasound. (authors)

Short-term Effects of Ambient Air Pollution on Emergency Department Visits for Asthma: An Assessment of Effect Modification by Prior Allergic Disease History

Directory of Open Access Journals (Sweden)

Juhwan Noh

2016-09-01

Full Text Available Objectives The goal of this study was to investigate the short-term effect of ambient air pollution on emergency department (ED visits in Seoul for asthma according to patients’ prior history of allergic diseases. Methods Data on ED visits from 2005 to 2009 were obtained from the Health Insurance Review and Assessment Service. To evaluate the risk of ED visits for asthma related to ambient air pollutants (carbon monoxide [CO], nitrogen dioxide [NO2], ozone [O3], sulfur dioxide [SO2], and particulate matter with an aerodynamic diameter <10 μm [PM10], a generalized additive model with a Poisson distribution was used; a single-lag model and a cumulative-effect model (average concentration over the previous 1-7 days were also explored. The percent increase and 95% confidence interval (CI were calculated for each interquartile range (IQR increment in the concentration of each air pollutant. Subgroup analyses were done by age, gender, the presence of allergic disease, and season. Results A total of 33 751 asthma attack cases were observed during the study period. The strongest association was a 9.6% increase (95% CI, 6.9% to 12.3% in the risk of ED visits for asthma per IQR increase in O3 concentration. IQR changes in NO2 and PM10 concentrations were also significantly associated with ED visits in the cumulative lag 7 model. Among patients with a prior history of allergic rhinitis or atopic dermatitis, the risk of ED visits for asthma per IQR increase in PM10 concentration was higher (3.9%; 95% CI, 1.2% to 6.7% than in patients with no such history. Conclusions Ambient air pollutants were positively associated with ED visits for asthma, especially among subjects with a prior history of allergic rhinitis or atopic dermatitis.

Adolescents’ Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms

Science.gov (United States)

Kemigisha, Elizabeth; Nyakato, Viola N.; Bruce, Katharine; Ndaruhutse Ruzaaza, Gad; Mlahagwa, Wendo; Ninsiima, Anna B.; Coene, Gily; Leye, Els; Michielsen, Kristien

2018-01-01

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense—i.e., body image, self-esteem, and gender equitable norms—and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10–14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7–28) and median 22 (IQR: 19, 24, possible range: 5–25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11–44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended. PMID:29470388

Glenohumeral range of motion (ROM) and isometric strength of professional team handball athletes, part III: changes over the playing season.

Science.gov (United States)

Fieseler, Georg; Jungermann, Philipp; Koke, Alexander; Irlenbusch, Lars; Delank, Karl-Stefan; Schwesig, René

2015-12-01

The aim of our study was to investigate the relation of workload on range of motion and isometric strength of team handball athletes' shoulders over a competitive season. 31 Professional male handball athletes underwent clinical shoulder examinations. Athletes were examined subsequently during the complete playing season (week 0, 6, 22 and 40) to determine bilateral isometric shoulder rotational strength and active range of motion (ROM). In addition, relative (intraclass correlation coefficients (ICC) and absolute (standard error of measurement) reliability were calculated. Intraobserver reliability was excellent (ICC 0.76-0.98) for isometric strength and flexibility measurements. Internal rotation (IR) and total arc ROM in the throwing shoulder (TS) decreased significantly (p handball players' shoulders changed significantly from the beginning to the end of a season. More specifically, the repetitive forces accumulated during the competitive season resulted in altered GIRD, ERG and isometric strength of the dominant glenohumeral joint.

Hedgehogs on the move: Testing the effects of land use change on home range size and movement patterns of free-ranging Ethiopian hedgehogs.

Science.gov (United States)

Abu Baker, Mohammad A; Reeve, Nigel; Conkey, April A T; Macdonald, David W; Yamaguchi, Nobuyuki

2017-01-01

Degradation and alteration of natural environments because of agriculture and other land uses have major consequences on vertebrate populations, particularly on spatial organization and movement patterns. We used GPS tracking to study the effect of land use and sex on the home range size and movement of a typical model species, the Ethiopian hedgehogs. We used free-ranging hedgehogs from two areas with different land use practices: 24 from an area dominated by irrigated farms (12 ♂♂, 12 ♀♀) and 22 from a natural desert environment within a biosphere reserve (12 ♂♂, 10 ♀♀). Animals were significantly heavier in the resource-rich irrigated farms area (417.71 ±12.77SE g) in comparison to the natural desert area (376.37±12.71SE g). Both habitat and sex significantly influenced the home range size of hedgehogs. Home ranges were larger in the reserve than in the farms area. Total home ranges averaged 103 ha (±17 SE) for males and 42 ha (±11SE) for females in the farms area, but were much larger in the reserve averaging 230 ha (±33 SE) for males and 150 ha (±29 SE) for females. The home ranges of individuals of both sexes overlapped. Although females were heavier than males, body weight had no effect on home range size. The results suggest that resources provided in the farms (e.g. food, water, and shelters) influenced animal density and space use. Females aggregated around high-resource areas (either farms or rawdhats), whereas males roamed over greater distances, likely in search of mating opportunities to maximize reproductive success. Most individual home ranges overlapped with many other individuals of either sex, suggesting a non-territorial, promiscuous mating. Patterns of space use and habitat utilization are key factors in shaping aspects of reproductive biology and mating system. To minimize the impacts of agriculture on local wildlife, we recommend that biodiversity-friendly agro-environmental schemes be introduced in the Middle East where

Hedgehogs on the move: Testing the effects of land use change on home range size and movement patterns of free-ranging Ethiopian hedgehogs.

Directory of Open Access Journals (Sweden)

Mohammad A Abu Baker

Full Text Available Degradation and alteration of natural environments because of agriculture and other land uses have major consequences on vertebrate populations, particularly on spatial organization and movement patterns. We used GPS tracking to study the effect of land use and sex on the home range size and movement of a typical model species, the Ethiopian hedgehogs. We used free-ranging hedgehogs from two areas with different land use practices: 24 from an area dominated by irrigated farms (12 ♂♂, 12 ♀♀ and 22 from a natural desert environment within a biosphere reserve (12 ♂♂, 10 ♀♀. Animals were significantly heavier in the resource-rich irrigated farms area (417.71 ±12.77SE g in comparison to the natural desert area (376.37±12.71SE g. Both habitat and sex significantly influenced the home range size of hedgehogs. Home ranges were larger in the reserve than in the farms area. Total home ranges averaged 103 ha (±17 SE for males and 42 ha (±11SE for females in the farms area, but were much larger in the reserve averaging 230 ha (±33 SE for males and 150 ha (±29 SE for females. The home ranges of individuals of both sexes overlapped. Although females were heavier than males, body weight had no effect on home range size. The results suggest that resources provided in the farms (e.g. food, water, and shelters influenced animal density and space use. Females aggregated around high-resource areas (either farms or rawdhats, whereas males roamed over greater distances, likely in search of mating opportunities to maximize reproductive success. Most individual home ranges overlapped with many other individuals of either sex, suggesting a non-territorial, promiscuous mating. Patterns of space use and habitat utilization are key factors in shaping aspects of reproductive biology and mating system. To minimize the impacts of agriculture on local wildlife, we recommend that biodiversity-friendly agro-environmental schemes be introduced in the Middle

Climate-change-induced range shifts of three allergenic ragweeds (Ambrosia L.) in Europe and their potential impact on human health

DEFF Research Database (Denmark)

Rasmussen, Karen; Thyrring, Jakob; Borchsenius, Finn

2017-01-01

Invasive allergenic plant species may have severe health-related impacts. In this study we aim to predict the effects of climate change on the distribution of three allergenic ragweed species (Ambrosia spp.) in Europe and discuss the potential associated health impact. We built species distribution...... models based on presence-only data for three ragweed species, using MAXENT software. Future climatic habitat suitability was modeled under two IPCC climate change scenarios (RCP 6.0 and RCP 8.5). We quantify the extent of the increase in ‘high allergy risk’ (HAR) areas, i.e., parts of Europe...... with climatic conditions corresponding to the highest quartile (25%) of present day habitat suitability for each of the three species. We estimate that by year 2100, the distribution range of all three ragweed species increases towards Northern and Eastern Europe under all climate scenarios. HAR areas...

Rapid changes in the range limits of Scots pine 4000 years ago

International Nuclear Information System (INIS)

Gear, A.J.; Huntley, B.

1991-01-01

Paleoecological data provide estimates of response rates to past climate changes. Fossil Pinus sylvestris stumps in far northern Scotland demonstrate former presence of pine trees where conventional pollen evidence of pine forests is lacking. Radiocarbon, dendrochronological, and fine temporal-resolution palynological data show that pine forest were present for about four centuries some 4,000 years ago; the forests expanded and then retreated rapidly some 70 to 80 kilometers. Despite the rapidity of this response to climate change, it occurred at rates slower by an order of magnitude than those necessary to maintain equilibrium with forecast climate changes attributed to the greenhouse effect

Diversification of the phaseoloid legumes: effects of climate change, range expansion and habit shift.

Science.gov (United States)

Li, Honglei; Wang, Wei; Lin, Li; Zhu, Xiangyun; Li, Jianhua; Zhu, Xinyu; Chen, Zhiduan

2013-01-01

Understanding which factors have driven the evolutionary success of a group is a fundamental question in biology. Angiosperms are the most successful group in plants and have radiated and adapted to various habitats. Among angiosperms, legumes are a good example for such successful radiation and adaptation. We here investigated how the interplay of past climate changes, geographical expansion and habit shifts has promoted diversification of the phaseoloid legumes, one of the largest clades in the Leguminosae. Using a comprehensive genus-level phylogeny from three plastid markers, we estimate divergence times, infer habit shifts, test the phylogenetic and temporal diversification heterogeneity, and reconstruct ancestral biogeographical ranges. We found that the phaseoloid lineages underwent twice dramatic accumulation. During the Late Oligocene, at least six woody clades rapidly diverged, perhaps in response to the Late Oligocene warming and aridity, and a result of rapidly exploiting new ecological opportunities in Asia, Africa and Australia. The most speciose lineage is herbaceous and began to rapidly diversify since the Early Miocene, which was likely ascribed to arid climates, along with the expansion of seasonally dry tropical forests in Africa, Asia, and America. The phaseoloid group provides an excellent case supporting the idea that the interplay of ecological opportunities and key innovations drives the evolutionary success.

Diversification of the phaseoloid legumes: Effects of climate change, range expansion and habit shift

Directory of Open Access Journals (Sweden)

Honglei eLi

2013-10-01

Full Text Available Understanding which factors have driven the evolutionary success of a group is a fundamental question in biology. Angiosperms are the most successful group in plants and have radiated and adapted to various habitats. Among angiosperms, legumes are a good example for such successful radiation and adaptation. We here investigated how the interplay of past climate changes, geographical expansion and habit shifts have promoted diversification of the phaseoloid legumes, one of the largest clades in the Leguminosae. Using a comprehensive genus-level phylogeny from three plastid markers, we estimate divergence times, infer habit shifts, test the phylogenetic and temporal diversification heterogeneity, and reconstruct ancestral biogeographical ranges. We found that the phaseoloid lineages underwent twice dramatic accumulation. During the Late Oligocene, at least six woody clades rapidly diverged, perhaps in response to the Late Oligocene warming and aridity, and a result of rapidly exploiting new ecological opportunities in Asia, Africa and Australia. The most speciose lineage is herbaceous and began to rapidly diversify since the Early Miocene, which was likely ascribed to arid climates, along with the expansion of seasonally dry tropical forests in Africa, Asia and America. The phaseoloid group provides an excellent case supporting the idea that the interplay of ecological opportunities and key innovations drive the evolutionary success.

Effect of changing from the National Health and Nutritional Examination Survey III spirometry reference range to that of the Global Lung Initiative 2012 at Gold Coast Hospital and Health Service.

Science.gov (United States)

Embling, Laura A K; Zagami, Debbie; Sriram, Krishna Bajee; Gordon, Robert J; Sivakumaran, Pathmanathan

2016-12-01

The categorisation of lung disease into obstructive ventilatory defect (OVD) and tendency to a restrictive ventilatory defect (TRVD) patterns using spirometry is used to guide both prognostication and treatment. The effectiveness of categorisation depends upon having reference ranges that accurately represent the population they describe. The Global Lung Initiative 2012 (GLI 2012) has spirometry reference ranges drawn from the largest sample size to date. This study aimed to determine whether using spirometry reference ranges from the new GLI 2012 dataset, compared to the previously used National Health and Nutritional Examination Survey III (NHANES III) dataset, resulted in a change in diagnosis between OVD, TRVD and normal ventilatory pattern (NVP). Spirometry data were collected from 301 patients, aged 18-80 years, undergoing investigation at the Gold Coast Hospital and Health Service (GCHHS) throughout February and March 2014. OVD was defined as a forced expiratory volume in 1 second (FEV 1 ) divided by forced vital capacity (FVC) less than lower limit of normal (LLN). TRVD was defined as FEV 1 /FVC ≥ LLN, FEV 1 reference range resulted in a change in diagnosis of lung disease in 5.9% of the individuals included in this study. This variance in diagnosis when changing reference ranges should be taken into account by clinicians as it may affect patient management.

Bonded versus vacuum-formed retainers: a randomized controlled trial. Part 1: stability, retainer survival, and patient satisfaction outcomes after 12 months.

Science.gov (United States)

Forde, Katherine; Storey, Madeleine; Littlewood, Simon J; Scott, Paul; Luther, Friedy; Kang, Jing

2017-10-20

There is a shortage of evidence on the best type of retainer. Evaluate upper and lower bonded retainers (BRs) versus upper and lower vacuum-formed retainers (VFRs) over 12 months, in terms of stability, retainer survival, and patient satisfaction. Two-arm parallel group multi-centre randomized controlled clinical trial. Sixty consecutive patients completing fixed appliance therapy and requiring retainers were recruited from 3 hospital departments. They were randomly allocated to either upper and lower labial segment BRs (n = 30) or upper and lower full-arch VFRs (n = 30). Primary outcome was stability. Secondary outcomes were retainer survival and patient satisfaction. A random sequence of treatment allocation was computer-generated and implemented by sealing in sequentially numbered opaque sealed envelopes independently prepared in advance. Patients, operators and outcome could not be blinded due to the nature of the intervention. Thirty patients received BRs (median [Mdn] age 16 years, inter-quartile range [IQR] = 2) and 30 received VFRs (Mdn age 17 years, IQR = 4). Baseline characteristics were similar between groups. At 12 months, there were no statistically significant inter-group differences in post-treatment change of maxillary labial segment alignment (BR = 1.1 mm, IQR = 1.56, VFR = 0.76 mm, IQR = 1.55, P = 0.61); however, there was greater post-treatment change in the mandibular VFR group (BR = 0.77 mm, IQR = 1.46, VFR = 1.69mm, IQR = 2.00, P = 0.008). The difference in maxillary retainer survival rates were statistically non-significant, P = 0.34 (BR = 63.6%, 239.3 days, 95% confidence interval [CI] = 191.1-287.5, VFR = 73.3%, 311.1 days, 95% CI = 278.3-344.29). The mandibular BR had a lower survival rate (P = 0.01) at 12 months (BR = 50%, 239.3 days 95% CI = 191.1-287.5, VFR = 80%, 324.9 days 95% CI = 295.4-354.4). More subjects with VFRs reported discomfort (P = 0.002) and speech difficulties (P = 0.004) but found them easier to clean than those with

The Effect of Heart Rate on Exposure Window and Best Phase for Stress Perfusion Computed Tomography: Lessons From the CORE320 Study.

Science.gov (United States)

Steveson, Chloe; Schuijf, Joanne D; Vavere, Andrea L; Mather, Richard T; Caton, Teresa; Mehra, Vishal; Betoko, Aisha; Cox, Christopher; Lima, Joao Ac; George, Richard T

The aim of this study is to evaluate the effect of heart rate on exposure window, best phase, and image quality for stress computed tomography perfusion (CTP) in the CORE320 study. The CTP data sets were analyzed to determine the best phase for perfusion analysis. A predefined exposure window covering 75% to 95% of the R-R cycle was used. Of the 368 patients included in the analysis, 93% received oral β blockade before the rest scan. The median heart rate during the stress acquisition was 69 bpm (interquartile range [IQR], 60-77). The median best phase was 81% (IQR, 76-90), and length of exposure window was 22% (IQR, 19-24). The best phase was significantly later in the cardiac cycle with higher heart rates (P stress scan was 5.3 mSv (IQR, 3.8-6.1). Stress myocardial CTP imaging can be performed using prospective electrocardiography triggering, an exposure window of 75% to 95%, and β-blockade resulting in good or excellent image quality in the majority (80%) of patients while maintaining a low effective radiation dose.

Crop wild relatives range shifts and conservation in Europe under climate change

NARCIS (Netherlands)

Aguirre Gutierrez, Jesus; Treuren, van R.; Hoekstra, R.; Hintum, van T.J.L.

2017-01-01

Aim: Climate change is expected to have a great impact on the distribution of wild flora around the world. Wild plant species are an important component of the genetic resources for crop improvement, which is especially important in face of climate change impacts. Still, many crop wild relatives

Benchmarking novel approaches for modelling species range dynamics.

Science.gov (United States)

Zurell, Damaris; Thuiller, Wilfried; Pagel, Jörn; Cabral, Juliano S; Münkemüller, Tamara; Gravel, Dominique; Dullinger, Stefan; Normand, Signe; Schiffers, Katja H; Moore, Kara A; Zimmermann, Niklaus E

2016-08-01

Increasing biodiversity loss due to climate change is one of the most vital challenges of the 21st century. To anticipate and mitigate biodiversity loss, models are needed that reliably project species' range dynamics and extinction risks. Recently, several new approaches to model range dynamics have been developed to supplement correlative species distribution models (SDMs), but applications clearly lag behind model development. Indeed, no comparative analysis has been performed to evaluate their performance. Here, we build on process-based, simulated data for benchmarking five range (dynamic) models of varying complexity including classical SDMs, SDMs coupled with simple dispersal or more complex population dynamic models (SDM hybrids), and a hierarchical Bayesian process-based dynamic range model (DRM). We specifically test the effects of demographic and community processes on model predictive performance. Under current climate, DRMs performed best, although only marginally. Under climate change, predictive performance varied considerably, with no clear winners. Yet, all range dynamic models improved predictions under climate change substantially compared to purely correlative SDMs, and the population dynamic models also predicted reasonable extinction risks for most scenarios. When benchmarking data were simulated with more complex demographic and community processes, simple SDM hybrids including only dispersal often proved most reliable. Finally, we found that structural decisions during model building can have great impact on model accuracy, but prior system knowledge on important processes can reduce these uncertainties considerably. Our results reassure the clear merit in using dynamic approaches for modelling species' response to climate change but also emphasize several needs for further model and data improvement. We propose and discuss perspectives for improving range projections through combination of multiple models and for making these approaches

Response of small glaciers to climate change: runoff from glaciers of the Wind River range, Wyoming

Science.gov (United States)

Bliss, A. K.; Stamper, B.

2017-12-01

Runoff from glaciers affects downstream ecosystems by influencing the quantity, seasonality, and chemistry of the water. We describe the present state of glaciers in the Wind River range, Wyoming and consider how these glaciers will change in the future. Wind River glaciers have been losing mass in recent decades, as seen with geodetic techniques and by examining glacier morphology. Interestingly, the 2016/7 winter featured one of the largest snowfalls on record. Our primary focus is the Dinwoody Glacier ( 3 km^2, 3300-4000 m above sea level). We present data collected in mid-August 2017 including glacier ablation rates, snow line elevations, and streamflow. We compare measured glacier mass loss to streamflow at the glacier terminus and at a USGS stream gauge farther downstream. Using a hydrological model, we explore the fate of glacial runoff as it moves into downstream ecosystems and through ranchlands important to local people. The techniques used here can be applied to similar small-glacier systems in other parts of the world.

HEVC for high dynamic range services

Science.gov (United States)

Kim, Seung-Hwan; Zhao, Jie; Misra, Kiran; Segall, Andrew

2015-09-01

Displays capable of showing a greater range of luminance values can render content containing high dynamic range information in a way such that the viewers have a more immersive experience. This paper introduces the design aspects of a high dynamic range (HDR) system, and examines the performance of the HDR processing chain in terms of compression efficiency. Specifically it examines the relation between recently introduced Society of Motion Picture and Television Engineers (SMPTE) ST 2084 transfer function and the High Efficiency Video Coding (HEVC) standard. SMPTE ST 2084 is designed to cover the full range of an HDR signal from 0 to 10,000 nits, however in many situations the valid signal range of actual video might be smaller than SMPTE ST 2084 supported range. The above restricted signal range results in restricted range of code values for input video data and adversely impacts compression efficiency. In this paper, we propose a code value remapping method that extends the restricted range code values into the full range code values so that the existing standards such as HEVC may better compress the video content. The paper also identifies related non-normative encoder-only changes that are required for remapping method for a fair comparison with anchor. Results are presented comparing the efficiency of the current approach versus the proposed remapping method for HM-16.2.

Radiation exposure of ventilated trauma patients in intensive care: a retrospective study comparing two time periods.

Science.gov (United States)

Yee, Micaela V; Barron, Rochelle A; Knobloch, Tom A; Pandey, Umesh; Twyford, Catherine; Freebairn, Ross C

2012-08-01

To describe the cumulative effective dose of radiation that was received during the initial Emergency Department assessment and ICU stay of patients admitted with trauma, who required mechanical ventilation, during two time periods. A retrospective analysis of radiological and clinical data, set in a regional nonurban ICU. Two cohorts (starting 1 January 2004 and 1 January 2009), each comprising 45 adult patients admitted with trauma who were mechanically ventilated in intensive care, were studied. Frequency and type of radiological examinations, demographic information, and clinical data were collated from the radiological database, hospital admission record and Australian Outcomes Research Tool for Intensive Care database. Cumulative effective doses were calculated and expressed as a total dose and average daily dose for each cohort. The median cumulative effective dose per patient (in milliSieverts) increased from 34.59 [interquartile range (IQR) 9.08-43.91] in 2004 to 40.51 (IQR 22.01-48.87) in 2009, P=0.045. An increased number of computed tomography examinations per patient was also observed over the same interval from an average of 2.11 (median 2, IQR 1-3) in 2004 to an average of 2.62 (2, 2-4) in 2009, P=0.046. The radiation exposure of mechanically ventilated trauma patients in intensive care has increased over time. Radiation exposure should be prospectively monitored and staff should be aware of the increased risk resulting from this change in practice.

Paleoecological and paleoenvironmental changes during the continental Middle-Late Permian transition at the SE Iberian Ranges, Spain

Science.gov (United States)

De la Horra, R.; Galán-Abellán, A. B.; López-Gómez, J.; Sheldon, N. D.; Barrenechea, J. F.; Luque, F. J.; Arche, A.; Benito, M. I.

2012-08-01

The Middle and Late Permian are characterized by a pair of mass-extinction events that are recorded in both marine and continental environments. Here, we present the first continental western peri-Tethyan record of an extinction event located in the Middle-Late interval. In the SE Iberian Ranges, Central Spain, the transition between the Lower and Middle subunits of the Middle Permian Alcotas Formation indicates a significant paleoclimatic change from arid and semiarid conditions towards more humid conditions. Coincident with the onset of humid conditions there were changes in the sedimentology, mineralogy, and geochemistry that indicate significant environmental changes including a shift in weathering intensity and a change of fluvial style from braided to meandering systems. Near the top of the Middle Subunit, a local biotic crisis is recorded by palynomorph assemblages. Following this crisis, there is a total absence of coal beds, plant remains, and microflora that defines a barren zone in the uppermost part of the Alcotas Formation which is recorded throughout the basin. The barren zone is accompanied by a shift back to braided stream systems, but not by a return to carbonate-bearing paleosols indicative of arid or semi-arid conditions. This combination of features is consistent with other Middle-Late continental basins related with mass extinctions, so the barren zone is interpreted as the extinction interval. The regional character of the extinction interval and its proximity with the Middle-Late Permian transition could be related with the global mid-Capitanian biotic turnover described in this period of time in other marine basins. However, the common difficulties of dating with precision non-marine rocks make this relationship difficult to probe in the Iberian Basin and in other Middle-Late Permian basins. Further work, including high resolution carbon-isotope analyses and complete studies of the magnetostratigraphy, should be desirable in order to obtain

Erythropoietic response to anaemia of dialysis naïve patients with ...

African Journals Online (AJOL)

dl; the red cell indices were within normal ranges except for Red cell distribution width‑Coefficient of variation (%) which was elevated (16.29%). The mean serum ferritin, sTfR, and sEpo were 70.58 ± 46.44 ng/ml (interquartile range [IQR] ...

Evidence for range contraction of snowshoe hare in Pennsylvania

Science.gov (United States)

Diefenbach, Duane R.; Rathbun, Stephen L.; Vreeland, J.K.; Grove, Deborah; Kanapaux, William J.

2016-01-01

In Pennsylvania, Lepus americanus (Snowshoe Hare) is near the southern limits of its range and at risk of range contraction because of loss of early-successional forest and impacts of climate change. We used hunter-harvest data to investigate changes in the distribution of Snowshoe Hare in Pennsylvania (1983–2011), forest inventory and land-use data to assess changes in amount and distribution of early-successional forest (1988–2011), and occupancy modeling (2004) to identify habitat and climate variables that explain the current distribution of Snowshoe Hare. We determined presence of Snowshoe Hare based on visual sightings, observations of tracks, and DNA analysis of fecal pellets, and used repeated visits to sampling sites and occupancy models to estimate occupancy rates (Ψ). Hunter-harvest data indicated the range of Snowshoe Hare in Pennsylvania contracted towards northwestern and northeastern portions of the state. Based on occupancy modeling, Snowshoe Hare were most likely to occupy early-successional and mixed deciduous-coniferous forest types and areas with colder winter temperatures, which coincided with the distribution of hunter harvests. Among the 4 forest types, we estimated Ψ = 0.52-0.79 and Ψ = 0.10-0.32 where winter temperatures were coldest and warmest, respectively. Total forest loss was Pennsylvania may decline from 0.27 in 2004 to 0.10–0.18 by 2050–2059, depending on the climate model. The range of Snowshoe Hare in Pennsylvania has contracted to regions of Pennsylvania with the coldest winter temperatures and most persistent snowpack, and based on projected climate change, our results suggest further range contraction of Snowshoe Hare in Pennsylvania.

Relative validity and reliability of a quantitative food frequency questionnaire for adults in Guam

Directory of Open Access Journals (Sweden)

Rachael T. Leon Guerrero

2015-05-01

Full Text Available Background: Guam is a US territory in the western Pacific with a diverse population that includes understudied ethnic groups such as Chamorros and Filipinos. A food frequency questionnaire (FFQ to estimate dietary intake was needed to facilitate studies of diet and health among adults living in Guam. Objective: To develop and validate an FFQ to assess dietary intake over a 1-year period among adult Guam residents. Design: A three-part study was conducted: 1 an initial cross-sectional study using 24-h recalls to identify a food and beverage list for the FFQ and resulting in a final FFQ containing 142 food and drink items; 2 to test reliability, 56 different individuals completed the FFQ twice; and 3 to test relative validity, self-administered FFQs and up to 2 days of food record data from an additional 109 individuals were collected, and daily nutrient intake from the two methods was compared. Results: The reliability of the FFQ was very good (ρ range=0.65–0.75, and the relative validity of the FFQ was good for women (median Spearman's correlation [ρ] between instruments of 0.45 across 20 nutrients and an interquartile range [IQR] of 0.42–0.58 and generally adequate for men (median ρ=0.31, IQR=0.23–0.55. Validity was also good for Chamorros (median ρ=0.47, IQR=0.38–0.53 and generally adequate for Filipinos (median ρ=0.42, IQR=0.20–0.62. Correlations after energy adjustment were lower (overall median ρ=0.20, IQR=0.14–0.26. Conclusions: The FFQ can be used to rank nutrient intake for adults in Guam and may be helpful in the analysis of relationships between diet and chronic disease in Guam.

Cognitive Style and Mobile E-Learning in Emergent Otorhinolaryngology-Head and Neck Surgery Disorders for Millennial Undergraduate Medical Students: Randomized Controlled Trial

Science.gov (United States)

Chao, Yi-Ping; Huang, Chung-Guei; Fang, Ji-Tseng; Wang, Shu-Ling; Chuang, Cheng-Keng; Kang, Chung-Jan; Hsin, Li-Jen; Lin, Wan-Ni; Fang, Tuan-Jen; Li, Hsueh-Yu

2018-01-01

Background Electronic learning (e-learning) through mobile technology represents a novel way to teach emergent otorhinolaryngology-head and neck surgery (ORL-HNS) disorders to undergraduate medical students. Whether a cognitive style of education combined with learning modules can impact learning outcomes and satisfaction in millennial medical students is unknown. Objective The aim of this study was to assess the impact of cognitive styles and learning modules using mobile e-learning on knowledge gain, competence gain, and satisfaction for emergent ORL-HNS disorders. Methods This randomized controlled trial included 60 undergraduate medical students who were novices in ORL-HNS at an academic teaching hospital. The cognitive style of the participants was assessed using the group embedded figures test. The students were randomly assigned (1:1) to a novel interactive multimedia (IM) group and conventional Microsoft PowerPoint show (PPS) group matched by age, sex, and cognitive style. The content for the gamified IM module was derived from and corresponded to the textbook-based learning material of the PPS module (video lectures). The participants were unblinded and used fully automated courseware containing the IM or PPS module on a 7-inch tablet for 100 min. Knowledge and competence were assessed using multiple-choice questions and multimedia situation tests, respectively. Each participant also rated their global satisfaction. Results All of the participants (median age 23 years, range 22-26 years; 36 males and 24 females) received the intended intervention after randomization. Overall, the participants had significant gains in knowledge (median 50%, interquartile range [IQR]=17%-80%, P<.001) and competence (median 13%, IQR=0%-33%, P=.006). There were no significant differences in knowledge gain (40%, IQR=13%-76% vs 60%, IQR=20%-100%, P=.42) and competence gain (0%, IQR= −21% to 38% vs 25%, IQR=0%-33%, P=.16) between the IM and PPS groups. However, the IM group had

Transcatheter Aortic Valve Replacement by a Novel Suprasternal Approach.

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Codner, Pablo; Pugliese, Daniel; Kouz, Rémi; Patel, Amisha; Chen, Cheng-Han; Terre, Juan; Eudailey, Kyle W; Nazif, Tamim; Vahl, Torsten P; George, Isaac; Khalique, Omar K; Hahn, Rebecca T; Leon, Martin B; Kodali, Susheel; Borger, Michael

2018-04-01

Transcatheter aortic valve replacement (TAVR) provides therapy for patients with severe aortic stenosis at extreme, high, or intermediate surgical risk. Transfemoral access has been the preferred access route; however, this approach is not suitable for many TAVR candidates. A suprasternal approach may allow for earlier ambulation and shorter hospital stay as compared with other, nontransfemoral approaches. A total of 11 patients with unsuitable transfemoral access underwent suprasternal TAVR. Propensity matching was used to compare suprasternal patients to patients undergoing transaortic, transapical, and trans-subclavian TAVR. Groups were well matched for baseline characteristics. A self-expanding valve device was used in 6 (54.5%) and a balloon-expandable valve in 5 (45.5%) of the 11 patients treated by the suprasternal route. Suprasternal and trans-subclavian patients were able to ambulate earlier than patients treated by the transaortic route, a median 1.6 days (interquartile range [IQR]: 0.9 to 1.8), 1.6 days (IQR: 0.9 to 2.7), and 3.9 days (IQR: 1.9 to 4.5) after the procedure for suprasternal, trans-subclavian, and transaortic patients, respectively (p = 0.001). Length of hospitalization was shorter for patients treated by suprasternal or trans-subclavian access in comparison with patients treated by the transaortic or transapical approach: median 4 days (IQR: 3 to 8) and 4 days (IQR: 4 to 8) versus 8 days (IQR: 6 to 14) and 6 days (IQR: 7 to 11) for suprasternal and trans-subclavian versus transaortic and transapical, respectively (p = 0.01). Suprasternal and trans-subclavian access are associated with earlier ambulation and shorter hospitalization than other nontransfemoral TAVR routes, without an increase in complications. Further study is required to determine if suprasternal is the alternative access of choice for TAVR patients with poor transfemoral vasculature. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

Insulinaemic and glycaemic responses to three forages in ponies.

