Impact of Amazon deforestation on climate simulations using the NCAR CCM2/BATS model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hahmann, A.N.; Dickinson, R.E.

Model validation and results are briefly presented for a simulation of deforestation of the Amazon rainforest. This initial study is made using assumptions regarding deforestation similar to those in earlier studies with several versions of the NCAR Community Climate Model (CCM) couples to the Biosphere-Atmosphere Transfer Scheme (BATS). The model used is a revised version of the NCAR CCM Version 2 coupled to BATS Version 1e. This paper discusses the portion of validation dealing with the distribution of precipitation; the simulation displays very good agreement with observed rainfall rates for the austral summer. Preliminary results from an 8-year simulation ofmore » deforestation are similar to that of previous studies. Annual precipitation and evaporation are reduced, while surface air temperatures show a slight increase. A substantial bimodal pattern appears in the results, with the Amazon decrease of precipitation and temperature increase accompanied by changes in the opposite sign to the southeast of the Amazon. Similar patterns have occurred in other studies, but not always in exactly the same locations. Evidently, how much of the region of rainfall increase occurs in the deforested area over the Amazon strongly affects the inferred statistics. It is likely that this pattern depends on the model control climatology and possibly other features. 16 refs., 2 figs., 2 tabs.« less

Modeling and Observational Study of the Global Atmospheric Impacts of Antarctic Sea Ice Anomalies

NASA Technical Reports Server (NTRS)

Bromwich, David H.; Hines, Keith M.

2004-01-01

A combined observational and modeling study considers the linkage between Antarctic sea ice and the climate of non-local latitudes. The observational component is based upon analyses of monthly station observations and the National Centers for Environmental Prediction (NCEP)/National Center for Atmospheric Research (NCAR) Reanalysis (NNR). The modeling component consists of simulations of the NCAR Community Climate Model versions 2 (CCM2) and 3 (CCM3) and the recent Community Atmosphere Model (CAM2). A convenient mechanism for communication between the Antarctic region (particularly the Ross Sea area) and the tropics and Northern Hemisphere is examined. The first evidence of this teleconnection came from CCM2 simulations performed during an earlier NASA supported project. Annual-cycle simulations with and without Antarctic sea ice show statistically- significant responses in monsoon precipitation over central and northern China during the month of September. The changes in monsoon precipitation are physically consistent with an intensified southwest Pacific (Northern Hemisphere) subtropical high in response to all Antarctic sea ice being removed and replaced with open water at -1.9"C. The intensified high is the northernmost component of three primary anomalies. The southernmost anomaly includes the Ross Sea area, where sea ice has been removed. An earlier study by Peng and Domros had also found a link between Antarctic sea ice and the East Asian monsoon circulation. The current project has helped to understand the teleconnection.

Recent variability of the solar spectral irradiance and its impact on climate modelling

NASA Astrophysics Data System (ADS)

Ermolli, I.; Matthes, K.; Dudok de Wit, T.; Krivova, N. A.; Tourpali, K.; Weber, M.; Unruh, Y. C.; Gray, L.; Langematz, U.; Pilewskie, P.; Rozanov, E.; Schmutz, W.; Shapiro, A.; Solanki, S. K.; Woods, T. N.

2013-04-01

The lack of long and reliable time series of solar spectral irradiance (SSI) measurements makes an accurate quantification of solar contributions to recent climate change difficult. Whereas earlier SSI observations and models provided a qualitatively consistent picture of the SSI variability, recent measurements by the SORCE (SOlar Radiation and Climate Experiment) satellite suggest a significantly stronger variability in the ultraviolet (UV) spectral range and changes in the visible and near-infrared (NIR) bands in anti-phase with the solar cycle. A number of recent chemistry-climate model (CCM) simulations have shown that this might have significant implications on the Earth's atmosphere. Motivated by these results, we summarize here our current knowledge of SSI variability and its impact on Earth's climate. We present a detailed overview of existing SSI measurements and provide thorough comparison of models available to date. SSI changes influence the Earth's atmosphere, both directly, through changes in shortwave (SW) heating and therefore, temperature and ozone distributions in the stratosphere, and indirectly, through dynamical feedbacks. We investigate these direct and indirect effects using several state-of-the art CCM simulations forced with measured and modelled SSI changes. A unique asset of this study is the use of a common comprehensive approach for an issue that is usually addressed separately by different communities. We show that the SORCE measurements are difficult to reconcile with earlier observations and with SSI models. Of the five SSI models discussed here, specifically NRLSSI (Naval Research Laboratory Solar Spectral Irradiance), SATIRE-S (Spectral And Total Irradiance REconstructions for the Satellite era), COSI (COde for Solar Irradiance), SRPM (Solar Radiation Physical Modelling), and OAR (Osservatorio Astronomico di Roma), only one shows a behaviour of the UV and visible irradiance qualitatively resembling that of the recent SORCE measurements. However, the integral of the SSI computed with this model over the entire spectral range does not reproduce the measured cyclical changes of the total solar irradiance, which is an essential requisite for realistic evaluations of solar effects on the Earth's climate in CCMs. We show that within the range provided by the recent SSI observations and semi-empirical models discussed here, the NRLSSI model and SORCE observations represent the lower and upper limits in the magnitude of the SSI solar cycle variation. The results of the CCM simulations, forced with the SSI solar cycle variations estimated from the NRLSSI model and from SORCE measurements, show that the direct solar response in the stratosphere is larger for the SORCE than for the NRLSSI data. Correspondingly, larger UV forcing also leads to a larger surface response. Finally, we discuss the reliability of the available data and we propose additional coordinated work, first to build composite SSI data sets out of scattered observations and to refine current SSI models, and second, to run coordinated CCM experiments.

Simulation of the modern arctic climate by the NCAR CCM1

NASA Technical Reports Server (NTRS)

Bromwich, David H.; Tzeng, Ren-Yow; Parish, Thomas, R.

1994-01-01

The National Center of Atmospheric Research (NCAR) Community Climate Model Version 1 (CCM1's) simulation of the modern arctic climate is evaluated by comparing a five-year seasonal cycle simulation with the European Center for Medium-Range Weather Forecasts (ECMWF) global analyses. The sea level pressure (SLP), storm tracks, vertical cross section of height, 500-hPa height, total energy budget, and moisture budget are analyzed to investigate the biases in the simulated arctic climate. The results show that the model simulates anomalously low SLP, too much storm activity, and anomalously strong baroclinicity to the west of Greenland and vice versa to the east of Greenland. This bias is mainly attributed to the model's topographic representation of Greenland. First, the broadened Greenland topography in the model distorts the path of cyclone waves over the North Atlantic Ocean. Second, the model oversimulates the ridge over Greenland, which intensifies its blocking effect and steers the cyclone waves clockwise around it and hence produces an artificial circum-Greenland trough. These biases are significantly alleviated when the horizontal resolution increases to T42. Over the Arctic basin, the model simulates large amounts of low-level (stratus) clouds in winter and almost no stratus in summer, which is opposite to the observations. This bias is mainly due to the location of the simulated SLP features and the negative anomaly of storm activity, which prevent the transport of moisture into this region during summer but favor this transport in winter. The moisture budget analysis shows that the model's net annual precipitation (P-E) between 70 deg N and the North Pole is 6.6 times larger than the observations and the model transports six times more moisture into this region. The bias in the advection term is attributed to the positive moisture fixer scheme and the distorted flow pattern. However, the excessive moisture transport into the Arctic basin does not solely result from the advection term. The contribution by the moisture fixer is as large as from advection. By contrast, the semi-Lagrangian transport scheme used in the CCM2 significantly improves the moisture simulation for this region; however, globally the error is as serious as for the positive moisture fixer scheme. Finally, because the model has such serious problems in simulating the present arctic climate, its simulations of past and future climate change for this region are questionable.

Mid-Holocene hydrologic model of the Shingobee watershed, Minnesota

USGS Publications Warehouse

Filby, S.K.; Locke, Sharon M.; Person, M.A.; Winter, T.C.; Rosenberry, D.O.; Nieber, J.L.; Gutowski, W.J.; Ito, E.

2002-01-01

A hydrologifc model of the Shingobee Watershed in north-central Minnesota was developed to reconstruct mid-Holocene paleo-lake levels for Williams Lake, a surface-water body located in the southern portion of the watershed. Hydrologic parameters for the model were first estimated in a calibration exercise using a 9-yr historical record (1990-1998) of climatic and hydrologic stresses. The model reproduced observed temporal and spatial trends in surface/groundwater levels across the watershed. Mid-Holocene aquifer and lake levels were then reconstructed using two paleoclimatic data sets: CCM1 atmospheric general circulation model output and pollen-transfer functions using sediment core data from Williams Lake. Calculated paleo-lake levels based on pollen-derived paleoclimatic reconstructions indicated a 3.5-m drop in simulated lake levels and were in good agreement with the position of mid-Holocene beach sands observed in a Williams Lake sediment core transect. However, calculated paleolake levels based on CCM1 climate forcing produced only a 0.05-m drop in lake levels. We found that decreases in winter precipitation rather than temperature increases had the largest effect on simulated mid-Holocene lake levels. The study illustrates how watershed models can be used to critically evaluate paleoclimatic reconstructions by integrating geologic, climatic, limnologic, and hydrogeologic data sets. ?? 2002 University of Washington.

The annual cycle of stratospheric water vapor in a general circulation model

NASA Technical Reports Server (NTRS)

Mote, Philip W.

1995-01-01

The application of general circulation models (GCM's) to stratospheric chemistry and transport both permits and requires a thorough investigation of stratospheric water vapor. The National Center for Atmospheric Research has redesigned its GCM, the Community Climate Model (CCM2), to enable studies of the chemistry and transport of tracers including water vapor; the importance of water vapor to the climate and chemistry of the stratosphere requires that it be better understood in the atmosphere and well represented in the model. In this study, methane is carried as a tracer and converted to water; this simple chemistry provides an adequate representation of the upper stratospheric water vapor source. The cold temperature bias in the winter polar stratosphere, which the CCM2 shares with other GCM's, produces excessive dehydration in the southern hemisphere, but this dry bias can be ameliorated by setting a minimum vapor pressure. The CCM2's water vapor distribution and seasonality compare favorably with observations in many respects, though seasonal variations including the upper stratospheric semiannual oscillation are generally too small. Southern polar dehydration affects midlatitude water vapor mixing ratios by a few tenths of a part per million, mostly after the demise of the vortex. The annual cycle of water vapor in the tropical and northern midlatitude lower stratosphere is dominated by drying at the tropical tropopause. Water vapor has a longer adjustment time than methane and had not reached equilibrium at the end of the 9 years simulated here.

Potential role of vegetation feedback in the climate sensitivity of high-latitude regions: A case study at 6000 years B.P.

USGS Publications Warehouse

Kutzbach, J.-E.; Bartlein, P.J.; Foley, J.A.; Harrison, S.P.; Hosteller, S.W.; Liu, Z.; Prentice, I.C.; Webb, T.

1996-01-01

Previous climate model simulations have shown that the configuration of the Earth's orbit during the early to mid-Holocene (approximately 10-5 kyr) can account for the generally warmer-than-present conditions experienced by the high latitudes of the northern hemisphere. New simulations for 6 kyr with two atmospheric/mixed-layer ocean models (Community Climate Model, version 1, CCM1, and Global ENvironmental and Ecological Simulation of Interactive Systems, version 2, GENESIS 2) are presented here and compared with results from two previous simulations with GENESIS 1 that were obtained with and without the albedo feedback due to climate-induced poleward expansion of the boreal forest. The climate model results are summarized in the form of potential vegetation maps obtained with the global BIOME model, which facilitates visual comparisons both among models and with pollen and plant macrofossil data recording shifts of the forest-tundra boundary. A preliminary synthesis shows that the forest limit was shifted 100-200 km north in most sectors. Both CCM1 and GENESIS 2 produced a shift of this magnitude. GENESIS 1 however produced too small a shift, except when the boreal forest albedo feedback was included. The feedback in this case was estimated to have amplified forest expansion by approximately 50%. The forest limit changes also show meridional patterns (greatest expansion in central Siberia and little or none in Alaska and Labrador) which have yet to be reproduced by models. Further progress in understanding of the processes involved in the response of climate and vegetation to orbital forcing will require both the deployment of coupled atmosphere-biosphere-ocean models and the development of more comprehensive observational data sets.

An investigation of the Archean climate using the NCAR CCm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jenkins, G.S.

1991-01-01

The Archean (2.5 to 3.8 billion years ago) is of interest climatically, because of the 'Faint-Young Sun Paradox', which can be characterized by the Sun's reduced energy output. This lower energy output leads to a frozen planet if the climate existed as it does today. But, the geologic record shows that water was flowing at the earth's surface 3.8 billion years ago. Energy Balance Models (EBMs) and one-dimensional radiative-convective (1DRC) models predict a frozen planet for this time period, unless large carbon dioxide (CO2) concentrations exist in the Archean atmosphere. The goal is to explore the Archean climate with themore » National Center for Atmospheric Research (NCAR), Community Climate Model (CCM). The search for negative feedbacks to explain the 'Faint-Young Sun Paradox' is the thrust of this study. This study undertakes a series of sensitivity simulations which first explores individual factors that may be important for the Archean. They include rotation rate, lower solar luminosity, and land fraction. Then, these climatic factors along with higher CO2 concentrations are combined into a set of experiments. A faster rotation rate may have existed in the Archean. The faster rotation rate simulations show warmer globally averaged surface temperatures that are caused by a 20 percent decrease in the total cloud fraction. The smaller cloud fraction is brought about by dynamical changes. A global ocean is a possibility for the Archean. A global ocean simulation predicts 4 K increase in global mean surface temperatures compared to the present-day climate control.« less

Facilitators and barriers of implementing the chronic care model in primary care: a systematic review.

PubMed

Kadu, Mudathira K; Stolee, Paul

2015-02-06

The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identify facilitators and barriers encountered during implementation. This study identified English-language, peer-reviewed research articles, describing the CCM in primary care settings. Searches were performed in three data bases: Web of Knowledge, Pubmed and Scopus. Article abstracts and titles were read based on whether they met the following inclusion criteria: 1) studies published after 2003 that described or evaluated the implementation of the CCM; 2) the care setting was primary care; 3) the target population of the study was adults over the age of 18 with chronic conditions. Studies were categorized by reference, study design and methods, participants and setting, study objective, CCM components used, and description of the intervention. The next stage of data abstraction involved qualitative analysis of cited barriers and facilitators using the Consolidating Framework for Research Implementation. This review identified barriers and facilitators of implementation across various primary care settings in 22 studies. The major emerging themes were those related to the inner setting of the organization, the process of implementation and characteristics of the individual healthcare providers. These included: organizational culture, its structural characteristics, networks and communication, implementation climate and readiness, presence of supportive leadership, and provider attitudes and beliefs. These findings highlight the importance of assessing organizational capacity and needs prior to and during the implementation of the CCM, as well as gaining a better understanding of health care providers' and organizational perspective.

Evaluation of the reactive nitrogen budget of the remote atmosphere in global models using airborne measurements

NASA Astrophysics Data System (ADS)

Murray, L. T.; Strode, S. A.; Fiore, A. M.; Lamarque, J. F.; Prather, M. J.; Thompson, C. R.; Peischl, J.; Ryerson, T. B.; Allen, H.; Blake, D. R.; Crounse, J. D.; Brune, W. H.; Elkins, J. W.; Hall, S. R.; Hintsa, E. J.; Huey, L. G.; Kim, M. J.; Moore, F. L.; Ullmann, K.; Wennberg, P. O.; Wofsy, S. C.

2017-12-01

Nitrogen oxides (NOx ≡ NO + NO2) in the background atmosphere are critical precursors for the formation of tropospheric ozone and OH, thereby exerting strong influence on surface air quality, reactive greenhouse gases, and ecosystem health. The impact of NOx on atmospheric composition and climate is sensitive to the relative partitioning of reactive nitrogen between NOx and longer-lived reservoir species of the total reactive nitrogen family (NOy) such as HNO3, HNO4, PAN and organic nitrates (RONO2). Unfortunately, global chemistry-climate models (CCMs) and chemistry-transport models (CTMs) have historically disagreed in their reactive nitrogen budgets outside of polluted continental regions, and we have lacked in situ observations with which to evaluate them. Here, we compare and evaluate the NOy budget of six global models (GEOS-Chem CTM, GFDL AM3 CCM, GISS E2.1 CCM, GMI CTM, NCAR CAM CCM, and UCI CTM) using new observations of total reactive nitrogen and its member species from the NASA Atmospheric Tomography (ATom) mission. ATom has now completed two of its four planned deployments sampling the remote Pacific and Atlantic basins of both hemispheres with a comprehensive suite of measurements for constraining reactive photochemistry. All six models have simulated conditions climatologically similar to the deployments. The GMI and GEOS-Chem CTMs have in addition performed hindcast simulations using the MERRA-2 reanalysis, and have been sampled along the flight tracks. We evaluate the performance of the models relative to the observations, and identify factors contributing to their disparate behavior using known differences in model oxidation mechanisms, heterogeneous loss pathways, lightning and surface emissions, and physical loss processes.

Micro-CT Imaging Reveals Mekk3 Heterozygosity Prevents Cerebral Cavernous Malformations in Ccm2-Deficient Mice

PubMed Central

Choi, Jaesung P.; Foley, Matthew; Zhou, Zinan; Wong, Weng-Yew; Gokoolparsadh, Naveena; Arthur, J. Simon C.; Li, Dean Y.; Zheng, Xiangjian

2016-01-01

Mutations in CCM1 (aka KRIT1), CCM2, or CCM3 (aka PDCD10) gene cause cerebral cavernous malformation in humans. Mouse models of CCM disease have been established by deleting Ccm genes in postnatal animals. These mouse models provide invaluable tools to investigate molecular mechanism and therapeutic approaches for CCM disease. However, the full value of these animal models is limited by the lack of an accurate and quantitative method to assess lesion burden and progression. In the present study we have established a refined and detailed contrast enhanced X-ray micro-CT method to measure CCM lesion burden in mouse brains. As this study utilized a voxel dimension of 9.5μm (leading to a minimum feature size of approximately 25μm), it is therefore sufficient to measure CCM lesion volume and number globally and accurately, and provide high-resolution 3-D mapping of CCM lesions in mouse brains. Using this method, we found loss of Ccm1 or Ccm2 in neonatal endothelium confers CCM lesions in the mouse hindbrain with similar total volume and number. This quantitative approach also demonstrated a rescue of CCM lesions with simultaneous deletion of one allele of Mekk3. This method would enhance the value of the established mouse models to study the molecular basis and potential therapies for CCM and other cerebrovascular diseases. PMID:27513872

Seasonal and interannual variability of carbon monoxide based on MOZAIC observations, MACC reanalysis, and model simulations over an urban site in India

NASA Astrophysics Data System (ADS)

Sheel, Varun; Sahu, L. K.; Kajino, M.; Deushi, M.; Stein, O.; Nedelec, P.

2014-07-01

The spatial and temporal variations of carbon monoxide (CO) are analyzed over a tropical urban site, Hyderabad (17°27'N, 78°28'E) in central India. We have used vertical profiles from the Measurement of ozone and water vapor by Airbus in-service aircraft (MOZAIC) aircraft observations, Monitoring Atmospheric Composition and Climate (MACC) reanalysis, and two chemical transport model simulations (Model for Ozone And Related Tracers (MOZART) and MRI global Chemistry Climate Model (MRI-CCM2)) for the years 2006-2008. In the lower troposphere, the CO mixing ratio showed strong seasonality, with higher levels (>300 ppbv) during the winter and premonsoon seasons associated with a stable anticyclonic circulation, while lower CO values (up to 100 ppbv) were observed in the monsoon season. In the planetary boundary layer (PBL), the seasonal distribution of CO shows the impact of both local meteorology and emissions. While the PBL CO is predominantly influenced by strong winds, bringing regional background air from marine and biomass burning regions, under calm conditions CO levels are elevated by local emissions. On the other hand, in the free troposphere, seasonal variation reflects the impact of long-range transport associated with the Intertropical Convergence Zone and biomass burning. The interannual variations were mainly due to transition from El Niño to La Niña conditions. The overall modified normalized mean biases (normalization based on the observed and model mean values) with respect to the observed CO profiles were lower for the MACC reanalysis than the MOZART and MRI-CCM2 models. The CO in the PBL region was consistently underestimated by MACC reanalysis during all the seasons, while MOZART and MRI-CCM2 show both positive and negative biases depending on the season.

Sensitivity of a cloud parameterization package in the National Center for Atmospheric Research Community Climate Model

NASA Astrophysics Data System (ADS)

Kao, C.-Y. J.; Smith, W. S.

1999-05-01

A physically based cloud parameterization package, which includes the Arakawa-Schubert (AS) scheme for subgrid-scale convective clouds and the Sundqvist (SUN) scheme for nonconvective grid-scale layered clouds (hereafter referred to as the SUNAS cloud package), is incorporated into the National Center for Atmospheric Research (NCAR) Community Climate Model, Version 2 (CCM2). The AS scheme is used for a more reasonable heating distribution due to convective clouds and their associated precipitation. The SUN scheme allows for the prognostic computation of cloud water so that the cloud optical properties are more physically determined for shortwave and longwave radiation calculations. In addition, the formation of anvil-like clouds from deep convective systems is able to be simulated with the SUNAS package. A 10-year simulation spanning the period from 1980 to 1989 is conducted, and the effect of the cloud package on the January climate is assessed by comparing it with various available data sets and the National Center for Environmental Protection/NCAR reanalysis. Strengths and deficiencies of both the SUN and AS methods are identified and discussed. The AS scheme improves some aspects of the model dynamics and precipitation, especially with respect to the Pacific North America (PNA) pattern. CCM2's tendency to produce a westward bias of the 500 mbar stationary wave (time-averaged zonal anomalies) in the PNA sector is remedied apparently because of a less "locked-in" heating pattern in the tropics. The additional degree of freedom added by the prognostic calculation of cloud water in the SUN scheme produces interesting results in the modeled cloud and radiation fields compared with data. In general, too little cloud water forms in the tropics, while excessive cloud cover and cloud liquid water are simulated in midlatitudes. This results in a somewhat degraded simulation of the radiation budget. The overall simulated precipitation by the SUNAS package is, however, substantially improved over the original CCM2.

The 'Year without summer 1816

NASA Astrophysics Data System (ADS)

Arfeuille, F.; Rozanov, E.; Peter, T.; Weisenstein, D.; Hadorn, G.; Bodenmann, T.; Brönnimann, S.

2010-09-01

One famous example of an extreme climatic event is the cold summer of 1816 in Europe and North America. This specific year, which was later called the "Year without summer 1816", had profound social and environmental effects. The cataclysmic eruption of Mt Tambora is now commonly known to have largely contributed to the negative temperature anomalies of the summer 1816, but some uncertainties remain. The eruption which occurred in April 1815 is the largest within the last 500 years and this extreme climatic forcing provides a real test for climate models. A crucial parameter to assess in order to simulate this eruption is the aerosol size distribution, which strongly influences the radiative impact of the aerosols (through changes in albedo and residence time in the stratosphere, among others) and the impacts on dynamics and chemistry. The representation of this major forcing is done by using the AER-2D aerosol model which calculates the size distribution of the aerosols formed after the eruption. The modeling of the climatic impacts is then done by the state-of-the-art Chemistry-Climate model (CCM) SOCOL. The characteristics of the Tambora eruption and results from simulations made using the aerosol model/CCM, with an emphasis on the radiative and chemical implications of the large aerosol, will be shown. For instance, the specific absorption/scattering ratio of Mt.Tambora aerosols induced a large stratospheric warming which will be analyzed. The climatic impacts will also be discussed in regards of the high sedimentation rate of Mt. Tambora aerosols, leading to a fast decrease of the atmospheric optical depth in the first two years after the eruption. The link will be made between the modeling results and proxy-reconstructions as well as with available historical daily data from Geneva, Switzerland. Finally, insights on the contemporary response to this climatic extreme will be shown.

a Physical Parameterization of Snow Albedo for Use in Climate Models.

NASA Astrophysics Data System (ADS)

Marshall, Susan Elaine

The albedo of a natural snowcover is highly variable ranging from 90 percent for clean, new snow to 30 percent for old, dirty snow. This range in albedo represents a difference in surface energy absorption of 10 to 70 percent of incident solar radiation. Most general circulation models (GCMs) fail to calculate the surface snow albedo accurately, yet the results of these models are sensitive to the assumed value of the snow albedo. This study replaces the current simple empirical parameterizations of snow albedo with a physically-based parameterization which is accurate (within +/- 3% of theoretical estimates) yet efficient to compute. The parameterization is designed as a FORTRAN subroutine (called SNOALB) which can be easily implemented into model code. The subroutine requires less then 0.02 seconds of computer time (CRAY X-MP) per call and adds only one new parameter to the model calculations, the snow grain size. The snow grain size can be calculated according to one of the two methods offered in this thesis. All other input variables to the subroutine are available from a climate model. The subroutine calculates a visible, near-infrared and solar (0.2-5 μm) snow albedo and offers a choice of two wavelengths (0.7 and 0.9 mu m) at which the solar spectrum is separated into the visible and near-infrared components. The parameterization is incorporated into the National Center for Atmospheric Research (NCAR) Community Climate Model, version 1 (CCM1), and the results of a five -year, seasonal cycle, fixed hydrology experiment are compared to the current model snow albedo parameterization. The results show the SNOALB albedos to be comparable to the old CCM1 snow albedos for current climate conditions, with generally higher visible and lower near-infrared snow albedos using the new subroutine. However, this parameterization offers a greater predictability for climate change experiments outside the range of current snow conditions because it is physically-based and not tuned to current empirical results.

Evaluation of Stratospheric Transport in New 3D Models Using the Global Modeling Initiative Grading Criteria

NASA Technical Reports Server (NTRS)

Strahan, Susan E.; Douglass, Anne R.; Einaudi, Franco (Technical Monitor)

2001-01-01

The Global Modeling Initiative (GMI) Team developed objective criteria for model evaluation in order to identify the best representation of the stratosphere. This work created a method to quantitatively and objectively discriminate between different models. In the original GMI study, 3 different meteorological data sets were used to run an offline chemistry and transport model (CTM). Observationally-based grading criteria were derived and applied to these simulations and various aspects of stratospheric transport were evaluated; grades were assigned. Here we report on the application of the GMI evaluation criteria to CTM simulations integrated with a new assimilated wind data set and a new general circulation model (GCM) wind data set. The Finite Volume Community Climate Model (FV-CCM) is a new GCM developed at Goddard which uses the NCAR CCM physics and the Lin and Rood advection scheme. The FV-Data Assimilation System (FV-DAS) is a new data assimilation system which uses the FV-CCM as its core model. One year CTM simulations of 2.5 degrees longitude by 2 degrees latitude resolution were run for each wind data set. We present the evaluation of temperature and annual transport cycles in the lower and middle stratosphere in the two new CTM simulations. We include an evaluation of high latitude transport which was not part of the original GMI criteria. Grades for the new simulations will be compared with those assigned during the original GMT evaluations and areas of improvement will be identified.

Simulation of the modern arctic climate by the NCAR CCM1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bromwich, D.H.; Tzeng, R.Y.; Parish, T.R.

The NCAR CCM1's simulation of the modern arctic climate is evaluated by comparing a five-year seasonal cycle simulation with the ECMWF global analyses. The sea level pressure (SLP), storm tracks, vertical cross section of height, 500-hPa height, total energy budget, and moisture budget are analyzed to investigate the biases in the simulated arctic climate. The results show that the model simulates anomalously low SLP, too much activity, and anomalously strong baroclinicity to the west of Greenland and vice versa to the east of Greenland. This bias is mainly attributed to the model's topographic representation of Greenland. First, the broadened Greenlandmore » topography in the model distorts the path of cyclone waves over the North Atlantic Ocean. Second, the model oversimulates the ridge over Greenland, which intensifies its blocking effect and steers the cyclone waves clockwise around it and hence produces an artificial [open quotes]circum-Greenland[close quotes] trough. These biases are significantly alleviated when the horizontal resolution increases to T42. Over the Arctic basin, the modal simulates large amounts of low-level (stratus) clouds in winter and almost no stratus in summer, which is opposite to the observations. This bias is mainly due to the location of the simulated SLP features and the negative anomaly of storm activity, which prevent the transport of moisture into this region during summer but favor this transport in winter. 26 refs., 14 figs., 42 tabs.« less

Land-atmosphere interactions over the continental United States

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zeng, Xubin

This paper briefly discusses four suggested modifications for land surface modeling in climate models. The impact of the modifications on climate simulations is analyzed with the Biosphere-Atmosphere Transfer Scheme (BATS) land surface model. It is found that the modifications can improve BATS simulations. In particular, the sensitivity of BATS to the prescribed value of physical root fraction which cannot be observed from satellite remote sensing or field experiments is improved. These modifications significantly reduce the excessive summer land surface temperature over the continental United States simulated by the National Center for Atmospheric Research Community Climate Model (CCM2) coupled with BATS.more » A land-atmosphere interaction mechanism involving energy and water cycles is proposed to explain the results. 9 refs., 1 fig.« less

Implications of CO Bias for Ozone and Methane Lifetime in a CCM

NASA Technical Reports Server (NTRS)

Strode, Sarah; Duncan, Bryan Neal; Yegorova, Elena; Douglass, Anne

2013-01-01

A low bias in carbon monoxide compared to observations at high latitudes is a common feature of chemistry climate models. CO bias can both indicate and contribute to a bias in modeled OH and methane lifetime. This study examines possible causes of CO bias in the ACCMIP simulation of the GEOSCCM, and considers how attributing the CO bias to uncertainty in CO emissions versus biases in other constituents impacts the relationship between CO bias and methane lifetime. We use a simplified model of CO tagged by source with specified OH to quantify the sensitivity of the CO bias to changes in CO emissions or OH concentration, comparing the modeled CO to surface and MOPITT observations. The simplified model shows that decreasing OH in the northern hemisphere removes most of the global mean and inter-hemispheric bias in surface CO. We then use results from this analysis to explore how adjusting CO sources in the CCM impacts the concentrations of ozone, OH and methane. The CCM simulation also exhibits biases in ozone and water vapor compared to observations. We use a parameterized CO-OH-CH4 model that takes ozone and water vapor as inputs to the parameterization to examine whether correcting water and ozone biases can alter OH enough to remove the CO bias. Through this analysis, we aim to better quantify the relationship between CO bias and model biases in ozone concentrations and methane lifetime.

The eHealth Enhanced Chronic Care Model: a theory derivation approach.

PubMed

Gee, Perry M; Greenwood, Deborah A; Paterniti, Debora A; Ward, Deborah; Miller, Lisa M Soederberg

2015-04-01

Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools. The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses. Using Theory Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms "CCM or Chronic Care Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness Self-management support" AND "Technology" AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM. We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider. The revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps.

Biosphere-Atmosphere Transfer Scheme (BATS) version le as coupled to the NCAR community climate model. Technical note. [NCAR (National Center for Atmospheric Research)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dickinson, R.E.; Henderson-Sellers, A.; Kennedy, P.J.

A comprehensive model of land-surface processes has been under development suitable for use with various National Center for Atmospheric Research (NCAR) General Circulation Models (GCMs). Special emphasis has been given to describing properly the role of vegetation in modifying the surface moisture and energy budgets. The result of these efforts has been incorporated into a boundary package, referred to as the Biosphere-Atmosphere Transfer Scheme (BATS). The current frozen version, BATS1e is a piece of software about four thousand lines of code that runs as an offline version or coupled to the Community Climate Model (CCM).

21st Century Trends in Antarctic Temperature and Polar Stratospheric Cloud (PSC) Area in the GEOS Chemistry-Climate Model

NASA Technical Reports Server (NTRS)

Hurwitz, M. M.; Newman, P. A.

2010-01-01

This study examines trends in Antarctic temperature and APSC, a temperature proxy for the area of polar stratospheric clouds, in an ensemble of Goddard Earth Observing System (GEOS) chemistry-climate model (CCM) simulations of the 21st century. A selection of greenhouse gas, ozone-depleting substance, and sea surface temperature scenarios is used to test the trend sensitivity to these parameters. One scenario is used to compare temperature trends in two versions of the GEOS CCM. An extended austral winter season is examined in detail. In May, June, and July, the expected future increase in CO2-related radiative cooling drives temperature trends in the Antarctic lower stratosphere. At 50 hPa, a 1.3 K cooling is expected between 2000 and 2100. Ozone levels increase, despite this robust cooling signal and the consequent increase in APSC, suggesting the enhancement of stratospheric transport in future. In the lower stratosphere, the choice of climate change scenarios does not affect the magnitude of the early winter cooling. Midwinter temperature trends are generally small. In October, APSC trends have the same sign as the prescribed halogen trends. That is, there are negative APSC trends in "grealistic future" simulations, where halogen loading decreases in accordance with the Montreal Protocol and CO2 continues to increase. In these simulations, the speed of ozone recovery is not influenced by either the choice of sea surface temperature and greenhouse gas scenarios or by the model version.

Effects of Greenhouse Gas Increase and Stratospheric Ozone Depletion on Stratospheric Mean Age of Air in 1960-2010

NASA Astrophysics Data System (ADS)

Li, F.; Newman, P. A.; Pawson, S.; Perlwitz, J.

2017-12-01

The strength of the stratospheric Brewer-Dobson circulation (BDC) in a changing climate has been extensively studied, but the relative importance of greenhouse gas (GHG) increases and stratospheric ozone depletion in driving the BDC changes remains uncertain. This study separates the impacts of GHG and stratospheric ozone forcings on stratospheric mean age of air in the 1960-2010 period using the Goddard Earth Observing System Model (GEOS) Chemistry-Climate Model (CCM). The experiment compares a set of controlled simulations using a coupled atmosphere-ocean version of the GEOS CCM, in which either GHGs, or stratospheric ozone, or both factors evolve over time. The model results show that GHGs and stratospheric ozone have about equal contributions to the simulated mean age decrease. It is also found that GHG increases account for about two thirds of the enhanced strength of the lower stratospheric residual circulation. The results show that ozone depletion causes an increase in the mean age of air in the Antarctic summer lower stratosphere through two processes: 1) a seasonal delay in the Antarctic polar vortex breakup, that inhibits young mid-latitude air from mixing with the older air inside the vortex; and 2) enhanced Antarctic downwelling, that brings older air from middle and upper stratosphere into the lower stratosphere.

Extracting climate memory using Fractional Integrated Statistical Model: A new perspective on climate prediction

PubMed Central

Yuan, Naiming; Fu, Zuntao; Liu, Shida

2014-01-01

Long term memory (LTM) in climate variability is studied by means of fractional integral techniques. By using a recently developed model, Fractional Integral Statistical Model (FISM), we in this report proposed a new method, with which one can estimate the long-lasting influences of historical climate states on the present time quantitatively, and further extract the influence as climate memory signals. To show the usability of this method, two examples, the Northern Hemisphere monthly Temperature Anomalies (NHTA) and the Pacific Decadal Oscillation index (PDO), are analyzed in this study. We find the climate memory signals indeed can be extracted and the whole variations can be further decomposed into two parts: the cumulative climate memory (CCM) and the weather-scale excitation (WSE). The stronger LTM is, the larger proportion the climate memory signals will account for in the whole variations. With the climate memory signals extracted, one can at least determine on what basis the considered time series will continue to change. Therefore, this report provides a new perspective on climate prediction. PMID:25300777

On the aliasing of the solar cycle in the lower stratospheric tropical temperature

NASA Astrophysics Data System (ADS)

Kuchar, Ales; Ball, William T.; Rozanov, Eugene V.; Stenke, Andrea; Revell, Laura; Miksovsky, Jiri; Pisoft, Petr; Peter, Thomas

2017-09-01

The double-peaked response of the tropical stratospheric temperature profile to the 11 year solar cycle (SC) has been well documented. However, there are concerns about the origin of the lower peak due to potential aliasing with volcanic eruptions or the El Niño-Southern Oscillation (ENSO) detected using multiple linear regression analysis. We confirm the aliasing using the results of the chemistry-climate model (CCM) SOCOLv3 obtained in the framework of the International Global Atmospheric Chemisty/Stratosphere-troposphere Processes And their Role in Climate Chemistry-Climate Model Initiative phase 1. We further show that even without major volcanic eruptions included in transient simulations, the lower stratospheric response exhibits a residual peak when historical sea surface temperatures (SSTs)/sea ice coverage (SIC) are used. Only the use of climatological SSTs/SICs in addition to background stratospheric aerosols removes volcanic and ENSO signals and results in an almost complete disappearance of the modeled solar signal in the lower stratospheric temperature. We demonstrate that the choice of temporal subperiod considered for the regression analysis has a large impact on the estimated profile signal in the lower stratosphere: at least 45 consecutive years are needed to avoid the large aliasing effect of SC maxima with volcanic eruptions in 1982 and 1991 in historical simulations, reanalyses, and observations. The application of volcanic forcing compiled for phase 6 of the Coupled Model Intercomparison Project (CMIP6) in the CCM SOCOLv3 reduces the warming overestimation in the tropical lower stratosphere and the volcanic aliasing of the temperature response to the SC, although it does not eliminate it completely.

Technical Report Series on Global Modeling and Data Assimilation. Volume 20; The Climate of the FVCCM-3 Model

NASA Technical Reports Server (NTRS)

Suarez, Max J. (Editor); Chang, Yehui; Schubert, Siegfried D.; Lin, Shian-Jiann; Nebuda, Sharon; Shen, Bo-Wen

2001-01-01

This document describes the climate of version 1 of the NASA-NCAR model developed at the Data Assimilation Office (DAO). The model consists of a new finite-volume dynamical core and an implementation of the NCAR climate community model (CCM-3) physical parameterizations. The version of the model examined here was integrated at a resolution of 2 degrees latitude by 2.5 degrees longitude and 32 levels. The results are based on assimilation that was forced with observed sea surface temperature and sea ice for the period 1979-1995, and are compared with NCEP/NCAR reanalyses and various other observational data sets. The results include an assessment of seasonal means, subseasonal transients including the Madden Julian Oscillation, and interannual variability. The quantities include zonal and meridional winds, temperature, specific humidity, geopotential height, stream function, velocity potential, precipitation, sea level pressure, and cloud radiative forcing.

Can increased leaf photosynthesis be converted into higher crop mass production? A simulation study for rice using the crop model GECROS

PubMed Central

Struik, Paul C.

2017-01-01

Abstract Various genetic engineering routes to enhance C3 leaf photosynthesis have been proposed to improve crop productivity. However, their potential contribution to crop productivity needs to be assessed under realistic field conditions. Using 31 year weather data, we ran the crop model GECROS for rice in tropical, subtropical, and temperate environments, to evaluate the following routes: (1) improving mesophyll conductance (gm); (2) improving Rubisco specificity (Sc/o); (3) improving both gm and Sc/o; (4) introducing C4 biochemistry; (5) introducing C4 Kranz anatomy that effectively minimizes CO2 leakage; (6) engineering the complete C4 mechanism; (7) engineering cyanobacterial bicarbonate transporters; (8) engineering a more elaborate cyanobacterial CO2-concentrating mechanism (CCM) with the carboxysome in the chloroplast; and (9) a mechanism that combines the low ATP cost of the cyanobacterial CCM and the high photosynthetic capacity per unit leaf nitrogen. All routes improved crop mass production, but benefits from Routes 1, 2, and 7 were ≤10%. Benefits were higher in the presence than in the absence of drought, and under the present climate than for the climate predicted for 2050. Simulated crop mass differences resulted not only from the increased canopy photosynthesis competence but also from changes in traits such as light interception and crop senescence. The route combinations gave larger effects than the sum of the effects of the single routes, but only Route 9 could bring an advantage of ≥50% under any environmental conditions. To supercharge crop productivity, exploring a combination of routes in improving the CCM, photosynthetic capacity, and quantum efficiency is required. PMID:28379522

The eHealth Enhanced Chronic Care Model: A Theory Derivation Approach

PubMed Central

Greenwood, Deborah A; Paterniti, Debora A; Ward, Deborah; Miller, Lisa M Soederberg

2015-01-01

Background Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools. Objective The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses. Methods Using Theory Derivation processes, we identified a “parent theory”, the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms “CCM or Chronic Care Model” AND “eHealth” or the specific identified components of eHealth. Additionally, “Chronic Illness Self-management support” AND “Technology” AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM. Results We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be placed within the context of community and enhanced with the benefits of the eCommunity or virtual communities, and (3) a complete feedback loop is needed to assure productive technology-based interactions between the patient and provider. Conclusions The revised model, eCCM, offers insight into the role of eHealth tools in self-management support for people with chronic conditions. Additional research and testing of the eCCM are the logical next steps. PMID:25842005

Can the GEOS CCM Simulate the Temperature Response to Warm Pool El Nino Events in the Antarctic Stratosphere?

NASA Technical Reports Server (NTRS)

Hurwitz, M. M.; Song, I.-S.; Oman, L. D.; Newman, P. A.; Molod, A. M.; Frith, S. M.; Nielsen, J. E.

2010-01-01

"Warm pool" (WP) El Nino events are characterized by positive sea surface temperature (SST) anomalies in the central equatorial Pacific. During austral spring. WP El Nino events are associated with an enhancement of convective activity in the South Pacific Convergence Zone, provoking a tropospheric planetary wave response and thus increasing planetary wave driving of the Southern Hemisphere stratosphere. These conditions lead to higher polar stratospheric temperatures and to a weaker polar jet during austral summer, as compared with neutral ENSO years. Furthermore, this response is sensitive to the phase of the quasi-biennial oscillation (QBO): a stronger warming is seen in WP El Nino events coincident with the easterly phase of the quasi-biennial oscillation (QBO) as compared with WP El Nino events coincident with a westerly or neutral QBO. The Goddard Earth Observing System (GEOS) chemistry-climate model (CCM) is used to further explore the atmospheric response to ENSO. Time-slice simulations are forced by composited SSTs from observed WP El Nino and neutral ENSO events. The modeled eddy heat flux, temperature and wind responses to WP El Nino events are compared with observations. A new gravity wave drag scheme has been implemented in the GEOS CCM, enabling the model to produce a realistic, internally generated QBO. By repeating the above time-slice simulations with this new model version, the sensitivity of the WP El Nino response to the phase of the quasi-biennial oscillation QBO is estimated.

Can the GEOS CCM Simulate the Temperature Response to Warm Pool El Nino Events in the Antarctic Stratosphere?

NASA Technical Reports Server (NTRS)

Hurwitz, M. M.; Song, I.-S.; Oman, L. D.; Newman, P. A.; Molod, A. M.; Frith, S. M.; Nielsen, J. E.

2011-01-01

"Warm pool" (WP) El Nino events are characterized by positive sea surface temperature (SST) anomalies in the central equatorial Pacific. During austral spring, WP El Nino events are associated with an enhancement of convective activity in the South Pacific Convergence Zone, provoking a tropospheric planetary wave response and thus increasing planetary wave driving of the Southern Hemisphere stratosphere. These conditions lead to higher polar stratospheric temperatures and to a weaker polar jet during austral summer, as compared with neutral ENSO years. Furthermore, this response is sensitive to the phase of the quasi-biennial oscillation (QBO): a stronger warming is seen in WP El Nino events coincident with the easterly phase of the quasi-biennial oscillation (QBO) as compared with WP El Nino events coincident with a westerly or neutral QBO. The Goddard Earth Observing System (GEOS) chemistry-climate model (CCM) is used to further explore the atmospheric response to ENSO. Time-slice simulations are forced by composited SSTs from observed NP El Nino and neutral ENSO events. The modeled eddy heat flux, temperature and wind responses to WP El Nino events are compared with observations. A new gravity wave drag scheme has been implemented in the GEOS CCM, enabling the model to produce e realistic, internally generated QBO. By repeating the above time-slice simulations with this new model version, the sensitivity of the WP El Nino response to the phase of the quasi-biennial oscillation QBO is estimated.

Evaluating data-driven causal inference techniques in noisy physical and ecological systems

NASA Astrophysics Data System (ADS)

Tennant, C.; Larsen, L.

2016-12-01

Causal inference from observational time series challenges traditional approaches for understanding processes and offers exciting opportunities to gain new understanding of complex systems where nonlinearity, delayed forcing, and emergent behavior are common. We present a formal evaluation of the performance of convergent cross-mapping (CCM) and transfer entropy (TE) for data-driven causal inference under real-world conditions. CCM is based on nonlinear state-space reconstruction, and causality is determined by the convergence of prediction skill with an increasing number of observations of the system. TE is the uncertainty reduction based on transition probabilities of a pair of time-lagged variables. With TE, causal inference is based on asymmetry in information flow between the variables. Observational data and numerical simulations from a number of classical physical and ecological systems: atmospheric convection (the Lorenz system), species competition (patch-tournaments), and long-term climate change (Vostok ice core) were used to evaluate the ability of CCM and TE to infer causal-relationships as data series become increasingly corrupted by observational (instrument-driven) or process (model-or -stochastic-driven) noise. While both techniques show promise for causal inference, TE appears to be applicable to a wider range of systems, especially when the data series are of sufficient length to reliably estimate transition probabilities of system components. Both techniques also show a clear effect of observational noise on causal inference. For example, CCM exhibits a negative logarithmic decline in prediction skill as the noise level of the system increases. Changes in TE strongly depend on noise type and which variable the noise was added to. The ability of CCM and TE to detect driving influences suggest that their application to physical and ecological systems could be transformative for understanding driving mechanisms as Earth systems undergo change.

Evolutionary bursts in Euphorbia (Euphorbiaceae) are linked with photosynthetic pathway.

PubMed

Horn, James W; Xi, Zhenxiang; Riina, Ricarda; Peirson, Jess A; Yang, Ya; Dorsey, Brian L; Berry, Paul E; Davis, Charles C; Wurdack, Kenneth J

2014-12-01

The mid-Cenozoic decline of atmospheric CO2 levels that promoted global climate change was critical to shaping contemporary arid ecosystems. Within angiosperms, two CO2 -concentrating mechanisms (CCMs)-crassulacean acid metabolism (CAM) and C4 -evolved from the C3 photosynthetic pathway, enabling more efficient whole-plant function in such environments. Many angiosperm clades with CCMs are thought to have diversified rapidly due to Miocene aridification, but links between this climate change, CCM evolution, and increased net diversification rates (r) remain to be further understood. Euphorbia (∼2000 species) includes a diversity of CAM-using stem succulents, plus a single species-rich C4 subclade. We used ancestral state reconstructions with a dated molecular phylogeny to reveal that CCMs independently evolved 17-22 times in Euphorbia, principally from the Miocene onwards. Analyses assessing among-lineage variation in r identified eight Euphorbia subclades with significantly increased r, six of which have a close temporal relationship with a lineage-corresponding CCM origin. Our trait-dependent diversification analysis indicated that r of Euphorbia CCM lineages is approximately threefold greater than C3 lineages. Overall, these results suggest that CCM evolution in Euphorbia was likely an adaptive strategy that enabled the occupation of increased arid niche space accompanying Miocene expansion of arid ecosystems. These opportunities evidently facilitated recent, replicated bursts of diversification in Euphorbia. © 2014 The Author(s). Evolution © 2014 The Society for the Study of Evolution.

Collaborative Chronic Care Models for Mental Health Conditions: Cumulative Meta-Analysis and Meta-Regression to Guide Future Research and Implementation

PubMed Central

Grogan-Kaylor, Andrew; Perron, Brian E.; Kilbourne, Amy M.; Woltmann, Emily; Bauer, Mark S.

2013-01-01

Objective Prior meta-analysis indicates that collaborative chronic care models (CCMs) improve mental and physical health outcomes for individuals with mental disorders. This study aimed to investigate the stability of evidence over time and identify patient and intervention factors associated with CCM effects in order to facilitate implementation and sustainability of CCMs in clinical practice. Method We reviewed 53 CCM trials that analyzed depression, mental quality of life (QOL), or physical QOL outcomes. Cumulative meta-analysis and meta-regression were supplemented by descriptive investigations across and within trials. Results Most trials targeted depression in the primary care setting, and cumulative meta-analysis indicated that effect sizes favoring CCM quickly achieved significance for depression outcomes, and more recently achieved significance for mental and physical QOL. Four of six CCM elements (patient self-management support, clinical information systems, system redesign, and provider decision support) were common among reviewed trials, while two elements (healthcare organization support and linkages to community resources) were rare. No single CCM element was statistically associated with the success of the model. Similarly, meta-regression did not identify specific factors associated with CCM effectiveness. Nonetheless, results within individual trials suggest that increased illness severity predicts CCM outcomes. Conclusions Significant CCM trials have been derived primarily from four original CCM elements. Nonetheless, implementing and sustaining this established model will require healthcare organization support. While CCMs have typically been tested as population-based interventions, evidence supports stepped care application to more severely ill individuals. Future priorities include developing implementation strategies to support adoption and sustainability of the model in clinical settings while maximizing fit of this multi-component framework to local contextual factors. PMID:23938600

An ethical justification for the Chronic Care Model (CCM)

PubMed Central

Oprea, Liviu; Braunack‐Mayer, Annette; Rogers, Wendy A.; Stocks, Nigel

2009-01-01

Abstract Background:  Chronic diseases are major causes of morbidity and mortality in developed countries. Their effects can be mitigated by high quality evidence‐based care, but this is not the norm in most systems. The Chronic Care Model (CCM) is an evidence‐based policy response to this practice gap, which uses multiple strategies to promote the quality of chronic care. Objective:  To review CCM with an ethical lens. Methods:  We reviewed the published empirical and non‐empirical articles of CCM to analyse the ethical underpinnings of this model. Results and conclusions:  We argue that its principal ethical value lies in the institutional cooperation it builds between the stakeholders involved in health care services. First, we briefly describe CCM and argue that the pathways through which it aims to improve patients’ health outcomes are not made explicit. Second, we argue that the potential of CCM to be more beneficent, compared with traditional health care systems, depends on its capacity to promote mutual trust between health care providers and patients. There is no evidence to date that the implementation of CCM enhances mutual trust between health care professionals and patients. Third, we argue that CCM seeks to enhance human agency, allowing increased expression of individual autonomy and increased respect for individuals thereby expanding human freedom and avoiding social discrimination. However, we review the communication patterns that characterize the model of doctor–patient relationship promoted by this model and argue that these communication patterns raise ethical concerns that may prevent the model from reaching its expected outcomes. PMID:19906213

Reducing Uncertainty in Chemistry Climate Model Predictions of Stratospheric Ozone

NASA Technical Reports Server (NTRS)

Douglass, A. R.; Strahan, S. E.; Oman, L. D.; Stolarski, R. S.

2014-01-01

Chemistry climate models (CCMs) are used to predict the future evolution of stratospheric ozone as ozone-depleting substances decrease and greenhouse gases increase, cooling the stratosphere. CCM predictions exhibit many common features, but also a broad range of values for quantities such as year of ozone-return-to-1980 and global ozone level at the end of the 21st century. Multiple linear regression is applied to each of 14 CCMs to separate ozone response to chlorine change from that due to climate change. We show that the sensitivity of lower atmosphere ozone to chlorine change deltaO3/deltaCly is a near linear function of partitioning of total inorganic chlorine (Cly) into its reservoirs; both Cly and its partitioning are controlled by lower atmospheric transport. CCMs with realistic transport agree with observations for chlorine reservoirs and produce similar ozone responses to chlorine change. After 2035 differences in response to chlorine contribute little to the spread in CCM results as the anthropogenic contribution to Cly becomes unimportant. Differences among upper stratospheric ozone increases due to temperature decreases are explained by differences in ozone sensitivity to temperature change deltaO3/deltaT due to different contributions from various ozone loss processes, each with their own temperature dependence. In the lower atmosphere, tropical ozone decreases caused by a predicted speed-up in the Brewer-Dobson circulation may or may not be balanced by middle and high latitude increases, contributing most to the spread in late 21st century predictions.

Skin cancer risks avoided by the Montreal Protocol--worldwide modeling integrating coupled climate-chemistry models with a risk model for UV.

PubMed

van Dijk, Arjan; Slaper, Harry; den Outer, Peter N; Morgenstern, Olaf; Braesicke, Peter; Pyle, John A; Garny, Hella; Stenke, Andrea; Dameris, Martin; Kazantzidis, Andreas; Tourpali, Kleareti; Bais, Alkiviadis F

2013-01-01

The assessment model for ultraviolet radiation and risk "AMOUR" is applied to output from two chemistry-climate models (CCMs). Results from the UK Chemistry and Aerosols CCM are used to quantify the worldwide skin cancer risk avoided by the Montreal Protocol and its amendments: by the year 2030, two million cases of skin cancer have been prevented yearly, which is 14% fewer skin cancer cases per year. In the "World Avoided," excess skin cancer incidence will continue to grow dramatically after 2030. Results from the CCM E39C-A are used to estimate skin cancer risk that had already been inevitably committed once ozone depletion was recognized: excess incidence will peak mid 21st century and then recover or even super-recover at the end of the century. When compared with a "No Depletion" scenario, with ozone undepleted and cloud characteristics as in the 1960s throughout, excess incidence (extra yearly cases skin cancer per million people) of the "Full Compliance with Montreal Protocol" scenario is in the ranges: New Zealand: 100-150, Congo: -10-0, Patagonia: 20-50, Western Europe: 30-40, China: 90-120, South-West USA: 80-110, Mediterranean: 90-100 and North-East Australia: 170-200. This is up to 4% of total local incidence in the Full Compliance scenario in the peak year. © 2012 Wiley Periodicals, Inc. Photochemistry and Photobiology © 2012 The American Society of Photobiology.

QBO Influence on Polar Stratospheric Variability in the GEOS Chemistry-Climate Model

NASA Technical Reports Server (NTRS)

Hurwitz, M. M.; Oman, L. D.; Li, F.; Slong, I.-S.; Newman, P. A.; Nielsen, J. E.

2010-01-01

The quasi-biennial oscillation modulates the strength of both the Arctic and Antarctic stratospheric vortices. Model and observational studies have found that the phase and characteristics of the quasi-biennial oscillation (QBO) contribute to the high degree of variability in the Arctic stratosphere in winter. While the Antarctic stratosphere is less variable, recent work has shown that Southern Hemisphere planetary wave driving increases in response to "warm pool" El Nino events that are coincident with the easterly phase of the QBO. These events hasten the breakup of the Antarctic polar vortex. The Goddard Earth Observing System (GEOS) chemistry-climate model (CCM) is now capable of generating a realistic QBO, due a new parameterization of gravity wave drag. In this presentation, we will use this new model capability to assess the influence of the QBO on polar stratospheric variability. Using simulations of the recent past, we will compare the modeled relationship between QBO phase and mid-winter vortex strength with the observed Holton-Tan relation, in both hemispheres. We will use simulations of the 21 St century to estimate future trends in the relationship between QBO phase and vortex strength. In addition, we will evaluate the combined influence of the QBO and El Nino/Southern Oscillation (ENSO) on the timing of the breakup of the polar stratospheric vortices in the GEOS CCM. We will compare the influence of these two natural phenomena with trends in the vortex breakup associated with ozone recovery and increasing greenhouse gas concentrations.

Evaluation of Convective Transport in the GEOS-5 Chemistry and Climate Model

NASA Technical Reports Server (NTRS)

Pickering, Kenneth E.; Ott, Lesley E.; Shi, Jainn J.; Tao. Wei-Kuo; Mari, Celine; Schlager, Hans

2011-01-01

The NASA Goddard Earth Observing System (GEOS-5) Chemistry and Climate Model (CCM) consists of a global atmospheric general circulation model and the combined stratospheric and tropospheric chemistry package from the NASA Global Modeling Initiative (GMI) chemical transport model. The subgrid process of convective tracer transport is represented through the Relaxed Arakawa-Schubert parameterization in the GEOS-5 CCM. However, substantial uncertainty for tracer transport is associated with this parameterization, as is the case with all global and regional models. We have designed a project to comprehensively evaluate this parameterization from the point of view of tracer transport, and determine the most appropriate improvements that can be made to the GEOS-5 convection algorithm, allowing improvement in our understanding of the role of convective processes in determining atmospheric composition. We first simulate tracer transport in individual observed convective events with a cloud-resolving model (WRF). Initial condition tracer profiles (CO, CO2, O3) are constructed from aircraft data collected in undisturbed air, and the simulations are evaluated using aircraft data taken in the convective anvils. A single-column (SCM) version of the GEOS-5 GCM with online tracers is then run for the same convective events. SCM output is evaluated based on averaged tracer fields from the cloud-resolving model. Sensitivity simulations with adjusted parameters will be run in the SCM to determine improvements in the representation of convective transport. The focus of the work to date is on tropical continental convective events from the African Monsoon Multidisciplinary Analyses (AMMA) field mission in August 2006 that were extensively sampled by multiple research aircraft.

Development of clinical contents model markup language for electronic health records.

PubMed

Yun, Ji-Hyun; Ahn, Sun-Ju; Kim, Yoon

2012-09-01

To develop dedicated markup language for clinical contents models (CCM) to facilitate the active use of CCM in electronic health record systems. Based on analysis of the structure and characteristics of CCM in the clinical domain, we designed extensible markup language (XML) based CCM markup language (CCML) schema manually. CCML faithfully reflects CCM in both the syntactic and semantic aspects. As this language is based on XML, it can be expressed and processed in computer systems and can be used in a technology-neutral way. CCML HAS THE FOLLOWING STRENGTHS: it is machine-readable and highly human-readable, it does not require a dedicated parser, and it can be applied for existing electronic health record systems.

Momentum and Energy Assessments with NASA and Other Model and Data Assimilation Systems

NASA Technical Reports Server (NTRS)

Salstein, David; Nelson, Peter; Hu, Wen-Jie

2001-01-01

Support from the NASA Global Modeling and Analysis Program has been used for the following research objectives: 1) the study of aspects of dynamics of torques and angular momentum based on the Goddard GEOS and other analyses; 2) the study of how models participating in the second Atmospheric Model Intercomparison Project (AMIP-2) have success in simulating certain large-scale quantities; 3) the study of the energetics and momentum cycle from certain runs from the Goddard Laboratory for Atmospheres and other models as well; 4) the assessment of changes in diabatic heating and related energetics in the community climate model (CCM3); 5) the analysis of modes of climate of the atmosphere, especially the Arctic and North Atlantic Oscillations. Further information on these endeavors will be provided in published works and the Final Report of the project.

Curcumin-loaded chitosan-cholesterol micelles: evaluation in monolayers and 3D cancer spheroid model.

PubMed

Muddineti, Omkara Swami; Kumari, Preeti; Ray, Eupa; Ghosh, Balaram; Biswas, Swati

2017-06-02

To improve the bioavailability and anticancer potential of curcumin by using a cholesterol-conjugated chitosan micelle. Methods & methods: Cholesterol was conjugated to chitosan (15 kDa) to form self-assembled micelles, which loaded curcumin. Physicochemical characterization and formulation optimization of the drug-loaded micelles (curcumin-loaded chitosan-cholesterol micelles [C-CCM]) were performed. In vitro cellular uptake and viability of C-CCM were investigated in melanoma and breast cancer cell lines. The antitumor efficacy was evaluated in 3D lung cancer spheroid model. The optimized C-CCM had size of approximately 162 nm with loading efficiency of approximately 36%. C-CCM was taken up efficiently by the cells, and it reduced cancer cell viability significantly compared with free curcumin. C-CCM enhanced the antitumor efficacy in spheroids, suggesting that C-CCM could be used as an effective chemotherapy in cancer.

21st Century Trends in the Potential for Ozone Depletion

NASA Astrophysics Data System (ADS)

Hurwitz, M. M.; Newman, P. A.

2009-05-01

We find robust trends in the area where Antarctic stratospheric temperatures are below the threshold for polar stratospheric cloud (PSC) formation in Goddard Earth Observing System (GEOS) chemistry-climate model (CCM) simulations of the 21st century. In late winter (September-October-November), cold area trends are consistent with the respective trends in equivalent effective stratospheric chlorine (EESC), i.e. negative cold area trends in 'realistic future' simulations where EESC decreases and the ozone layer recovers. In the early winter (April through June), regardless of EESC scenario, we find an increasing cold area trend in all simulations; multiple linear regression analysis shows that this early winter cooling trend is associated with the predicted increase in greenhouse gas concentrations in the future. We compare the seasonality of the potential for Antarctic ozone depletion in two versions of the GEOS CCM and assess the impact of the above-mentioned cold area trends on polar stratospheric chemistry.

Development of Clinical Contents Model Markup Language for Electronic Health Records

PubMed Central

Yun, Ji-Hyun; Kim, Yoon

2012-01-01

Objectives To develop dedicated markup language for clinical contents models (CCM) to facilitate the active use of CCM in electronic health record systems. Methods Based on analysis of the structure and characteristics of CCM in the clinical domain, we designed extensible markup language (XML) based CCM markup language (CCML) schema manually. Results CCML faithfully reflects CCM in both the syntactic and semantic aspects. As this language is based on XML, it can be expressed and processed in computer systems and can be used in a technology-neutral way. Conclusions CCML has the following strengths: it is machine-readable and highly human-readable, it does not require a dedicated parser, and it can be applied for existing electronic health record systems. PMID:23115739

Overcoming roadblocks: current and emerging reimbursement strategies for integrated mental health services in primary care.

PubMed

O'Donnell, Allison N; Williams, Mark; Kilbourne, Amy M

2013-12-01

The Chronic Care Model (CCM) has been shown to improve medical and psychiatric outcomes for persons with mental disorders in primary care settings, and has been proposed as a model to integrate mental health care in the patient-centered medical home under healthcare reform. However, the CCM has not been widely implemented in primary care settings, primarily because of a lack of a comprehensive reimbursement strategy to compensate providers for day-to-day provision of its core components, including care management and provider decision support. Drawing upon the existing literature and regulatory guidelines, we provide a critical analysis of challenges and opportunities in reimbursing CCM components under the current fee-for-service system, and describe an emerging financial model involving bundled payments to support core CCM components to integrate mental health treatment into primary care settings. Ultimately, for the CCM to be used and sustained over time to integrate physical and mental health care, effective reimbursement models will need to be negotiated across payers and providers. Such payments should provide sufficient support for primary care providers to implement practice redesigns around core CCM components, including care management, measurement-based care, and mental health specialist consultation.

Strategy for Identifying Repurposed Drugs for the Treatment of Cerebral Cavernous Malformation

PubMed Central

Gibson, Christopher C.; Zhu, Weiquan; Davis, Chadwick T.; Bowman-Kirigin, Jay A.; Chan, Aubrey C.; Ling, Jing; Walker, Ashley E.; Goitre, Luca; Monache, Simona Delle; Retta, Saverio Francesco; Shiu, Yan-Ting E.; Grossmann, Allie H.; Thomas, Kirk R.; Donato, Anthony J.; Lesniewski, Lisa A.; Whitehead, Kevin J.; Li, Dean Y.

2014-01-01

Background Cerebral cavernous malformation (CCM) is a hemorrhagic stroke disease affecting up to 0.5% of North Americans with no approved non-surgical treatment. A subset of patients have a hereditary form of the disease due primarily to loss-of-function mutations in KRIT1, CCM2, or PDCD10. We sought to identify known drugs that could be repurposed to treat CCM. Methods and Results We developed an unbiased screening platform based on both cellular and animal models of loss-of-function of CCM2. Our discovery strategy consisted of four steps: an automated immunofluorescence and machine-learning-based primary screen of structural phenotypes in human endothelial cells deficient in CCM2; a secondary screen of functional changes in endothelial stability in these same cells; a rapid in vivo tertiary screen of dermal microvascular leak in mice lacking endothelial Ccm2; and finally a quaternary screen of CCM lesion burden in these same mice. We screened 2,100 known drugs and bioactive compounds, and identified two candidates for further study, cholecalciferol (Vitamin D3) and tempol (a scavenger of superoxide). Each drug decreased lesion burden in a mouse model of CCM vascular disease by approximately 50%. Conclusions By identifying known drugs as potential therapeutics for CCM, we have decreased the time, cost, and risk of bringing treatments to patients. Each drug also prompts additional exploration of biomarkers of CCM disease. We further suggest that the structure-function screening platform presented here may be adapted and scaled to facilitate drug discovery for diverse loss-of-function genetic vascular disease. PMID:25486933

Middle Atmosphere Response to Different Descriptions of the 11-Year Solar Cycle in Spectral Irradiance in a Chemistry-Climate Model

NASA Technical Reports Server (NTRS)

Swartz, W. H.; Stolarski, R. S.; Oman, L. D.; Fleming, E. L.; Jackman, C. H.

2012-01-01

The 11-year solar cycle in solar spectral irradiance (SSI) inferred from measurements by the SOlar Radiation & Climate Experiment (SORCE) suggests a much larger variation in the ultraviolet than previously accepted. We present middle atmosphere ozone and temperature responses to the solar cycles in SORCE SSI and the ubiquitous Naval Research Laboratory (NRL) SSI reconstruction using the Goddard Earth Observing System chemistry-climate model (GEOS CCM). The results are largely consistent with other recent modeling studies. The modeled ozone response is positive throughout the stratosphere and lower mesosphere using the NRL SSI, while the SORCE SSI produces a response that is larger in the lower stratosphere but out of phase with respect to total solar irradiance above 45 km. The modeled responses in total ozone are similar to those derived from satellite and ground-based measurements, 3-6 Dobson Units per 100 units of 10.7-cm radio flux (F10.7) in the tropics. The peak zonal mean tropical temperature response 50 using the SORCE SSI is nearly 2 K per 100 units 3 times larger than the simulation using the NRL SSI. The GEOS CCM and the Goddard Space Flight Center (GSFC) 2-D coupled model are used to examine how the SSI solar cycle affects the atmosphere through direct solar heating and photolysis processes individually. Middle atmosphere ozone is affected almost entirely through photolysis, whereas the solar cycle in temperature is caused both through direct heating and photolysis feedbacks, processes that are mostly linearly separable. Further, the net ozone response results from the balance of ozone production at wavelengths less than 242 nm and destruction at longer wavelengths, coincidentally corresponding to the wavelength regimes of the SOLar STellar Irradiance Comparison Experiment (SOLSTICE) and Spectral Irradiance Monitor (SIM) on SORCE, respectively. A higher wavelength-resolution analysis of the spectral response could allow for a better prediction of the atmospheric response to arbitrary SSI variations.

Interannual Variability of the Tropical Energy Balance: Reconciling Observations and Models

NASA Technical Reports Server (NTRS)

Robertson, Franklin R.; Fitzjarrald, D. E.; Goodman, H. Michael (Technical Monitor)

2000-01-01

Since the beginning of the World Climate Research Program's Global Precipitation Climatology Project (GPCP) satellite remote sensing of precipitation has made dramatic improvements, particularly for tropical regions. Data from microwave and infrared sensors now form the most critical input to precipitation data sets and can be calibrated with surface gauges to so that the strengths of each data source can be maximized in some statistically optimal sense. Recent availability of the TRMM (Tropical Rainfall Measuring Mission) has further aided in narrowing uncertainties in rainfall over the tropics and subtropics. Although climate modeling efforts have long relied on space-based precipitation estimates for validation, we now are in a position to make more quantitative assessments of model performance, particularly in tropical regions. An integration of the CCM3 using observed SSTs as a lower boundary condition is used to examine how well this model responds to ENSO forcing in terms of anomalous precipitation. An integration of the NCEP spectral model used for the Reanalysis-11 effort is also examined. This integration is run with specified SSTs, but no data assimilation. Our analysis focuses on two aspects. First are the spatial anomalies that are indicative of dislocations in Hadley and Walker circulations. Second, we consider the ability of models to replicate observed increases in oceanic precipitation that are noted in satellite observations for large ENSO events. Finally, we consider a slab ocean version of the CCM3 model with prescribed ocean heat transports that mimic upwelling anomalies, but which still allows the surface energy balance to be predicted. This less restrictive experiment is used to understand why model experiments with specified SSTs seem to have noticeably less interannual variability than do the satellite precipitation observations.

The GEOS Chemistry Climate Model: Comparisons to Satellite Data

NASA Technical Reports Server (NTRS)

Stolarski, Richard S.; Douglass, Anne R.

2008-01-01

The Goddard Earth Observing System Chemistry Climate Model (GEOS CCM) has been developed by combining the atmospheric chemistry and transport modules developed over the years at Goddard and the GEOS general circulation model, also developed at Goddard. We will compare model simulations of ozone, and the minor constituents that affect ozone, for the period around 1980 with newly released revised data from the Limb Infrared Monitor of the Stratosphere (LIMS) instrument on Nimbus 4. We will also compare model simulations for the period of the early 2000s with the data from the Microwave Limb Sounder (MLS) and the High Resolution Dynamic Limb Sounder (HRDLS) on the Aura satellite. We will use these comparisons to examine the performance of the model for the present atmosphere and for the change that has occurred during the last 2 decades of ozone loss due to chlorine and bromine compounds released from chlorofluorocarbons and halons.

Numerical Uncertainties in the Simulation of Reversible Isentropic Processes and Entropy Conservation.

NASA Astrophysics Data System (ADS)

Johnson, Donald R.; Lenzen, Allen J.; Zapotocny, Tom H.; Schaack, Todd K.

2000-11-01

A challenge common to weather, climate, and seasonal numerical prediction is the need to simulate accurately reversible isentropic processes in combination with appropriate determination of sources/sinks of energy and entropy. Ultimately, this task includes the distribution and transport of internal, gravitational, and kinetic energies, the energies of water substances in all forms, and the related thermodynamic processes of phase changes involved with clouds, including condensation, evaporation, and precipitation processes.All of the processes noted above involve the entropies of matter, radiation, and chemical substances, conservation during transport, and/or changes in entropies by physical processes internal to the atmosphere. With respect to the entropy of matter, a means to study a model's accuracy in simulating internal hydrologic processes is to determine its capability to simulate the appropriate conservation of potential and equivalent potential temperature as surrogates of dry and moist entropy under reversible adiabatic processes in which clouds form, evaporate, and precipitate. In this study, a statistical strategy utilizing the concept of `pure error' is set forth to assess the numerical accuracies of models to simulate reversible processes during 10-day integrations of the global circulation corresponding to the global residence time of water vapor. During the integrations, the sums of squared differences between equivalent potential temperature e numerically simulated by the governing equations of mass, energy, water vapor, and cloud water and a proxy equivalent potential temperature te numerically simulated as a conservative property are monitored. Inspection of the differences of e and te in time and space and the relative frequency distribution of the differences details bias and random errors that develop from nonlinear numerical inaccuracies in the advection and transport of potential temperature and water substances within the global atmosphere.A series of nine global simulations employing various versions of Community Climate Models CCM2 and CCM3-all Eulerian spectral numerics, all semi-Lagrangian numerics, mixed Eulerian spectral, and semi-Lagrangian numerics-and the University of Wisconsin-Madison (UW) isentropic-sigma gridpoint model provides an interesting comparison of numerical accuracies in the simulation of reversibility. By day 10, large bias and random differences were identified in the simulation of reversible processes in all of the models except for the UW isentropic-sigma model. The CCM2 and CCM3 simulations yielded systematic differences that varied zonally, vertically, and temporally. Within the comparison, the UW isentropic-sigma model was superior in transporting water vapor and cloud water/ice and in simulating reversibility involving the conservation of dry and moist entropy. The only relative frequency distribution of differences that appeared optimal, in that the distribution remained unbiased and equilibrated with minimal variance as it remained statistically stationary, was the distribution from the UW isentropic-sigma model. All other distributions revealed nonstationary characteristics with spreading and/or shifting of the maxima as the biases and variances of the numerical differences of e and te amplified.

Time to Remission for Depression with Collaborative Care Management (CCM) in Primary Care.

PubMed

Garrison, Gregory M; Angstman, Kurt B; O'Connor, Stephen S; Williams, Mark D; Lineberry, Timothy W

2016-01-01

Collaborative care management (CCM) has been shown to have superior outcomes to usual care (UC) for depressed patients with a fixed end point. This study was a survival analysis over time comparing CCM with UC using remission (9-item Patient Health Questionnaire [PHQ-9] score <5) and persistent depressive symptoms (PDSs; PHQ-9 score ≥10) as end points. A retrospective cohort study of 7340 patients with depression cared for at 4 outpatient primary care clinics was conducted from March 2008 through June 2013. All adult patients diagnosed with depression (International Classification of Diseases, 9th Revision [ICD-9], codes 296.2-3) or dysthymia (ICD-9 code 300.4) with an initial PHQ-9 score ≥10 were included. CCM was implemented at all clinics between 2008 and 2010. Kaplan-Meyer survival curves for time to remission and PDSs were plotted. A Cox proportional hazards model was used to adjust for expected differences between patients choosing CCM versus UC. Median time to remission was 86 days (95% confidence interval [CI], 81-91 days) for the CCM group versus 614 days (95% CI, 565-692 days) for the UC group. Likewise, median duration of PDSs was 31 days (95% CI, 30-33 days) for the CCM group versus 154 days (95% CI, 138-182 days) for the UC group. In the Cox proportional hazards model, which controlled for covariates such as age, sex, race, diagnosis, and initial PHQ-9 score, CCM was associated with faster remission (hazard ratio of the CCM group [HRCCM], 2.48; 95% CI, 2.31-2.65). This study demonstrated that patients enrolled in CCM have a faster rate of remission and a shorter duration of PDSs than patients choosing UC. © Copyright 2016 by the American Board of Family Medicine.

Long-term variability of UV irradiance over Northern Eurasia according to satellite measurements, ERA-INTERIM dataset and INM-RSHU chemical climate model

NASA Astrophysics Data System (ADS)

Chubarova, Nataly; Pastukhova, Anna; Zhdanova, Ekaterina; Khlestova, Julia; Poliukhov, Alexei; Smyshlyaev, Sergei; Galin, Vener

2017-04-01

We present the results of long-term erythemal UV irradiance (ERY) changes over the territory of Northern Eurasia according to the ERA-INTERIM reanalysis dataset, INM-RSHU chemical climate model (CCM), and TOMS and OMI satellite data with the correction on absorbing aerosol based on the new Macv2 climatology updated from Kinne et al. (2013) over the 1979-2015 period. We show the existence of the pronounced positive ERY trend due to ozone in spring and summer over Europe and over the central areas of Siberia (up 3% over the decade). The changes in cloud cover provide even more significant ERY increase (up to 6-8% per decade). However, over Arctic region there is a pronounced negative ERY trend probably due to the effects of melting ice on global circulation processes. The combination of ozone and cloud effects provides the enhanced increase of the overall ERY trend: up to 6-9% in spring and summer over Eastern Europe, some regions of Siberia and the Far East. In addition, based on the method described in (Chubarova, Zhdanova, 2013) we estimated changes in UV resources over Northern Eurasia since 1979. We show that for the first skin type there is a significant geographical shift of UV categories: the increase in the UV optimum area in winter, where the vitamin D generation is possible without risk of getting sunburn, and its reducing in other months due to decrease in ozone and clouds. We also analyze the long-term UV changes simulated according to different scenarios using the INM-RSHU CCM. There is a general agreement between CCM and observational datasets, however, ERY trends due to cloudiness do not correspond sometimes in space and are smaller. We show that the positive ERY trend due to ozone is determined by the anthropogenic emissions of halogens. The variations in natural factors (solar activity and ocean surface temperature, stratospheric aerosol) only provide the increase in ERY dispersion. References: Kinne, S., O'Donnel D., Stier P., et al., J. Adv. Model. Earth Syst., 5, 704-740, 2013. Chubarova N., Zhdanova Ye. Photochemistry and Photobiology. - 2013. - Vol. 127. - P. 38-51.

Absorption mechanism of whey-protein-delivered curcumin using Caco-2 cell monolayers.

PubMed

Li, Ming; Cui, Jie; Ngadi, Michael O; Ma, Ying

2015-08-01

Curcumin (CCM) is a bioactive polyphenolic compound that suffers a low bioavailability because of its low water solubility. In this work β-lactoglobulin (β-Lg) and nanoemulsion were used as carriers to deliver curcumin. The pH stability of β-Lg-CCM was investigated. The digestion of β-Lg-CCM and the nanoemulsion was studied using an in vitro gastrointestinal model. The effect of different carriers on the permeability of curcumin was assessed using the Caco-2 cell monolayer model. The results revealed that the water solubility and the pH stability of curcumin significantly increased by binding with β-Lg. In SDS-PAGE experiments the β-Lg-CCM complex and nanoemulsion were found to be resistant to pepsin digestion but sensitive to trypsin. In the permeability experiment it was shown that the digested nanoemulsion and β-Lg-CCM improved significantly the permeation rate of curcumin. Copyright © 2015 Elsevier Ltd. All rights reserved.

Impacts of the Convective Transport Algorithm on Atmospheric Composition and Ozone-Climate Feedbacks in GEOS-CCM

NASA Technical Reports Server (NTRS)

Pawson, S.; Nielsen, Jon E.; Oman, L.; Douglass, A. R.; Duncan, B. N.; Zhu, Z.

2012-01-01

Convective transport is one of the dominant factors in determining the composition of the troposphere. It is the main mechanism for lofting constituents from near-surface source regions to the middle and upper troposphere, where they can subsequently be advected over large distances. Gases reaching the upper troposphere can also be injected through the tropopause and play a subsequent role in the lower stratospheric ozone balance. Convection codes in climate models remain a great source of uncertainty for both the energy balance of the general circulation and the transport of constituents. This study uses the Goddard Earth Observing System Chemistry-Climate Model (GEOS CCM) to perform a controlled experiment that isolates the impact of convective transport of constituents from the direct changes on the atmospheric energy balance. Two multi-year simulations are conducted. In the first, the thermodynamic variable, moisture, and all trace gases are transported using the multi-plume Relaxed-Arakawa-Schubert (RAS) convective parameterization. In the second simulation, RAS impacts the thermodynamic energy and moisture in this standard manner, but all other constituents are transported differently. The accumulated convective mass fluxes (including entrainment and detrainment) computed at each time step of the GCM are used with a diffusive (bulk) algorithm for the vertical transport, which above all is less efficient at transporting constituents from the lower to the upper troposphere. Initial results show the expected differences in vertical structure of trace gases such as carbon monoxide, but also show differences in lower stratospheric ozone, in a region where it can potentially impact the climate state of the model. This work will investigate in more detail the impact of convective transport changes by comparing the two simulations over many years (1996-2010), focusing on comparisons with observed constituent distributions and similarities and differences of patterns of inter-annual variability caused by the convective transport algorithm. In particular, the impact on lower stratospheric composition will be isolated and the subsequent feedbacks of ozone on the climate forcing and tropopause structure will be assessed.

On the role of the Antarctic continent in forcing large-scale circulations in the high southern latitudes

NASA Technical Reports Server (NTRS)

Parish, Thomas R.; Bromwich, David H.; Tzeng, Ren-Yow

1994-01-01

The Antarctic topography and attendant katabatic wind regime appear to play a key role in the climate of the high southern latitudes. During the nonsummer months, persistent and often times intense katabatic winds occur in the lowest few hundred meters of the Antarctic atmosphere. These slope flows transport significant amounts of cold air northward and thereby modify the horizontal pressure field over the high southern latitudes. Three-year seasonal cycle numerical simulations using the NCAR Community Climate Model Version 1 (CCM1) with and without representation of the Antarctic orography were performed to explore the role of the elevated terrain and drainage flows on the distribution and evolution of the horizontal pressure field. The katabatic wind regime is an important part of a clearly defined mean meridional circulation in the high southern latitudes. The position and intensity of the attendant sea level low pressure belt appears to be tied to the Antarctic orography. The seasonal movement of mass in the high southern latitudes is therefore constrained by the presence of the Antarctic ice sheet. The semiannual oscillation of pressure over Antarctica and the high southern latitutdes is well depicted in the CCM1 only when the Antarctic orography is included.

Validation of Slosh Modeling Approach Using STAR-CCM+

NASA Technical Reports Server (NTRS)

Benson, David J.; Ng, Wanyi

2018-01-01

Without an adequate understanding of propellant slosh, the spacecraft attitude control system may be inadequate to control the spacecraft or there may be an unexpected loss of science observation time due to higher slosh settling times. Computational fluid dynamics (CFD) is used to model propellant slosh. STAR-CCM+ is a commercially available CFD code. This paper seeks to validate the CFD modeling approach via a comparison between STAR-CCM+ liquid slosh modeling results and experimental, empirically, and analytically derived results. The geometries examined are a bare right cylinder tank and a right cylinder with a single ring baffle.

Understanding Differences in Chemistry Climate Model Projections of Stratospheric Ozone

NASA Technical Reports Server (NTRS)

Douglass, A. R.; Strahan, S. E.; Oman, L. D.; Stolarski, R. S.

2014-01-01

Chemistry climate models (CCMs) are used to project future evolution of stratospheric ozone as concentrations of ozone-depleting substances (ODSs) decrease and greenhouse gases increase, cooling the stratosphere. CCM projections exhibit not only many common features but also a broad range of values for quantities such as year of ozone return to 1980 and global ozone level at the end of the 21st century. Multiple linear regression is applied to each of 14 CCMs to separate ozone response to ODS concentration change from that due to climate change. We show that the sensitivity of lower stratospheric ozone to chlorine change Delta Ozone/Delta inorganic chlorine is a near-linear function of partitioning of total inorganic chlorine into its reservoirs; both inorganic chlorine and its partitioning are largely controlled by lower stratospheric transport. CCMs with best performance on transport diagnostics agree with observations for chlorine reservoirs and produce similar ozone responses to chlorine change. After 2035, differences in Delta Ozone/Delta inorganic chlorine contribute little to the spread in CCM projections as the anthropogenic contribution to inorganic chlorine becomes unimportant. Differences among upper stratospheric ozone increases due to temperature decreases are explained by differences in ozone sensitivity to temperature change Delta Ozone/Delta T due to different contributions from various ozone loss processes, each with its own temperature dependence. Ozone decrease in the tropical lower stratosphere caused by a projected speedup in the Brewer-Dobson circulation may or may not be balanced by ozone increases in the middle- and high-latitude lower stratosphere and upper troposphere. This balance, or lack thereof, contributes most to the spread in late 21st century projections.

Cloud Radiation Forcings and Feedbacks: General Circulation Model Tests and Observational Validation

NASA Technical Reports Server (NTRS)

Lee,Wan-Ho; Iacobellis, Sam F.; Somerville, Richard C. J.

1997-01-01

Using an atmospheric general circulation model (the National Center for Atmospheric Research Community Climate Model: CCM2), the effects on climate sensitivity of several different cloud radiation parameterizations have been investigated. In addition to the original cloud radiation scheme of CCM2, four parameterizations incorporating prognostic cloud water were tested: one version with prescribed cloud radiative properties and three other versions with interactive cloud radiative properties. The authors' numerical experiments employ perpetual July integrations driven by globally constant sea surface temperature forcings of two degrees, both positive and negative. A diagnostic radiation calculation has been applied to investigate the partial contributions of high, middle, and low cloud to the total cloud radiative forcing, as well as the contributions of water vapor, temperature, and cloud to the net climate feedback. The high cloud net radiative forcing is positive, and the middle and low cloud net radiative forcings are negative. The total net cloud forcing is negative in all of the model versions. The effect of interactive cloud radiative properties on global climate sensitivity is significant. The net cloud radiative feedbacks consist of quite different shortwave and longwave components between the schemes with interactive cloud radiative properties and the schemes with specified properties. The increase in cloud water content in the warmer climate leads to optically thicker middle- and low-level clouds and in turn to negative shortwave feedbacks for the interactive radiative schemes, while the decrease in cloud amount simply produces a positive shortwave feedback for the schemes with a specified cloud water path. For the longwave feedbacks, the decrease in high effective cloudiness for the schemes without interactive radiative properties leads to a negative feedback, while for the other cases, the longwave feedback is positive. These cloud radiation parameterizations are empirically validated by using a single-column diagnostic model. together with measurements from the Atmospheric Radiation Measurement program and from the Tropical Ocean Global Atmosphere Combined Ocean-Atmosphere Response Experiment. The inclusion of prognostic cloud water produces a notable improvement in the realism of the parameterizations, as judged by these observations. Furthermore, the observational evidence suggests that deriving cloud radiative properties from cloud water content and microphysical characteristics is a promising route to further improvement.

Causative impact of air pollution on evapotranspiration in the North China Plain.

PubMed

Yao, Ling

2017-10-01

Atmospheric dispersion conditions strongly impact air pollution under identical surface emissions. The degree of air pollution in the Jing-Jin-Ji region is so severe that it may impose feedback on local climate. Reference evapotranspiration (ET 0 ) plays a significant role in the estimation of crop water requirements, as well as in studies on climate variation and change. Since the traditional correlation analysis cannot capture the causality, we apply the convergent cross mapping method (CCM) in this study to observationally investigate whether the air pollution impacts ET 0 . The results indicate that southwest regions of Jing-Jin-Ji always suffer higher PM 2.5 concentration than north regions through the whole year, and correlation analysis suggests that PM 2.5 concentration has a significant negative effect on ET 0 in most cities. The causality detection with CCM quantitatively demonstrates the significantly causative influence of PM 2.5 concentration on ET 0 , higher PM 2.5 concentration decreasing ET 0 . However, CCM analysis suggests that PM 2.5 concentration has a relatively weak causal influence on ET 0 while the correlation analysis gives the near zero correlation coefficient in Zhangjiakou city, indicating that the causative influence of PM 2.5 concentration on ET 0 is better revealed with CCM method than the correlation analysis. Considering that ET 0 is strongly associated with crop water requirement, the amount of water for agricultural irrigation could be reduced at high PM 2.5 concentrations. These findings can be utilized to improve the efficiency of water resources utilization, and reduce the exploiting amount of groundwater in the Jing-Jin-Ji region, although PM 2.5 is detrimental to human health. Copyright © 2017 Elsevier Inc. All rights reserved.

High-Order Coupled Cluster Method (CCM) Calculations for Quantum Magnets with Valence-Bond Ground States

NASA Astrophysics Data System (ADS)

Farnell, D. J. J.; Richter, J.; Zinke, R.; Bishop, R. F.

2009-04-01

In this article, we prove that exact representations of dimer and plaquette valence-bond ket ground states for quantum Heisenberg antiferromagnets may be formed via the usual coupled cluster method (CCM) from independent-spin product (e.g. Néel) model states. We show that we are able to provide good results for both the ground-state energy and the sublattice magnetization for dimer and plaquette valence-bond phases within the CCM. As a first example, we investigate the spin-half J 1- J 2 model for the linear chain, and we show that we are able to reproduce exactly the dimerized ground (ket) state at J 2/ J 1=0.5. The dimerized phase is stable over a range of values for J 2/ J 1 around 0.5, and results for the ground-state energies are in good agreement with the results of exact diagonalizations of finite-length chains in this regime. We present evidence of symmetry breaking by considering the ket- and bra-state correlation coefficients as a function of J 2/ J 1. A radical change is also observed in the behavior of the CCM sublattice magnetization as we enter the dimerized phase. We then consider the Shastry-Sutherland model and demonstrate that the CCM can span the correct ground states in both the Néel and the dimerized phases. Once again, very good results for the ground-state energies are obtained. We find CCM critical points of the bra-state equations that are in agreement with the known phase transition point for this model. The results for the sublattice magnetization remain near to the "true" value of zero over much of the dimerized regime, although they diverge exactly at the critical point. Finally, we consider a spin-half system with nearest-neighbor bonds for an underlying lattice corresponding to the magnetic material CaV4O9 (CAVO). We show that we are able to provide excellent results for the ground-state energy in each of the plaquette-ordered, Néel-ordered, and dimerized regimes of this model. The exact plaquette and dimer ground states are reproduced by the CCM ket state in their relevant limits. Furthermore, we estimate the range over which the Néel order is stable, and we find the CCM result is in reasonable agreement with the results obtained by other methods. Our new approach has the dual advantages that it is simple to implement and that existing CCM codes for independent-spin product model states may be used from the outset. Furthermore, it also greatly extends the range of applicability to which the CCM may be applied. We believe that the CCM now provides an excellent choice of method for the study of systems with valence-bond quantum ground states.

Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices: A Modeling Study.

PubMed

Basu, Sanjay; Phillips, Russell S; Bitton, Asaf; Song, Zirui; Landon, Bruce E

2015-10-20

Physicians have traditionally been reimbursed for face-to-face visits. A new non-visit-based payment for chronic care management (CCM) of Medicare patients took effect in January 2015. To estimate financial implications of CCM payment for primary care practices. Microsimulation model incorporating national data on primary care use, staffing, expenditures, and reimbursements. National Ambulatory Medical Care Survey and other published sources. Medicare patients. 10 years. Practice-level. Comparison of CCM delivery approaches by staff and physicians. Net revenue per full-time equivalent (FTE) physician; time spent delivering CCM services. If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. Practices could expect approximately $332 per enrolled patient per year (95% CI, $234 to $429) if CCM services were delivered by registered nurses (RNs), approximately $372 (CI, $276 to $468) if services were delivered by licensed practical nurses, and approximately $385 (CI, $286 to $485) if services were delivered by medical assistants. For a typical practice, this equates to more than $75 ,00 of net annual revenue per FTE physician and 12 hours of nursing service time per week if 50% of eligible patients enroll. At a minimum, 131 Medicare patients (CI, 115 to 140 patients) must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services. If physicians were to deliver all CCM services, approximately 25% of practices nationwide could expect net revenue losses due to opportunity costs of face-to-face visit time. The CCM program may alter long-term primary care use, which is difficult to predict. Practices that rely on nonphysician team members to deliver CCM services will probably experience substantial net revenue gains but must enroll a sufficient number of eligible patients to recoup costs. None.

Attribution of recent ozone changes in the Southern Hemisphere mid-latitudes using statistical analysis and chemistry-climate model simulations

NASA Astrophysics Data System (ADS)

Zeng, Guang; Morgenstern, Olaf; Shiona, Hisako; Thomas, Alan J.; Querel, Richard R.; Nichol, Sylvia E.

2017-09-01

Ozone (O3) trends and variability from a 28-year (1987-2014) ozonesonde record at Lauder, New Zealand, have been analysed and interpreted using a statistical model and a global chemistry-climate model (CCM). Lauder is a clean rural measurement site often representative of the Southern Hemisphere (SH) mid-latitude background atmosphere. O3 trends over this period at this location are characterised by a significant positive trend below 6 km, a significant negative trend in the tropopause region and the lower stratosphere between 9 and 15 km, and no significant trend in the free troposphere (6-9 km) and the stratosphere above 15 km. We find that significant positive trends in lower tropospheric ozone are correlated with increasing temperature and decreasing relative humidity at the surface over this period, whereas significant negative trends in the upper troposphere and the lower stratosphere appear to be strongly linked to an upward trend of the tropopause height. Relative humidity and the tropopause height also dominate O3 variability at Lauder in the lower troposphere and the tropopause region, respectively. We perform an attribution of these trends to anthropogenic forcings including O3 precursors, greenhouse gases (GHGs), and O3-depleting substances (ODSs), using CCM simulations. Results indicate that changes in anthropogenic O3 precursors contribute significantly to stratospheric O3 reduction, changes in ODSs contribute significantly to tropospheric O3 reduction, and increased GHGs contribute significantly to stratospheric O3 increases at Lauder. Methane (CH4) likely contributes positively to O3 trends in both the troposphere and the stratosphere, but the contribution is not significant at the 95 % confidence level over this period. An extended analysis of CCM results covering 1960-2010 (i.e. starting well before the observations) reveals significant contributions from all forcings to O3 trends at Lauder - i.e. increases in GHGs and the increase in CH4 alone all contribute significantly to O3 increases, net increases in ODSs lead to O3 reduction, and increases in non-methane O3 precursors cause O3 increases in the troposphere and reductions in the stratosphere. This study suggests that a long-term ozonesonde record obtained at a SH mid-latitude background site (corroborated by a surface O3 record at a nearby SH mid-latitude site, Baring Head, which also shows a significant positive trend) is a useful indicator for detecting atmospheric composition and climate change associated with human activities.

Influence of an Internally-Generated QBO on Modeled Stratospheric Dynamics and Ozone

NASA Technical Reports Server (NTRS)

Hurwitz, M. M.; Newman, P. A.; Song, I. S.

2011-01-01

A GEOS V2 CCM simulation with an internally generated quasi-biennial oscillation (QBO) signal is compared to an otherwise identical simulation without a QBO. In a present-day climate, inclusion of the modeled QBO makes a significant difference to stratospheric dynamics and ozone throughout the year. The QBO enhances variability in the tropics, as expected, but also in the polar stratosphere in some seasons. The modeled QBO also affects the mean stratospheric climate. Because tropical zonal winds in the baseline simulation are generally easterly, there is a relative increase in zonal wind magnitudes in tropical lower and middle stratosphere in the QBO simulation. Extra-tropical differences between the QBO and 'no QBO' simulations thus reflect a bias toward the westerly phase of the QBO: a relative strengthening and poleward shifting the polar stratospheric jets, and a reduction in Arctic lower stratospheric ozone.

Micro-computed tomography in murine models of cerebral cavernous malformations as a paradigm for brain disease.

PubMed

Girard, Romuald; Zeineddine, Hussein A; Orsbon, Courtney; Tan, Huan; Moore, Thomas; Hobson, Nick; Shenkar, Robert; Lightle, Rhonda; Shi, Changbin; Fam, Maged D; Cao, Ying; Shen, Le; Neander, April I; Rorrer, Autumn; Gallione, Carol; Tang, Alan T; Kahn, Mark L; Marchuk, Douglas A; Luo, Zhe-Xi; Awad, Issam A

2016-09-15

Cerebral cavernous malformations (CCMs) are hemorrhagic brain lesions, where murine models allow major mechanistic discoveries, ushering genetic manipulations and preclinical assessment of therapies. Histology for lesion counting and morphometry is essential yet tedious and time consuming. We herein describe the application and validations of X-ray micro-computed tomography (micro-CT), a non-destructive technique allowing three-dimensional CCM lesion count and volumetric measurements, in transgenic murine brains. We hereby describe a new contrast soaking technique not previously applied to murine models of CCM disease. Volumetric segmentation and image processing paradigm allowed for histologic correlations and quantitative validations not previously reported with the micro-CT technique in brain vascular disease. Twenty-two hyper-dense areas on micro-CT images, identified as CCM lesions, were matched by histology. The inter-rater reliability analysis showed strong consistency in the CCM lesion identification and staging (K=0.89, p<0.0001) between the two techniques. Micro-CT revealed a 29% greater CCM lesion detection efficiency, and 80% improved time efficiency. Serial integrated lesional area by histology showed a strong positive correlation with micro-CT estimated volume (r(2)=0.84, p<0.0001). Micro-CT allows high throughput assessment of lesion count and volume in pre-clinical murine models of CCM. This approach complements histology with improved accuracy and efficiency, and can be applied for lesion burden assessment in other brain diseases. Copyright © 2016 Elsevier B.V. All rights reserved.

The influence of oceanic basins on drought and ecosystem dynamics in Northeast Brazil

NASA Astrophysics Data System (ADS)

Santos Pereira, Marcos Paulo; Justino, Flavio; Mendes Malhado, Ana Claudia; Barbosa, Humberto; Marengo, José

2014-12-01

The 2012 drought in Northeast Brazil was the harshest in decades, with potentially significant impacts on the vegetation of the unique semi-arid caatinga biome and on local livelihoods. Here, we use a coupled climate-vegetation model (CCM3-IBIS) to: (1) investigate the role of the Pacific and Atlantic oceans in the 2012 drought, and; (2) evaluate the response of the caatinga vegetation to the 2012 climate extreme. Our results indicate that anomalous sea surface temperatures (SSTs) in the Atlantic Ocean were the primary factor forcing the 2012 drought, with Pacific Ocean SST having a larger role in sustaining typical climatic conditions in the region. The drought strongly influenced net primary production in the caatinga, causing a reduction in annual net ecosystem exchange indicating a reduction in amount of CO2 released to the atmosphere.

Implementing collaborative care for depression treatment in primary care: A cluster randomized evaluation of a quality improvement practice redesign

PubMed Central

2011-01-01

Background Meta-analyses show collaborative care models (CCMs) with nurse care management are effective for improving primary care for depression. This study aimed to develop CCM approaches that could be sustained and spread within Veterans Affairs (VA). Evidence-based quality improvement (EBQI) uses QI approaches within a research/clinical partnership to redesign care. The study used EBQI methods for CCM redesign, tested the effectiveness of the locally adapted model as implemented, and assessed the contextual factors shaping intervention effectiveness. Methods The study intervention is EBQI as applied to CCM implementation. The study uses a cluster randomized design as a formative evaluation tool to test and improve the effectiveness of the redesign process, with seven intervention and three non-intervention VA primary care practices in five different states. The primary study outcome is patient antidepressant use. The context evaluation is descriptive and uses subgroup analysis. The primary context evaluation measure is naturalistic primary care clinician (PCC) predilection to adopt CCM. For the randomized evaluation, trained telephone research interviewers enrolled consecutive primary care patients with major depression in the evaluation, referred enrolled patients in intervention practices to the implemented CCM, and re-surveyed at seven months. Results Interviewers enrolled 288 CCM site and 258 non-CCM site patients. Enrolled intervention site patients were more likely to receive appropriate antidepressant care (66% versus 43%, p = 0.01), but showed no significant difference in symptom improvement compared to usual care. In terms of context, only 40% of enrolled patients received complete care management per protocol. PCC predilection to adopt CCM had substantial effects on patient participation, with patients belonging to early adopter clinicians completing adequate care manager follow-up significantly more often than patients of clinicians with low predilection to adopt CCM (74% versus 48%%, p = 0.003). Conclusions Depression CCM designed and implemented by primary care practices using EBQI improved antidepressant initiation. Combining QI methods with a randomized evaluation proved challenging, but enabled new insights into the process of translating research-based CCM into practice. Future research on the effects of PCC attitudes and skills on CCM results, as well as on enhancing the link between improved antidepressant use and symptom outcomes, is needed. Trial Registration ClinicalTrials.gov: NCT00105820 PMID:22032247

A Model and Satellite-Based Analysis of the Tropospheric Ozone Distribution in Clear Versus Convectively Cloudy Conditions

NASA Technical Reports Server (NTRS)

Strode, Sarah A.; Douglass, Anne R.; Ziemke, Jerald R.; Manyin, Michael; Nielsen, J. Eric; Oman, Luke D.

2017-01-01

Satellite observations of in-cloud ozone concentrations from the Ozone Monitoring Instrument and Microwave Limb Sounder instruments show substantial differences from background ozone concentrations. We develop a method for comparing a free-running chemistry-climate model (CCM) to in-cloud and background ozone observations using a simple criterion based on cloud fraction to separate cloudy and clear-sky days. We demonstrate that the CCM simulates key features of the in-cloud versus background ozone differences and of the geographic distribution of in-cloud ozone. Since the agreement is not dependent on matching the meteorological conditions of a specific day, this is a promising method for diagnosing how accurately CCMs represent the relationships between ozone and clouds, including the lower ozone concentrations shown by in-cloud satellite observations. Since clouds are associated with convection as well as changes in chemistry, we diagnose the tendency of tropical ozone at 400 hPa due to chemistry, convection and turbulence, and large-scale dynamics. While convection acts to reduce ozone concentrations at 400 hPa throughout much of the tropics, it has the opposite effect over highly polluted regions of South and East Asia.

Profiles of cardiovascular biomarkers according to severity stages of Chagas cardiomyopathy.

PubMed

Echeverría, Luis E; Rojas, Lyda Z; Calvo, Lauren S; Roa, Zayne M; Rueda-Ochoa, Oscar L; Morillo, Carlos A; Muka, Taulant; Franco, Oscar H

2017-01-15

Up 30 to 40% of Chagas patients exhibit cardiomyopathy with different degrees of cardiac involvement. Biomarkers may help in differentiation of the severity of Chagas cardiomyopathy (CCM). This study sought to examine the diagnostic value of a panel of biomarkers to distinguish the severity of (CCM). 100 patients with CCM were included in this cross-sectional study. Based on electrocardiogram and echocardiogram, CCM patients were classified in three stages according to disease's severity. Levels of high-sensitivity cardiac troponin T (Hs-cTnT), N-terminal pro B-type natriuretic peptide (NT-proBNP), galectin-3 (Gal-3), neutrophil gelatinase-associated lipocalin (NGAL), soluble ST2 (sST2) and cystatin-c (Cys-c) were measured. Logistic regression models were used to assess the association between levels of natural log-transformed values of biomarkers and stages C/D versus B. We also calculated the area under curve (AUC) for each of the models. In models adjusted for age, sex, body mass index, kidney function and medication use, increased levels of NT-proBNP (per 1 unit natural log-transformed values, odds ratio (OR)=5.55; 95CI%:1.65-18.72) and Hs-cTnT (per 1 unit natural log-transformed values, OR=7.11; 95CI%:1.41-35.90) showed significant association with the severity of CCM per 1 unit increase of biomarkers. The accuracy of NT-proBNP and Hs-cTnT for diagnosis of the severity of CCM was high: AUC of 0.968 and 0.956 respectively. No significant difference was found in the AUC between NT-proBNP and Hs-cTnT. No association was found between Gal-3, NGAL, sST2 and Cys-C and severity of CCM. NT-proBNP and Hs-cTnT have both same diagnostic value in distinguishing severity of CCM. Copyright © 2016. Published by Elsevier Ireland Ltd.

Comparison of manually produced and automated cross country movement maps using digital image processing techniques

NASA Technical Reports Server (NTRS)

Wynn, L. K.

1985-01-01

The Image-Based Information System (IBIS) was used to automate the cross country movement (CCM) mapping model developed by the Defense Mapping Agency (DMA). Existing terrain factor overlays and a CCM map, produced by DMA for the Fort Lewis, Washington area, were digitized and reformatted into geometrically registered images. Terrain factor data from Slope, Soils, and Vegetation overlays were entered into IBIS, and were then combined utilizing IBIS-programmed equations to implement the DMA CCM model. The resulting IBIS-generated CCM map was then compared with the digitized manually produced map to test similarity. The numbers of pixels comprising each CCM region were compared between the two map images, and percent agreement between each two regional counts was computed. The mean percent agreement equalled 86.21%, with an areally weighted standard deviation of 11.11%. Calculation of Pearson's correlation coefficient yielded +9.997. In some cases, the IBIS-calculated map code differed from the DMA codes: analysis revealed that IBIS had calculated the codes correctly. These highly positive results demonstrate the power and accuracy of IBIS in automating models which synthesize a variety of thematic geographic data.

Improving Access to Child Health Care in Indonesia Through Community Case Management.

PubMed

Setiawan, Agus; Dignam, Denise; Waters, Cheryl; Dawson, Angela

2016-11-01

Objectives In order to reduce infant mortality in Indonesia, community case management (CCM) was introduced. CCM is a community-based service delivery model to improve children's wellness and longevity, involving the delivery of lifesaving, curative interventions to address common childhood illnesses, particularly where there are limited facility-based services. This paper reports the findings of a qualitative study that investigated the implementation of CCM in the Kutai Timur district, East Kalimantan Indonesia from the perspective of mothers who received care. Methods Seven mothers and health workers were observed during a consultation and these mothers were interviewed in their home weeks after delivery. Field notes and the interview transcriptions were analysed thematically. Findings Mothers reported that their access to care had improved, along with an increase in their knowledge of infant danger signs and when to seek care. Family compliance with care plans was also found to have improved. Mothers expressed satisfaction with the care provided under the CCM model. The mothers expressed a need for a nurse or midwife to be posted in each village, preferably someone from that village. However two mothers did not wish their children to receive health interventions as they did not believe these to be culturally appropriate. Conclusion CCM is seen by rural Indonesian mothers to be a helpful model of care in terms of increasing access to health care and the uptake of lifesaving interventions for sick children. However there is a need to modify the program to demonstrate cultural sensitivity and meet cultural needs of the target population. While CCM is a potentially effective model of care, further integrative strategies are required to embed this model into maternal and child health service delivery.

Policy challenges facing integrated community case management in Sub-Saharan Africa.

PubMed

Bennett, Sara; George, Asha; Rodriguez, Daniela; Shearer, Jessica; Diallo, Brahima; Konate, Mamadou; Dalglish, Sarah; Juma, Pamela; Namakhoma, Ireen; Banda, Hastings; Chilundo, Baltazar; Mariano, Alda; Cliff, Julie

2014-07-01

To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Policy challenges facing integrated community case management in Sub-Saharan Africa

PubMed Central

Bennett, Sara; George, Asha; Rodriguez, Daniela; Shearer, Jessica; Diallo, Brahima; Konate, Mamadou; Dalglish, Sarah; Juma, Pamela; Namakhoma, Ireen; Banda, Hastings; Chilundo, Baltazar; Mariano, Alda; Cliff, Julie

2014-01-01

Objective To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. Methods Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. Results Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. Conclusions iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies. PMID:24750516

Development of the Joint NASA/NCAR General Circulation Model

NASA Technical Reports Server (NTRS)

Lin, S.-J.; Rood, R. B.

1999-01-01

The Data Assimilation Office at NASA/Goddard Space Flight Center is collaborating with NCAR/CGD in an ambitious proposal for the development of a unified climate, numerical weather prediction, and chemistry transport model which is suitable for global data assimilation of the physical and chemical state of the Earth's atmosphere. A prototype model based on the NCAR CCM3 physics and the NASA finite-volume dynamical core has been built. A unique feature of the NASA finite-volume dynamical core is its advanced tracer transport algorithm on the floating Lagrangian control-volume coordinate. The model currently has a highly idealized ozone production/loss chemistry derived from the observed 2D (latitude-height) climatology of the recent decades. Nevertheless, the simulated horizontal wave structure of the total ozone is in good qualitative agreement with the observed (TOMS). Long term climate simulations and NWP experiments have been carried out. Current up to date status and futur! e plan will be discussed in the conference.

Interpretation of Trace Gas Data Using Inverse Methods and Global Chemical Transport Models

NASA Technical Reports Server (NTRS)

Prinn, Ronald G.

1997-01-01

This is a theoretical research project aimed at: (1) development, testing, and refining of inverse methods for determining regional and global transient source and sink strengths for long lived gases important in ozone depletion and climate forcing, (2) utilization of inverse methods to determine these source/sink strengths which use the NCAR/Boulder CCM2-T42 3-D model and a global 3-D Model for Atmospheric Transport and Chemistry (MATCH) which is based on analyzed observed wind fields (developed in collaboration by MIT and NCAR/Boulder), (3) determination of global (and perhaps regional) average hydroxyl radical concentrations using inverse methods with multiple titrating gases, and, (4) computation of the lifetimes and spatially resolved destruction rates of trace gases using 3-D models. Important goals include determination of regional source strengths of methane, nitrous oxide, and other climatically and chemically important biogenic trace gases and also of halocarbons restricted by the Montreal Protocol and its follow-on agreements and hydrohalocarbons used as alternatives to the restricted halocarbons.

The Response of Tropical Tropospheric Ozone to ENSO

NASA Technical Reports Server (NTRS)

Oman, L. D.; Ziemke, J. R.; Douglass, A. R.; Waugh, D. W.; Lang, C.; Rodriguez, J. M.; Nielsen, J. E.

2011-01-01

We have successfully reproduced the Ozone ENSO Index (OEI) in the Goddard Earth Observing System (GEOS) chemistry-climate model (CCM) forced by observed sea surface temperatures over a 25-year period. The vertical ozone response to ENSO is consistent with changes in the Walker circulation. We derive the sensitivity of simulated ozone to ENSO variations using linear regression analysis. The western Pacific and Indian Ocean region shows similar positive ozone sensitivities from the surface to the upper troposphere, in response to positive anomalies in the Nino 3.4 Index. The eastern and central Pacific region shows negative sensitivities with the largest sensitivity in the upper troposphere. This vertical response compares well with that derived from SHADOZ ozonesondes in each region. The OEI reveals a response of tropospheric ozone to circulation change that is nearly independent of changes in emissions and thus it is potentially useful in chemistry-climate model evaluation.

Is the Chronic Care Model Integrated Into Research Examining Culturally Competent Interventions for Ethnically Diverse Adults With Type 2 Diabetes Mellitus? A Review.

PubMed

Dauvrin, Marie; Lorant, Vincent; d'Hoore, William

2015-12-01

The chronic care model (CCM) concerns both the medical and the cultural and linguistic needs of patients through the inclusion of cultural competence in the delivery system design. This literature review attempted to@@ identify the domains of the CCM culturally competent (CC) interventions that the adults from ethnic minorities suffering from type 2 diabetes mellitus report. We identified the CCM and the CC components in the relevant studies published between 2005 and 2014. Thirty-two studies were included. Thirty-one articles focused on self-management and 20 on community resources. Twenty-three interventions integrated cultural norms from the patients' backgrounds. CC interventions reported the CCM at the individual level but need to address the organizational level more effectively. The scope of CC interventions should be expanded to transform health care organizations and systems. © The Author(s) 2015.

Applying the chronic care model to an employee benefits program: a qualitative inquiry.

PubMed

Schauer, Gillian L; Wilson, Mark; Barrett, Barbara; Honeycutt, Sally; Hermstad, April K; Kegler, Michelle C

2013-12-01

To assess how employee benefits programs may strengthen and/or complement elements of the chronic care model (CCM), a framework used by health systems to improve chronic illness care. A qualitative inquiry consisting of semi-structured interviews with employee benefit administrators and partners from a self-insured, self-administered employee health benefits program was conducted at a large family-owned business in southwest Georgia. Results indicate that the employer adapted and used many health system-related elements of the CCM in the design of their benefit program. Data also suggest that the employee benefits program contributed to self-management skills and to informing and activating patients to interact with the health system. Findings suggest that employee benefits programs can use aspects of the CCM in their own benefit design, and can structure their benefits to contribute to patient-related elements from the CCM.

Strengthening the primary care workforce to deliver community case management for child health in rural Indonesia.

PubMed

Setiawan, Agus; Dawson, Angela

2017-10-02

Objectives The aim of the present study was to report on the implementation of community case management (CCM) to reduce infant mortality in a rural district, namely Kutai Timur, Kalimantan Indonesia. Methods An interpretive qualitative methodology was used. In-depth interviews were conducted with 18 primary healthcare workers (PHCWs), and PHCWs were observed during a consultation with mothers to gain insight into the delivery of the new protocol and workforce issues. The field notes and interview transcripts were analysed thematically. Results PHCWs reported that their performance had improved as a result of increased knowledge and confidence. The implementation of CCM had also reportedly enhanced the PHCWs' clinical reasoning. However, the participants noted confusion surrounding their role in prescribing medication. Conclusions CCM is viewed as a useful model of care in terms of enhancing the capacity of rural PHCWs to provide child health care and improve the uptake of life-saving interventions. However, work is needed to strengthen the workforce and to fully integrate CCM into maternal and child health service delivery across Indonesia. What is known about the topic? Indonesia has successfully reduced infant mortality in the past 10 years. However, concerns remain regarding issues related to disparities between districts. The number of infant deaths in rural areas tends to be staggeringly high compared with that in the cities. One of the causes is inadequate access to child health care. What does this paper add? CCM is a model of care that is designed to address childhood illnesses in limited-resource settings. In CCM, PHCWs are trained to deliver life-saving interventions to sick children in rural communities. In the present study, CCM improved the capacity of PHCWs to treat childhood illnesses. What are the implications for practitioners? CCM can be considered to strengthen PHCWs' competence in addressing infant mortality in areas where access to child health care is challenging. Policy regarding task shifting needs to be examined further so that CCM can be integrated into current health service delivery in Indonesia.

Response of the Antarctic Stratosphere to Warm Pool EI Nino Events in the GEOS CCM

NASA Technical Reports Server (NTRS)

Hurwitz, Margaret M.; Song, In-Sun; Oman, Luke D.; Newman, Paul A.; Molod, Andrea M.; Frith, Stacey M.; Nielsen, J. Eric

2011-01-01

A new type of EI Nino event has been identified in the last decade. During "warm pool" EI Nino (WPEN) events, sea surface temperatures (SSTs) in the central equatorial Pacific are warmer than average. The EI Nino signal propagates poleward and upward as large-scale atmospheric waves, causing unusual weather patterns and warming the polar stratosphere. In austral summer, observations show that the Antarctic lower stratosphere is several degrees (K) warmer during WPEN events than during the neutral phase of EI Nino/Southern Oscillation (ENSO). Furthermore, the stratospheric response to WPEN events depends of the direction of tropical stratospheric winds: the Antarctic warming is largest when WPEN events are coincident with westward winds in the tropical lower and middle stratosphere i.e., the westward phase of the quasi-biennial oscillation (QBO). Westward winds are associated with enhanced convection in the subtropics, and with increased poleward wave activity. In this paper, a new formulation of the Goddard Earth Observing System Chemistry-Climate Model, Version 2 (GEOS V2 CCM) is used to substantiate the observed stratospheric response to WPEN events. One simulation is driven by SSTs typical of a WPEN event, while another simulation is driven by ENSO neutral SSTs; both represent a present-day climate. Differences between the two simulations can be directly attributed to the anomalous WPEN SSTs. During WPEN events, relative to ENSO neutral, the model simulates the observed increase in poleward planetary wave activity in the South Pacific during austral spring, as well as the relative warming of the Antarctic lower stratosphere in austral summer. However, the modeled response to WPEN does not depend on the phase of the QBO. The modeled tropical wind oscillation does not extend far enough into the lower stratosphere and upper troposphere, likely explaining the model's insensitivity to the phase of the QBO during WPEN events.

The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

PubMed Central

Stellefson, Michael; Stopka, Christine

2013-01-01

Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. PMID:23428085

Climate variability related to the 11 year solar cycle as represented in different spectral solar irradiance reconstructions

NASA Astrophysics Data System (ADS)

Kruschke, Tim; Kunze, Markus; Misios, Stergios; Matthes, Katja; Langematz, Ulrike; Tourpali, Kleareti

2016-04-01

Advanced spectral solar irradiance (SSI) reconstructions differ significantly from each other in terms of the mean solar spectrum, that is the spectral distribution of energy, and solar cycle variability. Largest uncertainties - relative to mean irradiance - are found for the ultraviolet range of the spectrum, a spectral region highly important for radiative heating and chemistry in the stratosphere and troposphere. This study systematically analyzes the effects of employing different SSI reconstructions in long-term (40 years) chemistry-climate model (CCM) simulations to estimate related uncertainties of the atmospheric response. These analyses are highly relevant for the next round of CCM studies as well as climate models within the CMIP6 exercise. The simulations are conducted by means of two state-of-the-art CCMs - CESM1(WACCM) and EMAC - run in "atmosphere-only"-mode. These models are quite different with respect to the complexity of the implemented radiation and chemistry schemes. CESM1(WACCM) features a chemistry module with considerably higher spectral resolution of the photolysis scheme while EMAC employs a radiation code with notably higher spectral resolution. For all simulations, concentrations of greenhouse gases and ozone depleting substances, as well as observed sea surface temperatures (SST) are set to average conditions representative for the year 2000 (for SSTs: mean of decade centered over year 2000) to exclude anthropogenic influences and differences due to variable SST forcing. Only the SSI forcing differs for the various simulations. Four different forcing datasets are used: NRLSSI1 (used as a reference in all previous climate modeling intercomparisons, i.e. CMIP5, CCMVal, CCMI), NRLSSI2, SATIRE-S, and the SSI forcing dataset recommended for the CMIP6 exercise. For each dataset, a solar maximum and minimum timeslice is integrated, respectively. The results of these simulations - eight in total - are compared to each other with respect to their shortwave heating rate differences (additionally collated with line-by-line calculations using libradtran), differences in the photolysis rates, as well as atmospheric circulation features (temperature, zonal wind, geopotential height, etc.). It is shown that atmospheric responses to the different SSI datasets differ significantly from each other. This is a result from direct radiative effects as well as indirect effects induced by ozone feedbacks. Differences originating from using different SSI datasets for the same level of solar activity are in the same order of magnitude as those associated with the 11 year solar cycle within a specific dataset. However, the climate signals related to the solar cycle are quite comparable across datasets.

Crystal Structure of CCM3, a Cerebral Cavernous Malformation Protein Critical for Vascular Integrity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, X.; Zhang, R; Zhang, H

CCM3 mutations are associated with cerebral cavernous malformation (CCM), a disease affecting 0.1-0.5% of the human population. CCM3 (PDCD10, TFAR15) is thought to form a CCM complex with CCM1 and CCM2; however, the molecular basis for these interactions is not known. We have determined the 2.5 {angstrom} crystal structure of CCM3. This structure shows an all {alpha}-helical protein containing two domains, an N-terminal dimerization domain with a fold not previously observed, and a C-terminal focal adhesion targeting (FAT)-homology domain. We show that CCM3 binds CCM2 via this FAT-homology domain and that mutation of a highly conserved FAK-like hydrophobic pocket (HP1)more » abrogates CCM3-CCM2 interaction. This CCM3 FAT-homology domain also interacts with paxillin LD motifs using the same surface, and partial CCM3 co-localization with paxillin in cells is lost on HP1 mutation. Disease-related CCM3 truncations affect the FAT-homology domain suggesting a role for the FAT-homology domain in the etiology of CCM.« less

pH determines the energetic efficiency of the cyanobacterial CO2 concentrating mechanism.

PubMed

Mangan, Niall M; Flamholz, Avi; Hood, Rachel D; Milo, Ron; Savage, David F

2016-09-06

Many carbon-fixing bacteria rely on a CO2 concentrating mechanism (CCM) to elevate the CO2 concentration around the carboxylating enzyme ribulose bisphosphate carboxylase/oxygenase (RuBisCO). The CCM is postulated to simultaneously enhance the rate of carboxylation and minimize oxygenation, a competitive reaction with O2 also catalyzed by RuBisCO. To achieve this effect, the CCM combines two features: active transport of inorganic carbon into the cell and colocalization of carbonic anhydrase and RuBisCO inside proteinaceous microcompartments called carboxysomes. Understanding the significance of the various CCM components requires reconciling biochemical intuition with a quantitative description of the system. To this end, we have developed a mathematical model of the CCM to analyze its energetic costs and the inherent intertwining of physiology and pH. We find that intracellular pH greatly affects the cost of inorganic carbon accumulation. At low pH the inorganic carbon pool contains more of the highly cell-permeable H2CO3, necessitating a substantial expenditure of energy on transport to maintain internal inorganic carbon levels. An intracellular pH ≈8 reduces leakage, making the CCM significantly more energetically efficient. This pH prediction coincides well with our measurement of intracellular pH in a model cyanobacterium. We also demonstrate that CO2 retention in the carboxysome is necessary, whereas selective uptake of HCO3 (-) into the carboxysome would not appreciably enhance energetic efficiency. Altogether, integration of pH produces a model that is quantitatively consistent with cyanobacterial physiology, emphasizing that pH cannot be neglected when describing biological systems interacting with inorganic carbon pools.

pH determines the energetic efficiency of the cyanobacterial CO2 concentrating mechanism

PubMed Central

Flamholz, Avi; Hood, Rachel D.; Milo, Ron

2016-01-01

Many carbon-fixing bacteria rely on a CO2 concentrating mechanism (CCM) to elevate the CO2 concentration around the carboxylating enzyme ribulose bisphosphate carboxylase/oxygenase (RuBisCO). The CCM is postulated to simultaneously enhance the rate of carboxylation and minimize oxygenation, a competitive reaction with O2 also catalyzed by RuBisCO. To achieve this effect, the CCM combines two features: active transport of inorganic carbon into the cell and colocalization of carbonic anhydrase and RuBisCO inside proteinaceous microcompartments called carboxysomes. Understanding the significance of the various CCM components requires reconciling biochemical intuition with a quantitative description of the system. To this end, we have developed a mathematical model of the CCM to analyze its energetic costs and the inherent intertwining of physiology and pH. We find that intracellular pH greatly affects the cost of inorganic carbon accumulation. At low pH the inorganic carbon pool contains more of the highly cell-permeable H2CO3, necessitating a substantial expenditure of energy on transport to maintain internal inorganic carbon levels. An intracellular pH ≈8 reduces leakage, making the CCM significantly more energetically efficient. This pH prediction coincides well with our measurement of intracellular pH in a model cyanobacterium. We also demonstrate that CO2 retention in the carboxysome is necessary, whereas selective uptake of HCO3− into the carboxysome would not appreciably enhance energetic efficiency. Altogether, integration of pH produces a model that is quantitatively consistent with cyanobacterial physiology, emphasizing that pH cannot be neglected when describing biological systems interacting with inorganic carbon pools. PMID:27551079

The GEOS Chemistry Climate Model: Implications of Climate Feedbacks on Ozone Depletion and Recovery

NASA Technical Reports Server (NTRS)

Stolarski, Richard S.; Pawson, Steven; Douglass, Anne R.; Newman, Paul A.; Kawa, S. Randy; Nielsen, J. Eric; Rodriquez, Jose; Strahan, Susan; Oman, Luke; Waugh, Darryn

2008-01-01

The Goddard Earth Observing System Chemistry Climate Model (GEOS CCM) has been developed by combining the atmospheric chemistry and transport modules developed over the years at Goddard and the GEOS general circulation model, also developed at Goddard. The first version of the model was used in the CCMVal intercomparison exercises that contributed to the 2006 WMO/UNEP Ozone Assessment. The second version incorporates the updated version of the GCM (GEOS 5) and will be used for the next round of CCMVal evaluations and the 2010 Ozone Assessment. The third version, now under development, incorporates the combined stratosphere and troposphere chemistry package developed under the Global Modeling Initiative (GMI). We will show comparison to past observations that indicate that we represent the ozone trends over the past 30 years. We will also show the basic temperature, composition, and dynamical structure of the simulations. We will further show projections into the future. We will show results from an ensemble of transient and time-slice simulations, including simulations with fixed 1960 chlorine, simulations with a best guess scenario (Al), and simulations with extremely high chlorine loadings. We will discuss planned extensions of the model to include emission-based boundary conditions for both anthropogenic and biogenic compounds.

Staying Connected: Sustaining Collaborative Care Models with Limited Funding.

PubMed

Johnston, Brenda J; Peppard, Lora; Newton, Marian

2015-08-01

Providing psychiatric services in the primary care setting is challenging. The multidisciplinary, coordinated approach of collaborative care models (CCMs) addresses these challenges. The purpose of the current article is to discuss the implementation of a CCM at a free medical clinic (FMC) where volunteer staff provide the majority of services. Essential components of CCMs include (a) comprehensive screening and assessment, (b) shared development and communication of care plans among providers and the patient, and (c) care coordination and management. Challenges to implementing and sustaining a CCM at a FMC in Virginia attempting to meet the medical and psychiatric needs of the underserved are addressed. Although the CCM produced favorable outcomes, sustaining the model long-term presented many challenges. Strategies for addressing these challenges are discussed. Copyright 2015, SLACK Incorporated.

Dynamics of Carbon-Concentrating Mechanism Induction and Protein Relocalization during the Dark-to-Light Transition in Synchronized Chlamydomonas reinhardtii1[W][OPEN

PubMed Central

Mitchell, Madeline C.; Meyer, Moritz T.; Griffiths, Howard

2014-01-01

In the model green alga Chlamydomonas reinhardtii, a carbon-concentrating mechanism (CCM) is induced under low CO2 in the light and comprises active inorganic carbon transport components, carbonic anhydrases, and aggregation of Rubisco in the chloroplast pyrenoid. Previous studies have focused predominantly on asynchronous cultures of cells grown under low versus high CO2. Here, we have investigated the dynamics of CCM activation in synchronized cells grown in dark/light cycles compared with induction under low CO2. The specific focus was to undertake detailed time course experiments comparing physiology and gene expression during the dark-to-light transition. First, the CCM could be fully induced 1 h before dawn, as measured by the photosynthetic affinity for inorganic carbon. This occurred in advance of maximum gene transcription and protein accumulation and contrasted with the coordinated induction observed under low CO2. Between 2 and 1 h before dawn, the proportion of Rubisco and the thylakoid lumen carbonic anhydrase in the pyrenoid rose substantially, coincident with increased CCM activity. Thus, other mechanisms are likely to activate the CCM before dawn, independent of gene transcription of known CCM components. Furthermore, this study highlights the value of using synchronized cells during the dark-to-light transition as an alternative means of investigating CCM induction. PMID:25106822

Quantifying Uncertainty in Projections of Stratospheric Ozone Over the 21st Century

NASA Technical Reports Server (NTRS)

Charlton-Perez, A. J.; Hawkins, E.; Eyring, V.; Cionni, I.; Bodeker, G. E.; Kinnison, D. E.; Akiyoshi, H.; Frith, S. M.; Garcia, R.; Gettelman, A.;

Individual and social variables and their effect on Case/Care Manager Job Satisfaction: an exploratory study.

PubMed

Cosentino, Chiara; Bettuzzi, Morena; Campioli, Giulia; Di Marco, Valeria; Giacopuzzi, Giulia; Marinoni, Ivana; Orlandini, Lorenzo; Palermo, Angelo; Pattacini, Siria; Artioli, Giovanna

2017-07-18

The Case/Care Manager (CCM) is a new position for in the Italian National Health Service scenario. Job satisfaction plays a key role for the CCM to engage in his work, accomplishing it in a complete. Nurses' job satisfaction is a complex construct and many different variables can influence it: personal characteristics, cultural characteristic, social characteristic, organizational characteristic, and environmental characteristic. The main aim of this study is to assess the job satisfaction in a sample of CCM and to assess if and how Social Variables (organizational climate and health) and Individual (socio-demographic variables, coping strategies, emotion regulation) relate to the CCM job satisfaction. This study has a quantitative exploratory cross-sectional design. Participants were Nurse CCM with or without specific training who filled a battery of questionnaires : Job Satisfaction Survey (JSS) , section three of ICONAS questionnaire, section five of the Multidimensional Organizational Health Questionnaire (MOHQ), anamnestic sheet, Coping Orientation to the Problems Experienced (COPE-NVI-25), and Emotion Regulation Questionnaire (ERQ). The battery was administered online on the website of Italian Case Manager, Italian Association of Care Manager, and IPASVI Colleges. It was also distributed during the National Congress for Case Manager in Padua. 103 participants took part in the study. The total mean score of JSS was 117,28 (S.D.=21,12). The emotional regulation strategy most used was the "Cognitive Response", and the most used Coping strategy was "Problem Oriented". There were significant correlations between JSS and Social variables in the total score (ICONAS r=.574 p<0.01; MOHQ (positive indicators) r=.608 p<0.01; MOHQ (negative indicators) r=-.634 p <0.01) and in its subscales. There were also significant correlations between JSS subscales and Individual variables (COPE and ERQ). Participants with a specific training tend to use the emotion regulation strategy "Negative interpretation self-oriented" (U 910.500 p<0.005) and "Distraction" (U 885.000 p<0.005) more than those without specific training. The same significant difference was found in JSS pay (t=-2,48 per p<0.05) and JSS Fringe Benefits (t=-2,07 per p<0.05). The CCM job satisfaction seems to be ambivalent. It seems to be not entirely polarized on presence/absence, but rather still in a gray area. organizational climate and health influence significantly the overall perception of job satisfaction and its different areas. The most "avoiding" emotional regulation strategies, seem to negatively affect the perception of satisfaction. Emotional regulation and coping strategies related to challenges focusing and management, along with the individual perception of collaboration, positively influence satisfaction. Participants who underwent a specific CCM training, committing themselves financially and personally, perceive less job satisfaction when their role is not recognized in terms of pay. This study showed that that the main strategies used to regulate emotions are the Cognitive Response and the Social Contact. We suggest that further studies could be made to define the links between individual strategies and the presence of chronic distress and we suggest that a specific training on coping and emotion regulation may be implemented in graduation and post-graduation courses.

The Chronic Care Model and Technological Research and Innovation: A Scoping Review at the Crossroads

PubMed Central

Berntsen, Gro Karine Rosvold; Koricho, Absera Teshome; Sygna, Karin; Ruland, Cornelia

2015-01-01

Background Information and communication technologies (ICT) are key to optimizing the outcomes of the Chronic Care Model (CCM), currently acknowledged as the best synthesis of available evidence for chronic illness prevention and management. At the same time, CCM can offer a needed framework for increasing the relevance and feasibility of ICT innovation and research in health care. Little is known about how and to what extent CCM and ICT research inform each other to leverage mutual strengths. The current study examines: What characterizes work being done at the crossroads of CCM and ICT research and innovation? Objective Our aim is identify the gaps and potential that lie between the research domains CCM and ICT, thus enabling more substantive questions and opportunities for accelerating improvements in ICT-supported chronic care. Methods Using a scoping study approach, we developed a search strategy applied to medical and technical databases resulting in 1054 titles and abstracts that address CCM and ICT. After iteratively adapting our inclusion/exclusion criteria to balance between breadth and feasibility, 26 publications from 20 studies were found to fulfill our criteria. Following initial coding of each article according to predefined categories (eg, type of article, CCM component, ICT, health issue), a 1st level analysis was conducted resulting in a broad range of categories. These were gradually reduced by constantly comparing them for underlying commonalities and discrepancies. Results None of the studies included were from technical databases and interventions relied mostly on “old-fashioned” technologies. Technologies supporting “productive interactions” were often one-way (provider to patient), and it was sometimes difficult to decipher how CCM was guiding intervention design. In particular, the major focus on ICT to support providers did not appear unique to the challenges of chronic care. Challenges in facilitating CCM components through ICT included poorly designed user interfaces, digital divide issues, and lack of integration with existing infrastructure. Conclusions The CCM is a highly influential guide for health care development, which recognizes the need for alignment of system tools such as ICT. Yet, there seem to be alarmingly few touch points between the subject fields of “health service development” and “ICT-innovation”. Bridging these gaps needs explicit and urgent attention as the synergies between these domains have enormous potential. Policy makers and funding agencies need to facilitate the joining of forces between high-tech innovative expertise and experts in the chronic care system redesign that is required for tackling the current epidemic of long-term multiple conditions. PMID:25677200

The chronic care model and technological research and innovation: a scoping review at the crossroads.

PubMed

Gammon, Deede; Berntsen, Gro Karine Rosvold; Koricho, Absera Teshome; Sygna, Karin; Ruland, Cornelia

2015-02-06

Information and communication technologies (ICT) are key to optimizing the outcomes of the Chronic Care Model (CCM), currently acknowledged as the best synthesis of available evidence for chronic illness prevention and management. At the same time, CCM can offer a needed framework for increasing the relevance and feasibility of ICT innovation and research in health care. Little is known about how and to what extent CCM and ICT research inform each other to leverage mutual strengths. The current study examines: What characterizes work being done at the crossroads of CCM and ICT research and innovation? Our aim is identify the gaps and potential that lie between the research domains CCM and ICT, thus enabling more substantive questions and opportunities for accelerating improvements in ICT-supported chronic care. Using a scoping study approach, we developed a search strategy applied to medical and technical databases resulting in 1054 titles and abstracts that address CCM and ICT. After iteratively adapting our inclusion/exclusion criteria to balance between breadth and feasibility, 26 publications from 20 studies were found to fulfill our criteria. Following initial coding of each article according to predefined categories (eg, type of article, CCM component, ICT, health issue), a 1st level analysis was conducted resulting in a broad range of categories. These were gradually reduced by constantly comparing them for underlying commonalities and discrepancies. None of the studies included were from technical databases and interventions relied mostly on "old-fashioned" technologies. Technologies supporting "productive interactions" were often one-way (provider to patient), and it was sometimes difficult to decipher how CCM was guiding intervention design. In particular, the major focus on ICT to support providers did not appear unique to the challenges of chronic care. Challenges in facilitating CCM components through ICT included poorly designed user interfaces, digital divide issues, and lack of integration with existing infrastructure. The CCM is a highly influential guide for health care development, which recognizes the need for alignment of system tools such as ICT. Yet, there seem to be alarmingly few touch points between the subject fields of "health service development" and "ICT-innovation". Bridging these gaps needs explicit and urgent attention as the synergies between these domains have enormous potential. Policy makers and funding agencies need to facilitate the joining of forces between high-tech innovative expertise and experts in the chronic care system redesign that is required for tackling the current epidemic of long-term multiple conditions.

Midlatitude atmosphere-ocean interaction during El Nino. Part I. The north Pacific ocean

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alexander, M.A.

Atmosphere-ocean modeling experiments are used to investigate the formation of sea surface temperature (SST) anomalies in the North Pacific Ocean during fall and winter of the El Nino year. Experiments in which the NCAR Community Climate Model (CCM) surface fields are used to force a mixed-layer ocean model in the North Pacific (no air-sea feedback) are compared to simulations in which the CCM and North Pacific Ocean model are coupled. Anomalies in the atmosphere and the North Pacific Ocean during El Nino are obtained from the difference between simulations with and without prescribed warm SST anomalies in the tropical Pacific.more » In both the forced and coupled experiments, the anomaly pattern resembles a composite of the actual SST anomaly field during El Nino: warm SSTs develop along the coast of North America and cold SSTs form in the central Pacific. In the coupled simulations, air-sea interaction results in a 25% to 50% reduction in the magnitude of the SST and mixed-layer depth anomalies, resulting in more realistic SST fields. Coupling also decreases the SST anomaly variance; as a result, the anomaly centers remain statistically significant even though the magnitude of the anomalies is reduced. Three additional sensitivity studies indicate that air-sea feedback and entrainment act to damp SST anomalies while Ekman pumping has a negligible effect on mixed-layer depth and SST anomalies in midatitudes.« less

Bifurcating effects of hope and support in short- and long-term health outcomes among primary care patients without mental illness.

PubMed

Katerndahl, David

2014-08-01

Adverse life events and stressors can lead to symptoms, increased alcohol intake, and impaired functional status, while hope and social support can mitigate such adverse effects. Yet, there is reason to question such simple, linear relationships among healthy adults. The purpose of this study was to assess whether short-term or long-term changes in alcohol intake, psychological symptoms or functional status were better modelled as cusp catastrophic or linear processes among primary care patients without mental illness. This secondary analysis of a study on the stability of psychological symptoms among primary care patients without mental disorders included 38 subjects who completed baseline, and 2-month and/or 6-month assessments of psychological symptoms, functional status and stressors as well as hope and social support. The analyses modelled short-term and long-term changes in alcohol intake, psychological symptoms and functional status using cusp catastrophe (CCM) and linear modelling. Overall, four of the nine 2-month analyses found CCM superior to linear models; however, only one 6-month analysis (alcohol intake) found that CCM was superior. The 2-month cusp phenomena included both symptomatology and functional status. The asymmetry variables were often not significant in the CCM models; in fact, only distress was significant at all. While hope was a significant bifurcation variable at both the 2-month and 6-month levels, social support was a significant bifurcation variable for three of the four 2-month CCMs. In conclusion, while 6-month outcomes were rarely explained through CCM, half of 2-month outcomes were. Hope and support demonstrated bifurcation effects. © 2013 John Wiley & Sons, Ltd.

Implications of Lagrangian transport for coupled chemistry-climate simulations

NASA Astrophysics Data System (ADS)

Stenke, A.; Dameris, M.; Grewe, V.; Garny, H.

2008-10-01

For the first time a purely Lagrangian transport algorithm is applied in a fully coupled chemistry-climate model (CCM). We use the Lagrangian scheme ATTILA for the transport of water vapour, cloud water and chemical trace species in the ECHAM4.L39(DLR)/CHEM (E39C) CCM. The advantage of the Lagrangian approach is that it is numerically non-diffusive and therefore maintains steeper and more realistic gradients than the operational semi-Lagrangian transport scheme. In case of radiatively active species changes in the simulated distributions feed back to model dynamics which in turn affect the modelled transport. The implications of the Lagrangian transport scheme for stratospheric model dynamics and tracer distributions in the upgraded model version E39C-ATTILA (E39C-A) are evaluated by comparison with observations and results of the E39C model with the operational semi-Lagrangian advection scheme. We find that several deficiencies in stratospheric dynamics in E39C seem to originate from a pronounced modelled wet bias and an associated cold bias in the extra-tropical lowermost stratosphere. The reduction of the simulated moisture and temperature bias in E39C-A leads to a significant advancement of stratospheric dynamics in terms of the mean state as well as annual and interannual variability. As a consequence of the favourable numerical characteristics of the Lagrangian transport scheme and the improved model dynamics, E39C-A generally shows more realistic stratospheric tracer distributions: Compared to E39C high stratospheric chlorine (Cly) concentrations extend further downward and agree now well with analyses derived from observations. Therefore E39C-A realistically covers the altitude of maximum ozone depletion in the stratosphere. The location of the ozonopause, i.e. the transition from low tropospheric to high stratospheric ozone values, is also clearly improved in E39C-A. Furthermore, the simulated temporal evolution of stratospheric Cly in the past is realistically reproduced which is an important step towards a more reliable projection of future changes, especially of stratospheric ozone.

Modelling future changes to the stratospheric source gas injection of biogenic bromocarbons

NASA Astrophysics Data System (ADS)

Hossaini, R.; Chipperfield, M. P.; Dhomse, S.; Ordóñez, C.; Saiz-Lopez, A.; Abraham, N. L.; Archibald, A.; Braesicke, P.; Telford, P.; Warwick, N.; Yang, X.; Pyle, J.

2012-10-01

Simulations with a chemistry-climate model (CCM) show a future increase in the stratospheric source gas injection (SGI) of biogenic very short-lived substances (VSLS). For 2000, the modelled SGI of bromine from VSLS is ∼1.7 parts per trillion (pptv) and largest over the tropical West Pacific. For 2100, this increases to ∼2.0 and ∼2.7 pptv when the model is forced with Intergovernmental Panel on Climate Change (IPCC) representative concentration pathways (RCPs) 4.5 and 8.5. The increase is largely due to stronger tropical deep convection transporting more CHBr3 to the lower stratosphere. For CH2Br2, CHBr2Cl, CH2BrCl and CHBrCl2, changes to primary oxidant OH determines their SGI contribution. Under RCP 4.5 (moderate warming), OH increases in a warmer, more humid troposphere. Under RCP 8.5 (extreme warming) OH decreases significantly due to a large methane increase, allowing greater SGI of bromine from these VSLS. Potentially enhanced VSLS emissions in the future would further increase these estimates.

Measures of GCM Performance as Functions of Model Parameters Affecting Clouds and Radiation

NASA Astrophysics Data System (ADS)

Jackson, C.; Mu, Q.; Sen, M.; Stoffa, P.

2002-05-01

This abstract is one of three related presentations at this meeting dealing with several issues surrounding optimal parameter and uncertainty estimation of model predictions of climate. Uncertainty in model predictions of climate depends in part on the uncertainty produced by model approximations or parameterizations of unresolved physics. Evaluating these uncertainties is computationally expensive because one needs to evaluate how arbitrary choices for any given combination of model parameters affects model performance. Because the computational effort grows exponentially with the number of parameters being investigated, it is important to choose parameters carefully. Evaluating whether a parameter is worth investigating depends on two considerations: 1) does reasonable choices of parameter values produce a large range in model response relative to observational uncertainty? and 2) does the model response depend non-linearly on various combinations of model parameters? We have decided to narrow our attention to selecting parameters that affect clouds and radiation, as it is likely that these parameters will dominate uncertainties in model predictions of future climate. We present preliminary results of ~20 to 30 AMIPII style climate model integrations using NCAR's CCM3.10 that show model performance as functions of individual parameters controlling 1) critical relative humidity for cloud formation (RHMIN), and 2) boundary layer critical Richardson number (RICR). We also explore various definitions of model performance that include some or all observational data sources (surface air temperature and pressure, meridional and zonal winds, clouds, long and short-wave cloud forcings, etc...) and evaluate in a few select cases whether the model's response depends non-linearly on the parameter values we have selected.

A supermolecular curcumin for enhanced antiproliferative and proapoptotic activities: molecular characteristics, computer modeling and in vivo pharmacokinetics

NASA Astrophysics Data System (ADS)

Tan, Qunyou; Wu, Jianyong; Li, Yi; Mei, Hu; Zhao, Chunjing; Zhang, Jingqing

2013-01-01

The supermolecular curcumin (SMCCM) exhibiting remarkably improved solubility and release characteristics was fabricated to increase the oral bioavailability in rat as well as the antiproliferative and proapoptotic activities of curcumin (CCM) against human lung adenocarcinoma cell A549. SMCCM was characterized by differential scanning calorimetry, Fourier transform infrared spectroscopy, morphology and structure, aqueous solubility, and release behavior in vitro. Computer modeling of the supermolecular structure was performed. The pharmacokinetics, antiproliferative and proapoptotic activities of SMCCM were evaluated. The mechanisms by which SMCCM inhibited proliferation and induced apoptosis were identified. The formation of SMCCM was testified and the supermolecular structure was studied by a computer modeling technique. Compared to free CCM, SMCCM with much higher aqueous solubility exhibited obviously enhanced release and more favorable pharmacokinetic profiles, and, furthermore, SMCCM showed higher anticancer efficacy, enhanced induction of G2/M-phase arrest and apoptosis in A549 cells, which might be involved with the increases in reactive oxygen species production and intracellular Ca2+ accumulation, and a decrease in mitochondrial membrane potential. SMCCM remarkably enhanced not only the oral bioavailability but also the antiproliferative and proapoptotic activities of CCM along with improved solubility and release characteristics of CCM.

A supermolecular curcumin for enhanced antiproliferative and proapoptotic activities: molecular characteristics, computer modeling and in vivo pharmacokinetics.

PubMed

Tan, Qunyou; Wu, Jianyong; Li, Yi; Mei, Hu; Zhao, Chunjing; Zhang, Jingqing

2013-01-25

The supermolecular curcumin (SMCCM) exhibiting remarkably improved solubility and release characteristics was fabricated to increase the oral bioavailability in rat as well as the antiproliferative and proapoptotic activities of curcumin (CCM) against human lung adenocarcinoma cell A549. SMCCM was characterized by differential scanning calorimetry, Fourier transform infrared spectroscopy, morphology and structure, aqueous solubility, and release behavior in vitro. Computer modeling of the supermolecular structure was performed. The pharmacokinetics, antiproliferative and proapoptotic activities of SMCCM were evaluated. The mechanisms by which SMCCM inhibited proliferation and induced apoptosis were identified. The formation of SMCCM was testified and the supermolecular structure was studied by a computer modeling technique. Compared to free CCM, SMCCM with much higher aqueous solubility exhibited obviously enhanced release and more favorable pharmacokinetic profiles, and, furthermore, SMCCM showed higher anticancer efficacy, enhanced induction of G2/M-phase arrest and apoptosis in A549 cells, which might be involved with the increases in reactive oxygen species production and intracellular Ca(2+) accumulation, and a decrease in mitochondrial membrane potential. SMCCM remarkably enhanced not only the oral bioavailability but also the antiproliferative and proapoptotic activities of CCM along with improved solubility and release characteristics of CCM.

Documentation and Validation of the Goddard Earth Observing System (GEOS) Data Assimilation System, Version 4

NASA Technical Reports Server (NTRS)

Suarez, Max J. (Editor); daSilva, Arlindo; Dee, Dick; Bloom, Stephen; Bosilovich, Michael; Pawson, Steven; Schubert, Siegfried; Wu, Man-Li; Sienkiewicz, Meta; Stajner, Ivanka

2005-01-01

This document describes the structure and validation of a frozen version of the Goddard Earth Observing System Data Assimilation System (GEOS DAS): GEOS-4.0.3. Significant features of GEOS-4 include: version 3 of the Community Climate Model (CCM3) with the addition of a finite volume dynamical core; version two of the Community Land Model (CLM2); the Physical-space Statistical Analysis System (PSAS); and an interactive retrieval system (iRET) for assimilating TOVS radiance data. Upon completion of the GEOS-4 validation in December 2003, GEOS-4 became operational on 15 January 2004. Products from GEOS-4 have been used in supporting field campaigns and for reprocessing several years of data for CERES.

Ocean-Ice Sheet Interactions in the Norwegian Sea and Teleconnections to Low Latitude Hydrology and Atmospheric Circulation

NASA Astrophysics Data System (ADS)

Brendryen, J.; Hannisdal, B.; Haaga, K. A.; Haflidason, H.; Castro, D. D.; Grasmo, K. J.; Sejrup, H. P.; Edwards, R. L.; Cheng, H.; Kelly, M. J.; Lu, Y.

2016-12-01

Abrupt millennial scale climatic events known as Dansgaard-Oeschger events are a defining feature of the Quaternary climate system dynamics in the North Atlantic and beyond. We present a high-resolution multi-proxy record of ocean-ice sheet interactions in the Norwegian Sea spanning the interval between 50 and 150 ka BP. A comparison with low latitude records indicates a very close connection between the high northern latitude ocean-ice sheet interactions and large scale changes in low latitude atmospheric circulation and hydrology even on sub-millennial scales. The records are placed on a common precise radiometric chronology based on correlations to U/Th dated speleothem records from China and the Alps. This enables a comparison of the records to orbital and other climatically important parameters such as U/Th dated sea-level data from corals and speleothems. We explore the drive-response relationships in these coupled systems with the information transfer (IT) and the convergent cross mapping (CCM) analytical techniques. These methods employ conceptually different approaches to detect the relative strength and directionality of potentially chaotic and nonlinearly coupled systems. IT is a non-parametric measure of information transfer between data records based on transfer entropy, while CCM relies on delay reconstructions using Takens' theorem. This approach enables us to address how the climate system processes interact and how this interaction is affected by external forcing from for example greenhouse gases and orbital variability.

Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis

PubMed Central

Abu Dabrh, Abd Moain; Gionfriddo, Michael R.; Erwin, Patricia; Montori, Victor M.

2018-01-01

Background The Chronic Care Model (CCM) emerged in the 1990s as an approach to re-organize primary care and implement critical elements that enable it to proactively attend to patients with chronic conditions. The chronic care landscape has evolved further, as most patients now present with multiple chronic conditions and increasing psychosocial complexity. These patients face accumulating and overwhelming complexity resulting from the sum of uncoordinated responses to each of their problems. Minimally Disruptive Medicine (MDM) was proposed to respond to this challenge, aiming at improving outcomes that matter to patients with the smallest burden of treatment. We sought to critically appraise the extent to which MDM constructs (e.g., reducing patient work, improving patients’ capacity) have been adopted within CCM implementations. Methods We conducted a systematic review and qualitative thematic synthesis of reports of CCM implementations published from 2011–2016. Results CCM implementations were mostly aligned with the healthcare system’s goals, condition-specific, and targeted disease-specific outcomes or healthcare utilization. No CCM implementation addressed patient work. Few reduced treatment workload without adding additional tasks. Implementations supported patient capacity by offering information, but rarely offered practical resources (e.g., financial assistance, transportation), helped patients reframe their biography with chronic illness, or assisted them in engaging with a supportive social network. Few implementations aimed at improving functional status or quality of life, and only one-third of studies were targeted for patients of low socioeconomic status. Conclusion MDM provides a lens to operationalize how to care for patients with multiple chronic conditions, but its constructs remain mostly absent from how implementations of the CCM are currently reported. Improvements to the primary care of patients with multimorbidity may benefit from the application of MDM, and the current CCM implementations that do apply MDM constructs should be considered exemplars for future implementation work. PMID:29420543

The impact of low-level cloud over the eastern subtropical Pacific on the ``Double ITCZ'' in LASG FGCM-0

NASA Astrophysics Data System (ADS)

Dai, Fushan; Yu, Rucong; Zhang, Xuehong; Yu, Yongqiang; Li, Jianglong

2003-05-01

Like many other coupled models, the Flexible coupled General Circulation Model (FGCM-0) suffers from the spurious “Double ITCZ”. In order to understand the “Double ITCZ” in FGCM-0, this study first examines the low-level cloud cover and the bulk stability of the low troposphere over the eastern subtropical Pacific simulated by the National Center for Atmospheric Research (NCAR) Community Climate Model version 3 (CCM3), which is the atmosphere component model of FGCM-0. It is found that the bulk stability of the low troposphere simulated by CCM3 is very consistent with the one derived from the National Center for Environmental Prediction (NCEP) reanalysis, but the simulated low-level cloud cover is much less than that derived from the International Satellite Cloud Climatology Project (ISCCP) D2 data. Based on the regression equations between the low-level cloud cover from the ISCCP data and the bulk stability of the low troposphere derived from the NCEP reanalysis, the parameterization scheme of low-level cloud in CCM3 is modified and used in sensitivity experiments to examine the impact of low-level cloud over the eastern subtropical Pacific on the spurious “Double ITCZ” in FGCM-0. Results show that the modified scheme causes the simulated low-level cloud cover to be improved locally over the cold oceans. Increasing the low-level cloud cover off Peru not only significantly alleviates the SST warm biases in the southeastern tropical Pacific, but also causes the equatorial cold tongue to be strengthened and to extend further west. Increasing the low-level cloud fraction off California effectively reduces the SST warm biases in ITCZ north of the equator. In order to examine the feedback between the SST and low-level cloud cover off Peru, one additional sensitivity experiment is performed in which the SST over the cold ocean off Peru is restored. It shows that decreasing the SST results in similar impacts over the wide regions from the southeastern tropical Pacific northwestwards to the western/central equatorial Pacific as increasing the low-level cloud cover does.

Clinical course of untreated cerebral cavernous malformations: a meta-analysis of individual patient data.

PubMed

Horne, Margaret A; Flemming, Kelly D; Su, I-Chang; Stapf, Christian; Jeon, Jin Pyeong; Li, Da; Maxwell, Susanne S; White, Philip; Christianson, Teresa J; Agid, Ronit; Cho, Won-Sang; Oh, Chang Wan; Wu, Zhen; Zhang, Jun-Ting; Kim, Jeong Eun; Ter Brugge, Karel; Willinsky, Robert; Brown, Robert D; Murray, Gordon D; Al-Shahi Salman, Rustam

2016-02-01

Cerebral cavernous malformations (CCMs) can cause symptomatic intracranial haemorrhage (ICH), but the estimated risks are imprecise and predictors remain uncertain. We aimed to obtain precise estimates and predictors of the risk of ICH during untreated follow-up in an individual patient data meta-analysis. We invited investigators of published cohorts of people aged at least 16 years, identified by a systematic review of Ovid MEDLINE and Embase from inception to April 30, 2015, to provide individual patient data on clinical course from CCM diagnosis until first CCM treatment or last available follow-up. We used survival analysis to estimate the 5-year risk of symptomatic ICH due to CCMs (primary outcome), multivariable Cox regression to identify baseline predictors of outcome, and random-effects models to pool estimates in a meta-analysis. Among 1620 people in seven cohorts from six studies, 204 experienced ICH during 5197 person-years of follow-up (Kaplan-Meier estimated 5-year risk 15·8%, 95% CI 13·7-17·9). The primary outcome of ICH within 5 years of CCM diagnosis was associated with clinical presentation with ICH or new focal neurological deficit (FND) without brain imaging evidence of recent haemorrhage versus other modes of presentation (hazard ratio 5·6, 95% CI 3·2-9·7) and with brainstem CCM location versus other locations (4·4, 2·3-8·6), but age, sex, and CCM multiplicity did not add independent prognostic information. The 5-year estimated risk of ICH during untreated follow-up was 3·8% (95% CI 2·1-5·5) for 718 people with non-brainstem CCM presenting without ICH or FND, 8·0% (0·1-15·9) for 80 people with brainstem CCM presenting without ICH or FND, 18·4% (13·3-23·5) for 327 people with non-brainstem CCM presenting with ICH or FND, and 30·8% (26·3-35·2) for 495 people with brainstem CCM presenting with ICH or FND. Mode of clinical presentation and CCM location are independently associated with ICH within 5 years of CCM diagnosis. These findings can inform decisions about CCM treatment. UK Medical Research Council, Chief Scientist Office of the Scottish Government, and UK Stroke Association. Copyright © 2016 Horne et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

CASL VMA FY16 Milestone Report (L3:VMA.VUQ.P13.07) Westinghouse Mixing with COBRA-TF

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gordon, Natalie

2016-09-30

COBRA-TF (CTF) is a low-resolution code currently maintained as CASL's subchannel analysis tool. CTF operates as a two-phase, compressible code over a mesh comprised of subchannels and axial discretized nodes. In part because CTF is a low-resolution code, simulation run time is not computationally expensive, only on the order of minutes. Hi-resolution codes such as STAR-CCM+ can be used to train lower-fidelity codes such as CTF. Unlike STAR-CCM+, CTF has no turbulence model, only a two-phase turbulent mixing coefficient, β. β can be set to a constant value or calculated in terms of Reynolds number using an empirical correlation. Resultsmore » from STAR-CCM+ can be used to inform the appropriate value of β. Once β is calibrated, CTF runs can be an inexpensive alternative to costly STAR-CCM+ runs for scoping analyses. Based on the results of CTF runs, STAR-CCM+ can be run for specific parameters of interest. CASL areas of application are CIPS for single phase analysis and DNB-CTF for two-phase analysis.« less

An Evaluation of Collaborative Interventions to Improve Chronic Illness Care: Framework and Study Design

ERIC Educational Resources Information Center

Cretin, Shan; Shortell, Stephen M.; Keeler, Emmett B.

2004-01-01

The authors' dual-purpose evaluation assesses the effectiveness of formal collaboratives in stimulating organizational changes to improve chronic illness care (the chronic care model or CCM). Intervention and comparison sites are compared before and after introduction of the CCM. Multiple data sources are used to measure the degree of…

Parallel community climate model: Description and user`s guide

DOE Office of Scientific and Technical Information (OSTI.GOV)

Drake, J.B.; Flanery, R.E.; Semeraro, B.D.

This report gives an overview of a parallel version of the NCAR Community Climate Model, CCM2, implemented for MIMD massively parallel computers using a message-passing programming paradigm. The parallel implementation was developed on an Intel iPSC/860 with 128 processors and on the Intel Delta with 512 processors, and the initial target platform for the production version of the code is the Intel Paragon with 2048 processors. Because the implementation uses a standard, portable message-passing libraries, the code has been easily ported to other multiprocessors supporting a message-passing programming paradigm. The parallelization strategy used is to decompose the problem domain intomore » geographical patches and assign each processor the computation associated with a distinct subset of the patches. With this decomposition, the physics calculations involve only grid points and data local to a processor and are performed in parallel. Using parallel algorithms developed for the semi-Lagrangian transport, the fast Fourier transform and the Legendre transform, both physics and dynamics are computed in parallel with minimal data movement and modest change to the original CCM2 source code. Sequential or parallel history tapes are written and input files (in history tape format) are read sequentially by the parallel code to promote compatibility with production use of the model on other computer systems. A validation exercise has been performed with the parallel code and is detailed along with some performance numbers on the Intel Paragon and the IBM SP2. A discussion of reproducibility of results is included. A user`s guide for the PCCM2 version 2.1 on the various parallel machines completes the report. Procedures for compilation, setup and execution are given. A discussion of code internals is included for those who may wish to modify and use the program in their own research.« less

Simulating the Past, Present and Future of the Upper Troposphere and Lower Stratosphere

NASA Astrophysics Data System (ADS)

Gettelman, Andrew; Hegglin, Michaela

2010-05-01

A comprehensive assessment of coupled chemistry climate model (CCM) performance in the upper troposphere and lower stratosphere has been conducted with 18 models. Both qualitative and quantitative comparisons of model representation of UTLS dynamical, radiative and chemical structure have been conducted, using a collection of quantitative grading techniques. The models are able to reproduce the observed climatology of dynamical, radiative and chemical structure in the tropical and extratropical UTLS, despite relatively coarse vertical and horizontal resolution. Diagnostics of the Tropical Tropopause Layer (TTL), Tropopause Inversion Layer (TIL) and Extra-tropical Transition Layer (ExTL) are analyzed. The results provide new insight into the key processes that govern the dynamics and transport in the tropics and extra-tropicsa. The presentation will explain how models are able to reproduce key features of the UTLS, what features they do not reproduce, and why. Model trends over the historical period are also assessed and interannual variability is included in the metrics. Finally, key trends in the UTLS for the future with a given halogen and greenhouse gas scenario are presented, indicating significant changes in tropopause height and temperature, as well as UTLS ozone concentrations in the 21st century due to climate change and ozone recovery.

High-throughput sequencing of the entire genomic regions of CCM1/KRIT1, CCM2 and CCM3/PDCD10 to search for pathogenic deep-intronic splice mutations in cerebral cavernous malformations.

PubMed

Rath, Matthias; Jenssen, Sönke E; Schwefel, Konrad; Spiegler, Stefanie; Kleimeier, Dana; Sperling, Christian; Kaderali, Lars; Felbor, Ute

2017-09-01

Cerebral cavernous malformations (CCM) are vascular lesions of the central nervous system that can cause headaches, seizures and hemorrhagic stroke. Disease-associated mutations have been identified in three genes: CCM1/KRIT1, CCM2 and CCM3/PDCD10. The precise proportion of deep-intronic variants in these genes and their clinical relevance is yet unknown. Here, a long-range PCR (LR-PCR) approach for target enrichment of the entire genomic regions of the three genes was combined with next generation sequencing (NGS) to screen for coding and non-coding variants. NGS detected all six CCM1/KRIT1, two CCM2 and four CCM3/PDCD10 mutations that had previously been identified by Sanger sequencing. Two of the pathogenic variants presented here are novel. Additionally, 20 stringently selected CCM index cases that had remained mutation-negative after conventional sequencing and exclusion of copy number variations were screened for deep-intronic mutations. The combination of bioinformatics filtering and transcript analyses did not reveal any deep-intronic splice mutations in these cases. Our results demonstrate that target enrichment by LR-PCR combined with NGS can be used for a comprehensive analysis of the entire genomic regions of the CCM genes in a research context. However, its clinical utility is limited as deep-intronic splice mutations in CCM1/KRIT1, CCM2 and CCM3/PDCD10 seem to be rather rare. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Can we use the ozone response in a CCM to say which solar spectral irradiance is most likely correct?

NASA Astrophysics Data System (ADS)

Ball, William; Rozanov, Eugene; Shapiro, Anna

2015-04-01

Ozone plays a key role in the temperature structure of the Earth's atmosphere and absorbs damaging ultraviolet (UV) solar radiation. Evidence suggests that variations in stratospheric ozone resulting from changes in solar UV output may have an important role to play in weather over the North Atlantic and Europe on decadal timescales through a "top-down" coupling with the troposphere. However, the magnitude of the stratospheric response to the Sun over the 11-year solar cycle (SC) depends primarily on how much the UV changes. SC UV changes differ significantly between different observational instruments and the observations and models. The substantial disagreements between existing SSI datasets lead to different atmospheric responses when they are used in climate models and, therefore, we still cannot fully understand and simulate the ozone variability. We use the SOCOL chemistry-climate model, in specified dynamics mode, to calculate the atmospheric response from using different spectral irradiance from the SATIRE-S and NRLSSI models and with SORCE observations and a constant Sun. We compare the ozone and hydroxl results from these runs with observations to try to determine which SSI dataset is most likely to be correct. This is important to get a better understanding of which SSI dataset should be used in climate modelling and what magnitude of UV variability the Sun has. This will lead to a better understanding of the Sun's influence upon our climate and weather.

Stabilization of VEGFR2 signaling by cerebral cavernous malformation 3 is critical for vascular development.

PubMed

He, Yun; Zhang, Haifeng; Yu, Luyang; Gunel, Murat; Boggon, Titus J; Chen, Hong; Min, Wang

2010-04-06

Cerebral cavernous malformations (CCMs) are human vascular malformations caused by mutations in three genes of unknown function: CCM1, CCM2, and CCM3. CCM3, also known as PDCD10 (programmed cell death 10), was initially identified as a messenger RNA whose abundance was induced by apoptotic stimuli in vitro. However, the in vivo function of CCM3 has not been determined. Here, we describe mice with a deletion of the CCM3 gene either ubiquitously or specifically in the vascular endothelium, smooth muscle cells, or neurons. Mice with global or endothelial cell-specific deletion of CCM3 exhibited defects in embryonic angiogenesis and died at an early embryonic stage. CCM3 deletion reduced vascular endothelial growth factor receptor 2 (VEGFR2) signaling in embryos and endothelial cells. In response to VEGF stimulation, CCM3 was recruited to and stabilized VEGFR2, and the carboxyl-terminal domain of CCM3 was required for the stabilization of VEGFR2. Indeed, the CCM3 mutants found in human patients lacking the carboxyl-terminal domain were labile and were unable to stabilize and activate VEGFR2. These results demonstrate that CCM3 promotes VEGFR2 signaling during vascular development.

Using GMD Data, AIRS Measurements, and the NASA Chemistry-Climate Model to Reveal Regional and Seasonal Variation of Methane

NASA Astrophysics Data System (ADS)

Steele, K. J.; Duncan, B. N.; Warner, J. X.; Nielsen, J. E.

2010-12-01

The concentration of methane (CH4) has more than doubled in the atmosphere since the preindustrial era due to a change in source-sink interactions. Many studies have aimed to quantify CH4 source contributions, but 1) the long tropospheric lifetime of CH4, resulting in a high background concentration, 2) along with sources often having overlapping distributions, and 3) the uncertainty in the chemical sink of CH4 with the hydroxyl radical makes it difficult to constrain inputs to the CH4 budget. The purpose of this study was to use a variety of observations in conjunction with the NASA GEOS-5 climate-chemistry model (CCM) to better understand regional and seasonal variation in atmospheric CH4. Seasonal variation in surface in situ data from the NOAA ESRL Global Monitoring Division (GMD) and data from the Japanese Airlines (JAL) in the upper troposphere (UT) were compared to satellite observations recorded by the Atmospheric Infrared Sounder (AIRS) on the EOS/Aqua satellite, which is most sensitive to CH4 in the UT. There was more variability in CH4 at the GMD sites than in the JAL data or AIRS because the GMD sites are closer to the source. As the CH4 is lofted into the UT, it mixes with the background CH4 so the seasonal variation is dampened. The JAL data followed the AIRS observations as expected. There was less variability in all measurements in the Southern Hemisphere and over oceans because these areas are farther away from sources. While the observations from AIRS, JAL flights, and the GMD sites provide valuable information regarding source locations and atmospheric CH4 concentration, it is important to understand which CH4 sources have the largest contribution to CH4 emissions in different regions of the world and the influence of these sources on the global CH4 cycle. Model output from the GEOS-5 CCM was used to monitor individual CH4 sources (e.g. from rice production, wetlands, biofuel use, etc.) as they are transported from the surface to the UT. The model revealed that variation in source strength is dependent on the site location in relation to the source strength. Assessing CH4 source contributions to the UT revealed that variability is affected by seasonal variation in the sources convolved with seasonal variation in deep convection. More work is needed in order to constrain sources of atmospheric CH4. However, surface and tropospheric in situ data can be used to validate AIRS observations so that CH4 can be monitored at a global scale, and CCM output can aid in determining which sources have the largest contribution to atmospheric CH4.

Stratospheric ozone loss and Antarctic climate change: an update from a stratosphere resolving Chemistry Climate Model simulation

NASA Astrophysics Data System (ADS)

Abalichin, Janna; Kubin, Anne; Grieger, Jens; Langematz, Ulrike; Leckebusch, Gregor C.; Joeckel, Patrick; Brühl, Christoph

2010-05-01

The evolution of Antarctic climate during the past four decades was characterized by enhanced tropospheric westerlies and a negative trend in near-surface temperature over the Antarctic plateau during the austral summer, while the Antarctic Peninsula showed a warming (Thompson and Solomon, 2002). Model simulations suggested that these trends are most certainly attributable to the Antarctic ozone depletion since the early 1980s (Gillett and Thompson, 2003). However, the more recent publication of Steig et al. (2009) finds a warming of the whole Antarctic continent since 1957 in data from satellites and automatic weather stations. Motivated by this discussion we have analysed changes in stratospheric ozone, temperature and dynamics, and the corresponding signal in Antarctic climate in a transient simulation of the period 1960 to 2000, performed with the stratosphere-troposphere Chemistry-Climate Model (CCM) EMAC. The model has been integrated following the SCN2d scenario recommendations of the SPARC CCMVal initiative for the temporal evolution of greenhouse gases, ozone depleting substances and sea surface temperatures/sea ice. The model reproduces the main observed features of the Antarctic stratosphere since the 1960s, e.g. the establishment of the ozone hole in the 1980s, a negative stratospheric temperature trend, and a longer lived and deeper polar vortex and its more intense breakdown. The enhancement of the tropospheric jet is well reproduced as well. With respect to the near surface trends the model seems to support the recently published results of a weak positive temperature trend all over Antarctica. Analyses of heat and humidity fluxes will be used to support the interpretation of the model results.

A Semi-empirical Model of the Stratosphere in the Climate System

NASA Astrophysics Data System (ADS)

Sodergren, A. H.; Bodeker, G. E.; Kremser, S.; Meinshausen, M.; McDonald, A.

2014-12-01

Chemistry climate models (CCMs) currently used to project changes in Antarctic ozone are extremely computationally demanding. CCM projections are uncertain due to lack of knowledge of future emissions of greenhouse gases (GHGs) and ozone depleting substances (ODSs), as well as parameterizations within the CCMs that have weakly constrained tuning parameters. While projections should be based on an ensemble of simulations, this is not currently possible due to the complexity of the CCMs. An inexpensive but realistic approach to simulate changes in stratospheric ozone, and its coupling to the climate system, is needed as a complement to CCMs. A simple climate model (SCM) can be used as a fast emulator of complex atmospheric-ocean climate models. If such an SCM includes a representation of stratospheric ozone, the evolution of the global ozone layer can be simulated for a wide range of GHG and ODS emissions scenarios. MAGICC is an SCM used in previous IPCC reports. In the current version of the MAGICC SCM, stratospheric ozone changes depend only on equivalent effective stratospheric chlorine (EESC). In this work, MAGICC is extended to include an interactive stratospheric ozone layer using a semi-empirical model of ozone responses to CO2and EESC, with changes in ozone affecting the radiative forcing in the SCM. To demonstrate the ability of our new, extended SCM to generate projections of global changes in ozone, tuning parameters from 19 coupled atmosphere-ocean general circulation models (AOGCMs) and 10 carbon cycle models (to create an ensemble of 190 simulations) have been used to generate probability density functions of the dates of return of stratospheric column ozone to 1960 and 1980 levels for different latitudes.

Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study.

PubMed

O'Malley, Ann S; Sarwar, Rumin; Keith, Rosalind; Balke, Patrick; Ma, Sai; McCall, Nancy

2017-12-01

Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward. Semi-structured telephone interviews from January to April 2016 with 71 respondents. Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives. Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices. Improving providers' experiences with and uptake of CCM will require addressing several challenges, including the upfront investment for CCM set-up and the time required to provide CCM to more complex patients.

Countermeasure effectiveness against a man-portable air-defense system containing a two-color spinscan infrared seeker

NASA Astrophysics Data System (ADS)

Jackman, James; Richardson, Mark; Butters, Brian; Walmsley, Roy

2011-12-01

Man-portable air-defense (MANPAD) systems have developed sophisticated counter-countermeasures (CCM) to try and defeat any expendable countermeasure that is deployed by an aircraft. One of these is a seeker that is able to detect in two different parts of the electromagnetic spectrum. Termed two-color, the seeker can compare the emissions from the target and a countermeasure in different wavebands and reject the countermeasure. In this paper we describe the modeling process of a two-color infrared seeker using COUNTERSIM, a missile engagement and countermeasure software simulation tool. First, the simulations model a MANPAD with a two-color CCM which is fired against a fast jet model and a transport aircraft model releasing reactive countermeasures. This is then compared to when the aircraft releases countermeasures throughout an engagement up to the hit point to investigate the optimum flare firing time. The results show that the release time of expendable decoys as a countermeasure against a MANPAD with a two-color CCM is critical.

Impact of the Chronic Care Model on medication adherence when patients perceive cost as a barrier.

PubMed

Mackey, Katherine; Parchman, Michael L; Leykum, Luci K; Lanham, Holly J; Noël, Polly H; Zeber, John E

2012-07-01

Cost burdens represent a significant barrier to medication adherence among chronically ill patients, yet financial pressures may be mitigated by clinical or organizational factors, such as treatment aligned with the Chronic Care Model (CCM). This study examines how perceptions of chronic illness care attenuate the relationship between adherence and cost burden. Surveys were administered to patients at 40 small community-based primary care practices. Medication adherence was assessed using the 4-item Morisky scale, while five cost-related items documented recent pharmacy restrictions. CCM experiences were assessed via the 20-item Patient Assessment of Chronic Illness Care (PACIC). Nested random effects models determined if chronic care perceptions modified the association between medication adherence and cost-related burden. Of 1823 respondents reporting diabetes and other chronic diseases, one-quarter endorsed intrapersonal adherence barriers, while 23% restricted medication due of cost. Controlling for age and health status, the relationship between medication cost and CCM with adherence was significant; including PACIC scores attenuated cost-related problems patients with adequate or problematic adherence behavior. Patients experiencing treatment more consistent with the CCM reported better adherence and lower cost-related burden. Fostering highly activated patients and shared clinical decision making may help alleviate medication cost pressures and improve adherence. Published by Elsevier Ltd.

Probabilistic Analysis of a Composite Crew Module

NASA Technical Reports Server (NTRS)

Mason, Brian H.; Krishnamurthy, Thiagarajan

2011-01-01

An approach for conducting reliability-based analysis (RBA) of a Composite Crew Module (CCM) is presented. The goal is to identify and quantify the benefits of probabilistic design methods for the CCM and future space vehicles. The coarse finite element model from a previous NASA Engineering and Safety Center (NESC) project is used as the baseline deterministic analysis model to evaluate the performance of the CCM using a strength-based failure index. The first step in the probabilistic analysis process is the determination of the uncertainty distributions for key parameters in the model. Analytical data from water landing simulations are used to develop an uncertainty distribution, but such data were unavailable for other load cases. The uncertainty distributions for the other load scale factors and the strength allowables are generated based on assumed coefficients of variation. Probability of first-ply failure is estimated using three methods: the first order reliability method (FORM), Monte Carlo simulation, and conditional sampling. Results for the three methods were consistent. The reliability is shown to be driven by first ply failure in one region of the CCM at the high altitude abort load set. The final predicted probability of failure is on the order of 10-11 due to the conservative nature of the factors of safety on the deterministic loads.

Stabiliztin of VEGFR2 Signaling by Cerebral Cavernous Malformation 3 is Critical for Vascular Development

DOE Office of Scientific and Technical Information (OSTI.GOV)

Y He; H Zhang; L Yu

2011-12-31

Cerebral cavernous malformations (CCMs) are human vascular malformations caused by mutations in three genes of unknown function: CCM1, CCM2, and CCM3. CCM3, also known as PDCD10 (programmed cell death 10), was initially identified as a messenger RNA whose abundance was induced by apoptotic stimuli in vitro. However, the in vivo function of CCM3 has not been determined. Here, we describe mice with a deletion of the CCM3 gene either ubiquitously or specifically in the vascular endothelium, smooth muscle cells, or neurons. Mice with global or endothelial cell-specific deletion of CCM3 exhibited defects in embryonic angiogenesis and died at an earlymore » embryonic stage. CCM3 deletion reduced vascular endothelial growth factor receptor 2 (VEGFR2) signaling in embryos and endothelial cells. In response to VEGF stimulation, CCM3 was recruited to and stabilized VEGFR2, and the carboxyl-terminal domain of CCM3 was required for the stabilization of VEGFR2. Indeed, the CCM3 mutants found in human patients lacking the carboxyl-terminal domain were labile and were unable to stabilize and activate VEGFR2. These results demonstrate that CCM3 promotes VEGFR2 signaling during vascular development.« less

Assessment of the Breakup of the Antarctic Polar Vortex in Two New Chemistry-Climate Models

NASA Technical Reports Server (NTRS)

Hurwitz, M. M.; Newman, P. A.; Oman, L. D.; Li, F.; Morgenstern, O.; Braesicke, P.; Pyle, J. A.

2010-01-01

Successful simulation of the breakup of the Antarctic polar vortex depends on the representation of tropospheric stationary waves at Southern Hemisphere middle latitudes. This paper assesses the vortex breakup in two new chemistry-climate models (CCMs). The stratospheric version of the UK Chemistry and Aerosols model is able to reproduce the observed timing of the vortex breakup. Version 2 of the Goddard Earth Observing System (GEOS V2) model is typical of CCMs in that the Antarctic polar vortex breaks up too late; at 10 hPa, the mean transition to easterlies at 60 S is delayed by 12-13 days as compared with the ERA-40 and National Centers for Environmental Prediction reanalyses. The two models' skill in simulating planetary wave driving during the October-November period accounts for differences in their simulation of the vortex breakup, with GEOS V2 unable to simulate the magnitude and tilt of geopotential height anomalies in the troposphere and thus underestimating the wave driving. In the GEOS V2 CCM the delayed breakup of the Antarctic vortex biases polar temperatures and trace gas distributions in the upper stratosphere in November and December.

Child contact management in high tuberculosis burden countries: A mixed-methods systematic review.

PubMed

Szkwarko, Daria; Hirsch-Moverman, Yael; Du Plessis, Lienki; Du Preez, Karen; Carr, Catherine; Mandalakas, Anna M

2017-01-01

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996-2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children.

Calcium absorption from apple and orange juice fortified with calcium citrate malate (CCM).

PubMed

Andon, M B; Peacock, M; Kanerva, R L; De Castro, J A

1996-06-01

Determine calcium (Ca) absorption from Ca fortified orange and apple juice. Absorbability was assessed by measuring 45Ca absorption in healthy women (mean age 57 years, n = 57/group) and whole body 47Ca retention in adult female beagle dogs (n = 6/group) and young adult male rats (n = 6/group). Women received 6.24 mmol (250 mg) Ca as calcium citrate malate fortified orange juice (CCM-OJ) or apple juice (CCM-AJ). Dogs received 3.12 mmol (125 mg) Ca as CCM-OJ or CCM-AJ. Rats were administered 0.15 mmol (6 mg) Ca as either milk, CCM-OJ, or CCM-AJ. Additional 47Ca whole body retention experiments in rats measured the effects of differences in the carbohydrate and organic acid contents of the juices on Ca absorption. Mean +/- SEM percent Ca fractional absorption was greater (p < 0.003) in women who consumed CCM-AJ (42 +/- 2%) than those who consumed CCM-OJ (36 +/- 1%). Ca retention in dogs was 15 +/- 1% for CCM-OJ and 29 +/- 2% for CCM-AJ (p < 0.001). Ca retention was significantly different (p < 0.05) in rats administered milk (42 +/- 2%), CCM-OJ (52 +/- 2%), or CCM-AJ (61 +/- 2%). By manipulating the carbohydrate and organic acid concentrations of test solutions to mimic the composition of Ca fortified juices, we found that the greater fructose and lower organic acid content of apple juice accounted for its greater Ca absorbability. CCM fortified versions of orange and apple juice have high Ca absorbability and are potentially important vehicles for increasing dietary Ca intake. The greater Ca absorption from CCM-AJ compared with CCM-OJ is accounted for by differences in the carbohydrate and organic acid content of the juices. These data suggest that by modifying common beverage ingredients, products with even greater Ca absorbability could be formulated.

