Can Dynamic Global Vegetation Models Reproduce Satellite Observed Extreme Browning and Greening Events in Vegetation Productivity?

NASA Astrophysics Data System (ADS)

van Eck, C. M.; Morfopoulos, C.; Betts, R. A.; Chang, J.; Ciais, P.; Friedlingstein, P.; Regnier, P. A. G.

2016-12-01

The frequency and severity of extreme climate events such as droughts, extreme precipitation and heatwaves are expected to increase in our changing climate. These extreme climate events will have an effect on vegetation either by enhanced or reduced productivity. Subsequently, this can have a substantial impact on the terrestrial carbon sink and thus the global carbon cycle, especially as extreme climate events are expected to increase in frequency and severity. Connecting observational datasets with modelling studies provides new insights into these climate-vegetation interactions. This study aims to compare extremes in vegetation productivity as derived from observations with that of Dynamic Global Vegetation Models (DGVMs). In this case GIMMS-NDVI 3g is selected as the observational dataset and both JULES (Joint UK Land Environment Simulator) and ORCHIDEE (Organising Carbon and Hydrology In Dynamic Ecosystems) as the DGVMs. Both models are forced with PGFv2 Global Meteorological Forcing Dataset according to the ISI-MIP2 protocol for historical runs. Extremes in vegetation productivity are the focal point, which are identified as NDVI anomalies below the 10th percentile or above the 90th percentile during the growing season, referred to as browning or greening events respectively. The monthly NDVI dataset GIMMS-NDVI 3g is used to obtain the location in time and space of the vegetation extremes. The global GIMMS-NDVI 3g dataset has been subdivided into IPCC's SREX-regions for which the NDVI anomalies are calculated and the extreme thresholds are determined. With this information we can identify the location in time and space of the browning and greening events in remotely-sensed vegetation productivity. The same procedure is applied to the modelled Gross Primary Productivity (GPP) allowing a comparison between the spatial and temporal occurrence of the browning and greening events in the observational dataset and the models' output. The capacity of the models to catch observed extremes in vegetation productivity is assessed and compared. Factors contributing to observed and modelled vegetation browning/greening extremes are analysed. The results of this study provide a stepping stone to modelling future extremes in vegetation productivity.

External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities : A retrospective analysis.

PubMed

Andrä, Claudia; Klein, Alexander; Dürr, Hans Roland; Rauch, Josefine; Lindner, Lars Hartwin; Knoesel, Thomas; Angele, Martin; Baur-Melnyk, Andrea; Belka, Claus; Roeder, Falk

2017-08-01

To report our experience with EBRT combined with limb-sparing surgery in elderly patients (>70 years) with primary extremity soft tissue sarcomas (STS). Retrospectively analyzed were 35 patients (m:f 18:17, median 78 years) who all presented in primary situation without nodal/distant metastases (Charlson score 0/1 in 18 patients; ≥2 in 17 patients). Median tumor size was 10 cm, mainly located in lower limb (83%). Stage at presentation (UICC7th) was Ib:3%, 2a:20%, 2b:20%, and 3:57%. Most lesions were high grade (97%), predominantly leiomyosarcoma (26%) and undifferentiated pleomorphic/malignant fibrous histiocytoma (23%). Limb-sparing surgery was preceded (median 50 Gy) or followed (median 66 Gy) by EBRT. Median follow-up was 37 months (range 1-128 months). Margins were free in 26 patients (74%) and microscopically positive in 9 (26%). Actuarial 3‑ and 5‑year local control rates were 88 and 81% (4 local recurrences). Corresponding rates for distant control, disease-specific survival, and overall survival were 57/52%, 76/60%, and 72/41%. The 30-day mortality was 0%. Severe postoperative complications were scored in 8 patients (23%). Severe acute radiation-related toxicity was observed in 2 patients (6%). Patients with Charlson score ≥2 had a significantly increased risk for severe postoperative complications and acute radiation-related side effects. Severe late toxicities were found in 7 patients (20%), including fractures in 3 (8.6%). Final limb preservation rate was 97%. Combination of EBRT and limb-sparing surgery is feasible in elderly patients with acceptable toxicities and encouraging but slightly inferior outcome compared to younger patients. Comorbidity correlated with postoperative complications and acute toxicities. Late fracture risk seems slightly increased.

Sjögren syndrome presenting with hypopotassemic periodic paralysis due to renal tubular acidosis

PubMed Central

Ataoglu, Esra Hayriye; Demir, Betul; Tuna, Mazhar; Çavus, Bilger; Cetin, Faik; Temiz, Levent Umit; Ozturk, Savas; Yenigun, Mustafa

2012-01-01

Summary Background: Sjögren syndrome (SS) is an autoimmune-lymphoproliferative disorder characterized by mononuclear cell infiltration of exocrine glands. Clinically, Sjögren syndrome (SS) has a wide spectrum, varying from autoimmune exocrinopathy to systemic involvement. There have been few cases reporting that primary SS developed with distal renal tubular acidosis clinically. Case Report: Here, we present a case with primary Sjögren syndrome accompanied by hypopotassemic paralysis due to renal tubular acidosis. Severe hypopotassemia, hyperchloremic metabolic acidosis, alkaline urine and disorder in urinary acidification test were observed in the biochemical examination of the 16-year-old female patient, who had applied to our clinic for extreme loss of muscle force. After the examinations it was determined that the patient had developed Type 1 RTA (distal RTA) due to primary Sjögren syndrome. Potassium and alkaline replacement was made and an immediate total recovery was achieved. Conclusions: Hypopotassemic paralysis due to primary Sjögren syndrome is a rare but severe disorder that could lead to death if not detected early and cured appropriately. Thus, effective treatment should be immediately initiated in cases where severe hypopotassemia is accompanied by metabolic acidosis, and the cases should also be examined for extraglandular involvement of SS. PMID:23569525

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey.

PubMed

Yazgan, Cisel; Aksu, Nalan M

2016-06-01

To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries.

Analysing the response of European ecosystems to droughts and heat waves within ISI-MIP2 simulations.

NASA Astrophysics Data System (ADS)

Dury, M.; Henrot, A. J.; Francois, L. M.; Munhoven, G.; Jacquemin, I.; Friend, A. D.; Rademacher, T. T.; Hacket Pain, A. J.; Hickler, T.

2015-12-01

With unprecedented speed and extent, the future climate change can be expected to severely impact terrestrial ecosystems due to more frequent extreme events, such as droughts or heat waves. What will be the impacts of these extreme events on ecosystem functioning and structure? How far will net primary production be reduced by such events? What will be the impact on plant mortality? Could such events trigger changes in the abundance of plant species, thus leading to biome shifts? In this contribution, we propose to use ISI-MIP2 model historical simulations from the biome sector to analyse the response of ecosystems to droughts or heat waves, trying to understand the differences between several vegetation models (e.g. CARAIB, HYBRID, LPJ). The analysis will focus on Europe. It will compare and assess the model responses for a series of well-marked drought or heat wave events in the simulated historical period, such as those that occurred in 1976, 2003 or 2010. This analysis will be performed in terms of several important environmental variables, like soil water and hydric stress, runoff, PFT abundance, net primary productivity and biomass, fire frequency, turnover of soil organic matter, etc. Whenever possible, the response of the model will be compared to available data for the most recent well-marked events. Examples of data to be used are eddy covariance, satellite data (including leaf area and fire occurrence) or tree rings.

Primary xanthoma of the mandible

PubMed Central

de Moraes Ramos-Perez, FM; de Pádua, JM; Silva-Sousa, YTC; de Almeida, OP; da Cruz Perez, DE

2011-01-01

Bone xanthomas are rare and are usually are associated with endocrine or metabolic diseases, mainly lipid disorders. In the absence of systemic diseases, the lesion is called a primary xanthoma. Primary mandibular xanthomas are extremely rare. The aim of this report is to describe the clinical and radiographic findings of a primary mandibular xanthoma, discussing the epidemiological features, pathogenesis and differential diagnosis. A 25-year-old man was referred for evaluation of a left mandibular lesion detected in a routine radiographic exam. Radiographically, there was a diffuse, unilocular and radiolucent lesion, with irregular margins located adjacent to the surface from the distal root of the left mandibular third molar. The lesion was excised under local anaesthesia. Microscopically, there were several cells with a foamy and granular cytoplasm and central small, round nuclei, similar to xanthomatous macrophages. No lipid disorders were diagnosed. According to these features, the diagnosis of primary mandibular xanthoma was established. In conclusion, xanthomas of the jaws are rare and all seem to be primary and occur exclusively in the mandible. PMID:21831981

Primary prophylaxis for children with severe congenital factor VII deficiency - Clinical and laboratory assessment.

PubMed

Kuperman, A A; Barg, A A; Fruchtman, Y; Shaoul, E; Rosenberg, N; Kenet, G; Livnat, T

2017-09-01

Severe congenital factor VII (FVII) deficiency is a rare bleeding disorder. Prophylaxis with replacement therapy has been suggested to patients, yet the most beneficial dosing regimens and therapy intervals are still to be defined. Due to the lack of evidence-based data, we hereby present our experience with long-term administration and monitoring primary prophylaxis in children with severe FVII deficiency and an extremely high bleeding risk. Four children with familial FVII deficiency, treated by prophylactic recombinant activated factor VII (rFVIIa), 15-30μg/kg/dose, given 2-3 times weekly since infancy, are discussed. Clinical follow up and monitoring laboratory assays, including thrombin generation, measured at various time points after prophylactic rFVIIa administration are presented. Among our treated patients neither FVII activity nor thrombin generation parameters (both already declined 24h post rFVIIa administration) were able to predict the impact of prophylaxis, and could not be used as surrogate markers in order to assess the most beneficial treatment frequency. However, the long clinical follow-up and comprehensive laboratory assessment performed, have shown that early primary prophylaxis as administered in our cohort was safe and effective. Copyright © 2016 Elsevier Inc. All rights reserved.

Intracranial meningioma as primary presentation for an undiagnosed collision metastatic breast cancer: Case report and literature review

PubMed Central

Farrag, Ashraf; Ansari, Jawaher; Ali, Muhammad; Sunbuli, Ghanem; Kassem, Hassan; Al Hamad, Abdul-Aziz

2018-01-01

Intracranial metastasis from breast cancer is a relatively common finding, however, the appearance of breast cancer metastasis in a meningioma is very rare. Several cases of tumor-to-tumor metastasis and collision tumors have been reported previously, with meningioma being implicated as the most common benign intracranial neoplasm to harbour the metastasis. Occasionally, the discovery of a tumor-to-meningioma metastasis may herald the diagnosis of an occult primary malignancy. Careful histopathological assessment of the resected meningioma specimen is pivotal to the management of these patients, as this will alter the treatment plan and prognosis considerably. Intracranial meningioma with collision breast cancer as primary presentation of an undiagnosed metastatic breast cancer is extremely rare. The current study presents a case of intracranial meningioma with collision breast cancer as a primary presentation, and reviews the available evidence for this unusual disease entity. PMID:29725531

Intracranial meningioma as primary presentation for an undiagnosed collision metastatic breast cancer: Case report and literature review.

PubMed

Farrag, Ashraf; Ansari, Jawaher; Ali, Muhammad; Sunbuli, Ghanem; Kassem, Hassan; Al Hamad, Abdul-Aziz

2018-05-01

Intracranial metastasis from breast cancer is a relatively common finding, however, the appearance of breast cancer metastasis in a meningioma is very rare. Several cases of tumor-to-tumor metastasis and collision tumors have been reported previously, with meningioma being implicated as the most common benign intracranial neoplasm to harbour the metastasis. Occasionally, the discovery of a tumor-to-meningioma metastasis may herald the diagnosis of an occult primary malignancy. Careful histopathological assessment of the resected meningioma specimen is pivotal to the management of these patients, as this will alter the treatment plan and prognosis considerably. Intracranial meningioma with collision breast cancer as primary presentation of an undiagnosed metastatic breast cancer is extremely rare. The current study presents a case of intracranial meningioma with collision breast cancer as a primary presentation, and reviews the available evidence for this unusual disease entity.

Bronchopulmonary Dysplasia and Perinatal Characteristics Predict 1-Year Respiratory Outcomes in Newborns Born at Extremely Low Gestational Age: A Prospective Cohort Study.