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Carslake, H B; Argo, C McG; Pinchbeck, G L; Dugdale, A H A; McGowan, C M

2018-05-01

Reduction of the hyperinsulinaemic response to feeding is central to the management of insulin dysregulation (ID). The aim of this study was to compare insulinaemic and glycaemic responses to soaked hay, dry hay and haylage in ponies. Twelve ponies of mixed breeds were maintained under identical management conditions. A randomised four-way crossover trial was conducted, in which fasted animals were fed a meal of 0.25% body weight as dry matter intake soaked hay, dry hay or haylage, or administered an oral glucose test (OGT). Blood glucose and serum insulin concentrations were measured before and at 2h following OGT, and regularly for 5h following forage meals. Median and interquartile range (IQR) area under the curve (AUC) for insulin (AUC i ) was greater for haylage (median 6495; IQR 17352) vs. dry hay (2932; IQR 5937; P=0.019) and soaked hay (1066; IQR 1753; P=0.002), and greater for dry hay vs. soaked hay (P=0.002). The AUC for glucose (AUC g ) was lower for soaked hay (1021; IQR 99) vs. dry hay (1075; IQR 105; P=0.002) and haylage (1107; IQR 221; P=0.003). Six ponies were classified as having ID based on the OGT. AUC i was greater in ID vs. non-ID ponies after all forages. In contrast, there was no detectable effect of ID status on AUC g . On an equivalent dry matter basis, soaked hay produced the lowest insulinaemic and glycaemic responses to feeding, while haylage produced the highest responses. The insulinaemic effects of all forages were greater in ponies with ID. These data support the practice of soaking hay with water to reduce postprandial insulinaemic responses in ponies. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

A serosurvey of bluetongue and epizootic haemorrhagic disease in a convenience sample of sheep and cattle herds in Zimbabwe.

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Gordon, Stuart J G; Bolwell, Charlotte; Rogers, Chris W; Musuka, Godfrey; Kelly, Patrick; Guthrie, Alan; Mellor, Philip S; Hamblin, Chris

2017-11-14

A convenience sample of sheep and cattle herds around the cities of Harare, Kwekwe and Bulawayo, located in the Highveld region of Zimbabwe, was used to estimate the seroprevalence and sero-incidence of bluetongue virus (BTV) and epizootic haemorrhagic disease virus (EHDV) antibodies. A competitive enzyme-linked immunosorbent assay was used to identify serum antibodies against BTV and EHDV across three rainy seasons. The median sero-prevalence of BTV and EHDV antibodies in cattle was 62% (interquartile range [IQR]: 30-89) and 56% (IQR: 5-77), respectively. In sheep, the median sero-prevalence of BTV and EHDV was 41% (IQR: 19-63) and 0% (IQR: 0-21), respectively. Median sero-incidences of BTV and EHDV antibodies in cattle of 43% (IQR: 22-67) and 27% (IQR: 9-57) respectively were recorded. The median sero-incidence of BTV in sheep was 14% (IQR: 6-23). Based on these preliminary findings, animal health workers in Zimbabwe should continue to monitor the exposure rates of cattle and sheep to BTV and consider the possibility of strains emerging with increased pathogenicity. There are no previous published reports of antibodies against EHDV in Zimbabwe so the possibility of epizootic haemorrhagic disease existing in domestic livestock should now be considered by Zimbabwean animal health officials. Seroconversions to BTV and EHDV occurred predominantly at the end of each rainy season (March and April), which generally corresponds to high numbers of the Culicoides vectors. BTV isolations were made from three individual cows in two of the sentinel herds and all three were identified as serotype 3. This is the first time BTV serotype 3 has been recorded in Zimbabwe, although its presence in neighbouring South Africa is well documented.

Precision of quantitative computed tomography texture analysis using image filtering: A phantom study for scanner variability.

Science.gov (United States)

Yasaka, Koichiro; Akai, Hiroyuki; Mackin, Dennis; Court, Laurence; Moros, Eduardo; Ohtomo, Kuni; Kiryu, Shigeru

2017-05-01

Quantitative computed tomography (CT) texture analyses for images with and without filtration are gaining attention to capture the heterogeneity of tumors. The aim of this study was to investigate how quantitative texture parameters using image filtering vary among different computed tomography (CT) scanners using a phantom developed for radiomics studies.A phantom, consisting of 10 different cartridges with various textures, was scanned under 6 different scanning protocols using four CT scanners from four different vendors. CT texture analyses were performed for both unfiltered images and filtered images (using a Laplacian of Gaussian spatial band-pass filter) featuring fine, medium, and coarse textures. Forty-five regions of interest were placed for each cartridge (x) in a specific scan image set (y), and the average of the texture values (T(x,y)) was calculated. The interquartile range (IQR) of T(x,y) among the 6 scans was calculated for a specific cartridge (IQR(x)), while the IQR of T(x,y) among the 10 cartridges was calculated for a specific scan (IQR(y)), and the median IQR(y) was then calculated for the 6 scans (as the control IQR, IQRc). The median of their quotient (IQR(x)/IQRc) among the 10 cartridges was defined as the variability index (VI).The VI was relatively small for the mean in unfiltered images (0.011) and for standard deviation (0.020-0.044) and entropy (0.040-0.044) in filtered images. Skewness and kurtosis in filtered images featuring medium and coarse textures were relatively variable across different CT scanners, with VIs of 0.638-0.692 and 0.430-0.437, respectively.Various quantitative CT texture parameters are robust and variable among different scanners, and the behavior of these parameters should be taken into consideration.

Access to Grafts in a Liver Transplant Center: Does It Rely on the Severity of the Waiting List Population?

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Daciuk, N I; Quiñonez, E G; Poupard, M; Vergara Sandoval, R M; Mattera, F J

2018-03-01

The number of transplants performed relies, partially, on recipients' variables on the waiting list. The goal of this study was to compare recipients from a high-volume liver center in Argentina with the rest of the country. This study was a retrospective analysis of liver transplant recipients nationally between January 2013 and April 2017. It involved extracting data from the open database CRESI-SINTRA (the Argentinian database of the National Procurement Organization, an equivalent to the United Network for Organ Sharing); expressing results by percentages, medians, and interquartile ranges (IQRs); and comparing the national population with the population transplanted at Hospital El Cruce (HEC). The Mann-Whitney U test was used for analysis. Nationally, 1434 liver transplants were performed. A total of 177 (12.34%) were emergency status; 811 (56.6%) were by the Model for End-Stage Liver Disease (MELD) (n = 759)/PELD (Pediatric End-Stage Liver Disease) (n = 52), with a median graft assignment position of 5 (IQR, 3-10) in 57.2 days (IQR, 11-217). Median MELD access was 29 points (IQR, 24-33). A total of 446 (31.1%) had MELD exceptions; 249 (55.8%) of these were due to Milan hepatocellular carcinoma. At the HEC, 167 liver transplantations were performed; 26 (15.6%) were emergency status and 97 (58.1%) by MELD (none PELD). Their median graft assignment position was 4 (IQR, 4-16) in 19.1 days (IQR, 4-90); median MELD access was 28 points (IQR, 24-31). Forty-five patients (26.9%) had MELD exceptions; 31 (68.9%) were due to hepatocellular carcinoma. Our center has a larger proportion of recipients transplanted by emergency status and MELD, similar MELD access, and less waiting list time, reflecting our wide policy of liver graft acceptance. Copyright © 2017 Elsevier Inc. All rights reserved.

Contact force sensing for ablation of persistent atrial fibrillation: A randomized, multicenter trial.

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Conti, Sergio; Weerasooriya, Rukshen; Novak, Paul; Champagne, Jean; Lim, Hong Euy; Macle, Laurent; Khaykin, Yaariv; Pantano, Alfredo; Verma, Atul

2018-02-01

Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. PeAF was continuous for 26 weeks (interquartile range [IQR] 13-52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6-20] and 14 g [IQR 9-20] (P = .10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P = .70). Single procedure freedom from atrial arrhythmia was 60% in the CFS-guided arm and 63% in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6-19] vs 13.2 g [IQR 8-20], respectively; P = .0007) and less force-time integral (174 gs [IQR 91-330] vs 210 gs [IQR 113-388], respectively; P force/force-time integral was associated with significantly more gaps. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Characteristics of HIV-Infected Children at Enrollment into Care and at Antiretroviral Therapy Initiation in Central Africa.

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Adebola Adedimeji

Full Text Available Despite the World Health Organization (WHO regularly updating guidelines to recommend earlier initiation of antiretroviral therapy (ART in children, timely enrollment into care and initiation of ART in sub-Saharan Africa in children lags behind that of adults. The impact of implementing increasingly less restrictive ART guidelines on ART initiation in Central Africa has not been described.Data are from the Central Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA pediatric cohort of 3,426 children (0-15 years entering HIV care at 15 sites in Burundi, DRC, and Rwanda. Measures include CD4 count, WHO clinical stage, age, and weight-for-age Z score (WAZ, each at enrollment into HIV care and at ART initiation. Changes in the medians or proportions of each measure by year of enrollment and year of ART initiation were assessed to capture potential impacts of changing ART guidelines.Median age at care enrollment decreased from 77.2 months in 2004-05 to 30.3 months in 2012-13. The median age at ART initiation (n = 2058 decreased from 83.0 months in 2004-05 to 66.9 months in 2012-13. The proportion of children ≤24 months of age at enrollment increased from 12.7% in 2004-05 to 46.7% in 2012-13, and from 9.6% in 2004-05 to 24.2% in 2012-13 for ART initiation. The median CD4 count at enrollment into care increased from 563 (IQR: 275, 901 in 2004-05 to 660 (IQR: 339, 1071 cells/μl in 2012-13, and the median CD4 count at ART initiation increased from 310 (IQR:167, 600 in 2004-05 to 589 (IQR: 315, 1113 cells/μl in 2012-13. From 2004-05 to 2012-13, median WAZ improved from -2 (IQR: -3.4, -1.1 to -1 (IQR: -2.5, -0.2 at enrollment in care and from -2 (IQR: -3.8, -1.6 to -1 (IQR: -2.6, -0.4 at ART initiation.Although HIV-infected children ≤24 months of age accounted for half of all children enrolling in care in our cohort during 2012-13, they represented less than a quarter of all those who were initiated on ART during the same period

Assessing the Accuracy and Readability of Online Health Information for Patients With Pancreatic Cancer.

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Storino, Alessandra; Castillo-Angeles, Manuel; Watkins, Ammara A; Vargas, Christina; Mancias, Joseph D; Bullock, Andrea; Demirjian, Aram; Moser, A James; Kent, Tara S

2016-09-01

The degree to which patients are empowered by written educational materials depends on the text's readability level and the accuracy of the information provided. The association of a website's affiliation or focus on treatment modality with its readability and accuracy has yet to be thoroughly elucidated. To compare the readability and accuracy of patient-oriented online resources for pancreatic cancer by treatment modality and website affiliation. An online search of 50 websites discussing 5 pancreatic cancer treatment modalities (alternative therapy, chemotherapy, clinical trials, radiation therapy, and surgery) was conducted. The website's affiliation was identified. Readability was measured by 9 standardized tests, and accuracy was assessed by an expert panel. Nine standardized tests were used to compute the median readability level of each website. The median readability scores were compared among treatment modality and affiliation categories. Accuracy was determined by an expert panel consisting of 2 medical specialists and 2 surgical specialists. The 4 raters independently evaluated all websites belonging to the 5 treatment modalities (a score of 1 indicates that readability and accuracy based on the focus of the treatment modality and the website's affiliation. Websites discussing surgery (with a median readability level of 13.7 and an interquartile range [IQR] of 11.9-15.6) were easier to read than those discussing radiotherapy (median readability level, 15.2 [IQR, 13.0-17.0]) (P = .003) and clinical trials (median readability level, 15.2 [IQR, 12.8-17.0]) (P = .002). Websites of nonprofit organizations (median readability level, 12.9 [IQR, 11.2-15.0]) were easier to read than media (median readability level, 16.0 [IQR, 13.4-17.0]) (P readability level, 14.8 [IQR, 12.9-17.0]) (P readability level, 14.0 [IQR, 12.1-16.1]) were easier to read than media websites (P = .001). Among treatment modalities, alternative therapy websites exhibited the

Longevity of Cane Corso Italiano dog breed and its relationship with hair colour

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Evžen Korec

2017-06-01

Full Text Available The Cane Corso Italiano belongs among the new dog breeds that were fully recognised by Federation Cynologique Internationale (FCI in 2007. For the first time, this study describes a median lifespan using the data of 232 dogs of the Cane Corso Italiano breed collected from kennels and individual owners from 25 countries. The median lifespan of the whole examined group is 9.29 years (IQR 6.98-11.12, IQR = Interquartile Range. This paper is the first to describe the possible relationship between median lifespan and hair colour within one breed. The longest living group is formed by black brindle coloured dogs, with a median of 10.30 years (IQR 8.33-13.00, and brindle coloured dogs, with a median of 10.13 years (IQR 7.12-11.25. The median lifespan of black brindle dogs exceeded the overall median lifespan of all dogs by 1.01 year and the median lifespan of other colour dogs by 2.21 years. Our results suggest a possible way for a prolongation of age at death of the Cane Corso Italiano breed using appropriate breeding. The median lifespan of male Cane Corso Italiano dogs is 9.25 years (IQR 6.97-11.00 and female Cane Corso Italiano dogs 9.33 years (IQR 7.00-11.31. The statistical analysis using the Independent Samples Student’s t test confirmed that the lifespan of female dogs did not exceed the median lifespan of male dogs (P>0.01.

Systematic reviews of anesthesiologic interventions reported as statistically significant

DEFF Research Database (Denmark)

Imberger, Georgina; Gluud, Christian; Boylan, John

2015-01-01

statistically significant meta-analyses of anesthesiologic interventions, we used TSA to estimate power and imprecision in the context of sparse data and repeated updates. METHODS: We conducted a search to identify all systematic reviews with meta-analyses that investigated an intervention that may......: From 11,870 titles, we found 682 systematic reviews that investigated anesthesiologic interventions. In the 50 sampled meta-analyses, the median number of trials included was 8 (interquartile range [IQR], 5-14), the median number of participants was 964 (IQR, 523-1736), and the median number...

Two-year follow-up study of a group-based diabetes medical nutrition therapy and motivational interviewing intervention among African American women

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Miller ST

2017-04-01

Full Text Available Stephania T Miller,1 Sylvie A Akohoue2 1Department of Surgery, 2Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA Objectives: To assess the 2-year efficacy of a combined medical nutrition therapy and motivational interviewing (MI pilot study intervention and factors that influenced long-term dietary self-care.Research design and methods: Pilot study participants, African American women with type 2 diabetes, completed a 2-year follow-up study visit, including clinical assessments and completion of a dietary self-care questionnaire and a semi-structured interview. Wilcoxon signed-rank tests were used to evaluate differences between baseline and 2-year follow-up clinical and dietary self-care outcomes. Hierarchical coding was used to analyze semi-structured interviews and categorize facilitator and barrier themes into subthemes. Subthemes were quantified based on the number of subtheme-related comments. Results: Among the 12 participants (mean age 57.1±5.7 years, improvements were observed for HbA1c (baseline: 10.25%; interquartile range [IQR]: 8.10, 11.72 and follow-up: 8.8%; IQR: 7.48,10.22, systolic blood pressure (baseline: 142 mm Hg; IQR: 134.25, 157.25 and follow-up: 127 mm Hg; IQR: 113.5, 143.25, frequency of eating high-fat foods (baseline: 3.5 days; IQR: 2.75, 4.25 and follow-up: 3 days; IQR: 2.5, 4.5, and of spacing carbohydrates throughout the day (baseline: 3 days; IQR: 3.0, 4.0 and follow-up: 4 days; IQR: 1.5, 4.5. There was a statistically significant decrease (p=0.04 in the frequency of fruit and vegetable intake (baseline: 4 days; IQR: 3.75, 7.0 and follow-up: 3.5 days; IQR: 2.75, 4.0. Dietary self-care barriers and facilitators included internal (eg, motivation and external factors (eg, social support. Motivation (70 comments and lack of motivation (67 comments were the most pervasive facilitator and barrier subthemes, respectively. Conclusion: Overall, diabetes-related clinical and dietary

Deconstruction of Interhospital Transfer Workflow in Large Vessel Occlusion: Real-World Data in the Thrombectomy Era.

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Ng, Felix C; Low, Essie; Andrew, Emily; Smith, Karen; Campbell, Bruce C V; Hand, Peter J; Crompton, Douglas E; Wijeratne, Tissa; Dewey, Helen M; Choi, Philip M

2017-07-01

Interhospital transfer is a critical component in the treatment of acute anterior circulation large vessel occlusive stroke transferred for mechanical thrombectomy. Real-world data for benchmarking and theoretical modeling are limited. We sought to characterize transfer workflow from primary stroke center (PSC) to comprehensive stroke center after the publication of positive thrombectomy trials. Consecutive patients transferred from 3 high-volume PSCs to a single comprehensive stroke center between January 2015 and August 2016 were included in a retrospective study. Factors associated with key time metrics were analyzed with emphasis on PSC intrahospital workflow. Sixty-seven patients were identified. Median age was 74 years (interquartile range [IQR], 63.5-78) and National Institutes of Health Stroke Scale 17 (IQR, 12-21). Median transfer time measured by PSC-door-to-comprehensive stroke center-door was 128 minutes (IQR, 107-164), of which 82.8% was spent at PSCs (door-in-door-out [DIDO]; 106 minutes; IQR, 86-143). The lengthiest component of DIDO was computed-tomography-to-retrieval-request (median 59.5 minutes; IQR, 44-83). The 37.3% had DIDO exceeding 120 minutes. DIDO times differed significantly between PSCs ( P =0.01). In multivariate analyses, rerecruiting the initial ambulance crew for transfer ( P workflow represents a major opportunity to expedite mechanical thrombectomy and improve patient outcomes. © 2017 American Heart Association, Inc.

Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections.

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Leli, Christian; Ferranti, Marta; Moretti, Amedeo; Al Dhahab, Zainab Salim; Cenci, Elio; Mencacci, Antonella

2015-01-01

Procalcitonin (PCT) can discriminate bacterial from viral systemic infections and true bacteremia from contaminated blood cultures. The aim of this study was to evaluate PCT diagnostic accuracy in discriminating Gram-positive, Gram-negative, and fungal bloodstream infections. A total of 1,949 samples from patients with suspected bloodstream infections were included in the study. Median PCT value in Gram-negative (13.8 ng/mL, interquartile range (IQR) 3.4-44.1) bacteremias was significantly higher than in Gram-positive (2.1 ng/mL, IQR 0.6-7.6) or fungal (0.5 ng/mL, IQR 0.4-1) infections (P Gram-negatives from Gram-positives at the best cut-off value of 10.8 ng/mL and an AUC of 0.944 (95% CI 0.919-0.969, P Gram-negatives from fungi at the best cut-off of 1.6 ng/mL. Additional results showed a significant difference in median PCT values between Enterobacteriaceae and nonfermentative Gram-negative bacteria (17.1 ng/mL, IQR 5.9-48.5 versus 3.5 ng/mL, IQR 0.8-21.5; P Gram-negative from Gram-positive and fungal bloodstream infections. Nevertheless, its utility to predict different microorganisms needs to be assessed in further studies.

Use of social media to engage membership of a state health-system pharmacy organization.

Science.gov (United States)

Sabato, Leah A; Barone, Caroline; McKinney, Kathryn

2017-01-01

The influence of targeted strategies implemented to increase member engagement on a social media page of a professional pharmacy organization was studied. The Ohio Society of Health-System Pharmacists (OSHP) implemented posting strategies to increase member engagement with its social media page in late 2013. Data were collected retrospectively for a nine-month period in 2013 (preimplementation) and a matching nine-month period in 2014 (postimplementation). The primary endpoint was reach (as provided by the social media website). Data regarding reach were reported to OSHP page administrators on a weekly basis. Posts during the study period were characterized by the day of week, time of day, type of post, and corresponding reach. Continuous variables were represented using means and standard deviations or medians and interquartile ranges (IQRs); categorical data were represented by percentages. The total reach of posts during the nine-month study period increased postimplementation, from 10,826 to 32,338. Further, the median reach per post on the OSHP Facebook page was higher postimplementation (214; IQR, 107-380) versus preimplementation (152; IQR, 89-224; p = 0.035). Evening posts had significantly greater reach compared with nonevening posts. The median reach for evening posts was 232 (IQR, 143-378) versus 131 (IQR, 77-200) for nonevening posts (p system pharmacy organization's social media page. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Impact of a Physician-in-Triage Process on Resident Education

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Bret A. Nicks

2014-11-01

Full Text Available Introduction: Emergency department (ED crowding negatively impacts patient care quality and efficiency. To reduce crowding many EDs use a physician-in-triage (PIT process. However, few studies have evaluated the effect of a PIT processes on resident education. Our objective was to determine the impact of a PIT process implementation on resident education within the ED of an academic medical center. Methods: We performed a prospective cross-sectional study for a 10-week period from March to June 2011, during operationally historic trended peak patient volume and arrival periods. Emergency medicine residents (three-year program and faculty, blinded to the research objectives, were asked to evaluate the educational quality of each shift using a 5-point Likert scale. Residents and faculty also completed a questionnaire at the end of the study period assessing the perceived impact of the PIT process on resident education, patient care, satisfaction, and throughput. We compared resident and attending data using Mann-Whitney U tests. Results: During the study period, 54 residents and attendings worked clinically during the PIT process with 78% completing questionnaires related to the study. Attendings and residents indicated “no impact” of the PIT process on resident education [median Likert score of 3.0, inter-quartile range (IQR: 2-4]. There was no difference in attending and resident perceptions (p-value =0.18. Both groups perceived patient satisfaction to be “positively impacted” [4.0, IQR:2-4 for attendings vs 4.0,IQR:1-5 for residents, p-value =0.75]. Residents perceived more improvement in patient throughput to than attendings [3.5, IQR:3-4 for attendings vs 4.0, IQR:3-5 for residents, p-value =0.006]. Perceived impact on differential diagnosis generation was negative in both groups [2.0, IQR:1-3 vs 2.5, IQR:1-5, p-value = 0.42]. The impact of PIT on selection of diagnostic studies and medical decision making was negative for attendings

Forest Fire Smoke Exposures and Out-of-Hospital Cardiac Arrests in Melbourne, Australia: A Case-Crossover Study.

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Dennekamp, Martine; Straney, Lahn D; Erbas, Bircan; Abramson, Michael J; Keywood, Melita; Smith, Karen; Sim, Malcolm R; Glass, Deborah C; Del Monaco, Anthony; Haikerwal, Anjali; Tonkin, Andrew M

2015-10-01

Millions of people can potentially be exposed to smoke from forest fires, making this an important public health problem in many countries. In this study we aimed to measure the association between out-of-hospital cardiac arrest (OHCA) and forest fire smoke exposures in a large city during a severe forest fire season, and estimate the number of excess OHCAs due to the fire smoke. We investigated the association between particulate matter (PM) and other air pollutants and OHCA using a case-crossover study of adults (≥ 35 years of age) in Melbourne, Australia. Conditional logistic regression models were used to derive estimates of the percent change in the rate of OHCA associated with an interquartile range (IQR) increase in exposure. From July 2006 through June 2007, OHCA data were collected from the Victorian Ambulance Cardiac Arrest Registry. Hourly air pollution concentrations and meteorological data were obtained from a central monitoring site. There were 2,046 OHCAs with presumed cardiac etiology during our study period. Among men during the fire season, greater increases in OHCA were observed with IQR increases in the 48-hr lagged PM with diameter ≤ 2.5 μm (PM2.5) (8.05%; 95% CI: 2.30, 14.13%; IQR = 6.1 μg/m(3)) or ≤ 10 μm (PM10) (11.1%; 95% CI: 1.55, 21.48%; IQR = 13.7 μg/m(3)) and carbon monoxide (35.7%; 95% CI: 8.98, 68.92%; IQR = 0.3 ppm). There was no significant association between the rate of OHCA and air pollutants among women. One hundred seventy-four "fire-hours" (i.e., hours in which Melbourne's air quality was affected by forest fire smoke) were identified during 12 days of the 2006/2007 fire season, and 23.9 (95% CI: 3.1, 40.2) excess OHCAs were estimated to occur due to elevations in PM2.5 during these fire-hours. This study found an association between exposure to forest fire smoke and an increase in the rate of OHCA. These findings have implications for public health messages to raise community awareness and for planning of emergency

Rapid Inpatient Titration of Intravenous Treprostinil for Pulmonary Arterial Hypertension: Safe and Tolerable.

Science.gov (United States)

El-Kersh, Karim; Ruf, Kathryn M; Smith, J Shaun

There is no standard protocol for intravenous treprostinil dose escalation. In most cases, slow up-titration is performed in the outpatient setting. However, rapid up-titration in an inpatient setting is an alternative that provides opportunity for aggressive treatment of common side effects experienced during dose escalation. In this study, we describe our experience with inpatient rapid up-titration of intravenous treprostinil. This was a single-center, retrospective study in which we reviewed the data of subjects with pulmonary arterial hypertension treated at our center who underwent inpatient rapid up-titration of intravenous treprostinil. Our treprostinil dose escalation protocol included initiation at 2 ng·kg·min with subsequent up-titration by 1 ng·kg·min every 6 to 8 hours as tolerated by side effects. A total of 16 subjects were identified. Thirteen subjects were treprostinil naive (naive group), and 3 subjects were receiving subcutaneous treprostinil but were hospitalized for further intravenous up-titration of treprostinil dose (nonnaive group). In the naive group, the median maximum dose achieved was 20 ng·kg·min with an interquartile range (IQR) of 20-23 ng·kg·min. The median up-titration interval was 6 days (IQR: 4-9). In the nonnaive group, the median maximum dose achieved was 20 ng·kg·min (range: 17-30). The median up-titration interval was 8.5 days (range: 1.5-11). Overall, the median maximum dose achieved was 20 ng·kg·min (IQR: 20-23.5), and the median up-titration interval was 6 days (IQR: 4.6-9.25), with no reported significant adverse hemodynamic events. In patients with pulmonary arterial hypertension, rapid inpatient titration of intravenous treprostinil is safe and tolerable.

Association between use of interferon beta and progression of disability in patients with relapsing-remitting multiple sclerosis.

Science.gov (United States)

Shirani, Afsaneh; Zhao, Yinshan; Karim, Mohammad Ehsanul; Evans, Charity; Kingwell, Elaine; van der Kop, Mia L; Oger, Joel; Gustafson, Paul; Petkau, John; Tremlett, Helen

2012-07-18

Interferon beta is widely prescribed to treat multiple sclerosis (MS); however, its relationship with disability progression has yet to be established. To investigate the association between interferon beta exposure and disability progression in patients with relapsing-remitting MS. Retrospective cohort study based on prospectively collected data (1985-2008) from British Columbia, Canada. Patients with relapsing-remitting MS treated with interferon beta (n = 868) were compared with untreated contemporary (n = 829) and historical (n = 959) cohorts. The main outcome measure was time from interferon beta treatment eligibility (baseline) to a confirmed and sustained score of 6 (requiring a cane to walk 100 m; confirmed at >150 days with no measurable improvement) on the Expanded Disability Status Scale (EDSS) (range, 0-10, with higher scores indicating higher disability). A multivariable Cox regression model with interferon beta treatment included as a time-varying covariate was used to assess the hazard of disease progression associated with interferon beta treatment. Analyses also included propensity score adjustment to address confounding by indication. The median active follow-up times (first to last EDSS measurement) were as follows: for the interferon beta-treated cohort, 5.1 years (interquartile range [IQR], 3.0-7.0 years); for the contemporary control cohort, 4.0 years (IQR, 2.1-6.4 years); and for the historical control cohort, 10.8 years (IQR, 6.3-14.7 years). The observed outcome rates for reaching a sustained EDSS score of 6 were 10.8%, 5.3%, and 23.1% in the 3 cohorts, respectively. After adjustment for potential baseline confounders (sex, age, disease duration, and EDSS score), exposure to interferon beta was not associated with a statistically significant difference in the hazard of reaching an EDSS score of 6 when either the contemporary control cohort (hazard ratio, 1.30; 95% CI, 0.92-1.83; P = .14) or the historical control cohort (hazard ratio, 0

Variation in Emergency Department vs Internal Medicine Excess Charges in the United States.

Science.gov (United States)

Xu, Tim; Park, Angela; Bai, Ge; Joo, Sarah; Hutfless, Susan M; Mehta, Ambar; Anderson, Gerard F; Makary, Martin A

2017-08-01

Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers. To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians. Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016. Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount. Our analysis included 12 337 emergency medicine physicians from 2707 hospitals and 57 607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen

Climatic water deficit, tree species ranges, and climate change in Yosemite National Park

Science.gov (United States)

James A. Lutz; Jan W. van Wagtendonk; Jerry F. Franklin

2010-01-01

Modelled changes in climate water deficit between past, present and future climate scenarios suggest that recent past changes in forest structure and composition may accelerate in the future, with species responding individualistically to further declines in water availability. Declining water availability may disproportionately affect Pinus monticola...

Effect of regional precursor emission controls on long-range ozone transport – Part 1: Short-term changes in ozone air quality

Directory of Open Access Journals (Sweden)

J. J. West

2009-08-01

Full Text Available Observations and models demonstrate that ozone and its precursors can be transported between continents and across oceans. We model the influences of 10% reductions in anthropogenic nitrogen oxide (NO_x emissions from each of nine world regions on surface ozone air quality in that region and all other regions. In doing so, we quantify the relative importance of long-range transport between all source-receptor pairs, for direct short-term ozone changes. We find that for population-weighted concentrations during the three-month "ozone-season", the strongest inter-regional influences are from Europe to the Former Soviet Union, East Asia to Southeast Asia, and Europe to Africa. The largest influences per unit of NO_x reduced, however, are seen for source regions in the tropics and Southern Hemisphere, which we attribute mainly to greater sensitivity to changes in NO_x in the lower troposphere, and secondarily to increased vertical convection to the free troposphere in tropical regions, allowing pollutants to be transported further. Results show, for example, that NO_x reductions in North America are ~20% as effective per unit NO_x in reducing ozone in Europe during summer, as NO_x reductions from Europe itself. Reducing anthropogenic emissions of non-methane volatile organic compounds (NMVOCs and carbon monoxide (CO by 10% in selected regions, can have as large an impact on long-range ozone transport as NO_x reductions, depending on the source region. We find that for many source-receptor pairs, the season of greatest long-range influence does not coincide with the season when ozone is highest in the receptor region. Reducing NO_x emissions in most source regions causes a larger decrease in export of ozone from the source region than in ozone production outside of the source region.

Is YouTube Useful as a Source of Health Information for Adults With Type 2 Diabetes? A South Asian Perspective.