Child contact management in high tuberculosis burden countries: A mixed-methods systematic review

PubMed Central

Du Plessis, Lienki; Du Preez, Karen; Carr, Catherine; Mandalakas, Anna M.

2017-01-01

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996–2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population: child contacts (<15 years) exposed to TB in the household from programmatic settings in high burden countries (HBCs), b) interventions: CCM strategies implemented within the CCM cascade, c) comparisons: CCM strategies studied and compared in HBCs, and d) outcomes: monitoring and evaluation of CCM outcomes reported in the literature for each CCM cascade step. We included any quantitative, qualitative, mixed-methods study design except for randomized-controlled trials, editorials or commentaries. Thirty-seven studies were reviewed. Child contact losses varied greatly for screening, isoniazid preventive therapy initiation, and completion. CCM challenges included: infrastructure, knowledge, attitudes, stigma, access, competing priorities, and treatment. CCM recommendations included: health system strengthening, health education, and improved preventive therapy. Identified predictors included: index case and clinic characteristics, perceptions of barriers and risk, costs, and treatment characteristics. CCM lacks standardization resulting in common challenges and losses throughout the CCM cascade. Prioritization of a CCM-friendly healthcare environment with improved CCM processes and tools; health education; and active, evidence-based strategies can decrease barriers. A focused approach toward every aspect of the CCM cascade will likely diminish losses throughout the CCM cascade and ultimately decrease TB related morbidity and mortality in children. PMID:28763500

Volcanic forcing for climate modeling: a new microphysics-based data set covering years 1600-present

NASA Astrophysics Data System (ADS)

Arfeuille, F.; Weisenstein, D.; Mack, H.; Rozanov, E.; Peter, T.; Brönnimann, S.

2014-02-01

As the understanding and representation of the impacts of volcanic eruptions on climate have improved in the last decades, uncertainties in the stratospheric aerosol forcing from large eruptions are now linked not only to visible optical depth estimates on a global scale but also to details on the size, latitude and altitude distributions of the stratospheric aerosols. Based on our understanding of these uncertainties, we propose a new model-based approach to generating a volcanic forcing for general circulation model (GCM) and chemistry-climate model (CCM) simulations. This new volcanic forcing, covering the 1600-present period, uses an aerosol microphysical model to provide a realistic, physically consistent treatment of the stratospheric sulfate aerosols. Twenty-six eruptions were modeled individually using the latest available ice cores aerosol mass estimates and historical data on the latitude and date of eruptions. The evolution of aerosol spatial and size distribution after the sulfur dioxide discharge are hence characterized for each volcanic eruption. Large variations are seen in hemispheric partitioning and size distributions in relation to location/date of eruptions and injected SO2 masses. Results for recent eruptions show reasonable agreement with observations. By providing these new estimates of spatial distributions of shortwave and long-wave radiative perturbations, this volcanic forcing may help to better constrain the climate model responses to volcanic eruptions in the 1600-present period. The final data set consists of 3-D values (with constant longitude) of spectrally resolved extinction coefficients, single scattering albedos and asymmetry factors calculated for different wavelength bands upon request. Surface area densities for heterogeneous chemistry are also provided.

Volcanic forcing for climate modeling: a new microphysics-based dataset covering years 1600-present

NASA Astrophysics Data System (ADS)

Arfeuille, F.; Weisenstein, D.; Mack, H.; Rozanov, E.; Peter, T.; Brönnimann, S.

2013-02-01

As the understanding and representation of the impacts of volcanic eruptions on climate have improved in the last decades, uncertainties in the stratospheric aerosol forcing from large eruptions are now not only linked to visible optical depth estimates on a global scale but also to details on the size, latitude and altitude distributions of the stratospheric aerosols. Based on our understanding of these uncertainties, we propose a new model-based approach to generating a volcanic forcing for General-Circulation-Model (GCM) and Chemistry-Climate-Model (CCM) simulations. This new volcanic forcing, covering the 1600-present period, uses an aerosol microphysical model to provide a realistic, physically consistent treatment of the stratospheric sulfate aerosols. Twenty-six eruptions were modeled individually using the latest available ice cores aerosol mass estimates and historical data on the latitude and date of eruptions. The evolution of aerosol spatial and size distribution after the sulfur dioxide discharge are hence characterized for each volcanic eruption. Large variations are seen in hemispheric partitioning and size distributions in relation to location/date of eruptions and injected SO2 masses. Results for recent eruptions are in good agreement with observations. By providing accurate amplitude and spatial distributions of shortwave and longwave radiative perturbations by volcanic sulfate aerosols, we argue that this volcanic forcing may help refine the climate model responses to the large volcanic eruptions since 1600. The final dataset consists of 3-D values (with constant longitude) of spectrally resolved extinction coefficients, single scattering albedos and asymmetry factors calculated for different wavelength bands upon request. Surface area densities for heterogeneous chemistry are also provided.

Chronic care model implementation in the California State Prison System.

PubMed

Ha, Betsy Chang; Robinson, Greg

2011-04-01

The chronic care model (CCM) deployed through a learning collaborative strategy, such as the Institute for Healthcare Improvement's Breakthrough Series (BTS), is a widely adopted approach to improve care that has guided clinical quality initiatives nationally and internationally. The BTS collaborative approach has been used to improve chronic conditions at national and state levels and in single health care delivery systems but not in correctional health care. Combining the CCM with a learning collaborative strategy in prison health care is a new frontier. This article describes the adoption of the CCM using a learning collaborative approach in the California prison system under the mandate of a federal receivership and elucidates some barriers to implementation. Results from the first phase of a pilot study were positive in terms of benefit/ cost analysis and suggest financial and political viability to continue the program.

Does coupled ocean enhance ozone-hole-induced Southern Hemisphere circulation changes?

NASA Astrophysics Data System (ADS)

Son, S. W.; Han, B. R.; Kim, S. Y.; Park, R.

2017-12-01

The ozone-hole-induced Southern Hemisphere (SH) circulation changes, such as poleward shift of westerly jet and Hadley cell widening, have been typically explored with either coupled general circulation models (CGCMs) prescribing stratospheric ozone or chemistry-climate models (CCMs) prescribing surface boundary conditions. Only few studies have utilized ocean-coupled CCMs with a relatively coarse resolution. To better quantify the role of interactive chemistry and coupled ocean in the ozone-hole-induced SH circulation changes, the present study examines a set of CGCM and CCM simulations archived for the Coupled Model Intercomparison Project phase 5 (CMIP5) and CCM initiative (CCMI). Although inter-model spread of Antarctic ozone depletion is substantially large especially in the austral spring, both CGCMs with relatively simple ozone chemistry and CCMs with fully interactive comprehensive chemistry reasonably well reproduce long-term trends of Antarctic ozone and the associated polar-stratospheric temperature changes. Most models reproduce a poleward shift of SH jet and Hadley-cell widening in the austral summer in the late 20th century as identified in reanalysis datasets. These changes are quasi-linearly related with Antarctic ozone changes, confirming the critical role of Antarctic ozone depletion in the austral-summer zonal-mean circulation changes. The CGCMs with simple but still interactive ozone show slightly stronger circulation changes than those with prescribed ozone. However, the long-term circulation changes in CCMs are largely insensitive to the coupled ocean. While a few models show the enhanced circulation changes when ocean is coupled, others show essentially no changes or even weakened circulation changes. This result suggests that the ozone-hole-related stratosphere-troposphere coupling in the late 20th century may be only weakly sensitive to the coupled ocean.

Revised Tijeras Arroyo Groundwater Current Conceptual Model and Corrective Measures Evaluation Report - February 2018.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Copland, John R.

The U.S. Department of Energy (DOE) and the management and operating (M&O) contractor for Sandia National Laboratories beginning on May 1, 2017, National Technology & Engineering Solutions of Sandia, LLC (NTESS), hereinafter collectively referred to as DOE/NTESS, prepared this Revised Tijeras Arroyo Groundwater Current Conceptual Model (CCM) and Corrective Measures Evaluation (CME) Report , referred to as the Revised CCM/CME Report, to meet requirements under the Sandia National Laboratories-New Mexico (SNL/NM) Compliance Order on Consent (Consent Order). The Consent Order became effective on April 29, 2004. The Consent Order identifies the Tijeras Arroyo Groundwater (TAG) Area of Concern (AOC) asmore » an area of groundwater contamination requiring further characterization and corrective action. In November 2004, New Mexico Environment Department (NMED) approved the July 2004 CME Work Plan. In April 2005, DOE and the SNL M&O contractor at the time, Sandia Corporation (Sandia), hereinafter collectively referred to as DOE/Sandia, submitted a CME Report, but NMED did not finalize review of that document. In December 2016, DOE/Sandia submitted a combined and updated CCM/CME Report. NMED issued a disapproval letter in May 2017 that included comments on the December 2016 CCM/CME Report. In August 2017, NMED and DOE/NTESS staff held a meeting to discuss and clarify outstanding issues. This Revised CCM/CME Report addresses (1) the issues presented in the NMED May 2017 disapproval letter and (2) findings from the August 2017 meeting.« less

The association between chronic care management and the quality of thrombosis care

PubMed Central

Drewes, H.W.; Baan, C.A.; Westert, G.P.; Meijboom, B.R.; Lambooij, M.

2010-01-01

Introduction The oral anticoagulant therapy (OAT), used to prevent thrombosis, is associated with substantial avoidable hospitalization. Aim Identify the associations between chronic care management and the quality of OAT as suggested by the chronic care model (CCM) of Wagner. Methods Regression analysis with data of 61 thrombosis clinics and inductive analysis with 63 interviews with health care professionals of 23 thrombosis clinics. Results Results show substantial differences between regions in the quality of thrombosis care and the CCM activities. However, the variation in quality of care was not associated with the differences in CCM activities. The inductive analysis indicates that there are problems in the cooperation between caregivers. Several preferred CCM activities (e.g., multidisciplinary protocol) as well as the barriers to implement these activities (e.g., conflicting interests) were put forward by the health care professionals. Conclusion It can be concluded that there is variation in quality of thrombosis care between regions. This variation could not be explained by the observed differences in CCM activities. However, fragmentation is a major source of inefficiency according to health care professionals. The paper concludes with suggestions to improve chronic care management for thrombosis.

Flyback CCM inverter for AC module applications: iterative learning control and convergence analysis

NASA Astrophysics Data System (ADS)

Lee, Sung-Ho; Kim, Minsung

2017-12-01

This paper presents an iterative learning controller (ILC) for an interleaved flyback inverter operating in continuous conduction mode (CCM). The flyback CCM inverter features small output ripple current, high efficiency, and low cost, and hence it is well suited for photovoltaic power applications. However, it exhibits the non-minimum phase behaviour, because its transfer function from control duty to output current has the right-half-plane (RHP) zero. Moreover, the flyback CCM inverter suffers from the time-varying grid voltage disturbance. Thus, conventional control scheme results in inaccurate output tracking. To overcome these problems, the ILC is first developed and applied to the flyback inverter operating in CCM. The ILC makes use of both predictive and current learning terms which help the system output to converge to the reference trajectory. We take into account the nonlinear averaged model and use it to construct the proposed controller. It is proven that the system output globally converges to the reference trajectory in the absence of state disturbances, output noises, or initial state errors. Numerical simulations are performed to validate the proposed control scheme, and experiments using 400-W AC module prototype are carried out to demonstrate its practical feasibility.

Update on Novel CCM Gene Mutations in Patients with Cerebral Cavernous Malformations.

PubMed

Scimone, Concetta; Bramanti, Placido; Alafaci, Concetta; Granata, Francesca; Piva, Francesco; Rinaldi, Carmela; Donato, Luigi; Greco, Federica; Sidoti, Antonina; D'Angelo, Rosalia

2017-02-01

Cerebral cavernous malformations (CCMs) are lesions affecting brain microvessels. The pathogenesis is not clearly understood. Conventional classification criterion is based on genetics, and thus, familial and sporadic forms can be distinguished; however, classification of sporadic cases with multiple lesions still remains uncertain. To date, three CCM causative genes have been identified: CCM1/KRIT1, CCM2/MGC4607 and CCM3/PDCD10. In our previous mutation screening, performed in a cohort of 95 Italian patients, with both sporadic and familial cases, we identified several mutations in CCM genes. This study represents further molecular screening in a cohort of 19 Italian patients enrolled by us in the few last years and classified into familial, sporadic and sporadic with multiple lesions cases. Direct sequencing and multiplex ligation-dependent probe amplification (MLPA) analysis were performed to detect point mutations and large genomic rearrangements, respectively. Effects of detected mutations and single-nucleotide polymorphisms (SNPs) were evaluated by an in silico approach and by western blot analysis. A novel nonsense mutation in CCM1 and a novel missense mutation in CCM2 were detected; moreover, several CCM2 gene polymorphisms in sporadic CCM patients were reported. We believe that these data enrich the mutation spectrum of CCM genes, which is useful for genetic counselling to identify both familial and sporadic CCM cases, as early as possible.

A variant System I for cytochrome c biogenesis in archaea and some bacteria has a novel CcmE and no CcmH.

PubMed

Allen, James W A; Harvat, Edgar M; Stevens, Julie M; Ferguson, Stuart J

2006-09-04

C-type cytochromes are characterized by post-translational covalent attachment of heme to thiols that occur in a Cys-Xxx-Xxx-Cys-His motif. Three distinct biogenesis systems are known for this heme attachment. Archaea are now shown to contain a significantly modified form of cytochrome c maturation System I (the Ccm system). The most notable adaptation relative to the well-studied apparatus from proteobacteria and plants is a novel form of the heme chaperone CcmE, lacking the highly conserved histidine that covalently binds heme and is essential for function in Escherichia coli. In most archaeal CcmEs this histidine, normally found in a His-Xxx-Xxx-Xxx-Tyr motif, is replaced by a cysteine residue that occurs in a Cys-Xxx-Xxx-Xxx-Tyr motif. The CcmEs from two halobacteria contain yet another form of CcmE, having HxxxHxxxH approximately corresponding in alignment to the H/CxxxY motif. The CxxxY-type of CcmE is, surprisingly, also found in some bacterial genomes (including Desulfovibrio species). All of the modified CcmEs cluster together in a phylogenetic tree, as do other Ccm proteins from the same organisms. Significantly, CcmH is absent from all of the complete archaeal genomes we have studied, and also from most of the bacterial genomes that have CxxxY-type CcmE.

75 FR 31419 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-03

... Person Interview (PI) and CCM PFU have been added. These are to be conducted as part of a CCM evaluation... CCM PI OMB package. The CCM program will provide estimates of net coverage error and components of... (PI) and CCM PFU will be conducted. The purpose of the respondent debriefings is to obtain a...

Developing measures of educational change for academic health care teams implementing the chronic care model in teaching practices.

PubMed

Bowen, Judith L; Stevens, David P; Sixta, Connie S; Provost, Lloyd; Johnson, Julie K; Woods, Donna M; Wagner, Edward H

2010-09-01

The Chronic Care Model (CCM) is a multidimensional framework designed to improve care for patients with chronic health conditions. The model strives for productive interactions between informed, activated patients and proactive practice teams, resulting in better clinical outcomes and greater satisfaction. While measures for improving care may be clear, measures of residents' competency to provide chronic care do not exist. This report describes the process used to develop educational measures and results from CCM settings that used them to monitor curricular innovations. Twenty-six academic health care teams participating in the national and California Academic Chronic Care Collaboratives. Using successive discussion groups and surveys, participants engaged in an iterative process to identify desirable and feasible educational measures for curricula that addressed educational objectives linked to the CCM. The measures were designed to facilitate residency programs' abilities to address new accreditation requirements and tested with teams actively engaged in redesigning educational programs. Field notes from each discussion and lists from work groups were synthesized using the CCM framework. Descriptive statistics were used to report survey results and measurement performance. Work groups generated educational objectives and 17 associated measurements. Seventeen (65%) teams provided feasibility and desirability ratings for the 17 measures. Two process measures were selected for use by all teams. Teams reported variable success using the measures. Several teams reported use of additional measures, suggesting more extensive curricular change. Using an iterative process in collaboration with program participants, we successfully defined a set of feasible and desirable education measures for academic health care teams using the CCM. These were used variably to measure the results of curricular changes, while simultaneously addressing requirements for residency accreditation.

Combinatorial interaction between CCM pathway genes precipitates hemorrhagic stroke.

PubMed

Gore, Aniket V; Lampugnani, Maria Grazia; Dye, Louis; Dejana, Elisabetta; Weinstein, Brant M

2008-01-01

Intracranial hemorrhage (ICH) is a particularly severe form of stroke whose etiology remains poorly understood, with a highly variable appearance and onset of the disease (Felbor et al., 2006; Frizzell, 2005; Lucas et al., 2003). In humans, mutations in any one of three CCM genes causes an autosomal dominant genetic ICH disorder characterized by cerebral cavernous malformations (CCM). Recent evidence highlighting multiple interactions between the three CCM gene products and other proteins regulating endothelial junctional integrity suggests that minor deficits in these other proteins could potentially predispose to, or help to initiate, CCM, and that combinations of otherwise silent genetic deficits in both the CCM and interacting proteins might explain some of the variability in penetrance and expressivity of human ICH disorders. Here, we test this idea by combined knockdown of CCM pathway genes in zebrafish. Reducing the function of rap1b, which encodes a Ras GTPase effector protein for CCM1/Krit1, disrupts endothelial junctions in vivo and in vitro, showing it is a crucial player in the CCM pathway. Importantly, a minor reduction of Rap1b in combination with similar reductions in the products of other CCM pathway genes results in a high incidence of ICH. These findings support the idea that minor polygenic deficits in the CCM pathway can strongly synergize to initiate ICH.

The evolution of the Brewer-Dobson Circulation from 1960-2100 in simulations with the Chemistry Climate Model EMAC

NASA Astrophysics Data System (ADS)

Oberländer, Sophie; Langematz, Ulrike; Kubin, Anne; Abalichin, Janna; Meul, Stefanie; Jöckel, Patrick; Brühl, Christoph

2010-05-01

First results of research performed within the new DFG Research Unit Stratospheric Change and its Role for Climate Prediction (SHARP) will be presented. SHARP investigates past and future changes in stratospheric dynamics and composition to improve the understanding of global climate change and the accuracy of climate change predictions. SHARP combines the efforts of eight German research institutes and expertise in state-of-the-art climate modelling and observations. Within the scope of the scientific sub-project SHARP-BDC (Brewer-Dobson-Circulation) the past and future evolution of the BDC in an atmosphere with changing composition will be analysed. Radiosonde data show an annual mean cooling of the tropical lower stratosphere over the past few decades (Thompson and Solomon, 2005). Several independent model simulations indicate an acceleration of the BDC due to higher greenhouse gas (GHG) concentrations with direct impact on the exchange of air masses between the troposphere and stratosphere (e.g., Butchart et al, 2006). In contrast, from balloon-born measurements no significant acceleration in the BDC could be identified (Engel et al, 2008). This disagreement between observations and model analyses motivates further studies. For the future, expected changes in planetary wave generation and propagation in an atmosphere with increasing GHG concentrations are a major source of uncertainty for predicting future levels of stratospheric composition. To analyse and interpret the past and future evolution of the BDC, results from a transient multi-decadal simulation with the Chemistry-Climate Model (CCM) EMAC will be presented. The model has been integrated from 1960 to 2100 following the SCN2d scenario recommendations of the SPARC CCMVal initiative for the temporal evolution of GHGs, ozone depleting substances and sea surface temperatures as well as sea ice. The role of increasing GHG concentrations for the BDC will be assessed by comparing the SCN2d-results with a ‘non-climate change' (NCC) simulation, in which greenhouse gases have been kept fixed at their 1960 concentrations.

RCCM2-BATS model over tropical South America: Applications to tropical deforestation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hahmann, A.N.; Dickinson, R.E.

A multiyear simulation of the global climate uses a revised version of the National Center for Atmospheric Research (NCAR) Community Climate Model Version 2 (CCM2) coupled to the Biosphere-Atmosphere Transfer Scheme (BATS). It is compared with global and rain gauge precipitation climatologies to evaluate precipitation fields and European Centre for Medium-Range Forecasts analyses to evaluate the atmospheric circulation. The near-surface climate is compared with data from Amazonian field campaigns. The model simulation of the South American climate agrees closely with the observational record and is much improved from past simulations with previous versions of the NCAR Community Climate model overmore » this portion of the Tropics. The model is then used to study the local and regional response to tropical deforestation over Amazonia. In addition to the standard deforestation forcing, consisting mainly of increased albedo and decreased roughness length, two additional sensitivity experiments were conducted to assess the individual contributions from these forcings to the deforestation changes. The standard deforestation simulation shows slight increases in annually averaged surface temperature (+1{degrees}C) and reductions in annually averaged precipitation and evaporation (-363 and -149 mm yr{sup -1}, respectively). As expected, increases in surface albedo over Amazonia produce a reduction in net downward solar radiation at the surface and consequently a reduction in net surface radiation and surface latent heat flux. The roughness decrease, on the other hand, reduces the surface latent heat fluxes through decreases in the surface drag coefficient. The regional changes in moisture convergence and precipitation during the Amazonian wet season display a shift in the area of maximum precipitation rather than an overall decrease over the deforested area. 45 refs., 16 figs., 4 tabs.« less

Impact of climate variability on tropospheric ozone.

PubMed

Grewe, Volker

2007-03-01

A simulation with the climate-chemistry model (CCM) E39/C is presented, which covers both the troposphere and stratosphere dynamics and chemistry during the period 1960 to 1999. Although the CCM, by its nature, is not exactly representing observed day-by-day meteorology, there is an overall model's tendency to correctly reproduce the variability pattern due to an inclusion of realistic external forcings, like observed sea surface temperatures (e.g. El Niño), major volcanic eruption, solar cycle, concentrations of greenhouse gases, and Quasi-Biennial Oscillation. Additionally, climate-chemistry interactions are included, like the impact of ozone, methane, and other species on radiation and dynamics, and the impact of dynamics on emissions (lightning). However, a number of important feedbacks are not yet included (e.g. feedbacks related to biogenic emissions and emissions due to biomass burning). The results show a good representation of the evolution of the stratospheric ozone layer, including the ozone hole, which plays an important role for the simulation of natural variability of tropospheric ozone. Anthropogenic NO(x) emissions are included with a step-wise linear trend for each sector, but no interannual variability is included. The application of a number of diagnostics (e.g. marked ozone tracers) allows the separation of the impact of various processes/emissions on tropospheric ozone and shows that the simulated Northern Hemisphere tropospheric ozone budget is not only dominated by nitrogen oxide emissions and other ozone pre-cursors, but also by changes of the stratospheric ozone budget and its flux into the troposphere, which tends to reduce the simulated positive trend in tropospheric ozone due to emissions from industry and traffic during the late 80s and early 90s. For tropical regions the variability in ozone is dominated by variability in lightning (related to ENSO) and stratosphere-troposphere exchange (related to Northern Hemisphere Stratospheric dynamics and solar activity). Since tropospheric background chemistry is regarded only, the results are quantitatively limited with respect to derived trends. However, the main results are regarded to be robust. Although the horizontal resolution is rather coarse in comparison to regional models, such kind of simulations provide useful and necessary information on the impact of large-scale processes and inter-annual/decadal variations on regional air quality.

Rapid Crop Cover Mapping for the Conterminous United States.

PubMed

Dahal, Devendra; Wylie, Bruce; Howard, Danny

2018-06-05

Timely crop cover maps with sufficient resolution are important components to various environmental planning and research applications. Through the modification and use of a previously developed crop classification model (CCM), which was originally developed to generate historical annual crop cover maps, we hypothesized that such crop cover maps could be generated rapidly during the growing season. Through a process of incrementally removing weekly and monthly independent variables from the CCM and implementing a 'two model mapping' approach, we found it viable to generate conterminous United States-wide rapid crop cover maps at a resolution of 250 m for the current year by the month of September. In this approach, we divided the CCM model into one 'crop type model' to handle the classification of nine specific crops and a second, binary model to classify the presence or absence of 'other' crops. Under the two model mapping approach, the training errors were 0.8% and 1.5% for the crop type and binary model, respectively, while test errors were 5.5% and 6.4%, respectively. With spatial mapping accuracies for annual maps reaching upwards of 70%, this approach demonstrated a strong potential for generating rapid crop cover maps by the 1 st of September.

Satellite Observations and Chemistry Climate Models - A Meandering Path Towards Better Predictions

NASA Technical Reports Server (NTRS)

Douglass, Anne R.

2011-01-01

Knowledge of the chemical and dynamical processes that control the stratospheric ozone layer has grown rapidly since the 1970s, when ideas that depletion of the ozone layer due to human activity were put forth. The concept of ozone depletion due to anthropogenic chlorine increase is simple; quantification of the effect is much more difficult. The future of stratospheric ozone is complicated because ozone is expected to increase for two reasons: the slow decrease in anthropogenic chlorine due to the Montreal Protocol and its amendments and stratospheric cooling caused by increases in carbon dioxide and other greenhouse gases. Prediction of future ozone levels requires three-dimensional models that represent physical, photochemical and radiative processes, i.e., chemistry climate models (CCMs). While laboratory kinetic and photochemical data are necessary inputs for a CCM, atmospheric measurements are needed both to reveal physical and chemical processes and for comparison with simulations to test the conceptual model that CCMs represent. Global measurements are available from various satellites including but not limited to the LIMS and TOMS instruments on Nimbus 7 (1979 - 1993), and various instruments on the Upper Atmosphere Research Satellite (1991 - 2005), Envisat (2002 - ongoing), Sci-Sat (2003 - ongoing) and Aura (2004 - ongoing). Every successful satellite instrument requires a physical concept for the measurement, knowledge of physical chemical properties of the molecules to be measured, and stellar engineering to design an instrument that will survive launch and operate for years with no opportunity for repair but providing enough information that trend information can be separated from any instrument change. The on-going challenge is to use observations to decrease uncertainty in prediction. This talk will focus on two applications. The first considers transport diagnostics and implications for prediction of the eventual demise of the Antarctic ozone hole. The second focuses on the upper stratosphere, where ozone is predicted to increase both due to chlorine decrease and due to temperature decrease expected as a result of increased concentrations Of CO2 and other greenhouse gases. Both applications show how diagnostics developed from global observations are being used to explain why the ozone response varies among CCM predictions for stratospheric ozone in the 21st century.

STAR-CCM+ Verification and Validation Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pointer, William David

2016-09-30

The commercial Computational Fluid Dynamics (CFD) code STAR-CCM+ provides general purpose finite volume method solutions for fluid dynamics and energy transport. This document defines plans for verification and validation (V&V) of the base code and models implemented within the code by the Consortium for Advanced Simulation of Light water reactors (CASL). The software quality assurance activities described herein are port of the overall software life cycle defined in the CASL Software Quality Assurance (SQA) Plan [Sieger, 2015]. STAR-CCM+ serves as the principal foundation for development of an advanced predictive multi-phase boiling simulation capability within CASL. The CASL Thermal Hydraulics Methodsmore » (THM) team develops advanced closure models required to describe the subgrid-resolution behavior of secondary fluids or fluid phases in multiphase boiling flows within the Eulerian-Eulerian framework of the code. These include wall heat partitioning models that describe the formation of vapor on the surface and the forces the define bubble/droplet dynamic motion. The CASL models are implemented as user coding or field functions within the general framework of the code. This report defines procedures and requirements for V&V of the multi-phase CFD capability developed by CASL THM. Results of V&V evaluations will be documented in a separate STAR-CCM+ V&V assessment report. This report is expected to be a living document and will be updated as additional validation cases are identified and adopted as part of the CASL THM V&V suite.« less

Systems analysis of the CO2 concentrating mechanism in cyanobacteria

PubMed Central

Mangan, Niall M; Brenner, Michael P

2014-01-01

Cyanobacteria are photosynthetic bacteria with a unique CO2 concentrating mechanism (CCM), enhancing carbon fixation. Understanding the CCM requires a systems level perspective of how molecular components work together to enhance CO2 fixation. We present a mathematical model of the cyanobacterial CCM, giving the parameter regime (expression levels, catalytic rates, permeability of carboxysome shell) for efficient carbon fixation. Efficiency requires saturating the RuBisCO reaction, staying below saturation for carbonic anhydrase, and avoiding wasteful oxygenation reactions. We find selectivity at the carboxysome shell is not necessary; there is an optimal non-specific carboxysome shell permeability. We compare the efficacy of facilitated CO2 uptake, CO2 scavenging, and HCO3− transport with varying external pH. At the optimal carboxysome permeability, contributions from CO2 scavenging at the cell membrane are small. We examine the cumulative benefits of CCM spatial organization strategies: enzyme co-localization and compartmentalization. DOI: http://dx.doi.org/10.7554/eLife.02043.001 PMID:24842993

Rubisco small-subunit α-helices control pyrenoid formation in Chlamydomonas

PubMed Central

Meyer, Moritz T.; Genkov, Todor; Skepper, Jeremy N.; Jouhet, Juliette; Mitchell, Madeline C.; Spreitzer, Robert J.; Griffiths, Howard

2012-01-01

The pyrenoid is a subcellular microcompartment in which algae sequester the primary carboxylase, ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco). The pyrenoid is associated with a CO2-concentrating mechanism (CCM), which improves the operating efficiency of carbon assimilation and overcomes diffusive limitations in aquatic photosynthesis. Using the model alga Chlamydomonas reinhardtii, we show that pyrenoid formation, Rubisco aggregation, and CCM activity relate to discrete regions of the Rubisco small subunit (SSU). Specifically, pyrenoid occurrence was shown to be conditioned by the amino acid composition of two surface-exposed α-helices of the SSU: higher plant-like helices knock out the pyrenoid, whereas native algal helices establish a pyrenoid. We have also established that pyrenoid integrity was essential for the operation of an active CCM. With the algal CCM being functionally analogous to the terrestrial C4 pathway in higher plants, such insights may offer a route toward transforming algal and higher plant productivity for the future. PMID:23112177

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gilkey, Lindsay

This milestone presents a demonstration of the High-to-Low (Hi2Lo) process in the VVI focus area. Validation and additional calculations with the commercial computational fluid dynamics code, STAR-CCM+, were performed using a 5x5 fuel assembly with non-mixing geometry and spacer grids. This geometry was based on the benchmark experiment provided by Westinghouse. Results from the simulations were compared to existing experimental data and to the subchannel thermal-hydraulics code COBRA-TF (CTF). An uncertainty quantification (UQ) process was developed for the STAR-CCM+ model and results of the STAR UQ were communicated to CTF. Results from STAR-CCM+ simulations were used as experimental design pointsmore » in CTF to calibrate the mixing parameter β and compared to results obtained using experimental data points. This demonstrated that CTF’s β parameter can be calibrated to match existing experimental data more closely. The Hi2Lo process for the STAR-CCM+/CTF code coupling was documented in this milestone and closely linked L3:VVI.H2LP15.01 milestone report.« less

Choosing Meteorological Input for the Global Modeling Initiative Assessment of High Speed Aircraft

NASA Technical Reports Server (NTRS)

Douglas, A. R.; Prather, M. P.; Hall, T. M.; Strahan, S. E.; Rasch, P. J.; Sparling, L. C.; Coy, L.; Rodriquez, J. M.

1998-01-01

The Global Modeling Initiative (GMI) science team is developing a three dimensional chemistry and transport model (CTM) to be used in assessment of the atmospheric effects of aviation. Requirements are that this model be documented, be validated against observations, use a realistic atmospheric circulation, and contain numerical transport and photochemical modules representing atmospheric processes. The model must also retain computational efficiency to be tractable to use for multiple scenarios and sensitivity studies. To meet these requirements, a facility model concept was developed in which the different components of the CTM are evaluated separately. The first use of the GMI model will be to evaluate the impact of the exhaust of supersonic aircraft on the stratosphere. The assessment calculations will depend strongly on the wind and temperature fields used by the CTM. Three meteorological data sets for the stratosphere are available to GMI: the National Center for Atmospheric Research Community Climate Model (CCM2), the Goddard Earth Observing System Data Assimilation System (GEOS DAS), and the Goddard Institute for Space Studies general circulation model (GISS). Objective criteria were established by the GMI team to identify the data set which provides the best representation of the stratosphere. Simulations of gases with simple chemical control were chosen to test various aspects of model transport. The three meteorological data sets were evaluated and graded based on their ability to simulate these aspects of stratospheric measurements. This paper describes the criteria used in grading the meteorological fields. The meteorological data set which has the highest score and therefore was selected for GMI is CCM2. This type of objective model evaluation establishes a physical basis for interpretation of differences between models and observations. Further, the method provides a quantitative basis for defining model errors, for discriminating between different models, and for ready re-evaluation of improved models. These in turn will lead to a higher level of confidence in assessment calculations.

Sensitivity of aerosol loading and properties to cloudiness

NASA Astrophysics Data System (ADS)

Iversen, T.; Seland, O.; Kirkevag, A.; Kristjansson, J. E.

2005-12-01

Clouds influence aerosols in various ways. Sulfate is swiftly produced in liquid phase provided there is both sulfur dioxide and oxidants available. Nucleation and Aitken mode aerosol particles efficiently grow in size by collision and coagulation with cloud droplets. When precipitation is formed, aerosol and precursor gases may be quickly removed bay rainout. The dynamics associated with clouds in some cases may swiftly mix aerosols deeply into the troposphere. In some cases Aitken-mode particles may be formed in cloud droplets by splitting agglomerates of particulate matter such as black carbon In this presentation we will discuss how global cloudiness may influence the burden, residence time, and spatial distribution of sulfate, black carbon and particulate organic matter. A similar physico-chemical scheme for there compounds has been implemented in three generations of the NCAR community climate model (CCM3, CAM2 and CAM3). The scheme is documented in the literature and is a part of the Aerocom-intercomparison. There are many differences between these models. With respect to aerosols, a major difference is that CAM3 has a considerably higher global cloud volume and more then twice the amount of cloud water than CAM2 and CCM3. Atmospheric simulations have been made with prescribed ocean temperatures. It is slightly surprising to discover that certain aspects of the aerosols are not particularly sensitive to these differences in cloud availability. This sensitivity will be compared to sensitivities with respect to processing in deep convective clouds.

Red-pink pigmented Hymenobacter coccineus sp. nov., Hymenobacter lapidarius sp. nov. and Hymenobacter glacialis sp. nov., isolated from rocks in Antarctica.

PubMed

Sedláček, Ivo; Králová, Stanislava; Kýrová, Kamila; Mašlaňová, Ivana; Busse, Hans-Jürgen; Staňková, Eva; Vrbovská, Veronika; Němec, Miroslav; Barták, Miloš; Holochová, Pavla; Švec, Pavel; Pantůček, Roman

2017-06-01

Four rod-shaped and Gram-stain-negative bacterial strains, CCM 8647, CCM 8649T, CCM 8643T and CCM 8648T, were isolated from rock samples collected on James Ross Island, Antarctica. Extensive biotyping, fatty acid profiling, chemotaxonomy, 16S rRNA gene sequencing and whole-genome sequencing was applied to isolates to clarify their taxonomic position. Phylogenetic analysis based on 16S rRNA gene sequencing indicated that all four isolates belonged to the genus Hymenobacter. Strains CCM 8649T and CCM 8647 were most closely related to Hymenobacter arizonensis OR362-8T (94.4 % 16S rRNA gene sequence similarity), strain CCM 8643T to Hymenobacter terrae DG7AT (96.3 %) and strain CCM 8648T to Hymenobacter glaciei VUG-A130T (96.3 %). The predominant fatty acids of CCM 8649T and CCM 8647 were summed feature 3 (C16 : 1ω7c/C16 : 1ω6c), C16 : 1ω5c and iso-C15 : 0, whereas those of CCM 8643T and CCM 8648T were summed feature 3 (C16 : 1ω7c/C16 : 1ω6c) and C16 : 1ω5c. The quinone systems contained exclusively menaquinone MK-7. The major polyamine was sym-homospermidine. All four strains contained the major polar lipid phosphatidylethanolamine. The G+C content of genomic DNA ranged from 60-63 mol%. Whole-genome sequencing data supported the finding that isolates represented distinct species of the genus Hymenobacter. On the basis of the results obtained, three novel species are proposed for which the names Hymenobacter coccineus sp. nov., Hymenobacter lapidarius sp. nov. and Hymenobacter glacialis sp. nov. are suggested, with the type strains CCM 8649T (=LMG 29441T=P5239T), CCM 8643T (=LMG 29435T=P3150T) and CCM 8648T (=LMG 29440T=P5086T), respectively.

Circle of care modelling: an approach to assist in reasoning about healthcare change using a patient-centric system.

PubMed

Price, Morgan

2016-10-04

Many health system and health Information and Communication Technology (ICT) projects do not achieve their expected benefits. This paper presents an approach to exploring changes in the healthcare system to better understand the expected improvements and other changes by using a patient-centric modelling approach. Circle of care modeling (CCM) was designed to assist stakeholders in considering healthcare system changes using a patient centric approach. The CCM approach is described. It includes four steps, based on soft systems methodology: finding out, conceptual modelling, structured discussion, and describing potential improvements. There are four visualizations that are used though this process: patient-persona based rich pictures of care flows (as part of finding out), and three models: provider view, communication view, and information repository view (as part of conceptual modelling). Three case studies are presented where CCM was applied to different real-world healthcare problems: 1. Seeking improvements in continuity of care for end of life patients. 2. Exploring current practices for medication communication for ambulatory patients prior to an update of a jurisdictional drug information system. 3. Deciding how to improve attachment of patients to primary care. The cases illustrate how CCM helped stakeholders reason from a patient centered approach about gaps and improvements in care such as: data fragmentation (in 1), coordination efforts of medication management (in 2), and deciding to support a community health centre for unattached patients (in 3). The circle of care modelling approach has proved to be a useful tool in assisting stakeholders explore health system change in a patient centric approach. It is one way to instantiate the important principle of being patient centered into practice when considering health system changes.

Evidence-informed policymaking in practice: country-level examples of use of evidence for iCCM policy

PubMed Central

Rodríguez, Daniela C; Shearer, Jessica; Mariano, Alda RE; Juma, Pamela A; Dalglish, Sarah L; Bennett, Sara

2015-01-01

Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. As countries move to adopt iCCM, it becomes important to understand how this growing evidence base is viewed and used by national stakeholders. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and uses Carol Weiss’ models of research utilization to further explain the use of evidence in these contexts. A documentary review and in-depth stakeholder interviews were conducted as part of retrospective case studies in each study country. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organization and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. In terms of country-specific findings, Niger demonstrated both Interactive and Political models of research utilization by using iCCM to capitalize on the existing health infrastructure. Both Mozambique and Kenya exhibit Problem-Solving research utilization with different outcomes. Furthermore, the persistent quest for additional evidence suggests a Tactical use of research in Kenya. Results presented here indicate that while evidence from research studies and other contexts can be critical to policy development, local evidence is often needed to answer key policymaker questions. In the end, evidence may not be enough to overcome resistance if the policy is viewed as incompatible with national goals. PMID:26516149

Training Internists to Meet Critical Care Needs in the United States: A Consensus Statement from the Critical Care Societies Collaborative (CCSC)

PubMed Central

Pastores, Stephen M.; Martin, Greg S.; Baumann, Michael H.; Curtis, J. Randall; Farmer, J. Christopher; Fessler, Henry E.; Gupta, Rakesh; Hill, Nicholas S.; Hyzy, Robert C.; Kvetan, Vladimir; MacGregor, Drew A.; O’Grady, Naomi P.; Ognibene, Frederick P.; Rubenfeld, Gordon D.; Sessler, Curtis N.; Siegal, Eric; Simpson, Steven Q.; Spevetz, Antoinette; Ward, Nicholas S.; Zimmerman, Janice L.

2014-01-01

Objectives Multiple training pathways are recognized by the Accreditation Council for Graduate Medical Education (ACGME) for internal medicine (IM) physicians to certify in critical care medicine (CCM) via the American Board of Internal Medicine. While each involves 1 year of clinical fellowship training in CCM, substantive differences in training requirements exist among the various pathways. The Critical Care Societies Collaborative convened a task force to review these CCM pathways and to provide recommendations for unified and coordinated training requirements for IM-based physicians. Participants A group of CCM professionals certified in pulmonary-CCM and/or IM-CCM from ACGME-accredited training programs who have expertise in education, administration, research, and clinical practice. Data Sources and Synthesis Relevant published literature was accessed through a MEDLINE search and references provided by all task force members. Material published by the ACGME, American Board of Internal Medicine, and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force reached consensus using a roundtable meeting, electronic mail, and conference calls. Main Results Internal medicine-CCM–based fellowships have disparate program requirements compared to other internal medicine subspecialties and adult CCM fellowships. Differences between IM-CCM and pulmonary-CCM programs include the ratio of key clinical faculty to fellows and a requirement to perform 50 therapeutic bronchoscopies. Competency-based training was considered uniformly desirable for all CCM training pathways. Conclusions The task force concluded that requesting competency-based training and minimizing variations in the requirements for IM-based CCM fellowship programs will facilitate effective CCM training for both programs and trainees. PMID:24637881

Sensitivity of temporal heart rate variability in Poincaré plot to changes in parasympathetic nervous system activity.

PubMed

Karmakar, Chandan K; Khandoker, Ahsan H; Voss, Andreas; Palaniswami, Marimuthu

2011-03-03

A novel descriptor (Complex Correlation Measure (CCM)) for measuring the variability in the temporal structure of Poincaré plot has been developed to characterize or distinguish between Poincaré plots with similar shapes. This study was designed to assess the changes in temporal structure of the Poincaré plot using CCM during atropine infusion, 70° head-up tilt and scopolamine administration in healthy human subjects. CCM quantifies the point-to-point variation of the signal rather than gross description of the Poincaré plot. The physiological relevance of CCM was demonstrated by comparing the changes in CCM values with autonomic perturbation during all phases of the experiment. The sensitivities of short term variability (SD1), long term variability (SD2) and variability in temporal structure (CCM) were analyzed by changing the temporal structure by shuffling the sequences of points of the Poincaré plot. Surrogate analysis was used to show CCM as a measure of changes in temporal structure rather than random noise and sensitivity of CCM with changes in parasympathetic activity. CCM was found to be most sensitive to changes in temporal structure of the Poincaré plot as compared to SD1 and SD2. The values of all descriptors decreased with decrease in parasympathetic activity during atropine infusion and 70° head-up tilt phase. In contrast, values of all descriptors increased with increase in parasympathetic activity during scopolamine administration. The concordant reduction and enhancement in CCM values with parasympathetic activity indicates that the temporal variability of Poincaré plot is modulated by the parasympathetic activity which correlates with changes in CCM values. CCM is more sensitive than SD1 and SD2 to changes of parasympathetic activity.

An Assessment of the Potential Predictability of Drought Over the United States Based on Climate Model Simulations with Specified SST

NASA Technical Reports Server (NTRS)

Schubert, Siegfried; Wang, Hailan; Suarez, Max; Koster, Randal

2010-01-01

The USCLIV AR working group on drought recently initiated a series of global climate model simulations forced with idealized SST anomaly patterns, designed to address a number of uncertainties regarding the impact of SST forcing and the role of land-atmosphere feedbacks on regional drought. The runs were done with several global atmospheric models including NASA/NSIPP-l, NCEP/GFS, GFDLlAM2, and NCAR CCM3 and CAM3.5. Specific questions that the runs are designed to address include: What are mechanisms that maintain drought across the seasonal cycle and from one year to the next. To what extent can droughts develop independently of ocean variability due to year-to-year memory that may be inherent to the land. What is the role of the different ocean basins? Here we focus on the potential predictability of drought conditions over the United States. Specific issues addressed include the seasonality and regionality of the signal-to-noise ratios associated with Pacific and Atlantic SST forcing, and the sensitivity of the results to the climatological stationary waves simulated by the different AGCMs.

Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study.

PubMed

Miller, James S; English, Lacey; Matte, Michael; Mbusa, Rapheal; Ntaro, Moses; Bwambale, Shem; Kenney, Jessica; Siedner, Mark J; Reyes, Raquel; Lee, Patrick T; Mulogo, Edgar; Stone, Geren S

2018-02-27

Village health workers (VHWs) in five villages in Bugoye subcounty (Kasese District, Uganda) provide integrated community case management (iCCM) services, in which VHWs evaluate and treat malaria, pneumonia, and diarrhoea in children under 5 years of age. VHWs use a "Sick Child Job Aid" that guides them through the evaluation and treatment of these illnesses. A retrospective observational study was conducted to measure the quality of iCCM care provided by 23 VHWs in 5 villages in Bugoye subcounty over a 2-year period. Patient characteristics and clinical services were summarized using existing aggregate programme data. Lot quality assurance sampling of individual patient records was used to estimate adherence to the iCCM algorithm, VHW-level quality (based on adherence to the iCCM protocol), and change over time in quality of care (using generalized estimating equations regression modelling). For each of 23 VHWs, 25 patient visits were randomly selected from a 2-year period after iCCM care initiation. In these visits, 97% (150) of patients with diarrhoea were treated with oral rehydration and zinc, 95% (216) of patients with pneumonia were treated with amoxicillin, and 94% (240) of patients with malaria were treated with artemisinin-based combination therapy or rectal artesunate. However, only 44% (44) of patients with a negative rapid test for malaria were appropriately referred to a health facility. Overall, 75% (434) of patients received all the correct evaluation and management steps. Only 9 (39%) of the 23 VHWs met the pre-determined LQAS threshold for high-quality care over the 2-year observation period. Quality of care increased significantly in the first 6 months after initiation of iCCM services (p = 0.003), and then plateaued during months 7-24. Quality of care was high for uncomplicated malaria, pneumonia and diarrhoea. Overall quality of care was lower, in part because VHWs often did not follow the guidelines to refer patients with fever who tested negative for malaria. Quality of care appears to improve in the initial months after iCCM implementation, as VHWs gain initial experience in iCCM care.

CCM-3/STRIPAK promotes seamless tube extension through endocytic recycling.

PubMed

Lant, Benjamin; Yu, Bin; Goudreault, Marilyn; Holmyard, Doug; Knight, James D R; Xu, Peter; Zhao, Linda; Chin, Kelly; Wallace, Evan; Zhen, Mei; Gingras, Anne-Claude; Derry, W Brent

2015-03-06

The mechanisms governing apical membrane assembly during biological tube development are poorly understood. Here, we show that extension of the C. elegans excretory canal requires cerebral cavernous malformation 3 (CCM-3), independent of the CCM1 orthologue KRI-1. Loss of ccm-3 causes canal truncations and aggregations of canaliculular vesicles, which form ectopic lumen (cysts). We show that CCM-3 localizes to the apical membrane, and in cooperation with GCK-1 and STRIPAK, promotes CDC-42 signalling, Golgi stability and endocytic recycling. We propose that endocytic recycling is mediated through the CDC-42-binding kinase MRCK-1, which interacts physically with CCM-3-STRIPAK. We further show canal membrane integrity to be dependent on the exocyst complex and the actin cytoskeleton. This work reveals novel in vivo roles of CCM-3·STRIPAK in regulating tube extension and membrane integrity through small GTPase signalling and vesicle dynamics, which may help explain the severity of CCM3 mutations in patients.

Oxidative stress and inflammation in cerebral cavernous malformation disease pathogenesis: Two sides of the same coin.

PubMed

Retta, Saverio Francesco; Glading, Angela J

2016-12-01

Cerebral Cavernous Malformation (CCM) is a vascular disease of proven genetic origin, which may arise sporadically or is inherited as an autosomal dominant condition with incomplete penetrance and highly variable expressivity. CCM lesions exhibit a range of different phenotypes, including wide inter-individual differences in lesion number, size, and susceptibility to intracerebral hemorrhage (ICH). Lesions may remain asymptomatic or result in pathological conditions of various type and severity at any age, with symptoms ranging from recurrent headaches to severe neurological deficits, seizures, and stroke. To date there are no direct therapeutic approaches for CCM disease besides the surgical removal of accessible lesions. Novel pharmacological strategies are particularly needed to limit disease progression and severity and prevent de novo formation of CCM lesions in susceptible individuals. Useful insights into innovative approaches for CCM disease prevention and treatment are emerging from a growing understanding of the biological functions of the three known CCM proteins, CCM1/KRIT1, CCM2 and CCM3/PDCD10. In particular, accumulating evidence indicates that these proteins play major roles in distinct signaling pathways, including those involved in cellular responses to oxidative stress, inflammation and angiogenesis, pointing to pathophysiological mechanisms whereby the function of CCM proteins may be relevant in preventing vascular dysfunctions triggered by these events. Indeed, emerging findings demonstrate that the pleiotropic roles of CCM proteins reflect their critical capacity to modulate the fine-tuned crosstalk between redox signaling and autophagy that govern cell homeostasis and stress responses, providing a novel mechanistic scenario that reconciles both the multiple signaling pathways linked to CCM proteins and the distinct therapeutic approaches proposed so far. In addition, recent studies in CCM patient cohorts suggest that genetic susceptibility factors related to differences in vascular sensitivity to oxidative stress and inflammation contribute to inter-individual differences in CCM disease susceptibility and severity. This review discusses recent progress into the understanding of the molecular basis and mechanisms of CCM disease pathogenesis, with specific emphasis on the potential contribution of altered cell responses to oxidative stress and inflammatory events occurring locally in the microvascular environment, and consequent implications for the development of novel, safe, and effective preventive and therapeutic strategies. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Anticancer drug-based multifunctional nanogels through self-assembly of dextran-curcumin conjugates toward cancer theranostics.

PubMed

Nagahama, Koji; Sano, Yoshinori; Kumano, Takayuki

2015-06-15

Curcumin (CCM) has been received much attention in cancer theranostics because CCM exhibits both anticancer activity and strong fluorescence available for bio-imaging. However, CCM has never been utilized in clinical mainly due to its extremely low water solubility and its low cellular uptake into cancer cells. We fabricated novel CCM-based biodegradable nanoparticles through self-assembly of amphiphilic dextran-CCM conjugates. Significantly high CCM loading contents in the nanoparticles and the high water solubility were achieved. Importantly, the dextran-CCMs nanoparticles were effectively delivered into HeLa cells and exhibited strong fluorescence available for live-cell imaging, although the nanoparticles were not delivered into normal cells. Thus, the dextran-CCMs nanoparticles could be a promising for creation of novel CCM-based cancer theranostics with high efficacy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability.

PubMed

Daviaud, Emmanuelle; Besada, Donnela; Leon, Natalie; Rohde, Sarah; Sanders, David; Oliphant, Nicholas; Doherty, Tanya

2017-06-01

Sub-Saharan Africa still reports the highest rates of under-five mortality. Low cost, high impact interventions exist, however poor access remains a challenge. Integrated community case management (iCCM) was introduced to improve access to essential services for children 2-59 months through diagnosis, treatment and referral services by community health workers for malaria, pneumonia and diarrhea. This paper presents the results of an economic analysis of iCCM implementation in regions supported by UNICEF in six countries and assesses country-level scale-up implications. The paper focuses on costs to provider (health system and donors) to inform planning and budgeting, and does not cover cost-effectiveness. The analysis combines annualised set-up costs and 1 year implementation costs to calculate incremental economic and financial costs per treatment from a provider perspective. Affordability is assessed by calculating the per capita financial cost of the program as a percentage of the public health expenditure per capita. Time and financial implications of a 30% increase in utilization were modeled. Country scale-up is modeled for all children under 5 in rural areas. Utilization of iCCM services varied from 0.05 treatment/y/under-five in Ethiopia to over 1 in Niger. There were between 10 and 603 treatments/community health worker (CHW)/y. Consultation cost represented between 93% and 22% of economic costs per treatment influenced by the level of utilization. Weighted economic cost per treatment ranged from US$ 13 (2015 USD) in Ghana to US$ 2 in Malawi. CHWs spent from 1 to 9 hours a week on iCCM. A 30% increase in utilization would add up to 2 hours a week, but reduce cost per treatment (by 20% in countries with low utilization). Country scale up would amount to under US$ 0.8 per capita total population (US$ 0.06-US$0.74), between 0.5% and 2% of public health expenditure per capita but 8% in Niger. iCCM addresses unmet needs and impacts on under 5 mortality. An economic cost of under US$ 1/capita/y represents a sound investment. Utilization remains low however, and strategies must be developed as a priority to improve demand. Continued donor support is required to sustain iCCM services and strengthen its integration within national health systems.

Costs of implementing integrated community case management (iCCM) in six African countries: implications for sustainability

PubMed Central

Daviaud, Emmanuelle; Besada, Donnela; Leon, Natalie; Rohde, Sarah; Sanders, David; Oliphant, Nicholas; Doherty, Tanya

2017-01-01

Background Sub–Saharan Africa still reports the highest rates of under–five mortality. Low cost, high impact interventions exist, however poor access remains a challenge. Integrated community case management (iCCM) was introduced to improve access to essential services for children 2–59 months through diagnosis, treatment and referral services by community health workers for malaria, pneumonia and diarrhea. This paper presents the results of an economic analysis of iCCM implementation in regions supported by UNICEF in six countries and assesses country–level scale–up implications. The paper focuses on costs to provider (health system and donors) to inform planning and budgeting, and does not cover cost–effectiveness. Methods The analysis combines annualised set–up costs and 1 year implementation costs to calculate incremental economic and financial costs per treatment from a provider perspective. Affordability is assessed by calculating the per capita financial cost of the program as a percentage of the public health expenditure per capita. Time and financial implications of a 30% increase in utilization were modeled. Country scale–up is modeled for all children under 5 in rural areas. Results Utilization of iCCM services varied from 0.05 treatment/y/under–five in Ethiopia to over 1 in Niger. There were between 10 and 603 treatments/community health worker (CHW)/y. Consultation cost represented between 93% and 22% of economic costs per treatment influenced by the level of utilization. Weighted economic cost per treatment ranged from US$ 13 (2015 USD) in Ghana to US$ 2 in Malawi. CHWs spent from 1 to 9 hours a week on iCCM. A 30% increase in utilization would add up to 2 hours a week, but reduce cost per treatment (by 20% in countries with low utilization). Country scale up would amount to under US$ 0.8 per capita total population (US$ 0.06–US$0.74), between 0.5% and 2% of public health expenditure per capita but 8% in Niger. Conclusions iCCM addresses unmet needs and impacts on under 5 mortality. An economic cost of under US$ 1/capita/y represents a sound investment. Utilization remains low however, and strategies must be developed as a priority to improve demand. Continued donor support is required to sustain iCCM services and strengthen its integration within national health systems. PMID:28702174

Implications of Lagrangian Tracer Transport for Coupled Chemistry-Climate Simulations

NASA Astrophysics Data System (ADS)

Stenke, A.

2009-05-01

Today's coupled chemistry-climate models (CCM) consider a large number of trace species and feedback processes. Due to the radiative effect of some species, errors in simulated tracer distributions can feed back to model dynamics. Thus, shortcomings of the applied transport schemes can have severe implications for the overall model performance. Traditional Eulerian approaches show a satisfactory performance in case of homogeneously distributed trace species, but they can lead to severe problems when applied to highly inhomogeneous tracer distributions. In case of sharp gradients many schemes show a considerable numerical diffusion. Lagrangian approaches, on the other hand, combine a number of favourable numerical properties: They are strictly mass-conserving and do not suffer from numerical diffusion. Therefore they are able to maintain steeper gradients. A further advantage is that they allow the transport of a large number of tracers without being prohibitively expensive. A variety of benefits for stratospheric dynamics and chemistry resulting from a Lagrangian transport algorithm are demonstrated by the example of the CCM E39C. In an updated version of E39C, called E39C-A, the operational semi-Lagrangian advection scheme has been replaced with the purely Lagrangian scheme ATTILA. It will be shown that several model deficiencies can be cured by the choice of an appropriate transport algorithm. The most important advancement concerns the reduction of a pronounced wet bias in the extra- tropical lowermost stratosphere. In turn, the associated temperature error ("cold bias") is significantly reduced. Stratospheric wind variations are now in better agreement with observations, e.g. E39C-A is able to reproduce the stratospheric wind reversal in the Southern Hemisphere in summer which was not captured by the previous model version. Resulting changes in wave propagation and dissipation lead to a weakening of the simulated mean meridional circulation and therefore a more realistic representation of tropical upwelling. Simulated distributions of chemical tracers in the stratosphere are clearly improved. For example, the vertical distribution of stratospheric chlorine (Cly) is now in agreement with analyses derived from observations and other CCMs. As a consequence the model realistically covers the altitude of maximum ozone depletion in the stratosphere. Furthermore, the simulated temporal evolution of stratospheric Cly in the past agrees is realistically reproduced which is an important step towards more reliable projections of future changes, especially of stratospheric ozone.

A multi-institutional quality improvement initiative to transform education for chronic illness care in resident continuity practices.

PubMed

Stevens, David P; Bowen, Judith L; Johnson, Julie K; Woods, Donna M; Provost, Lloyd P; Holman, Halsted R; Sixta, Constance S; Wagner, Ed H

2010-09-01

There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care. To improve training for residents who provide chronic illness care in teaching practice settings. US teaching hospitals were invited to participate in one of two 18-month Breakthrough Series Collaboratives-either a national Collaborative, or a subsequent California Collaborative-to implement the Chronic Care Model (CCM) and related curriculum changes in resident practices. Most practices focused on patients with diabetes mellitus. Educational redesign strategies with related performance measures were developed for curricular innovations anchored in the CCM. In addition, three clinical measures-HbA1c <7%, LDL <100 mg/dL, and blood pressure

A Multi-Institutional Quality Improvement Initiative to Transform Education for Chronic Illness Care in Resident Continuity Practices

PubMed Central

Bowen, Judith L.; Johnson, Julie K.; Woods, Donna M.; Provost, Lloyd P.; Holman, Halsted R.; Sixta, Constance S.; Wagner, Ed H.

2010-01-01

BACKGROUND There is a gap between the need for patient-centered, evidence-based primary care for the large burden of chronic illness in the US, and the training of resident physicians to provide that care. OBJECTIVE To improve training for residents who provide chronic illness care in teaching practice settings. DESIGN US teaching hospitals were invited to participate in one of two 18-month Breakthrough Series Collaboratives—either a national Collaborative, or a subsequent California Collaborative—to implement the Chronic Care Model (CCM) and related curriculum changes in resident practices. Most practices focused on patients with diabetes mellitus. Educational redesign strategies with related performance measures were developed for curricular innovations anchored in the CCM. In addition, three clinical measures—HbA1c <7%, LDL <100 mg/dL, and blood pressure ≤130/80—and three process measures—retinal and foot examinations, and patient self-management goals—were tracked. PARTICIPANTS Fifty-seven teams from 37 self-selected teaching hospitals committed to implement the CCM in resident continuity practices; 41 teams focusing on diabetes improvement participated over the entire duration of one of the Collaboratives. INTERVENTIONS Teaching-practice teams—faculty, residents and staff—participated in Collaboratives by attending monthly calls and regular 2-day face-to-face meetings with the other teams. The national Collaborative faculty led calls and meetings. Each team used rapid cycle quality improvement (PDSA cycles) to implement the CCM and curricular changes. Teams reported education and clinical performance measures monthly. RESULTS Practices underwent extensive redesign to establish CCM elements. Education measures tracked substantial development of CCM-related learning. The clinical and process measures improved, however inconsistently, during the Collaboratives. CONCLUSIONS These initiatives suggest that systematic practice redesign for implementing the CCM along with linked educational approaches are achievable in resident continuity practices. Improvement of clinical outcomes in such practices is daunting but achievable. PMID:20737232

Assembling Components with Aspect-Oriented Modeling/Specification

DTIC Science & Technology

2003-10-01

2 COM: Component Object Mod 3 EJB: Enterprise Java Beans, h 4 CCM: CORBA® Component M 5 http...nt (GM of the co mbly of ct weav el, http: ttp:// java odel, htFigure 2: Connector as a Containertructure in the form of framework, which...assembles components in EJB3 , CCM4; or a package, using such way as manifest file to JavaBeans5. Also such connector in some cases plays the role as

Hydrogenetic Ferromanganese Crusts of the California Continental Margin

NASA Astrophysics Data System (ADS)

Conrad, Tracey A.

Hydrogenetic Ferromanganese (Fe-Mn) crusts grow from seawater and in doing so sequester elements of economic interest and serve as archives of past seawater chemistry. Ferromanganese crusts have been extensively studied in open-ocean environments. However, few studies have examined continent-proximal Fe-Mn crusts especially from the northeast Pacific. This thesis addresses Fe-Mn crusts within the northeast Pacific California continental margin (CCM), which is a dynamic geological and oceanographic environment. In the first of three studies, I analyzed the chemical and mineralogical composition of Fe-Mn crusts and show that continental-proximal processes greatly influence the chemistry and mineralogy of CCM Fe-Mn crusts. When compared to global open-ocean Fe-Mn crusts, CCM crusts have higher concentrations of iron, silica, and thorium with lower concentrations of many elements of economic interest including manganese, cobalt, and tellurium, among other elements. The mineralogy of CCM Fe-Mn crusts is also unique with more birnessite and todorokite present than found in open-ocean samples. Unlike open-ocean Fe-Mn crusts, carbonate-fluorapatite is not present in CCM crusts. This lack of phosphatization makes CCM Fe-Mn crusts excellent candidates for robust paleoceanography records. The second and third studies in this thesis use isotope geochemistry on select CCM Fe-Mn crusts from four seamounts in the CCM to study past terrestrial inputs into the CCM and sources and behavior of Pb and Nd isotopes over the past 7 million years along the northeast Pacific margin. The second study focuses on riverine inputs into the Monterey Submarine Canyon System and sources of the continental material. Osmium isotopes in the crusts are compared to the Cenozoic Os seawater curve to develop an age model for the samples that show the crusts range in age of initiation of crust growth from approximately 20 to 6 Myr. Lead and neodymium isotopes measured in select Fe-Mn crusts show that large amounts of terrestrial material entered the CCM via the Monterey Canyon from prior to 6.8+/-0.5 until 4.5 +/-0.5 Myr ago. These data combined with reconstructions of the paleo-coastline indicate that incision of the modern Monterey Canyon started around 7 Myr ago. Isotope plots of potential source regions indicate that the source of the material is the border of the southern Sierra Nevada and western Basin and Range. This answers a long-standing and fundamental question about the timing and formation of the Monterey Canyon, the dominant feature of the Monterey Bay. The third study presented here uses the differences in lead and neodymium isotopic values in CCM Fe-Mn crusts over time compared to open-ocean Pacific, North Pacific, and Arctic Ocean Fe-Mn crusts to identify regional time-series trends and sources for these important oceanographic tracers. I found that sediment fluxes and inputs of terrestrial material from North American rivers effects the lead and neodymium isotope composition of regional seawater.

Development, validation, and utility of an instrument to assess core competencies in the Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program.

PubMed

Leff, Stephen S; Baum, Katherine T; Bevans, Katherine B; Blum, Nathan J

2015-02-01

To describe the development and psychometric evaluation of the Core Competency Measure (CCM), an instrument designed to assess professional competencies as defined by the Maternal Child Health Bureau (MCHB) and targeted by Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs. The CCM is a 44-item self-report measure comprised of six subscales to assess clinical, interdisciplinary, family-centered/cultural, community, research, and advocacy/policy competencies. The CCM was developed in an iterative fashion through participatory action research, and then nine cohorts of LEND trainees (N = 144) from 14 different disciplines completed the CCM during the first week of the training program. A 6-factor confirmatory factor analysis model was fit to data from the 44 original items. After three items were removed, the model adequately fit the data (comparative fit indices = .93, root mean error of approximation = .06) with all factor loadings exceeding .55. The measure was determined to be quite reliable as adequate internal consistency and test-retest reliability were found for each subscale. The instrument's construct validity was supported by expected differences in self-rated competencies among fellows representing various disciplines, and the convergent validity was supported by the pattern of inter-correlations between subscale scores. The CCM appears to be a reliable and valid measure of MCHB core competencies for our sample of LEND trainees. It provides an assessment of key training areas addressed by the LEND program. Although the measure was developed within only one LEND Program, with additional research it has the potential to serve as a standardized tool to evaluate the strengths and limitations of MCHB training, both within and between programs.

The Comparative Studies of Binding Activity of Curcumin and Didemethylated Curcumin with Selenite: Hydrogen Bonding vs Acid-Base Interactions

NASA Astrophysics Data System (ADS)

Liao, Jiahn-Haur; Wu, Tzu-Hua; Chen, Ming-Yi; Chen, Wei-Ting; Lu, Shou-Yun; Wang, Yi-Hsuan; Wang, Shao-Pin; Hsu, Yen-Min; Huang, Yi-Shiang; Huang, Zih-You; Lin, Yu-Ching; Chang, Ching-Ming; Huang, Fu-Yung; Wu, Shih-Hsiung

2015-12-01

In this report, the in vitro relative capabilities of curcumin (CCM) and didemethylated curcumin (DCCM) in preventing the selenite-induced crystallin aggregation were investigated by turbidity tests and isothermal titration calorimetry (ITC). DCCM showed better activity than CCM. The conformers of CCM/SeO32- and DCCM/SeO32- complexes were optimized by molecular orbital calculations. Results reveal that the selenite anion surrounded by CCM through the H-bonding between CCM and selenite, which is also observed via IR and NMR studied. For DCCM, the primary driving force is the formation of an acid-base adduct with selenite showing that the phenolic OH group of DCCM was responsible for forming major conformer of DCCM. The formation mechanisms of selenite complexes with CCM or DCCM explain why DCCM has greater activity than CCM in extenuating the toxicity of selenite as to prevent selenite-induced lens protein aggregation.

Contemporary commercial music (CCM) survey: who's teaching what in nonclassical music.

PubMed

LoVetri, Jeannette L; Weekly, Edrie Means

2003-06-01

Currently, there is an increasing interest in and demand for training in a wide variety of nonclassical music--contemporary commercial music (CCM)--and most particularly for music theater. A survey of singing teachers was completed to elucidate their training, education, and experience with and methods of teaching CCM. Teachers were at colleges, universities, and conservatories as well as in private studios, both nationally and in several foreign countries. A substantial percentage of those teaching CCM had neither formal education in teaching it nor professional experience. Many of the respondents indicated conflict between classical and CCM styles. Respondents were generally familiar with voice science and voice medicine as well as certain CCM terminology. Teachers expressed an interest in obtaining more information, with an emphasis on healthy vocal production. These results are discussed, as well as implications for the singing teacher who desires specific training to teach CCM.

Relative Influence of Initial Surface and Atmospheric Conditions on Seasonal Water and Energy Balances

NASA Technical Reports Server (NTRS)

Oglesby, Robert J.; Marshall, Susan; Roads, John O.; Robertson, Franklin R.; Goodman, H. Michael (Technical Monitor)

2001-01-01

We constructed and analyzed wet and dry soil moisture composites for the mid-latitude GCIP region of the central US using long climate model simulations made with the NCAR CCM3 and reanalysis products from NCEP. Using the diagnostic composites as a guide, we have completed a series of predictability experiments in which we imposed soil water initial conditions in CCM3 for the GCIP region for June 1 from anomalously wet and dry years, with atmospheric initial conditions taken from June 1 of a year with 'near-normal' soil water, and initial soil water from the near-normal year and atmospheric initial conditions from the wet and dry years. Preliminary results indicate that the initial state of the atmosphere is more important than the initial state of soil water determining the subsequent late spring and summer evolution of sod water over the GCIP region. Surprisingly, neither the composites or the predictability experiments yielded a strong influence of soil moisture on the atmosphere. To explore this further, we have made runs with extreme dry soil moisture initial anomalies imposed over the GCIP region (the soil close to being completely dry). These runs did yield a very strong effect on the atmosphere that persisted for at least three months. We conclude that the magnitude of the initial soil moisture anomaly is crucial, at least in CCM3, and are currently investigating whether a threshold exists, below which little impact is seen. In a complementary study, we compared the impact of the initial condition of snow cover versus the initial atmospheric state over the western US (corresponding to the westward extension of the GAPP program follow-on to GCIP). In this case, the initial prescription of snow cover is far more important than the initial atmospheric state in determining the subsequent evolution of snow cover. We are currently working to understand the very different soil water and snow cover results.

Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design.

PubMed

Amouzou, Agbessi; Kanyuka, Mercy; Hazel, Elizabeth; Heidkamp, Rebecca; Marsh, Andrew; Mleme, Tiope; Munthali, Spy; Park, Lois; Banda, Benjamin; Moulton, Lawrence H; Black, Robert E; Hill, Kenneth; Perin, Jamie; Victora, Cesar G; Bryce, Jennifer

2016-03-01

We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. "Dose" variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. "Response" variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2-59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to "hard-to-reach" areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered. © The American Society of Tropical Medicine and Hygiene.

The potential for co-evolution of CO2-concentrating mechanisms and Rubisco in diatoms.

PubMed

Young, Jodi N; Hopkinson, Brian M

2017-06-01

Diatoms are a diverse group of unicellular algae that contribute significantly to global photosynthetic carbon fixation and export in the modern ocean, and are an important source of microfossils for paleoclimate reconstructions. Because of their importance in the environment, diatoms have been a focus of study on the physiology and ecophysiology of carbon fixation, in particular their CO2-concentrating mechanisms (CCMs) and Rubisco characteristics. While carbon fixation in diatoms is not as well understood as in certain model aquatic photoautotrophs, a greater number of species have been examined in diatoms. Recent work has highlighted a large diversity in the function, physiology, and kinetics of both the CCM and Rubisco between different diatom species. This diversity was unexpected since it has generally been assumed that CCMs and Rubiscos were similar within major algal lineages as the result of selective events deep in evolutionary history, and suggests a more recent co-evolution between the CCM and Rubisco within diatoms. This review explores our current understanding of the diatom CCM and highlights the diversity of both the CCM and Rubisco kinetics. We will suggest possible environmental, physiological, and evolutionary drivers for the co-evolution of the CCM and Rubisco in diatoms. © The Author 2017. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Familial Cerebral Cavernous Malformations Are Associated with Adrenal Calcifications on CT Scans: An Imaging Biomarker for a Hereditary Cerebrovascular Condition.

PubMed

Strickland, Corinne D; Eberhardt, Steven C; Bartlett, Mary R; Nelson, Jeffrey; Kim, Helen; Morrison, Leslie A; Hart, Blaine L

2017-08-01

Purpose To determine if adrenal calcifications seen at computed tomography (CT) are associated with familial cerebral cavernous malformations (fCCMs) in carriers of the CCM1 Common Hispanic Mutation. Materials and Methods This study was approved by the institutional review board. The authors retrospectively reviewed abdominal CT scans in 38 patients with fCCM, 38 unaffected age- and sex-matched control subjects, and 13 patients with sporadic, nonfamilial cerebral cavernous malformation (CCM). The size, number, and laterality of calcifications and the morphologic characteristics of the adrenal gland were recorded. Brain lesion count was recorded from brain magnetic resonance (MR) imaging in patients with fCCM. The prevalence of adrenal calcifications in patients with fCCM was compared with that in unaffected control subjects and those with sporadic CCM by using the Fisher exact test. Additional analyses were performed to determine whether age and brain lesion count were associated with adrenal findings in patients with fCCM. Results Small focal calcifications (SFCs) (≤5 mm) were seen in one or both adrenal glands in 19 of the 38 patients with fCCM (50%), compared with 0 of the 38 unaffected control subjects (P < .001) and 0 of the 13 subjects with sporadic CCM (P = .001). Adrenal calcifications in patients with fCCM were more frequently left sided, with 17 of 19 patients having more SFCs in the left adrenal gland than the right adrenal gland and 50 of the 61 observed SFCs (82%) found in the left adrenal gland. No subjects had SFCs on the right side only. In patients with fCCM, the presence of SFCs showed a positive correlation with age (P < .001) and number of brain lesions (P < .001). Conclusion Adrenal calcifications identified on CT scans are common in patients with fCCM and may be a clinically silent manifestation of disease. © RSNA, 2017.

Rapid crop cover mapping for the conterminous United States

USGS Publications Warehouse

Dahal, Devendra; Wylie, Bruce K.; Howard, Daniel

2018-01-01

Timely crop cover maps with sufficient resolution are important components to various environmental planning and research applications. Through the modification and use of a previously developed crop classification model (CCM), which was originally developed to generate historical annual crop cover maps, we hypothesized that such crop cover maps could be generated rapidly during the growing season. Through a process of incrementally removing weekly and monthly independent variables from the CCM and implementing a ‘two model mapping’ approach, we found it viable to generate conterminous United States-wide rapid crop cover maps at a resolution of 250 m for the current year by the month of September. In this approach, we divided the CCM model into one ‘crop type model’ to handle the classification of nine specific crops and a second, binary model to classify the presence or absence of ‘other’ crops. Under the two model mapping approach, the training errors were 0.8% and 1.5% for the crop type and binary model, respectively, while test errors were 5.5% and 6.4%, respectively. With spatial mapping accuracies for annual maps reaching upwards of 70%, this approach demonstrated a strong potential for generating rapid crop cover maps by the 1st of September.

Curcumin-incorporated albumin nanoparticles and its tumor image

NASA Astrophysics Data System (ADS)

Gong, Guangming; Pan, Qinqin; Wang, Kaikai; Wu, Rongchun; Sun, Yong; Lu, Ying

2015-01-01

Albumin is an ideal carrier for hydrophobic drugs. This paper reports a facile route to develop human serum albumin (HSA)-curcumin (CCM) nanoparticles, in which β-mercaptoethanol (β-ME) acted as an inducer and CCM acted as a bridge. Fluorescence quenching and conformational changes in HSA-CCM nanoparticles occurred during assembly. Disulfide bonds and hydrophobic interactions may play a key role in assembly. HSA-CCM nanoparticles were about 130 nm in size, and the solubility of CCM increased by more than 500 times. The HSA-CCM nanoparticles could accumulate at the cytoplasm of tumor cells and target the tumor tissues. Therefore, HSA nanoparticles fabricated by β-ME denaturation are promising nanocarriers for hydrophobic substances from chemotherapy drugs to imaging probes.

Curcumin-incorporated albumin nanoparticles and its tumor image.

PubMed

Gong, Guangming; Pan, Qinqin; Wang, Kaikai; Wu, Rongchun; Sun, Yong; Lu, Ying

2015-01-30

Albumin is an ideal carrier for hydrophobic drugs. This paper reports a facile route to develop human serum albumin (HSA)-curcumin (CCM) nanoparticles, in which β-mercaptoethanol (β-ME) acted as an inducer and CCM acted as a bridge. Fluorescence quenching and conformational changes in HSA-CCM nanoparticles occurred during assembly. Disulfide bonds and hydrophobic interactions may play a key role in assembly. HSA-CCM nanoparticles were about 130 nm in size, and the solubility of CCM increased by more than 500 times. The HSA-CCM nanoparticles could accumulate at the cytoplasm of tumor cells and target the tumor tissues. Therefore, HSA nanoparticles fabricated by β-ME denaturation are promising nanocarriers for hydrophobic substances from chemotherapy drugs to imaging probes.

Multipayer patient-centered medical home implementation guided by the chronic care model.

PubMed

Gabbay, Robert A; Bailit, Michael H; Mauger, David T; Wagner, Edward H; Siminerio, Linda

2011-06-01

A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives. Practices implemented the CCM and PCMH through regional Breakthrough Series learning collaboratives, supported by Improving Performance in Practice (IPIP) practice coaches, with required monthly quality reporting enhanced by multipayer infrastructure payments. Some 105 practices, representing 382 primary care providers, were engaged in the four regional collaboratives. The practices from the Southeast region of Pennsylvania focused on diabetes patients (n = 10,016). During the first intervention year (May 2008-May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients. Transforming primary care delivery through implementation of the PCMH and CCM supported by multipayer infrastructure payments holds significant promise to improve diabetes care.

Age of depressed patient does not affect clinical outcome in collaborative care management.

PubMed

Angstman, Kurt B; MacLaughlin, Kathy L; Rasmussen, Norman H; DeJesus, Ramona S; Katzelnick, David J

2011-09-01

Clinical response and remission for the treatment of depression has been shown to be improved utilizing collaborative care management (CCM). Prior studies have indicated that the presence of mental health comorbidities noted by self-rated screening tools at the intake for CCM are associated with worsening outcomes; few have examined directly the impact of age on clinical response and remission. The hypothesis was that when controlling for other mental health and demographic variables, the age of the patient at implementation of CCM does not significantly impact clinical outcome, and that CCM shows consistent efficacy across the adult age spectrum. We performed a retrospective chart analysis of a cohort of 574 patients with a clinical diagnosis of major depression (not dysthymia) treated in CCM who had 6 months of follow-up data. Using the age group as a categorical variable in logistic regression models demonstrated that while maintaining control of all other variables, age grouping remained a nonsignificant predictor of clinical response (P ≥ 0.1842) and remission (P ≥ 0.1919) after 6 months of treatment. In both models, a lower Generalized Anxiety Disorder-7 score and a negative Mood Disorder Questionnaire score were predictive of clinical response and remission. However, the initial Patient Health Questionnaire-9 score was a statistically significant predictor only for clinical remission (P = 0.0094), not for response (P = 0.0645), at 6 months. In a subset (n = 295) of the study cohort, clinical remission at 12 months was also not associated with age grouping (P ≥ 0.3355). The variables that were predictive of remission at 12 months were the presence of clinical remission at 6 months (odds ratio [OR], 7.4820; confidence interval [CI], 3.9301-14.0389; P < 0.0001), clinical response (with persistent symptoms) (OR, 2.7722; CI, 1.1950-6.4313; P = 0.0176), and a lower initial Patient Health Questionnaire-9 score (OR, 0.9121; CI, 0.8475-0.9816; P = 0.0140). Our study suggests that using CCM for depression treatment may transcend age-related differences in depression and result in positive outcomes regardless of age.

Identifying causal linkages between environmental variables and African conflicts

NASA Astrophysics Data System (ADS)

Nguy-Robertson, A. L.; Dartevelle, S.

2017-12-01

Environmental variables that contribute to droughts, flooding, and other natural hazards are often identified as factors contributing to conflict; however, few studies attempt to quantify these causal linkages. Recent research has demonstrated that the environment operates within a dynamical system framework and the influence of variables can be identified from convergent cross mapping (CCM) between shadow manifolds. We propose to use CCM to identify causal linkages between environmental variables and incidences of conflict. This study utilizes time series data from Climate Forecast System ver. 2 and MODIS satellite sensors processed using Google Earth Engine to aggregate country and regional trends. These variables are then compared to Armed Conflict Location & Event Data Project observations at similar scales. Results provide relative rankings of variables and their linkage to conflict. Being able to identify which factors contributed more strongly to a conflict can allow policy makers to prepare solutions to mitigate future crises. Knowledge of the primary environmental factors can lead to the identification of other variables to examine in the causal network influencing conflict.

Attitudes of anesthesiology residents toward critical care medicine training.

PubMed

Durbin, C G; McLafferty, C L

1993-09-01

The number of anesthesiology residents pursuing critical care medicine (CCM) fellowship training has been decreasing in recent years. A significant number of training positions remain unfilled each year. Possible causes of this decline were evaluated by surveying residents regarding their attitudes toward practice and training in CCM. All 38 anesthesiology programs having accredited CCM fellowships were surveyed. Four of these and one program without CCM fellowships were used to develop the survey instrument. Four programs without CCM fellowships and 34 programs with CCM fellowships make up the survey group. Returned were 640 surveys from 37 (97%) programs accounting for over 30% of the possible residents. Resident interest in pursuing CCM training decreased as year of residency increased (P < 0.0001). Residents in programs with little patient care responsibility during intensive care unit (ICU) rotations expressed less interest in CCM training (P < 0.012). The administrative role of the anesthesiology department in the ICU also influenced resident interest (P < 0.014). Written responses to open-ended questions suggested resident concerns with the following: stress of chronic care, financial consequences of additional year of training, ICU call frequency and load, ICU role ambiguity, and shared decision-making in the ICU. A recurring question was, "Are there jobs (outside of academics) for anesthesiologist intensivists?" Most residents knew a CCM anesthesiologist they admired and knew that there were unfilled fellowship positions available. Defining the job market, improving curriculum and teaching, supporting deferment of student loans, and introducing residents and medical students to the ICU earlier may increase the interest in CCM practice among anesthesiology residents.

The Comparative Studies of Binding Activity of Curcumin and Didemethylated Curcumin with Selenite: Hydrogen Bonding vs Acid-Base Interactions.

PubMed

Liao, Jiahn-Haur; Wu, Tzu-Hua; Chen, Ming-Yi; Chen, Wei-Ting; Lu, Shou-Yun; Wang, Yi-Hsuan; Wang, Shao-Pin; Hsu, Yen-Min; Huang, Yi-Shiang; Huang, Zih-You; Lin, Yu-Ching; Chang, Ching-Ming; Huang, Fu-Yung; Wu, Shih-Hsiung

2015-12-04

In this report, the in vitro relative capabilities of curcumin (CCM) and didemethylated curcumin (DCCM) in preventing the selenite-induced crystallin aggregation were investigated by turbidity tests and isothermal titration calorimetry (ITC). DCCM showed better activity than CCM. The conformers of CCM/SeO3(2-) and DCCM/SeO3(2-) complexes were optimized by molecular orbital calculations. Results reveal that the selenite anion surrounded by CCM through the H-bonding between CCM and selenite, which is also observed via IR and NMR studied. For DCCM, the primary driving force is the formation of an acid-base adduct with selenite showing that the phenolic OH group of DCCM was responsible for forming major conformer of DCCM. The formation mechanisms of selenite complexes with CCM or DCCM explain why DCCM has greater activity than CCM in extenuating the toxicity of selenite as to prevent selenite-induced lens protein aggregation.

Circuit to Construct Mapping: A Mathematical Tool for Assisting the Diagnosis and Treatment in Major Depressive Disorder

PubMed Central

Bielczyk, Natalia Z.; Buitelaar, Jan K.; Glennon, Jeffrey C.; Tiesinga, Paul H. E.

2015-01-01

Major depressive disorder (MDD) is a serious condition with a lifetime prevalence exceeding 16% worldwide. MDD is a heterogeneous disorder that involves multiple behavioral symptoms on the one hand and multiple neuronal circuits on the other hand. In this review, we integrate the literature on cognitive and physiological biomarkers of MDD with the insights derived from mathematical models of brain networks, especially models that can be used for fMRI datasets. We refer to the recent NIH research domain criteria initiative, in which a concept of “constructs” as functional units of mental disorders is introduced. Constructs are biomarkers present at multiple levels of brain functioning – cognition, genetics, brain anatomy, and neurophysiology. In this review, we propose a new approach which we called circuit to construct mapping (CCM), which aims to characterize causal relations between the underlying network dynamics (as the cause) and the constructs referring to the clinical symptoms of MDD (as the effect). CCM involves extracting diagnostic categories from behavioral data, linking circuits that are causal to these categories with use of clinical neuroimaging data, and modeling the dynamics of the emerging circuits with attractor dynamics in order to provide new, neuroimaging-related biomarkers for MDD. The CCM approach optimizes the clinical diagnosis and patient stratification. It also addresses the recent demand for linking circuits to behavior, and provides a new insight into clinical treatment by investigating the dynamics of neuronal circuits underneath cognitive dimensions of MDD. CCM can serve as a new regime toward personalized medicine, assisting the diagnosis and treatment of MDD. PMID:25767450

Integrated community case management for childhood illnesses: explaining policy resistance in Kenya.

PubMed

Juma, Pamela A; Owuor, Karen; Bennett, Sara

2015-12-01

There has been a re-emphasis recently on community health workers to provide child health care services including integrated community case management for childhood illness (iCCM). This research analysed iCCM policy development in Kenya and in particular the types of decision-making criteria used by Kenyan policy-makers in considering whether to advance iCCM policy. Data were collected through document reviews (n = 41) and semi-structured interviews (n = 19) with key stakeholders in iCCM policy including government officials, development partners, bilateral donors, and civil society organizations. Initial analysis was guided by the policy triangle with further analysis of factors affecting policy decision-making drawing upon a simple framework developed by Grindle and Thomas (Policy makers, policy choices and policy outcomes: the political economy of reform in developing countries. 1989; Policy Sci 22: :213-48.). Policy development for iCCM has been slow in Kenya, compared with other Sub-Saharan African countries. At the time of the study, the Government had just completed the Community Health Training Manual which incorporated iCCM as a module, but this was the only formal expression of iCCM in Kenya. We found technical considerations, notably concerns about community health workers dispensing antibiotics to be a key factor slowing iCCM policy development, but this also overlapped with bureaucratic considerations, such as how the development of community health worker cadres may affect clinicians, as well as initial concerns about how an integrated approach might affect vertically oriented programs. International actors through agreements such as the Millennium Development Goals helped to get child survival onto the national policy agenda and such actors were active promoters of iCCM policy change. However international funders had not committed funding to scale-up iCCM policy, and this probably constrained their influence over iCCM policy debate. Kenyan actors' concerns about iCCM underline the importance of adapting global policies to local conditions, and also generating local evidence to inform decision-making. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A three-dimensional simulation of the equatorial quasi-biennial oscillation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Takahashi, M.; Boville, B.A.

1992-06-15

A simulation of the equatorial quasi-biennial oscillation (QBO) has been obtained using a three-dimensional mechanistic model of the stratosphere. The model is a simplified form of the NCAR CCM (Community Climate Model) in which the troposphere has been replaced with a specified geopotential distribution near the tropical tropopause and most of the physical parameterizations have been removed. A Kelvin wave and a Rossby-gravity wave are forced at the bottom boundary as in previous one- and two-dimensional models. The model reproduces most of the principal features of the observed QBO, as do previous models with lower dimensionality. The principal difference betweenmore » the present model and previous QBO models is that the wave propagation is explicitly represented, allowing wave-wave interactions to take place. It is found that these interactions significantly affect the simulated oscillation. The interaction of the Rossby-gravity waves with the Kelvin waves results in about twice as much easterly compared to westerly forcing being required in order to obtain a QBO. 26 refs., 12 figs.« less

The carbonic anhydrase CAH1 is an essential component of the carbon-concentrating mechanism in Nannochloropsis oceanica.

PubMed

Gee, Christopher W; Niyogi, Krishna K

2017-04-25

Aquatic photosynthetic organisms cope with low environmental CO 2 concentrations through the action of carbon-concentrating mechanisms (CCMs). Known eukaryotic CCMs consist of inorganic carbon transporters and carbonic anhydrases (and other supporting components) that culminate in elevated [CO 2 ] inside a chloroplastic Rubisco-containing structure called a pyrenoid. We set out to determine the molecular mechanisms underlying the CCM in the emerging model photosynthetic stramenopile, Nannochloropsis oceanica , a unicellular picoplanktonic alga that lacks a pyrenoid. We characterized CARBONIC ANHYDRASE 1 ( CAH1 ) as an essential component of the CCM in N. oceanica CCMP1779. We generated insertions in this gene by directed homologous recombination and found that the cah1 mutant has severe defects in growth and photosynthesis at ambient CO 2 We identified CAH1 as an α-type carbonic anhydrase, providing a biochemical role in CCM function. CAH1 was found to localize to the lumen of the epiplastid endoplasmic reticulum, with its expression regulated by the external inorganic carbon concentration at both the transcript and protein levels. Taken together, these findings show that CAH1 is an indispensable component of what may be a simple but effective and dynamic CCM in N. oceanica .