PubMed

Keller, Roberta L; Feng, Rui; DeMauro, Sara B; Ferkol, Thomas; Hardie, William; Rogers, Elizabeth E; Stevens, Timothy P; Voynow, Judith A; Bellamy, Scarlett L; Shaw, Pamela A; Moore, Paul E

2017-08-01

To assess the utility of clinical predictors of persistent respiratory morbidity in extremely low gestational age newborns (ELGANs). We enrolled ELGANs (<29 weeks' gestation) at ≤7 postnatal days and collected antenatal and neonatal clinical data through 36 weeks' postmenstrual age. We surveyed caregivers at 3, 6, 9, and 12 months' corrected age to identify postdischarge respiratory morbidity, defined as hospitalization, home support (oxygen, tracheostomy, ventilation), medications, or symptoms (cough/wheeze). Infants were classified as having postprematurity respiratory disease (PRD, the primary study outcome) if respiratory morbidity persisted over ≥2 questionnaires. Infants were classified with severe respiratory morbidity if there were multiple hospitalizations, exposure to systemic steroids or pulmonary vasodilators, home oxygen after 3 months or mechanical ventilation, or symptoms despite inhaled corticosteroids. Mixed-effects models generated with data available at 1 day (perinatal) and 36 weeks' postmenstrual age were assessed for predictive accuracy. Of 724 infants (918 ± 234 g, 26.7 ± 1.4 weeks' gestational age) classified for the primary outcome, 68.6% had PRD; 245 of 704 (34.8%) were classified as severe. Male sex, intrauterine growth restriction, maternal smoking, race/ethnicity, intubation at birth, and public insurance were retained in perinatal and 36-week models for both PRD and respiratory morbidity severity. The perinatal model accurately predicted PRD (c-statistic 0.858). Neither the 36-week model nor the addition of bronchopulmonary dysplasia to the perinatal model improved accuracy (0.856, 0.860); c-statistic for BPD alone was 0.907. Both bronchopulmonary dysplasia and perinatal clinical data accurately identify ELGANs at risk for persistent and severe respiratory morbidity at 1 year. ClinicalTrials.gov: NCT01435187. Copyright © 2017 Elsevier Inc. All rights reserved.

Ancient bacterial endosymbionts of insects: Genomes as sources of insight and springboards for inquiry.

PubMed

Wernegreen, Jennifer J

2017-09-15

Ancient associations between insects and bacteria provide models to study intimate host-microbe interactions. Currently, a wealth of genome sequence data for long-term, obligately intracellular (primary) endosymbionts of insects reveals profound genomic consequences of this specialized bacterial lifestyle. Those consequences include severe genome reduction and extreme base compositions. This minireview highlights the utility of genome sequence data to understand how, and why, endosymbionts have been pushed to such extremes, and to illuminate the functional consequences of such extensive genome change. While the static snapshots provided by individual endosymbiont genomes are valuable, comparative analyses of multiple genomes have shed light on evolutionary mechanisms. Namely, genome comparisons have told us that selection is important in fine-tuning gene content, but at the same time, mutational pressure and genetic drift contribute to genome degradation. Examples from Blochmannia, the primary endosymbiont of the ant tribe Camponotini, illustrate the value and constraints of genome sequence data, and exemplify how genomes can serve as a springboard for further comparative and experimental inquiry. Copyright © 2017. Published by Elsevier Inc.

Asymmetrical Responses of Ecosystem Processes to Positive Versus Negative Precipitation Extremes: a Replicated Regression Experimental Approach

NASA Astrophysics Data System (ADS)

Felton, A. J.; Smith, M. D.

2016-12-01

Heightened climatic variability due to atmospheric warming is forecast to increase the frequency and severity of climate extremes. In particular, changes to interannual variability in precipitation, characterized by increases in extreme wet and dry years, are likely to impact virtually all terrestrial ecosystem processes. However, to date experimental approaches have yet to explicitly test how ecosystem processes respond to multiple levels of climatic extremity, limiting our understanding of how ecosystems will respond to forecast increases in the magnitude of climate extremes. Here we report the results of a replicated regression experimental approach, in which we imposed 9 and 11 levels of growing season precipitation amount and extremity in mesic grassland during 2015 and 2016, respectively. Each level corresponded to a specific percentile of the long-term record, which produced a large gradient of soil moisture conditions that ranged from extreme wet to extreme dry. In both 2015 and 2016, asymptotic responses to water availability were observed for soil respiration. This asymmetry was driven in part by transitions between soil moisture versus temperature constraints on respiration as conditions became increasingly dry versus increasingly wet. In 2015, aboveground net primary production (ANPP) exhibited asymmetric responses to precipitation that largely mirrored those of soil respiration. In total, our results suggest that in this mesic ecosystem, these two carbon cycle processes were more sensitive to extreme drought than to extreme wet years. Future work will assess ANPP responses for 2016, soil nutrient supply and physiological responses of the dominant plant species. Future efforts are needed to compare our findings across a diverse array of ecosystem types, and in particular how the timing and magnitude of precipitation events may modify the response of ecosystem processes to increasing magnitudes of precipitation extremes.

Imaging features of blast injuries: experience from 2015 Ankara bombing in Turkey

PubMed Central

Aksu, Nalan M

2016-01-01

Objective: To present the radiological features of blast-related injuries in the victims of the 10 October 2015 Ankara bombing and emphasize the importance of imaging. Methods: This retrospective descriptive study included a total of 28 patients who underwent CT scan or radiographic imaging within 6 h after the bombing on 10 October 2015. CT scans and plain radiographs were evaluated regarding mechanisms of injuries. Injuries were categorized as primary, secondary, tertiary and quaternary. The number of shrapnel and distribution of injuries were noted. Injury Severity Score (ISS) was used to rank the severity of the injury. Results: Primary blast injuries consisted of only tympanic membrane rupture. A high rate of patients (21/28 patients) in the study group suffered from secondary blast injuries. Tertiary injuries were detected in only three patients. Of the severely injured patients, five had abdominal injuries, three had thoracic injuries and six had extremity injuries. ISS was significantly higher in patients with thoracic and abdominal injuries. Conclusion: Our results after the suicide bomb attacks showed that the most common injury pattern was secondary blast injury. The torso was the most commonly injured body region, followed by the extremities. This specific injury pattern requires the use of immense radiological imaging. Hence, radiologists should be aware of the mechanisms and spectrums of blast-related injuries. Advances in knowledge: Both the unique injury pattern and the following chaos make blast-related injuries a challenge in terms of triage, diagnosis and management. Radiologists should be familiar with the wide spectrum of these unique injuries. PMID:26959613

Correlation between the hemodynamic gain obtained after operation of primary varicose veins and chronic venous disease classification.

PubMed

Dezotti, Nei Rodrigues Alves; Joviliano, Edwaldo Edner; Moriya, Takachi; Piccinato, Carlos Eli

2011-01-01

Previous studies have demonstrated improvement of venous hemodynamics after surgical treatment of primary varicose veins of the lower extremities using air plethysmography (APG). To correlate the venous hemodynamics obtained by APG with the CEAP classification after surgical treatment of primary varicose veins. We studied 63 limbs of 39 patients (35 women and 4 men) aged on average 46.3 years, operated upon at the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo, during the period from January 2001 to December 2004. The 63 limbs were divided into the three following groups according to CEAP classification: group C2 + C3 (38 limbs), group C4 (15 limbs) and group C5 + C6 (10 limbs). The patients were evaluated clinically before and 30 to 40 days after surgery by preoperative duplex ultrasonography and pre- and postoperative APG. There was an apparent hemodynamic improvement after surgical treatment of the varicose veins in the two groups of lower severity, but the improvement was significant in the most severe group based on venous filling index. Surgical treatment was beneficial for all three groups, but the greatest hemodynamic gain was observed in the group of highest clinical severity (group C5 + C6).

Extreme Fire Severity Patterns in Topographic, Convective and Wind-Driven Historical Wildfires of Mediterranean Pine Forests

PubMed Central

Lecina-Diaz, Judit; Alvarez, Albert; Retana, Javier

2014-01-01

Crown fires associated with extreme fire severity are extremely difficult to control. We have assessed fire severity using differenced Normalized Burn Ratio (dNBR) from Landsat imagery in 15 historical wildfires of Pinus halepensis Mill. We have considered a wide range of innovative topographic, fuel and fire behavior variables with the purposes of (1) determining the variables that influence fire severity patterns among fires (considering the 15 wildfires together) and (2) ascertaining whether different variables affect extreme fire severity within the three fire types (topographic, convective and wind-driven fires). The among-fires analysis showed that fires in less arid climates and with steeper slopes had more extreme severity. In less arid conditions there was more crown fuel accumulation and closer forest structures, promoting high vertical and horizontal fuel continuity and extreme fire severity. The analyses carried out for each fire separately (within fires) showed more extreme fire severity in areas in northern aspects, with steeper slopes, with high crown biomass and in climates with more water availability. In northern aspects solar radiation was lower and fuels had less water limitation to growth which, combined with steeper slopes, produced more extreme severity. In topographic fires there was more extreme severity in northern aspects with steeper slopes and in areas with more water availability and high crown biomass; in convection-dominated fires there was also more extreme fire severity in northern aspects with high biomass; while in wind-driven fires there was only a slight interaction between biomass and water availability. This latter pattern could be related to the fact that wind-driven fires spread with high wind speed, which could have minimized the effect of other variables. In the future, and as a consequence of climate change, new zones with high crown biomass accumulated in non-common drought areas will be available to burn as extreme severity wildfires. PMID:24465492

Extreme fire severity patterns in topographic, convective and wind-driven historical wildfires of Mediterranean pine forests.

PubMed

Lecina-Diaz, Judit; Alvarez, Albert; Retana, Javier

2014-01-01

Crown fires associated with extreme fire severity are extremely difficult to control. We have assessed fire severity using differenced Normalized Burn Ratio (dNBR) from Landsat imagery in 15 historical wildfires of Pinus halepensis Mill. We have considered a wide range of innovative topographic, fuel and fire behavior variables with the purposes of (1) determining the variables that influence fire severity patterns among fires (considering the 15 wildfires together) and (2) ascertaining whether different variables affect extreme fire severity within the three fire types (topographic, convective and wind-driven fires). The among-fires analysis showed that fires in less arid climates and with steeper slopes had more extreme severity. In less arid conditions there was more crown fuel accumulation and closer forest structures, promoting high vertical and horizontal fuel continuity and extreme fire severity. The analyses carried out for each fire separately (within fires) showed more extreme fire severity in areas in northern aspects, with steeper slopes, with high crown biomass and in climates with more water availability. In northern aspects solar radiation was lower and fuels had less water limitation to growth which, combined with steeper slopes, produced more extreme severity. In topographic fires there was more extreme severity in northern aspects with steeper slopes and in areas with more water availability and high crown biomass; in convection-dominated fires there was also more extreme fire severity in northern aspects with high biomass; while in wind-driven fires there was only a slight interaction between biomass and water availability. This latter pattern could be related to the fact that wind-driven fires spread with high wind speed, which could have minimized the effect of other variables. In the future, and as a consequence of climate change, new zones with high crown biomass accumulated in non-common drought areas will be available to burn as extreme severity wildfires.

Interpretation and use of the 5-level EQ-5D response labels varied with survey language among Asians in Singapore.

PubMed

Luo, Nan; Wang, Ye; How, Choon How; Tay, Ee Guan; Thumboo, Julian; Herdman, Michael

2015-10-01

This study aimed to investigate the comparability of the English, Chinese, and Malay versions of the 5-level EQ-5D (EQ-5D-5L) response labels in Singapore. Visitors to a primary care institution in Singapore (n = 743) were asked to complete two exercises: (1) rating the severity of the EQ-5D-5L response labels presented in English, Chinese, or Malay using a 0-100 numeric rating scale and (2) using the labels to describe various hypothetical health problems. Label ratings and choices between language versions were compared using regression analysis. Perceived severity of the English and Chinese labels was similar. Compared with their English counterparts, the Malay label "slight(ly)" was rated as more severe (adjusted mean difference: 10.5 to 14.5) and "unable"/"extreme(ly)" as less severe (adjusted mean difference: -13.3 to -11.0) (P < 0.001 for all). The Malay labels "no(t)" and "unable"/"extreme(ly)" and the less severe Chinese labels were more frequently used to describe hypothetical health problems than their English counterparts. Interpretation and use of the EQ-5D-5L response labels vary among Singaporeans using different language versions of the instrument. Future studies need to investigate ways to reduce the variations and increase the cross-cultural measurement equivalence of the instrument. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluating the Large-Scale Environment of Extreme Events Using Reanalyses

NASA Astrophysics Data System (ADS)

Bosilovich, M. G.; Schubert, S. D.; Koster, R. D.; da Silva, A. M., Jr.; Eichmann, A.