Science.gov (United States)

Leong, Amanda Y; Sanghera, Ravina; Jhajj, Jaspreet; Desai, Nandini; Jammu, Bikramjit Singh; Makowsky, Mark J

2017-12-25

To investigate the content, quality and popularity of information about type 2 diabetes available on YouTube. We searched YouTube with the terms Diabetes, Diabetes type 2, Diabetes South Asians, Diabetes Punjabi and Diabetes Hindi to identify videos concerning type 2 diabetes. A team of health-care providers independently classified the first 20 videos from each search as useful, misleading, or personal experience, rated them on a 5-point global quality scale (GQS) and categorized their content on a 26-point scale in duplicate. Useful videos were rated for reliability by using a 5-point modified DISCERN scale. Higher scores represent better quality, reliability and comprehensiveness. Of 100 videos, 71 met the inclusion criteria; 45 (63.4%) were rated as useful (median GQS, 3; interquartile range [IQR], 2 to 4); and 23 (32.4%) were deemed misleading (median GQS, 1; IQR, 1 to 2). Median reliability and content scores for useful videos were 3 (IQR, 2 to 3) and 5 (IQR, 3 to 10), respectively, and 6 videos met ≥ 4 of 5 reliability criteria. Overall, misleading videos were more popular than useful videos (median, 233 views/day; IQR, 26 to 523; vs. 8.3 views/day; IQR, 0.4 to 134.6; p<0.01). Culturally tailored videos were just as likely to be misleading and had similar GQS scores in comparison to nonculturally tailored videos (32.1% vs. 32.6% and 3 vs. 3, respectively). The quality of identified videos concerning type 2 diabetes was variable, and misleading videos were popular. Further creation and curation of high-quality video resources is required. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

Patient Handoffs: Is Cross Cover or Night Shift Better?

Science.gov (United States)

Higgins, Alanna; Brannen, Melissa L; Heiman, Heather L; Adler, Mark D

2017-06-01

Studies show singular handoffs between health care providers to be risky. Few describe sequential handoffs or compare handoffs from different provider types. We investigated the transfer of information across 2 handoffs using a piloted survey instrument. We compared cross-cover (every fourth night call) with dedicated night-shift residents. Surveys assessing provider knowledge of hospitalized patients were administered to pediatric residents. Primary teams were surveyed about their handoff upon completion of daytime coverage of a patient. Night-shift or cross-covering residents were surveyed about their handoff of the same patient upon completion of overnight coverage. Pediatric hospitalists rated the consistency of information between the surveys. Absolute difference was calculated between the 2 providers' rating of a patient's (a) complexity and (b) illness severity. Scores were compared across provider type. Fifty-nine complete handoff pairs were obtained. Fourteen and 45 handoff surveys were completed by a cross-covering and a night-shift provider, respectively. There was no significant difference in information consistency between primary and night-shift (median, 4.0; interquartile range [IQR], 3-4) versus primary and cross-covering providers (median, 4.0; IQR, 3-4). There was no significant difference in median patient complexity ratings (night shift, 3.0; IQR, 1-5, versus cross cover, 3.5; IQR, 1-5) or illness severity ratings (night shift, 2.0; IQR, 1-4, versus cross-cover, 3.0; IQR, 1-6) when comparing provider types giving a handoff. We did not find a difference in physicians' transfer of information during 2 handoffs among providers taking traditional call or on night shift. Development of tools to measure handoff consistency is needed.

Impact of a logistics management program on admitted patient boarders within an emergency department.

Science.gov (United States)

Healy-Rodriguez, Mary Anne; Freer, Chris; Pontiggia, Laura; Wilson, Rula; Metraux, Steve; Lord, Lyndsey

2014-03-01

ED crowding is a public health issue, and hospitals across the country must pursue aggressive strategies to improve patient flow to help solve this growing problem. The logistics management program (LMP) is an expansion of the bed management process to include a systematic approach to patient flow management throughout the facility and a clinical liaison or field agent to drive throughput at all points of care. The purpose of this study was to examine the effects of an LMP on ED length of stay (ED evaluation times and ED placement times), as well as inpatient length of stay (IPLOS). This is a quasi-experimental study of 28,684 ED admissions in a suburban, tertiary medical center before and after implementing an LMP (2008 vs 2009). The median ED evaluation time was 219 minutes (interquartile range [IQR], 178 minutes) in 2008 versus 207 minutes (IQR, 171 minutes) in 2009 (P < .001). The median ED placement time was 219 minutes (IQR, 259 minutes) in 2008 versus 193 minutes (IQR, 158 minutes) in 2009 (P < .001). The median IPLOS was 3.93 days (IQR, 4.9 days) in 2008 versus 3.83 days (IQR, 4.7 days) in 2009 (P < .001), which represents a reduction of 1,483 inpatient days in 2009. The results provide strong evidence to support the impact of an LMP on decreasing ED evaluation times, ED placement times, and IPLOS. Further exploration is needed to examine the program as a best practice, as well as its applicability for other facilities. Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Using Simulation as an Investigational Methodology to Explore the Impact of Technology on Team Communication and Patient Management: A Pilot Evaluation of the Effect of an Automated Compression Device.

Science.gov (United States)

Gittinger, Matthew; Brolliar, Sarah M; Grand, James A; Nichol, Graham; Fernandez, Rosemarie

2017-06-01

This pilot study used a simulation-based platform to evaluate the effect of an automated mechanical chest compression device on team communication and patient management. Four-member emergency department interprofessional teams were randomly assigned to perform manual chest compressions (control, n = 6) or automated chest compressions (intervention, n = 6) during a simulated cardiac arrest with 2 phases: phase 1 baseline (ventricular tachycardia), followed by phase 2 (ventricular fibrillation). Patient management was coded using an Advanced Cardiovascular Life Support-based checklist. Team communication was categorized in the following 4 areas: (1) teamwork focus; (2) huddle events, defined as statements focused on re-establishing situation awareness, reinforcing existing plans, and assessing the need to adjust the plan; (3) clinical focus; and (4) profession of team member. Statements were aggregated for each team. At baseline, groups were similar with respect to total communication statements and patient management. During cardiac arrest, the total number of communication statements was greater in teams performing manual compressions (median, 152.3; interquartile range [IQR], 127.6-181.0) as compared with teams using an automated compression device (median, 105; IQR, 99.5-123.9). Huddle events were more frequent in teams performing automated chest compressions (median, 4.0; IQR, 3.1-4.3 vs. 2.0; IQR, 1.4-2.6). Teams randomized to the automated compression intervention had a delay to initial defibrillation (median, 208.3 seconds; IQR, 153.3-222.1 seconds) as compared with control teams (median, 63.2 seconds; IQR, 30.1-397.2 seconds). Use of an automated compression device may impact both team communication and patient management. Simulation-based assessments offer important insights into the effect of technology on healthcare teams.

Quality of oral anticoagulation with phenprocoumon in regular medical care and its potential for improvement in a telemedicine-based coagulation service--results from the prospective, multi-center, observational cohort study thrombEVAL.

Science.gov (United States)

Prochaska, Jürgen H; Göbel, Sebastian; Keller, Karsten; Coldewey, Meike; Ullmann, Alexander; Lamparter, Heidrun; Jünger, Claus; Al-Bayati, Zaid; Baer, Christina; Walter, Ulrich; Bickel, Christoph; ten Cate, Hugo; Münzel, Thomas; Wild, Philipp S

2015-01-23

The majority of studies on quality of oral anticoagulation (OAC) therapy with vitamin K-antagonists are performed with short-acting warfarin. Data on long-acting phenprocoumon, which is frequently used in Europe for OAC therapy and is considered to enable more stable therapy adjustment, are scarce. In this study, we aimed to assess quality of OAC therapy with phenprocoumon in regular medical care and to evaluate its potential for optimization in a telemedicine-based coagulation service. In the prospective observational cohort study program thrombEVAL we investigated 2,011 patients from regular medical care in a multi-center cohort study and 760 patients from a telemedicine-based coagulation service in a single-center cohort study. Data were obtained from self-reported data, computer-assisted personal interviews, and laboratory measurements according to standard operating procedures with detailed quality control. Time in therapeutic range (TTR) was calculated by linear interpolation method to assess quality of OAC therapy. Study monitoring was carried out by an independent institution. Overall, 15,377 treatment years and 48,955 international normalized ratio (INR) measurements were analyzed. Quality of anticoagulation, as measured by median TTR, was 66.3% (interquartile range (IQR) 47.8/81.9) in regular medical care and 75.5% (IQR 64.2/84.4) in the coagulation service (P service with TTR at 76.2% [(IQR 65.6/84.7); P = 0.001)]. Prospective follow-up of coagulation service patients with pretreatment in regular medical care showed an improvement of the TTR from 66.2% (IQR 49.0/83.6) to 74.5% (IQR 62.9/84.2; P service. Treatment in the coagulation service contributed to an optimization of the profile of time outside therapeutic range, a 2.2-fold increase of stabile INR adjustment and a significant decrease in TTR variability by 36% (P Quality of anticoagulation with phenprocoumon was comparably high in this real-world sample of regular medical care. Treatment in a

Active Video Gaming for Children with Cerebral Palsy: Does a Clinic-Based Virtual Reality Component Offer an Additive Benefit? A Pilot Study.

Science.gov (United States)

Levac, Danielle; McCormick, Anna; Levin, Mindy F; Brien, Marie; Mills, Richard; Miller, Elka; Sveistrup, Heidi

2018-02-01

To compare changes in gross motor skills and functional mobility between ambulatory children with cerebral palsy who underwent a 1-week clinic-based virtual reality intervention (VR) followed by a 6-week, therapist-monitored home active video gaming (AVG) program and children who completed only the 6-week home AVG program. Pilot non-randomized controlled trial. Five children received 1 hour of VR training for 5 days followed by a 6-week home AVG program, supervised online by a physical therapist. Six children completed only the 6-week home AVG program. The Gross Motor Function Measure Challenge Module (GMFM-CM) and Six Minute Walk Test (6MWT) evaluated change. There were no significant differences between groups. The home AVG-only group demonstrated a statistically and clinically significant improvement in GMFM-CM scores following the 6-week AVG intervention (median difference 4.5 points, interquartile range [IQR] 4.75, p = 0.042). The VR + AVG group demonstrated a statistically and clinically significant decrease in 6MWT distance following the intervention (median decrease 68.2 m, IQR 39.7 m, p = 0.043). All 6MWT scores returned to baseline at 2 months post-intervention. Neither intervention improved outcomes in this small sample. Online mechanisms to support therapist-child communication for exercise progression were insufficient to individualize exercise challenge.

Cytokine expression during syphilis infection in HIV-1-infected individuals

DEFF Research Database (Denmark)

Knudsen, Andreas; Benfield, Thomas; Kofoed, Kristian

2009-01-01

BACKGROUND: Little is known about cytokine responses to syphilis infection in HIV-1-infected individuals. METHODS: We retrospectively identified patients with HIV-1 and Treponema pallidum coinfection. Plasma samples from before, during, and after coinfection were analyzed for interleukin (IL)-2, IL......-4, IL-6, IL-8, IL-10, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha. RESULTS: Thirty-six patients were included. IL-10 levels increased significantly in patients with primary or secondary stage syphilis from a median of 12.8 pg/mL [interquartile range (IQR), 11.0-27.8] before...... infection to 46.7 pg/mL (IQR, 28.4-78.9) at the time of diagnosis (P = 0.027) and decreased to 13.0 pg/mL (IQR, 6.2-19.4) after treatment of syphilis (P syphilis in patients with primary or secondary stage syphilis (median 3.9 pg...

Sun protection policies of Australian primary schools in a region of high sun exposure.

Science.gov (United States)

Harrison, S L; Garzón-Chavez, D R; Nikles, C J

2016-06-01

Queensland, Australia has the highest rates of skin cancer globally. Predetermined criteria were used to score the comprehensiveness of sun protection policies (SPP) of primary schools across Queensland. SPP were sought for schools in 10 regions (latitude range 16.3°S-28.1°S) from 2011 to 2014. Of the 723 schools sampled, 90.9% had a written SPP available publicly. Total SPP scores were low {mean 3.6 [95% CI: 3.4-3.9]; median 2 [interquartile range (IQR) 2, 4]}, with only 3.2% of schools achieving the maximum score of 12. Median SPP scores were higher in Northern and Central Queensland [both 2 (IQR 2, 6) and (IQR 2, 5), respectively] than in Southern Queensland [2 (IQR 2, 3); P = 0.004]. Clothing and hat-wearing were addressed in most policies (96% and 89%) while few schools used their SPP to plan outdoor events (5.2%) or reschedule activities to minimize sun exposure (11.7%). The SunSmart Schools program has been operating in Queensland for 17 years, and while most primary schools now have a written SPP, most are not comprehensive. Incentive-based approaches (5-star-rating award scheme and grants) may assist in addressing this issue, to reduce sun exposure of students and teachers. These data provide a baseline from which improvements in the comprehensiveness of school SPPs can be evaluated. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Cyclooxygenase inhibitors in preterm infants with patent ductus arteriosus: effects on cardiac and vascular indices.

Science.gov (United States)

Sehgal, Arvind; Doctor, Tejas; Menahem, Samuel

2014-12-01

Existing data suggest subendocardial ischemia in preterm infants with patent ductus arteriosus (PDA) and alterations in cardiac function after indomethacin administration. This study aimed to explore the evolution of left ventricular function by conventional echocardiography and speckle-tracking echocardiography (STE) and to ascertain the interrelationship with coronary flow indices in response to indomethacin. A prospective observational study was performed with preterm infants receiving indomethacin for medical closure of PDA. Serial echocardiography was performed, and the results were analyzed using analysis of variance. Intra- and interobserver variability was assessed using the intraclass correlation coefficient. Indomethacin was administered to 18 infants born at a median gestational age of 25.8 weeks (interquartile range [IQR], 24.2-28.1 weeks) with a birth weight of 773 g (IQR, 704-1,002 g). The median age of the infants was 7.5 days (IQR, 4-17). Global longitudinal strain (GLS) values significantly decreased immediately after indomethacin infusion (preindomethacin GLS, -19.1 ± 2.4 % vs. -15.9 ± 1.7 %; p < 0.0001) but had improved at reassessment after 1 h (-17.4 ± 1.8 %). Conventional echocardiographic indices did not show significant alterations. A significant increase in arterial resistance in the coronary vasculature from 1.7 to 2.4 mmHg/cm/s was demonstrated. A significant correlation was noted between peak systolic GLS and flow resistance in the coronary vasculature. Significant changes in myocardial indices were observed immediately after indomethacin infusion. Compared with conventional methods, STE is a more sensitive tool to facilitate understanding of hemodynamics in preterm infants.

A multi-species modelling approach to examine the impact of alternative climate change adaptation strategies on range shifting ability in a fragmented landscape

OpenAIRE

Synes, Nicholas W.; Watts, Kevin; Palmer, Stephen C.F.; Bocedi, Greta; Bartoń, Kamil A.; Osborne, Patrick E.; Travis, Justin M.J.

2015-01-01

An individual-based model of animal dispersal and population dynamics was used to test the effects of different climate change adaptation strategies on species range shifting ability, namely the improvement of existing habitat, restoration of low quality habitat and creation of new habitat. These strategies were implemented on a landscape typical of fragmentation in the United Kingdom using spatial rules to differentiate between the allocation of strategies adjacent to or away from existing h...

Conversion from insulin glargine U-100 to insulin glargine U-300 or insulin degludec and the impact on dosage requirements.

Science.gov (United States)

Pearson, Scott M; Trujillo, Jennifer M

2018-04-01

We wanted to determine whether basal insulin requirements change when patients transition from insulin glargine U-100 (Gla-100) to insulin glargine U-300 (Gla-300) or insulin degludec. This study involved subjects seen in the University of Colorado Health Endocrine Clinic who were transitioned from Gla-100 to either Gla-300 ( n = 95) or insulin degludec ( n = 39). The primary outcome was the difference between baseline Gla-100 dose and dose of Gla-300 or insulin degludec prescribed after first follow-up visit within 1-12 months. Secondary outcomes included changes in glycemic control and empiric dose conversion from Gla-100 to Gla-300 or insulin degludec on the day of transition. Wilcoxon rank sum tests evaluated changes in insulin doses, and paired t tests assessed changes in glycemic control using GraphPad statistical software. Median daily basal insulin dose increased for individuals transitioned from Gla-100 to Gla-300 from 30 [19-60 interquartile range (IQR)] units at baseline to 34.5 (19-70 IQR) units after follow up ( p = 0.01). For patients transitioned to insulin degludec, dose changes from baseline to follow up were not significantly different ( p = 0.56). At the time of transition, the prescribed dose of Gla-300 or insulin degludec did not significantly differ from the previous dose of Gla-100 ( p = 0.73 and 0.28, respectively), indicating that empiric dose adjustments were not routinely prescribed. Patients who transitioned from Gla-100 to Gla-300 had increased basal insulin requirements between visits, while basal insulin requirements for those transitioned from Gla-100 to insulin degludec were not significantly different.

Analytical Validation and Clinical Qualification of a New Immunohistochemical Assay for Androgen Receptor Splice Variant-7 Protein Expression in Metastatic Castration-resistant Prostate Cancer.

Science.gov (United States)

Welti, Jonathan; Rodrigues, Daniel Nava; Sharp, Adam; Sun, Shihua; Lorente, David; Riisnaes, Ruth; Figueiredo, Ines; Zafeiriou, Zafeiris; Rescigno, Pasquale; de Bono, Johann S; Plymate, Stephen R

2016-10-01

The androgen receptor splice variant-7 (AR-V7) has been implicated in the development of castration-resistant prostate cancer (CRPC) and resistance to abiraterone and enzalutamide. To develop a validated assay for detection of AR-V7 protein in tumour tissue and determine its expression and clinical significance as patients progress from hormone-sensitive prostate cancer (HSPC) to CRPC. Following monoclonal antibody generation and validation, we retrospectively identified patients who had HSPC and CRPC tissue available for AR-V7 immunohistochemical (IHC) analysis. Nuclear AR-V7 expression was determined using IHC H score (HS) data. The change in nuclear AR-V7 expression from HSPC to CRPC and the association between nuclear AR-V7 expression and overall survival (OS) was determined. Nuclear AR-V7 expression was significantly lower in HSPC (median HS 50, interquartile range [IQR] 17.5-90) compared to CRPC (HS 135, IQR 80-157.5; pprostate cancer. A higher level of AR-V7 identifies a group of patients who respond less well to certain prostate cancer treatments and live for a shorter period of time. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Widespread range expansions shape latitudinal variation in insect thermal limits

Science.gov (United States)

Lancaster, Lesley T.

2016-06-01

Current anthropogenic impacts, including habitat modification and climate change, may contribute to a sixth mass extinction. To mitigate these impacts and slow further losses of biodiversity, we need to understand which species are most at risk and identify the factors contributing to current and future declines. Such information is often obtained through large-scale, comparative and biogeographic analysis of lineages or traits that are potentially sensitive to ongoing anthropogenic change--for instance to predict which regions are most susceptible to climate change-induced biodiversity loss. However, for this approach to be generally successful, the underlying causes of identified geographical trends need to be carefully considered. Here, I augment and reanalyse a global data set of insect thermal tolerances, evaluating the contribution of recent and contemporary range expansions to latitudinal variation in thermal niche breadth. Previous indications that high-latitude ectotherms exhibit broad thermal niches and high warming tolerances held only for species undergoing range expansions or invasions. In contrast, species with stable or declining geographic ranges exhibit latitudinally decreasing absolute thermal tolerances and no latitudinal variation in tolerance breadths. Thus, non-range-expanding species, particularly insular or endemic species, which are often of highest conservation priority, are unlikely to tolerate future climatic warming at high latitudes.

Target recognition of log-polar ladar range images using moment invariants

Science.gov (United States)

Xia, Wenze; Han, Shaokun; Cao, Jie; Yu, Haoyong

2017-01-01

The ladar range image has received considerable attentions in the automatic target recognition field. However, previous research does not cover target recognition using log-polar ladar range images. Therefore, we construct a target recognition system based on log-polar ladar range images in this paper. In this system combined moment invariants and backpropagation neural network are selected as shape descriptor and shape classifier, respectively. In order to fully analyze the effect of log-polar sampling pattern on recognition result, several comparative experiments based on simulated and real range images are carried out. Eventually, several important conclusions are drawn: (i) if combined moments are computed directly by log-polar range images, translation, rotation and scaling invariant properties of combined moments will be invalid (ii) when object is located in the center of field of view, recognition rate of log-polar range images is less sensitive to the changing of field of view (iii) as object position changes from center to edge of field of view, recognition performance of log-polar range images will decline dramatically (iv) log-polar range images has a better noise robustness than Cartesian range images. Finally, we give a suggestion that it is better to divide field of view into recognition area and searching area in the real application.

Implementation and outcome evaluation of the Medical Education ...

African Journals Online (AJOL)

Implementation and outcome evaluation of the Medical Education ... the pretest median score was 55% (interquartile range (IQR) 40 - 62%) and the posttest ... This education mode offers the opportunity for health researchers to advance their ...

Incidence of nevirapine-associated hepatitis in an antenatal clinic ...

African Journals Online (AJOL)

based highly active antiretroviral therapy at a dedicated antenatal antiretroviral clinic between July 2004 and December 2006. Results. Three hundred and ninety women were included in the analysis. Median age was 29 (interquartile range (IQR)

Efficacy of an expanded ventilator bundle for the reduction of ventilator-associated pneumonia in the medical intensive care unit.

Science.gov (United States)

Blamoun, John; Alfakir, Maria; Rella, Marie E; Wojcik, Janice M; Solis, Roberto A; Anees Khan, M; DeBari, Vincent A

2009-03-01

The ventilator bundle (VB) includes a group of clinical maneuvers (head-of-bed elevation, "sedation vacation," deep vein thrombosis prophylaxis, and peptic ulcer disease prophylaxis) to improve outcomes in patients undergoing mechanical ventilation. We modified the standard VB in our medical intensive care unit to include a group of respiratory therapist-driven protocols and, postimplementation, observed a statistically significant (P = .0006) reduction in ventilator-associated pneumonia (VAP), from a median of 14.1 cases/10(3) ventilator-days (interquartile range [IQR] = 12.1 to 20.6) to 0 cases/10(3) ventilator-days (IQR = 0 to 1.1).

Three Year RSA Evaluation of Vitamin E Diffused Highly Cross-linked Polyethylene Liners and Cup Stability

DEFF Research Database (Denmark)

Sillesen, Nanna H; Greene, Meridith E; Nebergall, Audrey K

2015-01-01

10-year RSA. This is the first evaluation of the multicenter cohort after 3-years. All patients received E-XLPE liners (E1, Biomet) and porous-titanium coated cups (Regenerex, Biomet). There was no difference (P=0.450) in median femoral head penetration into the E-XLPE liners at 3-years comparing...... cobalt-chrome heads (-0.028mm; inter-quartile range (IQR) - 0.065 to 0.047) with ceramic heads (-0.043mm, IQR - 0.143to0.042). The 3-year follow-up indicates minimal E-XLPE liner penetration regardless of head material and minimal early cup movement....

Decontamination of stethoscope membranes with chlorhexidine: Should it be recommended?

Science.gov (United States)

Álvarez, José A; Ruíz, Susana R; Mosqueda, Juan L; León, Ximena; Arreguín, Virginia; Macías, Alejandro E; Macias, Juan H

2016-11-01

To determine differences in the recontamination of stethoscope membranes after cleaning with chlorhexidine, triclosan, or alcohol. Experimental, controlled, blinded trial to determine differences in the bacterial load on stethoscope membranes. Membranes were cultured by direct imprint after disinfection with 70% isopropyl alcohol, 1% triclosan, or 1% chlorhexidine and normal use for 4 hours. As a baseline and an immediate effect control, bacterial load of membranes without disinfection and after 1 minute of disinfection with isopropyl alcohol was determined as well. Three hundred seventy cultures of in-use stethoscopes were taken, 74 from each arm. In the baseline arm the median growth was 10 CFU (interquartile range [IQR], 32-42 CFU); meanwhile, in the isopropyl alcohol immediate-effect arm it was 0 CFU (IQR, 0-0 CFU). In the arms cultured after 4 hours, a median growth of 8 CFU (IQR, 1-28 CFU) in the isopropyl alcohol arm, 4 CFU (IQR, 0-17 CFU) in the triclosan arm, and 0 CFU (IQR, 0-1 CFU) in the chlorhexidine arm were seen. No significant differences were observed between the bacterial load of the chlorhexidine arm (after 4 hours of use) and that of the isopropyl alcohol arm (after 1 minute without use) (Z= 2.41; P > .05). Chlorhexidine can inhibit recontamination of stethoscope membranes and its use could help avoid cross-infection. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Is There a Relationship Between Body Mass Index and Fluoroscopy Time During Sacroiliac Joint Injection? A Multicenter Cohort Study.

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McCormick, Zachary L; Cushman, Daniel; Lee, David T; Scholten, Paul; Chu, Samuel K; Babu, Ashwin N; Caldwell, Mary; Ziegler, Craig; Ashraf, Humaira; Sundar, Bindu; Clark, Ryan; Gross, Claire; Cara, Jeffrey; McCormick, Kristen; Ross, Brendon; Smith, Clark C; Press, Joel; Smuck, Matthew; Walega, David R

2016-07-01

To determine the relationship between BMI and fluoroscopy time during intra-articular sacroiliac joint (SIJ) injections performed for a pain indication. Multicenter retrospective cohort study. Three academic, outpatient pain treatment centers. Patients who underwent fluoroscopy guided SIJ injection with encounter data regarding fluoroscopy time during the procedure and body mass index (BMI). Median and 25-75% Interquartile Range (IQR) fluoroscopy time. 459 SIJ injections (350 patients) were included in this study. Patients had a median age of 57 (IQR 44, 70) years, and 72% were female. The median BMI in the normal weight, overweight, and obese groups were 23 (IQR 21, 24), 27 (IQR 26, 29), and 35 (IQR 32, 40), respectively. There was no significant difference in the median fluoroscopy time recorded between these BMI classes (p = 0.45). First-time SIJ injection (p = 0.53), bilateral injection (p = 0.30), trainee involvement (p = 0.47), and new trainee involvement (trainee participation during the first 2 months of the academic year) (p = 0.85) were not associated with increased fluoroscopy time for any of the three BMI categories. Fluoroscopy time during sacroiliac joint injection is not increased in patients who are overweight or obese, regardless of whether a first-time sacroiliac joint injection was performed, bilateral injections were performed, a trainee was involved, or a new trainee was involved. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians

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Sanjeev Bhoi

2012-01-01

Full Text Available Background: Patients require procedural sedation and analgesia (PSA for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US guided peripheral nerve block is a safe alternative. Aim: Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED. Setting and Design: Prospective observational study conducted in ED. Materials and Methods: Patients above five years requiring analgesia for management of limb emergencies were recruited. Emergency Physicians trained in US guided nerve blocks performed the procedure. Statistical analysis: Effectiveness of pain control, using visual analogue scale was assessed at baseline and at 15 and 60 minutes after the procedure. Paired t test was used for comparison. Results: Fifty US guided nerve blocks were sciatic- 4 (8%, femoral-7 (14%, brachial- 29 (58%, median -6 (12%, and radial 2 (4% nerves. No patients required rescue PSA. Initial median VAS score was 9 (Inter Quartile Range [IQR] 7-10 and at 1 hour was 2(IQR 0-4. Median reduction in VAS score was 7.44 (IQR 8-10(75%, 1-2(25% (P=0.0001. Median procedure time was 9 minutes (IQR 3, 12 minutes and median time to reduction of pain was 5 minutes (IQR 1,15 minutes. No immediate or late complications noticed at 3 months. Conclusion: Ultrasound-guided nerve blocks can be safely and effectively performed for upper and lower limb emergencies by emergency physicians with adequate training.

Gammaknife radiosurgery in patients with acromegaly.

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Erdur, Fatih M; Kilic, Türker; Peker, Selcuk; Celik, Ozlem; Kadioglu, Pinar

2011-12-01

We aimed to evaluate the efficacy and reliability of gamma-knife radiosurgery (GKR) in 22 patients with acromegaly at the Endocrinology-Metabolism Clinic of Cerrahpasa Medical School. We collected data retrospectively from hospital records on disease activity and other pituitary functions, pituitary MRI and visual fields, before GKR and 6, 12, 24, 36, 48 and 60 months after GKR. The median follow-up duration after GKR was 60 months (interquartile range [IQR]: 24-60 months). The remission rate was 54.5% after the 60 months of follow-up. The median growth hormone (GH) level at 60 months after GKR (0.99 ng/mL [IQR: 0.36-2.2]) was significantly lower than the median GH level before GKR (5.65 ng/mL [IQR: 3.85-7.2] (p=0.002). The median insulin-like growth factor-1 (IGF-1) level 60 months after GKR (221.5 ng/mL [IQR: 149-535]) was significantly lower than the median IGF-1 level before GKR (582.5 ng/mL [IQR: 515-655]) (p=0.008). Tumour growth was well controlled in 20 patients (95.2%). Six patients (28.6%) developed new-onset hypopituitarism. We concluded that GKR is an effective adjuvant treatment to control tumour growth, lower GH and IGF-1 levels, and to increase remission rates in patients with acromegaly who were refractory to surgical and medical treatment. Copyright © 2011 Elsevier Ltd. All rights reserved.

Evolution of competitive ability within Lonicera japonica's invaded range

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Gregory A. Evans; Francis F. Kilkenny; Laura F. Galloway

2013-01-01

Factors influencing invasive taxa may change during the course of an invasion. For example, intraspecific competition is predicted to be more important in areas with older stands of dense monospecific invaders than at the margins of an invaded range. We evaluated evolution in response to predicted changes in competition by comparing the intraspecific competitive...

Ground-Dwelling Arthropod Communities of a Sky Island Mountain Range in Southeastern Arizona, USA: Obtaining a Baseline for Assessing the Effects of Climate Change.

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Wallace M Meyer

Full Text Available The few studies that have addressed past effects of climate change on species distributions have mostly focused on plants due to the rarity of historical faunal baselines. However, hyperdiverse groups like Arthropoda are vital to monitor in order to understand climate change impacts on biodiversity. This is the first investigation of ground-dwelling arthropod (GDA assemblages along the full elevation gradient of a mountain range in the Madrean Sky Island Region, establishing a baseline for monitoring future changes in GDA biodiversity. To determine how GDA assemblages relate to elevation, season, abiotic variables, and corresponding biomes, GDA were collected for two weeks in both spring (May and summer (September 2011 in the Santa Catalina Mountains, Arizona, using pitfall traps at 66 sites in six distinct upland (non-riparian/non-wet canyon biomes. Four arthropod taxa: (1 beetles (Coleoptera, (2 spiders (Araneae, (3 grasshoppers and crickets (Orthoptera, and (4 millipedes and centipedes (Myriapoda were assessed together and separately to determine if there are similar patterns across taxonomic groups. We collected 335 species of GDA: 192/3793 (species/specimens Coleoptera, 102/1329 Araneae, 25/523 Orthoptera, and 16/697 Myriapoda. GDA assemblages differed among all biomes and between seasons. Fifty-three percent (178 species and 76% (254 species of all GDA species were found in only one biome and during only one season, respectively. While composition of arthropod assemblages is tied to biome and season, individual groups do not show fully concordant patterns. Seventeen percent of the GDA species occurred only in the two highest-elevation biomes (Pine and Mixed Conifer Forests. Because these high elevation biomes are most threatened by climate change and they harbor a large percentage of unique arthropod species (11-25% depending on taxon, significant loss in arthropod diversity is likely in the Santa Catalina Mountains and other isolated

Distribution of specialized care centers in the United States.

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Wang, Henry E; Yealy, Donald M

2012-11-01

As a recommended strategy for optimally managing critical illness, regionalization of care involves matching the needs of the target population with available hospital resources. The national supply and characteristics of hospitals providing specialized critical care services is currently unknown. We seek to characterize the current distribution of specialized care centers in the United States. Using public data linked with the American Hospital Association directory and US Census, we identified US general acute hospitals providing specialized care for ST-segment elevation myocardial infarction (STEMI) (≥40 annual primary percutaneous coronary interventions reported in Medicare Hospital Compare), stroke (The Joint Commission certified stroke centers), trauma (American College of Surgeons or state-designated, adult or pediatric, level I or II), and pediatric critical care (presence of a pediatric ICU) services. We determined the characteristics and state-level distribution and density of specialized care centers (centers per state and centers per state population). Among 4,931 acute care hospitals in the United States, 1,325 (26.9%) provided one of the 4 defined specialized care services, including 574 STEMI, 763 stroke, 508 trauma, and 457 pediatric critical care centers. Approximately half of the 1,325 hospitals provided 2 or more specialized services, and one fifth provided 3 or 4 specialized services. There was variation in the number of each type of specialized care center in each state: STEMI median 7 interquartile range (IQR 2 to 14), stroke 8 (IQR 3 to 17), trauma 6 (IQR 3 to 11), pediatric specialized care 6 (IQR 3 to 11). Similarly, there was variation in the number of each type of specialized care center per population: STEMI median 1 center per 585,135 persons (IQR 418,729 to 696,143), stroke 1 center per 412,188 persons (IQR 321,604 to 572,387), trauma 1 center per 610,589 persons (IQR 406,192 to 917,588), and pediatric critical care 1 center per 665

Surgical stabilization of rib fractures using Inion OTPS wraps--techniques and quality of life follow-up.