Vegetation-climate feedbacks in the conversion of tropical savanna to grassland

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoffmann, W.A.; Jackson, R.B.

2000-05-01

Tropical savannas have been heavily impacted by human activity, with large expanses transformed from a mixture of trees and grasses to open grassland and agriculture. The National Center for Atmospheric Research (NCAR) CCM3 general circulation model, coupled with the NCAR Land Surface Model, was used to simulate the effects of this conversion on regional climate. Conversion of savanna to grassland reduced precipitation by approximately 10% in four of the five savanna regions under study; only the northern African savannas showed no significant decline. Associated with this decline was an increase in the frequency of dry periods within the wet season,more » a change that could be particularly damaging to shallow-rooted crops. The overall decline in precipitation is almost equally attributable to changes in albedo and roughness length. Conversion to grassland increased mean surface air temperature of all the regions by 0.5 C, primarily because of reductions in surface roughness length. Rooting depth, which decreases dramatically with the conversion of savanna to grassland, contributed little to the overall effect of savanna conversion, but deeper rooting had a small positive effect on latent heat flux with a corresponding reduction in sensible heat flux. The authors propose that the interdependence of climate and vegetation in these regions is manifested as a positive feedback loop in which anthropogenic impacts on savanna vegetation are exacerbated by declines in precipitation.« less

Structure and vascular function of MEKK3–cerebral cavernous malformations 2 complex

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fisher, Oriana S.; Deng, Hanqiang; Liu, Dou

Cerebral cavernous malformations 2 (CCM2) loss is associated with the familial form of CCM disease. The protein kinase MEKK3 (MAP3K3) is essential for embryonic angiogenesis in mice and interacts physically with CCM2, but how this interaction is mediated and its relevance to cerebral vasculature are unknown. Here we report that Mekk3 plays an intrinsic role in embryonic vascular development. Inducible endothelial Mekk3 knockout in neonatal mice is lethal due to multiple intracranial haemorrhages and brain blood vessels leakage. We discover direct interaction between CCM2 harmonin homology domain (HHD) and the N terminus of MEKK3, and determine a 2.35 Å cocrystalmore » structure. We find Mekk3 deficiency impairs neurovascular integrity, which is partially dependent on Rho–ROCK signalling, and that disruption of MEKK3:CCM2 interaction leads to similar neurovascular leakage. We conclude that CCM2:MEKK3-mediated regulation of Rho signalling is required for maintenance of neurovascular integrity, unravelling a mechanism by which CCM2 loss leads to disease.« less

Continuous esterification to produce biodiesel by SPES/PES/NWF composite catalytic membrane in flow-through membrane reactor: experimental and kinetic studies.

PubMed

Shi, Wenying; He, Benqiao; Cao, Yuping; Li, Jianxin; Yan, Feng; Cui, Zhenyu; Zou, Zhiqun; Guo, Shiwei; Qian, Xiaomin

2013-02-01

A novel composite catalytic membrane (CCM) was prepared from sulfonated polyethersulfone (SPES) and polyethersulfone (PES) blend supported by non-woven fabrics, as a heterogeneous catalyst to produce biodiesel from continuous esterification of oleic acid with methanol in a flow-through mode. A kinetic model of esterification was established based on a plug-flow assumption. The effects of the CCM structure (thickness, area, porosity, etc.), reaction temperature and the external and internal mass transfer resistances on esterification were investigated. The results showed that the CCM structure had a significant effect on the acid conversion. The external mass transfer resistance could be neglected when the flow rate was over 1.2 ml min(-1). The internal mass transfer resistance impacted on the conversion when membrane thickness was over 1.779 mm. An oleic acid conversion kept over 98.0% for 500 h of continuous running. The conversions obtained from the model are in good agreement with the experimental data. Copyright © 2012 Elsevier Ltd. All rights reserved.

Reducing agent-free synthesis of curcumin-loaded albumin nanoparticles by self-assembly at room temperature.

PubMed

Safavi, Maryam Sadat; Shojaosadati, Seyed Abbas; Yang, Hye Gyeong; Kim, Yejin; Park, Eun Ji; Lee, Kang Choon; Na, Dong Hee

2017-08-30

The purpose of this study was to prepare curcumin-loaded bovine serum albumin nanoparticles (CCM-BSA-NPs) by reducing agent-free self-assembly at room temperature. A 2 4 factorial design approach was used to investigate the CCM-BSA-NP preparation process at different pH values, temperatures, dithiothreitol amounts, and CCM/BSA mass ratios. Increasing the ionic strength enabled preparation of CCM-BSA-NPs at 25°C without reducing agent. CCM-BSA-NPs prepared under the optimized conditions at 25°C showed a particle size of 110±6nm, yield of 88.5%, and drug loading of 7.1%. The CCM-BSA-NPs showed strong antioxidant activity and neuroprotective effects in glutamate-induced mouse hippocampal neuronal HT22 cells. This study suggests that ionic strength can be a key parameter affecting the preparation of albumin-based NPs. Copyright © 2017 Elsevier B.V. All rights reserved.

RNA Editing Responses to Oxidative Stress between a Wild Abortive Type Male-Sterile Line and Its Maintainer Line

PubMed Central

Xiong, Jie; Tao, Tao; Luo, Zhi; Yan, Shuaigang; Liu, Yi; Yu, Xinqiao; Liu, Guolan; Xia, Hui; Luo, Lijun

2017-01-01

RNA editing of mitochondrial gene transcripts plays a central role during plant development and evolutionary adaptation. RNA editing has previously been reported to differ between the rice cytoplasmic male sterile (CMS) line and its maintainer line, which has been suggested as a cause for their different performances under environmental stress. To specifically test this hypothesis, a wild abortive (WA) CMS line (Huhan-1A) and its maintainer line (Huhan-1B) were utilized to investigate performances in response to oxidative stress, as well as RNA editing efficiencies on transcripts of six selected mitochondrial genes. Compared to the maintainer line, Huhan-1A represented both lower plant height and total antioxidant capacity, possessed higher total soluble protein and chlorophyll contents, accumulated less H2O2 content on the 3rd day after treatment (DAT), and exhibited higher survival ratio after re-watering. Furthermore, a total of 90 editing sites were detected on transcripts of six mitochondrial genes (atp9, nad2, nad7, nad9, ccmB, and ccmC) in both Huhan-1A and Huhan-1B on the 0, 1st, and 3rd DAT. Forty-eight sites were furthermore determined as stress-responsive sites (SRS). Generally, in response to oxidative stress, SRS in Huhan-1A increased the resulting editing efficiencies, while SRS in Huhan-1B decreased the resulting editing efficiencies. In addition, 33 and 22 sites at ccmB and ccmC were differentially edited between Huhan-1A and Huhan-1B, respectively, on the 0, 1st, and 3rd DAT. Editing efficiencies of ccmB and ccmC were generally lower in Huhan-1A (ccmB, 37.3–47.8%; ccmC, 41.2–52.3%) than those in Huhan-1B (ccmB, 82.6–86.5%; ccmC, 81.0–82.9%). Deficiencies of RNA editing in Huhan-1A at ccmB and ccmC could lead to the loss of transmembrane domains in their protein structures. Consequently, differences in RNA editing at ccmB and ccmC between the WA-CMS line and its maintainer line partially explained their different performances under stress. Moreover, we detected differences in expressions of pentatricopeptide repeat (PPR) genes between both lines, as well as significant correlations with RNA editing. Our study indicated potential associations of RNA editing and PPR genes in rice tolerance to abiotic stresses. However, the underlying molecular mechanisms of stress-adaptation, which are attributed to RNA editing on transcripts of mitochondrial genes, require further investigation. PMID:29234339

A Finite-Volume "Shaving" Method for Interfacing NASA/DAO''s Physical Space Statistical Analysis System to the Finite-Volume GCM with a Lagrangian Control-Volume Vertical Coordinate

NASA Technical Reports Server (NTRS)

Lin, Shian-Jiann; DaSilva, Arlindo; Atlas, Robert (Technical Monitor)

2001-01-01

Toward the development of a finite-volume Data Assimilation System (fvDAS), a consistent finite-volume methodology is developed for interfacing the NASA/DAO's Physical Space Statistical Analysis System (PSAS) to the joint NASA/NCAR finite volume CCM3 (fvCCM3). To take advantage of the Lagrangian control-volume vertical coordinate of the fvCCM3, a novel "shaving" method is applied to the lowest few model layers to reflect the surface pressure changes as implied by the final analysis. Analysis increments (from PSAS) to the upper air variables are then consistently put onto the Lagrangian layers as adjustments to the volume-mean quantities during the analysis cycle. This approach is demonstrated to be superior to the conventional method of using independently computed "tendency terms" for surface pressure and upper air prognostic variables.

Cluster-based analysis of multi-model climate ensembles

NASA Astrophysics Data System (ADS)

Hyde, Richard; Hossaini, Ryan; Leeson, Amber A.

2018-06-01

Clustering - the automated grouping of similar data - can provide powerful and unique insight into large and complex data sets, in a fast and computationally efficient manner. While clustering has been used in a variety of fields (from medical image processing to economics), its application within atmospheric science has been fairly limited to date, and the potential benefits of the application of advanced clustering techniques to climate data (both model output and observations) has yet to be fully realised. In this paper, we explore the specific application of clustering to a multi-model climate ensemble. We hypothesise that clustering techniques can provide (a) a flexible, data-driven method of testing model-observation agreement and (b) a mechanism with which to identify model development priorities. We focus our analysis on chemistry-climate model (CCM) output of tropospheric ozone - an important greenhouse gas - from the recent Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP). Tropospheric column ozone from the ACCMIP ensemble was clustered using the Data Density based Clustering (DDC) algorithm. We find that a multi-model mean (MMM) calculated using members of the most-populous cluster identified at each location offers a reduction of up to ˜ 20 % in the global absolute mean bias between the MMM and an observed satellite-based tropospheric ozone climatology, with respect to a simple, all-model MMM. On a spatial basis, the bias is reduced at ˜ 62 % of all locations, with the largest bias reductions occurring in the Northern Hemisphere - where ozone concentrations are relatively large. However, the bias is unchanged at 9 % of all locations and increases at 29 %, particularly in the Southern Hemisphere. The latter demonstrates that although cluster-based subsampling acts to remove outlier model data, such data may in fact be closer to observed values in some locations. We further demonstrate that clustering can provide a viable and useful framework in which to assess and visualise model spread, offering insight into geographical areas of agreement among models and a measure of diversity across an ensemble. Finally, we discuss caveats of the clustering techniques and note that while we have focused on tropospheric ozone, the principles underlying the cluster-based MMMs are applicable to other prognostic variables from climate models.

Transformation of Strontium during formation of biogenic calcium carbonate

NASA Astrophysics Data System (ADS)

Ohnuki, T.; Kozai, N.; Sakamoto, F.; Yamashita, M.; Horiieke, T.; Utsunomiya, S.

2016-12-01

Some amounts of radionuclides contaminated water containing 90Sr generated in the Fukushima Daiichi Nuclear Power Plant were leaked to sea water in the port. One of the possible method to eliminate 90Sr is co-precipitated with biogenic carbonates minerals (CCM). Specific bacteria are known to form biogenic CCM in groundwater. In the present study, we have screened specific bacterium to form CCM in saline water, and studied transformation of Sr during biogenic CCM. A marine microbe of strain TK2d, which is screened from Tokyo bay to form CCM in saline solution, was grown in the medium solution contained urea and Sr. The concentratuion of Sr2+ in the solution was monitored by ICP-OES (ICP-OES; 720 Agilent Technologies, Inc., USA) during the formation of biogenic CCM. The precipitates were analyzed by SEM, TEM, and XAFS. When 1.0 mM Sr was dissolved in the medium solution, the concentration of Sr decreased up to 0.02 mM within 10 days, indicating that most of Sr in the solution was eliminated within 10 days. SEM and TEM analyses showed that needle shaped CCM containing Ca and Sr were formed. The CCM was not single crystalline, but poly-crystalline of calcite and aragonite. The elemental mapping showed that Sr was present at the same position of Ca, indicating that Sr was coprecipitated with Ca. The XANES analysis of Sr in the precipitates showed that the XANES spectrum was not the same as that of Sr coprecipitated with an abiotic Ca carbonates. Linear combination fitting of XANES spectra by those of SrCl2 and SrCO3 showed that both Sr2+ and SrCO3 were present in CCM. Longer contact time resulted in higher content of SrCO3, indicating that Sr was incorporated gradually with time into CCM structure. Thus, Sr was changed its chemical species from adsorbed one to the incorporated one in biogenic CCM in saline solution. This work was partially supported by a research grant from the Japan Science and Technology Agency, Japan (research grant No. 260502).

Genome-Wide Identification of Regulatory Elements and Reconstruction of Gene Regulatory Networks of the Green Alga Chlamydomonas reinhardtii under Carbon Deprivation

PubMed Central

Vischi Winck, Flavia; Arvidsson, Samuel; Riaño-Pachón, Diego Mauricio; Hempel, Sabrina; Koseska, Aneta; Nikoloski, Zoran; Urbina Gomez, David Alejandro; Rupprecht, Jens; Mueller-Roeber, Bernd

2013-01-01

The unicellular green alga Chlamydomonas reinhardtii is a long-established model organism for studies on photosynthesis and carbon metabolism-related physiology. Under conditions of air-level carbon dioxide concentration [CO2], a carbon concentrating mechanism (CCM) is induced to facilitate cellular carbon uptake. CCM increases the availability of carbon dioxide at the site of cellular carbon fixation. To improve our understanding of the transcriptional control of the CCM, we employed FAIRE-seq (formaldehyde-assisted Isolation of Regulatory Elements, followed by deep sequencing) to determine nucleosome-depleted chromatin regions of algal cells subjected to carbon deprivation. Our FAIRE data recapitulated the positions of known regulatory elements in the promoter of the periplasmic carbonic anhydrase (Cah1) gene, which is upregulated during CCM induction, and revealed new candidate regulatory elements at a genome-wide scale. In addition, time series expression patterns of 130 transcription factor (TF) and transcription regulator (TR) genes were obtained for cells cultured under photoautotrophic condition and subjected to a shift from high to low [CO2]. Groups of co-expressed genes were identified and a putative directed gene-regulatory network underlying the CCM was reconstructed from the gene expression data using the recently developed IOTA (inner composition alignment) method. Among the candidate regulatory genes, two members of the MYB-related TF family, Lcr1 (Low-CO 2 response regulator 1) and Lcr2 (Low-CO 2 response regulator 2), may play an important role in down-regulating the expression of a particular set of TF and TR genes in response to low [CO2]. The results obtained provide new insights into the transcriptional control of the CCM and revealed more than 60 new candidate regulatory genes. Deep sequencing of nucleosome-depleted genomic regions indicated the presence of new, previously unknown regulatory elements in the C. reinhardtii genome. Our work can serve as a basis for future functional studies of transcriptional regulator genes and genomic regulatory elements in Chlamydomonas. PMID:24224019

Nonlinear Directed Interactions Between HRV and EEG Activity in Children With TLE.

PubMed

Schiecke, Karin; Pester, Britta; Piper, Diana; Benninger, Franz; Feucht, Martha; Leistritz, Lutz; Witte, Herbert

2016-12-01

Epileptic seizure activity influences the autonomic nervous system (ANS) in different ways. Heart rate variability (HRV) is used as indicator for alterations of the ANS. It was shown that linear, nondirected interactions between HRV and EEG activity before, during, and after epileptic seizure occur. Accordingly, investigations of directed nonlinear interactions are logical steps to provide, e.g., deeper insight into the development of seizure onsets. Convergent cross mapping (CCM) investigates nonlinear, directed interactions between time series by using nonlinear state space reconstruction. CCM is applied to simulated and clinically relevant data, i.e., interactions between HRV and specific EEG components of children with temporal lobe epilepsy (TLE). In addition, time-variant multivariate Autoregressive model (AR)-based estimation of partial directed coherence (PDC) was performed for the same data. Influence of estimation parameters and time-varying behavior of CCM estimation could be demonstrated by means of simulated data. AR-based estimation of PDC failed for the investigation of our clinical data. Time-varying interval-based application of CCM on these data revealed directed interactions between HRV and delta-related EEG activity. Interactions between HRV and alpha-related EEG activity were visible but less pronounced. EEG components mainly drive HRV. The interaction pattern and directionality clearly changed with onset of seizure. Statistical relevant interactions were quantified by bootstrapping and surrogate data approach. In contrast to AR-based estimation of PDC CCM was able to reveal time-courses and frequency-selective views of nonlinear interactions for the further understanding of complex interactions between the epileptic network and the ANS in children with TLE.

Evaluation of antioxidant and xanthine oxidase inhibitory activity of different solvent extracts of leaves of Citrullus colocynthis

PubMed Central

Nessa, Fazilatun; Khan, Saeed A.

2014-01-01

Background: Citrullus colocynthis is a folk medicinal plan of United Arab Emirates. Several studies on this plant reported and focused on the biological and toxicological profile of fruits pulp. The present study focused on the antioxidant potency of leaf extract of this plant. Aim: To evaluate the antioxidant and xanthine oxidase (XO) inhibitory activities of C. colocynthis by chemical method. Materials and Methods: Four different solvent extracts (methanol-CCM, methanol: water (1:1)-CCMW, chloroform-CCC and hexane-CCH) of leaves of C. colocynthis were investigated for their free radical scavenging activity using DPPH radical as a substrate, lipid peroxidation (LPO) inhibitory activity using a model system consisting of β-carotene-linoleic acid, superoxide radical scavenging activity (enzymatically/nonenzymatically) and XO inhibitory activity. A dose response curve was plotted for determining SC50 and IC50 values for expressing the results of free radical scavenging activity and XO inhibitory activities respectively. Results: The high polyphenolic content of CCM and CCMW extract showed highest antioxidant activity irrespective the method used for this investigation. The overall results decreased in the order of: CCM > CCMW > CCC > CCH. CCH extract was inactive towards chemically generated superoxide radical and poor DPPH radical scavengers. The results of LPO inhibitory activities of leaves extract (0.1, 0.5 and 1.0 mg/mL) also decreased in the order of: CCM > CCMW > CCC > CCH. Overall 1.0 mg/mL leaves extract showed highest antioxidant potency amongst the studied concentration. Conclusion: CCMW and CCM extract of C. colocynthis exhibited promising antioxidants and XO inhibitory activities. PMID:25002802

The millennium water vapour drop in chemistry-climate model simulations

NASA Astrophysics Data System (ADS)

Brinkop, Sabine; Dameris, Martin; Jöckel, Patrick; Garny, Hella; Lossow, Stefan; Stiller, Gabriele

2016-07-01

This study investigates the abrupt and severe water vapour decline in the stratosphere beginning in the year 2000 (the "millennium water vapour drop") and other similarly strong stratospheric water vapour reductions by means of various simulations with the state-of-the-art Chemistry-Climate Model (CCM) EMAC (ECHAM/MESSy Atmospheric Chemistry Model). The model simulations differ with respect to the prescribed sea surface temperatures (SSTs) and whether nudging is applied or not. The CCM EMAC is able to most closely reproduce the signature and pattern of the water vapour drop in agreement with those derived from satellite observations if the model is nudged. Model results confirm that this extraordinary water vapour decline is particularly obvious in the tropical lower stratosphere and is related to a large decrease in cold point temperature. The drop signal propagates under dilution to the higher stratosphere and to the poles via the Brewer-Dobson circulation (BDC). We found that the driving forces for this significant decline in water vapour mixing ratios are tropical sea surface temperature (SST) changes due to a coincidence with a preceding strong El Niño-Southern Oscillation event (1997/1998) followed by a strong La Niña event (1999/2000) and supported by the change of the westerly to the easterly phase of the equatorial stratospheric quasi-biennial oscillation (QBO) in 2000. Correct (observed) SSTs are important for triggering the strong decline in water vapour. There are indications that, at least partly, SSTs contribute to the long period of low water vapour values from 2001 to 2006. For this period, the specific dynamical state of the atmosphere (overall atmospheric large-scale wind and temperature distribution) is important as well, as it causes the observed persistent low cold point temperatures. These are induced by a period of increased upwelling, which, however, has no corresponding pronounced signature in SSTs anomalies in the tropics. Our free-running simulations do not capture the drop as observed, because a) the cold point temperature has a low bias and thus the water vapour variability is reduced and b) because they do not simulate the appropriate dynamical state. Large negative water vapour declines are also found in other years and seem to be a feature which can be found after strong combined El Niño/La Niña events if the QBO west phase during La Niña changes to the east phase.

Evolution of the eastward shift in the quasi-stationary minimum of the Antarctic total ozone column

NASA Astrophysics Data System (ADS)

Grytsai, Asen; Klekociuk, Andrew; Milinevsky, Gennadi; Evtushevsky, Oleksandr; Stone, Kane

2017-02-01

The quasi-stationary pattern of the Antarctic total ozone has changed during the last 4 decades, showing an eastward shift in the zonal ozone minimum. In this work, the association between the longitudinal shift of the zonal ozone minimum and changes in meteorological fields in austral spring (September-November) for 1979-2014 is analyzed using ERA-Interim and NCEP-NCAR reanalyses. Regressive, correlative and anomaly composite analyses are applied to reanalysis data. Patterns of the Southern Annular Mode and quasi-stationary zonal waves 1 and 3 in the meteorological fields show relationships with interannual variability in the longitude of the zonal ozone minimum. On decadal timescales, consistent longitudinal shifts of the zonal ozone minimum and zonal wave 3 pattern in the middle-troposphere temperature at the southern midlatitudes are shown. Attribution runs of the chemistry-climate version of the Australian Community Climate and Earth System Simulator (ACCESS-CCM) model suggest that long-term shifts of the zonal ozone minimum are separately contributed by changes in ozone-depleting substances and greenhouse gases. As is known, Antarctic ozone depletion in spring is strongly projected on the Southern Annular Mode in summer and impacts summertime surface climate across the Southern Hemisphere. The results of this study suggest that changes in zonal ozone asymmetry accompanying ozone depletion could be associated with regional climate changes in the Southern Hemisphere in spring.

Assessment of the monitoring and evaluation system for integrated community case management (ICCM) in Ethiopia: a comparison against global benchmark indicators.

PubMed

Mamo, Dereje; Hazel, Elizabeth; Lemma, Israel; Guenther, Tanya; Bekele, Abeba; Demeke, Berhanu

2014-10-01

Program managers require feasible, timely, reliable, and valid measures of iCCM implementation to identify problems and assess progress. The global iCCM Task Force developed benchmark indicators to guide implementers to develop or improve monitoring and evaluation (M&E) systems. To assesses Ethiopia's iCCM M&E system by determining the availability and feasibility of the iCCM benchmark indicators. We conducted a desk review of iCCM policy documents, monitoring tools, survey reports, and other rele- vant documents; and key informant interviews with government and implementing partners involved in iCCM scale-up and M&E. Currently, Ethiopia collects data to inform most (70% [33/47]) iCCM benchmark indicators, and modest extra effort could boost this to 83% (39/47). Eight (17%) are not available given the current system. Most benchmark indicators that track coordination and policy, human resources, service delivery and referral, supervision, and quality assurance are available through the routine monitoring systems or periodic surveys. Indicators for supply chain management are less available due to limited consumption data and a weak link with treatment data. Little information is available on iCCM costs. Benchmark indicators can detail the status of iCCM implementation; however, some indicators may not fit country priorities, and others may be difficult to collect. The government of Ethiopia and partners should review and prioritize the benchmark indicators to determine which should be included in the routine M&E system, especially since iCCMdata are being reviewed for addition to the HMIS. Moreover, the Health Extension Worker's reporting burden can be minimized by an integrated reporting approach.

Mandatory labeling requirements and over-the-counter cough and cold medication use in early childhood.

PubMed

DeGroot, Julie; Anderson, Laura N; Chen, Yang; Birken, Catherine S; Parkin, Patricia C; Carsley, Sarah; Khovratovich, Marina; Mamdani, Muhammad; Maguire, Jonathon L

2016-03-16

Due to rare but severe adverse events, Health Canada in October 2009 required manufacturers to relabel over-the-counter (OTC) cough and cold medication (CCM) to state that the products should not be used in children <6 years of age. The main objective of this study was to determine whether this labeling standard decreased OTC CCM use among young children with a recent cough, cold or flu. An interrupted time series study was conducted using data from the TARGet Kids! practice-based research network. A total of 3,515 healthy children 1-5 years of age were recruited from 2008-2011; of these, 1,072 had a cough, cold or flu in the previous month. Parents completed a standardized survey instrument. For the primary analysis, use of OTC CCMs prior to and after October 1, 2009 was compared using time series analyses. For the secondary analysis, multivariable logistic regression was used to identify predictors of recent OTC CCM use. OTC CCM use was reported in 222 of 1,072 (20.7%) children with a cough, cold or flu within the previous month. OTC CCM use declined from 22.2% to 17.8% following the October 2009 Health Canada labeling standard (p = 0.014). Maternal age <35 years (OR 1.49; 95% CI: 1.05-2.13) and having older siblings (OR 1.65; 95% CI: 1.16-2.35) were independently associated with OTC CCM use. Labeling legislation against OTC CCM use for children <6 years resulted in a small decrease in OTC CCM use. Stronger measures may be needed to curtail OTC CCM use, particularly for younger parents and those with multiple children.

Transport of Passive Tracers in Baroclinic Wave Life Cycles

NASA Technical Reports Server (NTRS)

Stone, Elizabeth M.; Randel, William J.; Stanford, John L.

1999-01-01

The transport of passive tracers in idealized baroclinic wave life cycles is studied using output from the National Center for Atmospheric Research Community Climate Model (CCM2). Two life cycles, LCn and LCs, are simulated, starting with baroclinically unstable initial conditions similar to those used by Thorncroft et al. in their study of two life cycle paradigms. The two life cycles LCn and LCs have different initial horizontal wind shear structures that result in distinctive nonlinear development. In terms of potential vorticity-potential temperature (PV-theta) diagnostics, the LCn case is characterized by thinning troughs that are advected anti-cyclonically and equatorward, while the LCs case has broadening troughs that wrap up cyclonically and poleward. Four idealized passive tracers are included in the model to be advected by the semi-Lagrangian transport scheme of the CCM2, and their evolutions are investigated throughout the life cycles. Tracer budgets are analyzed in terms of the transformed Eulerian mean constituent transport formalism in pressure coordinates and also in isentropic coordinates. Results for both LCn and LCs show transport that is downgradient with respect to the background structure of the tracer field, but with a characteristic spatial structure that maximizes in the middle to high latitudes. For the idealized tropospheric tracers in this study, this represents a net upward and poleward transport that enhances concentrations at high latitudes. These results vary little with the initial distribution of the constituent field. The time tendency of the tracer is influenced most strongly by the eddy flux term. with the largest transport occurring during the nonlinear growth stage of the life cycle. The authors also study the transport of a lower-stratospheric tracer, to examine stratosphere-troposphere exchange for baroclinic waves.

Expanding the chronic care framework to improve diabetes management: the REACH case study.

PubMed

Jenkins, Carolyn; Pope, Charlene; Magwood, Gayenell; Vandemark, Lisa; Thomas, Virginia; Hill, Karen; Linnen, Florene; Beck, Lorna Shelton; Zapka, Jane

2010-01-01

Reducing the burden of chronic conditions among minorities requires novel approaches to prevent and manage disease. This paper describes the expansion of the Chronic Care Model (CCM) to include a community focus for improving diabetes self-management and reducing health disparities. The literature review assesses the concept of "community" in improving outcomes as viewed by proponents of the CCM for chronic disease. The CCM was then modified and informed by experiences of a major community-based participatory action initiative to improve diabetes outcomes, the Racial and Ethnic Approaches to Community Health (REACH) Charleston and Georgetown Diabetes Coalition. Based on our experiences with community-based and health systems diabetes interventions, we present examples of improvements within both health delivery practice sites and other community systems that are essential for improving diabetes outcomes and reducing disparities. Building on the Centers for Disease Control and Prevention's (CDC) principles of community involvement, our coalition activities provide examples of working with community partners to frame this enhanced ecologically grounded Community CCM (CCCM). The resulting CCCM integrates expanded conceptual frameworks, evidence-based practice, community-based evidence and participatory actions, and highlights the possibilities and challenges for improving chronic disease outcomes and reducing disparities via community programs that foster individual, systems, community, and policy change.

Towards a Model Climatology of Relative Humidity in the Upper Troposphere for Estimation of Contrail and Contrail-Induced Cirrus

NASA Technical Reports Server (NTRS)

Selkirk, Henry B.; Manyin, M.; Ott, L.; Oman, L.; Benson, C.; Pawson, S.; Douglass, A. R.; Stolarski, R. S.

2011-01-01

The formation of contrails and contrail cirrus is very sensitive to the relative humidity of the upper troposphere. To reduce uncertainty in an estimate of the radiative impact of aviation-induced cirrus, a model must therefore be able to reproduce the observed background moisture fields with reasonable and quantifiable fidelity. Here we present an upper tropospheric moisture climatology from a 26-year ensemble of simulations using the GEOS CCM. We compare this free-running model's moisture fields to those obtained from the MLS and AIRS satellite instruments, our most comprehensive observational databases for upper tropospheric water vapor. Published comparisons have shown a substantial wet bias in GEOS-5 assimilated fields with respect to MLS water vapor and ice water content. This tendency is clear as well in the GEOS CCM simulations. The GEOS-5 moist physics in the GEOS CCM uses a saturation adjustment that prevents supersaturation, which is unrealistic when compared to in situ moisture observations from MOZAIC aircraft and balloon sondes as we will show. Further, the large-scale satellite datasets also consistently underestimate super-saturation when compared to the in-situ observations. We place these results in the context of estimates of contrail and contrail cirrus frequency.

Effects of fuel cetane number on the structure of diesel spray combustion: An accelerated Eulerian stochastic fields method

NASA Astrophysics Data System (ADS)

Jangi, Mehdi; Lucchini, Tommaso; Gong, Cheng; Bai, Xue-Song

2015-09-01

An Eulerian stochastic fields (ESF) method accelerated with the chemistry coordinate mapping (CCM) approach for modelling spray combustion is formulated, and applied to model diesel combustion in a constant volume vessel. In ESF-CCM, the thermodynamic states of the discretised stochastic fields are mapped into a low-dimensional phase space. Integration of the chemical stiff ODEs is performed in the phase space and the results are mapped back to the physical domain. After validating the ESF-CCM, the method is used to investigate the effects of fuel cetane number on the structure of diesel spray combustion. It is shown that, depending of the fuel cetane number, liftoff length is varied, which can lead to a change in combustion mode from classical diesel spray combustion to fuel-lean premixed burned combustion. Spray combustion with a shorter liftoff length exhibits the characteristics of the classical conceptual diesel combustion model proposed by Dec in 1997 (http://dx.doi.org/10.4271/970873), whereas in a case with a lower cetane number the liftoff length is much larger and the spray combustion probably occurs in a fuel-lean-premixed mode of combustion. Nevertheless, the transport budget at the liftoff location shows that stabilisation at all cetane numbers is governed primarily by the auto-ignition process.

Dual-model automatic detection of nerve-fibres in corneal confocal microscopy images.

PubMed

Dabbah, M A; Graham, J; Petropoulos, I; Tavakoli, M; Malik, R A

2010-01-01

Corneal Confocal Microscopy (CCM) imaging is a non-invasive surrogate of detecting, quantifying and monitoring diabetic peripheral neuropathy. This paper presents an automated method for detecting nerve-fibres from CCM images using a dual-model detection algorithm and compares the performance to well-established texture and feature detection methods. The algorithm comprises two separate models, one for the background and another for the foreground (nerve-fibres), which work interactively. Our evaluation shows significant improvement (p approximately 0) in both error rate and signal-to-noise ratio of this model over the competitor methods. The automatic method is also evaluated in comparison with manual ground truth analysis in assessing diabetic neuropathy on the basis of nerve-fibre length, and shows a strong correlation (r = 0.92). Both analyses significantly separate diabetic patients from control subjects (p approximately 0).

Temporal expansion of annual crop classification layers for the CONUS using the C5 decision tree classifier

USGS Publications Warehouse

Friesz, Aaron M.; Wylie, Bruce K.; Howard, Daniel M.

2017-01-01

Crop cover maps have become widely used in a range of research applications. Multiple crop cover maps have been developed to suite particular research interests. The National Agricultural Statistics Service (NASS) Cropland Data Layers (CDL) are a series of commonly used crop cover maps for the conterminous United States (CONUS) that span from 2008 to 2013. In this investigation, we sought to contribute to the availability of consistent CONUS crop cover maps by extending temporal coverage of the NASS CDL archive back eight additional years to 2000 by creating annual NASS CDL-like crop cover maps derived from a classification tree model algorithm. We used over 11 million records to train a classification tree algorithm and develop a crop classification model (CCM). The model was used to create crop cover maps for the CONUS for years 2000–2013 at 250 m spatial resolution. The CCM and the maps for years 2008–2013 were assessed for accuracy relative to resampled NASS CDLs. The CCM performed well against a withheld test data set with a model prediction accuracy of over 90%. The assessment of the crop cover maps indicated that the model performed well spatially, placing crop cover pixels within their known domains; however, the model did show a bias towards the ‘Other’ crop cover class, which caused frequent misclassifications of pixels around the periphery of large crop cover patch clusters and of pixels that form small, sparsely dispersed crop cover patches.

Value-based payment in implementing evidence-based care: the Mental Health Integration Program in Washington state.

PubMed

Bao, Yuhua; McGuire, Thomas G; Chan, Ya-Fen; Eggman, Ashley A; Ryan, Andrew M; Bruce, Martha L; Pincus, Harold Alan; Hafer, Erin; Unützer, Jürgen

2017-01-01

To assess the role of value-based payment (VBP) in improving fidelity and patient outcomes in community implementation of an evidence-based mental health intervention, the Collaborative Care Model (CCM). Retrospective study based on a natural experiment. We used the clinical tracking data of 1806 adult patients enrolled in a large implementation of the CCM in community health clinics in Washington state. VBP was initiated in year 2 of the program, creating a natural experiment. We compared implementation fidelity (measured by 3 process-of-care elements of the CCM) between patient-months exposed to VBP and patient-months not exposed to VBP. A series of regressions were estimated to check robustness of findings. We estimated a Cox proportional hazard model to assess the effect of VBP on time to achieving clinically significant improvement in depression (measured based on changes in depression symptom scores over time). Estimated marginal effects of VBP on fidelity ranged from 9% to 30% of the level of fidelity had there been no exposure to VBP (P <.05 for every fidelity measure). Improvement in fidelity in response to VBP was greater among providers with a larger patient panel and among providers with a lower level of fidelity at baseline. Exposure to VBP was associated with an adjusted hazard ratio of 1.45 (95% confidence interval, 1.04-2.03) for achieving clinically significant improvement in depression. VBP improved fidelity to key elements of the CCM, both directly incentivized and not explicitly incentivized by the VBP, and improved patient depression outcomes.

Weather and seasonal climate prediction for South America using a multi-model superensemble

NASA Astrophysics Data System (ADS)

Chaves, Rosane R.; Ross, Robert S.; Krishnamurti, T. N.

2005-11-01

This work examines the feasibility of weather and seasonal climate predictions for South America using the multi-model synthetic superensemble approach for climate, and the multi-model conventional superensemble approach for numerical weather prediction, both developed at Florida State University (FSU). The effect on seasonal climate forecasts of the number of models used in the synthetic superensemble is investigated. It is shown that the synthetic superensemble approach for climate and the conventional superensemble approach for numerical weather prediction can reduce the errors over South America in seasonal climate prediction and numerical weather prediction.For climate prediction, a suite of 13 models is used. The forecast lead-time is 1 month for the climate forecasts, which consist of precipitation and surface temperature forecasts. The multi-model ensemble is comprised of four versions of the FSU-Coupled Ocean-Atmosphere Model, seven models from the Development of a European Multi-model Ensemble System for Seasonal to Interannual Prediction (DEMETER), a version of the Community Climate Model (CCM3), and a version of the predictive Ocean Atmosphere Model for Australia (POAMA). The results show that conditions over South America are appropriately simulated by the Florida State University Synthetic Superensemble (FSUSSE) in comparison to observations and that the skill of this approach increases with the use of additional models in the ensemble. When compared to observations, the forecasts are generally better than those from both a single climate model and the multi-model ensemble mean, for the variables tested in this study.For numerical weather prediction, the conventional Florida State University Superensemble (FSUSE) is used to predict the mass and motion fields over South America. Predictions of mean sea level pressure, 500 hPa geopotential height, and 850 hPa wind are made with a multi-model superensemble comprised of six global models for the period January, February, and December of 2000. The six global models are from the following forecast centers: FSU, Bureau of Meteorology Research Center (BMRC), Japan Meteorological Agency (JMA), National Centers for Environmental Prediction (NCEP), Naval Research Laboratory (NRL), and Recherche en Prevision Numerique (RPN). Predictions of precipitation are made for the period January, February, and December of 2001 with a multi-analysis-multi-model superensemble where, in addition to the six forecast models just mentioned, five additional versions of the FSU model are used in the ensemble, each with a different initialization (analysis) based on different physical initialization procedures. On the basis of observations, the results show that the FSUSE provides the best forecasts of the mass and motion field variables to forecast day 5, when compared to both the models comprising the ensemble and the multi-model ensemble mean during the wet season of December-February over South America. Individual case studies show that the FSUSE provides excellent predictions of rainfall for particular synoptic events to forecast day 3. Copyright

CCM-AMI, a Polyethylene Glycol Micelle with Amifostine, as an Acute Radiation Syndrome Protectant in C57BL/6 Mice.

PubMed

Chen, Chia-Hung; Kuo, Min-Liang; Wang, Jen-Ling; Liao, Wei-Chuan; Chang, Li-Ching; Chan, Leong-Perng; Lin, Johnson

2015-09-01

Acute radiation syndrome results from radiation exposure, such as in accidental nuclear disasters. Safe and effective radioprotectants, mitigators, and treatment drugs must be developed as medical countermeasures against radiation exposure. Here, the authors evaluated CCM-Ami, a novel polyethylene glycol micelle encapsulated with amifostine, for its radioprotective properties after total-body irradiation from a 60Co source. Male C57BL/6 mice (6-8 wk old) were intravenously injected with 45 mg kg(-1) of CCM-Ami 90 min before exposure to 7.2 and 8.5 Gy irradiation at a dose rate of 0.04 Gy min(-1). Both survival benefit and hematopoietic protection were observed after prophylactic CCM-Ami administration when compared with the effects measured in excipient control and amifostine groups. Pharmacokinetic results showed that after the intravenous injection, the plasma concentration of WR-1065, the active form of amifostine, was higher in CCM-Ami-treated mice than in amifostine-treated mice. These findings suggest that CCM-Ami-mediated hematopoietic protection plays a key role in enhancing survival of mice exposed to radiation toxicity and thus indicate that CCM-Ami is a radioprotectant that can be used safely and effectively in nuclear disasters.

Kuhn's Ontological Relativism.

ERIC Educational Resources Information Center

Sankey, Howard

2000-01-01

Discusses Kuhn's model of scientific theory change. Documents Kuhn's move away from conceptual relativism and rational relativism. Provides an analysis of his present ontological form of relativism. (CCM)

Applying Reflective Middleware Techniques to Optimize a QoS-enabled CORBA Component Model Implementation

NASA Technical Reports Server (NTRS)

Wang, Nanbor; Parameswaran, Kirthika; Kircher, Michael; Schmidt, Douglas

2003-01-01

Although existing CORBA specifications, such as Real-time CORBA and CORBA Messaging, address many end-to-end quality-of service (QoS) properties, they do not define strategies for configuring these properties into applications flexibly, transparently, and adaptively. Therefore, application developers must make these configuration decisions manually and explicitly, which is tedious, error-prone, and open sub-optimal. Although the recently adopted CORBA Component Model (CCM) does define a standard configuration framework for packaging and deploying software components, conventional CCM implementations focus on functionality rather than adaptive quality-of-service, which makes them unsuitable for next-generation applications with demanding QoS requirements. This paper presents three contributions to the study of middleware for QoS-enabled component-based applications. It outlines rejective middleware techniques designed to adaptively (1) select optimal communication mechanisms, (2) manage QoS properties of CORBA components in their contain- ers, and (3) (re)con$gure selected component executors dynamically. Based on our ongoing research on CORBA and the CCM, we believe the application of rejective techniques to component middleware will provide a dynamically adaptive and (re)configurable framework for COTS software that is well-suited for the QoS demands of next-generation applications.

Applying Reflective Middleware Techniques to Optimize a QoS-enabled CORBA Component Model Implementation

NASA Technical Reports Server (NTRS)

Wang, Nanbor; Kircher, Michael; Schmidt, Douglas C.

2000-01-01

Although existing CORBA specifications, such as Real-time CORBA and CORBA Messaging, address many end-to-end quality-of-service (QoS) properties, they do not define strategies for configuring these properties into applications flexibly, transparently, and adaptively. Therefore, application developers must make these configuration decisions manually and explicitly, which is tedious, error-prone, and often sub-optimal. Although the recently adopted CORBA Component Model (CCM) does define a standard configuration frame-work for packaging and deploying software components, conventional CCM implementations focus on functionality rather than adaptive quality-of service, which makes them unsuitable for next-generation applications with demanding QoS requirements. This paper presents three contributions to the study of middleware for QoS-enabled component-based applications. It outlines reflective middleware techniques designed to adaptively: (1) select optimal communication mechanisms, (2) man- age QoS properties of CORBA components in their containers, and (3) (re)configure selected component executors dynamically. Based on our ongoing research on CORBA and the CCM, we believe the application of reflective techniques to component middleware will provide a dynamically adaptive and (re)configurable framework for COTS software that is well-suited for the QoS demands of next-generation applications.

Simulation of the Pinatubo aerosol cloud in general circulation model

NASA Technical Reports Server (NTRS)

Boville, Byron A.; Holton, James R.; Mote, Philip W.

1991-01-01

The global transport and dispersion of the Pinatubo aerosol cloud are simulated by means of a high-resolution stratospheric version of the NCAR Community Climate Model (CCM2) with an annual cycle. A passive tracer was injected into the model stratosphere over the Philippine Islands on June 15, and the transport was simulated for 180 d using an accurate semi-Lagrangian advection scheme. The simulated volcanic aerosol cloud initially drifted westward and expanded in longitude and latitude. The bulk of the aerosol cloud dispersed zonally to form a continuous belt in longitude, and remained confined to the tropics, centered near the 20-mb level for the entire 180-d model run, although a small amount was transported episodically into the upper troposphere in association with convective disturbances. Aerosol transported to the troposphere was dispersed within a few weeks into the Northern Hemisphere extratropics. In the Southern Hemisphere, the aerosol was mixed into the region equatorward of the core of the polar night jet during the first 50 d, but penetration into southern polar latitudes was delayed until the final warming in November.

Identification and characterization of a carboxysomal γ-carbonic anhydrase from the cyanobacterium Nostoc sp. PCC 7120.

PubMed

de Araujo, Charlotte; Arefeen, Dewan; Tadesse, Yohannes; Long, Benedict M; Price, G Dean; Rowlett, Roger S; Kimber, Matthew S; Espie, George S

2014-09-01

Carboxysomes are proteinaceous microcompartments that encapsulate carbonic anhydrase (CA) and ribulose 1,5-bisphosphate carboxylase/oxygenase (Rubisco); carboxysomes, therefore, catalyze reversible HCO3 (-) dehydration and the subsequent fixation of CO2. The N- and C-terminal domains of the β-carboxysome scaffold protein CcmM participate in a network of protein-protein interactions that are essential for carboxysome biogenesis, organization, and function. The N-terminal domain of CcmM in the thermophile Thermosynechococcus elongatus BP-1 is also a catalytically active, redox regulated γ-CA. To experimentally determine if CcmM from a mesophilic cyanobacterium is active, we cloned, expressed and purified recombinant, full-length CcmM from Nostoc sp. PCC 7120 as well as the N-terminal 209 amino acid γ-CA-like domain. Both recombinant proteins displayed ethoxyzolamide-sensitive CA activity in mass spectrometric assays, as did the carboxysome-enriched TP fraction. NstCcmM209 was characterized as a moderately active and efficient γ-CA with a k cat of 2.0 × 10(4) s(-1) and k cat/K m of 4.1 × 10(6) M(-1) s(-1) at 25 °C and pH 8, a pH optimum between 8 and 9.5 and a temperature optimum spanning 25-35 °C. NstCcmM209 also catalyzed the hydrolysis of the CO2 analog carbonyl sulfide. Circular dichroism and intrinsic tryptophan fluorescence analysis demonstrated that NstCcmM209 was progressively and irreversibly denatured above 50 °C. NstCcmM209 activity was inhibited by the reducing agent tris(hydroxymethyl)phosphine, an effect that was fully reversed by a molar excess of diamide, a thiol oxidizing agent, consistent with oxidative activation being a universal regulatory mechanism of CcmM orthologs. Immunogold electron microscopy and Western blot analysis of TP pellets indicated that Rubisco and CcmM co-localize and are concentrated in Nostoc sp. PCC 7120 carboxysomes.

Chronic care management for dependence on alcohol and other drugs: the AHEAD randomized trial.

PubMed

Saitz, Richard; Cheng, Debbie M; Winter, Michael; Kim, Theresa W; Meli, Seville M; Allensworth-Davies, Don; Lloyd-Travaglini, Christine A; Samet, Jeffrey H

2013-09-18

People with substance dependence have health consequences, high health care utilization, and frequent comorbidity but often receive poor-quality care. Chronic care management (CCM) has been proposed as an approach to improve care and outcomes. To determine whether CCM for alcohol and other drug dependence improves substance use outcomes compared with usual primary care. The AHEAD study, a randomized trial conducted among 563 people with alcohol and other drug dependence at a Boston, Massachusetts, hospital-based primary care practice. Participants were recruited from September 2006 to September 2008 from a freestanding residential detoxification unit and referrals from an urban teaching hospital and advertisements; 95% completed 12-month follow-up. Participants were randomized to receive CCM (n=282) or no CCM (n=281). Chronic care management included longitudinal care coordinated with a primary care clinician; motivational enhancement therapy; relapse prevention counseling; and on-site medical, addiction, and psychiatric treatment, social work assistance, and referrals (including mutual help). The no CCM (control) group received a primary care appointment and a list of treatment resources including a telephone number to arrange counseling. The primary outcome was self-reported abstinence from opioids, stimulants, or heavy drinking. Biomarkers were secondary outcomes. There was no significant difference in abstinence from opioids, stimulants, or heavy drinking between the CCM (44%) and control (42%) groups (adjusted odds ratio, 0.84; 95% CI, 0.65-1.10; P=.21). No significant differences were found for secondary outcomes of addiction severity, health-related quality of life, or drug problems. No subgroup effects were found except among those with alcohol dependence, in whom CCM was associated with fewer alcohol problems (mean score, 10 vs 13; incidence rate ratio, 0.85; 95% CI, 0.72-1.00; P=.048). Among persons with alcohol and other drug dependence, CCM compared with a primary care appointment but no CCM did not increase self-reported abstinence over 12 months. Whether more intensive or longer-duration CCM is effective requires further investigation. clinicaltrials.gov Identifier: NCT00278447.

A model study of aggregates composed of spherical soot monomers with an acentric carbon shell

NASA Astrophysics Data System (ADS)

Luo, Jie; Zhang, Yongming; Zhang, Qixing

2018-01-01

Influences of morphology on the optical properties of soot particles have gained increasing attentions. However, studies on the effect of the way primary particles are coated on the optical properties is few. Aimed to understand how the primary particles are coated affect the optical properties of soot particles, the coated soot particle was simulated using the acentric core-shell monomers model (ACM), which was generated by randomly moving the cores of concentric core-shell monomers (CCM) model. Single scattering properties of the CCM model with identical fractal parameters were calculated 50 times at first to evaluate the optical diversities of different realizations of fractal aggregates with identical parameters. The results show that optical diversities of different realizations for fractal aggregates with identical parameters cannot be eliminated by averaging over ten random realizations. To preserve the fractal characteristics, 10 realizations of each model were generated based on the identical 10 parent fractal aggregates, and then the results were averaged over each 10 realizations, respectively. The single scattering properties of all models were calculated using the numerically exact multiple-sphere T-matrix (MSTM) method. It is found that the single scattering properties of randomly coated soot particles calculated using the ACM model are extremely close to those using CCM model and homogeneous aggregate (HA) model using Maxwell-Garnett effective medium theory. Our results are different from previous studies. The reason may be that the differences in previous studies were caused by fractal characteristics but not models. Our findings indicate that how the individual primary particles are coated has little effect on the single scattering properties of soot particles with acentric core-shell monomers. This work provides a suggestion for scattering model simplification and model selection.

Thallium stimulates ethanol production in immortalized hippocampal neurons

PubMed Central

2017-01-01

Lactate and ethanol (EtOH) were determined in cell culture medium (CCM) of immortalized hippocampal neurons (HN9.10e cell line) before and after incubation with Thallium (Tl). This cell line is a reliable, in vitro model of one of the most vulnerable regions of central nervous system. Cells were incubated for 48 h with three different single Tl doses: 1, 10, 100 μg/L (corresponding to 4.9, 49 and 490 nM, respectively). After 48 h, neurons were “reperfused” with fresh CCM every 24/48 h until 7 days after the treatment and the removed CCM was collected and analysed. Confocal microscopy was employed to observe morphological changes. EtOH was determined by head space—solid phase microextraction -gas chromatography -mass spectrometry (HS-SPME-GCMS), lactate by RP-HPLC with UV detection. Tl exposure had significant effects on neuronal growth rate and morphology. The damage degree was dose-dependent. In not exposed cells, EtOH concentration was 0.18 ± 0.013 mM, which represents about 5% of lactate concentration (3.4 ± 0.10 mM). After Tl exposure lactate and EtOH increased. In CCM of 100 and 10 μg/L Tl-treated cells, lactate increased 24 h after reperfusion up to 2 and 3.3 times the control value, respectively. In CCM of 10 and 100 μg/L Tl-treated cells 24 h after reperfusion, EtOH increased up to 0.3 and 0.58 mmol/L. respectively. These results are consistent with significant alterations in energy metabolism, despite the low doses of Tl employed and the relatively short incubation time. PMID:29161327

Acclimation to Very Low CO2: Contribution of Limiting CO2 Inducible Proteins, LCIB and LCIA, to Inorganic Carbon Uptake in Chlamydomonas reinhardtii1[OPEN

PubMed Central

Spalding, Martin H.

2014-01-01

The limiting-CO2 inducible CO2-concentrating mechanism (CCM) of microalgae represents an effective strategy to capture CO2 when its availability is limited. At least two limiting-CO2 acclimation states, termed low CO2 and very low CO2, have been demonstrated in the model microalga Chlamydomonas reinhardtii, and many questions still remain unanswered regarding both the regulation of these acclimation states and the molecular mechanism underlying operation of the CCM in these two states. This study examines the role of two proteins, Limiting CO2 Inducible A (LCIA; also named NAR1.2) and LCIB, in the CCM of C. reinhardtii. The identification of an LCIA-LCIB double mutant based on its inability to survive in very low CO2 suggests that both LCIA and LCIB are critical for survival in very low CO2. The contrasting effects of individual mutations in LCIB and LCIA compared with the effects of LCIB-LCIA double mutations on growth and inorganic carbon-dependent photosynthetic O2 evolution reveal distinct roles of LCIA and LCIB in the CCM. Although both LCIA and LCIB are essential for very low CO2 acclimation, LCIB appears to function in a CO2 uptake system, whereas LCIA appears to be associated with a HCO3− transport system. The contrasting and complementary roles of LCIA and LCIB in acclimation to low CO2 and very low CO2 suggest a possible mechanism of differential regulation of the CCM based on the inhibition of HCO3− transporters by moderate to high levels of CO2. PMID:25336519

Convergent cross-mapping and pairwise asymmetric inference.

PubMed

McCracken, James M; Weigel, Robert S

2014-12-01

Convergent cross-mapping (CCM) is a technique for computing specific kinds of correlations between sets of times series. It was introduced by Sugihara et al. [Science 338, 496 (2012).] and is reported to be "a necessary condition for causation" capable of distinguishing causality from standard correlation. We show that the relationships between CCM correlations proposed by Sugihara et al. do not, in general, agree with intuitive concepts of "driving" and as such should not be considered indicative of causality. It is shown that the fact that the CCM algorithm implies causality is a function of system parameters for simple linear and nonlinear systems. For example, in a circuit containing a single resistor and inductor, both voltage and current can be identified as the driver depending on the frequency of the source voltage. It is shown that the CCM algorithm, however, can be modified to identify relationships between pairs of time series that are consistent with intuition for the considered example systems for which CCM causality analysis provided nonintuitive driver identifications. This modification of the CCM algorithm is introduced as "pairwise asymmetric inference" (PAI) and examples of its use are presented.

Demand generation and social mobilisation for integrated community case management (iCCM) and child health: Lessons learned from successful programmes in Niger and Mozambique.

PubMed

Sharkey, Alyssa B; Martin, Sandrine; Cerveau, Teresa; Wetzler, Erica; Berzal, Rocio

2014-12-01

We present the approaches used in and outcomes resulting from integrated community case management (iCCM) programmes in Niger and Mozambique with a strong focus on demand generation and social mobilisation. We use a case study approach to describe the programme and contextual elements of the Niger and Mozambique programmes. Awareness and utilisation of iCCM services and key family practices increased following the implementation of the Niger and Mozambique iCCM and child survival programmes, as did care-seeking within 24 hours and care-seeking from appropriate, trained providers in Mozambique. These approaches incorporated interpersonal communication activities and community empowerment/participation for collective change, partnerships and networks among key stakeholder groups within communities, media campaigns and advocacy efforts with local and national leaders. iCCM programmes that train and equip community health workers and successfully engage and empower community members to adopt new behaviours, have appropriate expectations and to trust community health workers' ability to assess and treat illnesses can lead to improved care-seeking and utilisation, and community ownership for iCCM.

Methane Sensitivity to Perturbations in Tropospheric Oxidizing Capacity

NASA Technical Reports Server (NTRS)

Yegorova, Elena; Duncan, Bryan

2011-01-01

Methane is an important greenhouse gas and has a 25 times greater global warming potential than CO2 on a century timescale. Yet there are considerable uncertainties in the magnitude and variability of its sources and sinks. The response of the coupled non-linear methane-carbon monoxide-hydroxyl radical (OH) system is important in determining the tropospheric oxidizing capacity. Using the NASA Goddard Earth Observing System, Version 5 (GEOS-5) chemistry climate model, we study the response of methane to perturbations of OH and wetland emissions. We use a computationally-efficient option of the GEOS-5 CCM that includes an OH parameterization that accurately represents OH predicted by a full chemical mechanism. The OH parameterization allows for studying non-linear CH4-CO-OH feedbacks in computationally fast sensitivity experiments. We compare our results with surface observations (GMD) and discuss the range of uncertainty in OH and wetland emissions required to bring modeling results in better agreement with surface observations. Our results can be used to improve projections of methane emissions and methane growth.

Synergy, Salary, and Satisfaction: Benefits of Training in Critical Care Medicine and Infectious Diseases Gleaned From a National Pilot Survey of Dually Trained Physicians.

PubMed

Kadri, Sameer S; Rhee, Chanu; Magda, Gabriela; Strich, Jeffrey R; Cai, Rongman; Sun, Junfeng; Decker, Brooke K; O'Grady, Naomi P

2016-10-01

An increasing number of physicians are seeking dual training in critical care medicine (CCM) and infectious diseases (ID). Understanding experiences and perceptions of CCM-ID physicians could inform career choices and programmatic innovation. All physicians trained and/or certified in both CCM and ID to date in the United States were sent a Web-based questionnaire in 2015. Responses enabled a cross-sectional analysis of physician demographics and training and practice characteristics and satisfaction. Of 202 CCM-ID physicians, 196 were alive and reachable. The response rate was 79%. Forty-six percent trained and 34% practice in the northeastern United States. Only 40% received dual training at the same institution. Eighty-three percent identified as either an intensivist with ID expertise (44%) or as equally an intensivist and ID physician (38%). Median salary was $265 000 (interquartile range [IQR], $215 000-$350 000). Practice settings were split between academic (45%) and community settings (42%). Two-thirds are clinicians but 62% conduct some research and 26% practice outpatient ID. Top reasons to dually specialize included clinical synergy (70%), procedural activity (50%), and less interest in pulmonology (49%). Although 38% cited less proficiency with bronchoscopy as a disadvantage, 87% seldom need pulmonary consultation in the intensive care unit. Median career satisfaction was 4 (IQR, 4-5) out of 5, and 76% would dually train again. CCM-ID graduates prefer the acute care setting, predominantly CCM or a combination of CCM and ID. They find combination training and practice to be synergistic and satisfying, but most have had to seek CCM and ID training independently at separate institutions. Given these findings, avenues for combined training in CCM-ID should be considered. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Monitoring iCCM: a feasibility study of the indicator guide for monitoring and evaluating integrated community case management.

PubMed

Roberton, Timothy; Kasungami, Dyness; Guenther, Tanya; Hazel, Elizabeth

2016-07-01

Most countries in sub-Saharan Africa have now adopted integrated community case management (iCCM) of common childhood illnesses as a strategy to improve child health. In March 2014, the iCCM Task Force published an Indicator Guide for Monitoring and Evaluating iCCM: a 'menu' of recommended indicators with globally agreed definitions and methodology, to guide countries in developing robust iCCM monitoring systems. The Indicator Guide was conceived as an evolving document that would incorporate collective experience and learning as iCCM programmes themselves evolve. This article presents findings from two studies that examined the feasibility of collecting the Indicator Guide's 18 routine monitoring indicators with the iCCM monitoring systems that countries currently have in place. We reviewed iCCM monitoring tools, protocols and reports from a purposive sample of 10 countries in sub-Saharan Africa. We developed a scorecard system to assess which of the Indicator Guide's 18 routine monitoring indicators could be calculated with the given monitoring tools, and at which level of the health system the relevant information would be available. We found that the data needed to calculate many of the Indicator Guide's routine monitoring indicators are already being collected through existing monitoring systems, although much of these data are only available at health facility level and not aggregated to district or national levels. Our results highlight challenge of using supervision checklists as a data source, and the need for countries to maintain accurate deployment data for CHWs and CHW supervisors. We suggest that some of the recommended indicators need revising. Routine monitoring will be more feasible, effective and efficient if iCCM programmes focus on a smaller set of high-value indicators that are easy to measure, reliably interpreted and useful both for global and national stakeholders and for frontline health workers themselves. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

A randomized comparison of 5 versus 12 hours per day of cardiac contractility modulation treatment for heart failure patients: A preliminary report.

PubMed

Kloppe, Axel; Mijic, Dejan; Schiedat, Fabian; Bogossian, Harilaos; Mügge, Andreas; Rousso, Benny; Lemke, Bernd

2016-01-01

Cardiac contractility modulation (CCM) signals are non-excitatory electrical signals delivered during the absolute refractory period intended to improve contraction and cardiac function. Clinical trials have shown that CCM treatment significantly improves exercise tolerance and quality of life in symptomatic heart failure patients. Studies with CCM therapy typically include CCM delivery for 3, 5 or 7 h per day, although other configurations are also commonly used. Each has been associated with improved outcomes in heart failure, but it is not clear whether different application durations are associated with the various degrees of benefit. The purpose of the current pilot evaluation study was to evaluate the quality of life, exercise tolerance, and cardiac function, over a 6-month period when CCM was delivered for 5 h/day vs. 12 h/day. Increasing the daily CCM therapy duration is safe and as good as the standard CCM periods of application per day. This single center pilot evaluation study involved 19 medically refractory symptomatic patients with heart failure and reduced left ventricular function who underwent implantation of an Optimizer™ system (Impulse Dynamics, Orangeburg, NY, USA). Patients were randomized into one of two treatment groups; 5 h/day CCM treatment or 12 h/day CCM treatment. Subjects and evaluating physicians were blinded to the study group. Subjects returned to the hospital after 12 and 24 weeks. Efficacy evaluations included changes from baseline to 24 weeks in Minnesota Living With Heart Failure Questionnaire score (MLWHFQ), maximal oxygen consumption in the cardio-pulmonary stress test (peak VO2), New York Heart Association classification (NYHA), 6-min walk distance (6MWD), and ejection fraction (EF). At the end of 24 weeks, clinical improvement was observed in the entire cohort in all efficacy measures (mean change from baseline of -17.1 in MLWHFQ, -0.86 in NYHA, and improvement trend of 1.48 mL O2/kg/min in peak VO2, 31.3 m in 6MWD, and 2.25% in EF). There were no significant differences, either clinically or statistically, between the groups receiving CCM for 5 h/day vs. 12 h/day. Three subjects were voluntarily withdrawn before completing the study. One subject died from pneumonia after 125 days, and 6 serious adverse events were reported, none of which was classified as related to either the device or the procedure. Together with previously reported experience with CCM, delivery of CCM therapy is equally safe and appears similarly effective over the range of shorter (5 h) to longer (12 h) daily periods of application. Given the small sample size, further studies are warranted.

Quantifying the effect of mixing on the mean age of air in CCMVal-2 and CCMI-1 models

NASA Astrophysics Data System (ADS)

Dietmüller, Simone; Eichinger, Roland; Garny, Hella; Birner, Thomas; Boenisch, Harald; Pitari, Giovanni; Mancini, Eva; Visioni, Daniele; Stenke, Andrea; Revell, Laura; Rozanov, Eugene; Plummer, David A.; Scinocca, John; Jöckel, Patrick; Oman, Luke; Deushi, Makoto; Kiyotaka, Shibata; Kinnison, Douglas E.; Garcia, Rolando; Morgenstern, Olaf; Zeng, Guang; Stone, Kane Adam; Schofield, Robyn

2018-05-01

The stratospheric age of air (AoA) is a useful measure of the overall capabilities of a general circulation model (GCM) to simulate stratospheric transport. Previous studies have reported a large spread in the simulation of AoA by GCMs and coupled chemistry-climate models (CCMs). Compared to observational estimates, simulated AoA is mostly too low. Here we attempt to untangle the processes that lead to the AoA differences between the models and between models and observations. AoA is influenced by both mean transport by the residual circulation and two-way mixing; we quantify the effects of these processes using data from the CCM inter-comparison projects CCMVal-2 (Chemistry-Climate Model Validation Activity 2) and CCMI-1 (Chemistry-Climate Model Initiative, phase 1). Transport along the residual circulation is measured by the residual circulation transit time (RCTT). We interpret the difference between AoA and RCTT as additional aging by mixing. Aging by mixing thus includes mixing on both the resolved and subgrid scale. We find that the spread in AoA between the models is primarily caused by differences in the effects of mixing and only to some extent by differences in residual circulation strength. These effects are quantified by the mixing efficiency, a measure of the relative increase in AoA by mixing. The mixing efficiency varies strongly between the models from 0.24 to 1.02. We show that the mixing efficiency is not only controlled by horizontal mixing, but by vertical mixing and vertical diffusion as well. Possible causes for the differences in the models' mixing efficiencies are discussed. Differences in subgrid-scale mixing (including differences in advection schemes and model resolutions) likely contribute to the differences in mixing efficiency. However, differences in the relative contribution of resolved versus parameterized wave forcing do not appear to be related to differences in mixing efficiency or AoA.

Results and evaluation of key comparison CCM.P-K12.1 for very low helium flow rates (leak rates)

NASA Astrophysics Data System (ADS)

Šetina, Janez; Vičar, Martin; Pražák, Dominik

2015-01-01

The Czech Metrology Institute (CMI) took part and failed to prove equivalence in the Key Comparison CCM.P-K12 of helium leak artefacts (leak rates) into vacuum. After identifying and eliminating the cause of the failure, the Institute of Metals and Technology (IMT) of Slovenia, a successful participant in CCM.P-K12, volunteered to serve as pilot and link in a following bilateral comparison of IMT and CMI that obtained designation CCM.P-K12.1 in June 2012. It was decided to perform the comparison with a glass permeation helium leak artefact at nominally 3.10-11 mol/s (7.4.10-7 mbar.L.s-1) at 23 °C. Both the laboratory standards took part in CCM.P-K12 and were considered as primary. The comparison measurements were performed in October 2012. CMI proved equivalence both with IMT and with the reference value of the key comparison CCM.P-K12. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Expression Profiling-Based Identification of CO2-Responsive Genes Regulated by CCM1 Controlling a Carbon-Concentrating Mechanism in Chlamydomonas reinhardtii1

PubMed Central

Miura, Kenji; Yamano, Takashi; Yoshioka, Satoshi; Kohinata, Tsutomu; Inoue, Yoshihiro; Taniguchi, Fumiya; Asamizu, Erika; Nakamura, Yasukazu; Tabata, Satoshi; Yamato, Katsuyuki T.; Ohyama, Kanji; Fukuzawa, Hideya

2004-01-01

Photosynthetic acclimation to CO2-limiting stress is associated with control of genetic and physiological responses through a signal transduction pathway, followed by integrated monitoring of the environmental changes. Although several CO2-responsive genes have been previously isolated, genome-wide analysis has not been applied to the isolation of CO2-responsive genes that may function as part of a carbon-concentrating mechanism (CCM) in photosynthetic eukaryotes. By comparing expression profiles of cells grown under CO2-rich conditions with those of cells grown under CO2-limiting conditions using a cDNA membrane array containing 10,368 expressed sequence tags, 51 low-CO2 inducible genes and 32 genes repressed by low CO2 whose mRNA levels were changed more than 2.5-fold in Chlamydomonas reinhardtii Dangeard were detected. The fact that the induction of almost all low-CO2 inducible genes was impaired in the ccm1 mutant suggests that CCM1 is a master regulator of CCM through putative low-CO2 signal transduction pathways. Among low-CO2 inducible genes, two novel genes, LciA and LciB, were identified, which may be involved in inorganic carbon transport. Possible functions of low-CO2 inducible and/or CCM1-regulated genes are discussed in relation to the CCM. PMID:15235119

Uncertainties in modelling Mt. Pinatubo eruption with 2-D AER model and CCM SOCOL

NASA Astrophysics Data System (ADS)

Kenzelmann, P.; Weisenstein, D.; Peter, T.; Luo, B. P.; Rozanov, E.; Fueglistaler, S.; Thomason, L. W.

2009-04-01

Large volcanic eruptions may introduce a strong forcing on climate. They challenge the skills of climate models. In addition to the short time attenuation of solar light by ashes the formation of stratospheric sulphate aerosols, due to volcanic sulphur dioxide injection into the lower stratosphere, may lead to a significant enhancement of the global albedo. The sulphate aerosols have a residence time of about 2 years. As a consequence of the enhanced sulphate aerosol concentration both the stratospheric chemistry and dynamics are strongly affected. Due to absorption of longwave and near infrared radiation the temperature in the lower stratosphere increases. So far chemistry climate models overestimate this warming [Eyring et al. 2006]. We present an extensive validation of extinction measurements and model runs of the eruption of Mt. Pinatubo in 1991. Even if Mt. Pinatubo eruption has been the best quantified volcanic eruption of this magnitude, the measurements show considerable uncertainties. For instance the total amount of sulphur emitted to the stratosphere ranges from 5-12 Mt sulphur [e.g. Guo et al. 2004, McCormick, 1992]. The largest uncertainties are in the specification of the main aerosol cloud. SAGE II, for instance, could not measure the peak of the aerosol extinction for about 1.5 years, because optical termination was reached. The gap-filling of the SAGE II [Thomason and Peter, 2006] using lidar measurements underestimates the total extinctions in the tropics for the first half year after the eruption by 30% compared to AVHRR [Rusell et. al 1992]. The same applies to the optical dataset described by Stenchikov et al. [1998]. We compare these extinction data derived from measurements with extinctions derived from AER 2D aerosol model calculations [Weisenstein et al., 2007]. Full microphysical calculations with injections of 14, 17, 20 and 26 Mt SO2 in the lower stratosphere were performed. The optical aerosol properties derived from SAGE II measurements and from AER model calculation serve as input for the 3D chemistry climate model (CCM) SOCOL [Schraner et al., 2008]. The heating rates, calculated with SOCOL, are compared with a reference radiative transfer model LibRadtran [Mayer and Kylling, 2005]. This comparison suggests that SOCOL underestimates the net heating rate by 10-20%. In stark contrast, the temperature increase in the lower stratosphere due to absorption of longwave and near infrared radiation is overestimated by all SOCOL scenarios. This lets us conclude that SOCOL, and similarly other state-of-the-art CCMs, misrepresent processes required to model the effect of volcanic eruptions on the lower stratosphere and tropopause region. Possible reasons for model deficiencies could be too coarse vertical resolution or missing dynamical feedbacks near the tropopause and in the lower stratosphere. Another important feature is the warming of the tropical troposphere, which is present in the model simulation but was not observed with comparable amplitude in reality. The heating of the lower stratosphere in the models leads to an increase of stratospheric water vapour and influences the radiative and chemical properties of the stratosphere. Eyring, V. et al (2006), Assessment of temperature, trace species, and ozone in chemistry-climate model simulations of the recent past, Journal of Geophysical Research-Atmospheres, 111, D22,308. Guo, S., G. J. S. Bluth, W. I. Rose, I. M. Watson, and A. J. Prata (2004), Re-evaluation of SO2 release of the 15 June 1991 Pinatubo eruption using ultraviolet and infrared satellite sensors, Geochemistry Geophysics Geosystems, 5. Mayer, B., and A. Kylling (2005), Technical note: The libRadtran software package for radiative transfer calculations - description and examples of use, Atmos. Chem. Phys, 5, 1855-1877. McCormick, M. P. (1992), Initial assessment of the stratospheric and climatic impact of the 1991 Mount- Pinatubo eruption - prologue, Geophysical Research Letters, 19 (2), 149-149. Russell, P. B. et al. (1996), Global to microscale evolution of the Pinatubo volcanic aerosol derived from diverse measurements and analyses, Journal of Geophysical Research-Atmospheres, 101 (D13), 18,745- 18,763. Schraner, M. et al (2008), Technical note: Chemistry-climate model SOCOL: version 2.0 with improved transport and chemistry/microphysics schemes, Atmos. Chem. Phys., 8, 5957-5974. Stenchikov, G. L. et al (1998), Radiative forcing from the 1991 Mount Pinatubo volcanic eruption, Journal Of Geophysical Research-Atmospheres, 103 (D12), 13,837-13,857. Thomason, L., and T. Peter (2006), (eds.), SPARC Report No. 4, World Climate Research Programme WCRP- 124, WMO/TD No. 1295. Weisenstein, D. K. et al., Global 2-D intercomparison of sectional and modal aerosol modules, Atmos. Chem. Phys, 7 (9), 2339-2355.

Running STAR-CCM+ Software on the Peregrine System | High-Performance

Science.gov Websites

/bin/lmutil lmstat -c 1999@wind-lms.nrel.gov -a module load star-ccm export TMPDIR="/scratch/$USER + -power -rsh "ssh -oStrictHostKeyChecking=no" -machinefile nodelist -np $(($nodes*$cores , type the commands from the SLURM script and make sure the job runs: module load star-ccm export TMPDIR

Inflammatory cascades mediate synapse elimination in spinal cord compression

PubMed Central

2014-01-01

Background Cervical compressive myelopathy (CCM) is caused by chronic spinal cord compression due to spondylosis, a degenerative disc disease, and ossification of the ligaments. Tip-toe walking Yoshimura (twy) mice are reported to be an ideal animal model for CCM-related neuronal dysfunction, because they develop spontaneous spinal cord compression without any artificial manipulation. Previous histological studies showed that neurons are lost due to apoptosis in CCM, but the mechanism underlying this neurodegeneration was not fully elucidated. The purpose of this study was to investigate the pathophysiology of CCM by evaluating the global gene expression of the compressed spinal cord and comparing the transcriptome analysis with the physical and histological findings in twy mice. Methods Twenty-week-old twy mice were divided into two groups according to the magnetic resonance imaging (MRI) findings: a severe compression (S) group and a mild compression (M) group. The transcriptome was analyzed by microarray and RT-PCR. The cellular pathophysiology was examined by immunohistological analysis and immuno-electron microscopy. Motor function was assessed by Rotarod treadmill latency and stride-length tests. Results Severe cervical calcification caused spinal canal stenosis and low functional capacity in twy mice. The microarray analysis revealed 215 genes that showed significantly different expression levels between the S and the M groups. Pathway analysis revealed that genes expressed at higher levels in the S group were enriched for terms related to the regulation of inflammation in the compressed spinal cord. M1 macrophage-dominant inflammation was present in the S group, and cysteine-rich protein 61 (Cyr61), an inducer of M1 macrophages, was markedly upregulated in these spinal cords. Furthermore, C1q, which initiates the classical complement cascade, was more upregulated in the S group than in the M group. The confocal and electron microscopy observations indicated that classically activated microglia/macrophages had migrated to the compressed spinal cord and eliminated synaptic terminals. Conclusions We revealed the detailed pathophysiology of the inflammatory response in an animal model of chronic spinal cord compression. Our findings suggest that complement-mediated synapse elimination is a central mechanism underlying the neurodegeneration in CCM. PMID:24589419

Cytochrome P450 and matrix metalloproteinase genetic modifiers of disease severity in Cerebral Cavernous Malformation type 1

PubMed Central

Choquet, Hélène; Trapani, Eliana; Goitre, Luca; Trabalzini, Lorenza; Akers, Amy; Fontanella, Marco; Hart, Blaine L.; Morrison, Leslie A.; Pawlikowska, Ludmila; Kim, Helen; Retta, Saverio Francesco

2016-01-01

Background Familial Cerebral Cavernous Malformation type 1 (CCM1) is an autosomal dominant disease caused by mutations in the Krev Interaction Trapped 1 (KRIT1/CCM1) gene, and characterized by multiple brain lesions. CCM lesions manifest across a range of different phenotypes, including wide differences in lesion number, size and susceptibility to intracerebral hemorrhage (ICH). Oxidative stress plays an important role in cerebrovascular disease pathogenesis, raising the possibility that inter-individual variability in genes related to oxidative stress may contribute to the phenotypic differences observed in CCM1 disease. Here, we investigated whether candidate oxidative stress-related cytochrome P450 (CYP) and matrix metalloproteinase (MMP) genetic markers grouped by superfamilies, families or genes, or analyzed individually influence the severity of CCM1 disease. Methods Clinical assessment and cerebral susceptibility-weighted magnetic resonance imaging (SWI) were performed to determine total and large (≥5 mm in diameter) lesion counts as well as ICH in 188 Hispanic CCM1 patients harboring the founder KRIT1/CCM1 ‘common Hispanic mutation’ (CCM1–CHM). Samples were genotyped on the Affymetrix Axiom Genome-Wide LAT1 Human Array. We analyzed 1,122 genetic markers (both single nucleotide polymorphisms (SNPs) and insertion/deletions) grouped by CYP and MMP superfamily, family or gene for association with total or large lesion count and ICH adjusted for age at enrollment and gender. Genetic markers bearing the associations were then analyzed individually. Results The CYP superfamily showed a trend toward association with total lesion count (P=0.057) and large lesion count (P=0.088) in contrast to the MMP superfamily. The CYP4 and CYP8 families were associated with either large lesion count or total lesion count (P=0.014), and two other families (CYP46 and the MMP Stromelysins) were associated with ICH (P=0.011 and 0.007, respectively). CYP4F12 rs11085971, CYP8A1 rs5628, CYP46A1 rs10151332, and MMP3 rs117153070 single SNPs, mainly bearing the above-mentioned associations, were also individually associated with CCM1 disease severity. Conclusions Overall, our candidate oxidative stress-related genetic markers set approach outlined CYP and MMP families and identified suggestive SNPs that may impact the severity of CCM1 disease, including the development of numerous and large CCM lesions and ICH. These novel genetic risk factors of prognostic value could serve as early objective predictors of disease outcome and might ultimately provide better options for disease prevention and treatment. PMID:26795600

Cytochrome P450 and matrix metalloproteinase genetic modifiers of disease severity in Cerebral Cavernous Malformation type 1.

PubMed

Choquet, Hélène; Trapani, Eliana; Goitre, Luca; Trabalzini, Lorenza; Akers, Amy; Fontanella, Marco; Hart, Blaine L; Morrison, Leslie A; Pawlikowska, Ludmila; Kim, Helen; Retta, Saverio Francesco

2016-03-01

Familial Cerebral Cavernous Malformation type 1 (CCM1) is an autosomal dominant disease caused by mutations in the Krev Interaction Trapped 1 (KRIT1/CCM1) gene, and characterized by multiple brain lesions. CCM lesions manifest across a range of different phenotypes, including wide differences in lesion number, size and susceptibility to intracerebral hemorrhage (ICH). Oxidative stress plays an important role in cerebrovascular disease pathogenesis, raising the possibility that inter-individual variability in genes related to oxidative stress may contribute to the phenotypic differences observed in CCM1 disease. Here, we investigated whether candidate oxidative stress-related cytochrome P450 (CYP) and matrix metalloproteinase (MMP) genetic markers grouped by superfamilies, families or genes, or analyzed individually influence the severity of CCM1 disease. Clinical assessment and cerebral susceptibility-weighted magnetic resonance imaging (SWI) were performed to determine total and large (≥5mm in diameter) lesion counts as well as ICH in 188 Hispanic CCM1 patients harboring the founder KRIT1/CCM1 'common Hispanic mutation' (CCM1-CHM). Samples were genotyped on the Affymetrix Axiom Genome-Wide LAT1 Human Array. We analyzed 1,122 genetic markers (both single nucleotide polymorphisms (SNPs) and insertion/deletions) grouped by CYP and MMP superfamily, family or gene for association with total or large lesion count and ICH adjusted for age at enrollment and gender. Genetic markers bearing the associations were then analyzed individually. The CYP superfamily showed a trend toward association with total lesion count (P=0.057) and large lesion count (P=0.088) in contrast to the MMP superfamily. The CYP4 and CYP8 families were associated with either large lesion count or total lesion count (P=0.014), and two other families (CYP46 and the MMP Stromelysins) were associated with ICH (P=0.011 and 0.007, respectively). CYP4F12 rs11085971, CYP8A1 rs5628, CYP46A1 rs10151332, and MMP3 rs117153070 single SNPs, mainly bearing the above-mentioned associations, were also individually associated with CCM1 disease severity. Overall, our candidate oxidative stress-related genetic markers set approach outlined CYP and MMP families and identified suggestive SNPs that may impact the severity of CCM1 disease, including the development of numerous and large CCM lesions and ICH. These novel genetic risk factors of prognostic value could serve as early objective predictors of disease outcome and might ultimately provide better options for disease prevention and treatment. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Contour Connection Method for automated identification and classification of landslide deposits

NASA Astrophysics Data System (ADS)

Leshchinsky, Ben A.; Olsen, Michael J.; Tanyu, Burak F.

2015-01-01

Landslides are a common hazard worldwide that result in major economic, environmental and social impacts. Despite their devastating effects, inventorying existing landslides, often the regions at highest risk of reoccurrence, is challenging, time-consuming, and expensive. Current landslide mapping techniques include field inventorying, photogrammetric approaches, and use of bare-earth (BE) lidar digital terrain models (DTMs) to highlight regions of instability. However, many techniques do not have sufficient resolution, detail, and accuracy for mapping across landscape scale with the exception of using BE DTMs, which can reveal the landscape beneath vegetation and other obstructions, highlighting landslide features, including scarps, deposits, fans and more. Current approaches to landslide inventorying with lidar to create BE DTMs include manual digitizing, statistical or machine learning approaches, and use of alternate sensors (e.g., hyperspectral imaging) with lidar. This paper outlines a novel algorithm to automatically and consistently detect landslide deposits on a landscape scale. The proposed method is named as the Contour Connection Method (CCM) and is primarily based on bare earth lidar data requiring minimal user input such as the landslide scarp and deposit gradients. The CCM algorithm functions by applying contours and nodes to a map, and using vectors connecting the nodes to evaluate gradient and associated landslide features based on the user defined input criteria. Furthermore, in addition to the detection capabilities, CCM also provides an opportunity to be potentially used to classify different landscape features. This is possible because each landslide feature has a distinct set of metadata - specifically, density of connection vectors on each contour - that provides a unique signature for each landslide. In this paper, demonstrations of using CCM are presented by applying the algorithm to the region surrounding the Oso landslide in Washington (March 2014), as well as two 14,000 ha DTMs in Oregon, which were used as a comparison of CCM and manually delineated landslide deposits. The results show the capability of the CCM with limited data requirements and the agreement with manual delineation but achieving the results at a much faster time.

Bovine vaginal strain Kocuria kristinae and its characterization.

PubMed

Styková, Eva; Nemcová, Radomíra; Gancarčíková, Soňa; Valocký, Igor; Lauková, Andrea

2016-05-01

Kocuria spp. are widely distributed in nature. They are Gram-positive, coagulase-negative, coccoid bacteria belonging to the family Micrococcaceae, suborder Micrococcineae, order Actinomycetales, class Actinobacteria. In general, limited knowledge exists concerning the properties associated with the representants of the genus Kocuria, Kocuria kristinae as well. Following our previous results, K. kristinae Kk2014 Biocenol(™) (CCM 8628) was isolated from vagina of a healthy cow. Its taxonomical allottation was confirmed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) identification system and phenotypic characteristics. Kk2014 strain showed strong adherence capability to the vaginal mucus, produced organic acids which can play a role in prevention of unsuitable contamination, and showed in vitro antagonistic/antimicrobial activity against strains Arcanobacterium pyogenes CCM 5753, Fusobacterium necrophorum CCM 5982, Streptococcus equi subsp. zooepidemicus CCM 7316, and Gardnerella vaginalis CCM 6221. Antimicrobial activity ranged from 100 to 200 AU/mL, up to 32 mm in size, respectively.

CCM in the FUV

NASA Astrophysics Data System (ADS)

Cartledge, S. I. B.; Clayton, G. C.; Gordon, K. D.

2005-12-01

Over 90% of Milky Way extinction curves sampled from IR through UV wavelengths (UV coverage by IUE) conform to the CCM family of curves based on R(V), a single parameter linked to grain size. The far-ultraviolet (FUV) portion of this formulation, however, was based only on a few sight lines observed by Copernicus, and it has recently been shown that in certain cases CCM does not predict extinction in the FUV as accurately as it does at longer wavelengths. In this poster paper, we present preliminary results from our examination of the agreement between all publicly-available FUSE FUV spectra of reddened O and B stars and their corresponding extinction curves inferred from longer wavelength fluxes. The eventual goal of our project is to reformulate CCM, particularly in the FUV where we have compiled more than 90 sight lines observed by FUSE. We are also exploring correlations between bulk sight line properties and the form of the reconstituted CCM curves.

Evidence Suggesting that the Cardiomyocyte Circadian Clock Modulates Responsiveness of the Heart to Hypertrophic Stimuli in Mice

PubMed Central

Durgan, David J.; Tsai, Ju-Yun; Grenett, Maximiliano H.; Pat, Betty M.; Ratcliffe, William F.; Villegas-Montoya, Carolina; Garvey, Merissa E.; Nagendran, Jeevan; Dyck, Jason R.B.; Bray, Molly S.; Gamble, Karen L.; Gimble, Jeffrey M.; Young, Martin E.

2011-01-01

Circadian dyssynchrony of an organism (at the whole body level) with its environment, either through light/dark cycle or genetic manipulation of clock genes, augments various cardiometabolic diseases. The cardiomyocyte circadian clock has recently been shown to influence multiple myocardial processes, ranging from transcriptional regulation and energy metabolism, to contractile function. We therefore reasoned that chronic dyssychrony of the cardiomyocyte circadian clock with its environment would precipitate myocardial maladaptation to a circadian challenge (simulated shift work; SSW). To test this hypothesis, 2 and 20 month old wild-type and CCM (Cardiomyocyte Clock Mutant; a model with genetic temporal suspension of the cardiomyocyte circadian clock at the active-to-sleep phase transition) mice were subjected to chronic (16-wks) bi-weekly 12-hr phase shifts in the light/dark cycle (i.e., SSW). Assessment of adaptation/maladaptation at whole body homeostatic, gravimetric, humoral, histological, transcriptional, and cardiac contractile function levels revealed essentially identical responses between wild-type and CCM littermates. However, CCM hearts exhibit increased bi-ventricular weight, cardiomyocyte size, and molecular markers of hypertrophy (anf, mcip1) independent of aging and/or SSW. Similarly, a second genetic model of selective temporal suspension of the cardiomyocyte circadian clock (Cardiomyocyte-specific BMAL1 Knockout [CBK] mice) exhibits increased bi-ventricular weight and mcip1 expression. Wild-type mice exhibit 5-fold greater cardiac hypertrophic growth (and 6-fold greater anf mRNA induction) when challenged with the hypertrophic agonist isoproterenol at the active-to-sleep phase transition, relative to isoproterenol administration at the sleep-to-active phase transition. This diurnal variation was absent in CCM mice. Collectively, these data suggest that the cardiomyocyte circadian clock likely influences responsiveness of the heart to hypertrophic stimuli. PMID:21452915

Role of Equatorial Pacific SST Anomalies in Precipitation over Western Americas

NASA Astrophysics Data System (ADS)

Jong, B. T.; Ting, M.; Seager, R.; Henderson, N.; Lee, D.

2017-12-01

El Niño, as the prime source of seasonal to interannual climate predictability, could impose impacts on the Americas from tropical to mid-latitude regions. The teleconnection patterns are sensitive to the longitudinal location of the maximum tropical sea surface temperature anomalies (SSTA). Meanwhile, slight differences in the location and configuration of the anomalous atmospheric circulations could differentiate between a wet and dry season regionally. For example, the 2015/16 strong El Niño event did not bring excessive precipitation to California despite expectations based on observational and model-based analyses. Whether the westward shift in the tropical SSTA pattern played a key role during this event is examined. We conduct two SSTA-forced experimental runs in three NCAR GCMs (CCM3, CAM4, and CAM5): one forced by the observed February-March-April 2016 SSTA and the other forced by the model-ensemble mean forecast FMA 2016 SSTA from the North America Multi-Model Ensemble. The observed SSTAs, compared to the forecast SSTAs, are colder in the central-eastern tropical Pacific and slightly warmer in the westernmost tropical Pacific. In response, all three models have a weaker and westward shifted low-pressure anomaly over the North Pacific and west coast of North America when the observed SSTA is prescribed. As the result, northern California is either about the same or drier in the observed SSTA runs than in the forecast SSTA runs. However, the precipitation over southern California responds differently across models. One of the possible explanations is that in CCM3 the teleconnections respond mainly to the SSTA differences in the eastern tropical Pacific; while in CAM4 and CAM5, the teleconnections are also sensitive to the small SSTA differences in the western tropical Pacific. The results suggest that the tropical SSTA differences matter for atmospheric circulations and precipitation over western Americas even though models disagree on the details of the circulation responses and subsequently the sign of regional precipitation responses. Further work on the sensitivity of circulations and precipitation to the tropical Pacific SSTA forcing will be conducted to improve the prediction of precipitation over western Americas.