2014-12-01

Extreme conditions and events have always been a long standing concern in weather forecasting and national security. While some evidence indicates extreme weather will increase in global change scenarios, extremes are often related to the large scale atmospheric circulation, but also occurring infrequently. Reanalyses assimilate substantial amounts of weather data and a primary strength of reanalysis data is the representation of the large-scale atmospheric environment. In this effort, we link the occurrences of extreme events or climate indicators to the underlying regional and global weather patterns. Now, with greater than 3o years of data, reanalyses can include multiple cases of extreme events, and thereby identify commonality among the weather to better characterize the large-scale to global environment linked to the indicator or extreme event. Since these features are certainly regionally dependent, and also, the indicators of climate are continually being developed, we outline various methods to analyze the reanalysis data and the development of tools to support regional evaluation of the data. Here, we provide some examples of both individual case studies and composite studies of similar events. For example, we will compare the large scale environment for Northeastern US extreme precipitation with that of highest mean precipitation seasons. Likewise, southerly winds can shown to be a major contributor to very warm days in the Northeast winter. While most of our development has involved NASA's MERRA reanalysis, we are also looking forward to MERRA-2 which includes several new features that greatly improve the representation of weather and climate, especially for the regions and sectors involved in the National Climate Assessment.

Predictors of Drought Recovery across Forest Ecosystems

NASA Astrophysics Data System (ADS)

Anderegg, W.

2016-12-01

The impacts of climate extremes on terrestrial ecosystems are poorly understood but central for predicting carbon cycle feedbacks to climate change. Coupled climate-carbon cycle models typically assume that vegetation recovery from extreme drought is immediate and complete, which conflicts with basic plant physiological understanding. Here, we discuss what we have learned about forest ecosystem recovery from extreme drought across spatial and temporal scales, drawing on inference from tree rings, eddy covariance data, large scale gross primary productivity products, and ecosystem models. In tree rings, we find pervasive and substantial "legacy effects" of reduced growth and incomplete recovery for 1-4 years after severe drought, and that legacy effects are most prevalent in dry ecosystems, Pinaceae, and species with low hydraulic safety margins. At larger scales, we see relatively rapid recovery of ecosystem fluxes, with strong influences of ecosystem productivity and diversity and longer recovery periods in high latidue forests. In contrast, no or limited legacy effects are simulated in current climate-vegetation models after drought, and we highlight some of the key missing mechanisms in dynamic vegetation models. Our results reveal hysteresis in forest ecosystem carbon cycling and delayed recovery from climate extremes and help advance a predictive understanding of ecosystem recovery.

Primary hemangiosarcoma of the spleen with angioscintigraphic demonstration of metastases

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

Hermann, G.G.; Fogh, J.; Graem, N.

1984-04-15

A case of primary hemangiosarcoma of the spleen in a 48-year-old woman is presented. Twenty-eight months after splenectomy the patient developed a severe anemia of the microangiopathic type, thrombocytopenia, and a leukoerythroblastic peripheral blood picture. In contrast to x-ray and conventional /sup 99m/Tc-methylene-diphosphonate (MDP) bone scintigraphy, which showed only a few minor focal changes in the spine and ribs, angioscintigraphy with in vitro labeled /sup 99m/Tc-erythrocytes revealed extensive pathologic accumulations throughout the spine, femurs, and the liver, indicating the presence of extremely vascular metastases. Autopsy 15 months later confirmed the scintigraphic findings. Angiography with /sup 99m/Tc-labeled erythrocytes seems to bemore » useful for monitoring metastases from hemangiosarcomas.« less

Lithium-Air Cell Development

NASA Technical Reports Server (NTRS)

Reid, Concha M.; Dobley, Arthur; Seymour, Frasier W.

2014-01-01

Lithium-air (Li-air) primary batteries have a theoretical specific capacity of 11,400 Wh/kg, the highest of any common metal-air system. NASA is developing Li-air technology for a Mobile Oxygen Concentrator for Spacecraft Emergencies, an application which requires an extremely lightweight primary battery that can discharge over 24 hours continuously. Several vendors were funded through the NASA SBIR program to develop Li-air technology to fulfill the requirements of this application. New catalysts and carbon cathode structures were developed to enhance the oxygen reduction reaction and increase surface area to improve cell performance. Techniques to stabilize the lithium metal anode surface were explored. Experimental results for prototype laboratory cells are given. Projections are made for the performance of hypothetical cells constructed from the materials that were developed.

Primary tuberculosis of the glans penis.

PubMed

Jimenez Parra, Jose David; Alvarez Bandres, Silvia; Garcia Garcia, Diego; Torres Varas, Lorena; Sotil Arrieta, Amaia; Jimenez Calvo, Jesus

2014-03-01

Tuberculosis of the penis is an extremely rare disease with few cases reported in the literature. We present the case of a 64 year-old man with a whitish papular-ampullary eruption in the glans penis. After antibiotic/antimycotic therapy and several topical ointments for 3 months without response he was referred to our Department. Biopsy of the ulceration edge was performed and pathology result showed a chronic granulomatous inflammatory necrotizing lesion with granulomatous vasculitis lesions, without tumor infiltration. Systemic examination to rule out other tuberculosis foci was negative. With de suspicion of primary tuberculosis of the glans penis, anti tuberculosis therapy with Isoniazid and Piridoxine was started. Within a period of five months the ulceration healed significantly. Currently, the patient is still asymptomatic without glans penis lesions. Primary glans penis tuberculosis is a rare disease, but we must consider it (both primary and secondary forms) to try to avoid diagnostic delays that may cause prejudice for the patient. This condition promptly responds to anti tuberculosis therapy as evidenced by our case and many other reports.

Impacts of droughts and extreme-temperature events on gross primary production and ecosystem respiration: a systematic assessment across ecosystems and climate zones

NASA Astrophysics Data System (ADS)

von Buttlar, Jannis; Zscheischler, Jakob; Rammig, Anja; Sippel, Sebastian; Reichstein, Markus; Knohl, Alexander; Jung, Martin; Menzer, Olaf; Altaf Arain, M.; Buchmann, Nina; Cescatti, Alessandro; Gianelle, Damiano; Kiely, Gerard; Law, Beverly E.; Magliulo, Vincenzo; Margolis, Hank; McCaughey, Harry; Merbold, Lutz; Migliavacca, Mirco; Montagnani, Leonardo; Oechel, Walter; Pavelka, Marian; Peichl, Matthias; Rambal, Serge; Raschi, Antonio; Scott, Russell L.; Vaccari, Francesco P.; van Gorsel, Eva; Varlagin, Andrej; Wohlfahrt, Georg; Mahecha, Miguel D.

2018-03-01

Extreme climatic events, such as droughts and heat stress, induce anomalies in ecosystem-atmosphere CO2 fluxes, such as gross primary production (GPP) and ecosystem respiration (Reco), and, hence, can change the net ecosystem carbon balance. However, despite our increasing understanding of the underlying mechanisms, the magnitudes of the impacts of different types of extremes on GPP and Reco within and between ecosystems remain poorly predicted. Here we aim to identify the major factors controlling the amplitude of extreme-event impacts on GPP, Reco, and the resulting net ecosystem production (NEP). We focus on the impacts of heat and drought and their combination. We identified hydrometeorological extreme events in consistently downscaled water availability and temperature measurements over a 30-year time period. We then used FLUXNET eddy covariance flux measurements to estimate the CO2 flux anomalies during these extreme events across dominant vegetation types and climate zones. Overall, our results indicate that short-term heat extremes increased respiration more strongly than they downregulated GPP, resulting in a moderate reduction in the ecosystem's carbon sink potential. In the absence of heat stress, droughts tended to have smaller and similarly dampening effects on both GPP and Reco and, hence, often resulted in neutral NEP responses. The combination of drought and heat typically led to a strong decrease in GPP, whereas heat and drought impacts on respiration partially offset each other. Taken together, compound heat and drought events led to the strongest C sink reduction compared to any single-factor extreme. A key insight of this paper, however, is that duration matters most: for heat stress during droughts, the magnitude of impacts systematically increased with duration, whereas under heat stress without drought, the response of Reco over time turned from an initial increase to a downregulation after about 2 weeks. This confirms earlier theories that not only the magnitude but also the duration of an extreme event determines its impact. Our study corroborates the results of several local site-level case studies but as a novelty generalizes these findings on the global scale. Specifically, we find that the different response functions of the two antipodal land-atmosphere fluxes GPP and Reco can also result in increasing NEP during certain extreme conditions. Apparently counterintuitive findings of this kind bear great potential for scrutinizing the mechanisms implemented in state-of-the-art terrestrial biosphere models and provide a benchmark for future model development and testing.

Effectiveness of Anti-Dementia Drugs in Extremely Severe Alzheimer's Disease: A 12-Week, Multicenter, Randomized, Single-Blind Study.

PubMed

Hong, Yun Jeong; Choi, Seong Hye; Jeong, Jee Hyang; Park, Kyung Won; Na, Hae Ri

2018-01-01

There is insufficient evidence to guide decisions concerning how long anti-dementia drug (ADD) regimens should be maintained in severe Alzheimer's disease (AD). We investigated whether patients with extremely severe AD who were already receiving donepezil or memantine benefited from continuing treatment. In this randomized and rater-blinded trial, 65 AD patients with a Mini-Mental State Examination score from 0 to 5 and a score of 6c or worse on Functional Assessment Staging were randomly assigned to an ADD-continuation group (N = 30) or an ADD-discontinuation group (N = 35). The current use of donepezil or memantine was maintained for 12 weeks in the ADD-continuation group and was discontinued after baseline in the ADD-discontinuation group. Efficacy measures were obtained at baseline and 12 weeks. The primary efficacy variable was the change from baseline to the end of the study in Baylor Profound Mental State Examination (BPMSE) scores. The change in the BPMSE from baseline to the end of the study in the ADD-continuation group (a 0.4-point improvement) was not equivalent to that in the ADD-discontinuation group (a 0.5-point decline), as determined by two one-sided tests of equivalence. Study withdrawals due to adverse events (11.4% versus 6.7%) were more frequent in the ADD-discontinuation group than in the ADD-continuation group. Continued treatment with donepezil or memantine seems unequal and might be superior to withdrawal of the drugs in terms of the effects on global cognition in patients with extremely severe AD. Current Controlled Trials number: KCT0000874 (CRIS).

Does earlier arrival of the retrieval team improve short-term outcomes in outborn extremely premature infants?

PubMed

Sharpe, Janet B; Davies, Mark W

2018-05-31

The risk of mortality and morbidity is increased in outborn, extremely premature infants. We aim to determine whether earlier arrival of the retrieval team after the birth of infants less than 29 weeks gestation improves short-term mortality and morbidity. This is a retrospective analysis of a cohort of infants less than 29 weeks gestation who were retrieved to the Royal Brisbane and Women's Hospital (RBWH) over a 5-year period. Demographic information regarding the infant and mother, retrieval team arrival time and outcome data was collected. Primary outcomes investigated were mortality prior to discharge from hospital or a composite of mortality or severe intraventricular haemorrhage (IVH). Data on 105 infants were analysed; 88 infants (83.8%) survived to discharge home, and 79 (75.2%) survived to discharge without severe IVH. On univariate analysis, there was no significant association between age at arrival of the retrieval team and death prior to discharge (P = 0.94) or death prior to discharge or severe IVH (P = 0.83). On logistic regression analysis, age at arrival of retrieval team remained non-significant for a reduction in death prior to discharge and composite of death or severe IVH (P = 0.70 and P = 0.99, respectively). The earlier arrival of the retrieval team is not associated with improved short-term outcomes in outborn, extremely preterm infants who are retrieved and admitted to a tertiary neonatal intensive care unit - for infants where the retrieval team arrived within about 8 h of birth. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Extreme Attributions Predict the Course of Bipolar Depression: Results from the STEP-BD Randomized Controlled Trial of Psychosocial Treatment

PubMed Central

Stange, Jonathan P.; Sylvia, Louisa G.; da Silva Magalhães, Pedro Vieira; Miklowitz, David J.; Otto, Michael W.; Frank, Ellen; Berk, Michael; Nierenberg, Andrew A.; Deckersbach, Thilo

2013-01-01

Objective Little is known about predictors of recovery from bipolar depression or moderators of treatment response. In the present study we investigated attributional style (a cognitive pattern of explaining the causes of life events) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychotherapy for bipolar depression. Method 106 depressed outpatients with DSM-IV bipolar I or II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomized to intensive psychotherapy for depression (n=62), or collaborative care (n=44), a minimal psychoeducational intervention. The primary outcome was recovery status at each study visit as measured by the Clinical Monitoring Form. Attributional style was measured at baseline using the Attributional Style Questionnaire. Data were collected between 1998 and 2005. Results All analyses were by intention to treat. Extreme attributions predicted a lower likelihood of recovery (p=.01, OR=0.93, 95% CI=.88-.98) and longer time until recovery (p<.01, OR=0.96, 95% CI=.93-.99), independent of the effects of initial depression severity. Among individuals with more pessimistic attributional styles, initial depression severity predicted a lower likelihood of recovery (p=.01, OR=0.64, 95% CI=.45-.91) and longer time until recovery (p<.001, OR=0.76, 95% CI=.66-.88). There was no difference in recovery rates between intensive psychotherapy and collaborative care (OR=0.90, 95% CI=0.40-2.01) in the full sample. Conclusions These results suggest that extreme, rigid attributions may be associated with a more severe course of depression, and that evaluating attributional style may help clinicians to identify patients who are at risk for experiencing a more severe course of depression. PMID:23561230

Primary cutaneous adenosquamous carcinoma of the penis: the first characterization of HPV status in this rare and diagnostically challenging entity with review of glandular carcinomas of the penis.