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Campbell, Nicole; Conaglen, Paul; Martin, Katherine; Antippa, Phillip

2009-09-01

A variety of operative techniques have been described in the past for the surgical stabilization of fractured ribs. From February 2004 to November 2008, consecutive patients who underwent open reduction and internal fixation of traumatic fractured ribs during their index admission using the Inion orthopedic trauma plating system (OTPS) at a Level I trauma center were retrospectively analyzed. Demographics, Injury Severity Scores, number and site of rib fractures, operative details, and complications were recorded. All patients were followed-up with a questionnaire assessing chest symptoms, disability, and quality of life. Thirty-two patients underwent surgical stabilization with Inion OTPS. Road crashes were the commonest mechanism of injury (81%), followed by falls. Seventy-two percent of patients were male, with a median age at operation of 53 years (interquartile range [IQR], 40-64 years). Median number of ribs fixed was 3 (IQR, 2-4), while median number of fractures was 9 (IQR, 6-13). Median time to fixation was 5 days (IQR, 3-7 days), intensive care unit stay 3 days (IQR, 0.8-6.3 days), and total hospital stay 13.5 days (IQR, 8.8-22 days). Wound infection occurred in 19%, with nonunion of a fixed fracture in one patient. Sixty-three percent of patients completed the survey with a mean time between open reduction and internal fixation and questionnaire of 1,039 days (+/-480 days). Patients reported low levels of pain at rest and with coughing (median at rest 1.0/10 [IQR, 0-2.3/10]; with coughing 1.3/10 [IQR, 0-3.75/10]). Chest wall stiffness was experienced by 60% of patients, while dyspnoea at rest was reported by 20% of patients. Mean return to work (for 55%) was 3.9 months (+/-3.3 months). All patients were satisfied with the results of their operation. Patients demonstrated low levels of pain and satisfactory rehabilitation. The Inion OTPS system has several advantages including gradual transference of stress loads to bone, micromotion across the fracture

Probing the role of long-range interactions in the dynamics of a long-range Kitaev chain

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Dutta, Anirban; Dutta, Amit

2017-09-01

We study the role of long-range interactions (more precisely, the long-range superconducting gap term) on the nonequilibrium dynamics considering a long-range p -wave superconducting chain in which the superconducting term decays with distance between two sites in a power-law fashion characterized by an exponent α . We show that the Kibble-Zurek scaling exponent, dictating the power-law decay of the defect density in the final state reached following a slow (in comparison to the time scale associated with the minimum gap in the spectrum of the Hamiltonian) quenching of the chemical potential μ across a quantum critical point, depends nontrivially on the exponent α as long as α 2 , we find that the exponent saturates to the corresponding well-known value of 1 /2 expected for the short-range model. Furthermore, studying the dynamical quantum phase transitions manifested in the nonanalyticities in the rate function of the return possibility I (t ) in subsequent temporal evolution following a sudden change in μ , we show the existence of a new region; in this region, we find three instants of cusp singularities in I (t ) associated with a single sector of Fisher zeros. Notably, the width of this region shrinks as α increases and vanishes in the limit α →2 , indicating that this special region is an artifact of the long-range nature of the Hamiltonian.

Factors influencing time to diagnosis and initiation of treatment of endemic Burkitt Lymphoma among children in Uganda and western Kenya: a cross-sectional survey.

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Buckle, Geoffrey C; Collins, Jennifer Pfau; Sumba, Peter Odada; Nakalema, Beccy; Omenah, Dorine; Stiffler, Kristine; Casper, Corey; Otieno, Juliana A; Orem, Jackson; Moormann, Ann M

2013-09-30

Survival rates for children diagnosed with Burkitt lymphoma (BL) in Africa are far below those achieved in developed countries. Late stage of presentation contributes to poor prognosis, therefore this study investigated factors leading to delays in BL diagnosis and treatment of children in Uganda and western Kenya. Guardians of children diagnosed with BL were interviewed at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JTRH) and Uganda Cancer Institute (UCI) from Jan-Dec 2010. Information on sociodemographics, knowledge, attitudes, illness perceptions, health-seeking behaviors and prior health encounters was collected using a standardized, pre-tested questionnaire. Eighty-two guardians were interviewed (20 JTRH, 62 UCI). Median "total delay" (1st symptoms to BL diagnosis) was 12.1 weeks [interquartile range (IQR) 4.9-19.9] in Kenya and 12.9 weeks (IQR 4.3-25.7) in Uganda. In Kenya, median "guardian delay" (1st symptoms to 1st health encounter) and "health system delay" (1st health encounter to BL diagnosis) were 9.0 weeks (IQR 3.6-15.7) and 2.0 weeks (IQR 1.6-5.8), respectively. Data on guardian and health system delay in Uganda were only available for those with system delay 2.6 weeks (range 0.1-16.0), and total delay 10.7 weeks (range 1.7-154.3). Guardians in Uganda reported more health encounters than those in Kenya (median 5, range 3-16 vs. median 3, range 2-6). Among Kenyan guardians, source of income was the only independent predictor of delay, whereas in Uganda, guardian delay was influenced by guardians' beliefs on the curability of cancer, health system delay, by guardians' perceptions of cancer as a contagious disease, and total delay, by the number of children in the household and guardians' role as caretaker. Qualitative findings suggest financial costs, transportation, and other household responsibilities were major barriers to care. Delays from symptom onset to BL treatment were considerable given the rapid growth rate of this

Analysis of National Trends in Admissions for Pulmonary Embolism.

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Smith, Sean B; Geske, Jeffrey B; Kathuria, Parul; Cuttica, Michael; Schimmel, Daniel R; Courtney, D Mark; Waterer, Grant W; Wunderink, Richard G

2016-07-01

Pulmonary embolism (PE) remains a significant cause of hospital admission and health-care costs. Estimates of PE incidence came from the 1990s, and data are limited to describe trends in hospital admissions for PE over the past decade. We analyzed Nationwide Inpatient Sample data from 1993 to 2012 to identify patients admitted with PE. We included admissions with International Classification of Diseases, 9th revision, codes listing PE as the principal diagnosis as well as admissions with PE listed secondary to principal diagnoses of respiratory failure or DVT. Massive PE was defined by mechanical ventilation, vasopressors, or nonseptic shock. Outcomes included hospital lengths of stay, adjusted charges, and all-cause hospital mortality. Linear regression was used to analyze changes over time. Admissions for PE increased from 23 per 100,000 in 1993 to 65 per 100,000 in 2012 (P < .001). The percent of admissions meeting criteria for massive PE decreased (5.3% to 4.4%, P = .002), but the absolute number of admissions for massive PE increased (from 1.5 to 2.8 per 100,000, P < .001). Median length of stay decreased from 8 (interquartile range [IQR], 6-11) to 4 (IQR, 3-6) days (P < .001). Adjusted hospital charges increased from $16,475 (IQR, $10,748-$26,211) in 1993 to $25,728 (IQR, $15,505-$44,493) in 2012 (P < .001). All-cause hospital mortality decreased from 7.1% to 3.2% (P < .001), but population-adjusted deaths during admission for PE increased from 1.6 to 2.1 per 100,000 (P < .001). Total admissions and hospital charges for PE have increased over the past two decades. However, the population-adjusted admission rate has increased disproportionately to the incidence of patients with severe PE. We hypothesize that these findings reflect a concerning national movement toward more admissions of less severe PE. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study.

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Verma, Amol A; Guo, Yishan; Kwan, Janice L; Lapointe-Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Cram, Peter; Dhalla, Irfan A; Hwang, Stephen W; Laupacis, Andreas; Mamdani, Muhammad M; Shadowitz, Steven; Upshur, Ross; Reid, Robert J; Razak, Fahad

2017-12-11

The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period. There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%). Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high-quality, sustainable health care system. Copyright 2017

A study on the efficacy and safety of combining dental surgery with tonsillectomy in pediatrics

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Syed F

2018-03-01

Full Text Available Faizaan Syed,1 Joshua C Uffman,1,2 Dmitry Tumin,1 Catherine M Flaitz,3,4 Joseph D Tobias,1,2 Vidya T Raman1,2 1Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 2Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, 3Department of Dentistry, Nationwide Children’s Hospital, 4Division of Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA Purpose: Few data exist on combining pediatric surgical procedures under a single general anesthetic encounter (general anesthesia. We compared perioperative outcomes of combining dental surgical procedures with tonsillectomy during one anesthetic vs separate encounters. Methods: We classified elective tonsillectomy ± adenoidectomy and restorative dentistry as combined (group C or separate (group S. Outcomes included anesthesia time, recovery duration, the need for overnight hospital stay, and postoperative complications. Results: Patients aged 4±1 years underwent tonsillectomy and dental surgery in combination (n=7 or separately (n=27. No differences were noted in total anesthesia time (C: median: 150, interquartile range [IQR]: 99, 165 vs S: median: 109, IQR: 92, 132; 95% CI of difference in median: –58, +10 minutes; P=0.115 and total recovery time (C: median: 54, IQR: 40, 108 vs S: median: 72, IQR: 58, 109; 95% CI of difference in median: –16, +48 minutes; P=0.307. The need for overnight stay (C: 4 of 7, S: 20 of 27; P=0.394 did not differ between the groups. No postoperative complications were noted in either group. Conclusion: These preliminary data support the potential feasibility of combining dental procedures with tonsillectomy during a single anesthetic encounter. Such care may not only reduce costs but also limit parental work absences and increase convenience for patient families. When compared with procedures performed separately, combined procedures did not result in increased morbidity or

Segmentation of time series with long-range fractal correlations

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Bernaola-Galván, P.; Oliver, J.L.; Hackenberg, M.; Coronado, A.V.; Ivanov, P.Ch.; Carpena, P.

2012-01-01

Segmentation is a standard method of data analysis to identify change-points dividing a nonstationary time series into homogeneous segments. However, for long-range fractal correlated series, most of the segmentation techniques detect spurious change-points which are simply due to the heterogeneities induced by the correlations and not to real nonstationarities. To avoid this oversegmentation, we present a segmentation algorithm which takes as a reference for homogeneity, instead of a random i.i.d. series, a correlated series modeled by a fractional noise with the same degree of correlations as the series to be segmented. We apply our algorithm to artificial series with long-range correlations and show that it systematically detects only the change-points produced by real nonstationarities and not those created by the correlations of the signal. Further, we apply the method to the sequence of the long arm of human chromosome 21, which is known to have long-range fractal correlations. We obtain only three segments that clearly correspond to the three regions of different G + C composition revealed by means of a multi-scale wavelet plot. Similar results have been obtained when segmenting all human chromosome sequences, showing the existence of previously unknown huge compositional superstructures in the human genome. PMID:23645997

Segmentation of time series with long-range fractal correlations.

Science.gov (United States)

Bernaola-Galván, P; Oliver, J L; Hackenberg, M; Coronado, A V; Ivanov, P Ch; Carpena, P

2012-06-01

Segmentation is a standard method of data analysis to identify change-points dividing a nonstationary time series into homogeneous segments. However, for long-range fractal correlated series, most of the segmentation techniques detect spurious change-points which are simply due to the heterogeneities induced by the correlations and not to real nonstationarities. To avoid this oversegmentation, we present a segmentation algorithm which takes as a reference for homogeneity, instead of a random i.i.d. series, a correlated series modeled by a fractional noise with the same degree of correlations as the series to be segmented. We apply our algorithm to artificial series with long-range correlations and show that it systematically detects only the change-points produced by real nonstationarities and not those created by the correlations of the signal. Further, we apply the method to the sequence of the long arm of human chromosome 21, which is known to have long-range fractal correlations. We obtain only three segments that clearly correspond to the three regions of different G + C composition revealed by means of a multi-scale wavelet plot. Similar results have been obtained when segmenting all human chromosome sequences, showing the existence of previously unknown huge compositional superstructures in the human genome.

Glycemic and weight changes after persistent use of incident oral diabetes therapy: a Veterans Administration retrospective cohort study.

Science.gov (United States)

Huizinga, Mary Margaret; Roumie, Christianne L; Greevy, Robert A; Liu, Xulei; Murff, Harvey J; Hung, Adriana M; Grijalva, Carlos G; Griffin, Marie R

2010-11-01

Systematic reviews have reported that sulfonylureas and metformin were as effective in reducing hemoglobin A1c (A1C) as other oral antidiabetic drugs (OADs) in clinical trial populations. Data on comparative effectiveness of OADs in other populations is limited. The objective was to compare the effectiveness of incident OAD regimens in reducing A1C and to compare the effect of OADs on body mass index (BMI). Retrospective cohort study using data from the Veterans Affairs Mid-South network (2001-2007). Of 18 205 veterans who filled 19 511 incident OAD prescriptions, 2096 had complete covariates, persisted on their incident treatment for 12 months, and had baseline and 12-month A1C values. For the BMI analysis, 2484 patients had complete information. Incident OAD regimens included metformin and sulfonylureas. Primary outcomes were 12-month A1C and BMI, which were compared controlling for demographic characteristics, baseline A1C and BMI, psychiatric diagnoses, and healthcare utilization. Median [interquartile range (IQR)] A1C decreased from 7.1% [6.5, 7.8] at baseline to 6.5% [6.0, 7.0] at 12 months. Twelve month-A1C in sulfonylurea users was similar to metformin users. The median [IQR] BMI decreased from 31.1 [27.8, 34.9] to 30.7 [27.5, 34.5] kg/m(2). Sulfonylureas were associated with a significantly higher 12-month BMI than metformin (12-month adjusted mean difference: 1.05 kg/m(2), 95%CI: 0.90-1.20, p use of metformin as first choice of OAD because of similar glycemic control but improved BMI when compared to sulfonylureas. Copyright © 2010 John Wiley & Sons, Ltd.

The Association Between Maternal Chronic Inflammatory Bowel Disease and Long-term Health Outcomes in Children

DEFF Research Database (Denmark)

Jølving, Line R; Nielsen, Jan; Beck-Nielsen, Signe S

2017-01-01

-term child morbidities. RESULTS: The cohort comprised 9238 children born to women with IBD (exposed), and 1,371,407 born to women without IBD (unexposed). Median follow-up time among the exposed was 9.7 years (interquartile range [IQR] 4.9-15.7) and 13.8 (interquartile range 7.4-19.9) among the unexposed...

Morbidity in congenital heart surgery in a public hospital in Argentina.

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Althabe, María; Rodríguez R, Ricardo; Balestrini, María; Charroqui, Alberto; Krynski, Mariela; Lenz, Ana M; Montonati, Mercedes; Moreno, Guillermo; Pilan, María L; Magliola, Ricardo; García Delucis, Pablo

2018-02-01

To describe the complications associated with heart surgery, compare them to a reference population, and identify mortality risk factors. Retrospective and descriptive study. All patients who underwent surgery at Hospital Garrahan in the 2013-2015 period were included. Age, weight, procedure, mechanical ventilation, length of stay in days, morbidity, and course were recorded. Renal failure requiring dialysis, neurological deficit, permanent pacemaker, circulatory support, phrenic nerve or vocal cord palsy, reoperation, wound infection, chylothorax, and tracheotomy were considered morbidities. A descriptive, statistical analysis by risk category was done using the Society of Thoracic Surgeons (STS) morbidity score. 1536 patients, median age: 12 months (interquartile range [IQR] 25-75: 3-60), weight: 8 kg (IQR 25-75: 4.4 to 17.5), mortality: 5%. A total of 361 events were recorded in 183 patients. An unplanned reoperation was the most common event (7.2%); the rest occurred in < 3% of patients. Compared to patients without complications, patients who had events required more days on mechanical ventilation: 9.95 (IQR 25-75: 7.6512.24) versus 1.8 (IQR 2575: 1.46-2.14), p< 0.00001; a longer length of stay: 28.8 (IQR 25-75: 25.1-32.5) versus 8.5 (IQR 25-75: 7.9-9.2), p< 0.0001; and had a higher mortality: 19.6% versus 3.1% (RR: 4.58, 95% CI: 3.4 to 6.0), p< 0.0001. Circulatory support and renal failure were associated with a higher mortality. An unplanned reoperation was the most common event. Patients with complications required more days on mechanical ventilation and a longer length of stay and had a higher mortality. Circulatory support and renal failure were associated with a higher mortality. Sociedad Argentina de Pediatría

Impact of Freezing Time on Dornic Acidity in Three Types of Milk: Raw Donor Milk, Mother's Own Milk, and Pasteurized Donor Milk.

Science.gov (United States)

Vázquez-Román, Sara; Escuder-Vieco, Diana; García-Lara, Nadia Raquel; Alonso-Díaz, Clara; Lora, David; Martín-Pelegrina, María Dolores; Pallás-Alonso, Carmen Rosa

2016-03-01

Although under certain circumstances it is necessary to express milk, there are not many recommendations about the ideal storage conditions for human milk. The objectives of this study were to analyze the effects on Dornic acidity of frozen storage at -20 °C in three types of milk: raw donor milk, mother's own raw milk, and pasteurized donor milk. Forty-three samples of raw donor milk, 40 samples of pasteurized donor milk, and 16 samples of mother's own milk were analyzed. Dornic acidity was measured at time 0, before freezing. The remaining aliquots were frozen and analyzed after 1, 2, 3, and 4 weeks and after 2 and 3 months. In raw donor milk, the median acidity at the start was 3 °D (interquartile range [IQR] 2-3 °D); after 3 months, it was 5 °D (IQR 3-7 °D), with a significant increase in acidity after the second week. In mother's own milk, the mean acidity at the start was 3 °D (IQR 2-4 °D) and 7 °D (IQR 4-8 °D) at 3 months. The increase was significant after the third week. In pasteurized donor milk, the mean acidity was 3 °D (IQR 2-3 °D) at the start and 2 °D (IQR 2-3 °D) at the end. When comparing the three types of milk, there were significant differences from the first week between the two types of raw milk and the pasteurized milk (p raw milks (p = 0.77). Dornic acidity in unpasteurized milk significantly increases with the duration of freezing, probably due to the action of lipases, which is lost with pasteurization. It would be advisable to reduce the length of freezing time for unpasteurized milk.

Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage.

Directory of Open Access Journals (Sweden)

Jacqueline Ramke

Full Text Available To define and demonstrate effective cataract surgical coverage (eCSC, a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC with quality (post-operative visual outcome.All Rapid Assessment of Avoidable Blindness (RAAB surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60, CSC (operated cataract as a proportion of operable plus operated cataract and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated.Datasets from 20 countries were included (2005-2013; 67,337 participants; 5,474 cataract surgeries. Median CSC was 53.7% (inter-quartile range[IQR] 46.1-66.6%, CSOGood was 58.9% (IQR 53.7-67.6% and CSOPoor was 17.7% (IQR 11.3-21.1%. Coverage and quality of cataract surgery were moderately associated-every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2-50.6%, approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5-7.1% than for CSC (median 2.3% IQR -1.5-11.6%.eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

High Lifetime Pregnancy and Low Contraceptive Usage Among Sex Workers Who Use Drugs- An Unmet Reproductive Health Need

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Alexson Debbie

2011-08-01

Full Text Available Abstract Background The objective of this study was to describe levels of pregnancy and contraceptive usage among a cohort of street-based female sex workers (FSWs in Vancouver. Methods The study sample was obtained from a community-based prospective cohort study (2006-2008 of 211 women in street-based sex work who use drugs, 176 of whom had reported at least one prior pregnancy. Descriptive statistics were used to estimate lifetime pregnancy prevalence, pregnancy outcomes (miscarriage, abortion, adoption, child apprehension, child custody, and contraceptive usage. In secondary analyses, associations between contraceptive usage, individual and interpersonal risk factors and high number of lifetime pregnancies (defined as greater than the sample mean of 4 were examined. Results Among our sample, 84% reported a prior pregnancy, with a mean of 4 lifetime pregnancies (median = 3; IQR: 2-5. The median age of women reporting 5+ pregnancies was 38 years old [interquartile range (IQR: 25.0-39.0] compared to 34 years [IQR: 25.0-39.0] among women reporting 4 or fewer prior pregnancies. 45% were Caucasian and 47% were of Aboriginal ancestry. We observed high rates of previous abortion (median = 1;IQR:1-3, apprehension (median = 2; IQR:1-4 and adoption (median = 1; IQR:1-2 among FSWs who reported prior pregnancy. The use of hormonal and insertive contraceptives was limited. In bivariate analysis, tubal ligation (OR = 2.49; [95%CI = 1.14-5.45], and permanent contraceptives (e.g., tubal ligation and hysterectomy (OR = 2.76; [95%CI = 1.36-5.59] were both significantly associated with having five or more pregnancies. Conclusion These findings demonstrate high levels of unwanted pregnancy in the context of low utilization of effective contraceptives and suggest a need to improve the accessibility and utilization of reproductive health services, including family planning, which are appropriately targeted and tailored for FSWs in Vancouver.

A Comparison of Outcomes Following Laparoscopic and Open Hysterectomy With or Without Lymphadenectomy for Presumed Early-Stage Endometrial Cancer: Results From the Medical Research Council ASTEC Trial.

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Kyrgiou, Maria; Swart, Anne-Marie; Qian, Wendi; Warwick, Jane

2015-10-01

Laparoscopic hysterectomy (LH) is increasingly used for the management of endometrial malignancy. Its benefits may be particularly pronounced as these women are more likely to be older or obese. The aim of this study was to determine whether outcomes for LH are comparable to the open hysterectomy (OH). This was a prospective cohort study nested within the multicenter ASTEC (A Study in the Treatment of Endometrial Cancer) randomized controlled trial (1998-2005). Women with presumed early endometrial cancer were included. Laparoscopic hysterectomy was compared with OH with or without systematic lymphadenectomy. Overall survival, time to first recurrence, complication rates, and surgical outcomes were the main outcome measures. Of 1408 women, 1309 (93%) received OH, and 99 (7%) had LH. LH was associated with longer operating time (median, LH 105 minutes [interquartile range (IQR), 60-150] vs OH 80 minutes [IQR, 60-95]; P < 0.001) but 50% shorter hospital stay (median, LH 4 days [IQR, 3-5] vs OH 6 days [IQR, 5-7]). The number of harvested lymph nodes was similar (median, LH 13 [IQR, 10-16] vs OH 12 [IQR, 11-13]; P = 0.67). LH had fewer intraoperative and postoperative adverse events (9% difference, LH 21% vs OH 30%; borderline significance; P = 0.07). The rate of conversion to laparotomy for the LH group was high (27%). The median follow-up was 37 months. After adjusting for significant prognostic factors, the hazard ratio for overall survival in those who underwent LH compared with those who underwent OH was 0.67 (95% confidence interval, 0.31-1.43) (P = 0.30). Laparoscopic hysterectomy for early endometrial cancer is safe. Although it requires longer operating time it is associated with shorter hospital stay and favorable morbidity profile. Further studies are required to assess the long-term safety.

Parental versus non-parental-directed donation: an 11-year experience of infectious disease testing at a pediatric tertiary care blood donor center.

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Jacquot, Cyril; Seo, Andrew; Miller, Peter M; Lezama, Niara; Criss, Valli R; Colvin, Camilla; Luban, Naomi L C; Wong, Edward C C

2017-11-01

Directed donation is associated with a higher prevalence of donations that are positive for infectious disease markers; however, little is known about the positive rates among parental-directed, non-parental-directed, and allogeneic donations. We reviewed blood-collection records from January 1997 through December 2008, including infectious disease results, among parental, non-parental, and community donations. Infectious disease rates were compared by Mann-Whitney U test. In total, 1532 parental, 4910 non-parental, and 17,423 community donations were examined. Among parental donors, the median rate of positive infectious disease testing was 8.66% (interquartile range (IQR), 4.49%) for first-time donors and 1.26% (IQR, 5.86%) for repeat donors; among non-parental donors, the rate was 1.09% (IQR, 0.98%) for first-time donors and 0% (IQR, 0.83%) for repeat donors; and, among community donors, the rate was 2.95% (IQR, 1.50%) for first-time donors and 0.45% (IQR, 0.82%) for repeat donors. The mean rate of positive infectious disease testing for first-time parental donors was significantly higher (7.63%), whereas all repeat donors had similar rates. However, the rate of positive infectious disease testing among first-time non-parental donors was significantly lower than that in the other groups, especially for the period from 2001 through 2008. First-time non-parental and community donors had significantly higher infectious disease risk than the respective repeat donors. First-time parental donors had the highest rates of positive infectious disease testing. We suggest that first-time parental blood donation should be discouraged. Repeat community donors or first-time non-parental donors provide a safer alternative. These findings can foster better patient education, donor selection, and possibly a reduced risk of infectious disease. © 2017 AABB.

Abnormal levels of expression of plasma microRNA-33 in patients with psoriasis.

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García-Rodríguez, S; Arias-Santiago, S; Orgaz-Molina, J; Magro-Checa, C; Valenzuela, I; Navarro, P; Naranjo-Sintes, R; Sancho, J; Zubiaur, M

2014-06-01

Circulating microRNAs (miRNA) are involved in the posttranscriptional regulation of genes associated with lipid metabolism (miRNA-33) and vascular function and angiogenesis (miRNA-126). The objective of this exploratory study was to measure plasma levels of miRNA-33 and miRNA-126 in patients with plaque psoriasis and evaluate their association with clinical parameters. We studied 11 patients with plaque psoriasis. The median Psoriasis Area Severity Index (PASI) was 13 (interquartile range [IQR], 9-14) and body surface area involvement was 12 (IQR, 11-15). Eleven healthy controls matched for age and sex were also included. We analyzed cardiovascular risk factors and subclinical carotid atheromatosis. Plasma miRNAs were evaluated using quantitative real-time polymerase chain reaction. Carotid intima-media thickness was greater in patients (0.57mm; IQR, 0.54-0.61; n=11) than in controls (0.50mm; IQR, 0.48-0.54; data available for 9 controls) (P=.0055, Mann-Whitney). Expression of miRNA-33 in patients (5.34; IQR, 3.12-7.96; n=11) was significantly higher than in controls (2.33; IQR, 1.71-2.84; only detected in 7 of 11 controls) (P=.0049, Wilcoxon signed rank). No differences in miRNA-126 levels were observed between patients and controls. In patients (n=11), we observed a positive correlation between miRNA-33 and insulin levels (r=0.7289, P=.0109) and a negative correlation between miRNA-126 and carotid intima-media thickness (r=-0.6181, P=.0426). In psoriasis patients plasma levels of lipid and glucose metabolism-related miRNA-33 are increased and correlated with insulin. The study of circulating miRNA-33 in psoriasis may provide new insights about the associated systemic inflammatory abnormalities. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

Impact of diagnostic ECG to wire delay in STEMI patients treated with primary PCI - a DANAMI-3 substudy

DEFF Research Database (Denmark)

Nepper-Christensen, Lars; Lønborg, Jacob; Høfsten, Dan Eik

2018-01-01

AIMS: We evaluated the impact of delay from diagnostic pre-hospital electrocardiogram (ECG) to wiring of the infarct related vessel (ECG-to-wire) >120 minutes on cardiovascular magnetic resonance (CMR) markers of reperfusion success and clinical outcome in patients with ST-segment elevation...... myocardial infarction (STEMI). METHODS AND RESULTS: We included 1492 patients in the analyses of clinical outcome. CMR was performed in 748 patients to evaluate infarct size and myocardial salvage. In total, 304 patients (20%) had ECG-to-wire >120 minutes, which was associated with larger acute infarct size...... (18% [interquartile range (IQR), 10-28] vs. 15% [8-24]; p=0.022) and smaller myocardial salvage (0.42 [IQR 0.28-0.57] vs. 0.50 [IQR 0.34-0.70]; p=0.002). However, 33% of the patients with ECG-to-wire >120 minutes still had a substantial myocardial salvage of more than 0.50. In a multivariable analysis...

Economic consequences of post-kala-azar dermal leishmaniasis in a rural Bangladeshi community.

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Ozaki, Masayo; Islam, Shamim; Rahman, Kazi Mizanur; Rahman, Anisur; Luby, Stephen P; Bern, Caryn

2011-09-01

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis. Bangladesh national treatment guidelines during the study period called for 120 intramuscular injections of sodium antimony gluconate (SAG). We assessed care-seeking behavior, diagnosis and treatment costs, and coping strategies among 134 PKDL patients; 56 (42%) patients had been treated with SAG, and 78 (58%) remained untreated. The median direct cost per patient treated was US$367 (interquartile range [IQR] = 90-284), more than two times the estimated per capita annual income for the study population. The most common coping strategy was to take a loan; the median amount borrowed was US$98 (IQR = 71-150), with a median interest of US$32 (IQR = 16-95). Households lost a median of 123 work-days per patient treated. The current regimen for PKDL imposes a significant financial burden, reinforcing the link between poverty and visceral leishmaniasis. More practical shorter-course regimens for PKDL are urgently needed to achieve national and regional visceral leishmaniasis elimination goals.

Dynamic range extension of BPM at the NSLS

International Nuclear Information System (INIS)

Bordoley, M.

1993-01-01

In order to overcome range limitations, the existing Beam Position Monitor (BPM) receiver was modified, extending the dynamic range from 35 dB to 60 dB. The modifications include the insertion of an RF PIN attenuator, RF amplifier, and control circuitry in line with the RF link to add an extra 25dB to the existing AGC loop. This stand alone 25dB RF gain control stage is integrated into the present system without any change to the existing receiver

Comparative phylogeography of two related plant species with overlapping ranges in Europe, and the potential effects of climate change on their intraspecific genetic diversity

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Provan Jim

2011-01-01

Full Text Available Abstract Background The aim of the present study was to use a combined phylogeographic and species distribution modelling approach to compare the glacial histories of two plant species with overlapping distributions, Orthilia secunda (one-sided wintergreen and Monotropa hypopitys (yellow bird's nest. Phylogeographic analysis was carried out to determine the distribution of genetic variation across the range of each species and to test whether both correspond to the "classic" model of high diversity in the south, with decreasing diversity at higher latitudes, or whether the cold-adapted O. secunda might retain more genetic variation in northern populations. In addition, projected species distributions based on a future climate scenario were modelled to assess how changes in the species ranges might impact on total intraspecific diversity in both cases. Results Palaeodistribution modelling and phylogeographic analysis using multiple genetic markers (chloroplast trnS-trnG region, nuclear ITS and microsatellites for O. secunda; chloroplast rps2, nuclear ITS and microsatellites for M. hypopitys indicated that both species persisted throughout the Last Glacial Maximum in southern refugia. For both species, the majority of the genetic diversity was concentrated in these southerly populations, whereas those in recolonized areas generally exhibited lower levels of diversity, particularly in M. hypopitys. Species distribution modelling based on projected future climate indicated substantial changes in the ranges of both species, with a loss of southern and central populations, and a potential northward expansion for the temperate M. hypopitys. Conclusions Both Orthilia secunda and Monotropa hypopitys appear to have persisted through the LGM in Europe in southern refugia. The boreal O. secunda, however, has retained a larger proportion of its genetic diversity in more northerly populations outside these refugial areas than the temperate M. hypopitys. Given

Ranging Behaviour of Commercial Free-Range Laying Hens.