Soil Moisture and Snow Cover: Active or Passive Elements of Climate

NASA Technical Reports Server (NTRS)

Oglesby, Robert J.; Marshall, Susan; Erickson, David J., III; Robertson, Franklin R.; Roads, John O.; Arnold, James E. (Technical Monitor)

2002-01-01

A key question is the extent to which surface effects such as soil moisture and snow cover are simply passive elements or whether they can affect the evolution of climate on seasonal and longer time scales. We have constructed ensembles of predictability studies using the NCAR CCM3 in which we compared the relative roles of initial surface and atmospheric conditions over the central and western U.S. in determining the subsequent evolution of soil moisture and of snow cover. Results from simulations with realistic soil moisture anomalies indicate that internal climate variability may be the strongest factor, with some indication that the initial atmospheric state is also important. Model runs with exaggerated soil moisture reductions (near-desert conditions) showed a much larger effect, with warmer surface temperatures, reduced precipitation, and lower surface pressures; the latter indicating a response of the atmospheric circulation. These results suggest the possibility of a threshold effect in soil moisture, whereby an anomaly must be of a sufficient size before it can have a significant impact on the atmospheric circulation and climate. Results from simulations with realistic snow cover anomalies indicate that the time of year can be crucial. When introduced in late winter, these anomalies strongly affected the subsequent evolution of snow cover. When introduced in early winter, however, little or no effect is seen on the subsequent snow cover. Runs with greatly exaggerated initial snow cover indicate that the high reflectivity of snow is the most important process by which snow cover can impact climate, through lower surface temperatures and increased surface pressures. The results to date were obtained for model runs with present-day conditions. We are currently analyzing runs made with projected forcings for the 21st century to see if these results are modified in any way under likely scenarios of future climate change. An intriguing new statistical technique involving 'clustering' is developed to assist in this analysis.

The Use of Modelling for Improving Pupils' Learning about Cells.

ERIC Educational Resources Information Center

Tregidgo, David; Ratcliffe, Mary

2000-01-01

Outlines the use of modeling in science teaching. Describes a study in which two parallel groups of year seven pupils modeled concepts of cell structure and function as they produced two- or three-dimensional representations of plant and animal cells. (Author/CCM)

3-D Geometric Modeling for the 21st Century.

ERIC Educational Resources Information Center

Ault, Holly K.

1999-01-01

Describes new geometric computer models used in contemporary computer-aided design (CAD) software including wire frame, surface, solid, and parametric models. Reviews their use in engineering design and discusses the impact of these new technologies on the engineering design graphics curriculum. (Author/CCM)

Effect of Curcumin Supplementation on Physiological Fatigue and Physical Performance in Mice

PubMed Central

Huang, Wen-Ching; Chiu, Wan-Chun; Chuang, Hsiao-Li; Tang, Deh-Wei; Lee, Zon-Min; Wei, Li; Chen, Fu-An; Huang, Chi-Chang

2015-01-01

Curcumin (CCM) is a well-known phytocompound and food component found in the spice turmeric and has multifunctional bioactivities. However, few studies have examined its effects on exercise performance and physical fatigue. We aimed to evaluate the potential beneficial effects of CCM supplementation on fatigue and ergogenic function following physical challenge in mice. Male ICR mice were divided into four groups to receive vehicle or CCM (180 μg/mL) by oral gavage at 0, 12.3, 24.6, or 61.5 mL/kg/day for four weeks. Exercise performance and anti-fatigue function were evaluated after physical challenge by forelimb grip strength, exhaustive swimming time, and levels of physical fatigue-associated biomarkers serum lactate, ammonia, blood urea nitrogen (BUN), and glucose and tissue damage markers such as aspartate transaminase (AST), alanine transaminase (ALT), and creatine kinase (CK). CCM supplementation dose-dependently increased grip strength and endurance performance and significantly decreased lactate, ammonia, BUN, AST, ALT, and CK levels after physical challenge. Muscular glycogen content, an important energy source for exercise, was significantly increased. CCM supplementation had few subchronic toxic effects. CCM supplementation may have a wide spectrum of bioactivities for promoting health, improving exercise performance and preventing fatigue. PMID:25647661

Demand generation and social mobilisation for integrated community case management (iCCM) and child health: Lessons learned from successful programmes in Niger and Mozambique

PubMed Central

Sharkey, Alyssa B; Martin, Sandrine; Cerveau, Teresa; Wetzler, Erica; Berzal, Rocio

2014-01-01

Aim We present the approaches used in and outcomes resulting from integrated community case management (iCCM) programmes in Niger and Mozambique with a strong focus on demand generation and social mobilisation. Methods We use a case study approach to describe the programme and contextual elements of the Niger and Mozambique programmes. Results Awareness and utilisation of iCCM services and key family practices increased following the implementation of the Niger and Mozambique iCCM and child survival programmes, as did care–seeking within 24 hours and care–seeking from appropriate, trained providers in Mozambique. These approaches incorporated interpersonal communication activities and community empowerment/participation for collective change, partnerships and networks among key stakeholder groups within communities, media campaigns and advocacy efforts with local and national leaders. Conclusions iCCM programmes that train and equip community health workers and successfully engage and empower community members to adopt new behaviours, have appropriate expectations and to trust community health workers’ ability to assess and treat illnesses can lead to improved care–seeking and utilisation, and community ownership for iCCM. PMID:25520800

Using Transport Diagnostics to Understand Chemistry Climate Model Ozone Simulations

NASA Technical Reports Server (NTRS)

Strahan, S. E.; Douglass, A. R.; Stolarski, R. S.; Akiyoshi, H.; Bekki, S.; Braesicke, P.; Butchart, N.; Chipperfield, M. P.; Cugnet, D.; Dhomse, S.;

Evaluation of stability of interface between CCM (Co-Cr-Mo) UCLA abutment and external hex implant.

PubMed

Yoon, Ki-Joon; Park, Young-Bum; Choi, Hyunmin; Cho, Youngsung; Lee, Jae-Hoon; Lee, Keun-Woo

2016-12-01

The purpose of this study is to evaluate the stability of interface between Co-Cr-Mo (CCM) UCLA abutment and external hex implant. Sixteen external hex implant fixtures were assigned to two groups (CCM and Gold group) and were embedded in molds using clear acrylic resin. Screw-retained prostheses were constructed using CCM UCLA abutment and Gold UCLA abutment. The external implant fixture and screw-retained prostheses were connected using abutment screws. After the abutments were tightened to 30 Ncm torque, 5 kg thermocyclic functional loading was applied by chewing simulator. A target of 1.0 × 10 6 cycles was applied. After cyclic loading, removal torque values were recorded using a driving torque tester, and the interface between implant fixture and abutment was evaluated by scanning electronic microscope (SEM). The means and standard deviations (SD) between the CCM and Gold groups were analyzed with independent t-test at the significance level of 0.05. Fractures of crowns, abutments, abutment screws, and fixtures and loosening of abutment screws were not observed after thermocyclic loading. There were no statistically significant differences at the recorded removal torque values between CCM and Gold groups ( P >.05). SEM analysis revealed that remarkable wear patterns were observed at the abutment interface only for Gold UCLA abutments. Those patterns were not observed for other specimens. Within the limit of this study, CCM UCLA abutment has no statistically significant difference in the stability of interface with external hex implant, compared with Gold UCLA abutment.

Models of Students' Thinking Concerning the Greenhouse Effect and Teaching Implications.

ERIC Educational Resources Information Center

Koulaidis, Vasilis; Christidou, Vasilia

1999-01-01

Primary school students (n=40) ages 11 and 12 years were interviewed concerning their conceptions of the greenhouse effect. Analysis of the data led to the formation of seven distinct models of thinking regarding this phenomenon. (Author/CCM)

Application of Seasonal CRM Integrations to Develop Statistics and Improved GCM Parameterization of Subgrid Cloud-Radiation Interactions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xiaoqing Wu; Xin-Zhong Liang; Sunwook Park

2007-01-23

The works supported by this ARM project lay the solid foundation for improving the parameterization of subgrid cloud-radiation interactions in the NCAR CCSM and the climate simulations. We have made a significant use of CRM simulations and concurrent ARM observations to produce long-term, consistent cloud and radiative property datasets at the cloud scale (Wu et al. 2006, 2007). With these datasets, we have investigated the mesoscale enhancement of cloud systems on surface heat fluxes (Wu and Guimond 2006), quantified the effects of cloud horizontal inhomogeneity and vertical overlap on the domain-averaged radiative fluxes (Wu and Liang 2005), and subsequently validatedmore » and improved the physically-based mosaic treatment of subgrid cloud-radiation interactions (Liang and Wu 2005). We have implemented the mosaic treatment into the CCM3. The 5-year (1979-1983) AMIP-type simulation showed significant impacts of subgrid cloud-radiation interaction on the climate simulations (Wu and Liang 2005). We have actively participated in CRM intercomparisons that foster the identification and physical understanding of common errors in cloud-scale modeling (Xie et al. 2005; Xu et al. 2005, Grabowski et al. 2005).« less

PUPTH Prehospital Air Medical Plasma (PAMP) Trial

DTIC Science & Technology

2014-07-01

collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for...projects. Scott Gunn, MD, is an Associate Professor of CCM and Emergency Medicine and Director , Combined Emergency Medicine/Internal Medicine/CCM...Residency Program. Dr. Gunn is also Director of the CCM Clinical Trials Program. As such, he is experienced in the design and monitoring of clinical trials

The US CLIVAR Working Group on Drought: A Multi-Model Assessment of the Impact of SST Anomalies on Regional Drought

NASA Astrophysics Data System (ADS)

Schubert; Drought Working Group, S.

2008-12-01

The USCLIVAR working group on drought recently initiated a series of global climate model simulations forced with idealized SST anomaly patterns, designed to address a number of uncertainties regarding the impact of SST forcing and the role of land-atmosphere feedbacks on regional drought. Specific questions that the runs are designed to address include: What are mechanisms that maintain drought across the seasonal cycle and from one year to the next. What is the role of the land? What is the role of the different ocean basins, including the impact of El Nino/Southern Oscillation (ENSO), the Pacific Decadal Oscillation (PDO), the Atlantic Multi-decadal Oscillation (AMO), and warming trends in the global oceans? The runs were done with several global atmospheric models including NASA/NSIPP-1, NCEP/GFS, GFDL/AM2, and NCAR CCM3 and CAM3. In addition, runs were done with the NCEP CFS (coupled atmosphere-ocean) model by employing a novel adjustment technique to nudge the coupled model towards the imposed SST forcing patterns. This talk provides an overview of the experiments and some initial results.

The US CLIVAR Working Group on Drought: A Multi-Model Assessment of the Impact of SST Anomalies on Regional Drought

NASA Technical Reports Server (NTRS)

Schubert, Siegfried

2008-01-01

The US CLIVAR working group on drought recently initiated a series of global climate model simulations forced with idealized SST anomaly patterns, designed to address a number of uncertainties regarding the impact of SST forcing and the role of land-atmosphere feedbacks on regional drought. Specific questions that the runs are designed to address include: What are mechanisms that maintain drought across the seasonal cycle and from one year to the next. What is the role of the land? What is the role of the different ocean basins, including the impact of EL Nino/Southern Oscillation (ENSO), the Pacific Decadal Oscillation (PDO), the Atlantic Multi-decadal Oscillation (AMO), and warming trends in the global oceans? The runs were done with several global atmospheric models including NASA/NSIPP-1, NCEP/GFS, GFDL/AM2, and NCAR CCM3 and CAM3. In addition, runs were done with the NCEP CFS (coupled atmosphere-ocean) model by employing a novel adjustment technique to nudge the coupled model towards the imposed SST forcing patterns. This talk provides an overview of the experiments and some initial results.

Micro-Rockets for the Classroom.

ERIC Educational Resources Information Center

Huebner, Jay S.; Fletcher, Alice S.; Cato, Julia A.; Barrett, Jennifer A.

1999-01-01

Compares micro-rockets to commercial models and water rockets. Finds that micro-rockets are more advantageous because they are constructed with inexpensive and readily available materials and can be safely launched indoors. (CCM)

Critical Care Medicine and Infectious Diseases: An Emerging Combined Subspecialty in the United States

PubMed Central

Kadri, Sameer S.; Rhee, Chanu; Fortna, Gregory S.; O'Grady, Naomi P.

2015-01-01

The recent rise in unfilled training positions among infectious diseases (ID) fellowship programs nationwide indicates that ID is declining as a career choice among internal medicine residency graduates. Supplementing ID training with training in critical care medicine (CCM) might be a way to regenerate interest in the specialty. Hands-on patient care and higher salaries are obvious attractions. High infection prevalence and antibiotic resistance in intensive care units, expanding immunosuppressed host populations, and public health crises such as the recent Ebola outbreak underscore the potential synergy of CCM-ID training. Most intensivists receive training in pulmonary medicine and only 1% of current board-certified intensivists are trained in ID. While still small, this cohort of CCM-ID certified physicians has continued to rise over the last 2 decades. ID and CCM program leadership nationwide must recognize these trends and the merits of the CCM-ID combination to facilitate creation of formal dual-training opportunities. PMID:25944345

Rapid, automated mosaicking of the human corneal subbasal nerve plexus.

PubMed

Vaishnav, Yash J; Rucker, Stuart A; Saharia, Keshav; McNamara, Nancy A

2017-11-27

Corneal confocal microscopy (CCM) is an in vivo technique used to study corneal nerve morphology. The largest proportion of nerves innervating the cornea lie within the subbasal nerve plexus, where their morphology is altered by refractive surgery, diabetes and dry eye. The main limitations to clinical use of CCM as a diagnostic tool are the small field of view of CCM images and the lengthy time needed to quantify nerves in collected images. Here, we present a novel, rapid, fully automated technique to mosaic individual CCM images into wide-field maps of corneal nerves. We implemented an OpenCV image stitcher that accounts for corneal deformation and uses feature detection to stitch CCM images into a montage. The method takes 3-5 min to process and stitch 40-100 frames on an Amazon EC2 Micro instance. The speed, automation and ease of use conferred by this technique is the first step toward point of care evaluation of wide-field subbasal plexus (SBP) maps in a clinical setting.

Evaluation of stability of interface between CCM (Co-Cr-Mo) UCLA abutment and external hex implant

PubMed Central

Yoon, Ki-Joon; Park, Young-Bum; Choi, Hyunmin; Cho, Youngsung; Lee, Jae-Hoon

2016-01-01

PURPOSE The purpose of this study is to evaluate the stability of interface between Co-Cr-Mo (CCM) UCLA abutment and external hex implant. MATERIALS AND METHODS Sixteen external hex implant fixtures were assigned to two groups (CCM and Gold group) and were embedded in molds using clear acrylic resin. Screw-retained prostheses were constructed using CCM UCLA abutment and Gold UCLA abutment. The external implant fixture and screw-retained prostheses were connected using abutment screws. After the abutments were tightened to 30 Ncm torque, 5 kg thermocyclic functional loading was applied by chewing simulator. A target of 1.0 × 106 cycles was applied. After cyclic loading, removal torque values were recorded using a driving torque tester, and the interface between implant fixture and abutment was evaluated by scanning electronic microscope (SEM). The means and standard deviations (SD) between the CCM and Gold groups were analyzed with independent t-test at the significance level of 0.05. RESULTS Fractures of crowns, abutments, abutment screws, and fixtures and loosening of abutment screws were not observed after thermocyclic loading. There were no statistically significant differences at the recorded removal torque values between CCM and Gold groups (P>.05). SEM analysis revealed that remarkable wear patterns were observed at the abutment interface only for Gold UCLA abutments. Those patterns were not observed for other specimens. CONCLUSION Within the limit of this study, CCM UCLA abutment has no statistically significant difference in the stability of interface with external hex implant, compared with Gold UCLA abutment. PMID:28018564

A New Water-Soluble Nanomicelle Formed through Self-Assembly of Pectin-Curcumin Conjugates: Preparation, Characterization, and Anticancer Activity Evaluation.

PubMed

Bai, Feng; Diao, Jiajing; Wang, Ying; Sun, Shixin; Zhang, Hongmei; Liu, Yunyun; Wang, Yanqing; Cao, Jian

2017-08-16

Curcumin is a dominating active component of Curcuma longa and has been studied widely because of its prominent biological activities. The extremely low aqueous solubility, stability, and bioavailability of curcumin limit its application in the field of medicine. In this study, we developed pectin-curcumin (PEC-CCM) conjugates that could self-assemble water-soluble nanomicelles in aqueous solution. The structure of PEC-CCM conjugates was characterized by ultraviolet-visible spectra, fluorescence spectra, Fourier transform infrared spectroscopy, and 1 H nuclear magnetic resonance spectroscopy. The thermal property of PEC-CCM conjugates was investigated by thermogravimetric analysis. It was found that PEC-CCM conjugates had formed nanomicelles in aqueous medium via self-assembly. These nanomicelles were observed as small spheres or ellipsoids and aggregated with a size range of 70-190 nm by transmission electron microscopy analysis. In a solution of nanomicelles, the stability of curcumin was improved, and its antioxidant property was preserved. The anticancer activity of PEC-CCM conjugates was quantified by the MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay using a hepatic cancer cell line (HepG2), a breast cancer cell line (MCF-7), a cervical cancer cell line (HeLa), and a human normal kidney cell line (293A). It was found that the curcumin of PEC-CCM conjugates had a more significant inhibitory effect on cancer cells and was less cytotoxic to normal cells than free curcumin was. PEC-CCM conjugates have great potential for some food and pharmaceutical applications.

Two-faced property of a market factor in asset pricing and diversification effect

NASA Astrophysics Data System (ADS)

Eom, Cheoljun

2017-04-01

This study empirically investigates the test hypothesis that a market factor acting as a representative common factor in the pricing models has a negative influence on constructing a well-diversified portfolio from the Markowitz mean-variance optimization function (MVOF). We use the comparative correlation matrix (C-CM) method to control a single eigenvalue among all eigenvalues included in the sample correlation matrix (S-CM), through the random matrix theory (RMT). In particular, this study observes the effect of the largest eigenvalue that has the property of the market factor. According to the results, the largest eigenvalue has the highest explanatory power on the stock return changes. The C-CM without the largest eigenvalue in the S-CM constructs a more diversified portfolio capable of improving the practical applicability of the MVOF. Moreover, the more diversified portfolio constructed from this C-CM has better out-of-sample performance in the future period. These results support the test hypothesis for the two-faced property of the market factor, defined by the largest eigenvalue.

Under-Five Child Mortality and Morbidity Associated with Consanguineous Child Marriage in Pakistan: Retrospective Analysis using Pakistan Demographic and Health Surveys, 1990-91, 2006-07, 2012-13.

PubMed

Mustafa, Mudasir; Zakar, Rubeena; Zakar, Muhammad Zakria; Chaudhry, Ashraf; Nasrullah, Muazzam

2017-05-01

Objective To assess the combined effect of consanguineous and child marriages (CCM) on children health, which has not previously been explored, either globally or locally. Methods We analyzed secondary data from a series of cross-sectional, nationally representative Pakistan Demographic and Health Surveys 1990-91, 2006-07, and 2012-13. A total of 5406 mothers with 10,164 children were included in the analysis. Child health was assessed by variables such as history of diarrhea, acute respiratory infection (ARI), ARI with fever, Under-5 child mortality (U5CM) and small-size birth (SSB). Associations among variables were assessed by calculating unadjusted Odd Ratios (OR) and adjusted OR (AOR). Results A majority (n = 6,247, 61%) of the births were to mothers having CCM as compare to non-CCM (3917, 39%). There was a significant association between CCM and U5CM during 1990-91 (AOR 1.24, 95% CI 1.03-1.49) and 2006-07 (AOR 1.25, 95% CI 1.05-1.51), and infant mortality in 1990-91 (AOR 1.39, 95% CI 1.05-1.85) and 2006-07 (AOR 1.61, 95% CI 1.17-2.21). A significant association was also found between CCM and SSB infants in the period 2006-07 (AOR 1.19, 95% CI 1.01-1.42) and 2012-13 (AOR 1.22, 95% CI 1.02-1.46). We noted no effect of CCM on diarrhea, ARI, and ARI with fever. Conclusion CCM increases the likelihood of U5CM, infant mortality and SSB infants. Further quantitative and qualitative research should be conducted to assess the effects of environmental, congenital and genetic factors on the health of children born to mothers in CCM.

Folic acid-targeted disulfide-based cross-linking micelle for enhanced drug encapsulation stability and site-specific drug delivery against tumors

PubMed Central

Zhang, Yumin; Zhou, Junhui; Yang, Cuihong; Wang, Weiwei; Chu, Liping; Huang, Fan; Liu, Qiang; Deng, Liandong; Kong, Deling; Liu, Jianfeng; Liu, Jinjian

2016-01-01

Although the shortcomings of small molecular antitumor drugs were efficiently improved by being entrapped into nanosized vehicles, premature drug release and insufficient tumor targeting demand innovative approaches that boost the stability and tumor responsiveness of drug-loaded nanocarriers. Here, we show the use of the core cross-linking method to generate a micelle with enhanced drug encapsulation ability and sensitivity of drug release in tumor. This kind of micelle could increase curcumin (Cur) delivery to HeLa cells in vitro and improve tumor accumulation in vivo. We designed and synthesized the core cross-linked micelle (CCM) with polyethylene glycol and folic acid-polyethylene glycol as the hydrophilic units, pyridyldisulfide as the cross-linkable and hydrophobic unit, and disulfide bond as the cross-linker. CCM showed spherical shape with a diameter of 91.2 nm by the characterization of dynamic light scattering and transmission electron microscope. Attributed to the core cross-linking, drug-loaded CCM displayed higher Nile Red or Cur-encapsulated stability and better sensitivity to glutathione than noncross-linked micelle (NCM). Cellular uptake and in vitro antitumor studies proved the enhanced endocytosis and better cytotoxicity of CCM-Cur against HeLa cells, which had a high level of glutathione. Meanwhile, the folate receptor-mediated drug delivery (FA-CCM-Cur) further enhanced the endocytosis and cytotoxicity. Ex vivo imaging studies showed that CCM-Cur and FA-CCM-Cur possessed higher tumor accumulation until 24 hours after injection. Concretely, FA-CCM-Cur exhibited the highest tumor accumulation with 1.7-fold of noncross-linked micelle Cur and 2.8-fold of free Cur. By combining cross-linking of the core with active tumor targeting of FA, we demonstrated a new and effective way to design nanocarriers for enhanced drug encapsulation, smart tumor responsiveness, and elevated tumor accumulation. PMID:27051287

Quantifying uncertainties of climate signals related to the 11-year solar cycle

NASA Astrophysics Data System (ADS)

Kruschke, T.; Kunze, M.; Matthes, K. B.; Langematz, U.; Wahl, S.

2017-12-01

Although state-of-the-art reconstructions based on proxies and (semi-)empirical models converge in terms of total solar irradiance, they still significantly differ in terms of spectral solar irradiance (SSI) with respect to the mean spectral distribution of energy input and temporal variability. This study aims at quantifying uncertainties for the Earth's climate related to the 11-year solar cycle by forcing two chemistry-climate models (CCMs) - CESM1(WACCM) and EMAC - with five different SSI reconstructions (NRLSSI1, NRLSSI2, SATIRE-T, SATIRE-S, CMIP6-SSI) and the reference spectrum RSSV1-ATLAS3, derived from observations. We conduct a unique set of timeslice experiments. External forcings and boundary conditions are fixed and identical for all experiments, except for the solar forcing. The set of analyzed simulations consists of one solar minimum simulation, employing RSSV1-ATLAS3 and five solar maximum experiments. The latter are a result of adding the amplitude of solar cycle 22 according to the five reconstructions to RSSV1-ATLAS3. Our results show that the climate response to the 11y solar cycle is generally robust across CCMs and SSI forcings. However, analyzing the variance of the solar maximum ensemble by means of ANOVA-statistics reveals additional information on the uncertainties of the mean climate signals. The annual mean response agrees very well between the two CCMs for most parts of the lower and middle atmosphere. Only the upper mesosphere is subject to significant differences related to the choice of the model. However, the different SSI forcings lead to significant differences in ozone concentrations, shortwave heating rates, and temperature throughout large parts of the mesosphere and upper stratosphere. Regarding the seasonal evolution of the climate signals, our findings for short wave heating rates, and temperature are similar to the annual means with respect to the relative importance of the choice of the model or the SSI forcing for the respective atmospheric layer. On the other hand, the predominantly dynamically driven signal in zonal wind is quite dependent on the choice of a CCM, mainly due to spatio-temporal shifts of similar responses. Within a given "model world" dynamical signals related to the different SSI forcings agree very well even under this monthly perspective.

Costing commodity and human resource needs for integrated community case management in thie differing community health strategies of Ethiopia, Kenya and Zambia.

PubMed

Nefdt, Rory; Ribaira, Eric; Diallo, Khassoum

2014-10-01

To ensure correct and appropriate funding is available, there is a need to estimate resource needs for improved planning and implementation of integrated Community Case Management (iCCM). To compare and estimate costs for commodity and human resource needs for iCCM, based on treatment coverage rates, bottlenecks and national targets in Ethiopia, Kenya and Zambia from 2014 to 2016. Resource needs were estimated using Ministry of Health (MoH) targets fronm 2014 to 2016 for implementation of case management of pneumonia, diarrhea and malaria through iCCM based on epidemiological, demographic, economic, intervention coverage and other health system parameters. Bottleneck analysis adjusted cost estimates against system barriers. Ethiopia, Kenya and Zambia were chosen to compare differences in iCCM costs in different programmatic implementation landscapes. Coverage treatment rates through iCCM are lowest in Ethiopia, followed by Kenya and Zambia, but Ethiopia had the greatest increases between 2009 and 2012. Deployment of health extension workers (HEWs) in Ethiopia is more advanced compared to Kenya and Zambia, which have fewer equivalent cadres (called commu- nity health workers (CHWs)) covering a smaller proportion of the population. Between 2014 and 2016, the propor- tion of treatments through iCCM compared to health centres are set to increase from 30% to 81% in Ethiopia, 1% to 18% in Kenya and 3% to 22% in Zambia. The total estimated cost of iCCM for these three years are USD 75,531,376 for Ethiopia, USD 19,839,780 for Kenya and USD 33,667,742 for Zambia. Projected per capita expen- diture for 2016 is USD 0.28 for Ethiopia, USD 0.20 in Kenya and USD 0.98 in Zambia. Commodity costs for pneumonia and diarrhea were a small fraction of the total iCCM budget for all three countries (less than 3%), while around 80% of the costs related to human resources. Analysis of coverage, demography and epidemiology data improves estimates of fimding requirements for iCCM. Bottleneck analysis adjusts cost estimates by including system barriers, thus reflecting a more accurate estimate of potential resource utilization. Adding pneumonia and diarrhea interventions to existing large scale community-based malaria case management programs is likely to require relatively small and nationally affordable investments. iCCM can be implemented for USD 0.09 to 0.98 per capita per annum, depending on the stage of scale-up and targets set by the MoH.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Erickson III, David J

The climate of the last glacial maximum (LGM) is simulated with a high-resolution atmospheric general circulation model, the NCAR CCM3 at spectral truncation of T170, corresponding to a grid cell size of roughly 75 km. The purpose of the study is to assess whether there are significant benefits from the higher resolution simulation compared to the lower resolution simulation associated with the role of topography. The LGM simulations were forced with modified CLIMAP sea ice distribution and sea surface temperatures (SST) reduced by 1 C, ice sheet topography, reduced CO{sub 2}, and 21,000 BP orbital parameters. The high-resolution model capturesmore » modern climate reasonably well, in particular the distribution of heavy precipitation in the tropical Pacific. For the ice age case, surface temperature simulated by the high-resolution model agrees better with those of proxy estimates than does the low-resolution model. Despite the fact that tropical SSTs were only 2.1 C less than the control run, there are many lowland tropical land areas 4-6 C colder than present. Comparison of T170 model results with the best constrained proxy temperature estimates (noble gas concentrations in groundwater) now yield no significant differences between model and observations. There are also significant upland temperature changes in the best resolved tropical mountain belt (the Andes). We provisionally attribute this result in part as resulting from decreased lateral mixing between ocean and land in a model with more model grid cells. A longstanding model-data discrepancy therefore appears to be resolved without invoking any unusual model physics. The response of the Asian summer monsoon can also be more clearly linked to local geography in the high-resolution model than in the low-resolution model; this distinction should enable more confident validation of climate proxy data with the high-resolution model. Elsewhere, an inferred salinity increase in the subtropical North Atlantic may have significant implications for ocean circulation changes during the LGM. A large part of the Amazon and Congo Basins are simulated to be substantially drier in the ice age - consistent with many (but not all) paleo data. These results suggest that there are considerable benefits derived from high-resolution model regarding regional climate responses, and that observationalists can now compare their results with models that resolve geography at a resolution comparable to that which the proxy data represent.« less

CASL VMA Milestone Report FY16 (L3:VMA.VUQ.P13.08): Westinghouse Mixing with STAR-CCM+

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gilkey, Lindsay Noelle

2016-09-30

STAR-CCM+ (STAR) is a high-resolution computational fluid dynamics (CFD) code developed by CD-adapco. STAR includes validated physics models and a full suite of turbulence models including ones from the k-ε and k-ω families. STAR is currently being developed to be able to do two phase flows, but the current focus of the software is single phase flow. STAR can use imported meshes or use the built in meshing software to create computation domains for CFD. Since the solvers generally require a fine mesh for good computational results, the meshes used with STAR tend to number in the millions of cells,more » with that number growing with simulation and geometry complexity. The time required to model the flow of a full 5x5 Mixing Vane Grid Assembly (5x5MVG) in the current STAR configuration is on the order of hours, and can be very computationally expensive. COBRA-TF (CTF) is a low-resolution subchannel code that can be trained using high fidelity data from STAR. CTF does not have turbulence models and instead uses a turbulent mixing coefficient β. With a properly calibrated β, CTF can be used a low-computational cost alternative to expensive full CFD calculations performed with STAR. During the Hi2Lo work with CTF and STAR, STAR-CCM+ will be used to calibrate β and to provide high-resolution results that can be used in the place of and in addition to experimental results to reduce the uncertainty in the CTF results.« less

Chronic disease management: implementation and coordination of healthcare systems for depressed elderly persons.

PubMed

Severinsson, Elisabeth; Holm, Anne Lise

2014-12-01

The aim of this study was to evaluate the implementation of the research-based Chronic Care Model (CCM), discuss methods and summarise research recommendations for improving the care of depressed elderly persons. Interviews were conducted and state-of-the-art reviews employed. Three important areas emerged: (1) barriers to and facilitating factors in the implementation of the CCM; (2) the challenges involved in re-designing the delivery system and interdisciplinary team collaboration; and (3) empirical evidence pertaining to self-management support and how older persons manage to live with depressive ill-health. In conclusion, implementation research requires evidence-based knowledge, staff involvement and familiarity with the context in which development occurs.

Outcome after surgical or conservative management of cerebral cavernous malformations.

PubMed

Moultrie, Fiona; Horne, Margaret A; Josephson, Colin B; Hall, Julie M; Counsell, Carl E; Bhattacharya, Jo J; Papanastassiou, Vakis; Sellar, Robin J; Warlow, Charles P; Murray, Gordon D; Al-Shahi Salman, Rustam

2014-08-12

There have been few comparative studies of microsurgical excision vs conservative management of cerebral cavernous malformations (CCM) and none of them has reliably demonstrated a statistically and clinically significant difference. We conducted a prospective, population-based study to identify and independently validate definite CCM diagnoses first made in 1999-2003 in Scottish adult residents. We used multiple sources of prospective follow-up to assess adults' dependence and to identify and independently validate outcome events. We used univariate and multivariable survival analyses to test the influence of CCM excision on outcome, adjusted for prognostic factors and baseline imbalances. Of 134 adults, 25 underwent CCM excision; these adults were younger (34 vs 43 years at diagnosis, p = 0.004) and more likely to present with symptomatic intracranial hemorrhage or focal neurologic deficit than adults managed conservatively (48% vs 26%; odds ratio 2.7, 95% confidence interval [CI] 1.1-6.5). During 5 years of follow-up, CCM excision was associated with a deterioration to an Oxford Handicap Scale score 2-6 sustained over at least 2 successive years (adjusted hazard ratio [HR] 2.2, 95% CI 1.1-4.3) and the occurrence of symptomatic intracranial hemorrhage or new focal neurologic deficit (adjusted HR 3.6, 95% CI 1.3-10.0). CCM excision was associated with worse outcomes over 5 years compared to conservative management. Long-term follow-up will determine whether this difference is sustained over patients' lifetimes. Meanwhile, a randomized controlled trial appears justified. This study provides Class III evidence that CCM excision worsens short-term disability scores and increases the risk of symptomatic intracranial hemorrhage and new focal neurologic deficits. © 2014 American Academy of Neurology.

Critical care medicine training and certification for emergency physicians.

PubMed

Huang, David T; Osborn, Tiffany M; Gunnerson, Kyle J; Gunn, Scott R; Trzeciak, Stephen; Kimball, Edward; Fink, Mitchell P; Angus, Derek C; Dellinger, R Phillip; Rivers, Emanuel P

2005-09-01

Demand for critical care services is increasing. Unless the supply of intensivists increases, critically ill patients will not have access to intensivists. Recent critical care society recommendations include increased graduate medical education support and expansion of the J-1 visa waiver program for foreign medical graduates. This article proposes additional recommendations, based on strengthening the relationship between emergency medicine and critical care medicine. Demand for critical care services is increasing. Unless the supply of intensivists increases, critically ill patients will not have access to intensivists. Recent critical care society recommendations include increased graduate medical education support and expansion of the J-1 visa waiver program for foreign medical graduates. This article proposes additional recommendations, based on strengthening the relationship between emergency medicine (EM) and critical care medicine (CCM). Critical care is a continuum that includes prehospital, emergency department (ED), and intensive care unit (ICU) care teams. Both EM and CCM require expertise in treating life-threatening acute illness, with many critically ill patients often presenting first to the ED. Increased patient volumes and acuity have resulted in longer ED lengths of stay and more critical care delivery in the ED. However, the majority of CCM fellowships do not accept EM residents, and those who successfully complete a fellowship do not have access to a U.S. certification exam in CCM. Despite these barriers, interest in CCM training among EM physicians is increasing. Dual EM/CCM-trained physicians not only will help alleviate the intensivist shortage but also will strengthen critical care delivery in the ED and facilitate coordination at the ED-ICU interface. We therefore propose that all accreditation bodies work cooperatively to create a route to CCM certification for emergency physicians who complete a critical care fellowship.

Retrieving hydrological connectivity from empirical causality in karst systems

NASA Astrophysics Data System (ADS)

Delforge, Damien; Vanclooster, Marnik; Van Camp, Michel; Poulain, Amaël; Watlet, Arnaud; Hallet, Vincent; Kaufmann, Olivier; Francis, Olivier

2017-04-01

Because of their complexity, karst systems exhibit nonlinear dynamics. Moreover, if one attempts to model a karst, the hidden behavior complicates the choice of the most suitable model. Therefore, both intense investigation methods and nonlinear data analysis are needed to reveal the underlying hydrological connectivity as a prior for a consistent physically based modelling approach. Convergent Cross Mapping (CCM), a recent method, promises to identify causal relationships between time series belonging to the same dynamical systems. The method is based on phase space reconstruction and is suitable for nonlinear dynamics. As an empirical causation detection method, it could be used to highlight the hidden complexity of a karst system by revealing its inner hydrological and dynamical connectivity. Hence, if one can link causal relationships to physical processes, the method should show great potential to support physically based model structure selection. We present the results of numerical experiments using karst model blocks combined in different structures to generate time series from actual rainfall series. CCM is applied between the time series to investigate if the empirical causation detection is consistent with the hydrological connectivity suggested by the karst model.

Methods for Creating and Animating a Computer Model Depicting the Structure and Function of the Sarcoplasmic Reticulum Calcium ATPase Enzyme.

ERIC Educational Resources Information Center

Chen, Alice Y.; McKee, Nancy

1999-01-01

Describes the developmental process used to visualize the calcium ATPase enzyme of the sarcoplasmic reticulum which involves evaluating scientific information, consulting scientists, model making, storyboarding, and creating and editing in a computer medium. (Author/CCM)

Curcumin inhibits vasculogenic mimicry through the downregulation of erythropoietin-producing hepatocellular carcinoma-A2, phosphoinositide 3-kinase and matrix metalloproteinase-2

PubMed Central

LIANG, YIMING; HUANG, MIN; LI, JIANWEN; SUN, XINLIN; JIANG, XIAODAN; LI, LIANGPING; KE, YIQUAN

2014-01-01

Glioblastomas (GBMs) are the most common and aggressive malignant primary brain tumors found in humans. In high-grade gliomas, vasculogenic mimicry (VM) is often detected. VM is the formation of de novo vascular networks by highly invasive tumor cells, instead of endothelial cells. An understanding of the mechanisms of VM formation will contribute to the targeted therapy of GBMs. In the present study, the efficacy of curcumin (CCM) on VM formation and its mechanisms were investigated. It was found that CCM inhibits the VM formation, proliferation, migration and invasion of human glioma U251 cells in a dose-dependent manner. Furthermore, CCM downregulated the protein and mRNA expression of erythropoietin-producing hepatocellular carcinoma-A2, phosphoinositide 3-kinase and matrix metalloproteinase-2, indicating that CCM may function through these factors for the inhibition of VM formation. These data provide novel insights into the use of CCM to antagonize VM, and may contribute to the angiogenesis-targeted therapy of malignant glioma. PMID:25202424

Heg1 and Ccm1/2 proteins control endocardial mechanosensitivity during zebrafish valvulogenesis

PubMed Central

Otten, Cécile; Renz, Marc

2018-01-01

Endothelial cells respond to different levels of fluid shear stress through adaptations of their mechanosensitivity. Currently, we lack a good understanding of how this contributes to sculpting of the cardiovascular system. Cerebral cavernous malformation (CCM) is an inherited vascular disease that occurs when a second somatic mutation causes a loss of CCM1/KRIT1, CCM2, or CCM3 proteins. Here, we demonstrate that zebrafish Krit1 regulates the formation of cardiac valves. Expression of heg1, which encodes a binding partner of Krit1, is positively regulated by blood-flow. In turn, Heg1 stabilizes levels of Krit1 protein, and both Heg1 and Krit1 dampen expression levels of klf2a, a major mechanosensitive gene. Conversely, loss of Krit1 results in increased expression of klf2a and notch1b throughout the endocardium and prevents cardiac valve leaflet formation. Hence, the correct balance of blood-flow-dependent induction and Krit1 protein-mediated repression of klf2a and notch1b ultimately shapes cardiac valve leaflet morphology. PMID:29364115

Chronic care model for the management of depression: synthesis of barriers to, and facilitators of, success.

PubMed

Holm, Anne Lise; Severinsson, Elisabeth

2012-12-01

Depression is a socially- and physically-disabling condition. The Chronic Care Model (CCM) was developed to promote better management of long-term conditions, such as depression, in primary care settings. The aim of the study was to identify barriers to, and facilitators of, success when implementing the CCM for the management of depression in primary care. A systematic search was conducted in electronic databases from January 2005 to December 2011. Thirteen articles met the inclusion criteria and were reviewed by means of a thematic analysis. The barriers were categorized under two themes: lack of organizational, administrative, and professional ability to change and implement the components of the CCM; and lack of clarity pertaining to the responsibility inherent in the role of care manager (often a nurse) when it comes to promoting the patient's self-management ability. In terms of the facilitators of success, two themes emerged: leadership support and vision, and redesigning the delivery system. When shaping an environment for organizational change, leadership and professionals must work towards a common goal and vision. Such processes require a care manager with a clear role and responsibilities in order for the health-care system to meet the needs of the person with depression. © 2012 The Authors. International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

LIFE CLIMATREE project: A novel approach for accounting and monitoring carbon sequestration of tree crops and their potential as carbon sink areas

NASA Astrophysics Data System (ADS)

Stergiou, John; Tagaris, Efthimios; -Eleni Sotiropoulou, Rafaella

2016-04-01

Climate Change Mitigation is one of the most important objectives of the Kyoto Convention, and is mostly oriented towards reducing GHG emissions. However, carbon sink is retained only in the calculation of the forests capacity since agricultural land and farmers practices for securing carbon stored in soils have not been recognized in GHG accounting, possibly resulting in incorrect estimations of the carbon dioxide balance in the atmosphere. The agricultural sector, which is a key sector in the EU, presents a consistent strategic framework since 1954, in the form of Common Agricultural Policy (CAP). In its latest reform of 2013 (reg. (EU) 1305/13) CAP recognized the significance of Agriculture as a key player in Climate Change policy. In order to fill this gap the "LIFE ClimaTree" project has recently founded by the European Commission aiming to provide a novel method for including tree crop cultivations in the LULUCF's accounting rules for GHG emissions and removal. In the framework of "LIFE ClimaTree" project estimation of carbon sink within EU through the inclusion of the calculated tree crop capacity will be assessed for both current and future climatic conditions by 2050s using the GISS-WRF modeling system in a very fine scale (i.e., 9km x 9km) using RCP8.5 and RCP4.5 climate scenarios. Acknowledgement: LIFE CLIMATREE project "A novel approach for accounting and monitoring carbon sequestration of tree crops and their potential as carbon sink areas" (LIFE14 CCM/GR/000635).

Modelling an advanced ManPAD with dual band detectors and a rosette scanning seeker head

NASA Astrophysics Data System (ADS)

Birchenall, Richard P.; Richardson, Mark A.; Butters, Brian; Walmsley, Roy

2012-01-01

Man Portable Air Defence Systems (ManPADs) have been a favoured anti aircraft weapon since their appearance on the military proliferation scene in the mid 1960s. Since this introduction there has been a 'cat and mouse' game of Missile Countermeasures (CMs) and the aircraft protection counter counter measures (CCMs) as missile designers attempt to defeat the aircraft platform protection equipment. Magnesium Teflon Viton (MTV) flares protected the target aircraft until the missile engineers discovered the art of flare rejection using techniques including track memory and track angle bias. These early CCMs relied upon CCM triggering techniques such as the rise rate method which would just sense a sudden increase in target energy and assume that a flare CM had been released by the target aircraft. This was not as reliable as was first thought as aspect changes (bringing another engine into the field of view) or glint from the sun could inadvertently trigger a CCM when not needed. The introduction of dual band detectors in the 1980s saw a major advance in CCM capability allowing comparisons between two distinct IR bands to be made thus allowing the recognition of an MTV flare to occur with minimal false alarms. The development of the rosette scan seeker in the 1980s complemented this advancement allowing the scene in the missile field of view (FOV) to be scanned by a much smaller (1/25) instantaneous FOV (IFOV) with the spectral comparisons being made at each scan point. This took the ManPAD from a basic IR energy detector to a pseudo imaging system capable of analysing individual elements of its overall FOV allowing more complex and robust CCM to be developed. This paper continues the work published in [1,2] and describes the method used to model an advanced ManPAD with a rosette scanning seeker head and robust CCMs similar to the Raytheon Stinger RMP.

A Phenomena-Oriented Environment for Teaching Process Modeling: Novel Modeling Software and Its Use in Problem Solving.

ERIC Educational Resources Information Center

Foss, Alan S.; Geurts, Kevin R.; Goodeve, Peter J.; Dahm, Kevin D.; Stephanopoulos, George; Bieszczad, Jerry; Koulouris, Alexandros

1999-01-01

Discusses a program that offers students a phenomenon-oriented environment expressed in the fundamental concepts and language of chemical engineering such as mass and energy balancing, phase equilibria, reaction stoichiometry and rate, modes of heat, and species transport. (CCM)

The added value of a mobile application of Community Case Management on referral, re-consultation and hospitalization rates of children aged under 5 years in two districts in Northern Malawi: study protocol for a pragmatic, stepped-wedge cluster-randomized controlled trial.

PubMed

Hardy, Victoria; O'Connor, Yvonne; Heavin, Ciara; Mastellos, Nikolaos; Tran, Tammy; O'Donoghue, John; Fitzpatrick, Annette L; Ide, Nicole; Wu, Tsung-Shu Joseph; Chirambo, Griphin Baxter; Muula, Adamson S; Nyirenda, Moffat; Carlsson, Sven; Andersson, Bo; Thompson, Matthew

2017-10-11

There is evidence to suggest that frontline community health workers in Malawi are under-referring children to higher-level facilities. Integrating a digitized version of paper-based methods of Community Case Management (CCM) could strengthen delivery, increasing urgent referral rates and preventing unnecessary re-consultations and hospital admissions. This trial aims to evaluate the added value of the Supporting LIFE electronic Community Case Management Application (SL eCCM App) compared to paper-based CCM on urgent referral, re-consultation and hospitalization rates, in two districts in Northern Malawi. This is a pragmatic, stepped-wedge cluster-randomized trial assessing the added value of the SL eCCM App on urgent referral, re-consultation and hospitalization rates of children aged 2 months and older to up to 5 years, within 7 days of the index visit. One hundred and two health surveillance assistants (HSAs) were stratified into six clusters based on geographical location, and clusters randomized to the timing of crossover to the intervention using simple, computer-generated randomization. Training workshops were conducted prior to the control (paper-CCM) and intervention (paper-CCM + SL eCCM App) in assigned clusters. Neither participants nor study personnel were blinded to allocation. Outcome measures were determined by abstraction of clinical data from patient records 2 weeks after recruitment. A nested qualitative study explored perceptions of adherence to urgent referral recommendations and a cost evaluation determined the financial and time-related costs to caregivers of subsequent health care utilization. The trial was conducted between July 2016 and February 2017. This is the first large-scale trial evaluating the value of adding a mobile application of CCM to the assessment of children aged under 5 years. The trial will generate evidence on the potential use of mobile health for CCM in Malawi, and more widely in other low- and middle-income countries. ClinicalTrials.gov, ID: NCT02763345 . Registered on 3 May 2016.

Modelling a man-portable air-defence (MANPAD) system with a conical scan two-colour infrared (IR) seeker

NASA Astrophysics Data System (ADS)

Jackman, James; Richardson, Mark; Butters, Brian; Walmsley, Roy

2011-11-01

The use of flares of flares against 1st and 2nd generation man-portable air-defence (MANPAD) systems proved to be very effective. This naturally led to the development of counter-countermeasures (CCM) that could be incorporated into the MANPADs infrared (IR) seeker. One possible CCM is two-colour where the seeker detects in two separate IR bands. It is designed to exploit the different spectral characteristics of the target and flare. In this paper we describe the modelling process of a two-colour conical scan (conscan) IR seeker using CounterSim, a missile engagement and countermeasure simulation software tool developed by Chemring Countermeasures Ltd. It starts by explaining the signal processing needed to be able to reject the flare and track the target. The MANPAD model is then used in an engagement with a fast jet model and a transport aircraft model. Flares are first deployed reactively then released throughout an engagement to investigate the effect of flare release time and the viability of pre-emptive countermeasures.

Cerebral Cavernous Malformation

MedlinePlus

... and individuals frequently have multiple CCMs found via magnetic resonance imaging. Individuals with CCM are faced with a diagnosis ... and individuals frequently have multiple CCMs found via magnetic resonance imaging. Individuals with CCM are faced with a diagnosis ...

[Development of quality of care indicators to support chronic disease management].

PubMed

Beaulieu, Marie-dominique; Pomey, Marie-pascale; Del Grande, Claudio; Côté, Brigitte; Tremblay, Éric; Ghorbel, Monia; Hua, Phuong

2015-01-01

This article presents the results of a project conducted by the Institut national d'excellence en santé et en services sociaux of Québec to develop quality of care indicators for the management of six chronic illnesses. Indicators were identified through literature searches and analysis of clinical practice guidelines (CPGs). Interdisciplinary expert panels assessed their validity and the strength of the evidence on which they were based. Representatives of patients (N = 19) and professionals (N = 29) were consulted on their relevance and acceptability. Indicators were categorized according to the Chronic Care Model (CCM). A total of 164 indicators were developed, 126 specific to the illnesses under study and 38 on processes and outcomes generic to the CCM. There was convergence between patients and professionals on the relevance of a majority of indicators. Professionals expressed concerns on the indicators measured by means of patient surveys that they considered to be too subjective. The importance given to CPGs as the main source of indicators resulted in a great number of indicators of the technical quality ofcare. Using the CCM contributed to a broader perspective of quality. The consultation process identified some of the concerns of professionals about indicator measurement, thusguidingfuture implementation initiatives.

Arsenic exposure assists ccm3 genetic polymorphism in elevating blood pressure

PubMed Central

Liu, Xinxia; Xing, Xiumei; Zhang, Huimin; Yun, Jianpei; Ou, Xiaoyan; Su, Xiaolin; Lu, Yao; Sun, Yi; Yang, Yarui; Jiang, Jun; Cui, Dong; Zhuang, Zhixiong; He, Yun

2018-01-01

Epidemiologic study has suggested that arsenic exposure is positively related to increased blood pressure. However, the underlying mechanism concerning interaction between genetic polymorphisms and arsenic exposure remains unclear. In present study, within 395 Chinese, the effects of interaction between arsenic exposure and CCM3 gene polymorphisms on elevation of blood pressure were probed by multiple Logistic regression models after adjusting for confounding factors. Firstly, we found that serum arsenic was positively associated with blood pressure, cholesterol, glucose and C-reactive protein. Then, adjusted for confounding factors of age, gender, smoking, alcohol consumption, BMI and degree of education, arsenic exposure incurred the hazard of increased systolic pressure and diastolic pressure, with odds ratios (ORs) being 1.725 and 1.425, respectively. Distinctly, we found that interactions between rs3804610* rs9818496, rs6784267*rs9818496, and rs3804610* rs6784267 variant genotype can increase significantly risks of SBP. Additionally, interactions between rs9818496, rs3804610 and rs6784267 genotypic variantions and arsenic exposure boosted the hazard of increased systolic pressure, with ORs being 1.496, 1.496 and 1.312. In conclusion, our fingdings suggest that As exposure of population can assist CCM3 polymorphism in elevating SBP. PMID:29435151

Long-Term Variability of UV Irradiance in the Moscow Region according to Measurement and Modeling Data

NASA Astrophysics Data System (ADS)

Chubarova, N. E.; Pastukhova, A. S.; Galin, V. Ya.; Smyshlyaev, S. P.

2018-03-01

We have found distinct long-period changes in erythemal UV radiation ( Q er) characterized by a pronounced decrease at the end of the 1970s and a statistically significant positive trend of more than 5%/10 years since 1979 over the territory of the Moscow region according to the measurements and reconstruction model. The positive Q er trend is shown to be associated mainly with a decrease in the effective cloud amount and total ozone content (TOC). Due to these variations, UV resources have significantly changed in spring for the population with the most vulnerable skin type I, which means a transition from the UV optimum to UV moderate excess conditions. The simulation experiments using the INM-RSHU chemistry climate model (CCM) for several scenarios with and without anthropogenic factors have revealed that the variations in the anthropogenic emissions of halogens have the most significant impact on the variability of TOC and Q er. Among natural factors, noticeable effects are observed due to volcanic aerosol. The calculations of the cloud transmittance of Q er are generally consistent with the measurements; however, they do not reproduce the observed value of the positive trend.

Novel functions of CCM1 delimit the relationship of PTB/PH domains.

PubMed

Zhang, Jun; Dubey, Pallavi; Padarti, Akhil; Zhang, Aileen; Patel, Rinkal; Patel, Vipulkumar; Cistola, David; Badr, Ahmed

2017-10-01

Three NPXY motifs and one FERM domain in CCM1 makes it a versatile scaffold protein for tethering the signaling components together within the CCM signaling complex (CSC). The cellular role of CCM1 protein remains inadequately expounded. Both phosphotyrosine binding (PTB) and pleckstrin homology (PH) domains were recognized as structurally related but functionally distinct domains. By utilizing molecular cloning, protein binding assays and RT-qPCR to identify novel cellular partners of CCM1 and its cellular expression patterns; by screening candidate PTB/PH proteins and subsequently structurally simulation in combining with current X-ray crystallography and NMR data to defined the essential structure of PTB/PH domain for NPXY-binding and the relationship among PTB, PH and FERM domain(s). We identified a group of 28 novel cellular partners of CCM1, all of which contain either PTB or PH domain(s), and developed a novel classification system for these PTB/PH proteins based on their relationship with different NPXY motifs of CCM1. Our results demonstrated that CCM1 has a wide spectrum of binding to different PTB/PH proteins and perpetuates their specificity to interact with certain PTB/PH domains through selective combination of three NPXY motifs. We also demonstrated that CCM1 can be assembled into oligomers through intermolecular interaction between its F3 lobe in FERM domain and one of the three NPXY motifs. Despite being embedded in FERM domain as F3 lobe, F3 module acts as a fully functional PH domain to interact with NPXY motif. The most salient feature of the study was that both PTB and PH domains are structurally and functionally comparable, suggesting that PTB domain is likely evolved from PH domain with polymorphic structural additions at its N-terminus. A new β1A-strand of the PTB domain was discovered and new minimum structural requirement of PTB/PH domain for NPXY motif-binding was determined. Based on our data, a novel theory of structure, function and relationship of PTB, PH and FERM domains has been proposed, which extends the importance of the NPXY-PTB/PH interaction on the CSC signaling and/or other cell receptors with great potential pointing to new therapeutic strategies. The study provides new insight into the structural characteristics of PTB/PH domains, essential structural elements of PTB/PH domain required for NPXY motif-binding, and function and relationship among PTB, PH and FERM domains. Copyright © 2017 Elsevier B.V. All rights reserved.

Distinguishing time-delayed causal interactions using convergent cross mapping

PubMed Central

Ye, Hao; Deyle, Ethan R.; Gilarranz, Luis J.; Sugihara, George

2015-01-01

An important problem across many scientific fields is the identification of causal effects from observational data alone. Recent methods (convergent cross mapping, CCM) have made substantial progress on this problem by applying the idea of nonlinear attractor reconstruction to time series data. Here, we expand upon the technique of CCM by explicitly considering time lags. Applying this extended method to representative examples (model simulations, a laboratory predator-prey experiment, temperature and greenhouse gas reconstructions from the Vostok ice core, and long-term ecological time series collected in the Southern California Bight), we demonstrate the ability to identify different time-delayed interactions, distinguish between synchrony induced by strong unidirectional-forcing and true bidirectional causality, and resolve transitive causal chains. PMID:26435402

Critical Care Medicine and Infectious Diseases: An Emerging Combined Subspecialty in the United States.

PubMed

Kadri, Sameer S; Rhee, Chanu; Fortna, Gregory S; O'Grady, Naomi P

2015-08-15

The recent rise in unfilled training positions among infectious diseases (ID) fellowship programs nationwide indicates that ID is declining as a career choice among internal medicine residency graduates. Supplementing ID training with training in critical care medicine (CCM) might be a way to regenerate interest in the specialty. Hands-on patient care and higher salaries are obvious attractions. High infection prevalence and antibiotic resistance in intensive care units, expanding immunosuppressed host populations, and public health crises such as the recent Ebola outbreak underscore the potential synergy of CCM-ID training. Most intensivists receive training in pulmonary medicine and only 1% of current board-certified intensivists are trained in ID. While still small, this cohort of CCM-ID certified physicians has continued to rise over the last 2 decades. ID and CCM program leadership nationwide must recognize these trends and the merits of the CCM-ID combination to facilitate creation of formal dual-training opportunities. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Mechanisms and Feedbacks Causing Changes in Upper Stratospheric Ozone in the 21st Century

NASA Technical Reports Server (NTRS)

Oman, Luke; Waugh, D. W.; Kawa, S. R.; Stolarski, R. S.; Douglass, A. R.; Newman, P. A.

2009-01-01

Stratospheric ozone is expected to increase during the 21st century as the abundance of halogenated ozone-depleting substances decrease to 1960 values. However, climate change will likely alter this "recovery" of stratospheric ozone by changing stratospheric temperatures, circulation, and abundance of reactive chemical species. Here we quantity the contribution of different mechanisms to changes in upper stratospheric ozone from 1960 to 2100 in the Goddard Earth Observing System Chemistry-Climate Model (GEOS CCM), using multiple linear regression analysis applied to simulations using either Alb or A2 greenhouse gas (GHG) scenarios. In both these scenarios upper stratospheric ozone has a secular increase over the 21st century. For the simulation using the Alb GHG scenario, this increase is determined by the decrease in halogen amounts and the greenhouse gas induced cooling, with roughly equal contributions from each mechanism. There is a larger cooling in the simulation using the A2 GHG scenario, but also enhanced loss from higher NOy and HOx concentrations, which nearly offsets the increase due to cooler temperatures. The resulting ozone evolutions are similar in the A2 and Alb simulations. The response of ozone due to feedbacks from temperature and HOx changes, related to changing halogen concentrations, are also quantified using simulations with fixed halogen concentrations.

Aha! The Power of Using 6 E's.

ERIC Educational Resources Information Center

Tall, Lyssa; Luttrell-Montes, Sally

1999-01-01

Describes the 6 E's approach which enhances student learning and encourages stronger conceptual connections. Provides step-by-step details of how the 6E Teaching/Learning Model was incorporated during the Make It R.E.A.L. Institute. (CCM)

The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams.

PubMed

Noël, Polly Hitchcock; Lanham, Holly J; Palmer, Ray F; Leykum, Luci K; Parchman, Michael L

2013-01-01

Recent research from a complexity theory perspective suggests that implementation of complex models of care, such as the Chronic Care Model (CCM), requires strong relationships and learning capacities among primary care teams. Our primary aim was to assess the extent to which practice member perceptions of relational coordination and reciprocal learning were associated with the presence of CCM elements in community-based primary care practices. We used baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM and improve risk factor control for patients with Type 2 diabetes in small primary care practices. Practice members (i.e., physicians, nonphysician providers, and staff) completed baseline assessments, which included the Relational Coordination Scale, Reciprocal Learning Scale, and the Assessment of Chronic Illness Care (ACIC) survey, along with items assessing individual and clinic characteristics. To assess the association between Relational Coordination, Reciprocal Learning, and ACIC, we used a series of hierarchical linear regression models accounting for clustering of individual practice members within clinics and controlling for individual- and practice-level characteristics and tested for mediation effects. A total of 283 practice members from 39 clinics completed baseline measures. Relational Coordination scores were significantly and positively associated with ACIC scores (Model 1). When Reciprocal Learning was added, Relational Coordination remained a significant yet notably attenuated predictor of ACIC (Model 2). The mediation effect was significant (z = 9.3, p < .01); 24% of the association between Relational Coordination and ACIC scores was explained by Reciprocal Learning. Of the individual- and practice-level covariates included in Model 3, only the presence of an electronic medical record was significant; Relational Coordination and Reciprocal Learning remained significant independent predictors of ACIC. Efforts to implement complex models of care should incorporate strategies to strengthen relational coordination and reciprocal learning among team members.

The Importance of Relational Coordination and Reciprocal Learning for Chronic Illness Care within Primary Care Teams

PubMed Central

Noël, Polly Hitchcock; Lanham, Holly J.; Palmer, Ray F.; Leykum, Luci K.; Parchman, Michael L.

2012-01-01

Background Recent research from a complexity theory perspective suggests that implementation of complex models of care, such as the Chronic Care Model (CCM), requires strong relationships and learning capacities among primary care teams. Purposes Our primary aim was to assess the extent to which practice member perceptions of relational coordination and reciprocal learning were associated with the presence of CCM elements in community-based primary care practices. Methodology/Approach We used baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM and improve risk factor control for patients with type 2 diabetes in small primary care practices. Practice members (i.e., physicians, non-physician providers, and staff) completed baseline assessments, which included the Relational Coordination Scale, Reciprocal Learning Scale, and the Assessment of Chronic Illness Care (ACIC) survey, along with items assessing individual and clinic characteristics. To assess the association between Relational Coordination, Reciprocal Learning, and ACIC, we used a series of hierarchical linear regression models accounting for clustering of individual practice members within clinics and controlling for individual- and practice-level characteristics, and tested for mediation effects. Findings 283 practice members from 39 clinics completed baseline measures. Relational Coordination scores were significantly and positively associated with ACIC scores (Model 1). When Reciprocal Learning was added, Relational Coordination remained a significant yet notably attenuated predictor of ACIC (Model 2). The mediation effect was significant (z = 9.3, p<.01); 24% of the association between Relational Coordination and ACIC scores was explained by Reciprocal Learning. Of the individual and practice level covariates included in Model 3, only the presence of an electronic medical record was significant; Relational Coordination and Reciprocal Learning remained significant independent predictors of ACIC. Practice Implications Efforts to implement complex models of care should incorporate strategies to strengthen relational coordination and reciprocal learning among team members. PMID:22310483

Ground-state ordering of the J1-J2 model on the simple cubic and body-centered cubic lattices

NASA Astrophysics Data System (ADS)

Farnell, D. J. J.; Götze, O.; Richter, J.

2016-06-01

The J1-J2 Heisenberg model is a "canonical" model in the field of quantum magnetism in order to study the interplay between frustration and quantum fluctuations as well as quantum phase transitions driven by frustration. Here we apply the coupled cluster method (CCM) to study the spin-half J1-J2 model with antiferromagnetic nearest-neighbor bonds J1>0 and next-nearest-neighbor bonds J2>0 for the simple cubic (sc) and body-centered cubic (bcc) lattices. In particular, we wish to study the ground-state ordering of these systems as a function of the frustration parameter p =z2J2/z1J1 , where z1 (z2) is the number of nearest (next-nearest) neighbors. We wish to determine the positions of the phase transitions using the CCM and we aim to resolve the nature of the phase transition points. We consider the ground-state energy, order parameters, spin-spin correlation functions, as well as the spin stiffness in order to determine the ground-state phase diagrams of these models. We find a direct first-order phase transition at a value of p =0.528 from a state of nearest-neighbor Néel order to next-nearest-neighbor Néel order for the bcc lattice. For the sc lattice the situation is more subtle. CCM results for the energy, the order parameter, the spin-spin correlation functions, and the spin stiffness indicate that there is no direct first-order transition between ground-state phases with magnetic long-range order, rather it is more likely that two phases with antiferromagnetic long range are separated by a narrow region of a spin-liquid-like quantum phase around p =0.55 . Thus the strong frustration present in the J1-J2 Heisenberg model on the sc lattice may open a window for an unconventional quantum ground state in this three-dimensional spin model.

Trace gas variability within the Asian monsoon anticyclone on intraseasonal and interannual timescales

NASA Astrophysics Data System (ADS)

Nützel, Matthias; Dameris, Martin; Fierli, Federico; Stiller, Gabriele; Garny, Hella; Jöckel, Patrick

2016-04-01

The Asian monsoon and the associated monsoon anticyclone have the potential of substantially influencing the composition of the UTLS (upper troposphere/lower stratosphere) and hence global climate. Here we study the variability of the Asian summer monsoon anticyclone in the UTLS on intraseasonal and interannual timescales using results from long term simulations performed with the CCM EMAC (ECHAM5/MESSy Atmospheric Chemistry). In particular, we focus on specified dynamics simulations (Newtonian relaxation to ERA-Interim data) covering the period 1980-2013, which have been performed within the ESCiMo (Earth System Chemistry integrated Modelling) project (Jöckel et al., GMDD, 2015). Our main focus lies on variability of the anticyclone's strength (in terms of potential vorticity, geopotential and circulation) and variability in trace gas signatures (O3, H2O) within the anticyclone. To support our findings, we also include observations from satellites (MIPAS, MLS). Our work is linked to the EU StratoClim campaign in 2016.

Impacts of tropical deforestation. Part II: The role of large-scale dynamics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, H.; Henderson-Sellers, A.; McGuffie, K.

1996-10-01

This is the second in a pair of papers in which the possible impacts of tropical deforestation are examined using a version of the NCAR CCM1. The emphasis in this paper is on the influence of tropical deforestation on the large-scale climate system. This influence is explored through the examination of the regional moisture budget and through an analysis of the Hadley and Walker circulations. Modification of the model surface parameters to simulate tropical deforestation produces significant modifications of both Hadley and Walker circulations, which result in changes distant from the region of deforestation. A mechanism for propagation to middlemore » and high latitudes of disturbances arising form tropical deforestation is proposed based on Rossby wave propagation mechanisms. These mechanisms, which have also been associated with the extratropical influences of ENSO events, provide a pathway for the dispersion of the tropical disturbances to high latitudes. 27 refs., 20 figs., 1 tab.« less

Cardiac contractility modulation in heart failure patients: Randomized comparison of signal delivery through one vs. two ventricular leads.

PubMed

Röger, Susanne; Said, Samir; Kloppe, Axel; Lawo, Thomas; Emig, Ulf; Rousso, Benny; Gutterman, David; Borggrefe, Martin; Kuschyk, Jürgen

2017-01-01

Cardiac contractility modulation (CCM) is an electrical stimulation treatment for symptomatic heart failure (HF) patients. The procedure involves implantation of two ventricular leads for delivery of CCM impulses. The purpose of this study is to compare the efficacy and safety of CCM when the signal is delivered through one vs. two ventricular leads. This prospective blinded randomized trial enrolled 48 patients. Eligible subjects had symptoms despite optimal HF medications, left ventricular ejection fraction <40% and peakVO 2 ≥9ml O 2 /kg/min. All patients received a CCM system with two ventricular leads, and were randomized to CCM active through both or just one ventricular lead; 25 patients were randomized to receive signal delivery through two leads (Group A) and 23 patients to signal delivery through one lead (Group B). The study compared the mean changes from baseline to 6 months follow-up in peakVO 2 , New York Heart Association (NYHA) classification, and quality of life (by MLWHFQ). Following 6 months, similar and significant (p<0.05) improvements from baseline in NYHA (-0.7±0.5 vs. -0.9±0.7) and MLWHFQ (-14±20 vs. -16±22) were observed in Group A and in Group B. PeakVO 2 showed improvement trends in both groups (0.34±1.52 vs. 0.10±2.21ml/kg/min; p=ns). No patient died. Serious adverse event rates (20 events in 10 subjects) were not different between groups. No statistically significant difference was found in any of the study endpoints. The efficacy and safety of CCM in this study were similar when the signal was delivered through either one or two ventricular leads. These results support the potential use of a single ventricular lead for delivery of CCM. Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Nationwide implementation of integrated community case management of childhood illness in Rwanda

PubMed Central

Mugeni, Catherine; Levine, Adam C; Munyaneza, Richard M; Mulindahabi, Epiphanie; Cockrell, Hannah C; Glavis-Bloom, Justin; Nutt, Cameron T; Wagner, Claire M; Gaju, Erick; Rukundo, Alphonse; Habimana, Jean Pierre; Karema, Corine; Ngabo, Fidele; Binagwaho, Agnes

2014-01-01

ABSTRACT Background: Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive reporting and referral services. Methods: We used data from the Rwanda health management information system (HMIS) to calculate monthly all-cause under-5 mortality rates, health facility use rates, and community-based treatment rates for childhood illness in each district. We then compared a 3-month baseline period prior to iCCM implementation with a seasonally matched comparison period 1 year after iCCM implementation. Finally, we compared the actual changes in all-cause child mortality and health facility use over this time period with the changes that would have been expected based on baseline trends in Rwanda. Results: The number of children receiving community-based treatment for diarrhea and pneumonia increased significantly in the 1-year period after iCCM implementation, from 0.83 cases/1,000 child-months to 3.80 cases/1,000 child-months (P = .01) and 0.25 cases/1,000 child-months to 5.28 cases/1,000 child-months (P<.001), respectively. On average, total under-5 mortality rates declined significantly by 38% (P<.001), and health facility use declined significantly by 15% (P = .006). These decreases were significantly greater than would have been expected based on baseline trends. Conclusions: This is the first study to demonstrate decreases in both child mortality and health facility use after implementing iCCM of childhood illness at a national level. While our study design does not allow for direct attribution of these changes to implementation of iCCM, these results are in line with those of prior studies conducted at the sub-national level in other low-income countries. PMID:25276592

Access to integrated community case management of childhood illnesses services in rural Ethiopia: a qualitative study of the perspectives and experiences of caregivers

PubMed Central

Shaw, Bryan; Amouzou, Agbessi; Miller, Nathan P; Tafesse, Mengistu; Bryce, Jennifer; Surkan, Pamela J

2016-01-01

Background: In 2010, Ethiopia began scaling up the integrated community case management (iCCM) of childhood illness strategy throughout the country allowing health extension workers (HEWs) to treat children in rural health posts. After 2 years of iCCM scale up, utilization of HEWs remains low. Little is known about factors related to the use of health services in this setting. This research aimed to elicit perceptions and experiences of caregivers to better understand reasons for low utilization of iCCM services. Methods: A rapid ethnographic assessment was conducted in eight rural health post catchment areas in two zones: Jimma and West Hararghe. In total, 16 focus group discussions and 78 in-depth interviews were completed with mothers, fathers, HEWs and community health volunteers. Results: In spite of the HEW being a core component of iCCM, we found that the lack of availability of HEWs at the health post was one of the most common barriers to the utilization of iCCM services mentioned by caregivers. Financial and geographic challenges continue to influence caregiver decisions despite extension of free child health services in communities. Acceptability of HEWs was often low due to a perceived lack of sensitivity of HEWs and concerns about medicines given at the health post. Social networks acted both to facilitate and hinder use of HEWs. Many mothers stated a preference for using the health post, but some were unable to do so due to objections or alternative care-seeking preferences of gatekeepers, often mothers-in-law and husbands. Conclusion: Caregivers in Ethiopia face many challenges in using HEWs at the health post, potentially resulting in low demand for iCCM services. Efforts to minimize barriers to care seeking and to improve demand should be incorporated into the iCCM strategy in order to achieve reductions in child mortality and promote equity in access and child health outcomes. PMID:26608585

Improvement to the Convergence-Confinement Method: Inclusion of Support Installation Proximity and Stiffness

NASA Astrophysics Data System (ADS)

Oke, Jeffrey; Vlachopoulos, Nicholas; Diederichs, Mark

2018-05-01

The convergence-confinement method (CCM) is a method that has been introduced in tunnel construction that considers the ground response to the advancing tunnel face and the interaction with installed support. One limitation of the CCM is due to the numerically or empirically driven nature of the longitudinal displacement profile and the incomplete consideration of the longitudinal arching effect that occurs during tunnelling operations as part of the face effect. In this paper, the authors address the issue associated with when the CCM is used within squeezing ground conditions at depth. Based on numerical analysis, the authors have proposed a methodology and solution to improving the CCM in order to allow for more accurate results for squeezing ground conditions for three different excavation cases involving various excavation-support increments and distances from the face to the supported front. The tunnelling methods of consideration include: tunnel boring machine, mechanical (conventional), and drill and blast.

A randomized controlled trial to evaluate the safety and efficacy of cardiac contractility modulation in patients with systolic heart failure: rationale, design, and baseline patient characteristics.

PubMed

Abraham, William T; Burkhoff, Daniel; Nademanee, Koonlawee; Carson, Peter; Bourge, Robert; Ellenbogen, Kenneth A; Parides, Michael; Kadish, Alan

2008-10-01

Cardiac contractility modulation (CCM) signals are nonexcitatory electrical signals delivered during the cardiac absolute refractory period that enhance the strength of cardiac muscular contraction. Prior research in experimental and human heart failure has shown that CCM signals normalize phosphorylation of key proteins and expression of genes coding for proteins involved in regulation of calcium cycling and contraction. The results of prior clinical studies of CCM have supported its safety and efficacy. A large-scale clinical study, the FIX-HF-5 study, is currently underway to test the safety and efficacy of this treatment. In this article, we provide an overview of the system used to deliver CCM signals, the implant procedure, and the details and rationale of the FIX-HF-5 study design. Baseline characteristics for patients randomized in this trial are also presented.

CauseMap: fast inference of causality from complex time series.

PubMed

Maher, M Cyrus; Hernandez, Ryan D

2015-01-01

Background. Establishing health-related causal relationships is a central pursuit in biomedical research. Yet, the interdependent non-linearity of biological systems renders causal dynamics laborious and at times impractical to disentangle. This pursuit is further impeded by the dearth of time series that are sufficiently long to observe and understand recurrent patterns of flux. However, as data generation costs plummet and technologies like wearable devices democratize data collection, we anticipate a coming surge in the availability of biomedically-relevant time series data. Given the life-saving potential of these burgeoning resources, it is critical to invest in the development of open source software tools that are capable of drawing meaningful insight from vast amounts of time series data. Results. Here we present CauseMap, the first open source implementation of convergent cross mapping (CCM), a method for establishing causality from long time series data (≳25 observations). Compared to existing time series methods, CCM has the advantage of being model-free and robust to unmeasured confounding that could otherwise induce spurious associations. CCM builds on Takens' Theorem, a well-established result from dynamical systems theory that requires only mild assumptions. This theorem allows us to reconstruct high dimensional system dynamics using a time series of only a single variable. These reconstructions can be thought of as shadows of the true causal system. If reconstructed shadows can predict points from opposing time series, we can infer that the corresponding variables are providing views of the same causal system, and so are causally related. Unlike traditional metrics, this test can establish the directionality of causation, even in the presence of feedback loops. Furthermore, since CCM can extract causal relationships from times series of, e.g., a single individual, it may be a valuable tool to personalized medicine. We implement CCM in Julia, a high-performance programming language designed for facile technical computing. Our software package, CauseMap, is platform-independent and freely available as an official Julia package. Conclusions. CauseMap is an efficient implementation of a state-of-the-art algorithm for detecting causality from time series data. We believe this tool will be a valuable resource for biomedical research and personalized medicine.

Selecting Meteorological Input for the Global Modeling Initiative Assessments

NASA Technical Reports Server (NTRS)

Strahan, Susan; Douglass, Anne; Prather, Michael; Coy, Larry; Hall, Tim; Rasch, Phil; Sparling, Lynn

1999-01-01

The Global Modeling Initiative (GMI) science team has developed a three dimensional chemistry and transport model (CTM) to evaluate the impact of the exhaust of supersonic aircraft on the stratosphere. An important goal of the GMI is to test modules for numerical transport, photochemical integration, and model dynamics within a common framework. This work is focussed on the dependence of the overall assessment on the wind and temperature fields used by the CTM. Three meteorological data sets for the stratosphere were available to GMI: the National Center for Atmospheric Research Community Climate Model (CCM2), the Goddard Earth Observing System Data Assimilation System (GEOS-DAS), and the Goddard Institute for Space Studies general circulation model (GISS-2'). Objective criteria were established by the GMI team to evaluate which of these three data sets provided the best representation of trace gases in the stratosphere today. Tracer experiments were devised to test various aspects of model transport. Stratospheric measurements of long-lived trace gases were selected as a test of the CTM transport. This presentation describes the criteria used in grading the meteorological fields and the resulting choice of wind fields to be used in the GMI assessment. This type of objective model evaluation will lead to a higher level of confidence in these assessments. We suggest that the diagnostic tests shown here be used to augment traditional general circulation model evaluation methods.

Final report on the key comparison, CCM.M.P-K15.1 in the pressure range from 1.0 × 10-4 Pa to 1.0 Pa

NASA Astrophysics Data System (ADS)

Wuethrich, Christian; Hongyan, Yu

2017-01-01

At the CCM WG-LP meeting in Berlin in April 2011 the National Institute of Metrology of the people's republic of China asked for an opportunity to be linked to the CCM.M.P-K15 comparison which just ended. METAS, which had been active as pilot for the CCM.M.P-K15, agreed to make a link with NIM. The NIM introduced a new static expansion system in his laboratory. Two spinning rotor gauges and a control electronic are used as transfer standard. The circulation of the transfer standard was made in spring 2012. The drift of the accommodation coefficient of the two SRG was measured by the pilot before and after the comparison. The stability of the transfer standards was excellent and the equivalence between METAS and NIM has been demonstrated. A link to the CCM.M.P­K15 has been established using the results from METAS. It has been possible to achieve a link with a small uncertainty due to the strong correlation of the measurements of METAS in the two comparisons. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of congenital choledochal malformation: a retrospective case study in Southeast China

PubMed Central

Guo, Wan-liang; Zhan, Yang; Fang, Fang; Deng, Yan-bing; Zhao, Jun-gang

2018-01-01

Objective The aim of this study was to evaluate factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of congenital choledochal malformation (CCM). Design A 3-year retrospective study was undertaken between January 2013 and December 2015 in four centres in China. Setting This involved a retrospective chart review of paediatric patients with CCM in four large hospitals in Southeast China. Participants Sixty-five paediatric patients with CCM were included in this study. We derived all available information on patient demographics, clinical characteristics, preoperative complications and surgical methods from the charts of all these patients. Interventions Univariate and multivariate logistic regression analyses were used to evaluate factors significantly affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of CCM. Results Twenty-three of the 65 case surgeries were performed using laparoscopic technique, and 42 surgeries were performed by conventional open surgery. The median operating time was 215 min (range 120–430 min). The morphological subtype of CCM and the presence of cholecystitis or cholangitis were the only factors found to affect the operating time (p<0.05). Logistic regression analysis confirmed cholangitis as an independent risk factor. Conclusions The morphological subtype of CMM and the presence of cholecystitis or cholangitis are factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of CCM, whereas cholangitis is an independent risk factor. PMID:29804066

Ground Vehicle CFD at TARDEC

DTIC Science & Technology

2012-05-21

Cooling Sytem: StarCCM+ Blast / Crew Safety: LS- Dyna Fatigue & FEA: Abaqus / NCode Each code run with ~40-80 CPUs on TARDEC HPC Models...suppression, blast solid modeling have particular scaling problems because of the use of Lagrangian particles Example: Dust modeling for engine...for technology demonstrator vehicles UNCLASSIFIED 9 Example CFD Interest Areas • Underbody mine blast • HVAC design / interior cooling

Cost-effectiveness analysis of the national implementation of integrated community case management and community-based health planning and services in Ghana for the treatment of malaria, diarrhoea and pneumonia.

PubMed

Escribano Ferrer, Blanca; Hansen, Kristian Schultz; Gyapong, Margaret; Bruce, Jane; Narh Bana, Solomon A; Narh, Clement T; Allotey, Naa-Korkor; Glover, Roland; Azantilow, Naa-Charity; Bart-Plange, Constance; Sagoe-Moses, Isabella; Webster, Jayne

2017-07-05

Ghana has developed two main community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia: the integrated community case management (iCCM) and the community-based health planning and services (CHPS). The aim of the study was to assess the cost-effectiveness of these strategies under programme conditions. A cost-effectiveness analysis was conducted. Appropriate diagnosis and treatment given was the effectiveness measure used. Appropriate diagnosis and treatment data was obtained from a household survey conducted 2 and 8 years after implementation of iCCM in the Volta and Northern Regions of Ghana, respectively. The study population was carers of children under-5 years who had fever, diarrhoea and/or cough in the last 2 weeks prior to the interview. Costs data was obtained mainly from the National Malaria Control Programme (NMCP), the Ministry of Health, CHPS compounds and from a household survey. Appropriate diagnosis and treatment of malaria, diarrhoea and suspected pneumonia was more cost-effective under the iCCM than under CHPS in the Volta Region, even after adjusting for different discount rates, facility costs and iCCM and CHPS utilization, but not when iCCM appropriate treatment was reduced by 50%. Due to low numbers of carers visiting a CBA in the Northern Region it was not possible to conduct a cost-effectiveness analysis in this region. However, the cost analysis showed that iCCM in the Northern Region had higher cost per malaria, diarrhoea and suspected pneumonia case diagnosed and treated when compared to the Volta Region and to the CHPS strategy in the Northern Region. Integrated community case management was more cost-effective than CHPS for the treatment of malaria, diarrhoea and suspected pneumonia when utilized by carers of children under-5 years in the Volta Region. A revision of the iCCM strategy in the Northern Region is needed to improve its cost-effectiveness. Long-term financing strategies should be explored including potential inclusion in the National Health Insurance Scheme (NHIS) benefit package. An acceptability study of including iCCM in the NHIS should be conducted.

Introducing an algal carbon-concentrating mechanism into higher plants: location and incorporation of key components.

PubMed

Atkinson, Nicky; Feike, Doreen; Mackinder, Luke C M; Meyer, Moritz T; Griffiths, Howard; Jonikas, Martin C; Smith, Alison M; McCormick, Alistair J

2016-05-01

Many eukaryotic green algae possess biophysical carbon-concentrating mechanisms (CCMs) that enhance photosynthetic efficiency and thus permit high growth rates at low CO2 concentrations. They are thus an attractive option for improving productivity in higher plants. In this study, the intracellular locations of ten CCM components in the unicellular green alga Chlamydomonas reinhardtii were confirmed. When expressed in tobacco, all of these components except chloroplastic carbonic anhydrases CAH3 and CAH6 had the same intracellular locations as in Chlamydomonas. CAH6 could be directed to the chloroplast by fusion to an Arabidopsis chloroplast transit peptide. Similarly, the putative inorganic carbon (Ci) transporter LCI1 was directed to the chloroplast from its native location on the plasma membrane. CCP1 and CCP2 proteins, putative Ci transporters previously reported to be in the chloroplast envelope, localized to mitochondria in both Chlamydomonas and tobacco, suggesting that the algal CCM model requires expansion to include a role for mitochondria. For the Ci transporters LCIA and HLA3, membrane location and Ci transport capacity were confirmed by heterologous expression and H(14) CO3 (-) uptake assays in Xenopus oocytes. Both were expressed in Arabidopsis resulting in growth comparable with that of wild-type plants. We conclude that CCM components from Chlamydomonas can be expressed both transiently (in tobacco) and stably (in Arabidopsis) and retargeted to appropriate locations in higher plant cells. As expression of individual Ci transporters did not enhance Arabidopsis growth, stacking of further CCM components will probably be required to achieve a significant increase in photosynthetic efficiency in this species. © 2015 The Authors. Plant Biotechnology Journal published by Society for Experimental Biology and The Association of Applied Biologists and John Wiley & Sons Ltd.

A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda.

PubMed

Kabakyenga, Jerome; Barigye, Celestine; Brenner, Jennifer; Maling, Samuel; Buchner, Denise; Nettle-Aquirre, Alberto; Singhal, Nalini; Kyomuhangi, Teddy; Tumusiime, David; Finch, Janet; MacLeod, Stuart

2016-03-01

Benefits of mobile phone deployment for children <5 in low-resource settings remain unproven. The target population of the current demonstration study in Bushenyi District, Uganda, presented with acute fever, pneumonia, or diarrhoea and were treated by community health workers (CHWs) providing integrated community case management (iCCM). An observational study was conducted in five parishes (47 villages) served by CHWs well versed in iCCM with supplemental training in mobile phone use. Impact was assessed by quantitative measures and qualitative evaluation through household surveys, focus group discussions, and key informant interviews. CHWs in targeted sites improved child healthcare through mobile phone use coupled with iCCM. Of acutely ill children, 92.6% were correctly managed. Significant improvements in clinical outcomes compared to those obtained by CHWs with enhanced iCCM training alone were unproven in this limited demonstration. Nonetheless, qualitative evaluation showed gains in treatment planning, supply management, and logistical efficiency. Provider confidence and communications were enhanced as was ease and accuracy of record keeping. Mobile phones appear synergistic with iCCM to bolster basic supportive care for acutely ill children provided by CHWs. The full impact of expanded mobile phone deployment warrants further evaluation prior to scaling up in low-resource settings.

Cancer cell membrane-coated magnetic nanoparticles for MR/NIR fluorescence dual-modal imaging and photodynamic therapy.

PubMed

Li, Jiong; Wang, Xuandong; Zheng, Dongye; Lin, Xinyi; Wei, Zuwu; Zhang, Da; Li, Zhuanfang; Zhang, Yun; Wu, Ming; Liu, Xiaolong

2018-05-22

Theranostic nanoprobes integrated with dual-modal imaging and therapeutic functions, such as photodynamic therapy (PDT), have exhibited significant potency in cancer treatments due to their high imaging accuracy and non-invasive advantages for cancer elimination. However, biocompatibility and highly efficient accumulation of these nanoprobes in tumor are still unsatisfactory for clinical application. In this study, a photosensitizer -loaded magnetic nanobead with surface further coated with a layer of cancer cell membrane (SSAP-Ce6@CCM) was designed to improve the biocompatibility and cellular uptake and ultimately achieve enhanced MR/NIR fluorescence imaging and PDT efficacy. Compared with similar nanobeads without CCM coating, SSAP-Ce6@CCM showed significantly enhanced cellular uptake, as evidenced by Prussian blue staining, confocal laser scanning microscopy (CLSM) and flow cytometric analysis. Consequently, SSAP-Ce6@CCM displayed a more distinct MR/NIR imaging ability and more obvious photo-cytotoxicity towards cancer cells under 670 nm laser irradiation. Furthermore, the enhanced PDT effect benefited from the surface coating of cancer cell membrane was demonstrated in SMMC-7721 tumor-bearing mice through tumor growth observation and tumor tissue pathological examination. Therefore, this CCM-disguised nanobead that integrated the abilities of MR/NIR fluorescence dual-modal imaging and photodynamic therapy might be a promising theranostic platform for tumor treatment.

Chronic care model strategies in the United States and Germany deliver patient-centered, high-quality diabetes care.

PubMed

Stock, Stephanie; Pitcavage, James M; Simic, Dusan; Altin, Sibel; Graf, Christian; Feng, Wen; Graf, Thomas R

2014-09-01

Improving the quality of care for chronic diseases is an important issue for most health care systems in industrialized nations. One widely adopted approach is the Chronic Care Model (CCM), which was first developed in the late 1990s. In this article we present the results from two large surveys in the United States and Germany that report patients' experiences in different models of patient-centered diabetes care, compared to the experiences of patients who received routine diabetes care in the same systems. The study populations were enrolled in either Geisinger Health System in Pennsylvania or Barmer, a German sickness fund that provides medical insurance nationwide. Our findings suggest that patients with type 2 diabetes who were enrolled in the care models that exhibited key features of the CCM were more likely to receive care that was patient-centered, high quality, and collaborative, compared to patients who received routine care. This study demonstrates that quality improvement can be realized through the application of the Chronic Care Model, regardless of the setting or distinct characteristics of the program. Project HOPE—The People-to-People Health Foundation, Inc.

The Asian-Australian monsoon and El Nino-Southern Oscillation in the NCAR Climate System Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meehl, G.A.; Arblaster, J.M.

Features associated with the Asian-Australian monsoon system and El Nino-Southern Oscillation (ENSO) are described in the National Center for Atmospheric Research (NCAR) global coupled Climate System Model (CSM). Simulation characteristics are compared with a version of the atmospheric component of the CSM, the NCAR CCM3, run with time-evolving SSTs from 1950 to 1994, and with observations. The CSM is shown to represent most major features of the monsoon system in terms of mean climatology, interannual variability, and connections to the tropical Pacific. This includes a representation of the Southern Oscillation links between strong Asian-Australian monsoons and associated negative SST anomaliesmore » in the eastern equatorial Pacific. The equatorial SST gradient across the Pacific in the CSM is shown to be similar to the observed with somewhat cooler mean SSTs across the entire Pacific by about 1--2 C. The seasonal cycle of SSTs in the eastern equatorial Pacific has the characteristic signature seen in the observations of relatively warmer SSTs propagating westward in the first half of the year followed by the reestablishment of the cold tongue with relatively colder SSTs propagating westward in the second half of the year. Like other global coupled models, the propagation is similar to the observed but with the establishment of the relatively warmer water in the first half of the year occurring about 1--2 months later than observed. The seasonal cycle of precipitation in the tropical eastern Pacific is also similar to other global coupled models in that there is a tendency for a stronger-than-observed double ITCZ year round, particularly in northern spring, but with a well-reproduced annual maximum of ITCZ strength north of the equator in the second half of the year.« less

Final report on RMO Vickers key comparison COOMET M.H-K1

NASA Astrophysics Data System (ADS)

Aslanyan, E.; Menelao, F.; Herrmann, K.; Aslanyan, A.; Pivovarov, V.; Galat, E.; Dovzhenko, Y.; Zhamanbalin, M.