PubMed

Rush, P S; Shiau, J M; Hibler, B P; Longley, B J; Downs, T M; Bennett, D D

2016-12-01

Glandular and pseudoglandular tumors of the penile skin are extremely uncommon and can present diagnostic challenges. Primary adenosquamous carcinoma of the penis is an extremely rare tumor, composed of distinct areas of malignant squamous and glandular cells, making it a diagnostically challenging entity. The World Health Organization (WHO) recognizes several subtypes of squamous cell carcinoma (SCC), each with its own distinctive pathologic appearance, clinical associations and prognosis. Among these variants is the exceedingly uncommon adenosquamous carcinoma (ASC), representing 1%-2% of all SCC of the penis. Recent large studies have interrogated the presence of human papillomavirus (HPV) in malignant penile tumors and have shown specific morphologic patterns and clinical presentations to associate with HPV status. However, given the rarity of the adenosquamous variant of SCC, it has largely been excluded from these studies. The glandular components of these lesions can present a confusing appearance, particularly when a large tumor is represented on a small biopsy. Here we describe a difficult histologic presentation of this rare tumor, with the first published characterization of the HPV status of this subtype. This case represents a distinctly unusual case of metastatic HPV-positive primary cutaneous adenosquamous carcinoma of the penis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Impacts of droughts and extreme-temperature events on gross primary production and ecosystem respiration: a systematic assessment across ecosystems and climate zones

USDA-ARS?s Scientific Manuscript database

Extreme climatic events, such as droughts and heat stress induce anomalies in ecosystem-atmosphere CO2 fluxes, such as gross primary production (GPP) and ecosystem respiration (Reco), and, hence, can change the net ecosystem carbon balance. However, despite our increasing understanding of the underl...

Comparing the basins of attraction for several methods in the circular Sitnikov problem with spheroid primaries

NASA Astrophysics Data System (ADS)

Zotos, Euaggelos E.

2018-06-01

The circular Sitnikov problem, where the two primary bodies are prolate or oblate spheroids, is numerically investigated. In particular, the basins of convergence on the complex plane are revealed by using a large collection of numerical methods of several order. We consider four cases, regarding the value of the oblateness coefficient which determines the nature of the roots (attractors) of the system. For all cases we use the iterative schemes for performing a thorough and systematic classification of the nodes on the complex plane. The distribution of the iterations as well as the probability and their correlations with the corresponding basins of convergence are also discussed. Our numerical computations indicate that most of the iterative schemes provide relatively similar convergence structures on the complex plane. However, there are some numerical methods for which the corresponding basins of attraction are extremely complicated with highly fractal basin boundaries. Moreover, it is proved that the efficiency strongly varies between the numerical methods.

Neurodevelopmental Outcomes of Extremely Preterm Infants Randomized to Stress Dose Hydrocortisone.

PubMed

Parikh, Nehal A; Kennedy, Kathleen A; Lasky, Robert E; Tyson, Jon E

2015-01-01

To compare the effects of stress dose hydrocortisone therapy with placebo on survival without neurodevelopmental impairments in high-risk preterm infants. We recruited 64 extremely low birth weight (birth weight ≤1000 g) infants between the ages of 10 and 21 postnatal days who were ventilator-dependent and at high-risk for bronchopulmonary dysplasia. Infants were randomized to a tapering 7-day course of stress dose hydrocortisone or saline placebo. The primary outcome at follow-up was a composite of death, cognitive or language delay, cerebral palsy, severe hearing loss, or bilateral blindness at a corrected age of 18-22 months. Secondary outcomes included continued use of respiratory therapies and somatic growth. Fifty-seven infants had adequate data for the primary outcome. Of the 28 infants randomized to hydrocortisone, 19 (68%) died or survived with impairment compared with 22 of the 29 infants (76%) assigned to placebo (relative risk: 0.83; 95% CI, 0.61 to 1.14). The rates of death for those in the hydrocortisone and placebo groups were 31% and 41%, respectively (P = 0.42). Randomization to hydrocortisone also did not significantly affect the frequency of supplemental oxygen use, positive airway pressure support, or need for respiratory medications. In high-risk extremely low birth weight infants, stress dose hydrocortisone therapy after 10 days of age had no statistically significant effect on the incidence of death or neurodevelopmental impairment at 18-22 months. These results may inform the design and conduct of future clinical trials. ClinicalTrials.gov NCT00167544.

Individual muscle contributions to push and recovery subtasks during wheelchair propulsion.

PubMed

Rankin, Jeffery W; Richter, W Mark; Neptune, Richard R

2011-04-29

Manual wheelchair propulsion places considerable physical demand on the upper extremity and is one of the primary activities associated with the high prevalence of upper extremity overuse injuries and pain among wheelchair users. As a result, recent effort has focused on determining how various propulsion techniques influence upper extremity demand during wheelchair propulsion. However, an important prerequisite for identifying the relationships between propulsion techniques and upper extremity demand is to understand how individual muscles contribute to the mechanical energetics of wheelchair propulsion. The purpose of this study was to use a forward dynamics simulation of wheelchair propulsion to quantify how individual muscles deliver, absorb and/or transfer mechanical power during propulsion. The analysis showed that muscles contribute to either push (i.e., deliver mechanical power to the handrim) or recovery (i.e., reposition the arm) subtasks, with the shoulder flexors being the primary contributors to the push and the shoulder extensors being the primary contributors to the recovery. In addition, significant activity from the shoulder muscles was required during the transition between push and recovery, which resulted in increased co-contraction and upper extremity demand. Thus, strengthening the shoulder flexors and promoting propulsion techniques that improve transition mechanics have much potential to reduce upper extremity demand and improve rehabilitation outcomes. Copyright © 2011 Elsevier Ltd. All rights reserved.

Extreme Tetralogy of Fallot With Polycythemia in a Ferret (Mustela putorius furo).

PubMed

Dias, Sara; Planellas, Marta; Canturri, Albert; Martorell, Jaume

2017-06-01

A 5-month-old, intact male ferret (Mustela putorius furo) was presented with apathy, tachypnea and exercise intolerance. On initial physical examination, tachypnea and cyanosis were the two primary clinical signs detected. The complete blood count also revealed a severe polycythemia, with lymphopenia, neutrophilia and eosinophilia. Further diagnostic imaging tests were performed. The thoracic radiographs revealed cardiomegaly and a diffuse alveolar pulmonary pattern. Consequently, an echocardiography was performed and showed an interventricular septal defect, pulmonic artery occlusion, overriding of the aorta and right ventricle hypertrophy. All abnormalities were compatible with a tetralogy of Fallot (TOF). As a treatment plan, a phlebotomy was performed and the ferret was posteriorly maintained with oxygen and fluid therapy. The following day, the hematocrit decreased 11% and the respiratory distress improved. Four days later, the ferret got clinically worse and was euthanized. A necropsy was performed and confirmed the presence of an extreme TOF with a diffused interstitial pneumonia secondary to Pneumocystis carinii. To the author's knowledge, this is the first report of an extreme tetralogy of Fallot with polycythemia in a ferret. Copyright © 2017 Elsevier Inc. All rights reserved.

Nerve conduction velocity in human limbs with late sequelae after local cold injury.

PubMed

Arvesen, A; Wilson, J; Rosén, L

1996-06-01

Cold-induced neuropathy may play a dominant role in the long-term sequelae with cold sensitivity after local cold injuries (LCIs). Somatosensory functions were assessed and nerve conduction velocity (NCV) and motor distal delay (MDD) were measured in the limbs of 31 Norwegian former soldiers with persistent cold intolerance 3-4 years after the primary LCI. NCV measurements were performed in 24 lower and 16 upper extremities. NCV was related to degree of overall subjective complaints quantified by means of a visual analogue scale (VAS). Motor (MNCV) and sensory conduction velocity (SNCV) in the lower extremities and SNCV in the hands were significantly decreased compared with controls. MDD was pathologically increased in the feet. NCV of the forearms ranged from normal to significant reduction. The more pronounced effect on the lower extremities may be caused by deeper cooling of the calves compared with forearms for several reasons. No significant associations were found between VAS and NCV except for the right median nerve. NCV measurements may provide objective findings in cold-injured patients and in those with few or no conspicuous clinical signs.

Pain and severe sleep disturbance in the general population: Primary data and meta-analysis from 240,820 people across 45 low- and middle-income countries.

PubMed

Stubbs, Brendon; Vancampfort, Davy; Thompson, Trevor; Veronese, Nicola; Carvalho, Andre F; Solmi, Marco; Mugisha, James; Schofield, Patricia; Matthew Prina, A; Smith, Lee; Koyanagi, Ai

2018-05-22

Pain and sleep disturbances are widespread, and are an important cause of a reduced quality of life. Despite this, there is a paucity of multinational population data assessing the association between pain and sleep problems, particularly among low- and middle-income countries (LMICs). Therefore, we investigated the relationship between pain and severe sleep disturbance across 45 LMICs. Community-based data on 240,820 people recruited via the World Health Survey were analyzed. Multivariable logistic regression analyses adjusted for multiple confounders were performed to quantify the association between pain and severe sleep problems in the last 30 days. A mediation analysis was conducted to explore potential mediators of the relationship between pain and severe sleep disturbance. The prevalence of mild, moderate, severe, and extreme levels of pain was 26.0%, 16.2%, 9.1%, and 2.2% respectively, whilst 7.8% of adults had severe sleep problems. Compared to those with no pain, the odds ratio (OR, 95% CI) for severe sleep problems was 3.65 (3.24-4.11), 9.35 (8.19-10.67) and 16.84 (13.91-20.39) for those with moderate, severe and extreme pain levels respectively. A country wide meta-analysis adjusted for age and sex demonstrated a significant increased OR across all 45 countries. Anxiety, depression and stress sensitivity explained 12.9%, 3.6%, and 5.2%, respectively, of the relationship between pain and severe sleep disturbances. Pain and sleep problems are highly co-morbid across LMICs. Future research is required to better understand this relationship. Moreover, future interventions are required to prevent and manage the pain and sleep disturbance comorbidity. Copyright © 2018 Elsevier Inc. All rights reserved.

Rectal Cancer in the Eye: A Case Report of Orbital Metastasis.

PubMed

Nabeel, Mohammed; Farooqi, Rehan; Mohebtash, Mahsa; Desai, Rupak; Mansuri, Uvesh; Patel, Smit; Patel, Jinal; Khan, Vinshi Naz

2017-08-21

Orbital metastasis from colorectal cancer is extremely rare. In this case report, we describe a 48-year-old woman who presented with recurrent severe headaches and new onset constipation with no known history of cancer. After vigilant workup, imaging, and biopsies, she was diagnosed with orbital metastasis from a primary rectal carcinoma. She was started on chemotherapy and radiation therapy. Her chemotherapy regimen consisted of FLOX (leucovorin + fluorouracil + oxaliplatin), along with panitumumab, which she tolerated well. She received chemotherapy for seven months before she lost her battle with cancer.

Disaster triage after the Haitian earthquake.

PubMed

Smith, R M; Dyer, G S M; Antonangeli, K; Arredondo, N; Bedlion, H; Dalal, A; Deveny, G M; Joseph, G; Lauria, D; Lockhart, S H; Lucien, S; Marsh, S; Rogers, S O; Salzarulo, H; Shah, S; Toussaint, R J; Wagoner, J

2012-11-01

In the aftermath of the devastating Haitian earthquake, we became the primary relief service for a large group of severely injured earthquake victims. Finding ourselves virtually isolated with extremely limited facilities and a group of critically injured patients whose needs vastly outstripped the available resources we employed a disaster triage system to organize their clinical care. This report describes the specific injury profile of this group of patients, their clinical course, and the management philosophy that we employed. It provides useful lessons for similar situations in the future. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Soft tissue sarcoma of the upper extremities. Analysis of factors relevant for prognosis in 160 patients].