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Chielo, Leonard Ikenna; Pike, Tom; Cooper, Jonathan

2016-04-26

In this study, the range use and behaviour of laying hens in commercial free-range flocks was explored. Six flocks were each visited on four separate days and data collected from their outdoor area (divided into zones based on distance from shed and available resources). These were: apron (0-10 m from shed normally without cover or other enrichments); enriched belt (10-50 m from shed where resources such as manmade cover, saplings and dust baths were provided); and outer range (beyond 50 m from shed with no cover and mainly grass pasture). Data collection consisted of counting the number of hens in each zone and recording behaviour, feather condition and nearest neighbour distance (NND) of 20 birds per zone on each visit day. In addition, we used techniques derived from ecological surveys to establish four transects perpendicular to the shed, running through the apron, enriched belt and outer range. Number of hens in each 10 m × 10 m quadrat was recorded four times per day as was the temperature and relative humidity of the outer range. On average, 12.5% of hens were found outside. Of these, 5.4% were found in the apron; 4.3% in the enriched zone; and 2.8% were in the outer range. This pattern was supported by data from quadrats, where the density of hens sharply dropped with increasing distance from shed. Consequently, NND was greatest in the outer range, least in the apron and intermediate in the enriched belt. Hens sampled in outer range and enriched belts had better feather condition than those from the apron. Standing, ground pecking, walking and foraging were the most commonly recorded activities with standing and pecking most likely to occur in the apron, and walking and foraging more common in the outer range. Use of the outer range declined with lower temperatures and increasing relative humidity, though use of apron and enriched belt was not affected by variation in these measures. These data support previous findings that outer range areas tend to be

Increasing sea surface temperature and range shifts of intertidal gastropods along the Iberian Peninsula

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Rubal, Marcos; Veiga, Puri; Cacabelos, Eva; Moreira, Juan; Sousa-Pinto, Isabel

2013-03-01

There are well-documented changes in abundance and geographical range of intertidal invertebrates related to climate change at north Europe. However, the effect of sea surface warming on intertidal invertebrates has been poorly studied at lower latitudes. Here we analyze potential changes in the abundance patterns and distribution range of rocky intertidal gastropods related to climate change along the Iberian Peninsula. To achieve this aim, the spatial distribution and range of sub-tropical, warm- and cold-water species of intertidal gastropods was explored by a fully hierarchical sampling design considering four different spatial scales, i.e. from region (100 s of km apart) to quadrats (ms apart). Variability on their patterns of abundance was explored by analysis of variance, changes on their distribution ranges were detected by comparing with previous records and their relationship with sea water temperature was explored by rank correlation analyses. Mean values of sea surface temperature along the Iberian coast, between 1949 and 2010, were obtained from in situ data compiled for three different grid squares: south Portugal, north Portugal, and Galicia. Lusitanian species did not show significant correlation with sea water temperature or changes on their distributional range or abundance, along the temperature gradient considered. The sub-tropical species Siphonaria pectinata has, however, increased its distribution range while boreal cold-water species showed the opposite pattern. The latter was more evident for Littorina littorea that was almost absent from the studied rocky shores of the Iberian Peninsula. Sub-tropical and boreal species showed significant but opposite correlation with sea water temperature. We hypothesized that the energetic cost of frequent exposures to sub-lethal temperatures might be responsible for these shifts. Therefore, intertidal gastropods at the Atlantic Iberian Peninsula coast are responding to the effect of global warming as it

Selective pelvic autonomic nerve stimulation with simultaneous intraoperative monitoring of internal anal sphincter and bladder innervation.

Science.gov (United States)

Kneist, W; Kauff, D W; Koch, K P; Schmidtmann, I; Heimann, A; Hoffmann, K P; Lang, H

2011-01-01

Pelvic autonomic nerve preservation avoids postoperative functional disturbances. The aim of this feasibility study was to develop a neuromonitoring system with simultaneous intraoperative verification of internal anal sphincter (IAS) activity and intravesical pressure. 14 pigs underwent low anterior rectal resection. During intermittent bipolar electric stimulation of the inferior hypogastric plexus (IHP) and the pelvic splanchnic nerves (PSN), electromyographic signals of the IAS and manometry of the urinary bladder were observed simultaneously. Stimulation of IHP and PSN as well as simultaneous intraoperative monitoring could be realized with an adapted neuromonitoring device. Neurostimulation resulted in either bladder or IAS activation or concerted activation of both. Intravesical pressure increase as well as amplitude increase of the IAS neuromonitoring signal did not differ significantly between stimulation of IHP and PSN [6.0 cm H(2)O (interquartile range [IQR] 3.5-9.0) vs. 6.0 cm H(2)O (IQR 3.0-10.0) and 12.1 μV (IQR 3.0-36.7) vs. 40.1 μV (IQR 9.0-64.3)] (p > 0.05). Pelvic autonomic nerve stimulation with simultaneous intraoperative monitoring of IAS and bladder innervation is feasible. The method may enable neuromonitoring with increasing selectivity for pelvic autonomic nerve preservation. Copyright © 2011 S. Karger AG, Basel.

HIV-Infected Ugandan Women on Antiretroviral Therapy Maintain HIV-1 RNA Suppression Across Periconception, Pregnancy, and Postpartum Periods.

Science.gov (United States)

Matthews, Lynn T; Ribaudo, Heather B; Kaida, Angela; Bennett, Kara; Musinguzi, Nicholas; Siedner, Mark J; Kabakyenga, Jerome; Hunt, Peter W; Martin, Jeffrey N; Boum, Yap; Haberer, Jessica E; Bangsberg, David R

2016-04-01

HIV-infected women risk sexual and perinatal HIV transmission during conception, pregnancy, childbirth, and breastfeeding. We compared HIV-1 RNA suppression and medication adherence across periconception, pregnancy, and postpartum periods, among women on antiretroviral therapy (ART) in Uganda. We analyzed data from women in a prospective cohort study, aged 18-49 years, enrolled at ART initiation and with ≥1 pregnancy between 2005 and 2011. Participants were seen quarterly. The primary exposure of interest was pregnancy period, including periconception (3 quarters before pregnancy), pregnancy, postpartum (6 months after pregnancy outcome), or nonpregnancy related. Regression models using generalized estimating equations compared the likelihood of HIV-1 RNA ≤400 copies per milliliter, pregnancy, and 89% of postpartum visits, and was more likely during periconception (adjusted odds ratio, 2.15) compared with nonpregnant periods. Average ART adherence was 90% [interquartile range (IQR), 70%-98%], 93% (IQR, 82%-98%), 92% (IQR, 72%-98%), and 88% (IQR, 63%-97%) during nonpregnant, periconception, pregnant, and postpartum periods, respectively. Average adherence pregnancy were virologically suppressed at most visits, with an increased likelihood of suppression and high adherence during periconception follow-up. Increased frequency of 72-hour gaps suggests a need for increased adherence support during postpartum periods.

A Model for Long Range Planning for Seminole Community College.

Science.gov (United States)

Miner, Norris

A model for long-range planning designed to maximize involvement of college personnel, to improve communication among various areas of the college, to provide a process for evaluation of long-range plans and the planning process, to adjust to changing conditions, to utilize data developed at a level useful for actual operations, and to have…

Longitudinal Changes in Hip Strength and Range of Motion in Female Youth Soccer Players: Implications for ACL Injury, A Pilot Study.

Science.gov (United States)

Nguyen, Anh-Dung; Zuk, Emma F; Baellow, Andrea L; Pfile, Kate R; DiStefano, Lindsay J; Boling, Michelle C

2017-09-01

Risk of anterior cruciate ligament (ACL) injuries in young female athletes increases with age, appearing to peak during maturation. Changes in hip muscle strength and range of motion (ROM) during this time may contribute to altered dynamic movement patterns that are known to increase risk of ACL injuries. Understanding the longitudinal changes in hip strength and ROM is needed to develop appropriate interventions to reduce the risk of ACL injuries. To examine the longitudinal changes in hip strength and ROM in female youth soccer players. Longitudinal descriptive study. Field setting. 14 female youth soccer athletes (14.1 ± 1.1 y, 165.8 ± 5.3 cm, 57.5 ± 9.9 kg) volunteered as part of a multiyear risk factor screening project. Clinical measures of hip strength and ROM were collected annually over 3 consecutive years. Passive hip internal rotation (IR), external rotation (ER), abduction (ABD), and adduction (ADD) ROM were measured with a digital inclinometer. Isometric hip ABD and extension (EXT) strength were evaluated using a hand-held dynamometer. Separate repeated-measures ANOVAs compared hip strength and ROM values across 3 consecutive years (P hip ABD (P = .830) or EXT strength (P = .062) across 3 consecutive years. Longitudinal changes in hip ROM were observed with increases in hip IR (P = .001) and ABD (P hip ADD (P = .009) and ER (P hip occur as youth female soccer players increase in age. While there are no changes in hip strength, there is an increase in hip IR and ABD ROM with a concomitant decrease in hip ER and ADD ROM. The resulting asymmetries in hip ROM may decrease the activation and force producing capabilities of the hip muscles during dynamic activities, contributing to altered lower extremity mechanics known to increase the risk of ACL injuries.

Crystals of Janus colloids at various interaction ranges

Energy Technology Data Exchange (ETDEWEB)

Preisler, Z. [Dipartimento di Fisica, Università di Roma “Sapienza,” Piazzale Aldo Moro 5, 00185 Roma (Italy); Soft Condensed Matter, Debye Institute for Nanomaterials Science, Utrecht University, Princetonplein 5, 3584 CC Utrecht (Netherlands); Vissers, T. [Dipartimento di Fisica, Università di Roma “Sapienza,” Piazzale Aldo Moro 5, 00185 Roma (Italy); SUPA and School of Physics and Astronomy, The University of Edinburgh, James Clerk Maxwell Building, Peter Guthrie Tait Road, Edinburgh EH9 3FD (United Kingdom); Smallenburg, F. [Dipartimento di Fisica, Università di Roma “Sapienza,” Piazzale Aldo Moro 5, 00185 Roma (Italy); Institut für Theoretische Physik II: Weiche Materie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf (Germany); Sciortino, F. [Dipartimento di Fisica, Università di Roma “Sapienza,” Piazzale Aldo Moro 5, 00185 Roma (Italy)

2016-08-14

We investigate the effect of interaction range on the phase behaviour of Janus particles with a Kern-Frenkel potential. Specifically, we study interaction ranges Δ = 0.1σ, 0.3σ, 0.4σ, 0.5σ with σ the particle diameter, and use variable box shape simulations to predict crystal structures. We found that changing the interaction range beyond 0.2σ drastically increases the variety of possible crystal structures. In addition to close-packed structures, we find body-centered tetragonal and AA-stacked hexagonal crystals, as well as several lamellar crystals. For long interaction ranges and low temperatures, we also observe an extremely large number of metastable structures which compete with the thermodynamically stable ones. These competing structures hinder the detection of the lowest-energy crystal structures, and are also likely to interfere with the spontaneous formation of the ground-state structure. Finally, we determine the gas-liquid coexistence curves for several interaction ranges, and observe that these are metastable with respect to crystallization.

Crystals of Janus colloids at various interaction ranges

International Nuclear Information System (INIS)

Preisler, Z.; Vissers, T.; Smallenburg, F.; Sciortino, F.

2016-01-01

We investigate the effect of interaction range on the phase behaviour of Janus particles with a Kern-Frenkel potential. Specifically, we study interaction ranges Δ = 0.1σ, 0.3σ, 0.4σ, 0.5σ with σ the particle diameter, and use variable box shape simulations to predict crystal structures. We found that changing the interaction range beyond 0.2σ drastically increases the variety of possible crystal structures. In addition to close-packed structures, we find body-centered tetragonal and AA-stacked hexagonal crystals, as well as several lamellar crystals. For long interaction ranges and low temperatures, we also observe an extremely large number of metastable structures which compete with the thermodynamically stable ones. These competing structures hinder the detection of the lowest-energy crystal structures, and are also likely to interfere with the spontaneous formation of the ground-state structure. Finally, we determine the gas-liquid coexistence curves for several interaction ranges, and observe that these are metastable with respect to crystallization.

Measurements of short-range ordering in Ni3Al

International Nuclear Information System (INIS)

Okamoto, J.K.; Ahn, C.C.

1992-01-01

This paper reports on extended electron energy-loss fine structure (EXELFS) that has been used to measure short-range ordering in Ni 3 Al. Films of fcc Ni 3 Al with suppressed short-range order synthesized by vacuum evaporation of Ni 3 Al onto room temperature substrates. EXELFS data were taken from both Al K and Ni L 23 edges. The development of short-range order was observed after the samples were annealed for various times at temperatures below 350 degrees C. Upon comparison with ab initio planewave EXELFS calculations, it was found that the Warren-Cowley short-range order parameter a(1nn) changed by about -0.1 after 210 minutes of annealing at 150 degrees C

Foraminiferal Range Expansions: The Mediterranean Sea as a natural laboratory for climate induced invasions

Science.gov (United States)

Hortense Mouanga, Gloria; Langer, Martin R.

2015-04-01

Climate change and biological invasions are key processes that modify biodiversity. One of the most severely affected areas of global change is the Mediterranean Sea, where global warming and the opening of the Suez Canal triggered a mass invasion of tropical Red Sea taxa into Mediterranean territories. Climate models prognosticate that the Mediterranean Sea will be one of the most affected ocean regions and may thus serve as a natural laboratory of future global changes. Among the key taxa that are rapidly expanding their latitudinal range in the Mediterranean Sea are symbiont-bearing foraminifera of the genus Amphistegina. Their range expansion strongly correlates with rising sea surface temperatures and mirrors processes of global change. Amphisteginid foraminifera are among the most prolific foraminiferal species and contribute significantly to shallow-water carbonate sediments. Given their prominent environmental role, rapid biogeographic range expansion, and impact on native ecosystems, amphisteginid range expansion and invasion into new territory are likely to trigger changes in ecosystem functioning. Among the uncertainties, it is not known whether all parts of the Mediterranean will be affected equally and to what extent amphisteginid invasions will impact native biotas. We have initiated a new baseline study to explore the effects of invasive amphisteginids on native foraminiferal biotas and to monitor expansion rates and effects on ecosystem functioning along the current range expansion front. We will present new data on recent shift along the range expansion front and discuss cascading effects on community structures and species richness of native foraminiferal biotas. The magnitude and effects that climate change will have on the Mediterranean foraminiferal faunas may ultimately serve as an example of what would happen along expansion fronts in global oceans.

Changes in lion (Panthera leo) home range size in Waza National Park, Cameroon

NARCIS (Netherlands)

Tumenta, P.N.; Van't Zelfde, M.; Croes, B.M.; Buij, R.; Funston, P.J.; Haes, de H.A.U.; longh, De H.H.

2013-01-01

The spatial ecology of Africa lions (Panthera leo) was studied from 2007 to 2009 in Waza National Park, Cameroon, by equipping individual lions with GPS/VHF radio-collars. Mean home range estimates using 100% minimum convex polygons (MCP) and 95% kernel-density estimation (KDE) were respectively

Interplay of long-range and short-range Coulomb interactions in an Anderson-Mott insulator

Science.gov (United States)

Baćani, Mirko; Novak, Mario; Orbanić, Filip; Prša, Krunoslav; Kokanović, Ivan; Babić, Dinko

2017-07-01

In this paper, we tackle the complexity of coexisting disorder and Coulomb electron-electron interactions (CEEIs) in solids by addressing a strongly disordered system with intricate CEEIs and a screening that changes both with charge carrier doping level Q and temperature T . We report on an experimental comparative study of the T dependencies of the electrical conductivity σ and magnetic susceptibility χ of polyaniline pellets doped with dodecylbenzenesulfonic acid over a wide range. This material is special within the class of doped polyaniline by exhibiting in the electronic transport a crossover between a low-T variable range hopping (VRH) and a high-T nearest-neighbor hopping (NNH) well below room temperature. Moreover, there is evidence of a soft Coulomb gap ΔC in the disorder band, which implies the existence of a long-range CEEI. Simultaneously, there is an onsite CEEI manifested as a Hubbard gap U and originating in the electronic structure of doped polyaniline, which consists of localized electron states with dynamically varying occupancy. Therefore, our samples represent an Anderson-Mott insulator in which long-range and short-range CEEIs coexist. The main result of the study is the presence of a crossover between low- and high-T regimes not only in σ (T ) but also in χ (T ) , the crossover temperature T* being essentially the same for both observables over the entire doping range. The relatively large electron localization length along the polymer chains results in U being small, between 12 and 20 meV for the high and low Q , respectively. Therefore, the thermal energy at T* is sufficiently large to lead to an effective closing of the Hubbard gap and the consequent appearance of NNH in the electronic transport within the disorder band. ΔC is considerably larger than U , decreasing from 190 to 30 meV as Q increases, and plays the role of an activation energy in the NNH.

Ranging Behaviour of Commercial Free-Range Laying Hens

Directory of Open Access Journals (Sweden)

Leonard Ikenna Chielo

2016-04-01

Full Text Available In this study, the range use and behaviour of laying hens in commercial free-range flocks was explored. Six flocks were each visited on four separate days and data collected from their outdoor area (divided into zones based on distance from shed and available resources. These were: apron (0–10 m from shed normally without cover or other enrichments; enriched belt (10–50 m from shed where resources such as manmade cover, saplings and dust baths were provided; and outer range (beyond 50 m from shed with no cover and mainly grass pasture. Data collection consisted of counting the number of hens in each zone and recording behaviour, feather condition and nearest neighbour distance (NND of 20 birds per zone on each visit day. In addition, we used techniques derived from ecological surveys to establish four transects perpendicular to the shed, running through the apron, enriched belt and outer range. Number of hens in each 10 m × 10 m quadrat was recorded four times per day as was the temperature and relative humidity of the outer range. On average, 12.5% of hens were found outside. Of these, 5.4% were found in the apron; 4.3% in the enriched zone; and 2.8% were in the outer range. This pattern was supported by data from quadrats, where the density of hens sharply dropped with increasing distance from shed. Consequently, NND was greatest in the outer range, least in the apron and intermediate in the enriched belt. Hens sampled in outer range and enriched belts had better feather condition than those from the apron. Standing, ground pecking, walking and foraging were the most commonly recorded activities with standing and pecking most likely to occur in the apron, and walking and foraging more common in the outer range. Use of the outer range declined with lower temperatures and increasing relative humidity, though use of apron and enriched belt was not affected by variation in these measures. These data support previous findings that outer range

Predicting climate-induced range shifts: model differences and model reliability.

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Joshua J. Lawler; Denis White; Ronald P. Neilson; Andrew R. Blaustein

2006-01-01

Predicted changes in the global climate are likely to cause large shifts in the geographic ranges of many plant and animal species. To date, predictions of future range shifts have relied on a variety of modeling approaches with different levels of model accuracy. Using a common data set, we investigated the potential implications of alternative modeling approaches for...

Enhancing Transportation Equity Analysis for Long Range Planning and Decision Making

OpenAIRE

Bills, Tierra Suzan

2013-01-01

Metropolitan Planning Organizations (MPOs) regularly perform equity analyses for their long-range transportation plans, as this is required by Environmental Justice regulations. These regional-level plans may propose hundreds of transportation infrastructure and policy changes (e.g. highway and transit extensions, fare changes, pricing schemes, etc.) as well as land-use policy changes. The challenge is to assess the distribution of impacts from all the proposed changes across different popula...

Super-ranging. A new ranging strategy in European badgers.

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Aoibheann Gaughran

Full Text Available We monitored the ranging of a wild European badger (Meles meles population over 7 years using GPS tracking collars. Badger range sizes varied seasonally and reached their maximum in June, July and August. We analysed the summer ranging behaviour, using 83 home range estimates from 48 individuals over 6974 collar-nights. We found that while most adult badgers (males and females remained within their own traditional social group boundaries, several male badgers (on average 22% regularly ranged beyond these traditional boundaries. These adult males frequently ranged throughout two (or more social group's traditional territories and had extremely large home ranges. We therefore refer to them as super-rangers. While ranging across traditional boundaries has been recorded over short periods of time for extraterritorial mating and foraging forays, or for pre-dispersal exploration, the animals in this study maintained their super-ranges from 2 to 36 months. This study represents the first time such long-term extra-territorial ranging has been described for European badgers. Holding a super-range may confer an advantage in access to breeding females, but could also affect local interaction networks. In Ireland & the UK, badgers act as a wildlife reservoir for bovine tuberculosis (TB. Super-ranging may facilitate the spread of disease by increasing both direct interactions between conspecifics, particularly across social groups, and indirect interactions with cattle in their shared environment. Understanding super-ranging behaviour may both improve our understanding of tuberculosis epidemiology and inform future control strategies.

The Value of E-Learning for the Prevention of Healthcare-Associated Infections.

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Labeau, Sonia O; Rello, Jordi; Dimopoulos, George; Lipman, Jeffrey; Sarikaya, Aklime; Oztürk, Candan; Vandijck, Dominique M; Vogelaers, Dirk; Vandewoude, Koenraad; Blot, Stijn I

2016-09-01

BACKGROUND Healthcare workers (HCWs) lack familiarity with evidence-based guidelines for the prevention of healthcare-associated infections (HAIs). There is good evidence that effective educational interventions help to facilitate guideline implementation, so we investigated whether e-learning could enhance HCW knowledge of HAI prevention guidelines. METHODS We developed an electronic course (e-course) and tested its usability and content validity. An international sample of voluntary learners submitted to a pretest (T0) that determined their baseline knowledge of guidelines, and they subsequently studied the e-course. Immediately after studying the course, posttest 1 (T1) assessed the immediate learning effect. After 3 months, during which participants had no access to the course, a second posttest (T2) evaluated the residual learning effect. RESULTS A total of 3,587 HCWs representing 79 nationalities enrolled: 2,590 HCWs (72%) completed T0; 1,410 HCWs (39%) completed T1; and 1,011 HCWs (28%) completed T2. The median study time was 193 minutes (interquartile range [IQR], 96-306 minutes) The median scores were 52% (IQR, 44%-62%) for T0, 80% (IQR, 68%-88%) for T1, and 74% (IQR, 64%-84%) for T2. The immediate learning effect (T0 vs T1) was +24% (IQR, 12%-34%; P300 minutes yielded the greatest residual effect (24%). CONCLUSIONS Moderate time invested in e-learning yielded significant immediate and residual learning effects. Decision makers could consider promoting e-learning as a supporting tool in HAI prevention. Infect Control Hosp Epidemiol 2016;37:1052-1059.

Effect of vitamin D supplementation, directly or via breast milk for term infants, on serum 25 hydroxyvitamin D and related biochemistry, and propensity to infection: a randomised placebo-controlled trial.

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Chandy, David D; Kare, Jahnavi; Singh, Shakal N; Agarwal, Anjoo; Das, Vinita; Singh, Urmila; Ramesh, V; Bhatia, Vijayalakshmi

2016-07-01

We assessed the effect of vitamin D supplementation on related biochemistry, infection and dentition of the infant. In a double-blind, placebo-controlled trial conducted in Lucknow, India (latitude 26°N), 230 mother -newborn pairs were randomised to receive, for 9 months, 3000µg/month oral vitamin D3 by the mother (group A) or 10µg/d by the infant (group B) or double placebo (group C). All babies received 15 min of sun exposure (unclothed) during massage. Infants' median 25-hydroxyvitamin D (25(OH)D) was lower in group C (median 45·3; interquartile range (IQR) 22-59·5 nmol/l) than in groups A (median 60·8; IQR 41·3-80·5 nmol/l (P7.5µkat/l) was significantly more frequent in group C babies (16 %) than in group A (4 %) or group B (0 %) babies. The number of days with respiratory or diarrhoeal infection by 9 months of age was higher in group C (median 46·5; IQR 14·8-73·3 d) than in group A (median 18·5; IQR 8·8-31·0 d (P<0·01)) or group B (median 13·0; IQR 7·0-28·5 (P<0·05)). We conclude that monthly maternal or daily infant supplementation with vitamin D along with sun exposure is superior to sun exposure alone in maintaining normal infant 25(OH)D at 3·5 months, and provide protection from elevated alkaline phosphatase and infectious morbidity.

TRACnet Internet and Short Message Service Technology Improves Time to Antiretroviral Therapy Initiation Among HIV-infected Infants in Rwanda.

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Kayumba, Kizito; Nsanzimana, Sabin; Binagwaho, Agnes; Mugwaneza, Placidie; Rusine, John; Remera, Eric; Koama, Jean Baptiste; Ndahindwa, Vedaste; Johnson, Pamela; Riedel, David J; Condo, Jeanine

2016-07-01

Delays in testing HIV-exposed infants and obtaining results in resource-limited settings contribute to delays for initiating antiretroviral therapy (ART) in infants. To overcome this challenge, Rwanda expanded its national mobile and Internet-based HIV/AIDS informatics system, called TRACnet, to include HIV polymerase chain reaction (PCR) results in 2010. This study was performed to evaluate the impact of TRACnet technology on the time to delivery of test results and the subsequent initiation of ART in HIV-infected infants. A retrospective cohort study was conducted on 380 infants who initiated ART in 190 health facilities in Rwanda from March 2010 to June 2013. Program data collected by the TRACnet system were extracted and analyzed. Since the introduction of TRACnet for processing PCR results, the time to receive results has significantly decreased from a median of 144 days [interquartile range (IQR): 121-197 days] to 23 days (IQR: 17-43 days). The number of days between PCR sampling and health facility receipt of results decreased substantially from a median of 90 days (IQR: 83-158 days) to 5 days (IQR: 2-8 days). After receiving PCR results at a health facility, it takes a median of 44 days (IQR: 32-77 days) before ART initiation. Result turnaround time was significantly associated with time to initiating ART (P technology for communication of HIV PCR results, coupled with well-trained and skilled personnel, can reduce delays in communicating results to providers. Such reductions may improve timely ART initiation in resource-limited settings.

Air suctioning during colon biopsy forceps removal reduces bacterial air contamination in the endoscopy suite.

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Vavricka, S R; Tutuian, R; Imhof, A; Wildi, S; Gubler, C; Fruehauf, H; Ruef, C; Schoepfer, A M; Fried, M

2010-09-01

Bacterial contamination of endoscopy suites is of concern; however studies evaluating bacterial aerosols are lacking. We aimed to determine the effectiveness of air suctioning during removal of biopsy forceps in reducing bacterial air contamination. This was a prospective single-blinded trial involving 50 patients who were undergoing elective nontherapeutic colonoscopy. During colonoscopy, endoscopists removed the biopsy forceps first without and then with suctioning following contact with the sigmoid mucosa. A total of 50 L of air was collected continuously for 30 seconds at 30-cm distance from the biopsy channel valve of the colonoscope, with time starting at forceps removal. Airborne bacteria were collected by an impactor air sampler (MAS-100). Standard Petri dishes with CNA blood agar were used to culture Gram-positive bacteria. Main outcome measure was the bacterial load in endoscopy room air. At the beginning and end of the daily colonoscopy program, the median (and interquartile [IQR] range) bioaerosol burden was 4 colony forming units (CFU)/m (3) (IQR 3 - 6) and 16 CFU/m (3) (IQR 13 - 18), respectively. Air suctioning during removal of the biopsy forceps reduced the bioaerosol burden from a median of 14 CFU/m (3) (IQR 11 - 29) to a median of 7 CFU/m (3) (IQR 4 - 16) ( P = 0.0001). Predominantly enterococci were identified on the agar plates. The bacterial aerosol burden during handling of biopsy forceps can be reduced by applying air suction while removing the forceps. This simple method may reduce transmission of infectious agents during gastrointestinal endoscopies. Copyright Georg Thieme Verlag KG Stuttgart . New York.

A Comparison of Macintosh and Airtraq Laryngoscopes for Endotracheal Intubation in Adult Patients With Cervical Spine Immobilization Using Manual In Line Axial Stabilization: A Prospective Randomized Study.

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Vijayakumar, Vinodhadevi; Rao, Shwethapriya; Shetty, Nanda

2016-10-01

During cervical spine immobilization using Manual In Line Axial Stabilization (MILS), it is difficult to visualize the larynx by aligning the oropharyngeolaryngeal axes using Macintosh laryngoscope. Theoretically, Airtraq an anatomically shaped blade with endotracheal tube guide channel offers advantage over Macintosh. We hypothesized that intubation would be easier and faster with Airtraq compared with Macintosh laryngoscope. Ninety anesthetized adult patients with normal airways were intubated by experienced anesthesiologists after cervical immobilization with MILS either with Macintosh or Airtraq. Primary outcomes compared were successful intubation, and degree of difficulty of intubation as assessed by Intubation Difficulty Scale (IDS) score. Secondary outcomes compared were duration of laryngoscopy and intubation, degree of difficulty of intubation as assessed by Numerical Rating Scale score, soft tissue, and dental trauma. All 90 patients were successfully intubated in the first attempt. Intubation as assessed by IDS score was easier in Airtraq (84.44%) in contrast to slight difficulty in the Macintosh (77.78%) group; Numerical Rating Scale score was easy in both the groups (Airtraq-91.12%; Macintosh-93.34%). The median (interquartile range [IQR]) time for laryngoscopy, (12 s [IQR, 8 to 17.5) vs. 8 s [IQR, 6 to 12]); total duration for intubation (25 s [IQR, 20-33] vs. 22 s [IQR, 18-27.5]) were prolonged in Airtraq group in comparison to Macintosh group. In anesthetized adult patients with MILS compared with Macintosh, Airtraq provides equal success rate of intubation, statistically significant (although clinically insignificant) longer duration for laryngoscopy and intubation. Intubation with Airtraq was significantly easier than Macintosh as assessed by the IDS score.

Similar head impact acceleration measured using instrumented ear patches in a junior rugby union team during matches in comparison with other sports.

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King, Doug A; Hume, Patria A; Gissane, Conor; Clark, Trevor N

2016-07-01

OBJECTIVE Direct impact with the head and the inertial loading of the head have been postulated as major mechanisms of head-related injuries, such as concussion. METHODS This descriptive observational study was conducted to quantify the head impact acceleration characteristics in under-9-year-old junior rugby union players in New Zealand. The impact magnitude, frequency, and location were collected with a wireless head impact sensor that was worn by 14 junior rugby players who participated in 4 matches. RESULTS A total of 721 impacts > 10g were recorded. The median (interquartile range [IQR]) number of impacts per player was 46 (IQR 37-58), resulting in 10 (IQR 4-18) impacts to the head per player per match. The median impact magnitudes recorded were 15g (IQR 12g-21g) for linear acceleration and 2296 rad/sec(2) (IQR 1352-4152 rad/sec(2)) for rotational acceleration. CONCLUSIONS There were 121 impacts (16.8%) above the rotational injury risk limit and 1 (0.1%) impact above the linear injury risk limit. The acceleration magnitude and number of head impacts in junior rugby union players were higher than those previously reported in similar age-group sports participants. The median linear acceleration for the under-9-year-old rugby players were similar to 7- to 8-year-old American football players, but lower than 9- to 12-year-old youth American football players. The median rotational accelerations measured were higher than the median and 95th percentiles in youth, high school, and collegiate American football players.

Meeting increased demand for total knee replacement and follow-up: determining optimal follow-up.

Science.gov (United States)

Meding, J B; Ritter, M A; Davis, K E; Farris, A

2013-11-01

The strain on clinic and surgeon resources resulting from a rise in demand for total knee replacement (TKR) requires reconsideration of when and how often patients need to be seen for follow-up. Surgeons will otherwise require increased paramedical staff or need to limit the number of TKRs they undertake. We reviewed the outcome data of 16 414 primary TKRs undertaken at our centre to determine the time to re-operation for any reason and for specific failure mechanisms. Peak risk years for failure were determined by comparing the conditional probability of failure, the number of failures divided by the total number of TKRs cases, for each year. The median times to failure for the most common failure mechanisms were 4.9 years (interquartile range (IQR) 1.7 to 10.7) for femoral and tibial loosening, 1.9 years (IQR 0.8 to 3.9) for infection, 3.1 years (IQR 1.6 to 5.5) for tibial collapse and 5.6 years (IQR 3.4 to 9.3) for instability. The median time to failure for all revisions was 3.3 years (IQR 1.2 to 8.5), with an overall revision rate of 1.7% (n = 282). Results from our patient population suggest that patients be seen for follow-up at six months, one year, three years, eight years, 12 years, and every five years thereafter. Patients with higher pain in the early post-operative period or high body mass index (≥ 41 kg/m(2)) should be monitored more closely.