2013-01-01

This report describes a COOMET key comparison on Vickers hardness scales involving five National Metrology Institutes: PTB (Germany), BelGIM (Belarus), NSC IM (Ukraine), KazInMetr (Kazakhstan) and VNIIFTRI (Russia). The pilot laboratory was VNIIFTRI, and PTB acted as the linking institute to key comparisons CCM.H-K1.b and CCM.H-K1.c conducted for the Vickers hardness scales HV1 and HV30, respectively. The comparison was also conducted for the HV5 Vickers hardness scale, since this scale is most frequently used in practice in Russia and CIS countries that work according to GOST standards. In the key comparison, two sets of hardness reference blocks for the Vickers hardness scales HV1, HV5 and HV30 consisting each of three hardness reference blocks with hardness levels of 450 HV and 750 HV were used. The measurement results and uncertainty assessments for HV1 and HV30 hardness scales, as announced by BelGIM, NSC IM, KazInMetr and VNIIFTRI, are in good agreement with the key comparison reference values of CCM.H-K1.b and CCM.H-K1.c. The comparison results for the HV5 hardness scale are viewed as additional information, since up to today no CCM key comparisons on this scale have yet been carried out. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Magnetic Resonance Thermometry-Guided Stereotactic Laser Ablation of Cavernous Malformations in Drug-Resistant Epilepsy: Imaging and Clinical Results

PubMed Central

McCracken, D. Jay; Willie, Jon T.; Fernald, Brad; Saindane, Amit M.; Drane, Daniel L.; Barrow, Daniel L.; Gross, Robert E.

2016-01-01

BACKGROUND Surgery is indicated for cerebral cavernous malformations (CCM) that cause medically refractory epilepsy. Real-time magnetic resonance thermography (MRT)-guided stereotactic laser ablation (SLA) is a minimally invasive approach to treating focal brain lesions. SLA of CCM has not previously been described. OBJECTIVE To describe MRT-guided SLA, a novel approach to treating CCM-related epilepsy, with respect to feasibility, safety, imaging, and seizure control in 5 consecutive patients. METHODS Five patients with medically refractory epilepsy undergoing standard presurgical evaluation were found to have corresponding lesions fulfilling imaging characteristics of CCM and were prospectively enrolled. Each underwent stereotactic placement of a saline-cooled cannula containing an optical fiber to deliver 980-nm diode laser energy via twist drill craniostomy. MR anatomic imaging was used to evaluate targeting prior to ablation. MR imaging provided evaluation of targeting and near real-time feedback regarding extent of tissue thermocoagulation. Patients maintained seizure diaries, and remote imaging (6–21 months post-ablation) was obtained in all patients. RESULTS Imaging revealed no evidence of acute hemorrhage following fiber placement within presumed CCM. MRT during treatment and immediate post-procedure imaging confirmed desired extent of ablation. We identified no adverse events or neurological deficits. Four of 5 (80%) patients achieved freedom from disabling seizures after SLA alone (Engel class 1 outcome), with follow-up ranging 12–28 months. Reimaging of all subjects (6–21 months) indicated lesion diminution with surrounding liquefactive necrosis, consistent with the surgical goal of extended lesionotomy. CONCLUSION Minimally invasive MRT-guided SLA of epileptogenic CCM is a potentially safe and effective alternative to open resection. Additional experience and longer follow-up are needed. PMID:27959970

Emotion Recognition From Singing Voices Using Contemporary Commercial Music and Classical Styles.

PubMed

Hakanpää, Tua; Waaramaa, Teija; Laukkanen, Anne-Maria

2018-02-22

This study examines the recognition of emotion in contemporary commercial music (CCM) and classical styles of singing. This information may be useful in improving the training of interpretation in singing. This is an experimental comparative study. Thirteen singers (11 female, 2 male) with a minimum of 3 years' professional-level singing studies (in CCM or classical technique or both) participated. They sang at three pitches (females: a, e1, a1, males: one octave lower) expressing anger, sadness, joy, tenderness, and a neutral state. Twenty-nine listeners listened to 312 short (0.63- to 4.8-second) voice samples, 135 of which were sung using a classical singing technique and 165 of which were sung in a CCM style. The listeners were asked which emotion they heard. Activity and valence were derived from the chosen emotions. The percentage of correct recognitions out of all the answers in the listening test (N = 9048) was 30.2%. The recognition percentage for the CCM-style singing technique was higher (34.5%) than for the classical-style technique (24.5%). Valence and activation were better perceived than the emotions themselves, and activity was better recognized than valence. A higher pitch was more likely to be perceived as joy or anger, and a lower pitch as sorrow. Both valence and activation were better recognized in the female CCM samples than in the other samples. There are statistically significant differences in the recognition of emotions between classical and CCM styles of singing. Furthermore, in the singing voice, pitch affects the perception of emotions, and valence and activity are more easily recognized than emotions. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Guided bone regeneration with asymmetric collagen-chitosan membranes containing aspirin-loaded chitosan nanoparticles

PubMed Central

Zhang, Jiayu; Ma, Shiqing; Liu, Zihao; Geng, Hongjuan; Lu, Xin; Zhang, Xi; Li, Hongjie; Gao, Chenyuan; Zhang, Xu; Gao, Ping

2017-01-01

Introduction Membranes allowing the sustained release of drugs that can achieve cell adhesion are very promising for guided bone regeneration. Previous studies have suggested that aspirin has the potential to promote bone regeneration. The purpose of this study was to prepare a local drug delivery system with aspirin-loaded chitosan nanoparticles (ACS) contained in an asymmetric collagen-chitosan membrane (CCM). Methods In this study, the ACS were fabricated using different concentrations of aspirin (5 mg, 25 mg, 50 mg, and 75 mg). The drug release behavior of ACS was studied. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) were used to examine the micromorphology of ACS and aspirin-loaded chitosan nanoparticles contained in chitosan-collagen membranes (ACS-CCM). In vitro bone mesenchymal stem cells (BMSCs) were cultured and critical-sized cranial defects on Sprague-Dawley rats were made to evaluate the effect of the ACS-CCM on bone regeneration. Results Drug release behavior results of ACS showed that the nanoparticles fabricated in this study could successfully sustain the release of the drug. TEM showed the morphology of the nanoparticles. SEM images indicated that the asymmetric membrane comprised a loose collagen layer and a dense chitosan layer. In vitro studies showed that ACS-CCM could promote the proliferation of BMSCs, and that the degree of differentiated BMSCs seeded on CCMs containing 50 mg of ACS was higher than that of other membranes. Micro-computed tomography showed that 50 mg of ACS-CCM resulted in enhanced bone regeneration compared with the control group. Conclusion This study shows that the ACS-CCM would allow the sustained release of aspirin and have further osteogenic potential. This membrane is a promising therapeutic approach to guiding bone regeneration. PMID:29276386

Small fiber neuropathy in Parkinson's disease: A clinical, pathological and corneal confocal microscopy study.

PubMed

Kass-Iliyya, Lewis; Javed, Saad; Gosal, David; Kobylecki, Christopher; Marshall, Andrew; Petropoulos, Ioannis N; Ponirakis, Georgios; Tavakoli, Mitra; Ferdousi, Maryam; Chaudhuri, Kallol Ray; Jeziorska, Maria; Malik, Rayaz A; Silverdale, Monty A

2015-12-01

Autonomic and somatic denervation is well established in Parkinson's disease (PD). (1) To determine whether corneal confocal microscopy (CCM) can non-invasively demonstrate small nerve fiber damage in PD. (2) To identify relationships between corneal nerve parameters, intraepidermal nerve fiber density (IENFD) and clinical features of PD. Twenty-six PD patients and 26 controls underwent CCM of both eyes. 24/26 PD patients and 10/26 controls underwent skin biopsies from the dorsa of both feet. PD patients underwent assessment of parasympathetic function [deep breathing heart rate variability (DB-HRV)], autonomic symptoms [scale for outcomes in Parkinson's disease - autonomic symptoms (SCOPA-AUT)], motor symptoms [UPDRS-III "ON"] and cumulative Levodopa dose. PD patients had significantly reduced corneal nerve fiber density (CNFD) with increased corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL) compared to controls. CNBD and CNFL but not CNFD correlated inversely with UPDRS-III and SCOPA-AUT. All CCM parameters correlated strongly with DB-HRV. There was no correlation between CCM parameters and disease duration, cumulative Levodopa dose or pain. IENFD was significantly reduced in PD compared to controls and correlated with CNFD and UPDRS-III. However, unlike CCM measures, IENFD correlated with disease duration and cumulative Levodopa dose but not with autonomic dysfunction. CCM identifies corneal nerve fiber pathology, which correlates with autonomic symptoms, parasympathetic deficits and motor scores in patients with PD. IENFD is also reduced and correlates with CNFD and motor symptoms but not parasympathetic deficits, indicating it detects different aspects of peripheral nerve pathology in PD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Guided bone regeneration with asymmetric collagen-chitosan membranes containing aspirin-loaded chitosan nanoparticles.

PubMed

Zhang, Jiayu; Ma, Shiqing; Liu, Zihao; Geng, Hongjuan; Lu, Xin; Zhang, Xi; Li, Hongjie; Gao, Chenyuan; Zhang, Xu; Gao, Ping

2017-01-01

Membranes allowing the sustained release of drugs that can achieve cell adhesion are very promising for guided bone regeneration. Previous studies have suggested that aspirin has the potential to promote bone regeneration. The purpose of this study was to prepare a local drug delivery system with aspirin-loaded chitosan nanoparticles (ACS) contained in an asymmetric collagen-chitosan membrane (CCM). In this study, the ACS were fabricated using different concentrations of aspirin (5 mg, 25 mg, 50 mg, and 75 mg). The drug release behavior of ACS was studied. Transmission electron microscopy (TEM) and scanning electron microscopy (SEM) were used to examine the micromorphology of ACS and aspirin-loaded chitosan nanoparticles contained in chitosan-collagen membranes (ACS-CCM). In vitro bone mesenchymal stem cells (BMSCs) were cultured and critical-sized cranial defects on Sprague-Dawley rats were made to evaluate the effect of the ACS-CCM on bone regeneration. Drug release behavior results of ACS showed that the nanoparticles fabricated in this study could successfully sustain the release of the drug. TEM showed the morphology of the nanoparticles. SEM images indicated that the asymmetric membrane comprised a loose collagen layer and a dense chitosan layer. In vitro studies showed that ACS-CCM could promote the proliferation of BMSCs, and that the degree of differentiated BMSCs seeded on CCMs containing 50 mg of ACS was higher than that of other membranes. Micro-computed tomography showed that 50 mg of ACS-CCM resulted in enhanced bone regeneration compared with the control group. This study shows that the ACS-CCM would allow the sustained release of aspirin and have further osteogenic potential. This membrane is a promising therapeutic approach to guiding bone regeneration.

The CCM Model: A Management Approach to Performance Optimization

ERIC Educational Resources Information Center

Geroy, Gary D.; Bray, Amber; Venneberg, Donald L.

2005-01-01

Three leadership styles are frequently discussed in the literature today: transactional, transformational, and most recently--transcendental. Managers may be able to put transactional, transformational, and transcendental leadership style theories into practice without inventing a new set of processes and procedures to achieve individual follower…

The isothermal fatigue behavior of a unidirectional SiC/Ti composite and the Ti alloy matrix

NASA Technical Reports Server (NTRS)

Gayda, John, Jr.; Gabb, Timothy P.; Freed, Alan D.

1989-01-01

The high temperature fatigue behavior of a metal matrix composite (MMC) consisting of Ti-15V-3Cr-3Al-3Sn (Ti-15-3) matrix reinforced by 33 vol percent of continuous unidirectional SiC fibers was experimentally and analytically evaluated. Isothermal MMC fatigue tests with constant amplitude loading parallel to the fiber direction were performed at 300 and 550 C. Comparative fatigue tests of the Ti-15-3 matrix alloy were also conducted. Composite fatigue behavior and the in-situ stress state of the fiber and matrix were analyzed with a micromechanical model, the Concentric Cylinder Model (CCM). The cyclic stress-strain response of the composite was stable at 300 C. However, an increase in cyclic mean strain foreshortened MMC fatigue life at high strain ranges at 550 C. Fatigue tests of the matrix alloy and CCM analyses indicated this response was associated with stress relaxation of the matrix in the composite.

Conjugation of curcumin onto alginate enhances aqueous solubility and stability of curcumin.

PubMed

Dey, Soma; Sreenivasan, K

2014-01-01

Curcumin is a potential drug for various diseases including cancer. Prime limitations associated with curcumin are low water solubility, rapid hydrolytic degradation and poor bioavailability. In order to redress these issues we developed Alginate-Curcumin (Alg-Ccm) conjugate which was characterized by FTIR and (1)H NMR spectroscopy. The conjugate self-assembled in aqueous solution forming micelles with an average hydrodynamic diameter of 459 ± 0.32 nm and negative zeta potential. The spherical micelles were visualized by TEM. The critical micelle concentration (CMC) of Alg-Ccm conjugate was determined. A significant enhancement in the aqueous solubility of curcumin was observed upon conjugation with alginate. Formation of micelles improved the stability of curcumin in water at physiological pH. The cytotoxic activity of Alg-Ccm was quantified by MTT assay using L-929 fibroblast cells and it was found to be potentially cytotoxic. Hence, Alg-Ccm could be a promising drug conjugate as well as a nanosized delivery vehicle. Copyright © 2013 Elsevier Ltd. All rights reserved.

Capillary isoelectric focusing and fluorometric detection of proteins and microorganisms dynamically modified by poly(ethylene glycol) pyrenebutanoate.

PubMed

Horka, Marie; Ruzicka, Filip; Horký, Jaroslav; Holá, Veronika; Slais, Karel

2006-12-15

The nonionogenic pyrene-based tenside, poly(ethylene glycol) pyrenebutanoate, was prepared and applied in capillary isoelectric focusing with fluorometric detection. This dye was used here as a buffer additive in capillary isoelectric focusing for a dynamic modification of the sample of proteins and microorganisms. The values of the isoelectric points of the labeled bioanalytes were calculated with use of the fluorescent pI markers and were found comparable with pI of the native compounds. The mixed cultures of proteins and microorganisms, Escherichia coli CCM 3954, Staphylococcus epidermidis CCM 4418, Proteus vulgaris, Enterococcus faecalis CCM 4224, and Stenotrophomonas maltophilia, the strains of the yeast cells, Candida albicans CCM 8180, Candida krusei, Candida parapsilosis, Candida glabrata, Candida tropicalis, and Saccharomyces cerevisiae were reproducibly focused and separated by the suggested technique. Using UV excitation for the on-column fluorometric detection, the minimum detectable amount was down to 10 cells injected on the separation capillary.

Follow-up Contemporary Commercial Music (CCM) Survey: who's teaching what in nonclassical music.

PubMed

Weekly, Edrie Means; Lovetri, Jeannette L

2009-05-01

A previous study, published in the Journal of Voice in 2003, revealed that a majority of teachers of Music Theater (MT), a style of Contemporary Commercial Music (CCM), had little professional experience and little formal training in vocal pedagogy for this style. Those who did indicate that they had had training did not describe the training nor quantify it in any manner. To ascertain what type of training was available for CCM in general and MT, in particular, a follow-up study seemed warranted. A new questionnaire was developed which asked for further information from teachers of MT in several areas including performance experience, training methods, teaching philosophy, the use of terminology, knowledge of voice science and medicine, and other parameters. Responses were gathered from 145 singing teachers throughout the United States and several foreign countries. Statistical analysis obtained from the data may lead to both a better understanding of the kind of training available for teachers of CCM repertoire, and of its content and applicability.

P-cadherin promotes collective cell migration via a Cdc42-mediated increase in mechanical forces

PubMed Central

Plutoni, Cédric; Bazellieres, Elsa; Le Borgne-Rochet, Maïlys; Comunale, Franck; Brugues, Agusti; Séveno, Martial; Planchon, Damien; Thuault, Sylvie; Morin, Nathalie; Bodin, Stéphane; Trepat, Xavier

2016-01-01

Collective cell migration (CCM) is essential for organism development, wound healing, and metastatic transition, the primary cause of cancer-related death, and it involves cell–cell adhesion molecules of the cadherin family. Increased P-cadherin expression levels are correlated with tumor aggressiveness in carcinoma and aggressive sarcoma; however, how P-cadherin promotes tumor malignancy remains unknown. Here, using integrated cell biology and biophysical approaches, we determined that P-cadherin specifically induces polarization and CCM through an increase in the strength and anisotropy of mechanical forces. We show that this mechanical regulation is mediated by the P-cadherin/β-PIX/Cdc42 axis; P-cadherin specifically activates Cdc42 through β-PIX, which is specifically recruited at cell–cell contacts upon CCM. This mechanism of cell polarization and migration is absent in cells expressing E- or R-cadherin. Thus, we identify a specific role of P-cadherin through β-PIX–mediated Cdc42 activation in the regulation of cell polarity and force anisotropy that drives CCM. PMID:26783302

Integrated Community Case Management of Childhood Illness in Ethiopia: Implementation Strength and Quality of Care

PubMed Central

Miller, Nathan P.; Amouzou, Agbessi; Tafesse, Mengistu; Hazel, Elizabeth; Legesse, Hailemariam; Degefie, Tedbabe; Victora, Cesar G.; Black, Robert E.; Bryce, Jennifer

2014-01-01

Ethiopia has scaled up integrated community case management of childhood illness (iCCM) in most regions. We assessed the strength of iCCM implementation and the quality of care provided by health extension workers (HEWs). Data collectors observed HEWs' consultations with sick children and carried out gold standard re-examinations. Nearly all HEWs received training and supervision, and essential commodities were available. HEWs provided correct case management for 64% of children. The proportions of children correctly managed for pneumonia, diarrhea, and malnutrition were 72%, 79%, and 59%, respectively. Only 34% of children with severe illness were correctly managed. Health posts saw an average of 16 sick children in the previous 1 month. These results show that iCCM can be implemented at scale and that community-based HEWs can correctly manage multiple illnesses. However, to increase the chances of impact on child mortality, management of severe illness and use of iCCM services must be improved. PMID:24799369

Identifying organisational principles and management practices important to the quality of health care services for chronic conditions.

PubMed

Frølich, Anne

2012-02-01

The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved. The aim of this dissertation is to describe the effect of determinants, such as organisational structures and management practices including two selected incentives, on the quality of care in chronic diseases. The dissertation is based on four studies with the following purposes: 1) macro- or healthcare system-level identification of organisational structures and principles that affect the quality of health care services, based on a comparison of KP and the Danish health care system; 2) meso- or organisation-level identification of management practices with positive effects on screening rates for hemoglobin A1c and lipid profile in diabetes; 3) evaluation of the effect of the CCM on quality of health care services and continuity of care in a Danish setting; 4) micro- or practice-level evaluation of the effect of financial incentives and public performance reporting on the behaviour of professionals and quality of care. Using secondary data, KP and the Danish health care system were compared in terms of six central dimensions: population, health care professionals, health care organisations, utilization patterns, quality measurements, and costs. Differences existed between the two systems on all dimensions, complicating the interpretation of findings. For instance, observed differences might be due to similar tendencies in the two health care systems that were observed at different times, rather than true structural differences. The expenses in the two health care systems were corrected for differences in the populations served and the purchasing power of currencies. However, no validated methods existed to correct for observed differences in case-mixes of chronic conditions. Data from a population of about half a million patients with diabetes in a large U.S. integrated health care delivery system affiliated with 41 medical centers employing 15 different CCM management practices was the basis for identifying effective management practices. Through the use of statistical modelling, the management practice of provider alerts was identified as most effective for promoting screening for hemoglobin A1c and lipid profile. The CCM was used as a framework for implementing four rehabilitation programs. The model promoted continuity of care and quality of health care services. New management practices were developed in the study, and known practices were further developed. However, the observational nature of the study limited the generalisability of the findings. In a structured literature survey focusing on the effect of financial incentives and public performance reporting on the quality of health care services, few studies documenting an effect were identified. The results varied, and important program aspects or contextual variables were often omitted. A model describing the effects of the two incentives on the conduct of health care professionals and their interaction with the organisations in which they serve was developed. On the macro-level, organisational differences between KP and the Danish health care system related to the primary care sectors, utilization patterns, and the quality of health care services, supporting a hypothesis that KP's focus on primary care is a beneficial form of organisation. On the meso-level, use of the CCM improved quality of health care services, but the effect is complicated and context dependent. The CCM was found to be useful in the Danish health care system, and the model was also further developed in a Danish setting. On the micro-level, quality was improved by financial incentives and disclosure in a complex interplay with other central factors in the work environment of health care professionals.

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence.

PubMed

Bosch-Capblanch, Xavier; Marceau, Claudine

2014-12-01

To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi-component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming-up of CHW, micro-franchising or social franchising. On-site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers' basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Large, multi-faceted, iCCM programmes, with strong components of training, supervision, which included additional support of equipment and supplies, seemed to improve selected quality of care outcomes. However, current evaluation and reporting practices need to be revised in a new research agenda to address the methodological challenges of iCCM evaluations.

Formation of Fe-Mn crusts within a continental margin environment

USGS Publications Warehouse

Conrad, Tracey A.; Hein, James R.; Paytan, Adina; Clague, David A.

2017-01-01

This study examines Fe-Mn crusts that form on seamounts along the California continental-margin (CCM), within the United States 200 nautical mile exclusive economic zone. The study area extends from approximately 30° to 38° North latitudes and from 117° to 126° West longitudes. The area of study is a tectonically active northeast Pacific plate boundary region and is also part of the North Pacific Subtropical Gyre with currents dominated by the California Current System. Upwelling of nutrient-rich water results in high primary productivity that produces a pronounced oxygen minimum zone. Hydrogenetic Fe-Mn crusts forming along the CCM show distinct chemical and mineral compositions compared to open-ocean crusts. On average, CCM crusts contain more Fe relative to Mn than open-ocean Pacific crusts. The continental shelf and slope release both Fe and Mn under low-oxygen conditions. Silica is also enriched relative to Al compared to open-ocean crusts. This is due to the North Pacific silica plume and enrichment of Si along the path of deep-water circulation, resulting in Si enrichment in bottom and intermediate waters of the eastern Pacific.The CCM Fe-Mn crusts have a higher percentage of birnessite than open-ocean crusts, reflecting lower dissolved seawater oxygen that results from the intense coastal upwelling and proximity to zones of continental slope pore-water anoxia. Carbonate fluorapatite (CFA) is not present and CCM crusts do not show evidence of phosphatization, even in the older sections. The mineralogy indicates a suboxic environment under which birnessite forms, but in which pH is not high enough to facilitate CFA deposition. Growth rates of CCM crusts generally increase with increasing water depth, likely due to deep-water Fe sources mobilized from reduced shelf and slope sediments.Many elements of economic interest including Mn, Co, Ni, Cu, W, and Te have slightly or significantly lower concentrations in CCM crusts relative to crusts from the Pacific Prime Crust Zone and other open-ocean basins. However, concentrations of total rare earth elements and yttrium average only slightly lower contents and in the future may be a strategic resource for the U.S.

Strategies of dissolved inorganic carbon use in macroalgae across a gradient of terrestrial influence: implications for the Great Barrier Reef in the context of ocean acidification

NASA Astrophysics Data System (ADS)

Diaz-Pulido, Guillermo; Cornwall, Christopher; Gartrell, Patrick; Hurd, Catriona; Tran, Dien V.

2016-12-01

Macroalgae are generally used as indicators of coral reef status; thus, understanding the drivers and mechanisms leading to increased macroalgal abundance are of critical importance. Ocean acidification (OA) due to elevated carbon dioxide (CO2) concentrations has been suggested to stimulate macroalgal growth and abundance on reefs. However, little is known about the physiological mechanisms by which reef macroalgae use CO2 from the bulk seawater for photosynthesis [i.e., (1) direct uptake of bicarbonate (HCO3 -) and/or CO2 by means of carbon concentrating mechanisms (CCM) and (2) the diffusive uptake of CO2], which species could benefit from increased CO2 or which habitats may be more susceptible to acidification-induced algal proliferations. Here, we provide the first quantitative examination of CO2-use strategies in coral reef macroalgae and provide information on how the proportion of species and the proportional abundance of species utilising each of the carbon acquisition strategies varies across a gradient of terrestrial influence (from inshore to offshore reefs) in the Great Barrier Reef (GBR). Four macroalgal groups were identified based on their carbon uptake strategies: (1) CCM-only (HCO3 - only users); (2) CCM-HCO3 -/CO2 (active uptake HCO3 - and/or CO2 use); (3) Non-CCM species (those relying on diffusive CO2 uptake); and (4) Calcifiers. δ13C values of macroalgae, confirmed by pH drift assays, show that diffusive CO2 use is more prevalent in deeper waters, possibly due to low light availability that limits activity of CCMs. Inshore shallow reefs had a higher proportion of CCM-only species, while reefs further away from terrestrial influence and exposed to better water quality had a higher number of non-CCM species than inshore and mid-shelf reefs. As non-CCM macroalgae are more responsive to increased seawater CO2 and OA, reef slopes of the outer reefs are probably the habitats most vulnerable to the impacts of OA. Our results suggest a potentially important role of carbon physiology in structuring macroalgal communities in the GBR.

Clinical marginal and internal adaptation of CAD/CAM milling, laser sintering, and cast metal ceramic crowns.

PubMed

Tamac, Ece; Toksavul, Suna; Toman, Muhittin

2014-10-01

Metal ceramic crowns are widely used in clinical practice, but comparisons of the clinical adaptation of restorations made with different processing techniques are lacking. The purpose of this study was to compare the clinical marginal and internal adaptation of metal ceramic crowns fabricated with 3 different techniques: computer-aided design and computer-aided manufacturing (CAD/CAM) milling (CCM), direct metal laser sintering (DMLS), and traditional casting (TC). Twenty CCM, 20 DMLS, and 20 TC metal ceramic crowns were fabricated for 42 patients. Before luting the crowns, silicone replicas were obtained to measure marginal gap and internal adaptation that was evaluated at 3 regions: axial wall, axio-occlusal angle, and occlusal surface. Measurements were made with a reflected light binocular stereomicroscope at 20× magnification and analyzed with 1-way analysis of variance (ANOVA) and the Bonferroni post hoc test (α=.05). The mean marginal gap values were 86.64 μm for CCM, 96.23 μm for DMLS, and 75.92 μm for TC. The means at the axial wall region were 117.5 μm for the CCM group, 139.02 μm for the DMLS group, and 121.38 μm for the TC group. One-way ANOVA revealed no statistically significant differences among the groups for measurements at the marginal gap (P=.082) and the axial wall region (P=.114). The means at the axio-occlusal region were 142.1 μm for CCM, 188.12 μm for DMLS, and 140.63 μm for TC, and those at the occlusal surface region were 265.73 μm for CCM, 290.39 μm for DMLS, and 201.09 μm for TC. The mean values of group DMLS were significantly higher at the axio-occlusal region and the occlusal surface region than those of other groups (P<.05). CCM, DMLS and TC metal ceramic crowns performed similarly in terms of clinical marginal and axial wall adaptation. The cement film thickness at the occlusal region and axio-occlusal region were higher for DMLS crowns. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

[Development and application of component-based Chinese medicine theory].

PubMed

Zhang, Jun-Hua; Fan, Guan-Wei; Zhang, Han; Fan, Xiao-Hui; Wang, Yi; Liu, Li-Mei; Li, Chuan; Gao, Yue; Gao, Xiu-Mei; Zhang, Bo-Li

2017-11-01

Traditional Chinese medicine (TCM) prescription is the main therapies for disease prevention and treatment in Chinese medicine. Following the guidance of the theory of TCM and developing drug by composing prescriptions of TCM materials and pieces, it is a traditional application mode of TCM, and still widely used in clinic. TCM prescription has theoretical advantages and rich clinical application experience in dealing with multi-factor complex diseases, but scientific research is relatively weak. The lack of scientific cognition of the effective substances and mechanism of Chinese medicine leads to insufficient understanding of the efficacy regularity, which affects the stability of effect and hinders the improvement of quality of Chinese medicinal products. Component-based Chinese medicine (CCM) is an innovation based on inheritance, which breaks through the tradition of experience-based prescription and realize the transformation of compatibility from herbal pieces to components. CCM is an important achievement during the research process of modernization of Chinese medicine. Under the support of three national "973" projects, in order to reveal the scientific connotation of the prescription compatibility theory and develop innovative Chinese drugs, we have launched theoretical innovation and technological innovation around the "two relatively clear", and opened up the research field of CCM. CCM is an innovation based on inheritance, breaking through the tradition of experience based prescription, and realizing the transformation from compatibility of herbal pieces to component compatibility, which is an important achievement of the modernization of traditional Chinese medicine. In the past more than 10 years, with the deepening of research and the expansion of application, the theory and methods of CCM and efficacy-oriented compatibility have been continuously improved. The value of CCM is not only in developing new drug, more important is to build a communication bridge between traditional Chinese medicine and modern science and construct the system of key technologies which meet the need of innovation and development of TCM. This paper focused on the research progress, related concepts and technology development of CCM, as well as its application prospect in the theory research of Chinese medicine, development of innovative Chinese drugs, secondary development of Chinese patent medicine and upgrading of pharmaceutical technology. Copyright© by the Chinese Pharmaceutical Association.

Monitoring intensive care unit performance—impact of a novel individualised performance scorecard in critical care medicine: a mixed-methods study protocol

PubMed Central

Neilipovitz, David; Sarti, Aimee J; Rosenberg, Erin; Ishaq, Rabia; Thornton, Mary; Kim, John

2018-01-01

Introduction Patients admitted to a critical care medicine (CCM) environment, including an intensive care unit (ICU), are susceptible to harm and significant resource utilisation. Therefore, a strategy to optimise provider performance is required. Performance scorecards are used by institutions for the purposes of driving quality improvement. There is no widely accepted or standardised scorecard that has been used for overall CCM performance. We aim to improve quality of care, patient safety and patient/family experience in CCM practice through the utilisation of a standardised, repeatable and multidimensional performance scorecard, designed to provide a continuous review of ICU physician and nurse practice, as well as departmental metrics. Methods and analysis This will be a mixed-methods, controlled before and after study to assess the impact of a CCM-specific quality scorecard. Scorecard metrics were developed through expert consensus and existing literature. The study will include 19 attending CCM physicians and approximately 300 CCM nurses. Patient data for scorecard compilation are collected daily from bedside flow sheets. Preintervention baseline data will be collected for 6 months for each participant. After this, each participant will receive their scorecard measures. Following a 3-month washout period, postintervention data will be collected for 6 months. The primary outcome will be change in performance metrics following the provision of scorecard feedback to subjects. A cost analysis will also be performed, with the purpose of comparing total ICU costs prior to implementation of the scorecard with total ICU costs following implementation of the scorecard. The qualitative portion will include interviews with participants following the intervention phase. Interviews will be analysed in order to identify recurrent themes and subthemes, for the purposes of driving scorecard improvement. Ethics and dissemination This protocol has been approved by the local research ethics board. Publication of results is anticipated in 2019. If this intervention is found to improve patient- and unit-directed outcomes, with evidence of cost-effectiveness, it would support the utilisation of such a scorecard as a quality standard in CCM. PMID:29358441

How do we know? An assessment of integrated community case management data quality in four districts of Malawi.

PubMed

Yourkavitch, Jennifer; Zalisk, Kirsten; Prosnitz, Debra; Luhanga, Misheck; Nsona, Humphreys

2016-11-01

The World Health Organization contracted annual data quality assessments of Rapid Access Expansion (RAcE) projects to review integrated community case management (iCCM) data quality and the monitoring and evaluation (M&E) system for iCCM, and to suggest ways to improve data quality. The first RAcE data quality assessment was conducted in Malawi in January 2014 and we present findings pertaining to data from the health management information system at the community, facility and other sub-national levels because RAcE grantees rely on that for most of their monitoring data. We randomly selected 10 health facilities (10% of eligible facilities) from the four RAcE project districts, and collected quantitative data with an adapted and comprehensive tool that included an assessment of Malawi's M&E system for iCCM data and a data verification exercise that traced selected indicators through the reporting system. We rated the iCCM M&E system across five function areas based on interviews and observations, and calculated verification ratios for each data reporting level. We also conducted key informant interviews with Health Surveillance Assistants and facility, district and central Ministry of Health staff. Scores show a high-functioning M&E system for iCCM with some deficiencies in data management processes. The system lacks quality controls, including data entry verification, a protocol for addressing errors, and written procedures for data collection, entry, analysis and management. Data availability was generally high except for supervision data. The data verification process identified gaps in completeness and consistency, particularly in Health Surveillance Assistants' record keeping. Staff at all levels would like more training in data management. This data quality assessment illuminates where an otherwise strong M&E system for iCCM fails to ensure some aspects of data quality. Prioritizing data management with documented protocols, additional training and approaches to create efficient supervision practices may improve iCCM data quality. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence

PubMed Central

Bosch–Capblanch, Xavier; Marceau, Claudine

2014-01-01

Aim To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Methods Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. Results The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi–component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming–up of CHW, micro–franchising or social franchising. On–site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers’ basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Conclusion Large, multi–faceted, iCCM programmes, with strong components of training, supervision, which included additional support of equipment and supplies, seemed to improve selected quality of care outcomes. However, current evaluation and reporting practices need to be revised in a new research agenda to address the methodological challenges of iCCM evaluations. PMID:25520793

Integrated community case management in Malawi: an analysis of innovation and institutional characteristics for policy adoption.

PubMed

Rodríguez, Daniela C; Banda, Hastings; Namakhoma, Ireen

2015-12-01

In 2007, Malawi became an early adopter of integrated community case management for childhood illnesses (iCCM), a policy aimed at community-level treatment for malaria, diarrhoea and pneumonia for children below 5 years. Through a retrospective case study, this article explores critical issues in implementation that arose during policy formulation through the lens of the innovation (i.e. iCCM) and of the institutions involved in the policy process. Data analysis is founded on a documentary review and 21 in-depth stakeholder interviews across institutions in Malawi. Findings indicate that the characteristics of iCCM made it a suitable policy to address persistent challenges in child mortality, namely that ill children were not interacting with health workers on a timely basis and consequently were dying in their communities. Further, iCCM was compatible with the Malawian health system due to the ability to build on an existing community health worker cadre of health surveillance assistants (HSAs) and previous experiences with treatment provision at the community level. In terms of institutions, the Ministry of Health (MoH) demonstrated leadership in the overall policy process despite early challenges of co-ordination within the MoH. WHO, United Nations Children's Fund (UNICEF) and implementing organizations played a supportive role in their position as knowledge brokers. Greater challenges were faced in the organizational capacity of the MoH. Regulatory issues around HSA training as well as concerns around supervision and overburdening of HSAs were discussed, though not fully addressed during policy development. Similarly, the financial sustainability of iCCM, including the mechanisms for channelling funding flows, also remains an unresolved issue. This analysis highlights the role of implementation questions during policy development. Despite several outstanding concerns, the compatibility between iCCM as a policy alternative and the local context laid the foundation for Malawi's road to early adoption of iCCM. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Access to integrated community case management of childhood illnesses services in rural Ethiopia: a qualitative study of the perspectives and experiences of caregivers.

PubMed

Shaw, Bryan; Amouzou, Agbessi; Miller, Nathan P; Tafesse, Mengistu; Bryce, Jennifer; Surkan, Pamela J

2016-06-01

In 2010, Ethiopia began scaling up the integrated community case management (iCCM) of childhood illness strategy throughout the country allowing health extension workers (HEWs) to treat children in rural health posts. After 2 years of iCCM scale up, utilization of HEWs remains low. Little is known about factors related to the use of health services in this setting. This research aimed to elicit perceptions and experiences of caregivers to better understand reasons for low utilization of iCCM services. A rapid ethnographic assessment was conducted in eight rural health post catchment areas in two zones: Jimma and West Hararghe. In total, 16 focus group discussions and 78 in-depth interviews were completed with mothers, fathers, HEWs and community health volunteers. In spite of the HEW being a core component of iCCM, we found that the lack of availability of HEWs at the health post was one of the most common barriers to the utilization of iCCM services mentioned by caregivers. Financial and geographic challenges continue to influence caregiver decisions despite extension of free child health services in communities. Acceptability of HEWs was often low due to a perceived lack of sensitivity of HEWs and concerns about medicines given at the health post. Social networks acted both to facilitate and hinder use of HEWs. Many mothers stated a preference for using the health post, but some were unable to do so due to objections or alternative care-seeking preferences of gatekeepers, often mothers-in-law and husbands. Caregivers in Ethiopia face many challenges in using HEWs at the health post, potentially resulting in low demand for iCCM services. Efforts to minimize barriers to care seeking and to improve demand should be incorporated into the iCCM strategy in order to achieve reductions in child mortality and promote equity in access and child health outcomes. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

GLYOXALASE I A111E, PARAOXONASE 1 Q192R AND L55M POLYMORPHISMS IN ITALIAN PATIENTS WITH SPORADIC CEREBRAL CAVERNOUS MALFORMATIONS: A PILOT STUDY.

PubMed

Rinaldi, C; Bramanti, P; Famà, A; Scimone, C; Donato, L; Antognelli, C; Alafaci, C; Tomasello, F; D'Angelo, R; Sidoti, A

2015-01-01

It is already known that the conditions of increased oxidative stress are associated to a greater susceptibility to vascular malformations including cerebral cavernous malformations (CCMs). These are vascular lesions of the CNS characterized by abnormally enlarged capillary cavities that can occur sporadically or as a familial autosomal dominant condition with incomplete penetrance and variable clinical expression attributable to mutations in three different genes: CCM1(Krit1), CCM2 (MGC4607) and CCM3 (PDCD10). Polymorphisms in the genes encoding for enzymes involved in the antioxidant systems such as glyoxalase I (GLO I) and paraoxonase I (PON I) could influence individual susceptibility to the vascular malformations. A single nucleotide polymorphism was identified in the exon 4 of GLO 1 gene that causes an amino acid substitution of Ala for Glu (Ala111Glu). Two common polymorphisms have been described in the coding region of PON1, which lead to glutamine → arginine substitution at 192 (Q192R) and a leucine → methionine substitution at 55 (L55M). The polymorphisms were characterized in 59 patients without mutations in the CCM genes versus 213 healthy controls by PCR/RFLP methods using DNA from lymphocytes. We found that the frequency of patients carrying the GLO1 A/E genotype among the case group (56%) was four-fold higher than among the controls (14.1%). In the cohort of CCM patients, an increase in the frequency of PON192 Q/R genotype was observed (39% in the CCM group versus 3.7% in the healthy controls). Similarly, an increase was observed in the proportion of individuals with the genotype R/R in the disease group (5%) in respect to the normal healthy cohort (0.5%). Finally, the frequency of the PON55 heterozygotes L/M genotype was 29% in patients with CCMs and 4% in the healthy controls. The same trend was observed in PON55 homozygous M/M genotype frequency (CCMs 20% vs controls 10%). The present study aimed to investigate the possible association of GLO1 A111E, PON1 Q192R and L55M polymorphisms with the risk of CCMs. We found that individuals with the GLO1 A /E genotype, PON192/QR-RR genotypes and PON55/LM-MM genotypes had a significantly higher risk of CCMs compared with the other genotypes. However, because CCM is a heterogeneous disease, other additional factors might be involved in the initiation and progression of CCM disease.

Monitoring iCCM referral systems: Bugoye Integrated Community Case Management Initiative (BIMI) in Uganda.

PubMed

English, Lacey; Miller, James S; Mbusa, Rapheal; Matte, Michael; Kenney, Jessica; Bwambale, Shem; Ntaro, Moses; Patel, Palka; Mulogo, Edgar; Stone, Geren S

2016-04-29

In Uganda, over half of under-five child mortality is attributed to three infectious diseases: malaria, pneumonia and diarrhoea. Integrated community case management (iCCM) trains village health workers (VHWs) to provide in-home diagnosis and treatment of these common childhood illnesses. For severely ill children, iCCM relies on a functioning referral system to ensure timely treatment at a health facility. However, referral completion rates vary widely among iCCM programmes and are difficult to monitor. The Bugoye Integrated Community Case Management Initiative (BIMI) is an iCCM programme operating in Bugoye sub-county, Uganda. This case study describes BIMI's experience with monitoring referral completion at Bugoye Health Centre III (BHC), and outlines improvements to be made within iCCM referral systems. This study triangulated multiple data sources to evaluate the strengths and gaps in the BIMI referral system. Three quantitative data sources were reviewed: (1) VHW report of referred patients, (2) referral forms found at BHC, and (3) BHC patient records. These data sources were collated and triangulated from January-December 2014. The goal was to determine if patients were completing their referrals and if referrals were adequately documented using routine data sources. From January-December 2014, there were 268 patients referred to BHC, as documented by VHWs. However, only 52 of these patients had referral forms stored at BHC. Of the 52 referral forms found, 22 of these patients were also found in BHC register books recorded by clinic staff. Thus, the study found a mismatch between VHW reports of patient referrals and the referral visits documented at BHC. This discrepancy may indicate several gaps: (1) referred patients may not be completing their referral, (2) referral forms may be getting lost at BHC, and, (3) referred patients may be going to other health facilities or drug shops, rather than BHC, for their referral. This study demonstrates the challenges of effectively monitoring iCCM referral completion, given identified limitations such as discordant data sources, incomplete record keeping and lack of unique identifiers. There is a need to innovate and improve the ways by which referral compliance is monitored using routine data, in order to improve the percentage of referrals completed. Through research and field experience, this study proposes programmatic and technological solutions to rectify these gaps within iCCM programmes facing similar challenges. With improved monitoring, VHWs will be empowered to increase referral completion, allowing critically ill children to access needed health services.

Bilateral key comparison CCM.P-K3.1 for absolute pressure measurements from 3 × 10-6 Pa to 9 × 10-4 Pa

NASA Astrophysics Data System (ADS)

Fedchak, J. A.; Bock, Th; Jousten, K.

2014-01-01

This report describes the bilateral key comparison CCM.P-K3.1 between the National Institute of Standards and Technology (NIST) and Physikalisch-Technische Bundesanstalt (PTB) for absolute pressure in the range from 3 × 10-6 Pa to 9 × 10-4 Pa. This comparison was a follow-up to the comparison CCM.P-K3. Two ionization gauges and two spinning rotor gauges (SRGs) were used as the transfer standards for the comparison. The SRGs were used to compare the standards at a pressure of 9 × 10-4 Pa and to normalize the ionization gauge readings. The two ionization gauges were used to compare the standards in the pressure range of from 3 × 10-6 Pa to 3 × 10-4 Pa. Both laboratories used dynamic expansion chambers as standards in the comparison. The two labs showed excellent agreement with each other and with the CCM.P-K3 key comparison reference value (KCRV) over the entire range. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

The Canadian Heart Health Strategy and Action Plan: Cardiac rehabilitation as an exemplar of chronic disease management.

PubMed

Arthur, H M; Suskin, N; Bayley, M; Fortin, M; Howlett, J; Heckman, G; Lewanczuk, R

2010-01-01

In October 2006, federal funding was announced for the development of a national strategy to fight cardiovascular disease (CVD) in Canada. The comprehensive, independent, stakeholder-driven Canadian Heart Health Strategy and Action Plan (CHHS-AP) was delivered to the Minister of Health on February 24, 2009. The mandate of CHHS-AP Theme Working Group (TWG) 6 was to identify the optimal chronic disease management model that incorporated timely access to rehabilitation services and end-of-life planning and care. The purpose of the present paper was to provide an overview of worldwide approaches to CVD and cardiac rehabilitation (CR) strategies and recommendations for CR care in Canada, within the context of the well-known Chronic Care Model (CCM). A separate paper will address end-of-life issues in CVD. TWG 6 was composed of content representatives, primary care representatives and patients. Input in the area of Aboriginal and indigenous cardiovascular health was obtained through individual expert consultation. Information germane to the present paper was gathered from international literature and best practice guidelines. The CCM principles were discussed and agreed on by all. Prioritization of recommendations and overall messaging was discussed and decided on within the entire TWG. The full TWG report was presented to the CHHS-AP Steering Committee and was used to inform the recommendations of the CHHS-AP. Specific actionable recommendations for CR are made in accordance with the key principles of the CCM. The present CR blueprint, as part of the CHHS-AP, will be a first step toward reducing the health care burden of CVD in Canada.

The Evidence-base for Using Ontologies and Semantic Integration Methodologies to Support Integrated Chronic Disease Management in Primary and Ambulatory Care: Realist Review. Contribution of the IMIA Primary Health Care Informatics WG.

PubMed

Liyanage, H; Liaw, S-T; Kuziemsky, C; Terry, A L; Jones, S; Soler, J K; de Lusignan, S

2013-01-01

Most chronic diseases are managed in primary and ambulatory care. The chronic care model (CCM) suggests a wide range of community, technological, team and patient factors contribute to effective chronic disease management. Ontologies have the capability to enable formalised linkage of heterogeneous data sources as might be found across the elements of the CCM. To describe the evidence base for using ontologies and other semantic integration methods to support chronic disease management. We reviewed the evidence-base for the use of ontologies and other semantic integration methods within and across the elements of the CCM. We report them using a realist review describing the context in which the mechanism was applied, and any outcome measures. Most evidence was descriptive with an almost complete absence of empirical research and important gaps in the evidence-base. We found some use of ontologies and semantic integration methods for community support of the medical home and for care in the community. Ubiquitous information technology (IT) and other IT tools were deployed to support self-management support, use of shared registries, health behavioural models and knowledge discovery tools to improve delivery system design. Data quality issues restricted the use of clinical data; however there was an increased use of interoperable data and health system integration. Ontologies and semantic integration methods are emergent with limited evidence-base for their implementation. However, they have the potential to integrate the disparate community wide data sources to provide the information necessary for effective chronic disease management.

Critical Communicative Methodology: Informing Real Social Transformation through Research

ERIC Educational Resources Information Center

Gomez, Aitor; Puigvert, Lidia; Flecha, Ramon

2011-01-01

The critical communicative methodology (CCM) is a methodological response to the dialogic turn of societies and sciences that has already had an important impact in transforming situations of inequality and exclusion. Research conducted with the CCM implies continuous and egalitarian dialogue among researchers and the people involved in the…

CCM key comparison CCM.D-K4 'Hydrometer'

NASA Astrophysics Data System (ADS)

Lorefice, S.; Becerra, L. O.; Lenard, E.; Lee, Y. J.; Lee, W. G.; Madec, T.; Meury, P. A.; Caceres, J.; Santos, C.; Vamossy, C.; Man, J.; Fen, K.; Toda, K.; Wright, J.; Bettin, H.; Toth, H.

2016-01-01

This report presents the comparison philosophy, methodology, analysis and the results of the designed CCM.D-K4 key comparison that covered the calibration of high resolution hydrometers for liquid and alcoholometers in the density range 600 kg/m3 to 2000 kg/m3 at the temperature of 20°C. The main purpose of this comparison was not only to evaluate the degree of equivalence in the calibration of high accuracy hydrometers between NMI participants, but also to link, were it is possible, the results of previous comparisons to Key Comparison Reference Values (KCRVs) of CCM.D-K4. Eleven NMI laboratories took part in the CCM.D-K4 divided in two groups (petals). With the CCM.D-K4 purpose, two similar sets consisting of three hydrometers for liquid density determinations and an alcoholometer were circulated to the NMI participants as a travelling standard in the time interval from January 2011 to April 2012. Twelve Key Comparison Reference Values (KCRVs) for each petal have been obtained at the density values related to the tested density marks of the transfer standards by the results of participants. The KCRVs and corresponding uncertainties were calculated by the weighted mean in the case of consistent results, otherwise the median was used. The degree of equivalence (DoE) with respect to the corresponding KCRV was determined for each participant and, in this particular comparison, the Weighted Least Squares (WLS) method was used to link the individual DoE of each participant by a continuous function. Significant drift of the transfer standards was not detected. This report also gives instructions on calculating pair-wise degrees of equivalence, with the addition of any information on correlations that may be necessary to estimate more accurately as well as the procedure for linking international comparisons to the CCM.D-K4. Finally an example of linkage to the CCM.D-K4 is given by dealing with the results of the bilateral comparison between INRiM and NMIA, which was added to this comparison so that all participants were engaged after the breakage of the 9340171 artefact. A particularly good agreement was found among the results provided by most of the participants, even if some systematic differences and either underestimated or overestimated uncertainties of the submitted results can be identified with respect to the KCRVs. In general the deviations of the laboratory results to the KCRVs are within of 1/3rd to 1/4th of a scale division and the uncertainty at 95% is usually within half a division. During the analysis of the submitted results, a systematic difference between the first and last immersed mark was also noted, possibly due to a temperature gradient along the stem and/or wetting of the stem around the tested mark, and therefore a corrected claimed uncertainty from each laboratory is expected. However this comparison may help the laboratories to solve some residual or marginal problems as well as to better understand the uncertainty components. The comparison fully supports the calibration measurement capabilities table in the BIPM key comparison database (KCDB). The results can be used to link regional comparisons to this CCM key comparison Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Nonlinear dynamics of global atmospheric and Earth-system processes

NASA Technical Reports Server (NTRS)

Saltzman, Barry; Ebisuzaki, Wesley; Maasch, Kirk A.; Oglesby, Robert; Pandolfo, Lionel

1991-01-01

General Circulation Model (GCM) studies of the atmospheric response to change boundary conditions are discussed. Results are reported on an extensive series of numerical studies based on the National Center for Atmospheric Research (NCAR) Community Climate Model (CCM) general circulation model. In these studies the authors determined the response to systematic changes in atmospheric CO2 ranging from 100 to 1000 ppm; to changes in the prescribed sea surface temperature (SST) in the Gulf of Mexico, such as occurred during the deglaciation phase of the last ice age; to changes in soil moisture over North America; and to changes in sea ice extent in the Southern Hemisphere. Study results show that the response of surface temperature and other variables is nearly logarithmic, with lower levels of CO2 implying greater sensitivity of the atmospheric state to changes in CO2. It was found that the surface temperature of the Gulf of Mexico exerts considerable control over the storm track and behavior of storm systems over the North Atlantic through its influence on evaporation and the source of latent heat. It was found that reductions in soil moisture can play a significant role in amplifying and maintaining North American drought, particularly when a negative soil moisture anomaly prevails late in the spring.

Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach.

PubMed

Kitson, Nicole A; Price, Morgan; Lau, Francis Y; Showler, Grey

2013-10-17

Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication management involves key recurrent activities (determine need, prescribe, dispense, administer, and monitor/evaluate) with information communicated within and between each. Despite its importance, there is a lack of conceptual models that explore medication communication specifically across roles and settings. This research seeks to address that gap. The Circle of Care Modeling (CCM) approach was used to build a model of medication communication activities across the circle of care. CCM positions the patient in the centre of his or her own healthcare system; providers and other roles are then modeled around the patient as a web of relationships. Recurrent medication communication activities were mapped to the medication management framework. The research occurred in three iterations, to test and revise the model: Iteration 1 consisted of a literature review and internal team discussion, Iteration 2 consisted of interviews, observation, and a discussion group at a Community Health Centre, and Iteration 3 consisted of interviews and a discussion group in the larger community. Each iteration provided further detail to the Circle of Care medication communication model. Specific medication communication activities were mapped along each communication pathway between roles and to the medication management framework. We could not map all medication communication activities to the medication management framework; we added Coordinate as a separate and distinct recurrent activity. We saw many examples of coordination activities, for instance, Medical Office Assistants acting as a liaison between pharmacists and family physicians to clarify prescription details. Through the use of CCM we were able to unearth tacitly held knowledge to expand our understanding of medication communication. Drawing out the coordination activities could be a missing piece for us to better understand how to streamline and improve multi-step communication processes with a goal of improving patient safety.

Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach

PubMed Central

2013-01-01

Background Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication management involves key recurrent activities (determine need, prescribe, dispense, administer, and monitor/evaluate) with information communicated within and between each. Despite its importance, there is a lack of conceptual models that explore medication communication specifically across roles and settings. This research seeks to address that gap. Methods The Circle of Care Modeling (CCM) approach was used to build a model of medication communication activities across the circle of care. CCM positions the patient in the centre of his or her own healthcare system; providers and other roles are then modeled around the patient as a web of relationships. Recurrent medication communication activities were mapped to the medication management framework. The research occurred in three iterations, to test and revise the model: Iteration 1 consisted of a literature review and internal team discussion, Iteration 2 consisted of interviews, observation, and a discussion group at a Community Health Centre, and Iteration 3 consisted of interviews and a discussion group in the larger community. Results Each iteration provided further detail to the Circle of Care medication communication model. Specific medication communication activities were mapped along each communication pathway between roles and to the medication management framework. We could not map all medication communication activities to the medication management framework; we added Coordinate as a separate and distinct recurrent activity. We saw many examples of coordination activities, for instance, Medical Office Assistants acting as a liaison between pharmacists and family physicians to clarify prescription details. Conclusions Through the use of CCM we were able to unearth tacitly held knowledge to expand our understanding of medication communication. Drawing out the coordination activities could be a missing piece for us to better understand how to streamline and improve multi-step communication processes with a goal of improving patient safety. PMID:24134454

The Impact of Warm Pool El Nino Events on Antarctic Ozone

NASA Technical Reports Server (NTRS)

Hurwitz, Margaret M.; Newman, P. A.; Song, In-Sun; Frith, Stacey M.

2011-01-01

Warm pool El Nino (WPEN) events are characterized by positive sea surface temperature (SST) anomalies in the central equatorial Pacific in austral spring and summer. Previous work found an enhancement in planetary wave activity in the South Pacific in austral spring, and a warming of 3-5 K in the Antarctic lower stratosphere during austral summer, in WPEN events as compared with ENSO neutral. In this presentation, we show that weakening of the Antarctic vortex during WPEN affects the structure and magnitude of high-latitude total ozone. We use total ozone data from TOMS and OMI, as well as station data from Argentina and Antarctica, to identify shifts in the longitudinal location of the springtime ozone minimum from its climatological position. In addition, we examine the sensitivity of the WPEN-related ozone response to the phase of the quasi-biennial oscillation (QBO). We then compare the observed response to WPEN events with Goddard Earth Observing System chemistry-climate model, version 2 (GEOS V2 CCM) simulations. Two, 50-year time-slice simulations are forced by annually repeating SST and sea ice climatologies, one set representing observed WPEN events and the second set representing neutral ENSO events, in a present-day climate. By comparing the two simulations, we isolate the impact of WPEN events on lower stratospheric ozone, and furthermore, examine the sensitivity of the WPEN ozone response to the phase of the QBO.

Convergent Cross Mapping: Basic concept, influence of estimation parameters and practical application.

PubMed

Schiecke, Karin; Pester, Britta; Feucht, Martha; Leistritz, Lutz; Witte, Herbert

2015-01-01

In neuroscience, data are typically generated from neural network activity. Complex interactions between measured time series are involved, and nothing or only little is known about the underlying dynamic system. Convergent Cross Mapping (CCM) provides the possibility to investigate nonlinear causal interactions between time series by using nonlinear state space reconstruction. Aim of this study is to investigate the general applicability, and to show potentials and limitation of CCM. Influence of estimation parameters could be demonstrated by means of simulated data, whereas interval-based application of CCM on real data could be adapted for the investigation of interactions between heart rate and specific EEG components of children with temporal lobe epilepsy.

A Simple Combinatorial Codon Mutagenesis Method for Targeted Protein Engineering.

PubMed

Belsare, Ketaki D; Andorfer, Mary C; Cardenas, Frida S; Chael, Julia R; Park, Hyun June; Lewis, Jared C

2017-03-17

Directed evolution is a powerful tool for optimizing enzymes, and mutagenesis methods that improve enzyme library quality can significantly expedite the evolution process. Here, we report a simple method for targeted combinatorial codon mutagenesis (CCM). To demonstrate the utility of this method for protein engineering, CCM libraries were constructed for cytochrome P450 BM3 , pfu prolyl oligopeptidase, and the flavin-dependent halogenase RebH; 10-26 sites were targeted for codon mutagenesis in each of these enzymes, and libraries with a tunable average of 1-7 codon mutations per gene were generated. Each of these libraries provided improved enzymes for their respective transformations, which highlights the generality, simplicity, and tunability of CCM for targeted protein engineering.

75 FR 1589 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

... Census Coverage Measurement Recall Bias Panel Study has been added. Two previous notices were published... Reinterview, and Recall Bias Panel Study. OMB Control Number: None. Form Number(s): All data will be collected... different PI enumerator. In addition to the CCM PI Operation, CCM will conduct a Recall Bias Panel Study...

The Effects of Cognitive Conflict Management on Cognitive Development and Science Achievement

ERIC Educational Resources Information Center

Budiman, Zainol Badli; Halim, Lilia; Mohd Meerah, Subahan; Osman, Kamisah

2014-01-01

Three teaching methods were compared in this study, namely a Cognitive Conflict Management Module (CCM) that is infused into Cognitive Acceleration through Science Education (CASE), (Module A) CASE without CCM (Module B) and a conventional teaching method. This study employed a pre- and post-test quasi-experimental design using non-equivalent…

Coaching, Counseling, and Mentoring: A Strategic Need in Training and Development

ERIC Educational Resources Information Center

Demik, Randal J.

2007-01-01

Literature within HRD is reviewed that aides in the understanding of Coaching, Counseling, and Mentoring (CCM) as a strategic need. Published case studies are presented where CCM strategies have been put into practice in the workplace to foster an environment of performance improvement. By developing and implementing these approaches,…

Gas Furnace with Pulsed Feeding of the Heating Agent for Volume Precision Heat Treatment of CCM Rolls

NASA Astrophysics Data System (ADS)

Moroz, V. I.; Egorova, V. M.; Gusev, S. V.

2001-05-01

A standard chamber batch furnace of the Severstal' plant has been modified for precision heat treatment of CCM rolls. The certification tests of a charge of rolls from steel 24KhM1F have shown the technical and economical advantages of the new design.

The Community College of Maine Annual Report, Year Two, 1990-1991.

ERIC Educational Resources Information Center

Maine Univ., Augusta. Office of Distance Education.

The Community College of Maine (CCM) makes use of new telecommunications and information technologies to overcome the barriers of geography, cost, and time that have always limited access to higher education for Maine's rural communities. Currently, the Interactive Television System (ITV) is the primary means used to broadcast CCM courses, but…

Measuring Coverage in MNCH: Evaluation of Community-Based Treatment of Childhood Illnesses through Household Surveys

PubMed Central

Hazel, Elizabeth; Requejo, Jennifer; David, Julia; Bryce, Jennifer

2013-01-01

Community case management (CCM) is a strategy for training and supporting workers at the community level to provide treatment for the three major childhood diseases—diarrhea, fever (indicative of malaria), and pneumonia—as a complement to facility-based care. Many low- and middle-income countries are now implementing CCM and need to evaluate whether adoption of the strategy is associated with increases in treatment coverage. In this review, we assess the extent to which large-scale, national household surveys can serve as sources of baseline data for evaluating trends in community-based treatment coverage for childhood illnesses. Our examination of the questionnaires used in Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between 2005 and 2010 in five sub-Saharan African countries shows that questions on care seeking that included a locally adapted option for a community-based provider were present in all the DHS surveys and in some MICS surveys. Most of the surveys also assessed whether appropriate treatments were available, but only one survey collected information on the place of treatment for all three illnesses. This absence of baseline data on treatment source in household surveys will limit efforts to evaluate the effects of the introduction of CCM strategies in the study countries. We recommend alternative analysis plans for assessing CCM programs using household survey data that depend on baseline data availability and on the timing of CCM policy implementation. PMID:23667329

Transcriptome-Wide Changes in Chlamydomonas reinhardtii Gene Expression Regulated by Carbon Dioxide and the CO2-Concentrating Mechanism Regulator CIA5/CCM1[W][OA

PubMed Central

Fang, Wei; Si, Yaqing; Douglass, Stephen; Casero, David; Merchant, Sabeeha S.; Pellegrini, Matteo; Ladunga, Istvan; Liu, Peng; Spalding, Martin H.

2012-01-01

We used RNA sequencing to query the Chlamydomonas reinhardtii transcriptome for regulation by CO2 and by the transcription regulator CIA5 (CCM1). Both CO2 and CIA5 are known to play roles in acclimation to low CO2 and in induction of an essential CO2-concentrating mechanism (CCM), but less is known about their interaction and impact on the whole transcriptome. Our comparison of the transcriptome of a wild type versus a cia5 mutant strain under three different CO2 conditions, high CO2 (5%), low CO2 (0.03 to 0.05%), and very low CO2 (<0.02%), provided an entry into global changes in the gene expression patterns occurring in response to the interaction between CO2 and CIA5. We observed a massive impact of CIA5 and CO2 on the transcriptome, affecting almost 25% of all Chlamydomonas genes, and we discovered an array of gene clusters with distinctive expression patterns that provide insight into the regulatory interaction between CIA5 and CO2. Several individual clusters respond primarily to either CIA5 or CO2, providing access to genes regulated by one factor but decoupled from the other. Three distinct clusters clearly associated with CCM-related genes may represent a rich source of candidates for new CCM components, including a small cluster of genes encoding putative inorganic carbon transporters. PMID:22634760

Microseismic source locations with deconvolution migration

NASA Astrophysics Data System (ADS)

Wu, Shaojiang; Wang, Yibo; Zheng, Yikang; Chang, Xu

2018-03-01

Identifying and locating microseismic events are critical problems in hydraulic fracturing monitoring for unconventional resources exploration. In contrast to active seismic data, microseismic data are usually recorded with unknown source excitation time and source location. In this study, we introduce deconvolution migration by combining deconvolution interferometry with interferometric cross-correlation migration (CCM). This method avoids the need for the source excitation time and enhances both the spatial resolution and robustness by eliminating the square term of the source wavelets from CCM. The proposed algorithm is divided into the following three steps: (1) generate the virtual gathers by deconvolving the master trace with all other traces in the microseismic gather to remove the unknown excitation time; (2) migrate the virtual gather to obtain a single image of the source location and (3) stack all of these images together to get the final estimation image of the source location. We test the proposed method on complex synthetic and field data set from the surface hydraulic fracturing monitoring, and compare the results with those obtained by interferometric CCM. The results demonstrate that the proposed method can obtain a 50 per cent higher spatial resolution image of the source location, and more robust estimation with smaller errors of the localization especially in the presence of velocity model errors. This method is also beneficial for source mechanism inversion and global seismology applications.

Interannual Variability and Trends of Extratropical Ozone, Part II: Southern Hemisphere. Part 2; Southern Hemisphere

NASA Technical Reports Server (NTRS)

Yung, Y. L.

2008-01-01

A principal component analysis (PCA) is applied to the Southern Hemisphere (SH) total column ozone following the method established for analyzing the data in the Northern Hemisphere (NH) in a companion paper. The interannual variability (IAV) of extratropical O-3 in the SH is characterized by four main modes, which account for 75% of the total variance. The first two leading modes are approximately zonally symmetric and relate to the Southern Hemisphere annular mode and the quasi-biennial oscillation. The third and fourth modes exhibit wavenumber-1 structures. Contrary to the Northern Hemisphere, the third and fourth are nor related to stationary waves. Similar results obtained for the 30 100-hPa geopotential thickness.The decreasing O3 trend in the SH is captured in the first mode. The largest trend is at the South Pole, with value similar to-2 Dobson Units (DU)/yr. Both the spatial pattern and trends in the column ozone are captured by the Goddard Earth Observation System chemistry-climate model (GEOS-CCM) in the SH.

Supplement to CCM.D-K4 'Hydrometer' report: linkage of EURAMET.M.D-K4 comparison, SIM.M.D-K4 comparison and the supplementary SIM.M.D-S2 to CCM.D-K4 'Hydrometer'

NASA Astrophysics Data System (ADS)

Lorefice, S.; Becerra, L. O.

2017-01-01

Evaluation of different types of comparisons to a common set of reference values of a CIPM key comparison is essential to satisfy the concept of the CIPM Mutual Recognition Arrangement (CIPM MRA), where the DoEs of any participant who took part in comparisons should be within the Calibration and Measurement Capability (CMC) section of the CIPM MRA Key Comparison Data Base. The subject of this supplementary report is therefore to present the equivalence of each National Metrological Institute (NMI) participant in the CCM.D-K4 'Hydrometer' key comparison, which was performed in the density range 600 kg/m3 to 2000 kg/m3 at the temperature of 20 °C, and the linkage of the European and Inter-American NMI results performed in the RMO.M.D-K4 comparisons as well as those of the supplementary SIM.M.D-S2 to the common set of KCRVs of the CCM.D-K4 'Hydrometer'. The linking procedure has been obtained by numerical simulation, based on the Monte Carlo method, in which the differences in the results of the different comparison between the intended laboratory and one or more linking laboratory/ies, which took part in both comparisons, are correlated with a continuous function describing the DoEs of the linking laboratory/ies with respect to the common set of KCRVs of the CCM.D-K4. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Functional Traits for Carbon Access in Macrophytes

PubMed Central

Pfister, Catherine A.; Wootton, J. Timothy

2016-01-01

Understanding functional trait distributions among organisms can inform impacts on and responses to environmental change. In marine systems, only 1% of dissolved inorganic carbon in seawater exists as CO2. Thus the majority of marine macrophytes not only passively access CO2 for photosynthesis, but also actively transport CO2 and the more common bicarbonate (HCO3-, 92% of seawater dissolved inorganic carbon) into their cells. Because species with these carbon concentrating mechanisms (CCMs) are non-randomly distributed in ecosystems, we ask whether there is a phylogenetic pattern to the distribution of CCMs among algal species. To determine macrophyte traits that influence carbon uptake, we assessed 40 common macrophyte species from the rocky intertidal community of the Northeast Pacific Ocean to a) query whether macrophytes have a CCM and b) determine the evolutionary history of CCMs, using ancestral state reconstructions and stochastic character mapping based on previously published data. Thirty-two species not only depleted CO2, but also concentrated and depleted HCO3-, indicative of a CCM. While analysis of CCMs as a continuous trait in 30 families within Phylum Rhodophyta showed a significant phylogenetic signal under a Brownian motion model, analysis of CCMs as a discrete trait (presence or absence) indicated that red algal families are more divergent than expected in their CCM presence or absence; CCMs are a labile trait within the Rhodophyta. In contrast, CCMs were present in each of 18 Ochrophyta families surveyed, indicating that CCMs are highly conserved in the brown algae. The trait of CCM presence or absence was largely conserved within Families. Fifteen of 23 species tested also changed the seawater buffering capacity, or Total Alkalinity (TA), shifting DIC composition towards increasing concentrations of HCO3- and CO2 for photosynthesis. Manipulating the external TA of the local environment may influence carbon availability in boundary layers and areas of low water mixing, offering an additional mechanism to increase CO2 availability. PMID:27415005

Physician involvement in disease management as part of the CCM.

PubMed

Wallace, Paul J

2005-01-01

Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I.

Physician Involvement in Disease Management as Part of the CCM

PubMed Central

Wallace, Paul J.

2005-01-01

Phase I of the voluntary chronic care improvement (CCI-I) under traditional fee-for-service Medicare initiative seeks to extend the benefits of disease management to an elderly population with comorbid chronic medical conditions. Active, sustained involvement of treating physicians, a historical deficit of disease management programs, is a CCI-I program goal. During the last decade, Kaiser Permanente, an integrated health care delivery system with more than 60 years of experience in managing the care of individuals and populations, has applied the chronic care model (CCM) to develop care management strategies for populations of patients with chronic medical conditions. Physician leadership and involvement have been key to successfully incorporating these practices into care. The scope of physician involvement in leading, developing, and delivering chronic illness care management at Kaiser Permanente is described as a basis for identifying opportunities to involve practicing physicians in the CCI-I. PMID:17288075

Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus

PubMed Central

Williams, Edith M.; Ortiz, Kasim; Browne, Teri

2014-01-01

Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions. PMID:26464854

Structure/Function of the Novel Proteins LCIB and LCIC in the Chlamydomonas CCM

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martin, Spalding H.

2017-05-09

The goal of this project was to investigate the function of two novel proteins, LCIB and LCIC, which together form an essential protein complex that is required for function of a carbon-dioxide-concentrating mechanism (CCM) required by microalgae to grow in environments where carbon dioxide levels are at or below air equilibration levels.

Effective Reading Comprehension in EFL Contexts: Individual and Collaborative Concept Mapping Strategies

ERIC Educational Resources Information Center

Riahi, Zahra; Pourdana, Natasha

2017-01-01

The present study attempted to investigate the possible impacts of Individual Concept Mapping (ICM) and Collaborative Concept Mapping (CCM) strategies on Iranian EFL learners' reading comprehension. For this purpose, 90 pre-intermediate female language learners ranged between 12 to 17 years of age were selected to randomly assign into ICM, CCM and…

Physician attitude toward depression care interventions: Implications for implementation of quality improvement initiatives

PubMed Central

Henke, Rachel Mosher; Chou, Ann F; Chanin, Johann C; Zides, Amanda B; Scholle, Sarah Hudson

2008-01-01

Background Few individuals with depression treated in the primary care setting receive care consistent with clinical treatment guidelines. Interventions based on the chronic care model (CCM) have been promoted to address barriers and improve the quality of care. A current understanding of barriers to depression care and an awareness of whether physicians believe interventions effectively address those barriers is needed to enhance the success of future implementation. Methods We conducted semi-structured interviews with 23 primary care physicians across the US regarding their experience treating patients with depression, barriers to care, and commonly promoted CCM-based interventions. Themes were identified from interview transcripts using a grounded theory approach. Results Six barriers emerged from the interviews: difficulty diagnosing depression, patient resistance, fragmented mental health system, insurance coverage, lack of expertise, and competing demands and other responsibilities as a primary care provider. A number of interventions were seen as helpful in addressing these barriers – including care managers, mental health integration, and education – while others received mixed reviews. Mental health consultation models received the least endorsement. Two systems-related barriers, the fragmented mental health system and insurance coverage limitations, appeared incompletely addressed by the interventions. Conclusion CCM-based interventions, which include care managers, mental health integration, and patient education, are most likely to be implemented successfully because they effectively address several important barriers to care and are endorsed by physicians. Practices considering the adoption of interventions that received less support should educate physicians about the benefit of the interventions and attend to physician concerns prior to implementation. A focus on interventions that address systems-related barriers is needed to overcome all barriers to care. PMID:18826646

Chronic disease management for depression in US medical practices: results from the Health Tracking Physician Survey.

PubMed

Zafar, Waleed; Mojtabai, Ramin

2011-07-01

Chronic care model (CCM) envisages a multicomponent systematic remodeling of ambulatory care to improve chronic diseases management. Application of CCM in primary care management of depression has traditionally lagged behind the application of this model in management of other common chronic illnesses. In past research, the use of CCM has been operationalized by measuring the use of evidence-based organized care management processes (CMPs). To compare the use of CMPs in treatment of depression with the use of these processes in treatment of diabetes and asthma and to examine practice-level correlates of this use. Using data from the 2008 Health Tracking Physician Survey, a nationally representative sample of physicians in the United States, we compared the use of 5 different CMPs: written guidelines in English and other languages for self-management, availability of staff to educate patients about self-management, availability of nurse care managers for care coordination, and group meetings of patients with staff. We further examined the association of practice-level characteristics with the use of the 5 CMPs for management of depression. CMPs were more commonly used for management of diabetes and asthma than for depression. The use of CMPs for depression was more common in health maintenance organizations [adjusted odds ratios (AOR) ranging from 2.45 to 5.98 for different CMPs], in practices that provided physicians with feedback regarding quality of care to patients (AOR range, 1.42 to 1.69), and in practices with greater use of clinical information technology (AOR range, 1.06 to 1.11). The application of CMPs in management of depression continues to lag behind other common chronic conditions. Feedbacks on quality of care and expanded use of information technology may improve application of CMPs for depression care in general medical settings.

The Canadian Heart Health Strategy and Action Plan: Cardiac rehabilitation as an exemplar of chronic disease management

PubMed Central

Arthur, Heather M; Suskin, Neville; Bayley, Mark; Fortin, Martin; Howlett, Jonathan; Heckman, George; Lewanczuk, Richard

2010-01-01

BACKGROUND: In October 2006, federal funding was announced for the development of a national strategy to fight cardiovascular disease (CVD) in Canada. The comprehensive, independent, stakeholder-driven Canadian Heart Health Strategy and Action Plan (CHHS-AP) was delivered to the Minister of Health on February 24, 2009. OBJECTIVES: The mandate of CHHS-AP Theme Working Group (TWG) 6 was to identify the optimal chronic disease management model that incorporated timely access to rehabilitation services and end-of-life planning and care. The purpose of the present paper was to provide an overview of worldwide approaches to CVD and cardiac rehabilitation (CR) strategies and recommendations for CR care in Canada, within the context of the well-known Chronic Care Model (CCM). A separate paper will address end-of-life issues in CVD. METHODS: TWG 6 was composed of content representatives, primary care representatives and patients. Input in the area of Aboriginal and indigenous cardiovascular health was obtained through individual expert consultation. Information germane to the present paper was gathered from international literature and best practice guidelines. The CCM principles were discussed and agreed on by all. Prioritization of recommendations and overall messaging was discussed and decided on within the entire TWG. The full TWG report was presented to the CHHS-AP Steering Committee and was used to inform the recommendations of the CHHS-AP. RESULTS: Specific actionable recommendations for CR are made in accordance with the key principles of the CCM. CONCLUSIONS: The present CR blueprint, as part of the CHHS-AP, will be a first step toward reducing the health care burden of CVD in Canada. PMID:20101356

Critical Care and Personalized or Precision Medicine: Who needs whom?

PubMed

Sugeir, Shihab; Naylor, Stephen

2018-02-01

The current paradigm of modern healthcare is a reactive response to patient symptoms, subsequent diagnosis and corresponding treatment of the specific disease(s). This approach is predicated on methodologies first espoused by the Cnidean School of Medicine approximately 2500years ago. More recently escalating healthcare costs and relatively poor disease treatment outcomes have fermented a rethink in how we carry out medical practices. This has led to the emergence of "P-Medicine" in the form of Personalized and Precision Medicine. The terms are used interchangeably, but in fact there are significant differences in the way they are implemented. The former relies on an "N-of-1" model whereas the latter uses a "1-in-N" model. Personalized Medicine is still in a fledgling and evolutionary phase and there has been much debate over its current status and future prospects. A confounding factor has been the sudden development of Precision Medicine, which has currently captured the imagination of policymakers responsible for modern healthcare systems. There is some confusion over the terms Personalized versus Precision Medicine. Here we attempt to define the key differences and working definitions of each P-Medicine approach, as well as a taxonomic relationship tree. Finally, we discuss the impact of Personalized and Precision Medicine on the practice of Critical Care Medicine (CCM). Practitioners of CCM have been participating in Personalized Medicine unknowingly as it takes the protocols of sepsis, mechanical ventilation, and daily awakening trials and applies it to each individual patient. However, the immediate next step for CCM should be an active development of Precision Medicine. This developmental process should break down the silos of modern medicine and create a multidisciplinary approach between clinicians and basic/translational scientists. Copyright © 2017 Elsevier Inc. All rights reserved.

Using CFC-12 and HCl to quantify the annual cycle of the stratospheric contribution to ozone in the Arctic troposphere

NASA Astrophysics Data System (ADS)

Liang, Q.; Douglass, A. R.; Duncan, B. N.; Stolarski, R. S.; Witte, J. C.

2007-12-01

In this study, we use CFC-12 and hydrochloric acid (HCl) to quantify the annual cycle of stratosphere-to- troposphere transport of O3 to the Arctic troposphere. To do so, we analyze results from a 5-year stratosphere and troposphere simulation from the Global Modeling Initiative (GMI) Chemical Transport Model (CTM) for 1994- 1998 and a 10-year simulation using the GEOS Chemistry Climate Model (GEOS CCM) for 1995-2004. The later includes a tagged CFC-12 tracer to track the transport of aged stratospheric air into the troposphere. We compare the simulated CFC-12 with 10 years surface CFC-12 measurements at two NOAA-GMD sites, Alert and Barrow. We compare O3 with 10 years of ozonesondes at Alert, Eureka, and Resolute. CFC-12, HCl and O3 are all compared with satellite observations from the Advanced Composition Explorer (ACE) and several MkIV balloon measurements in the Arctic. The GEOS CCM and GMI CTM simulations capture well the observed magnitude and annual cycle of CFC-12, HCl, and O3 in the stratosphere and troposphere. Since CFC-12 is emitted at the surface and destroyed in the stratosphere while HCl and O3 are produced in the stratosphere, the stratospheric air shows strong correlation between HCl and O3 and anti-correlation between CFC-12 and O3. We use the CFC-12 tagged tracer to track the transport from the stratosphere to the troposphere and the subsequent transport into the lower troposphere in the Arctic. HCl is paired with O3 to quantify the stratospheric contribution to O3 in the troposphere by applying a scaling factor to the simulated HCl using the HCl-O3 regression ratio. O3 and its annual cycle in the upper troposphere are dominated by stratospheric influence, which peaks in spring. The stratospheric contribution decreases as altitude decreases, accompanied by a delay in the phase of maximum. In the middle troposphere (2-6km), the stratospheric contribution peaks during the summer and is comparable to that of net photochemistry. Due to inefficient transport into the lower Arctic surface, the stratospheric contribution of O3 at the surface accounts for only a few (<5) ppbv.

A Pilot for Improving Depression Care on College Campuses: Results of the College Breakthrough Series-Depression (CBS-D) Project

ERIC Educational Resources Information Center

Chung, Henry; Klein, Michael C.; Silverman, Daniel; Corson-Rikert, Janet; Davidson, Eleanor; Ellis, Patricia; Kasnakian, Caroline

2011-01-01

Objective: To implement a pilot quality improvement project for depression identification and treatment in college health. Participants: Eight college health center teams composed primarily of primary care and counseling service directors and clinicians. Methods: Chronic (Collaborative) Care Model (CCM) used with standardized screening to…

Project LAUNCH: Bringing Space into Math and Science Classrooms

NASA Technical Reports Server (NTRS)

Fauerbach, M.; Henry, D. P.; Schmidt, D. L.

2005-01-01

Project LAUNCH is a K-12 teacher professional development program, which has been created in collaboration between the Whitaker Center for Science, Mathematics and Technology Education at Florida Gulf Coast University (FGCU), and the Florida Space Research Institute (FSRI). Utilizing Space as the overarching theme it is designed to improve mathematics and science teaching, using inquiry based, hands-on teaching practices, which are aligned with Florida s Sunshine State Standards. Many students are excited about space exploration and it provides a great venue to get them involved in science and mathematics. The scope of Project LAUNCH however goes beyond just providing competency in the subject area, as pedagogy is also an intricate part of the project. Participants were introduced to the Conceptual Change Model (CCM) [1] as a framework to model good teaching practices. As the CCM closely follows what scientists call the scientific process, this teaching method is also useful to actively engage institute participants ,as well as their students, in real science. Project LAUNCH specifically targets teachers in low performing, high socioeconomic schools, where the need for skilled teachers is most critical.

Automatic analysis of diabetic peripheral neuropathy using multi-scale quantitative morphology of nerve fibres in corneal confocal microscopy imaging.

PubMed

Dabbah, M A; Graham, J; Petropoulos, I N; Tavakoli, M; Malik, R A

2011-10-01

Diabetic peripheral neuropathy (DPN) is one of the most common long term complications of diabetes. Corneal confocal microscopy (CCM) image analysis is a novel non-invasive technique which quantifies corneal nerve fibre damage and enables diagnosis of DPN. This paper presents an automatic analysis and classification system for detecting nerve fibres in CCM images based on a multi-scale adaptive dual-model detection algorithm. The algorithm exploits the curvilinear structure of the nerve fibres and adapts itself to the local image information. Detected nerve fibres are then quantified and used as feature vectors for classification using random forest (RF) and neural networks (NNT) classifiers. We show, in a comparative study with other well known curvilinear detectors, that the best performance is achieved by the multi-scale dual model in conjunction with the NNT classifier. An evaluation of clinical effectiveness shows that the performance of the automated system matches that of ground-truth defined by expert manual annotation. Copyright © 2011 Elsevier B.V. All rights reserved.

Kansas Primary Care Weighs In: A Pilot Randomized Trial of a Chronic Care Model Program for Obesity in 3 Rural Kansas Primary Care Practices

ERIC Educational Resources Information Center

Ely, Andrea C.; Banitt, Angela; Befort, Christie; Hou, Qing; Rhode, Paula C.; Grund, Chrysanne; Greiner, Allen; Jeffries, Shawn; Ellerbeck, Edward

2008-01-01

Context: Obesity is a chronic disease of epidemic proportions in the United States. Primary care providers are critical to timely diagnosis and treatment of obesity, and need better tools to deliver effective obesity care. Purpose: To conduct a pilot randomized trial of a chronic care model (CCM) program for obesity care in rural Kansas primary…

Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: "the Belgian experience".

PubMed

Sunaert, Patricia; Bastiaens, Hilde; Feyen, Luc; Snauwaert, Boris; Nobels, Frank; Wens, Johan; Vermeire, Etienne; Van Royen, Paul; De Maeseneer, Jan; De Sutter, An; Willems, Sara

2009-08-23

Most research publications on Chronic Care Model (CCM) implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Belgian healthcare setting, a setting where the organisational framework for chronic care is mainly hospital-centered. Process evaluation of an action research project (2003-2007) guided by the CCM in a well-defined geographical area with 76,826 inhabitants and an estimated number of 2,300 type 2 diabetes patients. In consultation with the region a program for type 2 diabetes patients was developed. The degree of implementation of the CCM in the region was assessed using the Assessment of Chronic Illness Care survey (ACIC). A multimethod approach was used to evaluate the implementation process. The resulting data were triangulated in order to identify the main facilitators and barriers encountered during the implementation process. The overall ACIC score improved from 1.45 (limited support) at the start of the study to 5.5 (basic support) at the end of the study. The establishment of a local steering group and the appointment of a program manager were crucial steps in strengthening primary care. The willingness of a group of well-trained and motivated care providers to invest in quality improvement was an important facilitator. Important barriers were the complexity of the intervention, the lack of quality data, inadequate information technology support, the lack of commitment procedures and the uncertainty about sustainable funding. Guided by the CCM, this study highlights the opportunities and the bottlenecks for adapting chronic care delivery in a primary care system with limited structure. The study succeeded in achieving a considerable improvement of the overall support for diabetes patients but further improvement requires a shift towards system thinking among policy makers. Currently primary care providers lack the opportunities to take up full responsibility for chronic care. ClinicalTrials.gov Identifier: NCT00824499.

Regulatory components of carbon concentrating mechanisms in aquatic unicellular photosynthetic organisms.

PubMed

Tomar, Vandana; Sidhu, Gurpreet Kaur; Nogia, Panchsheela; Mehrotra, Rajesh; Mehrotra, Sandhya

2017-11-01

This review provides an insight into the regulation of the carbon concentrating mechanisms (CCMs) in lower organisms like cyanobacteria, proteobacteria, and algae. CCMs evolved as a mechanism to concentrate CO 2 at the site of primary carboxylating enzyme Ribulose-1, 5-bisphosphate carboxylase oxygenase (Rubisco), so that the enzyme could overcome its affinity towards O 2 which leads to wasteful processes like photorespiration. A diverse set of CCMs exist in nature, i.e., carboxysomes in cyanobacteria and proteobacteria; pyrenoids in algae and diatoms, the C 4 system, and Crassulacean acid metabolism in higher plants. Prime regulators of CCM in most of the photosynthetic autotrophs belong to the LysR family of transcriptional regulators, which regulate the activity of the components of CCM depending upon the ambient CO 2 concentrations. Major targets of these regulators are carbonic anhydrase and inorganic carbon uptake systems (CO 2 and HCO 3 - transporters) whose activities are modulated either at transcriptional level or by changes in the levels of their co-regulatory metabolites. The article provides information on the localization of the CCM components as well as their function and participation in the development of an efficient CCM. Signal transduction cascades leading to activation/inactivation of inducible CCM components on perception of low/high CO 2 stimuli have also been brought into picture. A detailed study of the regulatory components can aid in identifying the unraveled aspects of these mechanisms and hence provide information on key molecules that need to be explored to further provide a clear understanding of the mechanism under study.

The Impact of Posttraumatic Stress Disorder on the 6-Month Outcomes in Collaborative Care Management for Depression.

PubMed

Angstman, Kurt B; Marcelin, Alberto; Gonzalez, Cesar A; Kaufman, Tara K; Maxson, Julie A; Williams, Mark D

2016-07-01

Posttraumatic stress disorder (PTSD) has symptoms that exist along a spectrum that includes depression and the 2 disorders may coexist. Collaborative care management (CCM) has been successfully used in outpatient mental health management (especially depression and anxiety) with favorable outcomes. Despite this, there exist limited data on clinical impact of a diagnosis of PTSD on depression outcomes in CCM. The present study used a retrospective cohort design to examine the association of PTSD with depression outcomes among 2121 adult patients involved in CCM in a primary care setting. Using standardized self-report measures, baseline depression scores and 6-month outcome scores were evaluated. Seventy-six patients had a diagnosis of PTSD documented in their electronic medical record. Patients with PTSD reported more severe depressive symptoms at baseline (Patient Health Questionnaire-9 score of 17.9 vs 15.4, P < .001) than those without PTSD. Controlling for sociodemographic and clinical characteristics, a clinical diagnosis of PTSD was associated with lower odds (AOR = 0.457, CI = 0.274-0.760, P = .003) of remission at 6 months and was also associated with higher odds (AOR = 3.112, CI = 1.921-5.041, P < .001) of persistent depressive symptoms at 6 months after CCM. When coexisting with depression, a diagnosis of PTSD was associated with worse depression outcomes, when managed with CCM in primary care. Opportunities still exist for more aggressive management of depression in these patients to help improve remission as well as reduce persistent depressive symptoms. © The Author(s) 2016.

Sustained Axenic Metabolic Activity by the Obligate Intracellular Bacterium Coxiella burnetii▿ †

PubMed Central

Omsland, Anders; Cockrell, Diane C.; Fischer, Elizabeth R.; Heinzen, Robert A.

2008-01-01

Growth of Coxiella burnetii, the agent of Q fever, is strictly limited to colonization of a viable eukaryotic host cell. Following infection, the pathogen replicates exclusively in an acidified (pH 4.5 to 5) phagolysosome-like parasitophorous vacuole. Axenic (host cell free) buffers have been described that activate C. burnetii metabolism in vitro, but metabolism is short-lived, with bacterial protein synthesis halting after a few hours. Here, we describe a complex axenic medium that supports sustained (>24 h) C. burnetii metabolic activity. As an initial step in medium development, several biological buffers (pH 4.5) were screened for C. burnetii metabolic permissiveness. Based on [35S]Cys-Met incorporation, C. burnetii displayed optimal metabolic activity in citrate buffer. To compensate for C. burnetii auxotrophies and other potential metabolic deficiencies, we developed a citrate buffer-based medium termed complex Coxiella medium (CCM) that contains a mixture of three complex nutrient sources (neopeptone, fetal bovine serum, and RPMI cell culture medium). Optimal C. burnetii metabolism occurred in CCM with a high chloride concentration (140 mM) while the concentrations of sodium and potassium had little effect on metabolism. CCM supported prolonged de novo protein and ATP synthesis by C. burnetii (>24 h). Moreover, C. burnetii morphological differentiation was induced in CCM as determined by the transition from small-cell variant to large-cell variant. The sustained in vitro metabolic activity of C. burnetii in CCM provides an important tool to investigate the physiology of this organism including developmental transitions and responses to antimicrobial factors associated with the host cell. PMID:18310349

Effects of seven antifouling compounds on photosynthesis and inorganic carbon use in sugar kelp Saccharina latissima (Linnaeus).