PubMed

Lehnhardt, M; Hirche, C; Daigeler, A; Goertz, O; Ring, A; Hirsch, T; Drücke, D; Hauser, J; Steinau, H U

2012-02-01

Soft tissue sarcomas (STS) are a rare entity with reduced prognosis due to their aggressive biology. For an optimal treatment of STS identification of independent prognostic factors is crucial in order to reduce tumor-related mortality and recurrence rates. The surgical oncological concept includes wide excisions with resection safety margins >1 cm which enables acceptable functional results and reduced rates of amputation of the lower extremities. In contrast, individual anatomy of the upper extremities, in particular of the hand, leads to an intentional reduction of resection margins in order to preserve the extremity and its function with the main intention of tumor-free resection margins. In this study, the oncological safety and outcome as well as functional results were validated by a retrospective analysis of survival rate, recurrence rate and potential prognostic factors. A total of 160 patients who had been treated for STS of the upper extremities were retrospectively included. Independent prognostic factors were analyzed (primary versus recurrent tumor, tumor size, resection status, grade of malignancy, additional therapy, localization in the upper extremity). Kaplan-Meier analyses for survival rate and local control were calculated. Further outcome measures were functional results validated by the DASH score and rate of amputation. In 130 patients (81%) wide tumor excision (R0) was performed and in 19 patients (12%) an amputation was necessary. The 5-year overall survival rate was 70% and the 5-year survival rate in primary tumors was 81% whereas in recurrences 55% relapsed locally. The 10-year overall survival rate was 45% and the 5-year recurrence rate was 18% for primary STS and 43% for recurrent STS. Variance analysis revealed primary versus recurrent tumor, tumor size, resection status and grade of malignancy as independent prognostic factors. Analysis of functional results showed a median DASH score of 37 (0-100; 0=contralateral extremity). The 5-year survival and local recurrence rates are comparable to STS wide resections with safety margins >1 cm for the lower extremities and the trunk. Analysis of prognostic factors revealed resection status and the tumor-free resection margins to be the main goals in STS resection of upper extremity.

The analysis on the extreme water shortage event in Hangzhou in 1247 AD and its natural and social backgrounds

NASA Astrophysics Data System (ADS)

Liu, Haolong

2017-04-01

Yangtze River Delta locating in the north subtropics of China, is famous for numerous rivers and lakes. Because of East Asian monsoon rainfall, flood is always the most primary disaster in this area during the past 2000 years. However, there were also several extreme water shortage events in the history. Example in Hangzhou in 1247 AD was such a typical year in the area. In the paper, the severity of this extreme event and the closely tied spatiotemporal variation of drought in Yangtze River Delta was quantitatively analyzed on the basis of documentary records during Southern Song Dynasty. Furtherly, its natural and social backgrounds was discussed. The result s are summarized as follows: 1) Wells, canals and West Lake of Hangzhou dried up in 1247 AD. The water level of canals was about 1.32-2.64 m lower than that in the normal year. The reduction of storage capacity in West Lake was 21 million stere or so. 2) The droughts in Yangtze River Delta was moderate on the whole, but that in the west of Zhejiang Province was severe. The drought in Hangzhou lasted from the 2nd lunar month to the end of this year. 3) The water shortage event was closely related to the quick going north and farther northern location of summer rain belt. The descending sea-level weakening the tide in Qiantang River, can also reduce the supply of water resources. 4) The quick growth of urban population, excessive aquaculture, and ineffective government supervision played an important social role in the process of this event. In the all, this extreme water shortage event was the result of both natural and social factors. This research is very helpful for the futuristic water resource forecast in Yangtze River Delta, and it also affords us lessons on the risk management and heritage conservation that merit attention. Key Words: Hangzhou, 1247 AD, water shortage, canal, West Lake, natural factors, social factors

[Extreme (complicated, ultra-high) refractive errors: terminological misconceptions!?

PubMed

Avetisov, S E

2018-01-01

The article reviews development mechanisms of different refractive errors accompanied by marked defocus of light rays reaching the retina. Terminology used for such ametropias includes terms extreme, ultra-high and complicated. Justification of their usage for primary ametropias, whose symptom complex is based on changes in axial eye length, is an ongoing discussion. To comply with thesaurus definitions of 'diagnosis' and 'pathogenesis', to characterize refractive and anatomical-functional disorders in patients with primary ametropias it is proposed to use the terms 'hyperaxial and hypoaxial syndromes' with elaboration of specific symptoms instead of such expressions as extreme (ultra-high) myopia and hypermetropia.

[A psycholinguistic study in a patient with echolalia].

PubMed

Diesfeldt, H F

1986-10-01

Language is often impaired in patients with a primary degenerative dementia syndrome. Severe dementia may even lead to mutism, a condition in which the person does not produce any spontaneous speech, despite preservation of consciousness. The question is if there are any language abilities left in patients who do not speak. In this single case-study the echolalic behaviour of a patient with severe dementia and mixed transcortical aphasia (or isolation of the speech area) was analysed by means of special linguistic tasks. In repeating sentences violating number agreement, the patient spontaneously corrected the pronoun, the noun or the verb. Furthermore, her verbal output during repetition tasks was highly constrained to lexically acceptable Dutch nouns. Despite extremely poor comprehension, this patient did not repeat verbal utterances in a parrot-like fashion. There are not many reports in the literature of patients who develop a mixed transcortical aphasia as a consequence of primary degenerative dementia. A comparable case was described by H. Whitaker. Single case-studies, such as these, are essential to our insight into the course of language breakdown in senile dementia. The preserved repetition ability of this patient demonstrates the robustness of the articulatory loop system, even if there is a severe comprehension deficit.

Perceived psychological stress and upper extremity cumulative trauma disorders.

PubMed

Strasser, P B; Lusk, S L; Franzblau, A; Armstrong, T J

1999-01-01

This report presents data exploring the relationship between perceived psychological stress and several variables implicated in the etiology of upper extremity cumulative trauma disorders (UECTDs). The sample was 354 workers from three different manufacturing companies. The primary job exposure for the subjects was that they were engaged in jobs that involved repetitious movements of the upper extremities, primarily of the hands and arms. Data collection included a detailed health history, a comprehensive physical examination of the upper extremities, limited electrodiagnostic testing, Cohen's Perceived Stress Scale, Karasek's Job Content Questionnaire, demographic information, and a measurement of repetition. Descriptive analyses, analysis of variance, correlational analyses, and multiple linear regression were used to examine the data. Perceived stress, as measured in this study, was only weakly associated with repetition, job dissatisfaction, and subjective complaints related to UECTDs. In addition, factors generally accepted as related to UECTDs (e.g., repetition, female gender, hormonal influences, and existing medical conditions) were not robust predictors of perceived stress. The major limitation is related to the measurement of perceived psychological stress. Like most psychosocial phenomena, perceived stress is a complex construct, one that is difficult to measure and correlate with health outcomes. Further research is necessary to examine what role, if any, perceived stress may have in the etiology of UECTDs.

Severe retinopathy of prematurity predicts delayed white matter maturation and poorer neurodevelopment.

PubMed

Glass, Torin J A; Chau, Vann; Gardiner, Jane; Foong, Justin; Vinall, Jillian; Zwicker, Jill G; Grunau, Ruth E; Synnes, Anne; Poskitt, Kenneth J; Miller, Steven P

2017-11-01

To determine whether severe retinopathy of prematurity (ROP) is associated with (1) abnormal white matter maturation and (2) neurodevelopmental outcomes at 18 months' corrected age (CA) compared with neonates without severe ROP. We conducted a prospective longitudinal cohort of extremely preterm neonates born 24-28 weeks' gestational age recruited between 2006 and 2013 with brain MRIs obtained both early in life and at term-equivalent age. Severe ROP was defined as ROP treated with retinal laser photocoagulation. Using diffusion tensor imaging and tract-based spatial statistics (TBSS), white matter maturation was assessed by mean fractional anisotropy (FA) in seven predefined regions of interest. Neurodevelopmental outcomes were assessed with Bayley Scales of Infant and Toddler Development-III (Bayley-III) composite scores at 18 months' CA. Subjects were compared using Fisher's exact, Kruskal-Wallis and generalised estimating equations. Families were recruited from the neonatal intensive care unit at BC Women's Hospital. Of 98 extremely preterm neonates (median: 26.0 weeks) assessed locally for ROP, 19 (19%) had severe ROP and 83 (85%) were assessed at 18 months' CA. Severe ROP was associated with lower FA in the posterior white matter, and with decreased measures of brain maturation in the optic radiations, posterior limb of the internal capsule (PLIC) and external capsule on TBSS. Bayley-III cognitive and motor scores were lower in infants with severe ROP. Severe ROP is associated with maturational delay in the optic radiations, PLIC, external capsule and posterior white matter, housing the primary visual and motor pathways, and is associated with poorer cognitive and motor outcomes at 18 months' CA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Unusual primary HIV infection with colonic ulcer complicated by hemorrhagic shock: a case report

PubMed Central

2010-01-01

Introduction Timely diagnosis of primary HIV infection is important to prevent further transmission of HIV. Primary HIV infection may take place without symptoms or may be associated with fever, pharyngitis or headache. Sometimes, the clinical presentation includes aseptic meningitis or cutaneous lesions. Intestinal ulceration due to opportunistic pathogens (cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii) has been described in patients with AIDS. However, although invasion of intestinal lymphoid tissue is a prominent feature of human and simian lentivirus infections, colonic ulceration has not been reported in acute HIV infection. Case description A 42-year-old Caucasian man was treated with amoxicillin-clavulanate for pharyngitis. He did not improve, and a rash developed. History taking revealed a negative HIV antibody test five months previously and unprotected sex with a male partner the month before admission. Repeated tests revealed primary HIV infection with an exceptionally high HIV-1 RNA plasma concentration (3.6 × 107 copies/mL) and a low CD4 count (101 cells/mm3, seven percent of total lymphocytes). While being investigated, the patient had a life-threatening hematochezia. After angiographic occlusion of a branch of the ileocaecal artery and initiation of antiretroviral therapy, the patient became rapidly asymptomatic and could be discharged. Colonoscopy revealed a bleeding colonic ulcer. We were unable to identify an etiology other than HIV for this ulcer. Conclusion This case adds to the known protean manifestation of primary HIV infection. The lack of an alternative etiology, despite extensive investigations, suggests that this ulcer was directly caused by primary HIV infection. This conclusion is supported by the well-described extensive loss of intestinal mucosal CD4+ T cells associated with primary HIV infection, the extremely high HIV viral load observed in our patient, and the rapid improvement of the ulcer after initiation of highly active antiretroviral therapy. This case also adds to the debate on treatment for primary HIV infection, especially in the context of severe symptoms and an extremely high viral load. PMID:20727146

Primary Ewing's sarcoma-primitive neuroectodermal tumor of the uterus: a case report and literature review.

PubMed

Park, Jeong-Yeol; Lee, Sun; Kang, Hyoung Jin; Kim, Hy-Sook; Park, Sang-Yoon

2007-08-01

Primary Ewing's sarcoma-primitive neuroectodermal tumor (ES-PNET) of the uterus is an extremely rare malignancy. A 30-year-old Korean woman presented with abnormal uterine bleeding with uterine enlargement. A computed tomography (CT) scan and magnetic resonance imaging (MRI) of the abdomen and pelvis showed a huge uterine mass measuring 18 x 20 x 21 cm, metastasis to both pelvic and para-aortic lymph nodes, and omental infiltration. The pathology report of the uterine mass described a uniformly hypercellular tumor, which was arranged in diffuse solid sheets of uniform, small, rounded, and sometimes spindle-shaped cells, with scanty cytoplasm. Immunohistochemically, the mass tested positive for vimentin, CD99, and chromogranin. The patient received several courses of combination chemotherapy and radiotherapy but died from tumor progression 16 months after the initial diagnosis. This is a rare case of primary uterine ES-PNET in a woman of reproductive age. A review of the literature indicates that primary uterine ES-PNET requires early diagnosis and multimodality treatment including surgery, chemotherapy, and radiotherapy. The behavior of this tumor is potentially aggressive.

Therapeutic apheresis for severe hypertriglyceridemia in pregnancy.

PubMed

Basar, Rafet; Uzum, Ayse Kubat; Canbaz, Bulent; Dogansen, Sema Ciftci; Kalayoglu-Besisik, Sevgi; Altay-Dadin, Senem; Aral, Ferihan; Ozbey, Nese Colak

2013-05-01

During pregnancy, a progressive increase in serum triglyceride (TG) and cholesterol levels is observed whereas TG levels mostly remain <300 mg/dl. In women with genetic forms of hypertriglyceridemia, pregnancy may cause extremely elevated TG levels leading to potentially life-threatening pancreatitis attacks and chylomicronemia syndrome. The only safe medical treatment option during pregnancy is ω-3 fatty acids, which have moderate TG lowering effects. Therapeutic apheresis could be used as primary treatment approach during pregnancy. We reported the effect of double filtration apheresis in one pregnant women with severe hypertriglyceridemia, therapeutic plasmapheresis and double filtration methods in the other severe hypertriglyceridemic pregnant woman; a 32-year-old pregnant woman (patient 1) with a history of hypertriglyceridemia-induced acute pancreatitis during pregnancy and a 30-year-old pregnant woman with extremely high TG levels (12,000 mg/dl) leading to chylomicronemia syndrome (patient 2). Medical nutrition therapy and ω-3 fatty acids were also provided. Double filtration apheresis (patient 1) and plasmapheresis + double filtration apheresis (patient 2) were used. When we calculated the TG levels before and after therapeutic apheresis, maximum decrease achieved with double filtration apheresis was 46.3 % for patient 1 and 37.3 % for patient 2. However, with plasmapheresis TG level declined by 72 % in patient 2. Plasmapheresis seemed to be more efficient to decrease TG levels. Iron deficiency anemia was the main complication apart from technical difficulties by lipemic obstruction of tubing system. Healthy babies were born. Delivery led to decreases in TG levels. It is concluded that during pregnancy therapeutic apheresis is an effective method to decrease extremely high TG levels and risks of its potentially life-threatening complications.