Effect of Aspect on Climate Variation in Mountain Ranges of Shen-nongjia Massif, Central China

Institute of Scientific and Technical Information of China (English)

ZHANG Yi

2018-01-01

The aim of this study was to better understand the mechanisms of regional climate variation in mountain ranges with con-trasting aspects as mediated by changes in global climate. It may help predict trends of vegetation variations in native ecosystems in natural reserves. As measures of climate response, temperature and precipitation data from the north, east, and south-facing mountain ranges of Shennongjia Massif in the coldest and hottest months (January and July), different seasons (spring, summer, autumn, and win-ter) and each year were analyzed from a long-term dataset (1960 to 2003) to tested variations characteristics, temporal and spatial quan-titative relationships of climates. The results showed that the average seasonal temperatures and precipitation in the north, east, and south aspects of the mountain ranges changed at different rates. The average seasonal temperatures change rate ranges in the north, east, and south-facing mountain ranges were from –0.0210℃ /yr to 0.0143℃ /yr,–0.0166℃ /yr to 0.0311℃ /yr, and –0.0290℃ /yr to 0.0084℃ /yr, respectively,and seasonal precipitation variation magnitude were from –1.4940 mm/yr to 0.6217 mm/yr, –1.6833 mm/yr to 2.6182 mm/yr, and –0.8567 mm/yr to 1.4077 mm/yr, respectively. The climates variation trend among the three mountain ranges were different in magnitude and direction, showing a complicated change of the climates in mountain ranges and some inconsistency with general trends in global climate change. The climate variations were significantly different and positively correlated cross mountain ranges, revealing that aspects significantly affected on climate variations and these variations resulted from a larger air circulation sys-tem, which were sensitive to global climate change. We conclude that location and terrain of aspect are the main factors affecting dif-ferences in climate variation among the mountain ranges with contrasting aspects.

Eliminating Glutamatergic Input onto Horizontal Cells Changes the Dynamic Range and Receptive Field Organization of Mouse Retinal Ganglion Cells.

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Ströh, Sebastian; Puller, Christian; Swirski, Sebastian; Hölzel, Maj-Britt; van der Linde, Lea I S; Segelken, Jasmin; Schultz, Konrad; Block, Christoph; Monyer, Hannah; Willecke, Klaus; Weiler, Reto; Greschner, Martin; Janssen-Bienhold, Ulrike; Dedek, Karin

2018-02-21

In the mammalian retina, horizontal cells receive glutamatergic inputs from many rod and cone photoreceptors and return feedback signals to them, thereby changing photoreceptor glutamate release in a light-dependent manner. Horizontal cells also provide feedforward signals to bipolar cells. It is unclear, however, how horizontal cell signals also affect the temporal, spatial, and contrast tuning in retinal output neurons, the ganglion cells. To study this, we generated a genetically modified mouse line in which we eliminated the light dependency of feedback by deleting glutamate receptors from mouse horizontal cells. This genetic modification allowed us to investigate the impact of horizontal cells on ganglion cell signaling independent of the actual mode of feedback in the outer retina and without pharmacological manipulation of signal transmission. In control and genetically modified mice (both sexes), we recorded the light responses of transient OFF-α retinal ganglion cells in the intact retina. Excitatory postsynaptic currents (EPSCs) were reduced and the cells were tuned to lower temporal frequencies and higher contrasts, presumably because photoreceptor output was attenuated. Moreover, receptive fields of recorded cells showed a significantly altered surround structure. Our data thus suggest that horizontal cells are responsible for adjusting the dynamic range of retinal ganglion cells and, together with amacrine cells, contribute to the center/surround organization of ganglion cell receptive fields in the mouse. SIGNIFICANCE STATEMENT Horizontal cells represent a major neuronal class in the mammalian retina and provide lateral feedback and feedforward signals to photoreceptors and bipolar cells, respectively. The mode of signal transmission remains controversial and, moreover, the contribution of horizontal cells to visual processing is still elusive. To address the question of how horizontal cells affect retinal output signals, we recorded the light

Holocene alluvial stratigraphy and response to climate change in the Roaring River valley, Front Range, Colorado, USA

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Madole, Richard F.

2012-09-01

Stratigraphic analyses and radiocarbon geochronology of alluvial deposits exposed along the Roaring River, Colorado, lead to three principal conclusions: (1) the opinion that stream channels in the higher parts of the Front Range are relics of the Pleistocene and nonalluvial under the present climate, as argued in a water-rights trial USA v. Colorado, is untenable, (2) beds of clast-supported gravel alternate in vertical succession with beds of fine-grained sediment (sand, mud, and peat) in response to centennial-scale changes in snowmelt-driven peak discharges, and (3) alluvial strata provide information about Holocene climate history that complements the history provided by cirque moraines, periglacial deposits, and paleontological data. Most alluvial strata are of late Holocene age and record, among other things, that: (1) the largest peak flows since the end of the Pleistocene occurred during the late Holocene; (2) the occurrence of a mid- to late Holocene interval (~ 2450-1630(?) cal yr BP) of warmer climate, which is not clearly identified in palynological records; and (3) the Little Ice Age climate seems to have had little impact on stream channels, except perhaps for minor (~ 1 m) incision.

Home range behavior among box turtles (Terrapene c. carolina) of a bottomland forest in Maryland

Science.gov (United States)

Stickel, L.F.

1989-01-01

Eastern box turtles (Terrapene c. carolina) in a Maryland bottomland forest were studied over a period of years (1944-1981). Home ranges of 51 males averaged 146 + SD 48 m long and 105 + SD 38 m wide; ranges of 52 females averaged 144 + SD 52 m long and 100 + SD 38 m wide. An approximation of average home range size, based on an ellipse, is 1.20 ha for males and 1.13 ha for females. Sizes of home ranges of individuals did not differ significantly between 1945 and the full term of their captures (0 =14 yr) (AOV; P > 0.05). Mean distance between capture sites, which provides an index to range size, was not significantly different among the years of 1945, 1955, 1965, and 1975 (AOV; P > 0.05). Geographic centers of ranges of 77 males in the bottomlands showed no significant (AOV; P > 0.05) change for 46, and change over relatively short distances (0 =57 + SD 23 m) for the others. Among 70 females, there was no significant change for 46 and change over short distances (0=61 + SD 24 m) for the others. Changes in location were more frequent between 1965 and 1975, a period of pronounced population decline, than between previous decades (significant only for females, x2 P < 0.025). Hibernation sites ordinarily (21 of 23 Individuals) were within the normal bottom]and range; hibernation sites of different years were near each other (all of 4 individuals). In contrast, nesting sites were far distant, extending the home range by 400-700 m, but those of different years were near each other (6 individuals). Mating partners occupied broadly overlapping or contiguous ranges (35 records). Interactions between males (18 records) were identical to courtship behavior, and are believed not to represent territorial aggression.

Whitebark pine, population density, and home-range size of grizzly bears in the greater yellowstone ecosystem.

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Daniel D Bjornlie

Full Text Available Changes in life history traits of species can be an important indicator of potential factors influencing populations. For grizzly bears (Ursus arctos in the Greater Yellowstone Ecosystem (GYE, recent decline of whitebark pine (WBP; Pinus albicaulis, an important fall food resource, has been paired with a slowing of population growth following two decades of robust population increase. These observations have raised questions whether resource decline or density-dependent processes may be associated with changes in population growth. Distinguishing these effects based on changes in demographic rates can be difficult. However, unlike the parallel demographic responses expected from both decreasing food availability and increasing population density, we hypothesized opposing behavioral responses of grizzly bears with regard to changes in home-range size. We used the dynamic changes in food resources and population density of grizzly bears as a natural experiment to examine hypotheses regarding these potentially competing influences on grizzly bear home-range size. We found that home-range size did not increase during the period of whitebark pine decline and was not related to proportion of whitebark pine in home ranges. However, female home-range size was negatively associated with an index of population density. Our data indicate that home-range size of grizzly bears in the GYE is not associated with availability of WBP, and, for female grizzly bears, increasing population density may constrain home-range size.

Whitebark pine, population density, and home-range size of grizzly bears in the greater Yellowstone ecosystem

Science.gov (United States)

Bjornlie, Daniel D.; van Manen, Frank T.; Ebinger, Michael R.; Haroldson, Mark A.; Thompson, Daniel J.; Costello, Cecily M.

2014-01-01

Changes in life history traits of species can be an important indicator of potential factors influencing populations. For grizzly bears (Ursus arctos) in the Greater Yellowstone Ecosystem (GYE), recent decline of whitebark pine (WBP; Pinus albicaulis), an important fall food resource, has been paired with a slowing of population growth following two decades of robust population increase. These observations have raised questions whether resource decline or density-dependent processes may be associated with changes in population growth. Distinguishing these effects based on changes in demographic rates can be difficult. However, unlike the parallel demographic responses expected from both decreasing food availability and increasing population density, we hypothesized opposing behavioral responses of grizzly bears with regard to changes in home-range size. We used the dynamic changes in food resources and population density of grizzly bears as a natural experiment to examine hypotheses regarding these potentially competing influences on grizzly bear home-range size. We found that home-range size did not increase during the period of whitebark pine decline and was not related to proportion of whitebark pine in home ranges. However, female home-range size was negatively associated with an index of population density. Our data indicate that home-range size of grizzly bears in the GYE is not associated with availability of WBP, and, for female grizzly bears, increasing population density may constrain home-range size.

Whitebark pine, population density, and home-range size of grizzly bears in the greater yellowstone ecosystem.

Science.gov (United States)

Bjornlie, Daniel D; Van Manen, Frank T; Ebinger, Michael R; Haroldson, Mark A; Thompson, Daniel J; Costello, Cecily M

2014-01-01

Changes in life history traits of species can be an important indicator of potential factors influencing populations. For grizzly bears (Ursus arctos) in the Greater Yellowstone Ecosystem (GYE), recent decline of whitebark pine (WBP; Pinus albicaulis), an important fall food resource, has been paired with a slowing of population growth following two decades of robust population increase. These observations have raised questions whether resource decline or density-dependent processes may be associated with changes in population growth. Distinguishing these effects based on changes in demographic rates can be difficult. However, unlike the parallel demographic responses expected from both decreasing food availability and increasing population density, we hypothesized opposing behavioral responses of grizzly bears with regard to changes in home-range size. We used the dynamic changes in food resources and population density of grizzly bears as a natural experiment to examine hypotheses regarding these potentially competing influences on grizzly bear home-range size. We found that home-range size did not increase during the period of whitebark pine decline and was not related to proportion of whitebark pine in home ranges. However, female home-range size was negatively associated with an index of population density. Our data indicate that home-range size of grizzly bears in the GYE is not associated with availability of WBP, and, for female grizzly bears, increasing population density may constrain home-range size.

Delineation of concentration ranges and longitudinal changes of human plasma protein variants.

Directory of Open Access Journals (Sweden)

Olgica Trenchevska

Full Text Available Human protein diversity arises as a result of alternative splicing, single nucleotide polymorphisms (SNPs and posttranslational modifications. Because of these processes, each protein can exists as multiple variants in vivo. Tailored strategies are needed to study these protein variants and understand their role in health and disease. In this work we utilized quantitative mass spectrometric immunoassays to determine the protein variants concentration of beta-2-microglobulin, cystatin C, retinol binding protein, and transthyretin, in a population of 500 healthy individuals. Additionally, we determined the longitudinal concentration changes for the protein variants from four individuals over a 6 month period. Along with the native forms of the four proteins, 13 posttranslationally modified variants and 7 SNP-derived variants were detected and their concentration determined. Correlations of the variants concentration with geographical origin, gender, and age of the individuals were also examined. This work represents an important step toward building a catalog of protein variants concentrations and examining their longitudinal changes.

Range Process Simulation Tool

Science.gov (United States)

Phillips, Dave; Haas, William; Barth, Tim; Benjamin, Perakath; Graul, Michael; Bagatourova, Olga

2005-01-01

Range Process Simulation Tool (RPST) is a computer program that assists managers in rapidly predicting and quantitatively assessing the operational effects of proposed technological additions to, and/or upgrades of, complex facilities and engineering systems such as the Eastern Test Range. Originally designed for application to space transportation systems, RPST is also suitable for assessing effects of proposed changes in industrial facilities and large organizations. RPST follows a model-based approach that includes finite-capacity schedule analysis and discrete-event process simulation. A component-based, scalable, open architecture makes RPST easily and rapidly tailorable for diverse applications. Specific RPST functions include: (1) definition of analysis objectives and performance metrics; (2) selection of process templates from a processtemplate library; (3) configuration of process models for detailed simulation and schedule analysis; (4) design of operations- analysis experiments; (5) schedule and simulation-based process analysis; and (6) optimization of performance by use of genetic algorithms and simulated annealing. The main benefits afforded by RPST are provision of information that can be used to reduce costs of operation and maintenance, and the capability for affordable, accurate, and reliable prediction and exploration of the consequences of many alternative proposed decisions.

Magnetism and atomic short-range order in Ni-Rh alloys

Science.gov (United States)

Carnegie, D. W., Jr.; Claus, H.

1984-07-01

Low-field ac susceptibility measurements of Ni-Rh samples of various concentrations are presented. Giant effects of the metallurgical state on the magnetic ordering temperature are associated with changes in the degree of atomic short-range order. By careful control of this degree of short-range order, it is possible to demonstrate the existence of a spin-glass state in Ni-Rh alloys.

Pulmonary hypertension not a major feature of early mixed connective tissue disease: A prospective clinicoserological study

Directory of Open Access Journals (Sweden)

Haroon N

2005-01-01

Full Text Available Background: Mixed connective tissue disease (MCTD has features common to lupus, scleroderma and myositis with high levels of antibodies to U1 ribonucleoprotein (U1 RNP. Identification of a high incidence of pulmonary artery hypertension (PAH has changed its prospect. We report the largest series from India. Settings and Design: Rheumatology unit of a tertiary care centre in India; prospective. Materials and Methods: Patients seen between January 2002 and June 2004, satisfying the Kasukawa criteria were enrolled. All patients had a complete laboratory work-up including pulmonary function test, 2-D echocardiography, and Schirmer′s test, antinuclear antibodies (ANA and antibodies to extractable nuclear antigens. HRCT of chest was done where indicated. All patients were given standard treatment and followed up regularly. Results: Out of 1500 patients, thirteen (one male were diagnosed to have MCTD. The median follow-up period was 18 months [Interquartile range (IQR 12-22]. The median age of onset of symptoms was 36 years (IQR 22-39 and the median duration of disease was three years (IQR 1.75-4. The most common manifestation was polyarthritis followed by puffy fingers. Sjogren′s syndrome, dysphagia and interstitial lung disease, was present in four, three and two patients respectively. Two patients each had myositis and migraine. None had PAH, serositis or renal involvement. Arthritis, puffy fingers and RaynaudÆs phenomenon were the most common manifestations at onset. All patients were positive for ANA and anti U1 RNP. Two patients each had antibodies to Sm and SSA. Response to treatment also was noted. Conclusion: Pulmonary artery hypertension is not common in early MCTD.

Global patterns of protection of elevational gradients in mountain ranges.

Science.gov (United States)

Elsen, Paul R; Monahan, William B; Merenlender, Adina M

2018-05-21

Protected areas (PAs) that span elevational gradients enhance protection for taxonomic and phylogenetic diversity and facilitate species range shifts under climate change. We quantified the global protection of elevational gradients by analyzing the elevational distributions of 44,155 PAs in 1,010 mountain ranges using the highest resolution digital elevation models available. We show that, on average, mountain ranges in Africa and Asia have the lowest elevational protection, ranges in Europe and South America have intermediate elevational protection, and ranges in North America and Oceania have the highest elevational protection. We use the Convention on Biological Diversity's Aichi Target 11 to assess the proportion of elevational gradients meeting the 17% suggested minimum target and examine how different protection categories contribute to elevational protection. When considering only strict PAs [International Union for Conservation of Nature (IUCN) categories I-IV, n = 24,706], nearly 40% of ranges do not contain any PAs, roughly half fail to meet the 17% target at any elevation, and ∼75% fail to meet the target throughout ≥50% of the elevational gradient. Observed elevational protection is well below optimal, and frequently below a null model of elevational protection. Including less stringent PAs (IUCN categories V-VI and nondesignated PAs, n = 19,449) significantly enhances elevational protection for most continents, but several highly biodiverse ranges require new or expanded PAs to increase elevational protection. Ensuring conservation outcomes for PAs with lower IUCN designations as well as strategically placing PAs to better represent and connect elevational gradients will enhance ecological representation and facilitate species range shifts under climate change. Copyright © 2018 the Author(s). Published by PNAS.

Changes in hip and ankle range of motion and hip muscle strength in 8–11 year old novice female ballet dancers and controls: a 12 month follow up study

Science.gov (United States)

Bennell, K; Khan, K; Matthews, B; Singleton, C

2001-01-01

Objectives—To evaluate in a 12 month longitudinal study changes in hip and ankle range of motion and hip muscle strength in young female novice ballet dancers. Methods—Fifty three of the original 77 (69%) female dancers aged 8–11 years and 40 of the original 49 (82%) controls returned for follow up measurements one year later. Supine right active hip external (ER) and internal (IR) rotation were measured using an inclinometer. A turnout protractor was used to assess standing active turnout range. Range of right weight bearing ankle dorsiflexion and calf muscle length were measured in a standing lunge position using an inclinometer. A manual muscle tester was used to assess right hip flexor, IR, ER, abductor and adductor strength. Results—The mean (SD) 12 month change in hip ER did not differ between dancers (11.7 (11.3)°) and controls (8.1 (17.6)°). Dancers gained 12.5 (13.5)° hip IR which was significantly greater than controls (0.5 (13.9)°). Greater IR change was associated with improved IR strength (r = 0.34, pballet students and controls at this young age. However, ankle dorsiflexion did not, which is probably due to this movement being blocked by bony apposition, rather than soft tissue stretch. This has implications for ballet teachers, as it has long been accepted that this movement could be improved with training. Dancers had greater increases in hip strength after 12 months compared with controls in muscles specific for ballet, suggesting that hip strength can be trained at this young age. Whether these gains are permanent requires further study. Key Words: dance; ballet; range of motion; muscle strength PMID:11157464

Safety and Efficacy of Focused Ultrasound Thalamotomy for Patients With Medication-Refractory, Tremor-Dominant Parkinson Disease: A Randomized Clinical Trial.

Science.gov (United States)

Bond, Aaron E; Shah, Binit B; Huss, Diane S; Dallapiazza, Robert F; Warren, Amy; Harrison, Madaline B; Sperling, Scott A; Wang, Xin-Qun; Gwinn, Ryder; Witt, Jennie; Ro, Susie; Elias, W Jeffrey

2017-12-01

Clinical trials have confirmed the efficacy of focused ultrasound (FUS) thalamotomy in essential tremor, but its effectiveness and safety for managing tremor-dominant Parkinson disease (TDPD) is unknown. To assess safety and efficacy at 12-month follow-up, accounting for placebo response, of unilateral FUS thalamotomy for patients with TDPD. Of the 326 patients identified from an in-house database, 53 patients consented to be screened. Twenty-six were ineligible, and 27 were randomized (2:1) to FUS thalamotomy or a sham procedure at 2 centers from October18, 2012, to January 8, 2015. The most common reasons for disqualification were withdrawal (8 persons [31%]), and not being medication refractory (8 persons [31%]). Data were analyzed using intention-to-treat analysis, and assessments were double-blinded through the primary outcome. Twenty patients were randomized to unilateral FUS thalamotomy, and 7 to sham procedure. The sham group was offered open-label treatment after unblinding. The predefined primary outcomes were safety and difference in improvement between groups at 3 months in the on-medication treated hand tremor subscore from the Clinical Rating Scale for Tremor (CRST). Secondary outcomes included descriptive results of Unified Parkinson's Disease Rating Scale (UPDRS) scores and quality of life measures. Of the 27 patients, 26 (96%) were male and the median age was 67.8 years (interquartile range [IQR], 62.1-73.8 years). On-medication median tremor scores improved 62% (IQR, 22%-79%) from a baseline of 17 points (IQR, 10.5-27.5) following FUS thalamotomy and 22% (IQR, -11% to 29%) from a baseline of 23 points (IQR, 14.0-27.0) after sham procedures; the between-group difference was significant (Wilcoxon P = .04). On-medication median UPDRS motor scores improved 8 points (IQR, 0.5-11.0) from a baseline of 23 points (IQR, 15.5-34.0) following FUS thalamotomy and 1 point (IQR, -5.0 to 9.0) from a baseline of 25 points (IQR, 15.0-33.0) after sham

Recent changes in seasonal variations of climate within the range of northern caribou populations

Directory of Open Access Journals (Sweden)

Paul H. Whitfield

2005-05-01

Full Text Available The Arctic is one region where it is expected that the impacts of a globally changing climate will be readily observed. We present results that indicate that climate derivatives of potential significance to caribou changed during the past 50 years. Many temperature derivatives reflect the increasing overall temperature in the Arctic such as decreases in the number of days with low temperatures, increases in the number of days with thaw, and days with extremely warm temperatures. Other derivatives reflect changes in the precipitation regime such as days with heavy precipitation and number of days when rain fell on snow. Our results indicate that specific caribou herds from across the Arctic were subjected to different variations of these derivatives in different seasons in the recent past. Examination of temperature and precipitation at finer time-steps than annual or monthly means, shows that climatic variations in the region are neither consistent through the seasons nor across space. Decadal changes in seasonal patterns of temperature and precipitation are shown for selected herds. A process for assessing caribou-focused climate derivatives is proposed.

Changing Snow Cover and Stream Discharge in the Western United States - Wind River Range, Wyoming

Science.gov (United States)

Hall, Dorothy K.; Foster, James L.; DiGirolamo, Nicolo E.; Barton, Jonathan S.; Riggs, George A.

2011-01-01

Earlier onset of springtime weather has been documented in the western United States over at least the last 50 years. Because the majority (>70%) of the water supply in the western U.S. comes from snowmelt, analysis of the declining spring snowpack has important implications for the management of water resources. We studied ten years of Moderate-Resolution Imaging Spectroradiometer (MODIS) snow-cover products, 40 years of stream discharge and meteorological station data and 30 years of snow-water equivalent (SWE) SNOw Telemetry (SNOTEL) data in the Wind River Range (WRR), Wyoming. Results show increasing air temperatures for.the 40-year study period. Discharge from streams in WRR drainage basins show lower annual discharge and earlier snowmelt in the decade of the 2000s than in the previous three decades. Changes in streamflow may be related to increasing air temperatures which are probably contributing to a reduction in snow cover, although no trend of either increasingly lower streamflow or earlier snowmelt was observed within the decade of the 2000s. And SWE on 1 April does not show an expected downward trend from 1980 to 2009. The extent of snow cover derived from the lowest-elevation zone of the WRR study area is strongly correlated (r=0.91) with stream discharge on 1 May during the decade of the 2000s. The strong relationship between snow cover and streamflow indicates that MODIS snow-cover maps can be used to improve management of water resources in the drought-prone western U.S.

Improving Tanzanian childbirth service quality.

Science.gov (United States)

Jaribu, Jennie; Penfold, Suzanne; Green, Cathy; Manzi, Fatuma; Schellenberg, Joanna

2018-04-16

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

Range expansion by Passer montanus in North America

Science.gov (United States)

Burnett, J.L.; Roberts, C.P.; Allen, Craig R.; Brown, M.B.; Moulton, M.P.

2017-01-01

Passer montanus became established in a small area of central North America following its introduction in 1870. P. montanus underwent minimal range expansion in the first 100 years following introduction. However, the North American population of P. montanus is now growing in size and expanding in geographic distribution, having expanded approximately 125 km to the north by 1970. We quantify the distance of spread by P. montanus from its introduction site in the greater St. Louis, Missouri-Illinois, USA area, using distributional (presence) data from the National Audubon Society Christmas Bird Count surveys for the period of 1951 to 2014. Linear regressions of the average annual range center of P. montanus confirmed significant shifts to the north at a rate of 3.3 km/year (P Linear regressions of the linear and angular distance of range center indicates significant northern movement (change in angle of mean range center; P < 0.001) since 1951. Our results quantify the extent of a northward range expansion, and suggesting a probable spread of this species northward.

Expansion Under Climate Change: The Genetic Consequences.

Science.gov (United States)

Garnier, Jimmy; Lewis, Mark A

2016-11-01

Range expansion and range shifts are crucial population responses to climate change. Genetic consequences are not well understood but are clearly coupled to ecological dynamics that, in turn, are driven by shifting climate conditions. We model a population with a deterministic reaction-diffusion model coupled to a heterogeneous environment that develops in time due to climate change. We decompose the resulting travelling wave solution into neutral genetic components to analyse the spatio-temporal dynamics of its genetic structure. Our analysis shows that range expansions and range shifts under slow climate change preserve genetic diversity. This is because slow climate change creates range boundaries that promote spatial mixing of genetic components. Mathematically, the mixing leads to so-called pushed travelling wave solutions. This mixing phenomenon is not seen in spatially homogeneous environments, where range expansion reduces genetic diversity through gene surfing arising from pulled travelling wave solutions. However, the preservation of diversity is diminished when climate change occurs too quickly. Using diversity indices, we show that fast expansions and range shifts erode genetic diversity more than slow range expansions and range shifts. Our study provides analytical insight into the dynamics of travelling wave solutions in heterogeneous environments.

Parameter changes in silicon IMPATT diodes for mm wavelength range exposed to gamma-radiation

International Nuclear Information System (INIS)

Shcherbina, L.V.; Torchinskaya, T.V.; Shcherbina, E.S.; Polupan, G.P.

1999-01-01

We investigated the p + -n-n + -silicon mesa-diodes fabricated using batch technique whose breakdown voltage was 19±1 V. The exposition of IMPATT diodes to 60 Co gamma-radiation was made in the 10 3 to 10 7 Gy dose range. When the gamma-irradiation dose was increased up to (5-8)*10 5 Gy, then the thermal-generation component of the reverse current was monotonously decreasing. The breakdown voltage remained the same during gamma-irradiation. It was shown experimentally that exposition of diodes to (5-8)*10 5 Gy doses of gamma-irradiation led to some drop of both the number of microplasmas in the avalanche breakdown region and the micro plasma noise level. 60 Co gamma-irradiation in the 10 3 -8*10 5 Gy dose range led also to the growth of the microwave output power P out . The decrease of the micro plasma number in the avalanche breakdown region and Pout growth may be explained if one assumes that gamma-irradiation in the 10 3 - 8*10 5 Gy dose range leads to 'healing' of structural defects in the semiconductor due to their interaction with the radiation-induced point defects. The gamma-irradiation dose increase over 8*10 5 Gy results in a storage of some radiation-induced defects in the IMPATT diode base and electrical parameters of diodes are degrading

Implications of stress range for inelastic analysis

International Nuclear Information System (INIS)

Karabin, M.E.; Dhalla, A.K.

1981-01-01

The elastic stress range over a complete load cycle is routinely used to formulate simplified rules regarding the inelastic behavior of structures operating at elevated temperature. For example, a 300 series stainless steel structure operating at elevated temperature, in all probability, would satisfy the ASME Boiler and Pressure Vessel Code criteria if the linearized elastic stress range is less than three times the material yield strength. However, at higher elastic stress ranges it is difficult to judge, a priori, that a structural component would comply with inelastic Code criteria after a detailed inelastic analysis. The purpose of this paper is to illustrate that it is not the elastic stress range but the stress intensities at specific times during a thermal transient which provide a better insight into the inelastic response of the structure. The specific example of the CRBRP flued head design demonstrates that the temperature differential between various parts of the structure can be changed by modifying the insulation pattern and heat flow path in the structure, without significantly altering the elastic stress range over a complete load cycle. However, the modified design did reduce the stress intensity during steady state elevated temperature operation. This modified design satisfied the inelastic Code criteria whereas the initial design failed to comply with the strain accumulation criterion

Intraspecific Genetic dynamics under Climate Change

DEFF Research Database (Denmark)

Florez Rodriguez, Alexander

Climate change has a deep influence on the maintenance and generation of global biodiversity. Past contractions, expansions and shifts in species’ ranges drove to changes in species genetic diversity. Noteworthy, the interaction among: climate change, range, population size and extinction is often...

Relationship of Circulating C5a and Complement Factor H Levels With Disease Control in Pregnant Women With Asthma.

Science.gov (United States)

Bohács, Anikó; Bikov, András; Ivancsó, István; Czaller, Ibolya; Böcskei, Renáta; Müller, Veronika; Rigó, János; Losonczy, György; Tamási, Lilla

2016-04-01

Asthma often complicates pregnancy and represents a risk of serious pregnancy complications. The complement system contributes to asthma pathogenesis and is up-regulated in healthy gestation as well. The anaphylatoxin C5a has a major pro-inflammatory role, and the complement factor H is a main soluble regulator protein both in asthma and during pregnancy; however, peripheral levels of these complement factors and their relationship to disease control have not yet been evaluated in pregnant subjects with asthma. The present study aimed to investigate circulating C5a and complement factor H levels in asthma (non-pregnant subjects with asthma; n = 19) and in pregnancy with asthma (pregnant subjects with asthma; n = 22), compared with healthy non-pregnant (n = 21) and healthy pregnant women (n = 13) and to test their relationship to clinical parameters of asthma (lung function, airway inflammation, and symptoms). Circulating C5a levels were higher in the pregnant asthma subject group compared with the healthy non-pregnant, healthy pregnant, and non-pregnant asthma groups: median 2.629 (interquartile range [IQR] 2.257-3.052) ng/mL versus 1.84 (IQR 1.576-2.563), 1.783 (IQR 0.6064-2.786), and 2.024 (IQR 1.232-2.615) ng/mL, respectively (P = .02 in all cases). C5a correlated negatively with FEV1 (r = -0.44, P = .039) and FVC values (r = -0.64, P = .001) in the pregnant asthma group and positively with fraction of exhaled nitric oxide levels in the non-pregnant asthma group (n = 12, r = 0.78, P = .004). Complement factor H levels were elevated in both the healthy pregnant and pregnant asthma subject groups compared with the healthy non-pregnant group (median 1,082 [IQR 734.9-1,224] and 910.7 [IQR 614.5-1076] μg/mL vs. 559.7 [IQR 388.7-783.1] μg/mL, P = .002 and P = .004, respectively) but not in the pregnant asthma group compared with the non-pregnant asthma group (median 687.4 [IQR 441.6-947.6] μg/mL, P = .10). Asthma during pregnancy increases the circulating level of

Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways.