PubMed

Johansson, Per; Eriksson, Karl Martin; Axelsson, Lennart; Blanck, Hans

2012-10-01

Macroalgae depend on carbon-concentrating mechanisms (CCMs) to maintain a high photosynthetic activity under conditions of low carbon dioxide (CO(2)) availability. Because such conditions are prevalent in marine environments, CCMs are important for upholding the macroalgal primary productivity in coastal zones. This study evaluated the effects of seven antifouling compounds-chlorothalonil, DCOIT, dichlofluanid, diuron, irgarol, tolylfluanid, and zinc pyrithione (ZnTP)-on the photosynthesis and CCM of sugar kelp (Saccharina latissima (L.)). Concentration-response curves of these toxicants were established using inhibition of carbon incorporation, whereas their effects over time and their inhibition of the CCM were studied using inhibition of O(2) evolution. We demonstrate that exposure to all compounds except ZnTP (< 1000 nM) resulted in toxicity to photosynthesis of S. latissima. However, carbon incorporation and O(2) evolution differed in their ability to detect toxicity from some of the compounds. Diuron, irgarol, DCOIT, tolylfluanid, and, to some extent, dichlofluanid inhibited carbon incorporation. Chlorothalonil did not inhibit carbon incorporation but clearly inhibited oxygen (O(2)) evolution. Photosynthesis showed only little recovery during the 2-h postexposure period. Inhibition of photosynthesis even increased after the end of exposure to chlorothalonil and tolylfluanid. Through changes in pH of the medium, toxic effects on the CCM could be studied isolated from photosynthesis effects. The CCM of S. latissima was inhibited by chlorothalonil, DCOIT, dichlofluanid, and tolylfluanid. Such inhibition of the CCM, or the absence thereof, deepens the understanding the mechanism of action of the studied compounds.

Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation.

PubMed

Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

2014-08-01

The Kabeho Mwana project (2006-2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.

Evaluation of Acoustic Emission NDE of Composite Crew Module Service Module/Alternate Launch Abort System (CCM SM/ALAS) Test Article Failure Tests

NASA Technical Reports Server (NTRS)

Horne, Michael R.; Madaras, Eric I.

2010-01-01

Failure tests of CCM SM/ALAS (Composite Crew Module Service Module / Alternate Launch Abort System) composite panels were conducted during July 10, 2008 and July 24, 2008 at Langley Research Center. This is a report of the analysis of the Acoustic Emission (AE) data collected during those tests.

Final report on COOMET Vickers PTB/VNIIFTRI key comparison (COOMET.M.H-K1.b and COOMET.M.H-K1.c)

NASA Astrophysics Data System (ADS)

Aslanyan, E.; Herrmann, K.

2013-01-01

This report describes a COOMET key comparison on Vickers hardness scales of two National Metrology Institutes—PTB and VNIIFTRI. The pilot laboratory was PTB, which was the linking institute with the key comparison reference values of CCM.H-K1. In the key comparison two sets of hardness reference blocks for the Vickers hardness scales HV1 and HV30, each consisting of three hardness reference blocks with the hardness levels 240 HV, 540 HV and 840 HV, are used. The same hardness reference blocks were used previously in the key comparison CCM.H-K1. The measurement results and uncertainty assessments, announced by VNIIFTRI, are in good agreement with the key comparison reference values of CCM.H-K1. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

PubMed Central

Shaw, Brian I.; Asadhi, Elijah; Owuor, Kevin; Okoth, Peter; Abdi, Mohammed; Cohen, Craig R.; Onono, Maricianah

2016-01-01

Integrated community case management (iCCM) programs that train lay community health workers (CHWs) in the diagnosis and treatment of diarrhea, malaria, and pneumonia have been increasingly adopted throughout sub-Saharan Africa to provide services in areas where accessibility to formal public sector health services is low. One important aspect of successful iCCM programs is the acceptability and utilization of services provided by CHWs. To understand community perceptions of the quality of care in an iCCM intervention in western Kenya, we used the Primary Care Assessment Survey to compare caregiver attitudes about the diagnosis and treatment of childhood pneumonia as provided by CHWs and facility-based health workers (FBHWs). Overall, caregivers rated CHWs more highly than FBHWs across a set of 10 domains that capture multiple dimensions of the care process. Caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care on clinical aspects. These results argue for the continued implementation and scale-up of iCCM programs as an acceptable intervention for increasing access to treatment of childhood pneumonia. PMID:26976883

Tropical Diabatic Heating and the Role of Convective Processes as Represented in Several Contemporary Climate Models

NASA Technical Reports Server (NTRS)

Robertson, Franklin R.; Roads, John; Oglesby, Robert; Marshall, Susan

2004-01-01

One of the most fundamental properties of the global heat balance is the net heat input into the tropical atmosphere that helps drive the planetary atmospheric circulation. Although broadly understood in terms of its gross structure and balance of source / sink terms, incorporation of the relevant processes in predictive models is still rather poor. The work reported here examines the tropical radiative and water cycle behavior as produced by four contemporary climate models. Among these are the NSIPP-2 (NASA Seasonal to Interannual Prediction Project) which uses the RAS convective parameterization; the FVCCM, a code using finite volume numerics and the CCM3.6 physics; FVCCM-MCRAS again having the finite volume numerics, but MCRAS convective parameterization and a different radiation treatment; and, finally, the NCEP GSM which uses the RAS. Using multi-decadal integrations with specified SSTs we examine the statistics of radiative / convective processes and associated energy transports, and then estimate model energy flux sensitivities to SST changes. In particular the behavior of the convective parameterizations is investigated. Additional model integrations are performed specifically to assess the importance representing convective inhibition in regulating convective cloud-top structure and moisture detrainment as well as controlling surface energy fluxes. To evaluate the results of these experiments, a number of satellite retrievals are used: TRMM retrievals of vertical reflectivity structure, rainfall rate, and inferred diabatic heating are analyzed to show both seasonal and interannual variations in vertical structure of latent heat release. Top-of-atmosphere radiative fluxes from ERBS and CERES are used to examine shortwave and longwave cloud forcing and to deduce required seasonal energy transports. Retrievals of cloud properties from ISCCP and water vapor variations from SSM/T-2 are also used to understand behavior of the humidity fields. These observations are supplemented with output form the DOE Reanalysis-2.

Foundation for the redefinition of the kilogram

NASA Astrophysics Data System (ADS)

Richard, Philippe; Fang, Hao; Davis, Richard

2016-10-01

The redefinition of the kilogram, expected to be approved in the autumn of 2018, will replace the artefact definition of the kilogram by assigning a fixed numerical value to a fundamental constant of physics. While the concept of such a change is pleasing, the mass community as represented by the Consultative Committee for Mass and Related Quantities (CCM) was faced with a number of technical and procedural challenges that needed to be met in order to profit in any meaningful way from the proposed change. In the following, we outline these challenges and how the CCM has met and is meeting them. We focus especially on what the mass community requires of the new definition and the process by which the CCM has sought to ensure that these needs will be met.

Changing fluvial styles in volcaniclastic successions: A cretaceous example from the Cerro Barcino Formation, Patagonia

NASA Astrophysics Data System (ADS)

Umazano, A. Martín; Krause, J. Marcelo; Bellosi, Eduardo S.; Perez, Mariano; Visconti, Graciela; Melchor, Ricardo N.

2017-08-01

The Cretaceous Puesto La Paloma (PLPM) and Cerro Castaño (CCM) members (Cerro Barcino Formation, Chubut Group) are pyroclastic-rich, alluvial successions deposited in the Somuncurá-Cañadón Asfalto Basin during sag and endorheic conditions. The PLPM comprises sheet-like tuffaceous sandstone strata, whereas the overlying CCM includes sheet-to ribbon-channel sandstone bodies intercalated within tuffaceous and fine-grained sediments. In this context, the goals of this contribution were: i) to make a detailed documentation of the contrasting sedimentary palaeonvironments; and ii) to infer the allocyclic controls that governed the sedimentation of both units. The study area is located in the western sector of the basin, where six localities, which were studied. Six facies associations were defined including ash-falls, sheet-floods, shallow lakes, aeolian, fluvial channel-belts, and reworked debris-flows. We defined four stratigraphic intervals for the studied sections, denominated 1 to 4 in chronological order of deposition, which increase their thicknesses toward the Puesto Mesa-Cerro León site. The interval 1 (18-42 m thick) corresponds to the PLPM and includes numerous pedogenized sheet-flood deposits, carbonate-rich lacustrine, aeolian sandy facies, and ash-fall beds. The interval 1 is interpreted as an ephemeral and unconfined alluvial system that interacted with aeolian dunes and dry interdune zones. The interval 2 (20-47 m thick) represents the lower part of the CCM. It shows an alternation of fluvial channel-belt deposits and vegetated floodplain facies with sediments originated from sheet-floods, lakes, and few ash-falls and debris-flows. The mean palaeoflow was toward E-SE, except in the northernmost locality where the drainage was towards SW. Proportion of channel-belt bodies ranges from 10 to 36%, reaching higher values in the northern part of the study area, where they are also thicker. The interval 2 represents a permanent, meandering or locally low-sinuosity, fluvial system, and displays both an increase of lacustrine facies and a decrease of ash-fall deposits. The interval 3 (7.5-27 m thick) corresponds to the middle part of the CCM, and lacks channel-belt bodies. It has the highest participation of sheet-flood and ash-fall deposits. This interval entirely records a pedogenized floodplain setting. In relation to the interval 2, participation of debris-flow deposits remains constant and lacustrine facies subtly increases. The interval 4 (18-148 m thick) represents the upper part of the CCM. It comprises an alternation of channel-belt bodies and pedogenized floodplain facies, the last characterized by sheet-flood, lake, debris-flow, and volcanic ash rain deposits. The mean palaeoflow was toward E-SE, except in the two localities positioned further north where the drainage was towards NE and SSE. Proportion of channel-belt deposits ranges from 6 to 32%. It represents channelized and perennial fluvial systems with meandering and locally low-sinuosity styles. Increase in channel proportion and thicker channel bodies are in the northern part of the study area. Particularly, in Puesto Mesa-Cerro León locality this interval is the thickest and has the highest proportion of thicker channel-belt bodies. We interpret these changes in facies architecture as the response to alternated periods of high (intervals 1 and 3) and low (intervals 2 and 4) primary pyroclastic sediment supply. Moreover, there was a climatic change to wetter conditions (intervals 1 to 2-4); as well as intrabasinal tectonic activity in northern area for intervals 2 and 4 inferred from palaeocurrent data.

Exploratory Causal Analysis in Bivariate Time Series Data

NASA Astrophysics Data System (ADS)

McCracken, James M.

Many scientific disciplines rely on observational data of systems for which it is difficult (or impossible) to implement controlled experiments and data analysis techniques are required for identifying causal information and relationships directly from observational data. This need has lead to the development of many different time series causality approaches and tools including transfer entropy, convergent cross-mapping (CCM), and Granger causality statistics. In this thesis, the existing time series causality method of CCM is extended by introducing a new method called pairwise asymmetric inference (PAI). It is found that CCM may provide counter-intuitive causal inferences for simple dynamics with strong intuitive notions of causality, and the CCM causal inference can be a function of physical parameters that are seemingly unrelated to the existence of a driving relationship in the system. For example, a CCM causal inference might alternate between ''voltage drives current'' and ''current drives voltage'' as the frequency of the voltage signal is changed in a series circuit with a single resistor and inductor. PAI is introduced to address both of these limitations. Many of the current approaches in the times series causality literature are not computationally straightforward to apply, do not follow directly from assumptions of probabilistic causality, depend on assumed models for the time series generating process, or rely on embedding procedures. A new approach, called causal leaning, is introduced in this work to avoid these issues. The leaning is found to provide causal inferences that agree with intuition for both simple systems and more complicated empirical examples, including space weather data sets. The leaning may provide a clearer interpretation of the results than those from existing time series causality tools. A practicing analyst can explore the literature to find many proposals for identifying drivers and causal connections in times series data sets, but little research exists of how these tools compare to each other in practice. This work introduces and defines exploratory causal analysis (ECA) to address this issue along with the concept of data causality in the taxonomy of causal studies introduced in this work. The motivation is to provide a framework for exploring potential causal structures in time series data sets. ECA is used on several synthetic and empirical data sets, and it is found that all of the tested time series causality tools agree with each other (and intuitive notions of causality) for many simple systems but can provide conflicting causal inferences for more complicated systems. It is proposed that such disagreements between different time series causality tools during ECA might provide deeper insight into the data than could be found otherwise.

Human health risk assessment of nitrosamines and nitramines for potential application in CO2 capture.

PubMed

Ravnum, S; Rundén-Pran, E; Fjellsbø, L M; Dusinska, M

2014-07-01

Emission and accumulation of carbon dioxide (CO2) in the atmosphere exert an environmental and climate change challenge. An attempt to deal with this challenge is made at Mongstad by application of amines for CO2 capture and storage (CO2 capture Mongstad (CCM) project). As part of the CO2 capture process, nitrosamines and nitramines may be emitted. Toxicological testing of nitrosamines and nitramines indicate a genotoxic potential of these substances. Here we present a risk characterization and assessment for five nitrosamines (N-Nitrosodi-methylamine (NDMA) N-Nitrosodi-ethylamine (NDEA), N-Nitroso-morpholine (NNM), N-Nitroso-piperidine (NPIP), and Dinitroso-piperazine (DNP)) and two nitramines (N-Methyl-nitramine (NTMA), Dimethyl-nitramine (NDTMA)), which are potentially emitted from the CO2 capture plant (CCP). Human health risk assessment of genotoxic non-threshold substances is a heavily debated topic, and no consensus methodology exists internationally. Extrapolation modeling from high-dose animal exposures to low-dose human exposures can be crucial for the final risk calculation. In the work presented here, different extrapolation models are discussed, and suggestions on applications are given. Then, preferred methods for calculating derived minimal effect level (DMEL) are presented with the selected nitrosamines and nitramines. Copyright © 2014 Elsevier Inc. All rights reserved.

From Communication Skills to Skillful Communication: A Longitudinal Integrated Curriculum for Critical Care Medicine Fellows.

PubMed

Roze des Ordons, Amanda L; Doig, Christopher J; Couillard, Philippe; Lord, Jason

2017-04-01

Communication with patients and families in critical care medicine (CCM) can be complex and challenging. A longitudinal curricular model integrating multiple techniques within classroom and clinical milieus may facilitate skillful communication across diverse settings. In 2014-2015, the authors developed and implemented a curriculum for CCM fellows at the Cumming School of Medicine, University of Calgary, to promote the longitudinal development of skillful communication. A departmental needs assessment informed curriculum development. Five 4-hour classroom sessions were developed: basic communication principles, family meetings about goals and transitions of care, discussing patient safety incidents, addressing conflict, and offering organ donation. Teaching methods-including instructor-led presentations incorporating a consistent framework for approaching challenging conversations, simulation and clinical practice, and feedback from peers, trained facilitators, family members, and clinicians-supported integration of skills into the clinical setting and longitudinal development of skillful communication. Seven fellows participated during the first year of the curriculum. CCM fellows engaged enthusiastically in the program, commented that the framework provided was helpful, and highly valued the opportunity to practice challenging communication scenarios, learn from observing their peers, and receive immediate feedback. More detailed accounts of fellows', patients', and family members' experiences will be obtained to guide curricular development. The curriculum will be expanded to involve other members of the multidisciplinary intensive care unit team, and faculty education initiatives will be offered to enhance the quality of the feedback provided. The impact of the curriculum on initial skill development, retention, and progression will be assessed.

The day/night proteome in the murine heart.

PubMed

Podobed, Peter; Pyle, W Glen; Ackloo, Suzanne; Alibhai, Faisal J; Tsimakouridze, Elena V; Ratcliffe, William F; Mackay, Allison; Simpson, Jeremy; Wright, David C; Kirby, Gordon M; Young, Martin E; Martino, Tami A

2014-07-15

Circadian rhythms are essential to cardiovascular health and disease. Temporal coordination of cardiac structure and function has focused primarily at the physiological and gene expression levels, but these analyses are invariably incomplete, not the least because proteins underlie many biological processes. The purpose of this study was to reveal the diurnal cardiac proteome and important contributions to cardiac function. The 24-h day-night murine cardiac proteome was assessed by two-dimensional difference in gel electrophoresis (2D-DIGE) and liquid chromatography-mass spectrometry. Daily variation was considerable, as ∼7.8% (90/1,147) of spots exhibited statistical changes at paired times across the 24-h light- (L) dark (D) cycle. JTK_CYCLE was used to investigate underlying diurnal rhythms in corresponding mRNA. We next revealed that disruption of the L:D cycle altered protein profiles and diurnal variation in cardiac function in Langendorff-perfused hearts, relative to the L:D cycle. To investigate the role of the circadian clock mechanism, we used cardiomyocyte clock mutant (CCM) mice. CCM myofilaments exhibited a loss of time-of-day-dependent maximal calcium-dependent ATP consumption, and altered phosphorylation rhythms. Moreover, the cardiac proteome was significantly altered in CCM hearts, especially enzymes regulating vital metabolic pathways. Lastly, we used a model of pressure overload cardiac hypertrophy to demonstrate the temporal proteome during heart disease. Our studies demonstrate that time of day plays a direct role in cardiac protein abundance and indicate a novel mechanistic contribution of circadian biology to cardiovascular structure and function.

The day/night proteome in the murine heart

PubMed Central

Podobed, Peter; Pyle, W. Glen; Ackloo, Suzanne; Alibhai, Faisal J.; Tsimakouridze, Elena V.; Ratcliffe, William F.; Mackay, Allison; Simpson, Jeremy; Wright, David C.; Kirby, Gordon M.; Young, Martin E.

2014-01-01

Circadian rhythms are essential to cardiovascular health and disease. Temporal coordination of cardiac structure and function has focused primarily at the physiological and gene expression levels, but these analyses are invariably incomplete, not the least because proteins underlie many biological processes. The purpose of this study was to reveal the diurnal cardiac proteome and important contributions to cardiac function. The 24-h day-night murine cardiac proteome was assessed by two-dimensional difference in gel electrophoresis (2D-DIGE) and liquid chromatography-mass spectrometry. Daily variation was considerable, as ∼7.8% (90/1,147) of spots exhibited statistical changes at paired times across the 24-h light- (L) dark (D) cycle. JTK_CYCLE was used to investigate underlying diurnal rhythms in corresponding mRNA. We next revealed that disruption of the L:D cycle altered protein profiles and diurnal variation in cardiac function in Langendorff-perfused hearts, relative to the L:D cycle. To investigate the role of the circadian clock mechanism, we used cardiomyocyte clock mutant (CCM) mice. CCM myofilaments exhibited a loss of time-of-day-dependent maximal calcium-dependent ATP consumption, and altered phosphorylation rhythms. Moreover, the cardiac proteome was significantly altered in CCM hearts, especially enzymes regulating vital metabolic pathways. Lastly, we used a model of pressure overload cardiac hypertrophy to demonstrate the temporal proteome during heart disease. Our studies demonstrate that time of day plays a direct role in cardiac protein abundance and indicate a novel mechanistic contribution of circadian biology to cardiovascular structure and function. PMID:24789993

Increase in flood frequency during extreme aridity in the Eastern Mediterranean at the last interglacial

NASA Astrophysics Data System (ADS)

Kiro, Yael; Goldstein, Steven L.; Kushnir, Yochanan; Lazr, Boaz; Stein, Mordechai

2017-04-01

The Levant region of the Eastern Mediterranean is expected to suffer greatly from climate change. It is a drought-sensitive area, where warming climate may have already affected political stability in the region. Climate models and observations show a recent drying trend around the entire Mediterranean during winter, the wet season, that has been attributed to a combination of natural variability and increased greenhouse gas concentrations. Together with the drying trend, the region has also experienced more intense rainfall events. Thick halite sequences revealed by the Dead Sea Deep Drilling project (DSDDP) cores show that extremely arid conditions prevailed in the Levant during Marine Isotope Stage (MIS) 5e. This time interval was relatively warm and characterized by an average precipitation rate of 50% compared to the present (based on water and salt budgets). It also exhibited strong fluctuations between wet periods similar to the present-day lasting a few thousands of years, and dry periods with precipitation as low as 20% of the present-day over intervals lasting a few hundreds of years. At the same time, the climate was characterized by scarce but intense rainfall events in the southern Levant and increased flash flood frequency. The increase in precipitation in the south is indicated by changes in 234U/238U activity ratios in authigenic minerals in the cores, which is a good proxy for identifying changes in water sources. The synoptic configuration, of overall increased aridity together with an increase in southern precipitation and flash floods, is known from the present climate but is less dominant than the normal conditions whereby winter precipitation is fed by a Mediterranean moisture source. Climate models suggest that an increase in both summer and winter precipitation occurred during the peak insolation at 125 ka, with both the Mediterranean and the tropics as possible moisture sources. At 120 ka, climate model runs using the NCAR CCM3, show a decrease in precipitation, which coincides with the thick sequence of halite in the DSDDP core. Despite the decrease in total annual precipitation, the 120 ka simulation shows an increase in autumn precipitation that seems to be the result of intensification of the African Monsoon. This autumn intensification coincides with a drift in the positive summer insolation anomaly toward the fall season, and highlights the significance of the orbital forcing of mid-latitude climate. These results have a direct relationship to modern climate and possibly its expected future changes. Today, a manifestation of the African Monsoon in the Levant is the active Red Sea Trough (RST), which is responsible for major flooding in the Levant and the Middle East during the autumn. Modern observations show that the current increase in aridity is associated with a decrease in the major Mediterranean source (the Cyprus Low) contributor to Levant precipitation and an increase in RST frequency.

A “Coiled-Coil” Motif Is Important for Oligomerization and DNA Binding Properties of Human Cytomegalovirus Protein UL77

PubMed Central

Dittmer, Alexandra; Lapp, Sara; Bogner, Elke

2011-01-01

Human cytomegalovirus (HCMV) UL77 gene encodes the essential protein UL77, its function is characterized in the present study. Immunoprecipitation identified monomeric and oligomeric pUL77 in HCMV infected cells. Immunostaining of purified virions and subviral fractions showed that pUL77 is a structural protein associated with capsids. In silico analysis revealed the presence of a coiled-coil motif (CCM) at the N-terminus of pUL77. Chemical cross-linking of either wild-type pUL77 or CCM deletion mutant (pUL77ΔCCM) implicated that CCM is critical for oligomerization of pUL77. Furthermore, co-immunoprecipitations of infected and transfected cells demonstrated that pUL77 interacts with the capsid-associated DNA packaging motor components, pUL56 and pUL104, as well as the major capsid protein. The ability of pUL77 to bind dsDNA was shown by an in vitro assay. Binding to certain DNA was further confirmed by an assay using biotinylated 36-, 250-, 500-, 1000-meric dsDNA and 966-meric HCMV-specific dsDNA designed for this study. The binding efficiency (BE) was determined by image processing program defining values above 1.0 as positive. While the BE of the pUL56 binding to the 36-mer bio-pac1 containing a packaging signal was 10.0±0.63, the one for pUL77 was only 0.2±0.03. In contrast to this observation the BE of pUL77 binding to bio-500 bp or bio-1000 bp was 2.2±0.41 and 4.9±0.71, respectively. By using pUL77ΔCCM it was demonstrated that this protein could not bind to dsDNA. These data indicated that pUL77 (i) could form homodimers, (ii) CCM of pUL77 is crucial for oligomerization and (iii) could bind to dsDNA in a sequence independent manner. PMID:21998635

Final report on the torque key komparison CCM.T-K1.2 measurand torque: 0 N.m, 500 N.m, 1000 N.m

NASA Astrophysics Data System (ADS)

Röske, Dirk

2015-01-01

The purpose of the CIPM subsequent bilateral comparison CCM.T-K1.2 was to link another participant, namely the National Institute of Metrology (Thailand), in short NIMT, to the CCM.T-K1 torque key comparison. The measuring capabilities up to 1000 N.m of dead-weight torque standard machines with supported lever were investigated. The pilot laboratory was the same in both comparisons—it was the Physikalisch-Technische Bundesanstalt (PTB, Braunschweig, Germany). The same two very stable torque transducers with well-known properties were used as travelling standards. The measurements at the participating laboratory were carried out between November 2007 and February 2008. According to the technical protocol, torque steps of 500 N.m and 1000 N.m had to be measured both in clockwise and anticlockwise directions. Corrections had to be applied to the results reported by the participants taking into account the use of different amplifiers, the creep (due to different loading times of the machines) and the environmental conditions in the laboratories (temperature and relative humidity of the ambient air). The results of the pilot laboratory in this bilateral comparison are in very good agreement with the same results obtained in the CCM.T-K1 comparison. For each of the transducers, the two torque steps and both senses of direction of the torque vector, the key comparison reference value of the CCM.T-K1 was taken, and the results of participant NIMT were calculated with respect to these values. The agreement between the results is very good. The smallest expanded (k = 2) relative uncertainty of the machine stated by the participant is 1 × 10-4. The results of the comparison support this uncertainty statement. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Dosimetric evaluation of high-dose-rate interstitial brachytherapy boost treatments for localized prostate cancer.

PubMed

Fröhlich, Georgina; Agoston, Péter; Lövey, József; Somogyi, András; Fodor, János; Polgár, Csaba; Major, Tibor

2010-07-01

To quantitatively evaluate the dose distributions of high-dose-rate (HDR) prostate implants regarding target coverage, dose homogeneity, and dose to organs at risk. Treatment plans of 174 implants were evaluated using cumulative dose-volume histograms (DVHs). The planning was based on transrectal ultrasound (US) imaging, and the prescribed dose (100%) was 10 Gy. The tolerance doses to rectum and urethra were 80% and 120%, respectively. Dose-volume parameters for target (V90, V100, V150, V200, D90, D(min)) and quality indices (DNR [dose nonuniformity ratio], DHI [dose homogeneity index], CI [coverage index], COIN [conformal index]) were calculated. Maximum dose in reference points of rectum (D(r)) and urethra (D(u)), dose to volume of 2 cm(3) of the rectum (D(2ccm)), and 0.1 cm(3) and 1% of the urethra (D(0.1ccm) and D1) were determined. Nonparametric correlation analysis was performed between these parameters. The median number of needles was 16, the mean prostate volume (V(p)) was 27.1 cm(3). The mean V90, V100, V150, and V200 were 99%, 97%, 39%, and 13%, respectively. The mean D90 was 109%, and the D(min) was 87%. The mean doses in rectum and urethra reference points were 75% and 119%, respectively. The mean volumetric doses were D(2ccm) = 49% for the rectum, D(0.1ccm) = 126%, and D1 = 140% for the urethra. The mean DNR was 0.37, while the DHI was 0.60. The mean COIN was 0.66. The Spearman rank order correlation coefficients for volume doses to rectum and urethra were R(D(r),D(2ccm)) = 0.69, R(D(u),D0.(1ccm)) = 0.64, R(D(u),D1) = 0.23. US-based treatment plans for HDR prostate implants based on the real positions of catheters provided acceptable dose distributions. In the majority of the cases, the doses to urethra and rectum were kept below the defined tolerance levels. For rectum, the dose in reference points correlated well with dose-volume parameters. For urethra dose characterization, the use of D1 volumetric parameter is recommended.

Surface acid-base behaviors of Chinese loess.

PubMed

Chu, Zhaosheng; Liu, Wenxin; Tang, Hongxiao; Qian, Tianwei; Li, Shushen; Li, Zhentang; Wu, Guibin

2002-08-15

Acid-base titration was applied to investigate the surface acid-base properties of a Chinese loess sample at different ionic strengths. The acidimetric supernatant was regarded as the system blank of titration to correct the influence of particle dissolution on the estimation of proton consumption. The titration behavior of the system blank could be described by the hydrolysis of Al3+ and Si(OH)4 in aqueous solution as well as the production of hydroxyaluminosilicates. The formation of Al-Si species on homogeneous surface sites by hydrous aluminum and silicic acid, released from solid substrate during the acidic titration, was considered in the model description of the back-titration procedure. A surface reaction model was suggested as follows: >SOH<-->SO(-)+H+, pK(a)(int)=3.48-3.98;>SOH+Al(3+)+H4SiO4<-->SOAl(OSi(OH)3(+)+2H+, pK(SC)=3.48-4.04. Two simple surface complexation models accounted for the interfacial structure, i.e., the constant capacitance model (CCM) and the diffuse layer model (DLM), and gave a satisfactory description of the experimental data. Considering the effect of ionic strength on the electrostatic profile at the solid-aqueous interface, the DLM was appropriate at the low concentrations (0.01 and 0.005 mol/L) of background electrolyte (NaNO3 in this study), while the CCM was preferable in the case of high ionic strength (0.1 mol/L).

Stratigraphy, correlation, depositional setting, and geophysical characteristics of the Oligocene Snowshoe Mountain Tuff and Creede Formation in two cored boreholes

USGS Publications Warehouse

Larsen, Daniel; Nelson, Philip H.

2000-01-01

Core descriptions and geophysical logs from two boreholes (CCM-1 and CCM-2) in the Oligocene Snowshoe Mountain Tuff and Creede Formation, south-central Colorado, are used to interpret sedimentary and volcanic facies associations and their physical properties. The seven facies association include a mixed sequence of intracaldera ash-flow tuffs and breccias, alluvial and lake margin deposits, and tuffaceous lake beds. These deposits represent volcanic units related to caldera collapse and emplacement of the Snowshoe Mountain Tuff, and sediments and pyroclastic material deposited in the newly formed caldera basin, Early sedimentation is interpreted to have been rapid, and to have occurred in volcaniclastic fan environments at CCM-1 and in a variery of volcaniclastic fan, braided stream shallow lacustrine, and mudflat environments at CCM-2. After an initial period of lake-level rise, suspension settling, turbidite, and debris-flow sedimentation occurred in lacustrine slope and basin environments below wave base. Carbonate sedimentation was initially sporadic, but more continuous in the latter part of the recorded lake history (after the H fallout tuff). Sublacustrine-fan deposition occurred at CCM-1 after a pronounced lake-level fall and subsequent rise that preceded the H tuff. Variations in density, neutron, gamma-ray, sonic, and electrical properties of deposits penetrated oin the two holes reflect variations in lithology, porosity, and alteration. Trends in the geophysical properties of the lacustrine strata are linked to downhole changes in authigenic mineralology and a decrease in porosity interpreted to have resulted primarily from diagenesis. Lithological and geophysical characteristics provide a basis for correlation of the cores; however, mineralogical methods of correlation are hampered by the degree of diagenesis and alteration.

Comparison of fracture resistance between cast, CAD/CAM milling, and direct metal laser sintering metal post systems.

PubMed

Bilgin, Mehmet Selim; Erdem, Ali; Dilber, Erhan; Ersoy, İbrahim

2016-01-01

The purpose of this study was to compare the fracture resistance of Co-Cr post-cores fabricated with 3 different techniques: traditional casting (TC), computer-aided design and manufacturing (CAD/CAM) milling (CCM) and direct metal laser sintering (DMLS). Forty intact human mandibular premolar were endodontically treated. The roots were then randomly divided into four groups according to the post systems: the control group was only filled with gutta percha. Co-Cr metal posts were fabricated with TC, CCM and DMLS in the other three groups. The posts were luted with a resin cement and subjected to compression test at a crosshead speed of 1mm/min. The statistical analysis of the data was performed using one-way analysis of variance (ANOVA) and multiple comparison post hoc Tukey tests (α=.05). The samples were examined under a stereomicroscope with ×20 magnification for the evaluation of the fracture types. The mean fracture loads were 432.69 N for control, 608.89 N for TC, 689.40 N for DMLS and 959.26 N for CCM. One-way ANOVA revealed significant difference between the groups (p<0.01). In the post hoc Tukey test, there were significant differences between groups except DMLS and TC. While Co-Cr posts fabricated by TC and DMLS systems performed similarly in terms of fracture resistance, posts fabricated by CCM techniques showed higher fracture resistance values. Co-Cr metal posts fabricated by CCM and DMLS could be an alternative to TC processing in daily clinical application. Copyright © 2015 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Identification of a Novel Gene, CIA6, Required for Normal Pyrenoid Formation in Chlamydomonas reinhardtii1[C][W][OA

PubMed Central

Ma, Yunbing; Pollock, Steve V.; Xiao, Ying; Cunnusamy, Khrishen; Moroney, James V.

2011-01-01

Chlamydomonas reinhardtii possesses a CO2-concentrating mechanism (CCM) that allows the alga to grow at low CO2 concentrations. One common feature seen in photosynthetic organisms possessing a CCM is the tight packaging of Rubisco within the cell. In many eukaryotic algae, Rubisco is localized to the pyrenoid, an electron-dense structure within the chloroplast. In order to identify genes required for a functional CCM, insertional Bleomycin resistance (BleR) mutants were generated and screened for growth on minimal medium under high CO2 conditions (5% CO2 in air) but only slow or no growth under very low CO2 conditions (0.01% CO2 in air). One mutant identified from this screen was named cia6. Physiological studies established that cia6 grows poorly on low levels of CO2 and has an impaired ability to accumulate inorganic carbon. The inserted BleR disrupted a gene encoding a protein with sequence similarity to proteins containing SET domain methyltransferase, although experiments using overexpressed CIA6 failed to demonstrate the methyltransferase activity. Electron microscopy revealed that the pyrenoid of cia6 mutant cells is highly disorganized. Complementation of the mutant restored the pyrenoid, the ability to grow under low-CO2 conditions, and the ability to concentrate inorganic carbon. Quantitative reverse transcription-polymerase chain reaction data from a low-CO2 induction time-course experiment demonstrated that the up-regulation of several CCM components is slower in cia6 compared with the wild type. This slow induction was further confirmed at the protein level using western blots. These results indicated that CIA6 is required for the formation of the pyrenoid and further supported the notion that the pyrenoid is required for a functional CCM in C. reinhardtii. PMID:21527423

What influences availability of medicines for the community management of childhood illnesses in central Uganda? Implications for scaling up the integrated community case management programme.

PubMed

Bagonza, James; Rutebemberwa, Elizeus; Eckmanns, Tim; Ekirapa-Kiracho, Elizabeth

2015-11-25

The integrated Community Case Management (iCCM) of childhood illnesses strategy has been adopted world over to reduce child related ill health and mortality. Community Health workers (CHWs) who implement this strategy need a regular supply of drugs to effectively treat children under 5 years with malaria, pneumonia and diarrhea. In this paper, we report the prevalence and factors influencing availability of medicines for managing malaria, pneumonia and diarrhea in communities in central Uganda. A cross sectional study was conducted among 303 CHWs in Wakiso district in central Uganda. Eligible CHWs from two randomly selected Health Sub Districts (HSDs) were interviewed. Questionnaires, check lists, record reviews were used to collect information on CHW background characteristics, CHW's prescription behaviors, health system support factors and availability of iCCM drugs. Multivariable logistic regression analysis was done to assess factors associated with availability of iCCM drugs. Out of 300 CHWs, 239 (79.9%) were females and mean age was 42.1 (standard deviation =11.1 years). The prevalence of iCCM drug availability was 8.3% and 33 respondents (11%) had no drugs at all. Factors associated with iCCM drug availability were; being supervised within the last month (adjusted OR = 3.70, 95% CI 1.22-11.24), appropriate drug prescriptions (adjusted OR = 3.71, 95% CI 1.38-9.96), regular submission of drug reports (adjusted OR = 4.02, 95% CI 1.62-10.10) and having a respiratory timer as a diagnostic tool (adjusted OR =3.11, 95% CI 1.08-9.00). The low medicine stocks for the community management of childhood illnesses calls for strengthening of CHW supervision, medicine prescription and reporting, and increasing availability of functional diagnostic tools.

KEY COMPARISON: Final report of comparison of the calibrations of hydrometers for liquid density determination between SIM laboratories: SIM.M.D-K4

NASA Astrophysics Data System (ADS)

Becerra, Luis Omar

2009-01-01

This SIM comparison on the calibration of high accuracy hydrometers was carried out within fourteen laboratories in the density range from 600 kg/m3 to 1300 kg/m3 in order to evaluate the degree of equivalence among participant laboratories. This key comparison anticipates the planned key comparison CCM.D-K4, and is intended to be linked with CCM.D-K4 when results are available. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (MRA).

Exceptional warming in the Western Pacific-Indian Ocean warm pool has contributed to more frequent droughts in eastern Africa

USGS Publications Warehouse

Funk, Christopher C.; Peterson, Thomas C.; Stott, Peter A.; Herring, Stephanie

2012-01-01

In 2011, East Africa faced a tragic food crisis that led to famine conditions in parts of Somalia and severe food shortages in parts of Ethiopia and Somalia. While many nonclimatic factors contributed to this crisis (high global food prices, political instability, and chronic poverty, among others) failed rains in both the boreal winter of 2010/11 and the boreal spring of 2011 played a critical role. The back-to-back failures of these rains, which were linked to the dominant La Niña climate and warm SSTs in the central and southeastern Indian Ocean, were particularly problematic since they followed poor rainfall during the spring and summer of 2008 and 2009. In fact, in parts of East Africa, in recent years, there has been a substantial increase in the number of below-normal rainy seasons, which may be related to the warming of the western Pacific and Indian Oceans (for more details, see Funk et al. 2008; Williams and Funk 2011; Williams et al. 2011; Lyon and DeWitt 2012). The basic argument of this work is that recent warming in the Indian–Pacific warm pool (IPWP) enhances the export of geopotential height energy from the warm pool, which tends to produce subsidence across eastern Africa and reduce onshore moisture transports. The general pattern of this disruption has been supported by canonical correlation analyzes and numerical experiments with the Community Atmosphere Model (Funk et al. 2008), diagnostic evaluations of reanalysis data (Williams and Funk 2011; Williams et al. 2011), and SST-driven experiments with ECHAM4.5, ECHAM5, and the Community Climate Model version 3 (CCM3.6) (Lyon and DeWitt 2012).

Directional solidification at ultra-high thermal gradient

NASA Technical Reports Server (NTRS)

Flemings, M. C.; Lee, D. S.; Neff, M. A.

1980-01-01

A high gradient controlled solidification (HGC) furnace was designed and operated at gradients up to 1800 C/cm to continuously produce aluminum alloys. Rubber '0' rings for the water cooling chamber were eliminated, while still maintaining water cooling directly onto the solidified metal. An HGC unit for high temperature ferrous alloys was also designed. Successful runs were made with cast iron, at thermal gradients up to 500 C/cm.

Final report on the key comparison CCM.P-K4.2012 in absolute pressure from 1 Pa to 10 kPa

NASA Astrophysics Data System (ADS)

Ricker, Jacob; Hendricks, Jay; Bock, Thomas; Dominik, Pražák; Kobata, Tokihiko; Torres, Jorge; Sadkovskaya, Irina

2017-01-01

The report summarizes the Consultative Committee for Mass (CCM) key comparison CCM.P-K4.2012 for absolute pressure spanning the range of 1 Pa to 10 000 Pa. The comparison was carried out at six National Metrology Institutes (NMIs), including National Institute of Standards and Technology (NIST), Physikalisch-Technische Bundesanstalt (PTB), Czech Metrology Institute (CMI), National Metrology Institute of Japan (NMIJ), Centro Nacional de Metrología (CENAM), and DI Mendeleyev Institute for Metrology (VNIIM). The comparison was made via a calibrated transfer standard measured at each of the NMIs facilities using their laboratory standard during the period May 2012 to September 2013. The transfer package constructed for this comparison preformed as designed and provided a stable artifact to compare laboratory standards. Overall the participants were found to be statistically equivalent to the key comparison reference value. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Corneal Confocal Microscopy Detects Early Nerve Regeneration in Diabetic Neuropathy After Simultaneous Pancreas and Kidney Transplantation

PubMed Central

Tavakoli, Mitra; Mitu-Pretorian, Maria; Petropoulos, Ioannis N.; Fadavi, Hassan; Asghar, Omar; Alam, Uazman; Ponirakis, Georgios; Jeziorska, Maria; Marshall, Andy; Efron, Nathan; Boulton, Andrew J.; Augustine, Titus; Malik, Rayaz A.

2013-01-01

Diabetic neuropathy is associated with increased morbidity and mortality. To date, limited data in subjects with impaired glucose tolerance and diabetes demonstrate nerve fiber repair after intervention. This may reflect a lack of efficacy of the interventions but may also reflect difficulty of the tests currently deployed to adequately assess nerve fiber repair, particularly in short-term studies. Corneal confocal microscopy (CCM) represents a novel noninvasive means to quantify nerve fiber damage and repair. Fifteen type 1 diabetic patients undergoing simultaneous pancreas–kidney transplantation (SPK) underwent detailed assessment of neurologic deficits, quantitative sensory testing (QST), electrophysiology, skin biopsy, corneal sensitivity, and CCM at baseline and at 6 and 12 months after successful SPK. At baseline, diabetic patients had a significant neuropathy compared with control subjects. After successful SPK there was no significant change in neurologic impairment, neurophysiology, QST, corneal sensitivity, and intraepidermal nerve fiber density (IENFD). However, CCM demonstrated significant improvements in corneal nerve fiber density, branch density, and length at 12 months. Normalization of glycemia after SPK shows no significant improvement in neuropathy assessed by the neurologic deficits, QST, electrophysiology, and IENFD. However, CCM shows a significant improvement in nerve morphology, providing a novel noninvasive means to establish early nerve repair that is missed by currently advocated assessment techniques. PMID:23002037

Systematic review; Nutritional therapy in gestational diabetes mellitus.

PubMed

Thomaz de Lima, Helaine; Lopes Rosado, Eliane; Ribeiro Neves, Paulo Augusto; Corrêa Monteiro Machado, Raphaela; Mello de Oliveira, Larissa; Saunders, Cláudia

2013-11-01

Several methods of dietetic counseling can be used in the nutritional therapy in gestational diabetes mellitus (GDM). The main methods are the traditional method (TM) and the carbohydrate counting (CCM). Presenting a systematic review of the literature on the impact of nutritional therapy in GDM, through TM and CCM, evaluating the results for maternal and child health. We searched databases PubMed, Scopus, Web of Science, Lilacs and CAPES Digital Bank of Thesis. The methodological quality of all the studies included was made using the Jadad score. We have found five studies that evaluated the effects of nutritional therapy, through the TM, on the maternal and child health. None study evaluating the CCM was detected in pregnant women with GDM Nutritional therapy given during antenatal care was effective in reducing pregnancy complications (preeclampsia, excessive gestational weight gain, necessity for cesarean delivery, for insulin therapy and for shoulder dystocia), perinatal complications (macrosomia, neonatal hypoglycemia, and birth weight) and also in better glycemic control. The use of nutritional therapy should be highlighted within the antenatal care for pregnant women with GDM, giving the satisfactory results on metabolic control and on pregnancy outcomes. Studies examining the CCM to GDM patients should be conducted to show its effects on maternal and child health.

A causal loop analysis of the sustainability of integrated community case management in Rwanda.

PubMed

Sarriot, Eric; Morrow, Melanie; Langston, Anne; Weiss, Jennifer; Landegger, Justine; Tsuma, Laban

2015-04-01

Expansion of community health services in Rwanda has come with the national scale up of integrated Community Case Management (iCCM) of malaria, pneumonia and diarrhea. We used a sustainability assessment framework as part of a large-scale project evaluation to identify factors affecting iCCM sustainability (2011). We then (2012) used causal-loop analysis to identify systems determinants of iCCM sustainability from a national systems perspective. This allows us to develop three high-probability future scenarios putting the achievements of community health at risk, and to recommend mitigating strategies. Our causal loop diagram highlights both balancing and reinforcing loops of cause and effect in the national iCCM system. Financial, political and technical scenarios carry high probability for threatening the sustainability through: (1) reduction in performance-based financing resources, (2) political shocks and erosion of political commitment for community health, and (3) insufficient progress in resolving district health systems--"building blocks"--performance gaps. In a complex health system, the consequences of choices may be delayed and hard to predict precisely. Causal loop analysis and scenario mapping make explicit complex cause-and-effects relationships and high probability risks, which need to be anticipated and mitigated. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Microvasculature of the cerebral cortex: a vascular corrosion cast and immunocytochemical study.

PubMed

Scala, Gaetano

2014-04-01

In mammals, the cerebral cortex microvasculature (CCM) of the neopallium plays important roles in the physiological and pathological processes of the brain. The aim of the present work is to analyze the CCM by use of the SEM-vascular corrosion cast technique, and to examine the immunocytochemical characteristics of the CCM in adult domestic ruminants (cattle, buffalo, and sheep) by using the SEM-immunogold technique. The CCM originated from the very small, finger-like terminal branches of the macrovasculature of the brain. The superficial cortical arterioles were more numerous than the deep straight arterioles which proceeded toward the white matter. The surface casts of the arterioles and capillaries of the cerebral cortex showed ring-shaped formations in the arterioles and at the origin of the capillaries. All capillaries down-stream from these ring-shaped formations were flaccid. Casts of the capillaries showed wrinkles due to the presence of endothelial folds, which is characteristic of varying blood pressure. Formations having intense anti-GIFAP immunoreactivity were frequently evident along the course of the blood capillaries in the cerebral cortex. These formations were probably astrocytes that might regulate the cerebral microcirculation based on physiological and pathological stimuli, such as neuronal activation. Copyright © 2014 Wiley Periodicals, Inc.

Cornea nerve fiber quantification and construction of phenotypes in patients with fibromyalgia

PubMed Central

Oudejans, Linda; He, Xuan; Niesters, Marieke; Dahan, Albert; Brines, Michael; van Velzen, Monique

2016-01-01

Cornea confocal microscopy (CCM) is a novel non-invasive method to detect small nerve fiber pathology. CCM generally correlates with outcomes of skin biopsies in patients with small fiber pathology. The aim of this study was to quantify the morphology of small nerve fibers of the cornea of patients with fibromyalgia in terms of density, length and branching and further phenotype these patients using standardized quantitative sensory testing (QST). Small fiber pathology was detected in the cornea of 51% of patients: nerve fiber length was significantly decreased in 44% of patients compared to age- and sex-matched reference values; nerve fiber density and branching were significantly decreased in 10% and 28% of patients. The combination of the CCM parameters and sensory tests for central sensitization, (cold pain threshold, mechanical pain threshold, mechanical pain sensitivity, allodynia and/or windup), yielded four phenotypes of fibromyalgia patients in a subgroup analysis: one group with normal cornea morphology without and with signs of central sensitization, and a group with abnormal cornea morphology parameters without and with signs of central sensitization. In conclusion, half of the tested fibromyalgia population demonstrates signs of small fiber pathology as measured by CCM. The four distinct phenotypes suggest possible differences in disease mechanisms and may require different treatment approaches. PMID:27006259

A critical courier role of volatile oils from Dalbergia odorifera for cardiac protection in vivo by QiShenYiQi.

PubMed

Yu, Jiahui; Zhang, Wen; Zhang, Yiqian; Wang, Yadong; Zhang, Boli; Fan, Guanwei; Zhu, Yan

2017-08-04

Component-based Chinese medicine (CCM) is derived from traditional Chinese medicine but produced with modern pharmaceutical standard and clearer clinical indications. However, it still faces challenges of defining individual component contribution in the complex formula. Using QiShenYiQi (QSYQ) as a model CCM, we investigated the role of Dalbergia odorifera (DO), an herbal component, in preventing myocardial damage. We showed that in vitro, QSYQ exerted considerable protective activities on cardiomyocytes from H 2 O 2 -induced mitochondrial dysfunction with or without DO. However, in isolated rat hearts, myocardial protection by QSYQ was significantly weakened without DO. In everted gut sac model, DO significantly enhanced absorption of the major QSYQ ingredients in different regions of rat intestine. Finally, in in vivo mouse model of doxorubicin (DOX)-induced myocardial damage, only QSYQ, but not QiShenYiQi without DO (QSYQ-DO), exerted a full protection. Taken together, our results showed that instead of directly contributing to the myocardial protection, Dalbergia odorifera facilitates the major active ingredients absorption and increases their efficacy, eventually enhancing the in vivo potency of QSYQ. These findings may shed new lights on our understanding of the prescription compatibility theory, as well as the impacts of "courier herbs" in component-based Chinese medicine.

The Communal Coping Model of Pain Catastrophizing in Daily Life: A Within-Couples Daily Diary Study

PubMed Central

Burns, John W.; Gerhart, James I.; Post, Kristina M.; Smith, David A.; Porter, Laura S.; Schuster, Erik; Buvanendran, Asokumar; Fras, Anne Marie; Keefe, Francis J.

2015-01-01

The Communal Coping Model (CCM) characterizes pain catastrophizing as a coping tactic whereby pain expression elicits assistance and empathic responses from others. Married couples (N = 105 couples; one spouse with chronic low back pain) completed electronic daily diary assessments 5 times/day for 14 days. On these diaries, patients reported pain catastrophizing, pain, function, and perceived spouse support, criticism and hostility. Non-patient spouses reported on their support, criticism, and hostility directed toward patients, as well as their observations of patient pain and pain behaviors. Hierarchical linear modeling tested concurrent and lagged (3 hours later) relationships. Principal findings included: a) within-person increases in pain catastrophizing were positively associated with spouse reports of patient pain behavior in concurrent and lagged analyses; b) within-person increases in pain catastrophizing were positively associated with patient perceptions of spouse support, criticism, and hostility in concurrent analyses; c) within-person increases in pain catastrophizing were negatively associated with spouse reports of criticism and hostility in lagged analyses. Spouses reported patient behaviors that were tied to elevated pain catastrophizing, and spouses changed their behavior during and following elevated pain catastrophizing episodes. Pain catastrophizing may affect the interpersonal environment of patients and spouses in ways consistent with the CCM. PMID:26320945

Rheumatic heart disease: infectious disease origin, chronic care approach.

PubMed

Katzenellenbogen, Judith M; Ralph, Anna P; Wyber, Rosemary; Carapetis, Jonathan R

2017-11-29

Rheumatic heart disease (RHD) is a chronic cardiac condition with an infectious aetiology, causing high disease burden in low-income settings. Affected individuals are young and associated morbidity is high. However, RHD is relatively neglected due to the populations involved and its lower incidence relative to other heart diseases. In this narrative review, we describe how RHD care can be informed by and integrated with models of care developed for priority non-communicable diseases (coronary heart disease), and high-burden communicable diseases (tuberculosis). Examining the four-level prevention model (primordial through tertiary prevention) suggests primordial and primary prevention of RHD can leverage off existing tuberculosis control efforts, given shared risk factors. Successes in coronary heart disease control provide inspiration for similarly bold initiatives for RHD. Further, we illustrate how the Chronic Care Model (CCM), developed for use in non-communicable diseases, offers a relevant framework to approach RHD care. Systems strengthening through greater integration of services can improve RHD programs. Strengthening of systems through integration/linkages with other well-performing and resourced services in conjunction with policies to adopt the CCM framework for the secondary and tertiary prevention of RHD in settings with limited resources, has the potential to significantly reduce the burden of RHD globally. More research is required to provide evidence-based recommendations for policy and service design.

Relationship between Trends in Land Precipitation and Tropical SST Gradient

NASA Technical Reports Server (NTRS)

Chung, Chul Eddy; Ramanathan, V.

2007-01-01

In this study, we examined global zonal/annual mean precipitation trends. Land precipitation trend from 1951 to 2002 shows widespread drying between 10 S to 20 N but the trend from 1977 to 2002 shows partial recovery. Based on general circulation model sensitivity studies, we suggested that these features are driven largely by the meridional SST gradient trend in the tropics. Our idealized CCM3 experiments substantiated that land precipitation is more sensitive to meridional SST gradient than to an overall tropical warming. Various simulations produced for the IPCC 4th assessment report demonstrate that increasing CO2 increases SST in the entire tropics non-uniformly and increases land precipitation only in certain latitude belts, again pointing to the importance of SST gradient change. Temporally varying aerosols in the IPCC simulations alter meridional SST gradient and land precipitation substantially. Anthropogenic aerosol direct solar forcing without its effects on SST is shown by the CCM3 to have weak but non-negligible influence on land precipitation.

Development Challenges of Utilizing a Corner Cube Mechanism Design with Successful IASI Flight Heritage for the Infrared Sounder (IRS) on MTG: Recurrent Mechanical Design not Correlated to Recurrent Development

NASA Astrophysics Data System (ADS)

Spanoudakis, Peter; Schwab, Philippe; Kiener, Lionel; Saudan, Herve; Perruchoud, Gerald

2015-09-01

The Corner Cube Mechanism (CCM) design for the Infra-Red Sounder (IRS) on MTG is based on the successful mechanism currently in orbit on the Infrared Atmospheric Sounding Interferometers (IASI) on the Metop satellites. The overall CCM performance is described with attention given to the specific design developments for the MTG project. A description is presented of the modifications introduced and challenges encountered to adapt the IASI space heritage design (which is only 15 years old) to meet the MTG specifications. A detailed account is provided regarding the tests performed on the adapted components for the new programme. The major issues encountered and solutions proposed are illustrated concerning the voice- coil actuator development, optical switch design, fatigue life of the flexure components and the adaptation of the launch locking device. Nevertheless, an Engineering Qualification Model was rapidly manufactured and now undergoing a qualification test campaign.

Analyzing Cultural Consensus with Proportional Reduction in Error (PRE): Beyond the Eigenvalue Ratio

ERIC Educational Resources Information Center

Lacy, Michael G.; Snodgrass, Jeffrey G.

2016-01-01

This article provides an alternate method to assess the fit of the cultural consensus model (CCM) of Romney and colleagues to the responses of a group of informants about a domain of knowledge, and thus also to evaluate the extent of shared knowledge within a group. Criteria for judging the existence of singular culture have been articulated…

Connected Component Model for Multi-Object Tracking.

PubMed

He, Zhenyu; Li, Xin; You, Xinge; Tao, Dacheng; Tang, Yuan Yan

2016-08-01

In multi-object tracking, it is critical to explore the data associations by exploiting the temporal information from a sequence of frames rather than the information from the adjacent two frames. Since straightforwardly obtaining data associations from multi-frames is an NP-hard multi-dimensional assignment (MDA) problem, most existing methods solve this MDA problem by either developing complicated approximate algorithms, or simplifying MDA as a 2D assignment problem based upon the information extracted only from adjacent frames. In this paper, we show that the relation between associations of two observations is the equivalence relation in the data association problem, based on the spatial-temporal constraint that the trajectories of different objects must be disjoint. Therefore, the MDA problem can be equivalently divided into independent subproblems by equivalence partitioning. In contrast to existing works for solving the MDA problem, we develop a connected component model (CCM) by exploiting the constraints of the data association and the equivalence relation on the constraints. Based upon CCM, we can efficiently obtain the global solution of the MDA problem for multi-object tracking by optimizing a sequence of independent data association subproblems. Experiments on challenging public data sets demonstrate that our algorithm outperforms the state-of-the-art approaches.

Selective classification and quantification model of C&D waste from material resources consumed in residential building construction.

PubMed

Mercader-Moyano, Pilar; Ramírez-de-Arellano-Agudo, Antonio

2013-05-01

The unfortunate economic situation involving Spain and the European Union is, among other factors, the result of intensive construction activity over recent years. The excessive consumption of natural resources, together with the impact caused by the uncontrolled dumping of untreated C&D waste in illegal landfills have caused environmental pollution and a deterioration of the landscape. The objective of this research was to generate a selective classification and quantification model of C&D waste based on the material resources consumed in the construction of residential buildings, either new or renovated, namely the Conventional Constructive Model (CCM). A practical example carried out on ten residential buildings in Seville, Spain, enabled the identification and quantification of the C&D waste generated in their construction and the origin of the waste, in terms of the building material from which it originated and its impact for every m(2) constructed. This model enables other researchers to establish comparisons between the various improvements proposed for the minimization of the environmental impact produced by building a CCM, new corrective measures to be proposed in future policies that regulate the production and management of C&D waste generated in construction from the design stage to the completion of the construction process, and the establishment of sustainable management for C&D waste and for the selection of materials for the construction on projected or renovated buildings.

Soil Moisture and Snow Cover: Active or Passive Elements of Climate?

NASA Technical Reports Server (NTRS)

Oglesby, Robert J.; Marshall, Susan; Erickson, David J., III; Robertson, Franklin R.; Roads, John O.; Arnold, James E. (Technical Monitor)

2002-01-01

A key question in the study of the hydrologic cycle is the extent to which surface effects such as soil moisture and snow cover are simply passive elements or whether they can affect the evolution of climate on seasonal and longer time scales. We have constructed ensembles of predictability studies using the NCAR CCM3 in which we compared the relative roles of initial surface and atmospheric conditions over the central and western U.S. in determining the subsequent evolution of soil moisture and of snow cover. We have also made sensitivity studies with exaggerated soil moisture and snow cover anomalies in order to determine the physical processes that may be important. Results from simulations with realistic soil moisture anomalies indicate that internal climate variability may be the strongest factor, with some indication that the initial atmospheric state is also important. The initial state of soil moisture does not appear important, a result that held whether simulations were started in late winter or late spring. Model runs with exaggerated soil moisture reductions (near-desert conditions) showed a much larger effect, with warmer surface temperatures, reduced precipitation, and lower surface pressures; the latter indicating a response of the atmospheric circulation. These results suggest the possibility of a threshold effect in soil moisture, whereby an anomaly must be of a sufficient size before it can have a significant impact on the atmospheric circulation and hence climate. Results from simulations with realistic snow cover anomalies indicate that the time of year can be crucial. When introduced in late winter, these anomalies strongly affected the subsequent evolution of snow cover. When introduced in early winter, however, little or no effect is seen on the subsequent snow cover. Runs with greatly exaggerated initial snow cover indicate that the high reflectively of snow is the most important process by which snow cover cart impact climate, through lower surface temperatures and increased surface pressures. In early winter, the amount of solar radiation is very small and so this albedo effect is inconsequential while in late winter, with the sun higher in the sky and period of daylight longer, the effect is much stronger.

Biocompatibility of metal injection molded versus wrought ASTM F562 (MP35N) and ASTM F1537 (CCM) cobalt alloys.

PubMed

Chen, Hao; Sago, Alan; West, Shari; Farina, Jeff; Eckert, John; Broadley, Mark

2011-01-01

We present a comparative analysis between biocompatibility test results of wrought and Metal Injection Molded (MIM) ASTM F562-02 UNS R30035 (MP35N) and F1537 UNS R31538 (CCM) alloy samples that have undergone the same generic orthopedic implant's mechanical, chemical surface pre-treatment, and a designed pre-testing sample preparation method. Because the biocompatibility properties resulting from this new MIM cobalt alloy process are not well understood, we conducted tests to evaluate cytotoxicity (in vitro), hemolysis (in vitro), toxicity effects (in vivo), tissue irritation level (in vivo), and pyrogenicity count (in vitro) on such samples. We show that our developed MIM MP35N and CCM materials and treatment processes are biocompatible, and that both the MIM and wrought samples, although somewhat different in microstructure and surface, do not show significant differences in biocompatibility.

Ultralow-frequency collective compression mode and strong interlayer coupling in multilayer black phosphorus

DOE PAGES

Dong, Shan; Zhang, Anmin; Liu, Kai; ...

2016-02-26

The recent renaissance of black phosphorus (BP) as a two-dimensional (2D) layered material has generated tremendous interest, but its unique structural characters underlying many of its outstanding properties still need elucidation. Here we report Raman measurements that reveal an ultralow-frequency collective compression mode (CCM) in BP, which is unprecedented among similar 2D layered materials. This novel CCM indicates an unusually strong interlayer coupling, and this result is quantitatively supported by a phonon frequency analysis and first-principles calculations. Moreover, the CCM and another branch of low-frequency Raman modes shift sensitively with changing number of layers, allowing an accurate determination of themore » thickness up to tens of atomic layers, which is considerably higher than previously achieved by using high-frequency Raman modes. Lastly, these findings offer fundamental insights and practical tools for further exploration of BP as a highly promising new 2D semiconductor.« less

Final Report on the Key Comparison CCM.P-K4.2012 in Absolute Pressure from 1 Pa to 10 kPa

PubMed Central

Ricker, Jacob; Hendricks, Jay; Bock, Thomas; Dominik, Pražák; Kobata, Tokihiko; Torres, Jorge; Sadkovskaya, Irina

2017-01-01

The report summarizes the Consultative Committee for Mass (CCM) key comparison CCM.P-K4.2012 for absolute pressure spanning the range of 1 Pa to 10 000 Pa. The comparison was carried out at six National Metrology Institutes (NMIs), including National Institute of Standards and Technology (NIST), Physikalisch-Technische Bundesanstalt (PTB), Czech Metrology Institute (CMI), National Metrology Institute of Japan (NMIJ), Centro Nacional de Metrología (CENAM), and DI Mendeleyev Institute for Metrology (VNIIM). The comparison was made via a calibrated transfer standard measured at each of the NMIs facilities using their laboratory standard during the period May 2012 to September 2013. The transfer package constructed for this comparison preformed as designed and provided a stable artifact to compare laboratory standards. Overall the participants were found to be statistically equivalent to the key comparison reference value. PMID:28216793

2.5D complex resistivity modeling and inversion using unstructured grids

NASA Astrophysics Data System (ADS)

Xu, Kaijun; Sun, Jie

2016-04-01

The characteristic of complex resistivity on rock and ore has been recognized by people for a long time. Generally we have used the Cole-Cole Model(CCM) to describe complex resistivity. It has been proved that the electrical anomaly of geologic body can be quantitative estimated by CCM parameters such as direct resistivity(ρ0), chargeability(m), time constant(τ) and frequency dependence(c). Thus it is very important to obtain the complex parameters of geologic body. It is difficult to approximate complex structures and terrain using traditional rectangular grid. In order to enhance the numerical accuracy and rationality of modeling and inversion, we use an adaptive finite-element algorithm for forward modeling of the frequency-domain 2.5D complex resistivity and implement the conjugate gradient algorithm in the inversion of 2.5D complex resistivity. An adaptive finite element method is applied for solving the 2.5D complex resistivity forward modeling of horizontal electric dipole source. First of all, the CCM is introduced into the Maxwell's equations to calculate the complex resistivity electromagnetic fields. Next, the pseudo delta function is used to distribute electric dipole source. Then the electromagnetic fields can be expressed in terms of the primary fields caused by layered structure and the secondary fields caused by inhomogeneities anomalous conductivity. At last, we calculated the electromagnetic fields response of complex geoelectric structures such as anticline, syncline, fault. The modeling results show that adaptive finite-element methods can automatically improve mesh generation and simulate complex geoelectric models using unstructured grids. The 2.5D complex resistivity invertion is implemented based the conjugate gradient algorithm.The conjugate gradient algorithm doesn't need to compute the sensitivity matrix but directly computes the sensitivity matrix or its transpose multiplying vector. In addition, the inversion target zones are segmented with fine grids and the background zones are segmented with big grid, the method can reduce the grid amounts of inversion, it is very helpful to improve the computational efficiency. The inversion results verify the validity and stability of conjugate gradient inversion algorithm. The results of theoretical calculation indicate that the modeling and inversion of 2.5D complex resistivity using unstructured grids are feasible. Using unstructured grids can improve the accuracy of modeling, but the large number of grids inversion is extremely time-consuming, so the parallel computation for the inversion is necessary. Acknowledgments: We thank to the support of the National Natural Science Foundation of China(41304094).

Soil Moisture and Snow Cover: Active or Passive Elements of Climate?

NASA Technical Reports Server (NTRS)

Oglesby, Robert J.; Marshall, Susan; Robertson, Franklin R.; Roads, John O.; Arnold, James E. (Technical Monitor)

2001-01-01

A key question in the study of the hydrologic cycle is the extent to which surface effects such as soil moisture and snow cover are simply passive elements or whether they can affect the evolution of climate on seasonal and longer time scales. We have constructed ensembles of predictability studies using the NCAR CCM3 in which we compared the relative roles of initial surface and atmospheric conditions over the central and western U.S. GAPP region in determining the subsequent evolution of soil moisture and of snow cover. We have also made sensitivity studies with exaggerated soil moisture and snow cover anomalies in order to determine the physical processes that may be important. Results from simulations with realistic soil moisture anomalies indicate that internal climate variability may be the strongest factor, with some indication that the initial atmospheric state is also important. The initial state of soil moisture does not appear important, a result that held whether simulations were started in late winter or late spring. Model runs with exaggerated soil moisture reductions (near-desert conditions) showed a much larger effect, with warmer surface temperatures, reduced precipitation, and lower surface pressures; the latter indicating a response of the atmospheric circulation. These results suggest the possibility of a threshold effect in soil moisture, whereby an anomaly must be of a sufficient size before it can have a significant impact on the atmospheric circulation and hence climate. Results from simulations with realistic snow cover anomalies indicate that the time of year can be crucial. When introduced in late winter, these anomalies strongly affected the subsequent evolution of snow cover. When introduced in early winter, however, little or no effect is seen on the subsequent snow cover. Runs with greatly exaggerated initial snow cover indicate that the high reflectivity of snow is the most important process by which snow cover can impact climate, through lower surface temperatures and increased surface pressures. In early winter, the amount of solar radiation is very small and so this albedo, effect is inconsequential while in late winter, with the sun higher in the sky and period of daylight longer, the effect is much stronger. The results to date were obtained for model runs with present-day conditions. We are currently analyzing runs made with projected forcings for the 21st century to see if these results are modified in any way under likely scenarios of future climate change.

Development and Implementation of CFD-Informed Models for the Advanced Subchannel Code CTF

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blyth, Taylor S.; Avramova, Maria

The research described in this PhD thesis contributes to the development of efficient methods for utilization of high-fidelity models and codes to inform low-fidelity models and codes in the area of nuclear reactor core thermal-hydraulics. The objective is to increase the accuracy of predictions of quantities of interests using high-fidelity CFD models while preserving the efficiency of low-fidelity subchannel core calculations. An original methodology named Physics- based Approach for High-to-Low Model Information has been further developed and tested. The overall physical phenomena and corresponding localized effects, which are introduced by the presence of spacer grids in light water reactor (LWR)more » cores, are dissected in corresponding four building basic processes, and corresponding models are informed using high-fidelity CFD codes. These models are a spacer grid-directed cross-flow model, a grid-enhanced turbulent mixing model, a heat transfer enhancement model, and a spacer grid pressure loss model. The localized CFD-models are developed and tested using the CFD code STAR-CCM+, and the corresponding global model development and testing in sub-channel formulation is performed in the thermal- hydraulic subchannel code CTF. The improved CTF simulations utilize data-files derived from CFD STAR-CCM+ simulation results covering the spacer grid design desired for inclusion in the CTF calculation. The current implementation of these models is examined and possibilities for improvement and further development are suggested. The validation experimental database is extended by including the OECD/NRC PSBT benchmark data. The outcome is an enhanced accuracy of CTF predictions while preserving the computational efficiency of a low-fidelity subchannel code.« less

Development and Implementation of CFD-Informed Models for the Advanced Subchannel Code CTF

NASA Astrophysics Data System (ADS)

Blyth, Taylor S.

The research described in this PhD thesis contributes to the development of efficient methods for utilization of high-fidelity models and codes to inform low-fidelity models and codes in the area of nuclear reactor core thermal-hydraulics. The objective is to increase the accuracy of predictions of quantities of interests using high-fidelity CFD models while preserving the efficiency of low-fidelity subchannel core calculations. An original methodology named Physics-based Approach for High-to-Low Model Information has been further developed and tested. The overall physical phenomena and corresponding localized effects, which are introduced by the presence of spacer grids in light water reactor (LWR) cores, are dissected in corresponding four building basic processes, and corresponding models are informed using high-fidelity CFD codes. These models are a spacer grid-directed cross-flow model, a grid-enhanced turbulent mixing model, a heat transfer enhancement model, and a spacer grid pressure loss model. The localized CFD-models are developed and tested using the CFD code STAR-CCM+, and the corresponding global model development and testing in sub-channel formulation is performed in the thermal-hydraulic subchannel code CTF. The improved CTF simulations utilize data-files derived from CFD STAR-CCM+ simulation results covering the spacer grid design desired for inclusion in the CTF calculation. The current implementation of these models is examined and possibilities for improvement and further development are suggested. The validation experimental database is extended by including the OECD/NRC PSBT benchmark data. The outcome is an enhanced accuracy of CTF predictions while preserving the computational efficiency of a low-fidelity subchannel code.

The stratopause semiannual oscillation in the NCAR Community Climate Model

NASA Technical Reports Server (NTRS)

Sassi, Fabrizio; Garcia, Roland R.; Boville, Byron A.

1993-01-01

The middle atmospheric version of the NCAR Community Climate Model (CCM2) has been used to study the development of the equatorial semiannual oscillation (SAO) in the stratosphere. The model domain extends from the ground to about 80 km, with a vertical resolution of 1 km. Transport of nitrous oxide (N2O) with simplified photochemistry is included in the calculation to illustrate the influence of tropical circulations on the distribution of trace species. Diagnosis of model output reveals two distinct phases in the evolution of the zonal mean state on the equator. In early December, a strong and broad easterly jet appears near the stratopause in connection with a midlatitude wave event (sudden stratospheric warming) that reverses the winter westerlies of the Northern Hemisphere throughout the upper stratosphere. When the wave forcing dies out, the radiative drive allows the westerlies to recover at midlatitudes, while easterlies persist in the tropics. The resulting strong meridional gradient of the zonal mean wind provides favorable conditions for the development of inertial instability at lower latitudes. The meridional circulation associated with the instability shapes the 'nose' of the easterly jet, reducing the extension of the unstable region. In equinoctial conditions, a jet of westerlies appears in the lower equatorial mesosphere and descends to lower altitudes; positive accelerations associated with the descending westerlies are due primarily to Kelvin waves. The descent of the westerly jet does not reproduce well the observed behavior of the SAO westerly phase, either in amplitude or in the extent of downward propagation. As a consequence, the model does not simulate the 'double peak' observed in the tropical distribution of N2O. Comparison of wave amplitudes in the model with those derived from satellite observations shows that the calculated amplitudes are larger than observed in the upper stratosphere. It follows that inadequate Kelvin wave forcing is not the cause of the weak westerly phase in the model, and that some other mechanism must be responsible for the generation of the strong westerly phase observed.

Perceptions of Adolescents with Overweight and Obesity for the Development of User-Centered Design Self-Management Tools within the Context of the Chronic Care Model: A Qualitative Study.

PubMed

Knoblock-Hahn, Amy L; Wray, Ricardo; LeRouge, Cynthia M

2016-06-01

The Chronic Care Model (CCM) is helpful to illustrate multiple levels of influence in the management of chronic disease, such as overweight and obesity in adolescents. Unfortunately, various constraints create gaps in the management process activities performed within the CCM. Consumer health technologies (CHT) may serve as a linkage between adolescents with overweight or obesity, their parents, and their pediatricians. To conduct formative research to qualitatively identify views of adolescents with overweight and obesity on use of consumer health technologies to manage weight loss across chronic care management settings. As part of a multi-perspective qualitative study, 10 focus groups were conducted with adolescents with overweight and obesity. Forty-eight adolescents (15 male, 33 female) aged 12 to 17 years who were current participants of an intensive lifestyle change camp in the summer of 2012 participated in focus groups. All adolescents were classified as overweight (21%) or obese (79%) according to body mass index (BMI) for age charts published by the Centers for Disease Control and Prevention. All focus groups were recorded, transcribed verbatim, and checked for accuracy. Predefined and open coding were used to analyze transcripts for emerging themes. Adolescents perceive CHT, with its functional requirements of assistance with restaurant food selection, teaching cooking skills, and providing encouragement and motivation, to be helpful with overweight and obesity self-management. Desired features to carry out these functional requirements included avatars, self-monitoring capabilities, social networking, and rewards. Our findings largely agree with previously reported parental perceptions of the benefit of CHT for adolescent overweight and obesity self-management and strengthen support for the design and implementation of CHT within the CCM. Copyright © 2016 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Adoption of the chronic care model to improve HIV care

PubMed Central

Tu, David; Belda, Patricia; Littlejohn, Doreen; Pedersen, Jeanette Somlak; Valle-Rivera, Juan; Tyndall, Mark

2013-01-01

Abstract Objective To measure the effectiveness of implementing the chronic care model (CCM) in improving HIV clinical outcomes. Design Multisite, prospective, interventional cohort study. Setting Two urban community health centres in Vancouver and Prince George, BC. Participants Two hundred sixty-nine HIV-positive patients (18 years of age or older) who received primary care at either of the study sites. Intervention Systematic implementation of the CCM during an 18-month period. Main outcome measures Documented pneumococcal vaccination, documented syphilis screening, documented tuberculosis screening, antiretroviral treatment (ART) status, ART status with undetectable viral load, CD4 cell count of less than 200 cells/mL, and CD4 cell count of less than 200 cells/mL while not taking ART compared during a 36-month period. Results Overall, 35% of participants were women and 59% were aboriginal persons. The mean age was 45 years and most participants had a history of injection drug use that was the presumed route of HIV transmission. During the study follow-up period, 39 people died, and 11 transferred to alternate care providers. Compared with their baseline clinical status, study participants showed statistically significant (P < .001 for all) increases in pneumococcal immunization (54% vs 84%), syphilis screening (56% vs 91%), tuberculosis screening (23% vs 38%), and antiretroviral uptake (47% vs 77%), as well as increased viral load suppression rates among those receiving ART (72% vs 90%). Stable housing at baseline was associated with a 4-fold increased probability of survival. Aboriginal ethnicity was not associated with better or worse outcomes at baseline or at follow-up. Conclusion Application of the CCM approach to HIV care in a marginalized, largely aboriginal patient population led to improved disease screening, immunization, ART uptake, and virologic suppression rates. In addition to addressing underlying social determinants of health, a paradigm shift away from an “infectious disease” approach to a “chronic disease management” approach to HIV care for marginalized populations is strongly recommended. PMID:23766052

Methodology for Computational Fluid Dynamic Validation for Medical Use: Application to Intracranial Aneurysm.

PubMed

Paliwal, Nikhil; Damiano, Robert J; Varble, Nicole A; Tutino, Vincent M; Dou, Zhongwang; Siddiqui, Adnan H; Meng, Hui

2017-12-01

Computational fluid dynamics (CFD) is a promising tool to aid in clinical diagnoses of cardiovascular diseases. However, it uses assumptions that simplify the complexities of the real cardiovascular flow. Due to high-stakes in the clinical setting, it is critical to calculate the effect of these assumptions in the CFD simulation results. However, existing CFD validation approaches do not quantify error in the simulation results due to the CFD solver's modeling assumptions. Instead, they directly compare CFD simulation results against validation data. Thus, to quantify the accuracy of a CFD solver, we developed a validation methodology that calculates the CFD model error (arising from modeling assumptions). Our methodology identifies independent error sources in CFD and validation experiments, and calculates the model error by parsing out other sources of error inherent in simulation and experiments. To demonstrate the method, we simulated the flow field of a patient-specific intracranial aneurysm (IA) in the commercial CFD software star-ccm+. Particle image velocimetry (PIV) provided validation datasets for the flow field on two orthogonal planes. The average model error in the star-ccm+ solver was 5.63 ± 5.49% along the intersecting validation line of the orthogonal planes. Furthermore, we demonstrated that our validation method is superior to existing validation approaches by applying three representative existing validation techniques to our CFD and experimental dataset, and comparing the validation results. Our validation methodology offers a streamlined workflow to extract the "true" accuracy of a CFD solver.

Climate and chemistry effects of a regional scale nuclear conflict

NASA Astrophysics Data System (ADS)

Stenke, A.; Hoyle, C. R.; Luo, B.; Rozanov, E.; Gröbner, J.; Maag, L.; Brönnimann, S.; Peter, T.

2013-05-01

Previous studies have highlighted the severity of detrimental effects for life on Earth after an assumed regionally limited nuclear war. These effects are caused by climatic, chemical and radiative changes persisting for up to one decade. However, so far only a very limited number of climate model simulations have been performed, giving rise to the question how realistic previous computations have been. This study uses the coupled chemistry climate model (CCM) SOCOL, which belongs to a different family of CCMs than previously used, to investigate the consequences of such a hypothetical nuclear conflict. In accordance with previous studies, the present work assumes a scenario of a nuclear conflict between India and Pakistan, each applying 50 warheads with an individual blasting power of 15 kt ("Hiroshima size") against the major population centers, resulting in the emission of tiny soot particles, which are generated in the firestorms expected in the aftermath of the detonations. Substantial uncertainties related to the calculation of likely soot emissions, particularly concerning assumptions of target fuel loading and targeting of weapons, have been addressed by simulating several scenarios, with soot emissions ranging from 1 to 12 Tg. Their high absorptivity with respect to solar radiation leads to a tremendous self-lofting of the soot particles into the strato- and mesosphere, where they remain for several years. Consequently, the model suggests Earth's surface temperatures to drop by several degrees Celsius due to the shielding of solar irradiance by the soot, indicating a major global cooling. In addition, there is a substantial reduction of precipitation lasting 5 to 10 yr after the conflict, depending on the magnitude of the initial soot release. Extreme cold spells associated with massive sea ice formation are found during Northern Hemisphere winter, which expose the continental land masses of Northern America and Eurasia to chilling coldness. In the stratosphere, the strong heating leads to an acceleration of catalytic ozone loss and, consequently, to enhancements of UV radiation at the ground. In contrast to surface temperature and precipitation changes, which show a linear dependence to the soot burden, there is a saturation effect with respect to stratospheric ozone chemistry. Soot emissions of 5 Tg lead to an ozone column reduction of almost 50% in northern high latitudes, while emitting 12 Tg only increases ozone loss by a further 10%. In summary, this study, though using a different chemistry climate model, corroborates the previous investigations with respect to the atmospheric impacts. In addition to these persistent effects, the present study draws attention to episodically cold phases, which would likely add to the severity of human harm worldwide. The best insurance against such a catastrophic development would be the delegitimization of nuclear weapons.

Climate and chemistry effects of a regional scale nuclear conflict

NASA Astrophysics Data System (ADS)

Stenke, A.; Hoyle, C. R.; Luo, B.; Rozanov, E.; Gröbner, J.; Maag, L.; Brönnimann, S.; Peter, T.

2013-10-01

Previous studies have highlighted the severity of detrimental effects for life on earth after an assumed regionally limited nuclear war. These effects are caused by climatic, chemical and radiative changes persisting for up to one decade. However, so far only a very limited number of climate model simulations have been performed, giving rise to the question how realistic previous computations have been. This study uses the coupled chemistry climate model (CCM) SOCOL, which belongs to a different family of CCMs than previously used, to investigate the consequences of such a hypothetical nuclear conflict. In accordance with previous studies, the present work assumes a scenario of a nuclear conflict between India and Pakistan, each applying 50 warheads with an individual blasting power of 15 kt ("Hiroshima size") against the major population centers, resulting in the emission of tiny soot particles, which are generated in the firestorms expected in the aftermath of the detonations. Substantial uncertainties related to the calculation of likely soot emissions, particularly concerning assumptions of target fuel loading and targeting of weapons, have been addressed by simulating several scenarios, with soot emissions ranging from 1 to 12 Tg. Their high absorptivity with respect to solar radiation leads to a rapid self-lofting of the soot particles into the strato- and mesosphere within a few days after emission, where they remain for several years. Consequently, the model suggests earth's surface temperatures to drop by several degrees Celsius due to the shielding of solar irradiance by the soot, indicating a major global cooling. In addition, there is a substantial reduction of precipitation lasting 5 to 10 yr after the conflict, depending on the magnitude of the initial soot release. Extreme cold spells associated with an increase in sea ice formation are found during Northern Hemisphere winter, which expose the continental land masses of North America and Eurasia to a cooling of several degrees. In the stratosphere, the strong heating leads to an acceleration of catalytic ozone loss and, consequently, to enhancements of UV radiation at the ground. In contrast to surface temperature and precipitation changes, which show a linear dependence to the soot burden, there is a saturation effect with respect to stratospheric ozone chemistry. Soot emissions of 5 Tg lead to an ozone column reduction of almost 50% in northern high latitudes, while emitting 12 Tg only increases ozone loss by a further 10%. In summary, this study, though using a different chemistry climate model, corroborates the previous investigations with respect to the atmospheric impacts. In addition to these persistent effects, the present study draws attention to episodically cold phases, which would likely add to the severity of human harm worldwide. The best insurance against such a catastrophic development would be the delegitimization of nuclear weapons.

Final report on APMP.M.M.K4.1—bilateral comparison of 1 kg stainless steel mass standards between KRISS and A*STAR

NASA Astrophysics Data System (ADS)

Chung, J. W.; Lee, S. M.; Lee, S. J.

2017-01-01

This report describes a bilateral comparison of 1 kg stainless steel mass standard between the Korea Research Institute of Standards and Science (KRISS), and the National Measurement Centre, Agency for Science, Technology and Research (A*STAR), Singapore, which is registered in the BIPM KCDB as APMP.M.M-K4.1. This nominal value was chosen as it followed the nominal value of CCM.M-K4. This bilateral comparison was piloted by KRISS. The transfer weight was delivered to A*STAR from KRISS in April 2015 and received back from A*STAR in October 2015. A*STAR are aiming to improve their calibration measurement capability (CMC) for mass of 1 kg. KRISS participated in both this comparison and CCM.M-K4, providing a link between the A*STAR result and the KCRV of CCM.M-K4. The final report of this comparison is given in this document. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Factors Affecting Availability of Essential Medicines among Community Health Workers in Ethiopia, Malawi, and Rwanda: Solving the Last Mile Puzzle

PubMed Central

Chandani, Yasmin; Noel, Megan; Pomeroy, Amanda; Andersson, Sarah; Pahl, Michelle K.; Williams, Timothy

2012-01-01

To understand how supply chain factors affect product availability at the community level, the Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project developed a theory of change (TOC) framework for gathering, organizing, and interpreting evidence about supply constraints to community case management (CCM). Baseline assessments in Ethiopia, Malawi, and Rwanda conducted in 2010 provided information on the strengths and weaknesses of existing CCM supply chains for five main products: antibiotics for pneumonia, oral rehydration solution, ready to use therapeutic food, zinc, and artemether/lumefantrine. The assessments tested the strength and validity of causal pathways identified in the TOC that were believed to influence availability of CCM products among community health workers (CHWs) for treating common childhood illnesses. Results of the assessments showed product availability to be weak in each country, with more than half of CHWs stocked out of at least one tracer product on the day of the assessment. This report will focus on the findings related to three key preconditions of the TOC and how these were used to inform the design of the CCM supply chain improvement strategy in each country. The three key preconditions include product availability at CHW resupply points, supply chain knowledge and capacity among CHWs and their supervisors, and availability of appropriate transportation. PMID:23136287

Factors affecting availability of essential medicines among community health workers in Ethiopia, Malawi, and Rwanda: solving the last mile puzzle.

PubMed

Chandani, Yasmin; Noel, Megan; Pomeroy, Amanda; Andersson, Sarah; Pahl, Michelle K; Williams, Timothy

2012-11-01

To understand how supply chain factors affect product availability at the community level, the Improving Supply Chains for Community Case Management of Pneumonia and Other Common Diseases of Childhood Project developed a theory of change (TOC) framework for gathering, organizing, and interpreting evidence about supply constraints to community case management (CCM). Baseline assessments in Ethiopia, Malawi, and Rwanda conducted in 2010 provided information on the strengths and weaknesses of existing CCM supply chains for five main products: antibiotics for pneumonia, oral rehydration solution, ready to use therapeutic food, zinc, and artemether/lumefantrine. The assessments tested the strength and validity of causal pathways identified in the TOC that were believed to influence availability of CCM products among community health workers (CHWs) for treating common childhood illnesses. Results of the assessments showed product availability to be weak in each country, with more than half of CHWs stocked out of at least one tracer product on the day of the assessment. This report will focus on the findings related to three key preconditions of the TOC and how these were used to inform the design of the CCM supply chain improvement strategy in each country. The three key preconditions include product availability at CHW resupply points, supply chain knowledge and capacity among CHWs and their supervisors, and availability of appropriate transportation.

Materials and Process Activities for NASA's Composite Crew Module

NASA Technical Reports Server (NTRS)

Polis, Daniel L.

2012-01-01

In January 2007, the NASA Administrator and Associate Administrator for the Exploration Systems Mission Directorate chartered the NASA Engineering and Safety Center (NESC) to design, build, and test a full-scale Composite Crew Module (CCM). The overall goal of the CCM project was to develop a team from the NASA family with hands-on experience in composite design, manufacturing, and testing in anticipation of future space exploration systems being made of composite materials. The CCM project was planned to run concurrently with the Orion project s baseline metallic design within the Constellation Program so that features could be compared and discussed without inducing risk to the overall Program. The materials and process activities were prioritized based on a rapid prototype approach. This approach focused developmental activities on design details with greater risk and uncertainty, such as out-of-autoclave joining, over some of the more traditional lamina and laminate building block levels. While process development and associated building block testing were performed, several anomalies were still observed at the full-scale level due to interactions between process robustness and manufacturing scale-up. This paper describes the process anomalies that were encountered during the CCM development and the subsequent root cause investigations that led to the final design solutions. These investigations highlight the importance of full-scale developmental work early in the schedule of a complex composite design/build project.

CCM-C,Collins checks the middeck experiment

NASA Image and Video Library

1999-07-24

S93-E-5016 (23 July 1999) --- Astronaut Eileen M. Collins, mission commander, checks on an experiment on Columbia's middeck during Flight Day 1 activity. The experiment is called the Cell Culture Model, Configuration C. Objectives of it are to validate cell culture models for muscle, bone and endothelial cell biochemical and functional loss induced by microgravity stress; to evaluate cytoskeleton, metabolism, membrane integrity and protease activity in target cells; and to test tissue loss pharmaceuticals for efficacy. The photo was recorded with an electronic still camera (ESC).