Neurodevelopmental Outcomes of Extremely Preterm Infants Randomized to Stress Dose Hydrocortisone

PubMed Central

Parikh, Nehal A.; Kennedy, Kathleen A.; Tyson, Jon E.

2015-01-01

Objective To compare the effects of stress dose hydrocortisone therapy with placebo on survival without neurodevelopmental impairments in high-risk preterm infants. Study Design We recruited 64 extremely low birth weight (birth weight ≤1000g) infants between the ages of 10 and 21 postnatal days who were ventilator-dependent and at high-risk for bronchopulmonary dysplasia. Infants were randomized to a tapering 7-day course of stress dose hydrocortisone or saline placebo. The primary outcome at follow-up was a composite of death, cognitive or language delay, cerebral palsy, severe hearing loss, or bilateral blindness at a corrected age of 18–22 months. Secondary outcomes included continued use of respiratory therapies and somatic growth. Results Fifty-seven infants had adequate data for the primary outcome. Of the 28 infants randomized to hydrocortisone, 19 (68%) died or survived with impairment compared with 22 of the 29 infants (76%) assigned to placebo (relative risk: 0.83; 95% CI, 0.61 to 1.14). The rates of death for those in the hydrocortisone and placebo groups were 31% and 41%, respectively (P = 0.42). Randomization to hydrocortisone also did not significantly affect the frequency of supplemental oxygen use, positive airway pressure support, or need for respiratory medications. Conclusions In high-risk extremely low birth weight infants, stress dose hydrocortisone therapy after 10 days of age had no statistically significant effect on the incidence of death or neurodevelopmental impairment at 18–22 months. These results may inform the design and conduct of future clinical trials. Trial Registration ClinicalTrials.gov NCT00167544 PMID:26376074

XAFS imaging of Tsukuba gabbroic rocks: area analysis of chemical composition and local structure.

PubMed

Mizusawa, Mari; Sakurai, Kenji

2004-03-01

Gabbroic rocks were collected at Mount Tsukuba in Japan, and their XAFS images were studied using a projection-type X-ray fluorescence (XRF) microscope, which is a powerful new tool recently developed for extremely rapid imaging. The instrument employs a grazing-incidence arrangement in order that primary X-rays illuminate the whole sample surface, as well as parallel-beam optics and an extremely close geometry in order to detect XRF by a high-performance X-ray CCD system with 1024 x 1024 pixels. The XRF image indicated that black amphibole and white feldspar, both of which are typical mineral textures of the rock, contain iron. The origin has been suggested to be several small yellowish-brown minerals contained there. The XAFS imaging has been carried out by repeating the exposure of XRF images during the energy scan of the primary X-rays. It has been found that the structure is qualitatively close to that of olivine, and the main differences found in both areas can be explained as a difference in iron and magnesium concentration, i.e. the mixed ratio of forsterite (Mg(2)SiO(4)) and fayalite (Fe(2)SiO(4)). The feasibility of the present XAFS imaging method has been demonstrated for realistic inhomogeneous minerals.

Prenatal Diagnosis of a Segmental Small Bowel Volvulus with Threatened Premature Labor

PubMed Central

Mottet, Nicolas; Ramanah, Rajeev; Riethmuller, Didier

2017-01-01

Fetal primary small bowel volvulus is extremely rare but represents a serious life-threatening condition needing emergency neonatal surgical management to avoid severe digestive consequences. We report a case of primary small bowel volvulus with meconium peritonitis prenatally diagnosed at 27 weeks and 4 days of gestation during threatened premature labor with reduced fetal movements. Ultrasound showed a small bowel mildly dilated with thickened and hyperechogenic intestinal wall, with a typical whirlpool configuration. Normal fetal development allowed continuation of pregnancy with ultrasound follow-up. Induction of labor was decided at 37 weeks and 2 days of gestation because of a significant aggravation of intestinal dilatation appearing more extensive with peritoneal calcifications leading to the suspicion of meconium peritonitis, associated with reduced fetal movements and reduced fetal heart rate variability, for neonatal surgical management with a good outcome. PMID:29230337

A double mutation in AGXT gene in families with primary hyperoxaluria type 1.

PubMed

Kanoun, Houda; Jarraya, Faiçal; Hadj Salem, Ikhlass; Mahfoudh, Hichem; Chaabouni, Yosr; Makni, Fatma; Hachicha, Jamil; Fakhfakh, Faiza

2013-12-01

Primary hyperoxaluria type 1 (PH1) is a severe autosomal recessive inherited disorder of glyoxylate metabolism caused by mutations in the AGXT gene on chromosome 2q37.3 that encodes the hepatic peroxisomal enzyme alanine:glyoxylate aminotransferase. These mutations are found throughout the entire gene and cause a wide spectrum of clinical severity. Rare in Europe, PH1 is responsible for 13% of the end stage renal failure in the Tunisian child. In the present work, we identified the double mutation c.32C>T (Pro11Leu) and c.731T>C (p.Ile244Thr) in AGXT gene in five unrelated Tunisian families with PH1 disease. Our results provide evidence regarding the potential involvement of c.32C>T, originally described as common polymorphism, on the resulting phenotype. We also reported an extreme intrafamilial heterogeneity in clinical presentation of PH1. Despite the same genetic background, the outcome of the affected members differs widely. The significant phenotypic heterogeneity observed within a same family, with a same genotype, suggests the existence of relevant modifier factors. © 2013.

How much do different global GPP products agree in distribution and magnitude of GPP extremes?

NASA Astrophysics Data System (ADS)

Kim, S.; Ryu, Y.; Jiang, C.

2016-12-01

To evaluate uncertainty of global Gross Primary Productivity (GPP) extremes, we compare three global GPP datasets derived from different data processing methods (e.g. MPI-BGC: machine-learning, MODIS GPP (MOD17): semi-empirical, Breathing Earth System Simulator (BESS): process based). We preprocess the datasets following the method from Zscheischler et al., (2012) to detect GPP extremes which occur in less than 1% of the number of whole pixels, and to identify 3D-connected spatiotemporal GPP extremes. We firstly analyze global patterns and the magnitude of GPP extremes with MPI-BGC, MOD17, and BESS over 2001-2011. For consistent analysis in the three products, spatial and temporal resolution were set at 50 km and a monthly scale, respectively. Our results indicated that the global patterns of GPP extremes derived from MPI-BGC and BESS agreed with each other by showing hotspots in Northeastern Brazil and Eastern Texas. However, the extreme events detected from MOD17 were concentrated in tropical forests (e.g. Southeast Asia and South America). The amount of GPP reduction caused by climate extremes considerably differed across the products. For example, Russian heatwave in 2010 led to 100 Tg C uncertainty (198.7 Tg C in MPI-BGC, 305.6 Tg C in MOD17, and 237.8 Tg C in BESS). Moreover, the duration of extreme events differ among the three GPP datasets for the Russian heatwave (MPI-BGC: May-Sep, MOD17: Jun-Aug, and BESS: May-Aug). To test whether Sun induced Fluorescence (SiF), a proxy of GPP, can capture GPP extremes, we investigate global distribution of GPP extreme events in BESS, MOD17 and GOME-2 SiF between 2008 and 2014 when SiF data is available. We found that extreme GPP events in GOME-2 SiF and MOD17 appear in tropical forests whereas those in BESS emerged in Northeastern Brazil and Eastern Texas. The GPP extremes by severe 2011 US drought were detected by BESS and MODIS, but not by SiF. Our findings highlight that different GPP datasets could result in varying duration and intensity of GPP extremes and distribution of hotspots, and this study could contribute to quantifying uncertainties in GPP extremes.

What is the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs? A systematic review and meta-analyses.

PubMed

Dagenais, Catherine; Lewis-Mikhael, Anne-Mary; Grabovac, Marinela; Mukerji, Amit; McDonald, Sarah D

2017-11-29

Given the controversy around mode of delivery, our objective was to assess the evidence regarding the safest mode of delivery for actively resuscitated extremely preterm cephalic/non-cephalic twin pairs before 28 weeks of gestation. We searched Cochrane CENTRAL, MEDLINE, EMBASE and  http://clinicaltrials.gov from January 1994 to January 2017. Two reviewers independently screened titles, abstracts and full text articles, extracted data and assessed risk of bias. We included randomized controlled trials and observational studies. Our primary outcome was a composite of neonatal death (<28 days of life) and severe brain injury in survivors (intraventricular hemorrhage grade ≥ 3 or periventricular leukomalacia). We performed random-effects meta-analyses, generating odds ratios with 95% confidence intervals for the first and second twin separately, and for both twins together. We assessed the risk of bias using a modified Newcastle Ottawa Scale (NOS) for observational studies and used Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Our search generated 2695 articles, and after duplicate removal, we screened 2051 titles and abstracts, selecting 113 articles for full-text review. We contacted 36 authors, and ultimately, three observational studies met our inclusion criteria. In cephalic/non-cephalic twin pairs delivered by caesarean section compared to vaginal birth at 24 +0 -27 +6  weeks the odds ratio for our composite outcome of neonatal death and severe brain injury for the cephalic first twin was 0.35 (95% CI 0.00-92.61, two studies, I 2  = 76%), 1.69 for the non-cephalic second twin (95% CI 0.04-72.81, two studies, I 2  = 55%) and 0.83 for both twins (95% CI 0.05-13.43, two studies, I 2  = 56%). According to the modified Newcastle Ottawa Scale we assessed individual study quality as being at high risk of bias and according to GRADE the overall evidence for our primary outcomes was very low. Our systematic review on the safest mode of delivery for extremely preterm cephalic/non-cephalic twin pairs found very limited existing evidence, without significant differences in neonatal death and severe brain injury by mode of delivery.

Alewife dieoffs: Why do they occur?

USGS Publications Warehouse

Colby, Peter J.

1971-01-01

Periodid midwinter, early spring, and summer mortalities of alewives (Alosa pseudoharengus) have been common in the Great Lakes since the first appearance of the silvery marine invader in Lake Ontario in the mid-1870's. In 1967 a nationally publicized dieoff of tremendous magnitude (estimated at several hundred million pounds of fish) in Lake Michigan resulted in losses to industry,municipalities, and recreational interests in excess of $100 million. The cause of these mortalities is still unclear. The apparent inability of this primarily marine species to adjust completely to the Great Lakes has several suspected causes, among which failure to adjust to temperature extremes and fluctuations in the Great Lakes now appears to be of primary importance. Other possible causes are exhaustion of the food supply, failure to osmoregulate (maintain a suitable chemical balance) adequately in fresh water, failure to extract sufficient iodine from the iodine-poor Great Lakes, and a combination of these several possibilities.

77 FR 30087 - Air Quality Designations for the 2008 Ozone National Ambient Air Quality Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-21

...This rule establishes initial air quality designations for most areas in the United States, including areas of Indian country, for the 2008 primary and secondary national ambient air quality standards (NAAQS) for ozone. The designations for several counties in Illinois, Indiana, and Wisconsin that the EPA is considering for inclusion in the Chicago nonattainment area will be designated in a subsequent action, no later than May 31, 2012. Areas designated as nonattainment are also being classified by operation of law according to the severity of their air quality problems. The classification categories are Marginal, Moderate, Serious, Severe, and Extreme. The EPA is establishing the air quality thresholds that define the classifications in a separate rule that the EPA is signing and publishing in the Federal Register on the same schedule as these designations. In accordance with that separate rule, six nonattainment areas in California are being reclassified to a higher classification.

Rectal Cancer in the Eye: A Case Report of Orbital Metastasis

PubMed Central

Nabeel, Mohammed; Farooqi, Rehan; Mohebtash, Mahsa; Mansuri, Uvesh; Patel, Smit; Patel, Jinal; Khan, Vinshi Naz

2017-01-01

Orbital metastasis from colorectal cancer is extremely rare. In this case report, we describe a 48-year-old woman who presented with recurrent severe headaches and new onset constipation with no known history of cancer. After vigilant workup, imaging, and biopsies, she was diagnosed with orbital metastasis from a primary rectal carcinoma. She was started on chemotherapy and radiation therapy. Her chemotherapy regimen consisted of FLOX (leucovorin + fluorouracil + oxaliplatin), along with panitumumab, which she tolerated well. She received chemotherapy for seven months before she lost her battle with cancer. PMID:29062621

Primary Occipital Ewing's Sarcoma with Subsequent Spinal Seeding.