Science.gov (United States)

Patel, A; Nouraei, S A R

2015-03-01

Emergency and difficult tracheal intubations are hazardous undertakings where successive laryngoscopy-hypoxaemia-re-oxygenation cycles can escalate to airway loss and the 'can't intubate, can't ventilate' scenario. Between 2013 and 2014, we extended the apnoea times of 25 patients with difficult airways who were undergoing general anaesthesia for hypopharyngeal or laryngotracheal surgery. This was achieved through continuous delivery of transnasal high-flow humidified oxygen, initially to provide pre-oxygenation, and continuing as post-oxygenation during intravenous induction of anaesthesia and neuromuscular blockade until a definitive airway was secured. Apnoea time commenced at administration of neuromuscular blockade and ended with commencement of jet ventilation, positive-pressure ventilation or recommencement of spontaneous ventilation. During this time, upper airway patency was maintained with jaw-thrust. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) was used in 15 males and 10 females. Mean (SD [range]) age at treatment was 49 (15 [25-81]) years. The median (IQR [range]) Mallampati grade was 3 (2-3 [2-4]) and direct laryngoscopy grade was 3 (3-3 [2-4]). There were 12 obese patients and nine patients were stridulous. The median (IQR [range]) apnoea time was 14 (9-19 [5-65]) min. No patient experienced arterial desaturation gaseous exchange through flow-dependent deadspace flushing. It has the potential to transform the practice of anaesthesia by changing the nature of securing a definitive airway in emergency and difficult intubations from a pressured stop-start process to a smooth and unhurried undertaking. © 2014 The Authors Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

Factors Affecting Home Ranges of Red Foxes in Ikh Nart Nature Reserve, Mongolia

Directory of Open Access Journals (Sweden)

Tserendorj Munkhzul

2012-12-01

Full Text Available Changes in red fox home range size in relation to environmental and intrinsic factors were studied using radio-telemetry during 2006–2008 in Ikh Nart Nature Reserve, southeastern Mongolia. We captured a total of 12 red foxes (8 females and 4 males and fi tted them with VHF radio-collars. Marked animals were tracked up to fi ve times a week to estimate home ranges. We also trapped small mammal and insects in different biotopes for 3 years to estimate relative abundance of prey. Our results showed that mean individual home range sizes varied widely and differed among years. There was variation in home ranges between adults versus juveniles, but no signifi cant difference was found between males versus females. In addition, mean home range size did not differ seasonally for pooled years. Variation in home ranges was best explained by a model that included covariates of year and age. We suggest that spatiotemporal changes in resource availability across years infl uenced home range dynamics of red foxes in our study.

Sympathoadrenal Activation and Endothelial Damage Are Inter Correlated and Predict Increased Mortality in Patients Resuscitated after Out-Of-Hospital Cardiac Arrest

DEFF Research Database (Denmark)

I. Johansson, Pär; Bro-Jeppesen, John; Kjaergaard, Jesper

2015-01-01

site ICU. Blood was sampled a median 135 min (Inter Quartile Range (IQR) 103-169) after OHCA. Plasma catecholamines (adrenaline, noradrenaline) and serum endothelial biomarkers (syndecan-1, thrombomodulin, sE-selectin, sVE-cadherin) were measured at admission (immediately after randomization). We had...

Mother-to-child transmission of HIV in a community-based ...

African Journals Online (AJOL)

interquartile range (IQR) 4 - 11.9).The HIV transmission rate was 5.1% (95% confidence interval (CI) 2.8 - 9.0%). Factors associated with transmission were advanced maternal WHO disease stage (odds ratio (OR) 9.57, p=0.02), and follow-up ...

Determination of dose ranges of gamma rays to induce specific changes in three ornamental species

International Nuclear Information System (INIS)

Gonzalez J, J.

2011-11-01

In order to confirming the possibility of to settle a dose range that takes place directly and not at random, a specific effect independently of the species that is were produced several similar organisms to three ornamental species took place via meristems cultivation: Petunia hybrid, Impatiens walleriana and Sprekelia formosissima, same that were irradiated in an irradiator Gamma cell 220, to different dose: 0, 3.5, 5.0, 7.5, 10, 12.5, 15, 17.5 and 20 Gy. Later on, of the plants treated via in vitro the subsequent generations were obtained until the M 4 . To determine the DL 50 and the possible good doses, the survival parameters, development, morphogenesis and height were evaluated during 8 weeks, interpreting based on them, the possible physiologic and genetic alterations induced by the radiation. The established DL 50 were: 7.5 Gy (Petunia), 19.0 Gy (Impatiens) and 12.0 Gy (Sprekelia). Based on the DL 50 of each species, a range of coincident dose settled down that produces a similar effect in the three species: a range of DL 23 to the DL 50 induces and alteration in the cytokinins production affecting directly in the leaves number, buds and plants taken place by meristem, also a range of DL 32 - DL 50 impacts in the auxins production altering to the radicule system. However, when being superimposed the dose is considered that the investigation should continue. (Author)

DOCUMENTATION AND DETECTION OF COLOUR CHANGES OF BAS RELIEVES USING CLOSE RANGE PHOTOGRAMMETRY

Directory of Open Access Journals (Sweden)

E. S. Malinverni

2017-05-01

Full Text Available The digitization of complex buildings, findings or bas relieves can strongly facilitate the work of archaeologists, mainly for in depth analysis tasks. Notwithstanding, whether new visualization techniques ease the study phase, a classical naked-eye approach for determining changes or surface alteration could bring towards several drawbacks. The research work described in these pages is aimed at providing experts with a workflow for the evaluation of alterations (e.g. color decay or surface alterations, allowing a more rapid and objective monitoring of monuments. More in deep, a pipeline of work has been tested in order to evaluate the color variation between surfaces acquired at different époques. The introduction of reliable tools of change detection in the archaeological domain is needful; in fact, the most widespread practice, among archaeologists and practitioners, is to perform a traditional monitoring of surfaces that is made of three main steps: production of a hand-made map based on a subjective analysis, selection of a sub-set of regions of interest, removal of small portion of surface for in depth analysis conducted in laboratory. To overcome this risky and time consuming process, digital automatic change detection procedure represents a turning point. To do so, automatic classification has been carried out according to two approaches: a pixel-based and an object-based method. Pixel-based classification aims to identify the classes by means of the spectral information provided by each pixel belonging to the original bands. The object-based approach operates on sets of pixels (objects/regions grouped together by means of an image segmentation technique. The methodology was tested by studying the bas-relieves of a temple located in Peru, named Huaca de la Luna. Despite the data sources were collected with unplanned surveys, the workflow proved to be a valuable solution useful to understand which are the main changes over time.

Documentation and Detection of Colour Changes of Bas Relieves Using Close Range Photogrammetry

Science.gov (United States)

Malinverni, E. S.; Pierdicca, R.; Sturari, M.; Colosi, F.; Orazi, R.

2017-05-01

The digitization of complex buildings, findings or bas relieves can strongly facilitate the work of archaeologists, mainly for in depth analysis tasks. Notwithstanding, whether new visualization techniques ease the study phase, a classical naked-eye approach for determining changes or surface alteration could bring towards several drawbacks. The research work described in these pages is aimed at providing experts with a workflow for the evaluation of alterations (e.g. color decay or surface alterations), allowing a more rapid and objective monitoring of monuments. More in deep, a pipeline of work has been tested in order to evaluate the color variation between surfaces acquired at different époques. The introduction of reliable tools of change detection in the archaeological domain is needful; in fact, the most widespread practice, among archaeologists and practitioners, is to perform a traditional monitoring of surfaces that is made of three main steps: production of a hand-made map based on a subjective analysis, selection of a sub-set of regions of interest, removal of small portion of surface for in depth analysis conducted in laboratory. To overcome this risky and time consuming process, digital automatic change detection procedure represents a turning point. To do so, automatic classification has been carried out according to two approaches: a pixel-based and an object-based method. Pixel-based classification aims to identify the classes by means of the spectral information provided by each pixel belonging to the original bands. The object-based approach operates on sets of pixels (objects/regions) grouped together by means of an image segmentation technique. The methodology was tested by studying the bas-relieves of a temple located in Peru, named Huaca de la Luna. Despite the data sources were collected with unplanned surveys, the workflow proved to be a valuable solution useful to understand which are the main changes over time.

Range expansion drives dispersal evolution in an equatorial three-species symbiosis.

Science.gov (United States)

Léotard, Guillaume; Debout, Gabriel; Dalecky, Ambroise; Guillot, Sylvain; Gaume, Laurence; McKey, Doyle; Kjellberg, Finn

2009-01-01

Recurrent climatic oscillations have produced dramatic changes in species distributions. This process has been proposed to be a major evolutionary force, shaping many life history traits of species, and to govern global patterns of biodiversity at different scales. During range expansions selection may favor the evolution of higher dispersal, and symbiotic interactions may be affected. It has been argued that a weakness of climate fluctuation-driven range dynamics at equatorial latitudes has facilitated the persistence there of more specialized species and interactions. However, how much the biology and ecology of species is changed by range dynamics has seldom been investigated, particularly in equatorial regions. We studied a three-species symbiosis endemic to coastal equatorial rainforests in Cameroon, where the impact of range dynamics is supposed to be limited, comprised of two species-specific obligate mutualists--an ant-plant and its protective ant--and a species-specific ant parasite of this mutualism. We combined analyses of within-species genetic diversity and of phenotypic variation in a transect at the southern range limit of this ant-plant system. All three species present congruent genetic signatures of recent gradual southward expansion, a result compatible with available regional paleoclimatic data. As predicted, this expansion has been accompanied by the evolution of more dispersive traits in the two ant species. In contrast, we detected no evidence of change in lifetime reproductive strategy in the tree, nor in its investment in food resources provided to its symbiotic ants. Despite the decreasing investment in protective workers and the increasing investment in dispersing females by both the mutualistic and the parasitic ant species, there was no evidence of destabilization of the symbiosis at the colonization front. To our knowledge, we provide here the first evidence at equatorial latitudes that biological traits associated with dispersal are

Research on range-gated laser active imaging seeker

Science.gov (United States)

You, Mu; Wang, PengHui; Tan, DongJie

2013-09-01

Compared with other imaging methods such as millimeter wave imaging, infrared imaging and visible light imaging, laser imaging provides both a 2-D array of reflected intensity data as well as 2-D array of range data, which is the most important data for use in autonomous target acquisition .In terms of application, it can be widely used in military fields such as radar, guidance and fuse. In this paper, we present a laser active imaging seeker system based on range-gated laser transmitter and sensor technology .The seeker system presented here consist of two important part, one is laser image system, which uses a negative lens to diverge the light from a pulse laser to flood illuminate a target, return light is collected by a camera lens, each laser pulse triggers the camera delay and shutter. The other is stabilization gimbals, which is designed to be a rotatable structure both in azimuth and elevation angles. The laser image system consists of transmitter and receiver. The transmitter is based on diode pumped solid-state lasers that are passively Q-switched at 532nm wavelength. A visible wavelength was chosen because the receiver uses a Gen III image intensifier tube with a spectral sensitivity limited to wavelengths less than 900nm.The receiver is image intensifier tube's micro channel plate coupled into high sensitivity charge coupled device camera. The image has been taken at range over one kilometer and can be taken at much longer range in better weather. Image frame frequency can be changed according to requirement of guidance with modifiable range gate, The instantaneous field of views of the system was found to be 2×2 deg. Since completion of system integration, the seeker system has gone through a series of tests both in the lab and in the outdoor field. Two different kinds of buildings have been chosen as target, which is located at range from 200m up to 1000m.To simulate dynamic process of range change between missile and target, the seeker system has

Current Trends and Challenges in Satellite Laser Ranging

Science.gov (United States)

Appleby, Graham M.; Bianco, Giuseppe; Noll, Carey E.; Pavlis, Erricos C.; Pearlman, Michael R.

2016-12-01

Satellite Laser Ranging (SLR) is used to measure accurately the distance from ground stations to retro-reflectors on satellites and on the Moon. SLR is one of the fundamental space-geodetic techniques that define the International Terrestrial Reference Frame (ITRF), which is the basis upon which many aspects of global change over space, time, and evolving technology are measured; with VLBI the two techniques define the scale of the ITRF; alone the SLR technique defines its origin (geocenter). The importance of the reference frame has recently been recognized at the inter-governmental level through the United Nations, which adopted in February 2015 the Resolution "Global Geodetic Reference Frame for Sustainable Development." Laser Ranging provides precision orbit determination and instrument calibration and validation for satellite-borne altimeters for the better understanding of sea level change, ocean dynamics, ice mass-balance, and terrestrial topography. It is also a tool to study the dynamics of the Moon and fundamental constants and theories. With the exception of the currently in-orbit GPS constellation, all GNSS satellites now carry retro-reflectors for improved orbit determination, harmonization of reference frames, and in-orbit co-location and system performance validation; the next generation of GPS satellites due for launch from 2019 onwards will also carry retro-reflectors. The ILRS delivers weekly realizations that are accumulated sequentially to extend the ITRF and the Earth Orientation Parameter series with a daily resolution. SLR technology continues to evolve towards the next-generation laser ranging systems and it is expected to successfully meet the challenges of the GGOS2020 program for a future Global Space Geodetic Network. Ranging precision is improving as higher repetition rate, narrower pulse lasers, and faster detectors are implemented within the network. Automation and pass interleaving at some stations is expanding temporal coverage and

Accuracy and Feasibility of an Android-Based Digital Assessment Tool for Post Stroke Visual Disorders-The StrokeVision App.

Science.gov (United States)

Quinn, Terence J; Livingstone, Iain; Weir, Alexander; Shaw, Robert; Breckenridge, Andrew; McAlpine, Christine; Tarbert, Claire M

2018-01-01

Visual impairment affects up to 70% of stroke survivors. We designed an app (StrokeVision) to facilitate screening for common post stroke visual issues (acuity, visual fields, and visual inattention). We sought to describe the test time, feasibility, acceptability, and accuracy of our app-based digital visual assessments against (a) current methods used for bedside screening and (b) gold standard measures. Patients were prospectively recruited from acute stroke settings. Index tests were app-based assessments of fields and inattention performed by a trained researcher. We compared against usual clinical screening practice of visual fields to confrontation, including inattention assessment (simultaneous stimuli). We also compared app to gold standard assessments of formal kinetic perimetry (Goldman or Octopus Visual Field Assessment); and pencil and paper-based tests of inattention (Albert's, Star Cancelation, and Line Bisection). Results of inattention and field tests were adjudicated by a specialist Neuro-ophthalmologist. All assessors were masked to each other's results. Participants and assessors graded acceptability using a bespoke scale that ranged from 0 (completely unacceptable) to 10 (perfect acceptability). Of 48 stroke survivors recruited, the complete battery of index and reference tests for fields was successfully completed in 45. Similar acceptability scores were observed for app-based [assessor median score 10 (IQR: 9-10); patient 9 (IQR: 8-10)] and traditional bedside testing [assessor 10 (IQR: 9-10); patient 10 (IQR: 9-10)]. Median test time was longer for app-based testing [combined time to completion of all digital tests 420 s (IQR: 390-588)] when compared with conventional bedside testing [70 s, (IQR: 40-70)], but shorter than gold standard testing [1,260 s, (IQR: 1005-1,620)]. Compared with gold standard assessments, usual screening practice demonstrated 79% sensitivity and 82% specificity for detection of a stroke-related field defect

A biomechanical analysis of a single-row suture anchor fixation of a large bony bankart lesion.

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Dyskin, Evgeny; Marzo, John M; Howard, Craig; Ehrensberger, Mark

2014-12-01

This study was conducted to assess whether a single-row suture anchor repair of a bony Bankart lesion comprising 19% of the glenoid length restores peak translational force and glenoid depth compared with the intact shoulder. Nine thawed adult cadaveric shoulders were dissected and mounted in 45° of abduction and 30° of external rotation. A bony Bankart lesion was simulated with an anterior longitudinal osteotomy, parallel to the superoinferior axis of the glenoid, equivalent to 19% of the glenoid length. The humeral head was displaced 10 mm anteriorly at a speed of 2 mm/s with a 50-N compressive load applied. Testing was performed with the glenoid intact, a simulated lesion, and the lesion repaired with 3 single-row suture anchors. Median (interquartile range [IQR]) peak translational force and glenoid depth were reported. The Friedman test and post hoc comparisons with the Wilcoxon signed rank test were used for between-group analyses. Peak translational force decreased after osteotomy (13.7 N; IQR, 9.6 to 15.5 N; P = .01) and increased after the repair (18.3 N; IQR, 18.3 to 20.6 N; P = .01) compared with the intact shoulder (23.7 N; IQR, 16.4 to 29.9 N). Glenoid depth significantly decreased after the osteotomy (0.2 mm; IQR, -0.6 to 0.7 mm) compared with baseline (1.7 mm; IQR, 1.3 to 2.0 mm; P = .01) and increased after repair (0.8 mm; IQR, 0.1 to 1.0 mm; P = .03) compared with the osteotomized shoulder. The glenoid depth of the repair was less than the baseline value (P = .01). Repair of an anterior bony Bankart lesion equivalent to 19% of the glenoid length with 3 suture anchors restored the peak translational force needed to anteriorly displace the humerus relative to the glenoid; however, this technique failed to restore the natural glenoid depth in a laboratory setting. Our findings describe the inability of a single-row suture anchor repair to provide anatomic fixation of the bony Bankart lesion equivalent to 19% of the glenoid length

Patient Awareness and Expectations of Pharmacist Services During Hospital Stay.

Science.gov (United States)

King, Philip K; Martin, Steven J; Betka, Eric M

2017-10-01

There are insufficient data in the United States regarding patient awareness and expectations of hospital pharmacist availability and services. The objective of this research is to assess patient awareness and expectations of hospital pharmacist services and to determine whether a marketing campaign for pharmacist services increases patient awareness and expectations. Eligible inpatients were surveyed before and after implementation of a hospital-wide pharmacist services marketing campaign (12 items; Likert scale of 1 [strongly disagree] to 4 [strongly agree]; maximum total score of 48) regarding awareness of pharmacist services. The primary outcome was the change in median total survey scores from baseline. Other outcomes included the frequency of patient requests for pharmacists. Similar numbers of patients completed the survey before and after the campaign (intervention, n = 140, vs control, n = 147). Awareness of pharmacist availability and services was increased (41 [interquartile ranges, IQRs: 36-46] vs 37 [IQR 31-43]; P marketing campaign implementation. Awareness among inpatients of pharmacist services is low. Marketing pharmacist availability and services to patients in the hospital improves awareness and expectations for pharmacist-provided care and increases the frequency of patient-initiated interaction between pharmacists and patients. This could improve patient outcomes as pharmacists become more integrally involved in direct patient care.

Coupling of sea level and tidal range changes, with implications for future water levels.

Science.gov (United States)

Devlin, Adam T; Jay, David A; Talke, Stefan A; Zaron, Edward D; Pan, Jiayi; Lin, Hui

2017-12-05

Are perturbations to ocean tides correlated with changing sea-level and climate, and how will this affect high water levels? Here, we survey 152 tide gauges in the Pacific Ocean and South China Sea and statistically evaluate how the sum of the four largest tidal constituents, a proxy for the highest astronomical tide (HAT), changes over seasonal and interannual time scales. We find that the variability in HAT is significantly correlated with sea-level variability; approximately 35% of stations exhibit a greater than ±50 mm tidal change per meter sea-level fluctuation. Focusing on a subset of three stations with long records, probability density function (PDF) analyses of the 95% percentile exceedance of total sea level (TSL) show long-term changes of this high-water metric. At Hong Kong, the increase in tides significantly amplifies the risk caused by sea-level rise. Regions of tidal decrease and/or amplification highlight the non-linear response to sea-level variations, with the potential to amplify or mitigate against the increased flood risk caused by sea-level rise. Overall, our analysis suggests that in many regions, local flood level determinations should consider the joint effects of non-stationary tides and mean sea level (MSL) at multiple time scales.

Ranging Behaviour of Commercial Free-Range Broiler Chickens 2: Individual Variation.

Science.gov (United States)

Taylor, Peta S; Hemsworth, Paul H; Groves, Peter J; Gebhardt-Henrich, Sabine G; Rault, Jean-Loup

2017-07-20

Little is known about broiler chicken ranging behaviour. Previous studies have monitored ranging behaviour at flock level but whether individual ranging behaviour varies within a flock is unknown. Using Radio Frequency Identification technology, we tracked 1200 individual ROSS 308 broiler chickens across four mixed sex flocks in two seasons on one commercial farm. Ranging behaviour was tracked from first day of range access (21 days of age) until 35 days of age in winter flocks and 44 days of age in summer flocks. We identified groups of chickens that differed in frequency of range visits: chickens that never accessed the range (13 to 67% of tagged chickens), low ranging chickens (15 to 44% of tagged chickens) that accounted for range visits and included chickens that used the range only once (6 to 12% of tagged chickens), and high ranging chickens (3 to 9% of tagged chickens) that accounted for 33 to 50% of all range visits. Males spent longer on the range than females in winter ( p ranging behaviour may help optimise ranging opportunities in free-range systems and is important to elucidate the potential welfare implications of ranging.

Patient acceptability of CT colonography compared with double contrast barium enema: results from a multicentre randomised controlled trial of symptomatic patients

International Nuclear Information System (INIS)

Wagner, Christian von; Smith, Samuel; Ghanouni, Alex; Power, Emily; Wardle, Jane; Halligan, Steve; Lilford, Richard J.; Morton, Dion; Dadswell, Edward; Atkin, Wendy

2011-01-01

To determine patient acceptability of barium enema (BE) or CT colonography (CTC). After ethical approval, 921 consenting patients with symptoms suggestive of colorectal cancer who had been randomly assigned and completed either BE (N = 606) or CTC (N = 315) received a questionnaire to assess experience of the clinical episode including bowel preparation, procedure and complications. Satisfaction, worry and physical discomfort were assessed using an adapted version of a validated acceptability scale. Non-parametric methods assessed differences between the randomised tests and the effect of patient characteristics. Patients undergoing BE were significantly less satisfied (median 61, interquartile range [IQR] 54-67 vs. median 64, IQR 56-69; p = 0.003) and experienced more physical discomfort (median 40, IQR 29-52 vs. median 35.5, IQR 25-47; p < 0.001) than those undergoing CTC. Post-test, BE patients were significantly more likely to experience 'abdominal pain/cramps' (68% vs. 57%; p = 0.007), 'soreness' (57% vs. 37%; p < 0.001), 'nausea/vomiting' (16% vs. 8%; p = 0.009), 'soiling' (31% vs. 23%; p = 0.034) and 'wind' (92% vs. 84%; p = 0.001) and in the case of 'wind' to also rate it as severe (27% vs. 15%; p < 0.001). CTC is associated with significant improvements in patient experience. These data support the case for CTC to replace BE. (orig.)

Patient acceptability of CT colonography compared with double contrast barium enema: results from a multicentre randomised controlled trial of symptomatic patients.

Science.gov (United States)

von Wagner, Christian; Smith, Samuel; Halligan, Steve; Ghanouni, Alex; Power, Emily; Lilford, Richard J; Morton, Dion; Dadswell, Edward; Atkin, Wendy; Wardle, Jane

2011-10-01

To determine patient acceptability of barium enema (BE) or CT colonography (CTC). After ethical approval, 921 consenting patients with symptoms suggestive of colorectal cancer who had been randomly assigned and completed either BE (N = 606) or CTC (N = 315) received a questionnaire to assess experience of the clinical episode including bowel preparation, procedure and complications. Satisfaction, worry and physical discomfort were assessed using an adapted version of a validated acceptability scale. Non-parametric methods assessed differences between the randomised tests and the effect of patient characteristics. Patients undergoing BE were significantly less satisfied (median 61, interquartile range [IQR] 54-67 vs. median 64, IQR 56-69; p = 0.003) and experienced more physical discomfort (median 40, IQR 29-52 vs. median 35.5, IQR 25-47; p < 0.001) than those undergoing CTC. Post-test, BE patients were significantly more likely to experience 'abdominal pain/cramps' (68% vs. 57%; p = 0.007), 'soreness' (57% vs. 37%; p < 0.001), 'nausea/vomiting' (16% vs. 8%; p = 0.009), 'soiling' (31% vs. 23%; p = 0.034) and 'wind' (92% vs. 84%; p = 0.001) and in the case of 'wind' to also rate it as severe (27% vs. 15%; p < 0.001). CTC is associated with significant improvements in patient experience. These data support the case for CTC to replace BE.

Low-level seaweed supplementation improves iodine status in iodine-insufficient women.

Science.gov (United States)

Combet, Emilie; Ma, Zheng Feei; Cousins, Frances; Thompson, Brett; Lean, Michael E J

2014-09-14

Iodine insufficiency is now a prominent issue in the UK and other European countries due to low intakes of dairy products and seafood (especially where iodine fortification is not in place). In the present study, we tested a commercially available encapsulated edible seaweed (Napiers Hebridean Seagreens® Ascophyllum nodosum species) for its acceptability to consumers and iodine bioavailability and investigated the impact of a 2-week daily seaweed supplementation on iodine concentrations and thyroid function. Healthy non-pregnant women of childbearing age, self-reporting low dairy product and seafood consumption, with no history of thyroid or gastrointestinal disease were recruited. Seaweed iodine (712 μg, in 1 g seaweed) was modestly bioavailable at 33 (interquartile range (IQR) 28-46) % of the ingested iodine dose compared with 59 (IQR 46-74) % of iodine from the KI supplement (n 22). After supplement ingestion (2 weeks, 0·5 g seaweed daily, n 42), urinary iodine excretion increased from 78 (IQR 39-114) to 140 (IQR 103-195) μg/l (Pseaweed was palatable and acceptable to consumers as a whole food or as a food ingredient and effective as a source of iodine in an iodine-insufficient population. In conclusion, seaweed inclusion in staple foods would serve as an alternative to fortification of salt or other foods with KI.

A cross-sectional study of tetanus and diphtheria antibody concentrations post vaccination among lung transplant patients compared with healthy individuals.

Science.gov (United States)

Rohde, K A; Cunningham, K C; Henriquez, K M; Nielsen, A R; Worzella, S L; Hayney, M S

2014-12-01

Lung transplant (LuTx) patients are routinely immunized against tetanus and diphtheria. However, few studies have been done to measure serologic immunity in the transplant population. The primary objective of this study was to compare tetanus and diphtheria antibody concentrations in LuTx vs. healthy subjects. Serum was used from an available sample of 111 total individuals (n = 36 healthy; n = 75 LuTx). Tetanus and diphtheria antibody concentrations were measured using an enzyme-linked immunosorbant assay method. A statistically significant difference in both tetanus and diphtheria antibody concentrations was found between the groups. The median concentration of tetanus antibody was higher for healthy individuals compared with the LuTx group (3.2 IU/mL [1.2-5.2 interquartile range {IQR}] vs. 1.3 IU/mL [0.4-2.6 IQR], respectively; P = 0.0001). No difference in time was found since the last tetanus-diphtheria vaccine or tetanus-diphtheria-pertussis vaccine dose between the groups (healthy 76.5 months [16-114 IQR] vs. LuTx 74.5 months [45-118 IQR]; P = 0.44). Tetanus and diphtheria immunizations are recommended for LuTx patients to reduce the risk of infection. Because the LuTx group has lower antibody concentrations, further studies should investigate the possible need for more frequent tetanus and diphtheria boosters. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Pelvic Floor Physical Therapy as Primary Treatment of Pelvic Floor Disorders With Urinary Urgency and Frequency-Predominant Symptoms.

Science.gov (United States)

Adams, Sonia R; Dessie, Sybil G; Dodge, Laura E; Mckinney, Jessica L; Hacker, Michele R; Elkadry, Eman A

2015-01-01

To assess the efficacy of pelvic floor physical therapy (PFPT) as primary treatment of urinary urgency and frequency symptoms We conducted a prospective cohort study of women with urinary urgency and frequency symptoms. Participants underwent PFPT once or twice per week for 10 weeks. Symptom improvement was assessed by validated questionnaires (Pelvic Floor Distress Inventory-Short Form 20 and Patient Global Impression of Improvement), voiding diaries, and subjective measures. Fifty-seven participants enrolled; 21 (36.8%) withdrew or completed less than 5 weeks of PFPT. Thirty-one (54.4%) of the remaining 36 participants completed 10 weeks of PFPT. The mean age of the study group (n = 36) was 48.9 ± 15.0 years. The primary diagnoses were overactive bladder syndrome (n = 24, 66.7%) and painful bladder syndrome (n = 12, 33.3%). Women attended a median of 14.0 (interquartile range [IQR], 8.0-16.0) PFPT visits over a median of 11.9 weeks (IQR, 10.0-18.1). At baseline, the median Pelvic Floor Distress Inventory-Short Form 20 score was 79.2 (IQR, 53.1-122.9), and decreased to 50.0 (IQR, 25.0-88.5; P therapies. The high dropout rates suggest that motivation or logistic factors may play a significant role in the utilization and success of this treatment option.

Hospital blood bank information systems accurately reflect patient transfusion: results of a validation study.

Science.gov (United States)

McQuilten, Zoe K; Schembri, Nikita; Polizzotto, Mark N; Akers, Christine; Wills, Melissa; Cole-Sinclair, Merrole F; Whitehead, Susan; Wood, Erica M; Phillips, Louise E

2011-05-01

Hospital transfusion laboratories collect information regarding blood transfusion and some registries gather clinical outcomes data without transfusion information, providing an opportunity to integrate these two sources to explore effects of transfusion on clinical outcomes. However, the use of laboratory information system (LIS) data for this purpose has not been validated previously. Validation of LIS data against individual patient records was undertaken at two major centers. Data regarding all transfusion episodes were analyzed over seven 24-hour periods. Data regarding 596 units were captured including 399 red blood cell (RBC), 95 platelet (PLT), 72 plasma, and 30 cryoprecipitate units. They were issued to: inpatient 221 (37.1%), intensive care 109 (18.3%), outpatient 95 (15.9%), operating theater 45 (7.6%), emergency department 27 (4.5%), and unrecorded 99 (16.6%). All products recorded by LIS as issued were documented as transfused to intended patients. Median time from issue to transfusion initiation could be calculated for 535 (89.8%) components: RBCs 16 minutes (95% confidence interval [CI], 15-18 min; interquartile range [IQR], 7-30 min), PLTs 20 minutes (95% CI, 15-22 min; IQR, 10-37 min), fresh-frozen plasma 33 minutes (95% CI, 14-83 min; IQR, 11-134 min), and cryoprecipitate 3 minutes (95% CI, -10 to 42 min; IQR, -15 to 116 min). Across a range of blood component types and destinations comparison of LIS data with clinical records demonstrated concordance. The difference between LIS timing data and patient clinical records reflects expected time to transport, check, and prepare transfusion but does not affect the validity of linkage for most research purposes. Linkage of clinical registries with LIS data can therefore provide robust information regarding individual patient transfusion. This enables analysis of joint data sets to determine the impact of transfusion on clinical outcomes. © 2010 American Association of Blood Banks.

Logistics and safety of extracorporeal membrane oxygenation in medical retrieval.

Science.gov (United States)

Burns, Brian J; Habig, Karel; Reid, Cliff; Kernick, Paul; Wilkinson, Chris; Tall, Gary; Coombes, Sarah; Manning, Ron

2011-01-01

This article reviews the logistics and safety of extracorporeal membrane oxygenation (ECMO) medical retrieval in New South Wales, Australia. We describe the logistics involved in ECMO road and rotary-wing retrieval by a multidisciplinary team during the H1N1 influenza epidemic in winter 2009 (i.e., June 1 to August 31, 2009). Basic patient demographics and key retrieval time lines were analyzed. There were 17 patients retrieved on ECMO, with their ages ranging from 22 to 55 years. The median weight was 110 kg. Four critical events were recorded during retrieval, with no adverse outcomes. The retrieval distance varied from 20.8 to 430 km. There were delays in times from retrieval booking to both retrieval tasking and retrieval team departure in 88% of retrievals. The most common reasons cited were "patient not ready" 23.5% (4/17); "vehicle not available," 23.5% (4/17); and "complex retrieval," 41.2% (7/17). The median time (hours:minutes) from booking with the medical retrieval unit (MRU) to tasking was 4:35 (interquartile range [IQR] 3:27-6:15). The median time lag from tasking to departure was 1:00 (IQR 00:10-2:20). The median stabilization time was 1:30 (IQR 1:20-1:55). The median retrieval duration was 7:35 (IQR 5:50-10:15). The process of development of ECMO retrieval was enabled by the preexistence of a high-volume experienced medical retrieval service. Although ECMO retrieval is not a new concept, we describe an entire process for ECMO retrieval that we believe will benefit other retrieval service providers. The increased workload of ECMO retrieval during the swine flu pandemic has led to refinement in the system and process for the future.

Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients.

Science.gov (United States)

Owler, Brian K; Carmo, Kathryn A Browning; Bladwell, Wendy; Fa'asalele, T Arieta; Roxburgh, Jane; Kendrick, Tina; Berry, Andrew

2015-09-01

Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions. A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail. Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median "time saved" was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours). Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions.