Observations of tropospheric trace gases from GOSAT thermal infrared spectra

NASA Astrophysics Data System (ADS)

Ohyama, Hirofumi; Shiomi, Kei; Kawakami, Shuji; Nakajima, Masakatsu; Maki, Takashi; Deushi, Makoto

2013-04-01

Thermal And Near infrared Sensor for carbon Observation-Fourier Transform Spectrometer (TANSO-FTS), which is one of the sensors onboard the Greenhouse gases Observing SATellite (GOSAT), measures the sunlight backscattered by the Earth's surface and atmosphere as well as the thermal radiance emitted from the Earth. Atmospheric trace gases such as ozone (O3), water vapor (H2O and HDO), methanol (CH3OH) and ammonia (NH3) are derived from the thermal infrared spectral radiance recorded with the TANSO-FTS by an optimal estimation retrieval approach. TANSO-FTS total ozone columns are compared with Dobson spectrophotometer and Ozone Monitoring Instrument (OMI) data. The TANSO-FTS total ozone retrievals exhibit a positive bias of 3-4% with a root-mean-square difference of 2-6% compared to the Dobson and OMI measurements. We compare TANSO-FTS tropospheric ozone columns to those from ozonesonde data as well as from a three-dimensional chemical-climate model (MRI-CCM2). The TANSO-FTS data have high correlations with the ozonesonde data. The seasonal trends of the retrieved tropospheric ozone are consistent with those of the ozonesonde data. The spatial distribution of the tropospheric ozone from the TANSO-FTS and MRI-CCM2 shows good agreement, especially in the high-level tropospheric ozone regions. We also retrieve tropospheric H2O and HDO profiles simultaneously, accounting for the cross correlations between the water isotopes. The joint retrieval results in precise estimation of the isotope ratio by partial cancellation of systematic errors common to both H2O and HDO. The retrieved profiles and columns are compared with radiosonde, GPS, and ground-based high-resolution FTS data. The temporal and spatial variations of the precipitable water and the isotope ratio are consistent with those of the validation data. Finally, air pollutants such as CH3OH and NH3 are retrieved using the retrieved ozone and water vapor. We present the latitudinal and seasonal variations of CH3OH related to plant growth and biomass burning, and the high-level NH3 in the hot spot areas.

Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

PubMed Central

Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

2014-01-01

ABSTRACT Background: The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. Methods: The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. Results: While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. Conclusions: The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates. PMID:25276593

The Vertical Structure of Relative Humidity and Ozone in the Tropical Upper Troposphere: Intercomparisons Among In Situ Observations, A-Train Measurements and Large-Scale Models

NASA Technical Reports Server (NTRS)

Selkirk, Henry B.; Manyin, Michael; Douglass, Anne R.; Oman, Luke; Pawson, Steven; Ott, Lesley; Benson, Craig; Stolarski, Richard

2010-01-01

In situ measurements in the tropics have shown that in regions of active convection, relative humidity with respect to ice in the upper troposphere is typically close to saturation on average, and supersaturations greater than 20% are not uncommon. Balloon soundings with the cryogenic frost point hygrometer (CFH) at Costa Rica during northern summer, for example, show this tendency to be strongest between 11 and 15.5 km (345-360 K potential temperature, or approximately 250-120 hPa). this is the altitude range of deep convective detrainment. Additionally, simultaneous ozonesonde measurements show that stratospheric air (O3 greater than 150 ppbv) can be found as low as approximately 14 km (350 K/150 hPa). In contrast, results from northern winter show a much drier upper troposphere and little penetration of stratospheric air below the tropopause at 17.5 km (approximately 383 K). We show that these results are consistent with in situ measurements from the Measurement of Ozone and water vapor by Airbus In-service airCraft (MOZAIC) program which samples a wider, though still limited, range of tropical locations. To generalize to the tropics as a whole, we compare our insitu results to data from two A-Train satellite instruments, the Atmospheric Infrared Sounder (AIRS) and the Microwave Limb Sounder (MLS) on the Aqua and Aura satellites respectively. Finally, we examine the vertical structure of water vapor, relative humidity and ozone in the NASA Goddard MERRA analysis, an assimilation dataset, and a new version of the GEOS CCM, a free-running chemistry-climate model. We demonstrate that conditional probability distributions of relative humidity and ozone are a sensitive diagnostic for assessing the representation of deep convection and upper troposphere/lower stratosphere mixing processes in large-scale analyses and climate models.

Interactive Electronic Decision Trees for the Integrated Primary Care Management of Febrile Children in Low Resource Settings - Review of existing tools.

PubMed

Keitel, Kristina; D'Acremont, Valérie

2018-04-20

The lack of effective, integrated diagnostic tools pose a major challenge to the primary care management of febrile childhood illnesses. These limitations are especially evident in low-resource settings and are often inappropriately compensated by antimicrobial over-prescription. Interactive electronic decision trees (IEDTs) have the potential to close these gaps: guiding antibiotic use and better identifying serious disease. This narrative review summarizes existing IEDTs, to provide an overview of their degree of validation, as well as to identify gaps in current knowledge and prospects for future innovation. Structured literature review in PubMed and Embase complemented by google search and contact with developers. Six integrated IEDTs were identified: three (eIMCI, REC, and Bangladesh digital IMCI) based on Integrated Management of Childhood Illnesses (IMCI); four (SL eCCM, MEDSINC, e-iCCM, and D-Tree eCCM) on Integrated Community Case Management (iCCM); two (ALMANACH, MSFeCARE) with a modified IMCI content; and one (ePOCT) that integrates novel content with biomarker testing. The types of publications and evaluation studies varied greatly: the content and evidence-base was published for two (ALMANACH and ePOCT), ALMANACH and ePOCT were validated in efficacy studies. Other types of evaluations, such as compliance, acceptability were available for D-Tree eCCM, eIMCI, ALMANACH. Several evaluations are still ongoing. Future prospects include conducting effectiveness and impact studies using data gathered through larger studies to adapt the medical content to local epidemiology, improving the software and sensors, and Assessing factors that influence compliance and scale-up. IEDTs are valuable tools that have the potential to improve management of febrile children in primary care and increase the rational use of diagnostics and antimicrobials. Next steps in the evidence pathway should be larger effectiveness and impact studies (including cost analysis) and continuous integration of clinically useful diagnostic and treatment innovations. Copyright © 2018. Published by Elsevier Ltd.

Completion of the mitochondrial genome sequence of onion (Allium cepa L.) containing the CMS-S male-sterile cytoplasm and identification of an independent event of the ccmF N gene split.

PubMed

Kim, Bongju; Kim, Kyunghee; Yang, Tae-Jin; Kim, Sunggil

2016-11-01

Cytoplasmic male-sterility (CMS) conferred by the CMS-S cytoplasm has been most commonly used for onion (Allium cepa L.) F 1 hybrid seed production. We first report the complete mitochondrial genome sequence containing CMS-S cytoplasm in this study. Initially, seven contigs were de novo assembled from 150-bp paired-end raw reads produced from the total genomic DNA using the Illumina NextSeq500 platform. These contigs were connected into a single circular genome consisting of 316,363 bp (GenBank accession: KU318712) by PCR amplification. Although all 24 core protein-coding genes were present, no ribosomal protein-coding genes, except rps12, were identified in the onion mitochondrial genome. Unusual trans-splicing of the cox2 gene was verified, and the cox1 gene was identified as part of the chimeric orf725 gene, which is a candidate gene responsible for inducing CMS. In addition to orf725, two small chimeric genes were identified, but no transcripts were detected for these two open reading frames. Thirteen chloroplast-derived sequences, with sizes of 126-13,986 bp, were identified in the intergenic regions. Almost 10 % of the onion mitochondrial genome was composed of repeat sequences. The vast majority of repeats were short repeats of <100 base pairs. Interestingly, the gene encoding ccmF N was split into two genes. The ccmF N gene split is first identified outside the Brassicaceae family. The breakpoint in the onion ccmF N gene was different from that of other Brassicaceae species. This split of the ccmF N gene was also present in 30 other Allium species. The complete onion mitochondrial genome sequence reported in this study would be fundamental information for elucidation of onion CMS evolution.

Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel

PubMed Central

Al-Shahi Salman, Rustam; A. Awad, Issam; Dahlem, Kristen; Flemming, Kelly; Hart, Blaine; Kim, Helen; Jusue-Torres, Ignacio; Kondziolka, Douglas; Lee, Cornelia; Morrison, Leslie; Rigamonti, Daniele; Rebeiz, Tania; Tournier-Lasserve, Elisabeth; Waggoner, Darrel; Whitehead, Kevin

2017-01-01

Abstract BACKGROUND: Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies. OBJECTIVE: To develop guidelines for CCM management. METHODS: The Angioma Alliance (www.angioma.org), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol. RESULTS: Of 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%). CONCLUSION: Current evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was similarly peer reviewed and is available on line www.angioma.org/CCMGuidelines. PMID:28387823

Surgical Management and Long-Term Seizure Outcome After Surgery for Temporal Lobe Epilepsy Associated with Cerebral Cavernous Malformations.

PubMed

Yang, Peng-Fan; Pei, Jia-Sheng; Jia, Yan-Zeng; Lin, Qiao; Xiao, Hui; Zhang, Ting-Ting; Zhong, Zhong-Hui

2018-02-01

Operative strategies for cerebral cavernous malformation (CCM)-associated temporal lobe epilepsy and timing of surgical intervention continue to be debated. This study aimed to establish an algorithm to evaluate the efficacy of surgical intervention strategies, to maximize positive surgical outcomes and minimize postsurgical neurologic deficits. 47 patients having undergone operation for CCM-associated temporal lobe epilepsy were retrospectively reviewed. They had received a diagnostic series for seizure localization, including long-term video electroencephalography (vEEG), high-resolution magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT). In patients with mesial temporal lobe CCMs, the involved structures (amygdala, hippocampus, or parahippocampal gyrus) were resected in addition to the lesions. Patients with neocortical epileptogenic CCM underwent extended lesionectomy guided by intraoperative electrocorticography; further performance of amygdalohippocampectomy depended on the extent of hippocampal epileptogenicity. The study cohort contained 28 patients with drug-resistant epilepsy (DRE), 12 with chronic epilepsy (CE), and 7 with sporadic seizure (SS). Normal temporal lobe metabolism was seen in 7/7 patients of the SS group. Hypometabolism was found in all patients with chronic disease except for those with posterior inferior and middle temporal gyrus cavernous malformations (CMs). Of the 31 patients with superficial neocortical CCM, 7 had normal PET without hippocampal sclerosis, 14 had ipsilateral temporal lobe hypometabolism without hippocampal sclerosis, and 10 had obvious hippocampal sclerosis and hypometabolism. Seizure freedom in DRE, CE, and SS was 82.1%, 75%, and 100%, respectively. A significant difference was found between lesion laterality and postoperative seizure control; the rate was lower in left-sided cases because of less aggressive resection. Our study demonstrates that the data from the presurgical evaluation, particularly regarding CM location, responsiveness to antiepileptic drugs, and temporal lobe metabolism, are crucial parameters for choosing surgical approaches to CCM-associated temporal lobe epilepsy. By this operative strategy, patients may receive maximized seizure control and minimized postsurgical neurologic sequelae. Copyright © 2017 Elsevier Inc. All rights reserved.

Causal Relationships Among Time Series of the Lange Bramke Catchment (Harz Mountains, Germany)

NASA Astrophysics Data System (ADS)

Aufgebauer, Britta; Hauhs, Michael; Bogner, Christina; Meesenburg, Henning; Lange, Holger

2016-04-01

Convergent Cross Mapping (CCM) has recently been introduced by Sugihara et al. for the identification and quantification of causal relationships among ecosystem variables. In particular, the method allows to decide on the direction of causality; in some cases, the causality might be bidirectional, indicating a network structure. We extend this approach by introducing a method of surrogate data to obtain confidence intervals for CCM results. We then apply this method to time series from stream water chemistry. Specifically, we analyze a set of eight dissolved major ions from three different catchments belonging to the hydrological monitoring system at the Bramke valley in the Harz Mountains, Germany. Our results demonstrate the potentials and limits of CCM as a monitoring instrument in forestry and hydrology or as a tool to identify processes in ecosystem research. While some networks of causally linked ions can be associated with simple physical and chemical processes, other results illustrate peculiarities of the three studied catchments, which are explained in the context of their special history.

Corneal confocal microscopy detects small fiber neuropathy in CMT1A patients

PubMed Central

Tavakoli, Mitra; Marshall, Andy; Banka, Siddharth; Petropoulos, Ioannis N; Fadavi, Hassan; Kingston, Helen; Malik, Rayaz A

2012-01-01

Although unmyelinated nerve fibers are affected in CMT1A, they have not been studied in detail due to the invasive nature of the techniques needed to study them. We established alterations in C-fiber bundles of the cornea in patients with CMT1A using non-invasive corneal confocal microscopy (CCM). Twelve patients with CMT1A and twelve healthy control subjects underwent assessment of neuropathic symptoms and deficits, electrophysiology, quantitative sensory testing, corneal sensitivity and corneal confocal microscopy. Corneal sensitivity, corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length and corneal nerve fiber tortuosity were significantly reduced in CMT1A patients compared to controls. There was a significant correlation between corneal sensation and CCM parameters with the severity of painful neuropathic symptoms, cold and warm thresholds and median nerve CMAP amplitude. CCM demonstrates significant damage to C-fiber bundles, which relates to some measures of neuropathy in CMT1A patients. PMID:22996176

Diabetic peripheral neuropathy assessment through texture based analysis of corneal nerve images

NASA Astrophysics Data System (ADS)

Silva, Susana F.; Gouveia, Sofia; Gomes, Leonor; Negrão, Luís; João Quadrado, Maria; Domingues, José Paulo; Morgado, António Miguel

2015-05-01

Diabetic peripheral neuropathy (DPN) is one common complication of diabetes. Early diagnosis of DPN often fails due to the non-availability of a simple, reliable, non-invasive method. Several published studies show that corneal confocal microscopy (CCM) can identify small nerve fibre damage and quantify the severity of DPN, using nerve morphometric parameters. Here, we used image texture features, extracted from corneal sub-basal nerve plexus images, obtained in vivo by CCM, to identify DPN patients, using classification techniques. A SVM classifier using image texture features was used to identify (DPN vs. No DPN) DPN patients. The accuracies were 80.6%, when excluding diabetic patients without neuropathy, and 73.5%, when including diabetic patients without diabetic neuropathy jointly with healthy controls. The results suggest that texture analysis might be used as a complementing technique for DPN diagnosis, without requiring nerve segmentation in CCM images. The results also suggest that this technique has enough sensitivity to detect early disorders in the corneal nerves of diabetic patients.

Assessment of the quality of primary care for the elderly according to the Chronic Care Model 1

PubMed Central

Silva, Líliam Barbosa; Soares, Sônia Maria; Silva, Patrícia Aparecida Barbosa; Santos, Joseph Fabiano Guimarães; Miranda, Lívia Carvalho Viana; Santos, Raquel Melgaço

2018-01-01

ABSTRACT Objective: to evaluate the quality of care provided to older people with diabetes mellitus and/or hypertension in the Primary Health Care (PHC) according to the Chronic Care Model (CCM) and identify associations with care outcomes. Method: cross-sectional study involving 105 older people with diabetes mellitus and/or hypertension. The Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used to evaluate the quality of care. The total score was compared with care outcomes that included biochemical parameters, body mass index, pressure levels and quality of life. Data analysis was based on descriptive statistics and multiple logistic regression. Results: there was a predominance of females and a median age of 72 years. The median PACIC score was 1.55 (IQ 1.30-2.20). Among the PACIC dimensions, the “delivery system design/decision support” was the one that presented the best result. There was no statistical difference between the medians of the overall PACIC score and individual care outcomes. However, when the quality of life and health satisfaction were simultaneously evaluated, a statistical difference between the medians was observed. Conclusion: the low PACIC scores found indicate that chronic care according to the CCM in the PHC seems still to fall short of its assumptions. PMID:29538582

Assessment of the quality of primary care for the elderly according to the Chronic Care Model.

PubMed

Silva, Líliam Barbosa; Soares, Sônia Maria; Silva, Patrícia Aparecida Barbosa; Santos, Joseph Fabiano Guimarães; Miranda, Lívia Carvalho Viana; Santos, Raquel Melgaço

2018-03-08

to evaluate the quality of care provided to older people with diabetes mellitus and/or hypertension in the Primary Health Care (PHC) according to the Chronic Care Model (CCM) and identify associations with care outcomes. cross-sectional study involving 105 older people with diabetes mellitus and/or hypertension. The Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used to evaluate the quality of care. The total score was compared with care outcomes that included biochemical parameters, body mass index, pressure levels and quality of life. Data analysis was based on descriptive statistics and multiple logistic regression. there was a predominance of females and a median age of 72 years. The median PACIC score was 1.55 (IQ 1.30-2.20). Among the PACIC dimensions, the "delivery system design/decision support" was the one that presented the best result. There was no statistical difference between the medians of the overall PACIC score and individual care outcomes. However, when the quality of life and health satisfaction were simultaneously evaluated, a statistical difference between the medians was observed. the low PACIC scores found indicate that chronic care according to the CCM in the PHC seems still to fall short of its assumptions.

Thermal responses of Symbiodinium photosynthetic carbon assimilation

NASA Astrophysics Data System (ADS)

Oakley, Clinton A.; Schmidt, Gregory W.; Hopkinson, Brian M.

2014-06-01

The symbiosis between hermatypic corals and their dinoflagellate endosymbionts, genus Symbiodinium, is based on carbon exchange. This symbiosis is disrupted by thermally induced coral bleaching, a stress response in which the coral host expels its algal symbionts as they become physiologically impaired. The disruption of the dissolved inorganic carbon (DIC) supply or the thermal inactivation of Rubisco have been proposed as sites of initial thermal damage that leads to the bleaching response. Symbiodinium possesses a highly unusual Form II ribulose bisphosphate carboxylase/oxygenase (Rubisco), which exhibits a lower CO2:O2 specificity and may be more thermally unstable than the Form I Rubiscos of other algae and land plants. Components of the CO2 concentrating mechanism (CCM), which supplies inorganic carbon for photosynthesis, may also be temperature sensitive. Here, we examine the ability of four cultured Symbiodinium strains to acquire and fix DIC across a temperature gradient. Surprisingly, the half-saturation constant of photosynthesis with respect to DIC concentration ( K P), an index of CCM function, declined with increasing temperature in three of the four strains, indicating a greater potential for photosynthetic carbon acquisition at elevated temperatures. In the fourth strain, there was no effect of temperature on K P. Finding no evidence for thermal inhibition of the CCM, we conclude that CCM components are not likely to be the primary sites of thermal damage. Reduced photosynthetic quantum yields, a hallmark of thermal bleaching, were observed at low DIC concentrations, leaving open the possibility that reduced inorganic carbon availability is involved in bleaching.

Antarctic Phytoplankton down-regulate Their Carbon-Concentrating Mechanisms under High CO2 with no Change in Growth Rates

NASA Astrophysics Data System (ADS)

Kranz, S. A.; Young, J. N.; Goldman, J.; Tortell, P. D.; Morel, F. M.

2016-02-01

High-latitude oceans, in particular the coastal Western Antarctic Peninsula (WAP) region of the Southern Ocean, are experiencing a rapidly changing environment due to rising surface ocean temperatures and CO2 concentrations. However, the direct effect of increasing CO2 on polar ocean primary production is unclear, with a number of experiments showing conflicting results. It has been hypothesized that increased CO2 may cause a reduction of the energy-intensive carbon concentrating mechanism (CCM) in phytoplankton, and these energy savings may lead to increased productivity. To test this hypothesis, we incubated natural phytoplankton communities in the WAP under high (800 ppm), current (400 ppm) and low (100 ppm) CO2 for 2 to 3 wk during the austral spring-summer of 2012/2013. In 2 incubations with diatom-dominated phytoplankton assemblages, high CO2 led to a clear down-regulation of CCM activity, as evidenced by an increase in half-saturation constants for CO2, a decrease in external carbonic anhydrase activity and a higher biological fractionation of stable carbon isotopes. In a third incubation, there was no observable regulation of the CCM. We did not observe a significant effect of CO2 on growth rates or community composition in the diatom-dominated communities. The lack of a measureable effect on growth despite CCM down-regulation is likely explained by a very small energetic requirement to concentrate CO2 and saturate Rubisco at low temperatures.

[Development of a novel absorbable nanofiber chitosan-collagen membrane by electrospinning and the preliminary study on guided bone regeneration].

PubMed

Gao, B; Li, X J; Lin, M; Li, Y Y; Dong, Y

2018-02-09

Objective: To evaluate the application effect of nanofiber chitosan-collagen membrane (NCM) on guided bone regeneration (GBR). Methods: The mixture of collagen, chitosan, polyethylene oxide was used to make up the NCM by electrospinning, then the NCM was crosslinked by glutaraldehyde vapor. The physical property of the NCM was measured by scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). MC3T3-E1 osteoblasts were cultured on NCM to characterize the biocompatibility. The effectiveness of four groups [contrast group, Bio-gide membrane (BGM), compressed chitosan-collagen menbrane (CCM), NCM/CCM] on bone regeneration were evaluated in critical-sized defects (diameter = 5 mm) in SD rats. Results: When the mixed solution consists of 4.0% collagen, 1.0% chitosan and 3.5% polyethylene oxide, the NCM could be validly fabricated by electrospinning. After cross-linking by glutaraldehyde vapor, the tensile strength and the stability of NCM in damp was enhanced. No cytotoxicity of the NCM was detected on MC3T3-E1 osteoblasts. In vivo study showed that the new bone regeneration ratio of NCM/CCM group was [(43.10±1.49)%], and this was similar to that of the group of BGM [(41.36±2.60)%] ( P> 0.05), but higher than that of the CCM group [(33.10±1.41)%] and the contrast group [(7.22±2.46)%] ( P< 0.05). Conclusions: The NCM can promote new bone regeneration effectively in GBR procedure.

Key comparison of liquid density standards

NASA Astrophysics Data System (ADS)

Buchner, Christian; Zelenka, Zoltan; Kajastie, Heikki; Madec, Tanguy; Wolf, Henning; Vámossy, Csilla; Lorefice, Salvatore; Garberg, Torgunn; Lenard, Elżbieta; Spohr, Isabel; Mares, Gabriela; Spurný, Robert; Lumbreras, Angel; Medina, Nieves; Y Akçadağ, Ümit; Perkin, Michael

2015-01-01

Hydrostatic density determination for liquids is mainly performed by laboratories to provide means for calibrating liquid density measuring instruments such as oscillation-type density meters. From 2002 to 2005 the CIPM key comparison CCM.D-K2 'comparison of liquid density standards' was carried out piloted by the PTB. The aim was to compare the results of the density determination by the participating laboratories to support entries to the CMC tables in this sub-field. To provide further laboratories the possibility to support their entries to the CMC tables at the meeting of the EUROMET Working Group on Density in 2007 this comparison was agreed on. BEV (Austria) organized the comparison supported by the PTB (Germany). For the comparison samples of pentadecane, water, tetrachloroethylene and of an oil of high viscosity were measured in the temperature range from 5 °C to 60 °C at atmospheric pressure by hydrostatic weighing. The measurements were completed in 2008. The reference values of the first reports based on the draft of the CCM.D-K2. After the official publication of the CCM.D-K2 the reference values were recalculated and the report was finalised in 2015. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Critical care trainees' career goals and needs: A Canadian survey.

PubMed

St-Onge, Maude; Mandelzweig, Keren; Marshall, John C; Scales, Damon C; Granton, John

2014-01-01

For training programs to meet the needs of trainees, an understanding of their career goals and expectations is required. Canadian critical care medicine (CCM) trainees were surveyed to understand their career goals in terms of clinical work, research, teaching, administration and management; and to identify their perceptions regarding the support they need to achieve their goals. The online survey was sent to all trainees registered in a Canadian adult or pediatric CCM program. It documented the participants' demographics; their career expectations; the perceived barriers and enablers to achieve their career goals; and their perceptions relating to their chances of developing a career in different areas. A response rate of 85% (66 of 78) was obtained. The majority expected to work in an academic centre. Only approximately one-third (31%) estimated their chances of obtaining a position in CCM as >75%. The majority planned to devote 25% to 75% of their time performing clinical work and <25% in education, research or administration. The trainees perceived that there were limited employment opportunities. Networking and having specialized expertise were mentioned as being facilitators for obtaining employment. They expressed a need for more protected time, resources and mentorship for nonclinical tasks during training. CCM trainees perceived having only limited support to help them to achieve their career goals and anticipate difficulties in obtaining successful employment. They identified several gaps that could be addressed by training programs, including more mentoring in the areas of research, education and administration.

Laboratory Evaluation of Isaria fumosorosea CCM 8367 and Steinernema feltiae Ustinov against Immature Stages of the Colorado Potato Beetle

PubMed Central

Hussein, Hany M.; Skoková Habuštová, Oxana; Půža, Vladimír; Zemek, Rostislav

2016-01-01

The Colorado potato beetle, Leptinotarsa decemlineata, has developed resistance to most registered pesticides and has become one of the most difficult insect pests to control. Development of new biopesticides targeting this pest might solve the resistance problem and contribute to sustainable crop production. Laboratory experiments were conducted to assess the efficacy of Isaria fumosorosea (syn. Paecilomyces fumosoroseus) strain CCM 8367 against L. decemlineata when applied alone or combined with the entomopathogenic nematode Steinernema feltiae. The last-instar larvae of the Colorado potato beetle showed the highest susceptibility to I. fumosorosea followed by pre-pupae and pupae. The median lethal concentration (LC50) was estimated to be 1.03×106 blastospores/ml. The strain CCM 8367 was more virulent, causing 92.6% mortality of larvae (LT50 = 5.0 days) compared to the reference strain Apopka 97, which caused 54.5% mortality (LT50 = 7.0 days). The combined application of the fungus with the nematodes increased the mortality up to 98.0%. The best results were obtained when S. feltiae was applied simultaneously with I. fumosorosea (LT50 = 2.0 days); later application negatively affected both the penetration rate and the development of the nematodes. We can conclude that the strain CCM 8367 of I. fumosorosea is a prospective biocontrol agent against immature stages of L. decemlineata. For higher efficacy, application together with an entomopathogenic nematode is recommended. PMID:27015633

An obesity/cardiometabolic risk reduction disease management program: a population-based approach.

PubMed

Villagra, Victor G

2009-04-01

Obesity is a critical health concern that has captured the attention of public and private healthcare payers who are interested in controlling costs and mitigating the long-term economic consequences of the obesity epidemic. Population-based approaches to obesity management have been proposed that take advantage of a chronic care model (CCM), including patient self-care, the use of community-based resources, and the realization of care continuity through ongoing communications with patients, information technology, and public policy changes. Payer-sponsored disease management programs represent an important conduit to delivering population-based care founded on similar CCM concepts. Disease management is founded on population-based disease identification, evidence-based care protocols, and collaborative practices between clinicians. While substantial clinician training, technology infrastructure commitments, and financial support at the payer level will be needed for the success of disease management programs in obesity and cardiometabolic risk reduction, these barriers can be overcome with the proper commitment. Disease management programs represent an important tool to combat the growing societal risks of overweight and obesity.

Effectiveness of two community-based strategies on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia in Ghana.

PubMed

Escribano-Ferrer, Blanca; Gyapong, Margaret; Bruce, Jane; Narh Bana, Solomon A; Narh, Clement T; Allotey, Naa-Korkor; Glover, Roland; Azantilow, Charity; Bart-Plange, Constance; Sagoe-Moses, Isabella; Webster, Jayne

2017-12-12

Ghana has developed two community-based strategies that aim to increase access to quality treatment for malaria, diarrhoea and suspected pneumonia, and to improve household and family practices: integrated Community Case Management (iCCM) and Community-based Health Planning and Services (CHPS). The objective of the study was to assess the effectiveness of iCCM and CHPS on disease knowledge and health behaviour regarding malaria, diarrhoea and pneumonia. A household survey was conducted two and eight years after implementation of iCCM in the Volta and Northern Regions of Ghana respectively, and more than ten years of CHPS implementation in both regions. The study population included 1356 carers of children under- five years of age who had fever, diarrhoea and/or cough in the two weeks prior to the interview. Disease knowledge was assessed based on the knowledge of causes and identification of signs of severe disease and its association with the sources of health education messages received. Health behaviour was assessed based on reported prompt care seeking behaviour, adherence to treatment regime, utilization of mosquito nets and having improved sanitation facilities, and its association with the sources of health education messages received. Health education messages from community-based agents (CBAs) in the Northern Region were associated with the identification of at least two signs of severe malaria (adjusted Odds Ratio (OR) 1.8, 95%CI 1.0, 3.3, p = 0.04), two practices that can cause diarrhoea (adjusted OR 4.7, 95%CI 1.4, 15.5, p = 0.02) 0and two signs of severe pneumonia (adjusted OR 7.7, 95%CI2.2, 26.5, p = 0.01)-the later also associated with prompt care seeking behaviour (p = 0.04). In the Volta Region, receiving messages on diarrhoea from CHPS was associated with the identification of at least two signs of severe diarrhoea (adjusted OR 3.6, 95%CI 1.4, 9.0), p = 0.02). iCCM was associated with prompt care seeking behaviour in the Volta Region and CHPS with prompt care seeking behaviour in the Northern Region (p < 0.5). Both iCCM and CHPS were associated with disease knowledge and health behaviour, but this was more pronounced for iCCM and in the Northern Region. HBC should continue to be considered as the strategy through which community-IMCI is implemented.

Final report of the APMP water flow key comparison: APMP.M.FF-K1

NASA Astrophysics Data System (ADS)

Lee, Kwang-Bock; Chun, Sejong; Terao, Yoshiya; Thai, Nguyen Hong; Tsair Yang, Cheng; Tao, Meng; Gutkin, Mikhail B.

2011-01-01

The key comparison, APMP.M.FF-K1, was undertaken by APMP/TCFF, the Technical Committee for Fluid Flow (TCFF) under the Asia Pacific Metrology Program (APMP). One objective of the key comparison was to demonstrate the degree of equivalence among six participating laboratories (KRISS, NMIJ, VMI, CMS, NIM and VNIIM) in water flow rate metrology by comparing the results with the key comparison reference value (KCRV) determined from the CCM.FF-K1 key comparison. The other objective of this key comparison was to provide supporting evidence for the calibration and measurement capabilities (CMCs), which had been declared by the participating laboratories during this key comparison. The Transfer Standard Package (TSP) was a Coriolis mass flowmeter, which had been used in the CCM.FF-K1 key comparison. Because the K-factors in the APMP.M.FF-K1 key comparison were slightly lower than the K-factors of the CCM.FF-K1 key comparison due to long-term drifts of the TSP, a correction value D was introduced. The value of D was given by a weighted sum between two link laboratories (NMIJ and KRISS), which participated in both the CCM.FF-K1 and the APMP.M.FF-K1 key comparisons. By this correction, the K-factors were laid between 12.004 and 12.017 at either low (Re = 254 000) or high (Re = 561 000) flow rates. Most of the calibration data were within expected uncertainty bounds. However, some data showed undulations, which gave large fluctuations of the metering factor at Re = 561 000. Calculation of degrees of equivalence showed that all the participating laboratories had deviations between -0.009 and 0.007 pulses/kg from the CCM.FF-K1 KCRV at either the low or the high flow rates. In case of En calculation, all the participating laboratories showed values less than 1, indicating that the corrected K-factors of all the laboratories were equivalent with the KCRV at both Re = 254 000 and 561 000. When the corrected K-factors from two participating laboratories were compared, all the numbers of equivalence showed values less than 1, indicating equivalence. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (MRA).

A Randomized Controlled Trial to Evaluate the Safety and Efficacy of Cardiac Contractility Modulation.

PubMed

Abraham, William T; Kuck, Karl-Heinz; Goldsmith, Rochelle L; Lindenfeld, JoAnn; Reddy, Vivek Y; Carson, Peter E; Mann, Douglas L; Saville, Benjamin; Parise, Helen; Chan, Rodrigo; Wiegn, Phi; Hastings, Jeffrey L; Kaplan, Andrew J; Edelmann, Frank; Luthje, Lars; Kahwash, Rami; Tomassoni, Gery F; Gutterman, David D; Stagg, Angela; Burkhoff, Daniel; Hasenfuß, Gerd

2018-05-05

The authors sought to confirm a subgroup analysis of the prior FIX-HF-5 (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure) study showing that cardiac contractility modulation (CCM) improved exercise tolerance (ET) and quality of life in patients with ejection fractions between 25% and 45%. CCM therapy for New York Heart Association (NYHA) functional class III and IV heart failure (HF) patients consists of nonexcitatory electrical signals delivered to the heart during the absolute refractory period. A total of 160 patients with NYHA functional class III or IV symptoms, QRS duration <130 ms, and ejection fraction ≥25% and ≤45% were randomized to continued medical therapy (control, n = 86) or CCM (treatment, n = 74, unblinded) for 24 weeks. Peak VO 2 (primary endpoint), Minnesota Living With Heart Failure questionnaire, NYHA functional class, and 6-min hall walk were measured at baseline and at 12 and 24 weeks. Bayesian repeated measures linear modeling was used for the primary endpoint analysis with 30% borrowing from the FIX-HF-5 subgroup. Safety was assessed by the percentage of patients free of device-related adverse events with a pre-specified lower bound of 70%. The difference in peak VO 2 between groups was 0.84 (95% Bayesian credible interval: 0.123 to 1.552) ml O 2 /kg/min, satisfying the primary endpoint. Minnesota Living With Heart Failure questionnaire (p < 0.001), NYHA functional class (p < 0.001), and 6-min hall walk (p = 0.02) were all better in the treatment versus control group. There were 7 device-related events, yielding a lower bound of 80% of patients free of events, satisfying the primary safety endpoint. The composite of cardiovascular death and HF hospitalizations was reduced from 10.8% to 2.9% (p = 0.048). CCM is safe, improves exercise tolerance and quality of life in the specified group of HF patients, and leads to fewer HF hospitalizations. (Evaluate Safety and Efficacy of the OPTIMIZER System in Subjects With Moderate-to-Severe Heart Failure; NCT01381172). Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Evaluation of the accuracy, consistency, and stability of measurements of the Planck constant used in the redefinition of the international system of units

NASA Astrophysics Data System (ADS)

Possolo, Antonio; Schlamminger, Stephan; Stoudt, Sara; Pratt, Jon R.; Williams, Carl J.

2018-02-01

The Consultative Committee for Mass and related quantities (CCM), of the International Committee for weights and measures (CIPM), has recently declared the readiness of the community to support the redefinition of the international system of units (SI) at the next meeting of the General Conference on Weights and Measures (CGPM) scheduled for November, 2018. Such redefinition will replace the international prototype of the Kilogram (IPK), as the definition and sole primary realization of the unit of mass, with a definition involving the Planck constant, h. This redefinition in terms of a fundamental constant of nature will enable widespread primary realizations not only of the kilogram but also of its multiples and sub-multiples, best to address the full range of practical needs in the measurement of mass. We review and discuss the statistical models and statistical data reductions, uncertainty evaluations, and substantive arguments that support the verification of several technical preconditions for the redefinition that the CCM has established, and whose verification the CCM has affirmed. These conditions relate to the accuracy and mutual consistency of qualifying measurement results. We review also an issue that has surfaced only recently, concerning the convergence toward a stable value, of the historical values that the task group on fundamental constants of the committee on Data for Science and Technology CODATA-TGFC has recommended for h over the years, even though the CCM has not deemed this issue to be relevant. We conclude that no statistically significant trend can be substantiated for these recommended values, but note that cumulative consensus values that may be derived from the historical measurement results for h seem to have converged while continuing to exhibit fluctuations that are typical of a process in statistical control. Finally, we argue that the most recent consensus value derived from the best measurements available for h, obtained using either a Kibble balance or the XRCD method, is reliable and has uncertainty no larger than the uncertainties surrounding the current primary and secondary realizations of the unit of mass, hence that no credible technical impediments stand in the way of the redefinition of the unit of mass in terms of a fixed value of h.

Category Captain Management: a new approach for healthcare suppliers to partner with their hospital customers.

PubMed

Trombetta, Bill

2007-01-01

Hospitals represent a substantial market for pharmaceutical and medical device companies. The typical approach by healthcare manufacturers and suppliers to hospitals is to send representatives or detailers to hospitals and meet with representatives of hospital formularies and purchasing officials. Classic channels systems, and specifically, Category Captain Management ("CCM") may provide more of a sustainable competitive advantage than traditional hospital detailing. The purpose of this article is to discuss how CCM might apply as an approach for healthcare suppliers to truly partner with their hospital customers.

Analysis of Low-Speed Stall Aerodynamics of a Business Jets Wing Using STAR-CCM+

NASA Technical Reports Server (NTRS)

Bui, Trong

2016-01-01

Reynolds-Averaged Navier-Stokes (RANS) computational fluid dynamics (CFD) analysis was conducted: to study the low-speed stall aerodynamics of a GIII aircrafts swept wing modified with (1) a laminar-flow wing glove, or (2) a seamless flap. The stall aerodynamics of these two different wing configurations were analyzed and compared with the unmodified baseline wing for low-speed flight. The Star-CCM+ polyhedral unstructured CFD code was first validated for wing stall predictions using the wing-body geometry from the First AIAA CFD High-Lift Prediction Workshop.

On the cradle of CCM research: discovery, development, and challenges ahead.

PubMed

Kaplan, Aaron

2017-06-01

Herein, 40 years after its discovery, I briefly and critically survey the development of ideas that propelled research on CO2-concentrating mechanisms (CCMs; a term proposed by Dean Price) of phytoplankton, mainly focusing on cyanobacteria. This is not a comprehensive review on CCM research, but a personal view on the past developments and challenges that lie ahead. © The Author 2017. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Introduction of mobile phones for use by volunteer community health workers in support of integrated community case management in Bushenyi District, Uganda: development and implementation process.

PubMed

Tumusiime, David Katuruba; Agaba, Gad; Kyomuhangi, Teddy; Finch, Jan; Kabakyenga, Jerome; MacLeod, Stuart

2014-01-01

A substantial literature suggests that mobile phones have great potential to improve management and survival of acutely ill children in rural Africa. The national strategy of the Ugandan Ministry of Health calls for employment of volunteer community health workers (CHWs) in implementation of Integrated Community Case Management (iCCM) of common illnesses (diarrhea, acute respiratory infection, pneumonia, fever/malaria) affecting children under five years of age. A mobile phone enabled system was developed within iCCM aiming to improve access by CHWs to medical advice and to strengthen reporting of data on danger signs and symptoms for acutely ill children under five years of age. Herein critical steps in development, implementation, and integration of mobile phone technology within iCCM are described. Mechanisms to improve diagnosis, treatment and referral of sick children under five were defined. Treatment algorithms were developed by the project technical team and mounted and piloted on the mobile phones, using an iterative process involving technical support personnel, health care providers, and academic support. Using a purposefully developed mobile phone training manual, CHWs were trained over an intensive five-day course to make timely diagnoses, recognize clinical danger signs, communicate about referrals and initiate treatment with appropriate essential drugs. Performance by CHWs and the accuracy and completeness of their submitted data was closely monitored post training test period and during the subsequent nine month community trial. In the full trial, the number of referrals and correctly treated children, based on the agreed treatment algorithms, was recorded. Births, deaths, and medication stocks were also tracked. Seven distinct phases were required to develop a robust mobile phone enabled system in support of the iCCM program. Over a nine month period, 96 CHWs were trained to use mobile phones and their competence to initiate a community trial was established through performance monitoring. Local information/communication consultants, working in concert with a university based department of pediatrics, can design and implement a robust mobile phone based system that may be anticipated to contribute to efficient delivery of iCCM by trained volunteer CHWs in rural settings in Uganda.

Improved sampling and analysis of images in corneal confocal microscopy.

PubMed

Schaldemose, E L; Fontain, F I; Karlsson, P; Nyengaard, J R

2017-10-01

Corneal confocal microscopy (CCM) is a noninvasive clinical method to analyse and quantify corneal nerve fibres in vivo. Although the CCM technique is in constant progress, there are methodological limitations in terms of sampling of images and objectivity of the nerve quantification. The aim of this study was to present a randomized sampling method of the CCM images and to develop an adjusted area-dependent image analysis. Furthermore, a manual nerve fibre analysis method was compared to a fully automated method. 23 idiopathic small-fibre neuropathy patients were investigated using CCM. Corneal nerve fibre length density (CNFL) and corneal nerve fibre branch density (CNBD) were determined in both a manual and automatic manner. Differences in CNFL and CNBD between (1) the randomized and the most common sampling method, (2) the adjusted and the unadjusted area and (3) the manual and automated quantification method were investigated. The CNFL values were significantly lower when using the randomized sampling method compared to the most common method (p = 0.01). There was not a statistical significant difference in the CNBD values between the randomized and the most common sampling method (p = 0.85). CNFL and CNBD values were increased when using the adjusted area compared to the standard area. Additionally, the study found a significant increase in the CNFL and CNBD values when using the manual method compared to the automatic method (p ≤ 0.001). The study demonstrated a significant difference in the CNFL values between the randomized and common sampling method indicating the importance of clear guidelines for the image sampling. The increase in CNFL and CNBD values when using the adjusted cornea area is not surprising. The observed increases in both CNFL and CNBD values when using the manual method of nerve quantification compared to the automatic method are consistent with earlier findings. This study underlines the importance of improving the analysis of the CCM images in order to obtain more objective corneal nerve fibre measurements. © 2017 The Authors Journal of Microscopy © 2017 Royal Microscopical Society.

Final report on EURAMET.M.P-K4.2010: Key and supplementary comparison of national pressure standards in the range 1 Pa to 15 kPa of absolute and gauge pressure

NASA Astrophysics Data System (ADS)

Krajíček, Zdeněk; Bergoglio, Mercede; Jousten, Karl; Otal, Pierre; Sabuga, Wladimir; Saxholm, Sari; Pražák, Dominik; Vičar, Martin

2014-01-01

This report describes a EURAMET comparison of five European National Metrology Institutes in low gauge and absolute pressure in gas (nitrogen), denoted as EURAMET.M.P-K4.2010. Its main intention is to state equivalence of the pressure standards, in particular those based on the technology of force-balanced piston gauges such as e.g. FRS by Furness Controls, UK and FPG8601 by DHI-Fluke, USA. It covers the range from 1 Pa to 15 kPa, both gauge and absolute. The comparison in absolute mode serves as a EURAMET Key Comparison which can be linked to CCM.P-K4 and CCM.P-K2 via PTB. The comparison in gauge mode is a supplementary comparison. The comparison was carried out from September 2008 till October 2012. The participating laboratories were the following: CMI, INRIM, LNE, MIKES, PTB-Berlin (absolute pressure 1 kPa and below) and PTB-Braunschweig (absolute pressure 1 kPa and above and gauge pressure). CMI was the pilot laboratory and provided a transfer standard for the comparison. This transfer standard was also the laboratory standard of CMI at the same time, which resulted in a unique and logistically difficult star comparison. Both in gauge and absolute pressures all the participating institutes successfully proved their equivalence with respect to the reference value and all also proved mutual bilateral equivalences in all the points. All the participating laboratories are also equivalent with the reference values of CCM.P-K4 and CCM.P-K2 in the relevant points. The comparison also proved the ability of FPG8601 to serve as a transfer standard. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Integrated community case management of malaria, pneumonia and diarrhoea across three African countries: A qualitative study exploring lessons learnt and implications for further scale up

PubMed Central

Strachan, Clare; Wharton–Smith, Alexandra; Sinyangwe, Chomba; Mubiru, Denis; Ssekitooleko, James; Meier, Joslyn; Gbanya, Miatta; Tibenderana, James K.; Counihan, Helen

2014-01-01

Numerous studies highlight the effectiveness of an integrated approach for the management of malaria, pneumonia and diarrhoea at the community level. There has however been little study on lessons learnt from implementation in practice and stakeholder experiences which could inform future programmatic planning and evaluation frameworks. A participatory, qualitative evaluation was conducted in the three varied settings of South Sudan, Uganda and Zambia, which have seen the scale up of integrated community case management (iCCM) over the last five years. All key in–country stakeholders were consulted on study design, with a particular focus on scope and methodology. Data collection methods included stakeholder consultations (key informant interviews, focus group discussions), and a review of project and Ministry of Health documentation. Data analysis followed the Framework Approach. Results suggest that iCCM implementation generally followed national pre–agreed guidelines. Overarching key programmatic recommendations included: collaboration with implementing partners in planning stages to positively impact on community acceptance and ownership; adoption of participatory training methods adapted to low literacy populations; development of alternative support supervision methods such as peer support groups; full integration of community level data into the health management information system and emphasizing data analysis, use and feedback at all levels; strengthened supply chains through improved quantification and procurement of commodities in conjunction with the national distribution network; community engagement to establish a support system for community health workers to increase their motivation; enhanced sensitisation and behaviour change communication to raise awareness and usage of appropriate health services; and advocacy at the national level for funding and logistical support for the continuation and integration of iCCM. This qualitative study is a valuable contribution in understanding the ‘hows’ of iCCM implementation with key insights for improved feasibility and acceptability. Main findings show how community support to iCCM and community health workers is necessary for sustained health benefits coupled with a focus on strengthening and ‘enabling’ the public health system. The participatory study design and methodologies used enabled the scope of the research enquiry to effectively capture various stakeholder perspectives. PMID:25520794

The dynamic monitoring of aeolian desertification land distribution and its response to climate change in northern China

NASA Astrophysics Data System (ADS)

Feng, Lili; Jia, Zhiqing; Li, Qingxue

2016-12-01

Aeolian desertification is poorly understood despite its importance for indicating environment change. Here we exploit Gaofen-1(GF-1) and Moderate Resolution Imaging Spectroradiometer (MODIS) data to develop a quick and efficient method for large scale aeolian desertification dynamic monitoring in northern China. This method, which is based on Normalized Difference Desertification Index (NDDI) calculated by band1 & band2 of MODIS reflectance data (MODIS09A1). Then we analyze spatial-temporal change of aeolian desertification area and detect its possible influencing factors, such as precipitation, temperature, wind speed and population by Convergent Cross Mapping (CCM) model. It suggests that aeolian desertification area with population indicates feedback (bi-directional causality) between the two variables (P < 0.05), but forcing of aeolian desertification area by population is weak. Meanwhile, we find aeolian desertification area is significantly affected by temperature, as expected. However, there is no obvious forcing for the aeolian desertification area and precipitation. Aeolian desertification area with wind speed indicates feedback (bi-directional causality) between the two variables with significant signal (P < 0.01). We infer that aeolian desertification is greatly affected by natural factors compared with anthropogenic factors. For the desertification in China, we are greatly convinced that desertification prevention is better than control.

The dynamic monitoring of aeolian desertification land distribution and its response to climate change in northern China

PubMed Central

Feng, Lili; Jia, Zhiqing; Li, Qingxue

2016-01-01

Aeolian desertification is poorly understood despite its importance for indicating environment change. Here we exploit Gaofen-1(GF-1) and Moderate Resolution Imaging Spectroradiometer (MODIS) data to develop a quick and efficient method for large scale aeolian desertification dynamic monitoring in northern China. This method, which is based on Normalized Difference Desertification Index (NDDI) calculated by band1 & band2 of MODIS reflectance data (MODIS09A1). Then we analyze spatial-temporal change of aeolian desertification area and detect its possible influencing factors, such as precipitation, temperature, wind speed and population by Convergent Cross Mapping (CCM) model. It suggests that aeolian desertification area with population indicates feedback (bi-directional causality) between the two variables (P < 0.05), but forcing of aeolian desertification area by population is weak. Meanwhile, we find aeolian desertification area is significantly affected by temperature, as expected. However, there is no obvious forcing for the aeolian desertification area and precipitation. Aeolian desertification area with wind speed indicates feedback (bi-directional causality) between the two variables with significant signal (P < 0.01). We infer that aeolian desertification is greatly affected by natural factors compared with anthropogenic factors. For the desertification in China, we are greatly convinced that desertification prevention is better than control. PMID:28004798

Calculation of paleohydraulic parameters of a fluvial system under spatially variable subsidence, of the Ericson sandstone, South western Wyoming

NASA Astrophysics Data System (ADS)

Snyder, H.; Leva-Lopez, J.

2017-12-01

During the late Campanian age in North America fluvial systems drained the highlands of the Sevier orogenic belt and travelled east towards the Western Interior Seaway. One of such systems deposited the Canyon Creek Member (CCM) of the Ericson Formation in south-western Wyoming. At this time the fluvial system was being partially controlled by laterally variable subsidence caused by incipient Laramide uplifts. These uplifts rather than real topographic features were only areas of reduced subsidence at the time of deposition of the CCM. Surface expression at that time must have been minimum, only minute changes in slope and accommodation. Outcrops around these Laramide structures, in particular both flanks of the Rock Springs Uplift, the western side of the Rawlins uplift and the north flank of the Uinta Mountains, have been sampled to study the petrography, grain size, roundness and sorting of the CCM, which along with the cross-bed thickness and bar thickness allowed calculation of the hydraulic parameters of the rivers that deposited the CCM. This study reveals how the fluvial system evolved and responded to the very small changes in subsidence and slope. Furthermore, the petrography will shed light on the provenance of these sandstones and on the relative importance of Sevier sources versus Laramide sources. This work is framed in a larger study that shows how incipient Laramide structural highs modified the behavior, style and architecture of the fluvial system, affecting its thickness, facies characteristics and net-to-gross both down-dip and along strike across the basin.

Tract-Specific Diffusion Tensor Imaging Reveals Laterality of Neurological Symptoms in Patients with Cervical Compression Myelopathy.

PubMed

Maki, Satoshi; Koda, Masao; Saito, Junya; Takahashi, Sho; Inada, Taigo; Kamiya, Koshiro; Ota, Mitsutoshi; Iijima, Yasushi; Masuda, Yoshitada; Matsumoto, Koji; Kojima, Masatoshi; Takahashi, Kazuhisa; Obata, Takayuki; Yamazaki, Masashi; Furuya, Takeo

2016-12-01

Patients with cervical compression myelopathy (CCM) generally present bilateral neurological symptoms in their extremities. However, a substantial portion of patients with CCM exhibit laterality of neurological symptoms. The aim of this study was to assess the correlation between intrinsic structural damage and laterality of symptoms using spinal cord diffusion tensor imaging (DTI) of the corticospinal tract. We enrolled 10 healthy volunteers and 40 patients with CCM in this study. We evaluated motor function using the American Spinal Injury Association (ASIA) motor score for left and right extremities. For DTI acquisitions, a 3.0-T magnetic resonance imaging system with diffusion-weighted spin-echo sequence was used. Regions-of-interest in the lateral column tracts were determined. We determined the correlations between fractional anisotropy (FA) and ASIA motor scores. An FA asymmetry index was calculated using left and right regions-of-interest. Four patients exhibited laterality of symptoms in their extremities, for which left and right ASIA scores correlated moderately with FA in the left and right lateral columns, respectively (left: ρ = 0.64, P < 0.001; right: ρ = 0.67, P < 0.001). The area under the receiver-operator characteristic curve showed that the FA asymmetry index indicated laterality of symptoms. Using tract-specific DTI, we demonstrated that microstructural damages in the left and right corticospinal tracts correlated with corresponding neurological symptoms in the ipsilateral side and the FA asymmetry index could indicate laterality in neurological symptoms of patients with CCM. Copyright © 2016 Elsevier Inc. All rights reserved.

Final report on key comparison EURAMET.M.P-K13 in the range 50 MPa to 500 MPa of hydraulic gauge pressure

NASA Astrophysics Data System (ADS)

Kocas, I.; Sabuga, W.; Bergoglio, M.; Eltaweel, A.; Korasie, C.; Farar, P.; Setina, J.; Waller, B.; Durgut, Y.

2015-01-01

The regional key comparison EURAMET.M.P-K13 for pressure measurements in liquid media from 50 MPa to 500 MPa was piloted by the TÜBİTAK UME Pressure Group Laboratories, Turkey. The transfer standard was a DH-Budenberg pressure balance with a free deformation piston-cylinder unit of 2 mm2 nominal effective area. Six laboratories from the EURAMET region, namely PTB, INRIM, SMU, IMT, NPL and UME, and two laboratories from the AFRIMETS region, NIS and NMISA participated in this comparison. Participant laboratories and countries are given in the bottom of the page. PTB participated in this comparison to provide a link to corresponding 500 MPa CCM key comparison CCM.P-K13. The results of all participants excepting NMISA and NPL were found to be consistent with the reference value of the actual comparison and of CCM.P-K13 within their claimed uncertainties (k = 2), at all pressures. Compared in pairs all laboratories with exception of NPL and NMISA demonstrate their agreement with each other within the expanded uncertainties (k = 2) at all pressures. The results are therefore considered to be satisfactory. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Performer's attitudes toward seeking health care for voice issues: understanding the barriers.

PubMed

Gilman, Marina; Merati, Albert L; Klein, Adam M; Hapner, Edie R; Johns, Michael M

2009-03-01

Contemporary commercial music (CCM) performers rely heavily on their voice, yet may not be aware of the importance of proactive voice care. This investigation intends to identify perceptions and barriers to seeking voice care among CCM artists. This cross-sectional observational study used a 10-item Likert-based response questionnaire to assess current perceptions regarding voice care in a population of randomly selected participants of professional CCM conference. Subjects (n=78) were queried regarding their likelihood to seek medical care for minor medical problems and specifically problems with their voice. Additional questions investigated anxiety about seeking voice care from a physician specialist, speech language pathologist, or voice coach; apprehension regarding findings of laryngeal examination, laryngeal imaging procedures; and the effect of medical insurance on the likelihood of seeking medical care. Eighty-two percent of subjects reported that their voice was a critical part of their profession; 41% stated that they were not likely to seek medical care for problems with their voice; and only 19% were reluctant to seek care for general medical problems (P<0.001). Anxiety about seeking a clinician regarding their voice was not a deterrent. Most importantly, 39% of subjects do not seek medical attention for their voice problems due to medical insurance coverage. The CCM artists are less likely to seek medical care for voice problems compared with general medical problems. Availability of medical insurance may be a factor. Availability of affordable voice care and education about the importance of voice care is needed in this population of vocal performers.

Modeling the optimal central carbon metabolic pathways under feedback inhibition using flux balance analysis.

PubMed

De, Rajat K; Tomar, Namrata

2012-12-01

Metabolism is a complex process for energy production for cellular activity. It consists of a cascade of reactions that form a highly branched network in which the product of one reaction is the reactant of the next reaction. Metabolic pathways efficiently produce maximal amount of biomass while maintaining a steady-state behavior. The steady-state activity of such biochemical pathways necessarily incorporates feedback inhibition of the enzymes. This observation motivates us to incorporate feedback inhibition for modeling the optimal activity of metabolic pathways using flux balance analysis (FBA). We demonstrate the effectiveness of the methodology on a synthetic pathway with and without feedback inhibition. Similarly, for the first time, the Central Carbon Metabolic (CCM) pathways of Saccharomyces cerevisiae and Homo sapiens have been modeled and compared based on the above understanding. The optimal pathway, which maximizes the amount of the target product(s), is selected from all those obtained by the proposed method. For this, we have observed the concentration of the product inhibited enzymes of CCM pathway and its influence on its corresponding metabolite/substrate. We have also studied the concentration of the enzymes which are responsible for the synthesis of target products. We further hypothesize that an optimal pathway would opt for higher flux rate reactions. In light of these observations, we can say that an optimal pathway should have lower enzyme concentration and higher flux rates. Finally, we demonstrate the superiority of the proposed method by comparing it with the extreme pathway analysis.

Psychiatric consultation in the collaborative care model: The "bipolar sieve" effect.

PubMed

Phelps, James R; James, James

2017-08-01

Around the world, psychiatrists are in exceptionally short supply. The majority of mental health treatment is delivered in primary care. In the United States, the Collaborative Care Model (CCM) addresses the shortfall of psychiatrists by providing indirect consultation in primary care. A Cochrane meta-analysis affirms the efficacy this model for depression and anxiety. However, our experience with the CCM suggests that most patients referred for consultation have problems far more complex than simple depression and anxiety. Based on preliminary data, we offer five linked hypotheses: (1) in an efficient collaborative care process, the majority of mental illnesses can be handled by providers who are less expensive and more plentiful than psychiatrists. (2) A majority of the remaining cases will be bipolar disorder variations. Differentiating these from PTSD, the most common alternative or comorbid diagnosis, is challenging and often requires a psychiatrist's input. (3) Psychiatric consultants can teach their primary care colleagues that bipolar diagnoses are estimations based on rigorously assessed probabilities, and that cases fall on a spectrum from unipolar to bipolar. (4) All providers must recognize that when bipolarity is missed, antidepressant prescription often follows. Antidepressants can induce bipolar mixed states, with extreme anxiety and potentially dangerous impulsivity and suicidality. (5) Psychiatrists can help develop clinical approaches in primary care that identify bipolarity and differentiate it from (or establish comorbidity with) PTSD; and psychiatrists can facilitate appropriate treatment, including bipolar-specific psychotherapies as well as use of mood stabilizers. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Diagnostic performance of surface electrocardiogram in early detection of chagasic cardiomyopathy].

PubMed

Bochard-Villanueva, Bruno; Estornell-Erill, Jordi; Fabregat-Andrés, Óscar; García-González, Pilar; Morell-Cabedo, Salvador; Ridocci-Soriano, Francisco

2015-03-15

Contrast-enhanced cardiac magnetic resonance imaging (CMR) allows early detection of myocardial involvement by Trypanosoma cruzi infection. The aim of our study was to assess the diagnostic performance of the surface electrocardiogram (ECG) in the early detection of Chagas' cardiomyopathy (CCM) compared with CMR. We included 43 asymptomatic patients (30 women, 42 ± 9.8 years), diagnosed of Chagas disease. The sample was divided into 2 groups according to the presence (n=17) or absence (n=26) of electrocardiographic abnormalities. All patients underwent CMR and late gadolinium enhancement (LGE) was used as a marker of early myocardial involvement. Six (14%) patients had a LGE significantly higher in the group who had electrocardiographic abnormalities (29 vs. 4%, P<.05). With CMR as the method of reference, the ECG had a sensitivity of 83% and a negative predictive value of 96% to detect CCM. ECG is a useful, inexpensive and globally available tool for the screening of CCM in asymptomatic patients but with proven myocardial involvement in CMR. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Device therapy in heart failure with reduced ejection fraction-cardiac resynchronization therapy and more.

PubMed

Duncker, D; Veltmann, C

2018-05-09

In patients with heart failure with reduced ejection fraction (HFrEF), optimal medical treatment includes beta-blockers, ACE inhibitors/angiotensinreceptor-neprilysin inhibitors (ARNI), mineralocorticoid receptor antagonists, and ivabradine when indicated. In device therapy of HFrEF, implantable cardioverter-defibrillators and cardiac resynchronization therapy (CRT) have been established for many years. CRT is the therapy of choice (class I indication) in symptomatic patients with HFrEF and a broad QRS complex with a left bundle branch block (LBBB) morphology. However, the vast majority of heart failure patients show a narrow QRS complex or a non-LBBB morphology. These patients are not candidates for CRT and alternative electrical therapies such as baroreflex activation therapy (BAT) and cardiac contractility modulation (CCM) may be considered. BAT modulates vegetative dysregulation in heart failure. CCM improves contractility, functional capacity, and symptoms. Although a broad data set is available for BAT and CCM, mortality data are still lacking for both methods. This article provides an overview of the device-based therapeutic options for patients with HFrEF.

Detection of coupling delay: A problem not yet solved

NASA Astrophysics Data System (ADS)

Coufal, David; Jakubík, Jozef; Jajcay, Nikola; Hlinka, Jaroslav; Krakovská, Anna; Paluš, Milan

2017-08-01

Nonparametric detection of coupling delay in unidirectionally and bidirectionally coupled nonlinear dynamical systems is examined. Both continuous and discrete-time systems are considered. Two methods of detection are assessed—the method based on conditional mutual information—the CMI method (also known as the transfer entropy method) and the method of convergent cross mapping—the CCM method. Computer simulations show that neither method is generally reliable in the detection of coupling delays. For continuous-time chaotic systems, the CMI method appears to be more sensitive and applicable in a broader range of coupling parameters than the CCM method. In the case of tested discrete-time dynamical systems, the CCM method has been found to be more sensitive, while the CMI method required much stronger coupling strength in order to bring correct results. However, when studied systems contain a strong oscillatory component in their dynamics, results of both methods become ambiguous. The presented study suggests that results of the tested algorithms should be interpreted with utmost care and the nonparametric detection of coupling delay, in general, is a problem not yet solved.

L3:PHI.CMD.P13.02 Support for CILC L1 Milestone Using STAR-CCM+

DOE Office of Scientific and Technical Information (OSTI.GOV)

Slattery, Stuart R.; Gurecky, William L.

2016-10-07

This report documents work performed to support Consortium for the Advanced Simulation of LWRs (CASL) modeling of Chalk River Unidentified Deposit (CRUD) Induced Power Shift (CIPS) and CRUD Induced Local Corrosion (CILC) using the Cicada package. The work documented here is intended to complement current and future CIPS and CILC modeling activities in CASL. We provide tools for crud and corrosion-related simulation and analysis by developing a better understanding of the interplay between the coupled physics that describe the phenomena at different time and length scales. We intend to use these models to better inform future simulation capability and development.

Impact of Personality Disorder Cluster on Depression Outcomes Within Collaborative Care Management Model of Care.

PubMed

George, Merit P; Garrison, Gregory M; Merten, Zachary; Heredia, Dagoberto; Gonzales, Cesar; Angstman, Kurt B

2018-01-01

Previous studies have suggested that having a comorbid personality disorder (PD) along with major depression is associated with poorer depression outcomes relative to those without comorbid PD. However, few studies have examined the influence of specific PD cluster types. The purpose of the current study is to compare depression outcomes between cluster A, cluster B, and cluster C PD patients treated within a collaborative care management (CCM), relative to CCM patients without a PD diagnosis. The overarching goal was to identify cluster types that might confer a worse clinical prognosis. This retrospective chart review study examined 2826 adult patients with depression enrolled in CCM. The cohort was divided into 4 groups based on the presence of a comorbid PD diagnosis (cluster A/nonspecified, cluster B, cluster C, or no PD). Baseline clinical and demographic variables, along with 6-month follow-up Patient Health Questionnaire-9 (PHQ-9) scores were obtained for all groups. Depression remission was defined as a PHQ-9 score <5 at 6 months, and persistent depressive symptoms (PDS) was defined as a PHQ-9 score ≥10 at 6 months. Adjusted odds ratios (AORs) were determined for both remission and PDS using logistic regression modeling for the 6-month PHQ-9 outcome, while retaining all study variables. A total of 59 patients (2.1%) had a cluster A or nonspecified PD diagnosis, 122 patients (4.3%) had a cluster B diagnosis, 35 patients (1.2%) had a cluster C diagnosis, and 2610 patients (92.4%) did not have any PD diagnosis. The presence of a cluster A/nonspecified PD diagnosis was associated with a 62% lower likelihood of remission at 6 months (AOR = 0.38; 95% CI 0.20-0.70). The presence of a cluster B PD diagnosis was associated with a 71% lower likelihood of remission at 6 months (AOR = 0.29; 95% CI 0.18-0.47). Conversely, having a cluster C diagnosis was not associated with a significantly lower likelihood of remission at 6 months (AOR = 0.83; 95% CI 0.42-1.65). Increased odds of having PDS at 6-month follow-up were seen with cluster A/nonspecified PD patients (AOR = 3.35; 95% CI 1.92-5.84) as well as cluster B patients (AOR = 3.66; 95% CI 2.45-5.47). However, cluster C patents did not have significantly increased odds of experiencing persistent depressive symptoms at 6-month follow-up (AOR = 0.95; 95% CI 0.45-2.00). Out of the 3 clusters, the presence of a cluster B PD diagnosis was most significantly associated with poorer depression outcomes at 6-month follow-up, including reduced remission rates and increased risk for PDS. The cluster A/nonspecified PD group also showed poor outcomes; however, the heterogeneity of this subgroup with regard to PD features must be noted. The development of novel targeted interventions for at-risk clusters may be warranted in order to improve outcomes of these patients within the CCM model of care.

Devitalization of bacterial and parasitic germs in sewage sludge during aerobic digestion under laboratory conditions.

PubMed

Juris, P; Plachý, P; Lauková, A

1995-05-01

The survival of 8 bacterial species (Pseudomonas sp., Salmonella sp., Enterobacteriae, Streptococcus sp., Escherichia coli) was detected in municipal sewage sludge up to 37 hours of mesophilic aerobic digestion under laboratory conditions. The model strain Enterococcus faecium CCM 4231 survived almost twice as long as the above-mentioned isolates. Similar findings, regarding the viability of the microorganisms studied, were also determined during thermophilic aerobic digestion of municipal sewage sludges. The final reduction in the total count of bacteria was not directly dependent on the temperature during aerobic digestion. It may be supposed that E. faecium CCM 4231 strain as a bacteriocin-producing strain with a broad antimicrobial spectrum, inoculated into the sludges, could inhibit the growth of microorganisms in the sludges by the way of its bacteriocin activity. Studying the effect of aerobic digestion on the viability of helminth eggs, the observed negative effect of higher temperatures was more expressive in comparison with bacterial strains. During thermophilic digestion process all helminth eggs (Ascaris suum, Toxocara canis) were devitalized. All eggs of T. canis were killed in experiments under mesophilic temperature. However, 32% of nonembryonated A. suum eggs remained viable.

Dynamic connectivity in the Southern California Bight and Georges Bank: Identifying ecosystem interactions using chaotic time series analysis

NASA Astrophysics Data System (ADS)

Ye, H.; Deyle, E. R.; Hsieh, C.; Sugihara, G.

2012-12-01

We used convergent cross mapping (CCM), a method grounded in nonlinear dynamical systems theory to analyze long-term time series of fish species from the California Cooperative Oceanic Fisheries Investigations ichthyoplankton (isolated to the Southern California Bight [SCB]) and NOAA National Marine Fisheries Service Northeast Fisheries Science Center trawl survey (isolated to the Georges Bank [GB] region) data sets. CCM gives a nonparametric indicator of the realized dynamic influence that one species has on another (i.e. how much the abundance of X at a particular time is dependent on the historical abundance of Y). We found there are more interactions between species in SCB compared to GB. An analysis of the interaction matrix showed that there is also more structure in the connectivity network of SCB compared to GB. We attribute this difference in connectivity to historical overexploitation of fish stocks in the North Atlantic, and reproduce this effect in simple multi-species fishery models. We discuss the implications of these results for ecosystem-based management and for restoration efforts.; Connectivity Networks for Fishes in the Southern California Bight (SCB) and Georges Bank (GB) as determined using cross-mapping.

A faster Rubisco with potential to increase photosynthesis in crops.

PubMed

Lin, Myat T; Occhialini, Alessandro; Andralojc, P John; Parry, Martin A J; Hanson, Maureen R

2014-09-25

In photosynthetic organisms, D-ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) is the major enzyme assimilating atmospheric CO2 into the biosphere. Owing to the wasteful oxygenase activity and slow turnover of Rubisco, the enzyme is among the most important targets for improving the photosynthetic efficiency of vascular plants. It has been anticipated that introducing the CO2-concentrating mechanism (CCM) from cyanobacteria into plants could enhance crop yield. However, the complex nature of Rubisco's assembly has made manipulation of the enzyme extremely challenging, and attempts to replace it in plants with the enzymes from cyanobacteria and red algae have not been successful. Here we report two transplastomic tobacco lines with functional Rubisco from the cyanobacterium Synechococcus elongatus PCC7942 (Se7942). We knocked out the native tobacco gene encoding the large subunit of Rubisco by inserting the large and small subunit genes of the Se7942 enzyme, in combination with either the corresponding Se7942 assembly chaperone, RbcX, or an internal carboxysomal protein, CcmM35, which incorporates three small subunit-like domains. Se7942 Rubisco and CcmM35 formed macromolecular complexes within the chloroplast stroma, mirroring an early step in the biogenesis of cyanobacterial β-carboxysomes. Both transformed lines were photosynthetically competent, supporting autotrophic growth, and their respective forms of Rubisco had higher rates of CO2 fixation per unit of enzyme than the tobacco control. These transplastomic tobacco lines represent an important step towards improved photosynthesis in plants and will be valuable hosts for future addition of the remaining components of the cyanobacterial CCM, such as inorganic carbon transporters and the β-carboxysome shell proteins.

On the utility of GPU accelerated high-order methods for unsteady flow simulations: A comparison with industry-standard tools

NASA Astrophysics Data System (ADS)

Vermeire, B. C.; Witherden, F. D.; Vincent, P. E.

2017-04-01

First- and second-order accurate numerical methods, implemented for CPUs, underpin the majority of industrial CFD solvers. Whilst this technology has proven very successful at solving steady-state problems via a Reynolds Averaged Navier-Stokes approach, its utility for undertaking scale-resolving simulations of unsteady flows is less clear. High-order methods for unstructured grids and GPU accelerators have been proposed as an enabling technology for unsteady scale-resolving simulations of flow over complex geometries. In this study we systematically compare accuracy and cost of the high-order Flux Reconstruction solver PyFR running on GPUs and the industry-standard solver STAR-CCM+ running on CPUs when applied to a range of unsteady flow problems. Specifically, we perform comparisons of accuracy and cost for isentropic vortex advection (EV), decay of the Taylor-Green vortex (TGV), turbulent flow over a circular cylinder, and turbulent flow over an SD7003 aerofoil. We consider two configurations of STAR-CCM+: a second-order configuration, and a third-order configuration, where the latter was recommended by CD-adapco for more effective computation of unsteady flow problems. Results from both PyFR and STAR-CCM+ demonstrate that third-order schemes can be more accurate than second-order schemes for a given cost e.g. going from second- to third-order, the PyFR simulations of the EV and TGV achieve 75× and 3× error reduction respectively for the same or reduced cost, and STAR-CCM+ simulations of the cylinder recovered wake statistics significantly more accurately for only twice the cost. Moreover, advancing to higher-order schemes on GPUs with PyFR was found to offer even further accuracy vs. cost benefits relative to industry-standard tools.

Eutectic superalloys by edge-defined, film-fed growth

NASA Technical Reports Server (NTRS)

Hurley, G. F.

1975-01-01

The feasibility of producing directionally solidified eutectic alloy composites by edge-defined, film-fed growth (EFG) was carried out. The three eutectic alloys which were investigated were gamma + delta, gamma/gamma prime + delta, and a Co-base TaC alloy containing Cr and Ni. Investigations into the compatibility and wettability of these metals with various carbides, borides, nitrides, and oxides disclosed that compounds with the largest (negative) heats of formation were most stable but poorest wetting. Nitrides and carbides had suitable stability and low contact angles but capillary rise was observed only with carbides. Oxides would not give capillary rise but would probably fulfill the other wetting requirements of EFG. Tantalum carbide was selected for most of the experimental portion of the program based on its exhibiting spontaneous capillary rise and satisfactory slow rate of degradation in the liquid metals. Samples of all three alloys were grown by EFG with the major experimental effort restricted to gamma + delta and gamma/gamma prime + delta alloys. In the standard, uncooled EFG apparatus, the thermal gradient was inferred from the growth speed and was 150 to 200 C/cm. This value may be compared to typical gradients of less than 100 C/cm normally achieved in a standard Bridgman-type apparatus. When a stream of helium was directed against the side of the bar during growth, the gradient was found to improve to about 250 C/cm. In comparison, a theoretical gradient of 700 C/cm should be possible under ideal conditions, without the use of chills. Methods for optimizing the gradient in EFG are discussed, and should allow attainment of close to the theoretical for a particular configuration.

Final Report: Comparison of the primary (national) standards of low-pressure gas flow

NASA Astrophysics Data System (ADS)

Benková, Miroslava; Makovnik, Stefan; Mickan, Bodo

2015-01-01

The EURAMET.M.FF-K6 comparison was organized for the purpose of determination of the degree of equivalence of the primary (national) standards for low-pressure gas flow measurement over the range (2 to 100) m3/h and was performed simultaneously with CCM.FF-K6.2011 with the same transfer standard. A rotary gas meter G65 was used as a transfer standard. The measurements were provided by prescribed reference conditions. Fifteen laboratories from EURAMET participated in this key comparison - SMU, Slovakia; PTB, Germany; CEM, Spain; LNE-LADG, France; VSL, Netherlands; CMI, Czech Republic; BEV, Austria; MKEH, Hungary; GUM Poland; SP, Sweden; METAS, Switzerland; DMDM, Serbia; TUBITAK-UME, Turkey; EIM, Greece; IMBiH, Bosnia-Herzegovina. The EURAMET.M.FF-K6 is linked to the CCM.FF-K6.2011 by correcting the results of three linking laboratories (Slovakia SMU, Germany PTB and France LNE LADG). This correction provides an estimate of what would have been the result from the EURAMET.M-FF-K6 participants, if they had actually participated in CCM.FF-K6.2011. According to the evaluation 93.7 % of the results were consistent with KCRV, 3.4 % of the results were in the warning level and 2.9 % of the results were inconsistent. The results of this comparison can be used for review of the CMC tables. Main text. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Longitudinal changes in seizure outcomes after resection of cerebral cavernous malformations in patients presenting with seizures: a long-term follow-up of 46 patients.

PubMed

Kim, Jiha; Kim, Chi Heon; Chung, Chun Kee

2014-08-01

Seizure is the most common presentation in patients with cerebral cavernous malformations (CCMs). Although many articles have documented seizure outcomes after resection of CCM, few have conducted long-term follow-ups; thus, the fluctuating seizure outcomes have been neglected. The purpose of this study is to describe long-term postoperative seizure outcomes in patients with CCM and to compare seizure outcomes between patients with sporadic seizures and those with chronic seizures. Forty-six patients with CCM presenting with seizures underwent surgery. The male-to-female ratio was 1:1, and the average age at initial seizure onset was 27.6 years. The mean preoperative seizure duration was 42.7 months. Patients were divided into two groups: a chronic group (N = 20) and a sporadic group (N = 26) according to seizure frequency and duration. The mean postoperative follow-up duration was 96.3 months, and the postoperative seizure outcomes were checked annually based upon Engel's classification. After the first year of follow-up, 80.8 % of the sporadic group and 75.0 % of the chronic group were evaluated as Engel class I. These rates increased to 100.0 % and 90.0 %, respectively, at the eighth year of follow-up. Overall, 29 (63.0 %) of the 46 patients experienced changes in seizure outcomes over the follow-up period. Despite their delayed improvements, the chronic group showed less favorable outcomes throughout follow-up (p = 0.025). Long-term follow-up is indispensable for accurately assessing postoperative seizure outcomes because these outcomes change continuously. We recommend earlier surgery to achieve seizure-free status in patients with CCM. However, even in the chronic group, surgery is recommended, considering the overall delayed improvement.

On the utility of GPU accelerated high-order methods for unsteady flow simulations: A comparison with industry-standard tools

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vermeire, B.C., E-mail: brian.vermeire@concordia.ca; Witherden, F.D.; Vincent, P.E.

First- and second-order accurate numerical methods, implemented for CPUs, underpin the majority of industrial CFD solvers. Whilst this technology has proven very successful at solving steady-state problems via a Reynolds Averaged Navier–Stokes approach, its utility for undertaking scale-resolving simulations of unsteady flows is less clear. High-order methods for unstructured grids and GPU accelerators have been proposed as an enabling technology for unsteady scale-resolving simulations of flow over complex geometries. In this study we systematically compare accuracy and cost of the high-order Flux Reconstruction solver PyFR running on GPUs and the industry-standard solver STAR-CCM+ running on CPUs when applied to amore » range of unsteady flow problems. Specifically, we perform comparisons of accuracy and cost for isentropic vortex advection (EV), decay of the Taylor–Green vortex (TGV), turbulent flow over a circular cylinder, and turbulent flow over an SD7003 aerofoil. We consider two configurations of STAR-CCM+: a second-order configuration, and a third-order configuration, where the latter was recommended by CD-adapco for more effective computation of unsteady flow problems. Results from both PyFR and STAR-CCM+ demonstrate that third-order schemes can be more accurate than second-order schemes for a given cost e.g. going from second- to third-order, the PyFR simulations of the EV and TGV achieve 75× and 3× error reduction respectively for the same or reduced cost, and STAR-CCM+ simulations of the cylinder recovered wake statistics significantly more accurately for only twice the cost. Moreover, advancing to higher-order schemes on GPUs with PyFR was found to offer even further accuracy vs. cost benefits relative to industry-standard tools.« less

The Effects of an Integrated Community Case Management Strategy on the Appropriate Treatment of Children and Child Mortality in Kono District, Sierra Leone: A Program Evaluation.

PubMed

Ratnayake, Ruwan; Ratto, Jeffrey; Hardy, Colleen; Blanton, Curtis; Miller, Laura; Choi, Mary; Kpaleyea, John; Momoh, Pheabean; Barbera, Yolanda

2017-09-01

Integrated community case management (iCCM) aims to reduce child mortality in areas with poor access to health care. iCCM was implemented in 2009 in Kono district, Sierra Leone, a postconflict area with high under-five mortality rates (U5MRs). We evaluated iCCM's impact and effects on child health using cluster surveys in 2010 (midterm) and 2013 (endline) to compare indicators on child mortality, coverage of appropriate treatment, timely access to care, quality of care, and recognition of community health workers (CHWs). The sample size was powered to detect a 28% decline in U5MR. Clusters were selected proportional to population size. All households were sampled to measure mortality and systematic random sampling was used to measure coverage in a subset of households. We used program data to evaluate utilization and access; 5,257 (2010) and 3,649 (2013) households were surveyed. U5MR did not change significantly (4.54 [95% confidence interval [CI]: 3.47-5.60] to 3.95 [95% CI: 3.06-4.83] deaths per 1,000 per month ( P = 0.4)) though a relative change smaller than 28% could not be detected. CHWs were the first source of care for 52% (2010) and 50.9% (2013) of children. Coverage of appropriate treatment of fever by CHWs or peripheral health units increased from 45.5% [95% CI: 39.2-52.0] to 58.2% [95% CI: 50.5-65.5] ( P = 0.01); changes for diarrhea and pneumonia were not significant. The continued reliance on the CHW as the first source of care and improved coverage for the appropriate treatment of fever support iCCM's role in Kono district.

Modeling and statistical analysis of feedback between NPP (MODIS NPP) and temperature for forest area Yenisei River

NASA Astrophysics Data System (ADS)

Kukoba, Nikolay; Ivanova, Yulia; Saltykov, Mikhail

Assimilation of carbon by green plants or net primary production (NPP) is one of the most important processes. It provide qualitative and quantitative estimates of the events occurring in the biosphere. Carbon assimilated by plants is used by them to increase their biomass and is a main process of food chains on Earth. NPP is highly variable in time and space. It may depend on physical factors such as temperature, humidity and concentration of nutrients in the soil, etc. And also depends on the types of vegetation (woody, herbaceous, coniferous, and deciduous, etc.). In this regard, it is very important to understand what kind of climate factor is a limiting factor of NPP in the given time and place. For this aim a statistical analysis of the feedback between NPP (MODIS NPP) and the temperature of the forest zone Yenisey River has been performed. We used the time series of NPP for studied territory between 2000 and 2012. The time series of temperature were calculated using the data from the satellite measurements (MODISTERRA) and the global network of weather stations. The considered territory is situated in the Yenisey River basin with diverse natural landscapes - from forest-tundra in the North to alpine meadows in the West Sayan Mountains in the South. This territory extends along the Yenisey River from north to south for about 2000 km. Plains and mountainous areas have been investigated separately. Mountain forests are located in the West Sayan and altitudinal zonation varies from 500 to 2000 m a.s.l. In order to investigate the causal relationships between temperature and NPP we applied the method of Convergent Cross-Mapping (CCM) (Sugihara et al., Science. 2012. V. 338. P. 496-500). This method in some case allows to determine what is a reason and what is consequence, that cannot be definded by simple correlation. It has been shown that the best results are obtained for the 8 -day composite satellite data during the growing season (MOD17A2, MOD11A2). By means of this method we obtained estimates of feedback strength between NPP and temperature. Application of this method for the study of CCM link between temperature and NPP was held for the first time.

Isotopic studies of authigenic sulfides, silicates and carbonates, and calcite and pyrite veinlets in the Creede Formation, San Juan Mountains, Southwest Colorado

USGS Publications Warehouse

Bethke, Philip M.; Rye, Robert O.; Finkelstein, David B.

2000-01-01

Sulfur isotope analysis of authigenic pyrite in the Creede Formation documents its precipitation by the reaction between iron in the volcaniclastic sediments and H2S formed through bacteriogenic reduction of sulfate added to the lake during and immediately following repeated volcanic eruptions during sedimentation. Pyrite veinlets in the underlying Snowshoe Mountain Tuff were formed by the percolation of H2S-bearing pore waters into fractures in the tuff. Conventional analyses of bulk samples of authigenic pyrite range from -20.4% to 34.5% essentially equivalent to the range of -30% to 40% determined using SHRIMP microprobe techniques. Conventional analyses of bulk samples of pyrite from veinlets in the Snowshow Mountain Tiff range from -3.5% to 17.6% much more limited than the ranges of -23% to 111% and -15.6% to 67.0% determined by SHRIMP and laser ablation microbeam techniques, respectively. The extreme range of δ34S for the veinlets is interpreted to be the result of continued fractionation of the already 34S-depleted pore water. Oxygen isotope analysis of authigenic smectite, kaolinite, and K-feldspar together with fluid-inclusion temperatures and oxygen isotope analysis of calcite coexisting with kaolinite indicate that the smectites formed early during burial diagenesis, in accord with petrographic observations. The 40Ar/39Ar dating of K-feldspar, concorfance of K-feldspar, kaolinite, and calcite δ18O values, and fluid-inclusion temperatures in calcite, indicate that the sediments at core hole CCM-1 were subjected to a hydrothermal event at 17.6 Ma. The minerals formed oxygen-shifted meteoric waters with δ18O values of ~-9% Smecities at CCM-1 at least partially exchanged with these waters. Carbon and oxygen isotope analysis of authigenic calcites in the Creede Formation show that they formed over a wide range of temperatures from fluids having a wide range of isotopic composition, presumably over an extended period time. Some of the cements apparently formed very late from unexchanged meteoric water. Concretions and possibly some cements at CCM-1 appear to have exchanged with the 17.6 Ma oxygen-shifted hydrothermal fluids. Such exchange is consistent with evidence that lacustrine carbonates at CCM-1 exchanged with low 18O waters, whereas those at CCM-2 underwent little, if any, exchange. The δ13C-δ18O values for calcite veinlets in the Creede Formation are similar to those for authegenic calcites. Fluid-inclusion temperatures and δ18O indicate that some were deposited during the 17.6 Ma hydrothermal event and others from unexchanged meteoric water at a later date. The isotope studies confirm that part of the model of Rye et al., proposing that the barites in the southern end of the Creede Mining District were formed by mixing of the Creede hydrotermal system with Lake Creede pore of lake waters. The silicate and carbonate isotope data indicate that the pores of the Creede Formation were occupied by at least three isotopically distinct water since the time of deposition. The original pore fluids were probably shifted to lower δ18O values during burial diagensis as a result of the hydrolysis of the volcanic glass to for smectites and other hydrous silicates. During or prior to a 17.6 Ma hydrothermal event in the vicinity of CCM-1, the Creede Formation was flushed with oxygen-shifted meteoric water, possibly related to the breaching of the east side of the caldera wall sometime between 20 and 22 Ma. Later, the Creede Formation was again flushed, this time with unexchanged meteoric water with δD-δ18O values of present-day waters, possibly during the incision of the Rio Grande drainage during uplifting of the southern Rocky Mountains beginning about 5 Ma.

Causality Analysis: Identifying the Leading Element in a Coupled Dynamical System

PubMed Central

BozorgMagham, Amir E.; Motesharrei, Safa; Penny, Stephen G.; Kalnay, Eugenia

2015-01-01

Physical systems with time-varying internal couplings are abundant in nature. While the full governing equations of these systems are typically unknown due to insufficient understanding of their internal mechanisms, there is often interest in determining the leading element. Here, the leading element is defined as the sub-system with the largest coupling coefficient averaged over a selected time span. Previously, the Convergent Cross Mapping (CCM) method has been employed to determine causality and dominant component in weakly coupled systems with constant coupling coefficients. In this study, CCM is applied to a pair of coupled Lorenz systems with time-varying coupling coefficients, exhibiting switching between dominant sub-systems in different periods. Four sets of numerical experiments are carried out. The first three cases consist of different coupling coefficient schemes: I) Periodic–constant, II) Normal, and III) Mixed Normal/Non-normal. In case IV, numerical experiment of cases II and III are repeated with imposed temporal uncertainties as well as additive normal noise. Our results show that, through detecting directional interactions, CCM identifies the leading sub-system in all cases except when the average coupling coefficients are approximately equal, i.e., when the dominant sub-system is not well defined. PMID:26125157

Critical care medicine beds, use, occupancy and costs in the United States: a methodological review

PubMed Central

Halpern, Neil A; Pastores, Stephen M.

2017-01-01

This article is a methodological review to help the intensivist gain insights into the classic and sometimes arcane maze of national databases and methodologies used to determine and analyze the intensive care unit (ICU) bed supply, occupancy rates, and costs in the United States (US). Data for total ICU beds, use and occupancy can be derived from two large national healthcare databases: the Healthcare Cost Report Information System (HCRIS) maintained by the federal Centers for Medicare and Medicaid Services (CMS) and the proprietary Hospital Statistics of the American Hospital Association (AHA). Two costing methodologies can be used to calculate ICU costs: the Russell equation and national projections. Both methods are based on cost and use data from the national hospital datasets or from defined groups of hospitals or patients. At the national level, an understanding of US ICU beds, use and cost helps provide clarity to the width and scope of the critical care medicine (CCM) enterprise within the US healthcare system. This review will also help the intensivist better understand published studies on administrative topics related to CCM and be better prepared to participate in their own local hospital organizations or regional CCM programs. PMID:26308432

Comparison in gas media (absolute and gauge mode)in the range from 25 kPa TO 200 kPa (EURAMET.M.P-K8)

NASA Astrophysics Data System (ADS)

Wuethrich, C.; Alisic, S.; Altintas, A.; van Andel, I.; C, In­Mook; Eltawil, A. A.; Farár, P.; Hetherington, P.; Koçaş, I.; Lefkopoulos, A.; Otal, P.; Prazak, D.; Sabuga, W.; Salustiano, R.; Sandu, I.; Sardi, M.; Saxholm, S.; Setina, J.; Spohr, I.; Steindl, D.; Testa, N.; Vámossy, C.; Grgec Bermanec, L.

2016-01-01

It was decided at the EURAMET TC-M meeting in Torino in 2006 to realize a comparison in gauge and absolute pressure up to 200 kPa as it would allow a link to the CCM.P-K6 and CCM.P-K2 comparisons to be established. This project interested a lot of laboratories from the beginning with 23 participants, 22 of which have submitted results. The circulation of the transfer standard began in July 2009 and lasted until January 2012. No major problems occurred during the transport. The measurand of the comparison is the effective area of a piston-cylinder determined in gauge and absolute pressure from 25 kPa to 200 kPa with pressure steps of 25 kPa. The transfer standard is a gas lubricated tungsten carbide piston-cylinder with an effective area of ~9.8 cm2, fabricated by DH Instruments and compatible with a PG-7601 pressure balance. Some participants used their own pressure balance while a pressure balance with a reference vacuum sensor has been circulated for the participants not equipped with this system. One participant (SMU, Slovakia) has never provided the measurement results and another participant (FORCE Technology, Denmark) submitted a revised set of measurement results after the pilot laboratory mentioned that the equivalence was not met. After the determination of the reference value, all the 22 participants who delivered the results in gauge pressure demonstrated equivalence respective to the reference value on most of the range. In absolute pressure the equivalence is demonstrated, for all nominal pressures, by all 17 participants who submitted results. The comparison is linked to the CCM.P-K6 for gauge pressure and to CCM.P-K2 for absolute pressure. The link does not strongly affect the equivalence of the results and an excellent degree of equivalence is achieved in gauge and absolute pressure. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).