PubMed

Alqahtani, Ali; Amer, Roaa; Bakhsh, Eman

2017-01-01

Ewing's sarcoma is a primary bone cancer that mainly affects the long bones. This malignancy is particularly common in pediatric patients. Primary cranial involvement accounts for 1% of cases, with occipital involvement considered extremely rare. In this case study, primary occipital Ewing's sarcoma with a posterior fossa mass and subsequent relapse resulting in spinal seeding is reported. A 3-year-old patient presented with a 1-year history of left-sided headaches, localized over the occipital bone with progressive torticollis. Computed tomography (CT) imaging showed a mass in the left posterior fossa compressing the brainstem. The patient then underwent surgical excision followed by adjuvant chemoradiation therapy. Two years later, the patient presented with severe lower back pain and urinary incontinence. Whole-spine magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) seeding from the L5 to the S4 vertebrae. Primary cranial Ewing's sarcoma is considered in the differential diagnosis of children with extra-axial posterior fossa mass associated with destructive permeative bone lesions. Although primary cranial Ewing's sarcoma typically has good prognosis, our patient developed metastasis in the lower spine. Therefore, with CNS Ewing's sarcoma, screening of the entire neural axis should be taken into consideration for early detection of CSF seeding metastasis in order to decrease the associated morbidity and mortality.

Serum Hepatocyte Growth Factor Is Probably Associated With 3-Month Prognosis of Acute Ischemic Stroke.

PubMed

Zhu, Zhengbao; Xu, Tan; Guo, Daoxia; Huangfu, Xinfeng; Zhong, Chongke; Yang, Jingyuan; Wang, Aili; Chen, Chung-Shiuan; Peng, Yanbo; Xu, Tian; Wang, Jinchao; Sun, Yingxian; Peng, Hao; Li, Qunwei; Ju, Zhong; Geng, Deqin; Chen, Jing; Zhang, Yonghong; He, Jiang

2018-02-01

Serum hepatocyte growth factor (HGF) is positively associated with poor prognosis of heart failure and myocardial infarction, and it can also predict the risk of ischemic stroke in population. The goal of this study was to investigate the association between serum HGF and prognosis of ischemic stroke. A total of 3027 acute ischemic stroke patients were included in this post hoc analysis of the CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). The primary outcome was composite outcome of death or major disability (modified Rankin Scale score ≥3) within 3 months. After multivariate adjustment, elevated HGF levels were associated with an increased risk of primary outcome (odds ratio, 1.50; 95% confidence interval, 1.10-2.03; P trend =0.015) when 2 extreme quartiles were compared. Each SD increase of log-transformed HGF was associated with 14% (95% confidence interval, 2%-27%) increased risk of primary outcome. Adding HGF quartiles to a model containing conventional risk factors improved the predictive power for primary outcome (net reclassification improvement: 17.50%, P <0.001; integrated discrimination index: 0.23%, P =0.022). The association between serum HGF and primary outcome could be modified by heparin pre-treatment ( P interaction =0.001), and a positive linear dose-response relationship between HGF and primary outcome was observed in patients without heparin pre-treatment ( P linearity <0.001) but not in those with heparin pre-treatment. Serum HGF levels were higher in the more severe stroke at baseline, and elevated HGF levels were probably associated with 3-month poor prognosis independently of stroke severity among ischemic stroke patients, especially in those without heparin pre-treatment. Further studies from other samples of ischemic stroke patients are needed to validate our findings. © 2018 American Heart Association, Inc.

MESSENGER Observations of Extreme Space Weather in Mercury's Magnetosphere

NASA Astrophysics Data System (ADS)

Slavin, J. A.

2013-09-01

Increasing activity on the Sun is allowing MESSENGER to make its first observations of Mercury's magnetosphere under extreme solar wind conditions. At Earth interplanetary shock waves and coronal mass ejections produce severe "space weather" in the form of large geomagnetic storms that affect telecommunications, space systems, and ground-based power grids. In the case of Mercury the primary effect of extreme space weather in on the degree to which this it's weak global magnetic field can shield the planet from the solar wind. Direct impact of the solar wind on the surface of airless bodies like Mercury results in space weathering of the regolith and the sputtering of atomic species like sodium and calcium to high altitudes where they contribute to a tenuous, but highly dynamic exosphere. MESSENGER observations indicate that during extreme interplanetary conditions the solar wind plasma gains access to the surface of Mercury through three main regions: 1. The magnetospheric cusps, which fill with energized solar wind and planetary ions; 2. The subsolar magnetopause, which is compressed and eroded by reconnection to very low altitudes where the natural gyro-motion of solar wind protons may result in their impact on the surface; 3. The magnetotail where hot plasma sheet ions rapidly convect sunward to impact the surface on the nightside of Mercury. The possible implications of these new MESSENGER observations for our ability to predict space weather at Earth and other planets will be described.

Forecasting seasonal hydrologic response in major river basins

NASA Astrophysics Data System (ADS)

Bhuiyan, A. M.

2014-05-01

Seasonal precipitation variation due to natural climate variation influences stream flow and the apparent frequency and severity of extreme hydrological conditions such as flood and drought. To study hydrologic response and understand the occurrence of extreme hydrological events, the relevant forcing variables must be identified. This study attempts to assess and quantify the historical occurrence and context of extreme hydrologic flow events and quantify the relation between relevant climate variables. Once identified, the flow data and climate variables are evaluated to identify the primary relationship indicators of hydrologic extreme event occurrence. Existing studies focus on developing basin-scale forecasting techniques based on climate anomalies in El Nino/La Nina episodes linked to global climate. Building on earlier work, the goal of this research is to quantify variations in historical river flows at seasonal temporal-scale, and regional to continental spatial-scale. The work identifies and quantifies runoff variability of major river basins and correlates flow with environmental forcing variables such as El Nino, La Nina, sunspot cycle. These variables are expected to be the primary external natural indicators of inter-annual and inter-seasonal patterns of regional precipitation and river flow. Relations between continental-scale hydrologic flows and external climate variables are evaluated through direct correlations in a seasonal context with environmental phenomenon such as sun spot numbers (SSN), Southern Oscillation Index (SOI), and Pacific Decadal Oscillation (PDO). Methods including stochastic time series analysis and artificial neural networks are developed to represent the seasonal variability evident in the historical records of river flows. River flows are categorized into low, average and high flow levels to evaluate and simulate flow variations under associated climate variable variations. Results demonstrated not any particular method is suited to represent scenarios leading to extreme flow conditions. For selected flow scenarios, the persistence model performance may be comparable to more complex multivariate approaches, and complex methods did not always improve flow estimation. Overall model performance indicates inclusion of river flows and forcing variables on average improve model extreme event forecasting skills. As a means to further refine the flow estimation, an ensemble forecast method is implemented to provide a likelihood-based indication of expected river flow magnitude and variability. Results indicate seasonal flow variations are well-captured in the ensemble range, therefore the ensemble approach can often prove efficient in estimating extreme river flow conditions. The discriminant prediction approach, a probabilistic measure to forecast streamflow, is also adopted to derive model performance. Results show the efficiency of the method in terms of representing uncertainties in the forecasts.

Extreme precipitation events and related weather patterns over Iraq

NASA Astrophysics Data System (ADS)

raheem Al-nassar, Ali; Sangrà, Pablo; Alarcón, Marta

2016-04-01

This study aims to investigate the extreme precipitation events and the associated weather phenomena in the Middle East and particularly in Iraq. For this purpose we used Baghdad daily precipitation records from the Iraqi Meteorological and Seismology Organization combined with ECMWF (ERA-Interim) reanalysis data for the period from January 2002 to December 2013. Extreme events were found statistically at the 90% percentile of the recorded precipitation, and were highly correlated with hydrological flooding in some cities of Iraq. We identified fifteen extreme precipitation events. The analysis of the corresponding weather patterns (500 hPa and 250 hPa geopotential and velocity field distribution) indicated that 5 events were related with cut off low causing the highest precipitation (180 mm), 3 events related with rex block (158 mm), 3 events related with jet streak occurrence (130 mm) and 4 events related with troughs (107 mm). . Five of these events caused flash floods and in particular one of them related with a rex block was the most dramatic heavy rain event in Iraq in 30 years. We investigated for each case the convective instability and dynamical forcing together with humidity sources. For convective instability we explored the distribution of the K index and SWEAT index. For dynamical forcing we analyzed at several levels Q vector, divergence, potential and relative vorticity advection and omega vertical velocity. Source of humidity was investigated through humidity and convergence of specific humidity distribution. One triggering factor of all the events is the advection and convergence of humidity from the Red Sea and the Persian Gulf. Therefore a necessary condition for extreme precipitation in Iraq is the advection and convergence of humidity from the Red Sea and Persian Gulf. Our preliminary analysis also indicates that extreme precipitation events are primary dynamical forced playing convective instability a secondary role.

Brown tumors of the anterior skull base as the initial manifestation of true normocalcemic primary hyperparathyroidism: report of three cases and review of the literature.

PubMed

Khalatbari, Mahmoud Reza; Hamidi, Mehrdokht; Moharamzad, Yashar; Setayesh, Ali; Amirjamshidi, Abbas

2013-01-01

Brown tumor is a bone lesion secondary to hyperparathyroidism of various etiologies. Skeletal involvement in primary hyperparathyroidism secondary to parathyroid adenoma is very uncommon and brown tumor has become extremely a rare clinical entity. Hyperparathyroidism is usually associated with high levels of serum calcium. Brown tumor as the only and initial symptom of normocalcemic primary hyperparathyroidism is extremely rare. Moreover, involvement of the skull base and the orbit is exceedingly rare. The authors would report three cases of brown tumor of the anterior skull base that were associated with true normocalcemic primary hyperparathyroidism. Clinical manifestations, neuroimaging findings, pathological findings, diagnosis and treatment of the patients are discussed and the relevant literature is reviewed.

Percutaneous intervention for infrainguinal occlusive disease in women: equivalent outcomes despite increased severity of disease compared with men.

PubMed

DeRubertis, Brian G; Vouyouka, Angela; Rhee, Soo J; Califano, Joseph; Karwowski, John; Angle, Niren; Faries, Peter L; Kent, K Craig

2008-07-01

Experience with open surgical bypass suggests similar overall outcomes in women compared with men, but significantly increased risk of wound complications. Percutaneous treatment of lower extremity occlusive disease is therefore an attractive alternative in women, although it is not clear whether there is a difference in outcomes between women and men treated with this technique. We sought to determine the results and predictors of failure in women treated by percutaneous intervention. Percutaneous infrainguinal revascularization was performed on 309 women between 2001 and 2006. Procedures, complications, demographics, comorbidities, and follow-up data were entered into a prospective database for review. Patency was assessed primarily by duplex ultrasonography. Outcomes were expressed by Kaplan-Meier curves and compared by log-rank analysis. A total of 447 percutaneous interventions performed in 309 women were analyzed and compared with 553 interventions in men. Mean age in women was 73.2 years; comorbidities included hypertension (HTN) (86%), diabetes melitus (DM) (58%), chronic renal insufficiency (CRI) (15%), hemodialysis (7%), hypercholesterolemia (52%), coronary artery disease (CAD) (42%), and tobacco use (47%). Indications in women included claudication (38.0%), rest pain (18.8%), and tissue loss (43.2%). Overall primary & secondary patency and limb-salvage rates for women were 38% +/- 4%, 66% +/- 3%, and 80% +/- 4% at 24 months. In this patient sample, women were significantly more likely than men to present with limb-threatening ischemia (61.6% vs 47.3%, P < 0.001) and have lesions of TASC C and D severity (71.4% vs 61.7%, P < .005). However, there were no significant differences in primary and secondary patency rates or limb-salvage rates between genders. Furthermore, while women with limb-threat, diabetes, and advanced TASC severity lesions were at increased risk of failure overall, there were no differences between women and men with these characteristics. Percutaneous infrainguinal revascularization is a very effective modality in women with lower extremity occlusive disease. Although women in this sample were more likely to present with limb-threat than men, patency and limb-salvage rates were equivalent between genders, even in high-risk subsets such as diabetics or those with lesions of increased TASC severity.

Projected timing of perceivable changes in climate extremes for terrestrial and marine ecosystems.