Clinical utility of breath ammonia for evaluation of ammonia physiology in healthy and cirrhotic adults

Science.gov (United States)

Spacek, Lisa A; Mudalel, Matthew; Tittel, Frank; Risby, Terence H; Solga, Steven F

2016-01-01

Blood ammonia is routinely used in clinical settings to assess systemic ammonia in hepatic encephalopathy and urea cycle disorders. Despite its drawbacks, blood measurement is often used as a comparator in breath studies because it is a standard clinical test. We sought to evaluate sources of measurement error and potential clinical utility of breath ammonia compared to blood ammonia. We measured breath ammonia in real time by quartz enhanced photoacoustic spectrometry and blood ammonia in 10 healthy and 10 cirrhotic participants. Each participant contributed 5 breath samples and blood for ammonia measurement within 1 h. We calculated the coefficient of variation (CV) for 5 breath ammonia values, reported medians of healthy and cirrhotic participants, and used scatterplots to display breath and blood ammonia. For healthy participants, mean age was 22 years (±4), 70% were men, and body mass index (BMI) was 27 (±5). For cirrhotic participants, mean age was 61 years (±8), 60% were men, and BMI was 31 (±7). Median blood ammonia for healthy participants was within normal range, 10 μmol L−1 (interquartile range (IQR), 3–18) versus 46 μmol L−1 (IQR, 23–66) for cirrhotic participants. Median breath ammonia was 379 pmol mL−1 CO2 (IQR, 265–765) for healthy versus 350 pmol mL−1 CO2 (IQR, 180–1013) for cirrhotic participants. CV was 17 ± 6%. There remains an important unmet need in the evaluation of systemic ammonia, and breath measurement continues to demonstrate promise to fulfill this need. Given the many differences between breath and blood ammonia measurement, we examined biological explanations for our findings in healthy and cirrhotic participants. We conclude that based upon these preliminary data breath may offer clinically important information this is not provided by blood ammonia. PMID:26658550

Cost-benefit of infection control interventions targeting methicillin-resistant Staphylococcus aureus in hospitals: systematic review.

Science.gov (United States)

Farbman, L; Avni, T; Rubinovitch, B; Leibovici, L; Paul, M

2013-12-01

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) incur significant costs. We aimed to examine the cost and cost-benefit of infection control interventions against MRSA and to examine factors affecting economic estimates. We performed a systematic review of studies assessing infection control interventions aimed at preventing spread of MRSA in hospitals and reporting intervention costs, savings, cost-benefit or cost-effectiveness. We searched PubMed and references of included studies with no language restrictions up to January 2012. We used the Quality of Health Economic Studies tool to assess study quality. We report cost and savings per month in 2011 US$. We calculated the median save/cost ratio and the save-cost difference with interquartile range (IQR) range. We examined the effects of MRSA endemicity, intervention duration and hospital size on results. Thirty-six studies published between 1987 and 2011 fulfilled inclusion criteria. Fifteen of the 18 studies reporting both costs and savings reported a save/cost ratio >1. The median save/cost ratio across all 18 studies was 7.16 (IQR 1.37-16). The median cost across all studies reporting intervention costs (n = 31) was 8648 (IQR 2025-19 170) US$ per month; median savings were 38 751 (IQR 14 206-75 842) US$ per month (23 studies). Higher save/cost ratios were observed in the intermediate to high endemicity setting compared with the low endemicity setting, in hospitals with 6 months. Infection control intervention to reduce spread of MRSA in acute-care hospitals showed a favourable cost/benefit ratio. This was true also for high MRSA endemicity settings. Unresolved economic issues include rapid screening using molecular techniques and universal versus targeted screening. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

MO-FG-303-03: Demonstration of Universal Knowledge-Based 3D Dose Prediction

Energy Technology Data Exchange (ETDEWEB)

Shiraishi, S; Moore, K L [University of California, San Diego, La Jolla, CA (United States)

2015-06-15

Purpose: To demonstrate a knowledge-based 3D dose prediction methodology that can accurately predict achievable radiotherapy distributions. Methods: Using previously treated plans as input, an artificial neural network (ANN) was trained to predict 3D dose distributions based on 14 patient-specific anatomical parameters including the distance (r) to planning target volume (PTV) boundary, organ-at-risk (OAR) boundary distances, and angular position ( θ,φ). 23 prostate and 49 stereotactic radiosurgery (SRS) cases with ≥1 nearby OARs were studied. All were planned with volumetric-modulated arc therapy (VMAT) to prescription doses of 81Gy for prostate and 12–30Gy for SRS. Site-specific ANNs were trained using all prostate 23 plans and using a 24 randomly-selected subset for the SRS model. The remaining 25 SRS plans were used to validate the model. To quantify predictive accuracy, the dose difference between the clinical plan and prediction were calculated on a voxel-by-voxel basis δD(r,θ,φ)=Dclin(r,θ,φ)-Dpred(r, θ,φ). Grouping voxels by boundary distance, the mean <δ Dr>=(1/N)Σ -θ,φ D(r,θ,φ) and inter-quartile range (IQR) quantified the accuracy of this method for deriving DVH estimations. The standard deviation (σ) of δ D quantified the 3D dose prediction error on a voxel-by-voxel basis. Results: The ANNs were highly accurate in predictive ability for both prostate and SRS plans. For prostate, <δDr> ranged from −0.8% to +0.6% (max IQR=3.8%) over r=0–32mm, while 3D dose prediction accuracy averaged from σ=5–8% across the same range. For SRS, from r=0–34mm the training set <δDr> ranged from −3.7% to +1.5% (max IQR=4.4%) while the validation set <δDr> ranged from −2.2% to +5.8% (max IQR=5.3%). 3D dose prediction accuracy averaged σ=2.5% for the training set and σ=4.0% over the same interval. Conclusion: The study demonstrates this technique’s ability to predict achievable 3D dose distributions for VMAT SRS and prostate. Future

MO-FG-303-03: Demonstration of Universal Knowledge-Based 3D Dose Prediction

International Nuclear Information System (INIS)

Shiraishi, S; Moore, K L

2015-01-01

Purpose: To demonstrate a knowledge-based 3D dose prediction methodology that can accurately predict achievable radiotherapy distributions. Methods: Using previously treated plans as input, an artificial neural network (ANN) was trained to predict 3D dose distributions based on 14 patient-specific anatomical parameters including the distance (r) to planning target volume (PTV) boundary, organ-at-risk (OAR) boundary distances, and angular position ( θ,φ). 23 prostate and 49 stereotactic radiosurgery (SRS) cases with ≥1 nearby OARs were studied. All were planned with volumetric-modulated arc therapy (VMAT) to prescription doses of 81Gy for prostate and 12–30Gy for SRS. Site-specific ANNs were trained using all prostate 23 plans and using a 24 randomly-selected subset for the SRS model. The remaining 25 SRS plans were used to validate the model. To quantify predictive accuracy, the dose difference between the clinical plan and prediction were calculated on a voxel-by-voxel basis δD(r,θ,φ)=Dclin(r,θ,φ)-Dpred(r, θ,φ). Grouping voxels by boundary distance, the mean =(1/N)Σ -θ,φ D(r,θ,φ) and inter-quartile range (IQR) quantified the accuracy of this method for deriving DVH estimations. The standard deviation (σ) of δ D quantified the 3D dose prediction error on a voxel-by-voxel basis. Results: The ANNs were highly accurate in predictive ability for both prostate and SRS plans. For prostate, ranged from −0.8% to +0.6% (max IQR=3.8%) over r=0–32mm, while 3D dose prediction accuracy averaged from σ=5–8% across the same range. For SRS, from r=0–34mm the training set ranged from −3.7% to +1.5% (max IQR=4.4%) while the validation set ranged from −2.2% to +5.8% (max IQR=5.3%). 3D dose prediction accuracy averaged σ=2.5% for the training set and σ=4.0% over the same interval. Conclusion: The study demonstrates this technique’s ability to predict achievable 3D dose distributions for VMAT SRS and prostate. Future investigations will attempt to

Medium Range Flood Forecasting for Agriculture Damage Reduction

Science.gov (United States)

Fakhruddin, S. H. M.

2014-12-01

Early warning is a key element for disaster risk reduction. In recent decades, major advancements have been made in medium range and seasonal flood forecasting. This progress provides a great opportunity to reduce agriculture damage and improve advisories for early action and planning for flood hazards. This approach can facilitate proactive rather than reactive management of the adverse consequences of floods. In the agricultural sector, for instance, farmers can take a diversity of options such as changing cropping patterns, applying fertilizer, irrigating and changing planting timing. An experimental medium range (1-10 day) flood forecasting model has been developed for Bangladesh and Thailand. It provides 51 sets of discharge ensemble forecasts of 1-10 days with significant persistence and high certainty. This type of forecast could assist farmers and other stakeholders for differential preparedness activities. These ensembles probabilistic flood forecasts have been customized based on user-needs for community-level application focused on agriculture system. The vulnerabilities of agriculture system were calculated based on exposure, sensitivity and adaptive capacity. Indicators for risk and vulnerability assessment were conducted through community consultations. The forecast lead time requirement, user-needs, impacts and management options for crops were identified through focus group discussions, informal interviews and community surveys. This paper illustrates potential applications of such ensembles for probabilistic medium range flood forecasts in a way that is not commonly practiced globally today.

Metrics for Electronic-Nursing-Record-Based Narratives: Cross-sectional Analysis

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Kim, Kidong; Jeong, Suyeon; Lee, Kyogu; Park, Hyeoun-Ae; Min, Yul Ha; Lee, Joo Yun; Kim, Yekyung; Yoo, Sooyoung; Doh, Gippeum

2016-01-01

Summary Objectives We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. Methods We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system. The standardized number of nursing narratives (i.e., the total number of nursing narratives divided by the length of the hospital stay) was suggested to integrate the frequency and quantity of nursing documentation. Results The standardized number of nursing narratives was higher for patients aged 70 years (median = 30.2 narratives/day, interquartile range [IQR] = 24.0–39.4 narratives/day), long (8 days) hospital stays (median = 34.6 narratives/day, IQR = 27.2–43.5 narratives/day), and hospital deaths (median = 59.1 narratives/day, IQR = 47.0–74.8 narratives/day). The standardized number of narratives was higher in “pregnancy, childbirth, and puerperium” (median = 46.5, IQR = 39.0–54.7) and “diseases of the circulatory system” admissions (median = 35.7, IQR = 29.0–43.4). Conclusions Diverse hospital admissions can be consistently described with nursing-document-derived metrics for similar hospital admissions and diagnoses. Some areas of hospital admissions may have consistently increasing volumes of nursing documentation across years. Usability of electronic nursing document metrics for evaluating healthcare requires multiple aspects of hospital admissions to be considered. PMID:27901174

Assessing the impact of mass rape on the incidence of HIV in conflict-affected countries.

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Supervie, Virginie; Halima, Yasmin; Blower, Sally

2010-11-27

To quantify the potential impact of mass rape on HIV incidence in seven conflict-afflicted countries (CACs), with severe HIV epidemics, in sub-Saharan Africa. Uncertainty analysis of a risk equation model. A mathematical model was used to evaluate the potential impact of mass rape on increasing HIV incidence in women and girls in Burundi, Democratic Republic of Congo (DRC), Rwanda, Sierra Leone, Somalia, southern Sudan and Uganda. The model was parameterized with data from UNAIDS/WHO and the US Census Bureau's International Database. Incidence data from UNAIDS/WHO were used for calibration. Mass rape could cause approximately five HIV infections per 100,000 females per year in the DRC, Sudan, Somalia and Sierra Leone, double the number in Burundi and Rwanda, and quadruple the number in Uganda. The number of females infected per year due to mass rape is likely to be relatively low in Somalia and Sierra Leone at 127 [median (interquartile range [IQR] 55-254)] and 156 [median (IQR 69-305)], respectively. Numbers could be high in the DRC and Uganda: 1120 [median (IQR 527-2360)] and 2172 [median (IQR 1031-4668)], respectively. In Burundi, Rwanda and Sudan, the numbers are likely to be intermediate. Under extreme conditions, 10,000 women and girls could be infected per year in the DRC and 20 000 women and girls could be infected per year in Uganda. Mass rape could increase annual incidence by approximately 7% [median (IQR 3-15)]. Interventions and treatment targeted to rape survivors during armed conflicts could reduce HIV incidence. Support should be provided both on the basis of human rights and public health.

Prevention of Hospital-Acquired Adverse Drug Reactions in Older People Using Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to Right Treatment Criteria: A Cluster Randomized Controlled Trial.

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O'Connor, Marie N; O'Sullivan, David; Gallagher, Paul F; Eustace, Joseph; Byrne, Stephen; O'Mahony, Denis

2016-08-01

To determine whether use of the Screening Tool of Older Persons' Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) criteria reduces incident hospital-acquired adverse drug reactions (ADRs), 28-day medication costs, and median length of hospital stay in older adults admitted with acute illness. Single-blind cluster randomized controlled trial (RCT) of unselected older adults hospitalized over a 13-month period. Tertiary referral hospital in southern Ireland. Consecutively admitted individuals aged 65 and older (N = 732). Single time point presentation to attending physicians of potentially inappropriate medications according to the STOPP/START criteria. The primary outcome was the proportion of participants experiencing one or more ADRs during the index hospitalization. Secondary outcomes were median length of stay (LOS) and 28-day total medication cost. One or more ADRs occurred in 78 of the 372 control participants (21.0%; median age 78, interquartile range (IQR) 72-84) and in 42 of the 360 intervention participants (11.7%; median age 80, IQR 73-85) (absolute risk reduction = 9.3%, number needed to treat = 11). The median LOS in the hospital was 8 days (IQR 4-14 days) in both groups. At discharge, median medication cost was significantly lower in the intervention group (€73.16, IQR €38.68-121.72) than in the control group (€90.62, IQR €49.38-162.53) (Wilcoxon rank test Z statistic = -3.274, P older adults but did not affect median LOS. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Nonalbumin proteinuria predominates in biopsy-proven tenofovir nephrotoxicity.

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Sise, Meghan E; Hirsch, Jamie S; Canetta, Pietro A; Herlitz, Leal; Mohan, Sumit

2015-05-15

Tenofovir disoproxil fumarate (TDF) nephrotoxicity is characterized by proximal renal tubular injury and dysmorphic mitochondria resulting in proteinuria, orthoglycemic glycosuria, and other markers of proximal tubular dysfunction. The objective of this study was to determine the pattern of proteinuria in patients with biopsy-proven TDF nephrotoxicity. Retrospective chart review. Patients with biopsy-proven TDF nephrotoxicity were identified and their medical charts and biopsy reports were reviewed. Comparison was made with HIV-infected patients not on TDF who underwent kidney biopsy. We identified 43 biopsy-proven cases of TDF nephrotoxicity; mean age 54.7 ± 0.4 years, 53% men, 42% whites. Thirty-seven cases reported proteinuria by dipstick of which only 60% had at least 2+ proteinuria. Twenty-seven patients had urine protein quantified by either 24-h collection or spot urine protein-to-creatinine ratio; median proteinuria was 1742 mg/day [interquartile range (IQR) 1200-2000 mg] and 1667 mg/g creatinine (IQR 851-1967 mg/g), respectively. Ten patients had concurrent urinary albumin measured, with a median 236 mg/g creatinine (IQR 137-343 mg/g). The mean urine albumin-to-urine protein ratio (uAPR) was 0.17 (IQR 0.14-0.19), confirming that TDF nephrotoxicity is primarily associated with nonalbumin proteinuria. Control cases had a uAPR of 0.65 (IQR 0.55-0.79) P < 0.001. Histopathology showed the predominance of proximal tubular injury with characteristic mitochondrial abnormalities. In the largest published cohort of patients with biopsy-proven TDF nephrotoxicity, we show that low uAPR is a reliable feature of this disease. Because of the predominance of nonalbumin proteinuria, dipstick urinalysis may be unreliable in TDF nephrotoxicity.

Procalcitonin Levels in Gram-Positive, Gram-Negative, and Fungal Bloodstream Infections

Directory of Open Access Journals (Sweden)

Christian Leli

2015-01-01

Full Text Available Procalcitonin (PCT can discriminate bacterial from viral systemic infections and true bacteremia from contaminated blood cultures. The aim of this study was to evaluate PCT diagnostic accuracy in discriminating Gram-positive, Gram-negative, and fungal bloodstream infections. A total of 1,949 samples from patients with suspected bloodstream infections were included in the study. Median PCT value in Gram-negative (13.8 ng/mL, interquartile range (IQR 3.4–44.1 bacteremias was significantly higher than in Gram-positive (2.1 ng/mL, IQR 0.6–7.6 or fungal (0.5 ng/mL, IQR 0.4–1 infections (P<0.0001. Receiver operating characteristic analysis showed an area under the curve (AUC for PCT of 0.765 (95% CI 0.725–0.805, P<0.0001 in discriminating Gram-negatives from Gram-positives at the best cut-off value of 10.8 ng/mL and an AUC of 0.944 (95% CI 0.919–0.969, P<0.0001 in discriminating Gram-negatives from fungi at the best cut-off of 1.6 ng/mL. Additional results showed a significant difference in median PCT values between Enterobacteriaceae and nonfermentative Gram-negative bacteria (17.1 ng/mL, IQR 5.9–48.5 versus 3.5 ng/mL, IQR 0.8–21.5; P<0.0001. This study suggests that PCT may be of value to distinguish Gram-negative from Gram-positive and fungal bloodstream infections. Nevertheless, its utility to predict different microorganisms needs to be assessed in further studies.

Coefficient of Variance as Quality Criterion for Evaluation of Advanced Hepatic Fibrosis Using 2D Shear-Wave Elastography.

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Lim, Sanghyeok; Kim, Seung Hyun; Kim, Yongsoo; Cho, Young Seo; Kim, Tae Yeob; Jeong, Woo Kyoung; Sohn, Joo Hyun

2018-02-01

To compare the diagnostic performance for advanced hepatic fibrosis measured by 2D shear-wave elastography (SWE), using either the coefficient of variance (CV) or the interquartile range divided by the median value (IQR/M) as quality criteria. In this retrospective study, from January 2011 to December 2013, 96 patients, who underwent both liver stiffness measurement by 2D SWE and liver biopsy for hepatic fibrosis grading, were enrolled. The diagnostic performances of the CV and the IQR/M were analyzed using receiver operating characteristic curves with areas under the curves (AUCs) and were compared by Fisher's Z test, based on matching the cutoff points in an interactive dot diagram. All P values less than 0.05 were considered significant. When using the cutoff value IQR/M of 0.21, the matched cutoff point of CV was 20%. When a cutoff value of CV of 20% was used, the diagnostic performance for advanced hepatic fibrosis ( ≥ F3 grade) with CV of less than 20% was better than that in the group with CV greater than or equal to 20% (AUC 0.967 versus 0.786, z statistic = 2.23, P = .025), whereas when the matched cutoff value IQR/M of 0.21 showed no difference (AUC 0.918 versus 0.927, z statistic = -0.178, P = .859). The validity of liver stiffness measurements made by 2D SWE for assessing advanced hepatic fibrosis may be judged using CVs, and when the CV is less than 20% it can be considered "more reliable" than using IQR/M of less than 0.21. © 2017 by the American Institute of Ultrasound in Medicine.

Near total parathyroidectomy is effective therapy for tertiary hyperparathyroidism.

Science.gov (United States)

Dewberry, Lindel Krige; Weber, Collin; Sharma, Jyotirmay

2014-07-01

Tertiary hyperparathyroidism (3°HPT) is defined as persistent hyperparathyroidism with hypercalcemia after renal transplantation. Near total parathyroidectomy (NTPTX) is the current standard for surgical intervention. The purpose of this study was to identify outcomes of NTPTX. A retrospective review was conducted of surgeries performed between 1994 and 2013. NTPTX resulted in resolution of 96.9 per cent of patients' hypercalcemia at a median follow-up of three years (interquartile range [IQR], 1 to 8). However, 3.1 per cent of patients remained hypercalcemic with a mean calcium of 10.5 ± 0.2 mg/dL. A total of 78.4 per cent of patients had parathyroid hormone (PTH) levels below 250 pg/mL at a median follow-up of two years (IQR, 2 to 8). The remaining 21.6 per cent had a median PTH of 535 (IQR, 345 to 857). PTH levels dropped from a median of 745 (IQR, 285.75 to 1594.25) pg/mL to 97 (IQR, 60 to 285) pg/mL one month post-NTPTX (P < 0.01). The most frequent complication was transient hypocalcemia in 27.1 per cent of patients, but no patients became permanently hypocalcemic. In the 1-month postoperative period, only one patient had a cardiac complication, and there was 0 per cent all-cause mortality. Glomerular filtration rate fell from 57.9 ± 28.3 mL/min pre-NTPTX to 53.2 ± 27.5 mL/min at 1-year post-NTPTX (P < 0.01). NTPTX effectively treats hypercalcemia in 3°HPT. However, PTH remains elevated (greater than 250) in 21.6 per cent of patients.

A randomized clinical trial of therapeutic hypothermia mode during transport for neonatal encephalopathy.

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Akula, Vishnu Priya; Joe, Priscilla; Thusu, Kajori; Davis, Alexis S; Tamaresis, John S; Kim, Sunhwa; Shimotake, Thomas K; Butler, Stephen; Honold, Jose; Kuzniewicz, Michael; DeSandre, Glenn; Bennett, Mihoko; Gould, Jeffrey; Wallenstein, Matthew B; Van Meurs, Krisa

2015-04-01

To determine if temperature regulation is improved during neonatal transport using a servo-regulated cooling device when compared with standard practice. We performed a multicenter, randomized, nonmasked clinical trial in newborns with neonatal encephalopathy cooled during transport to 9 neonatal intensive care units in California. Newborns who met institutional criteria for therapeutic hypothermia were randomly assigned to receive cooling according to usual center practices vs device servo-regulated cooling. The primary outcome was the percentage of temperatures in target range (33°-34°C) during transport. Secondary outcomes included percentage of newborns reaching target temperature any time during transport, time to target temperature, and percentage of newborns in target range 1 hour after cooling initiation. One hundred newborns were enrolled: 49 to control arm and 51 to device arm. Baseline demographics did not differ with the exception of cord pH. For each subject, the percentage of temperatures in the target range was calculated. Infants cooled using the device had a higher percentage of temperatures in target range compared with control infants (median 73% [IQR 17-88] vs 0% [IQR 0-52], P newborns with neonatal encephalopathy. Copyright © 2015 Elsevier Inc. All rights reserved.

Incorporating spatial autocorrelation into species distribution models alters forecasts of climate-mediated range shifts.

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Crase, Beth; Liedloff, Adam; Vesk, Peter A; Fukuda, Yusuke; Wintle, Brendan A

2014-08-01

Species distribution models (SDMs) are widely used to forecast changes in the spatial distributions of species and communities in response to climate change. However, spatial autocorrelation (SA) is rarely accounted for in these models, despite its ubiquity in broad-scale ecological data. While spatial autocorrelation in model residuals is known to result in biased parameter estimates and the inflation of type I errors, the influence of unmodeled SA on species' range forecasts is poorly understood. Here we quantify how accounting for SA in SDMs influences the magnitude of range shift forecasts produced by SDMs for multiple climate change scenarios. SDMs were fitted to simulated data with a known autocorrelation structure, and to field observations of three mangrove communities from northern Australia displaying strong spatial autocorrelation. Three modeling approaches were implemented: environment-only models (most frequently applied in species' range forecasts), and two approaches that incorporate SA; autologistic models and residuals autocovariate (RAC) models. Differences in forecasts among modeling approaches and climate scenarios were quantified. While all model predictions at the current time closely matched that of the actual current distribution of the mangrove communities, under the climate change scenarios environment-only models forecast substantially greater range shifts than models incorporating SA. Furthermore, the magnitude of these differences intensified with increasing increments of climate change across the scenarios. When models do not account for SA, forecasts of species' range shifts indicate more extreme impacts of climate change, compared to models that explicitly account for SA. Therefore, where biological or population processes induce substantial autocorrelation in the distribution of organisms, and this is not modeled, model predictions will be inaccurate. These results have global importance for conservation efforts as inaccurate

Fast long-range connections in transportation networks

International Nuclear Information System (INIS)

Palhares Viana, Matheus; Fontoura Costa, Luciano da

2011-01-01

Multidimensional scaling is applied in order to visualize an analogue of the small-world effect implied by edges having different displacement velocities in transportation networks. Our findings are illustrated for two real-world systems, namely the London urban network (streets and underground) and the US highway network enhanced by some of the main US airlines routes. We also show that the travel time in these two networks is drastically changed by attacks targeting the edges with large displacement velocities. - Highlights: → Multidimensional scaling used to visualize the effects of fast long-range connections. → Fast long-range connections are important to decrease the average travel time. → The average travel time diverges quickly when the network is under target attacks.

Hepatitis C virus (HCV) RNA profiles among chronic HIV/HCV-coinfected individuals in ESPRIT; spontaneous HCV RNA clearance observed in nine individuals.

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Grint, D; Tedaldi, E; Peters, L; Mocroft, A; Edlin, B; Gallien, S; Klinker, H; Boesecke, C; Kokordelis, P; Rockstroh, J K

2017-07-01

Studies have shown that hepatitis C virus (HCV) RNA levels remain stable over time in HIV/HCV-coinfected individuals taking combination antiretroviral therapy (cART), while spontaneous clearance of HCV RNA during the persistent infection phase has been documented only rarely among those with the CC interleukin (IL)-28B genotype. This study describes HCV RNA profiles and factors associated with changes over time in HCV RNA levels in the ESPRIT study. HIV/HCV-coinfected individuals positive for HCV RNA were included in the study. Follow-up was counted from the first HCV RNA positive test and censored at the initiation of interferon-based treatment. HCV RNA and IL-28B measurements were performed in the same reference laboratory. Random effects mixed models were used to analyse changes over time in HCV RNA. A total of 312 ESPRIT patients were included in the study (151 in the arm receiving subcutaneous recombinant IL-2 and 161 in the control arm). Most of the patients were white (89%) and male (76%), and they had a median of 5 HCV RNA measurements per person [interquartile range (IQR) 3-6; range 1-9]. Median follow-up was 5 years (IQR: 2-6 years). At baseline, 96% of patients were taking cART and 93% had undetectable HIV RNA. Mean HCV RNA levels decreased by 13% per year over the study period [95% confidence interval (CI) 8-18%; P < 0.0001]. Baseline HCV RNA levels and the change over time in HCV RNA did not differ by randomization arm (P = 0.16 and P = 0.56, respectively). Nine individuals spontaneously cleared HCV RNA during follow-up [IL-28B genotypes: CC, five patients (56%); CT, four patients (44%)]. HCV RNA levels decreased over time in this population with well-controlled HIV infection. Spontaneous clearance of HCV RNA was documented in five individuals with IL-28B genotype CC and four with the CT genotype. © 2016 British HIV Association.

Range shifts and global warming: ecological responses of Empetrum nigrum L. to experimental warming at its northern (high Arctic) and southern (Atlantic) geographical range margin

International Nuclear Information System (INIS)

Buizer, Bert; Weijers, Stef; Van Bodegom, Peter M; Van Breda, Johan; De Korte, Maarten; Van Rijckevorsel, Jaap; Rozema, Jelte; Alsos, Inger Greve; Eidesen, Pernille Bronken

2012-01-01

Global change is expected to lead to range shifts of plant species. The ecological mechanisms underpinning these shifts are currently not well understood. Here, we compared ecological responses possibly underlying southern range contraction and northern range expansion of Empetrum nigrum, a key species in northern heathlands, which may be related to global change. We hypothesized a negative response to warming in the ‘south’ (i.e. the Netherlands) and a positive response at the northern range margin (the tundra on Svalbard). Open top chambers (OTCs) were used to simulate global warming. In the ‘south’, OTC warming caused enhanced shoot growth and growth rate, biomass increment, advanced phenology, larger and heavier berries of Empetrum, while its growing season was extended by 75 days. Under OTC warming co-occurring Calluna vulgaris also showed an increased growing season length (by 98 days) as well as increased shoot growth rate and biomass growth, plant cover and height. Still, we found no evidence for increased competitiveness relative to Empetrum. In the ‘north’, Empetrum responded with increased shoot and biomass growth, enhanced berry development and ripening to warming. These responses exceeded those of co-occurring Cassiope tetragona with the exception of its biomass response. The direct and indirect ecological responses found do not readily explain the observed northward retreat of Empetrum at the southern range margin. The direct ecological responses found at its northern range margin are, on the other hand, in line with the increased occurrences of this species on Svalbard. (letter)

HIV RNA Suppression during and after Pregnancy among Women in the HIV Outpatient Study, 1996 to 2015.

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Patel, Monita; Tedaldi, Ellen; Armon, Carl; Nesheim, Steven; Lampe, Margaret; Palella, Frank; Novak, Richard; Sutton, Madeline; Buchacz, Kate

2018-01-01

To examine HIV viral suppression during/after pregnancy. Prospective observational cohort. We identified pregnancies from 1996 to 2015. We examined HIV RNA viral load (VL), VL suppression (≤500 copies/mL), and antiretroviral therapy (ART) status at pregnancy start, end, and 6 months postpartum. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for VL nonsuppression. Among 253 pregnancies analyzed, 34.8% of women exhibited VL suppression at pregnancy start, 60.1% at pregnancy end, and 42.7% at 6 months postpartum. Median VL (log 10 copies/mL) was 2.80 (interquartile range [IQR]: 1.40-3.85) at pregnancy start, 1.70 (IQR: 1.40-2.82) at pregnancy end, and 2.30 (IQR: 1.40-3.86) at postpartum. Risk of postpartum VL nonsuppression was also lower among women on ART and with VL suppression at pregnancy end (versus those not; adjusted RR = 0.30, 95% CI: 0.17-0.53). Maintaining VL suppression among US women remains a challenge, particularly during postpartum. Achieving VL suppression earlier during pregnancy benefits women subsequently.

Economic Consequences of Post–Kala-Azar Dermal Leishmaniasis in a Rural Bangladeshi Community

Science.gov (United States)

Ozaki, Masayo; Islam, Shamim; Rahman, Kazi Mizanur; Rahman, Anisur; Luby, Stephen P.; Bern, Caryn

2011-01-01

Post–kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis. Bangladesh national treatment guidelines during the study period called for 120 intramuscular injections of sodium antimony gluconate (SAG). We assessed care-seeking behavior, diagnosis and treatment costs, and coping strategies among 134 PKDL patients; 56 (42%) patients had been treated with SAG, and 78 (58%) remained untreated. The median direct cost per patient treated was US$367 (interquartile range [IQR] = 90–284), more than two times the estimated per capita annual income for the study population. The most common coping strategy was to take a loan; the median amount borrowed was US$98 (IQR = 71–150), with a median interest of US$32 (IQR = 16–95). Households lost a median of 123 work-days per patient treated. The current regimen for PKDL imposes a significant financial burden, reinforcing the link between poverty and visceral leishmaniasis. More practical shorter-course regimens for PKDL are urgently needed to achieve national and regional visceral leishmaniasis elimination goals. PMID:21896817

Do clinicians prescribe exercise similarly in patients with different cardiovascular diseases? Findings from the EAPC EXPERT working group survey

NARCIS (Netherlands)

Hansen, Dominique; Rovelo Ruiz, Gustavo; Doherty, Patrick; Iliou, Marie-Christine; Vromen, Tom; Hinton, Sally; Frederix, Ines; Wilhelm, Matthias; Schmid, Jean-Paul; Abreu, Ana; Ambrosetti, Marco; Garcia-Porrero, Esteban; Coninx, Karin; Dendale, Paul

2018-01-01

peak), frequency (median (IQR): 4 (2) days/week), session duration (median (IQR): 45 (18) min/session), programme duration (median (IQR): 12 (18) weeks), total exercise volume (median (IQR): 1215 (1961) peak-effort training hours) and prescription of strength training exercises (prescribed in 78% of