PubMed

Tan, Xuezhi; Gan, Thian Yew; Horton, Daniel E

2018-05-26

Human and natural systems have adapted to and evolved within historical climatic conditions. Anthropogenic climate change has the potential to alter these conditions such that onset of unprecedented climatic extremes will outpace evolutionary and adaptive capabilities. To assess whether and when future climate extremes exceed their historical windows of variability within impact-relevant socioeconomic, geopolitical, and ecological domains, we investigate the timing of perceivable changes (time of emergence; TOE) for 18 magnitude-, frequency-, and severity-based extreme temperature (10) and precipitation (8) indices using both multimodel and single-model multirealization ensembles. Under a high-emission scenario, we find that the signal of frequency- and severity-based temperature extremes is projected to rise above historical noise earliest in midlatitudes, whereas magnitude-based temperature extremes emerge first in low and high latitudes. Precipitation extremes demonstrate different emergence patterns, with severity-based indices first emerging over midlatitudes, and magnitude- and frequency-based indices emerging earliest in low and high latitudes. Applied to impact-relevant domains, simulated TOE patterns suggest (a) unprecedented consecutive dry day occurrence in >50% of 14 terrestrial biomes and 12 marine realms prior to 2100, (b) earlier perceivable changes in climate extremes in countries with lower per capita GDP, and (c) emergence of severe and frequent heat extremes well-before 2030 for the 590 most populous urban centers. Elucidating extreme-metric and domain-type TOE heterogeneities highlights the challenges adaptation planners face in confronting the consequences of elevated twenty-first century radiative forcing. © 2018 John Wiley & Sons Ltd.

Transcatheter aortic valve replacement in patients with severe mitral or tricuspid regurgitation at extreme risk for surgery.

PubMed

Little, Stephen H; Popma, Jeffrey J; Kleiman, Neal S; Deeb, G Michael; Gleason, Thomas G; Yakubov, Steven J; Checuti, Stan; O'Hair, Daniel; Bajwa, Tanvir; Mumtaz, Mubashir; Maini, Brijeshwar; Hartman, Alan; Katz, Stanley; Robinson, Newell; Petrossian, George; Heiser, John; Merhi, William; Moore, B Jane; Li, Shuzhen; Adams, David H; Reardon, Michael J

2018-05-01

Patients with symptomatic severe aortic stenosis and severe mitral regurgitation or severe tricuspid regurgitation were excluded from the major transcatheter aortic valve replacement trials. We studied these 2 subgroups in patients at extreme risk for surgery in the prospective, nonrandomized, single-arm CoreValve US Expanded Use Study. The primary end point was all-cause mortality or major stroke at 1 year. A favorable medical benefit was defined as a Kansas City Cardiomyopathy Questionnaire overall summary score greater than 45 at 6 months and greater than 60 at 1 year and with a less than 10-point decrease from baseline. There were 53 patients in each group. Baseline characteristics for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were age 84.2 ± 6.4 years and 84.9 ± 6.5 years; male, 29 (54.7%) and 22 (41.5%), and mean Society of Thoracic Surgeons score 9.9% ± 5.0% and 9.2% ± 4.0%, respectively. Improvement in valve regurgitation from baseline to 1 year occurred in 72.7% of the patients with severe mitral regurgitation and in 61.8% of patients with severe tricuspid regurgitation. A favorable medical benefit occurred in 31 of 47 patients (66.0%) with severe mitral regurgitation and 33 of 47 patients (70.2%) with severe tricuspid regurgitation at 6 months, and in 25 of 44 patients (56.8%) with severe mitral regurgitation and 24 of 45 patients (53.3%) with severe tricuspid regurgitation at 1 year. All-cause mortality or major stroke for the severe mitral regurgitation and severe tricuspid regurgitation cohorts were 11.3% and 3.8% at 30 days and 21.0% and 19.2% at 1 year, respectively. There were no major strokes in either group at 1 year. Transcatheter aortic valve replacement in patients with severe mitral regurgitation or severe tricuspid regurgitation is reasonable and safe and leads to improvement in atrioventricular valve regurgitation. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Twisting Tourniquet(©) Technique: introducing Schnogh, a novel device and its effectiveness in treating primary and secondary lymphedema of extremities.

PubMed

Chanwimalueang, Narumon; Ekataksin, Wichai; Piyaman, Parkpoom; Pattanapen, Gedsuda; Hanboon, Borimas K

2015-10-01

Twisting Tourniquet(©) or in Thai "Schnogh" is a new invention for compression therapy of lymphedema. Twisting Tourniquet(©) Technique (TTT) is totally noninvasive for lymphedema management. After the amazing successful evidence in the first series of 28 patients, we have conducted preliminary studies in lymphedema clinics. It was found that the combination of gradually increasing constriction force by Schnogh until desired pressure was reached and maintained for 15 min, followed by a 5-min release, doing repeatedly this compression-decompression for at least 10 sessions a day, can generate acceptable results. The aim of the study was to evaluate the scientific effectiveness and establish a treatment protocol of TTT proposed as a therapeutic approach for clinical management of lymphedema. During 2006-2013, from over 3500 patients, 647 with primary/secondary lymphedema passed inclusion criteria, 307 for upper, and 340 for lower extremity. In the 5-day course of TTT, each day patients underwent 10 sessions of a 15-min compression followed by a 5-min decompression. Vegan diet was encouraged as an adjuvant therapy. Among lymphedema patients whose spectrum of edema severity ranged from mild to gigantic, TTT yielded an average volume reduction rate (VR) at 50.2% and 55.6%, making the average edema reduction volume attained at 463 and 1856 mL for upper and lower limb, respectively. The uniformed practice by Schnogh which supports a continual compression-decompression maneuver over 3.5 h daily for five consecutive days could induce an average VR at above half of the swelling in extremities of 647 patients. Schnogh is therefore effective in clinical management of lymphedema under TTT treatment of fibroblastic interstitium. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Comparative skeletal features between Homo floresiensis and patients with primary growth hormone insensitivity (Laron Syndrome).

PubMed

Hershkovitz, Israel; Kornreich, Liora; Laron, Zvi

2007-10-01

Comparison between the skeletal remains of Homo floresiensis and the auxological and roentgenological findings in a large Israeli cohort of patients with Laron Syndrome (LS, primary or classical GH insensitivity or resistance) revealed striking morphological similarities, including extremely small stature and reduced cranial volume. LS is an autosomal recessive disease caused by a molecular defect of the Growth Hormone (GH) receptor or in the post-receptor cascades. Epidemiological studies have shown that LS occurs more often in consanguineous families and isolates, and it has been described in several countries in South East Asia. It is our conclusion that the findings from the island of Flores, which were attributed to a new species of the genus Homo, may in fact represent a local, highly inbred, Homo sapiens population in whom a mutation for the GH receptor had occurred. (c) 2007 Wiley-Liss, Inc.

The GTC: a convenient test bench for ELT demonstrations

NASA Astrophysics Data System (ADS)

Rodriguez Espinosa, Jose M.; Hammersley, Peter L.; Martinez-Roger, Carlos

2004-07-01

The Gran Telescopio Canarias (GTC) is, being assembled at the Observatorio del Roque de los Muchachos (ORM) in the island of La Palma. First light is expected for early 2005 with the first science observations late in 2005. The GTC, being a segmented primary mirror telescope, could be employed for testing several technological aspects relevant to the future generation of Extremely Large Telescopes (ELT). In the short term, the mass production of aespheric mirror segments can be examined in detail and improvements made along the way, or planned for the future. Indeed the GTC segments are now entering into a chain production scheme. Later on, different strategies for the control aspects of the primary mirror can be explored to optimize the optical performance of segmented telescopes. Moreover, the entire GTC active optics can offer a learning tool for testing various strategies and their application to ELTs.

Back pain caused by a pseudo-tumorous vertebral collapse: atypical presentation of primary vertebral hydatidosis.

PubMed

Mrabet, D; Rekik, S; Khiari, H; Mizouni, H; Meddeb, N; Cheour, I; Elleuch, M; Mnif, E; Mrabet, A; Sahli, H; Sellami, S

2011-03-24

Hydatidosis, also known as echinococcosis, is a rare but serious parasitic disease in endemic areas. Primary spinal location is extremely rare. This case report describes a rare instance of hydatid cyst that caused severe and progressive low-back pain and neurologic dysfunction. Spine MRI showed a unique vertebral collapse of Th12 body with multicystic lesions filling the spinal canal. In addition, hydatidosis serodiagnostic test was positive at 1/725. Treatment depended on the actual surgical removal of the cysts. Surgery consisted in excision and extirpation of the cysts, associated with decompressive laminectomy. The diagnosis was confirmed on the basis of histological results. No coincidental hydatid visceral involvement was found. Antihelminthic drugs (Albendazole) were promptly given before surgery for a long period. The outcome was satisfactorily marked by total regression of the motor deficit and sphincter disorders.

Quality improvement activity for improving pain management in acute extremity injuries in the emergency department.

PubMed

Chang, Hyung Lan; Jung, Jin Hee; Kwak, Young Ho; Kim, Do Kyun; Lee, Jin Hee; Jung, Jae Yun; Kwon, Hyuksool; Paek, So Hyun; Park, Joong Wan; Shin, Jonghwan

2018-03-01

The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED). This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40-S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse's pain assessment, including change of pain documentation on electronic medical records. The intervention was conducted from January to April in 2014 and outcome was compared between May and August in 2013 and 2014. The primary outcome was the rate of analgesic prescription, and the secondary outcome was the time to analgesic prescription. A total of 1,739 patients were included, and 20.3% of 867 patients in the pre-intervention period, and 28.8% of 872 patients in the post-intervention period received analgesics (P< 0.001). The prescription rate of analgesics for moderate-to-severe injuries was 36.4% in 2013 and 44.5% in 2014 (P=0.026). The time to analgesics prescription was 116.6 minutes (standard deviation 225.6) in 2013 and 64 minutes (standard deviation 75.5) in 2014 for all extremity injuries. The pain scoring increased from 1.4% to 51.6%. ED-based quality improvement activities including education and change of pain score documentation can improve the rate of analgesic prescription and time to prescription for patients with extremity injury in the ED.

Circadian system of mice integrates brief light stimuli.

PubMed

Van Den Pol, A N; Cao, V; Heller, H C

1998-08-01

Light is the primary sensory stimulus that synchronizes or entrains the internal circadian rhythms of animals to the solar day. In mammals photic entrainment of the circadian pacemaker residing in the suprachiasmatic nuclei is due to the fact that light at certain times of day can phase shift the pacemaker. In this study we show that the circadian system of mice can integrate extremely brief, repeated photic stimuli to produce large phase shifts. A train of 2-ms light pulses delivered as one pulse every 5 or 60 s, with a total light duration of 120 ms, can cause phase shifts of several hours that endure for weeks. Single 2-ms pulses of light were ineffective. Thus these data reveal a property of the mammalian circadian clock: it can integrate and store latent sensory information in such a way that a series of extremely brief photic stimuli, each too small to cause a phase shift individually, together can cause a large and long-lasting change in behavior.

Apodized Pupil Lyot Coronagraphs for Arbitrary Apertures. II. Theoretical Properties and Application to Extremely Large Telescopes

NASA Astrophysics Data System (ADS)

Soummer, Rémi; Pueyo, Laurent; Ferrari, André; Aime, Claude; Sivaramakrishnan, Anand; Yaitskova, Natalia

2009-04-01

We study the application of Lyot coronagraphy to future Extremely Large Telescopes (ELTs), showing that Apodized Pupil Lyot Coronagraphs enable high-contrast imaging for exoplanet detection and characterization with ELTs. We discuss the properties of the optimal pupil apodizers for this application (generalized prolate spheroidal functions). The case of a circular aperture telescope with a central obstruction is considered in detail, and we discuss the effects of primary mirror segmentation and secondary mirror support structures as a function of the occulting mask size. In most cases where inner working distance is critical, e.g., for exoplanet detection, these additional features do not alter the solutions derived with just the central obstruction, although certain applications such as quasar-host galaxy coronagraphic observations could benefit from designs that explicitly accomodate ELT spider geometries. We illustrate coronagraphic designs for several ELT geometries including ESO/OWL, the Thirty Mirror Telescope, the Giant Magellan Telescope, and describe numerical methods for generating these designs.

Acute bilateral painless radiculitis with abnormal Borrelia burgdorferi immunoblot.

PubMed

Almodovar, Jorge L; Hehir, Michael K; Nicholson, Katharine A; Stommel, Elijah W

2012-12-01

A 57-year-old woman with a history of hypertension and hypothyroidism presented with painless left arm weakness and numbness 2 weeks before evaluation. Nerve conduction studies of the left arm revealed normal motor and sensory responses. Needle examination revealed acute denervation changes in all myotomes of the affected extremity, including cervical paraspinals on the left, and several myotomes on the contralateral side. The laboratory evaluation revealed normal anti-GM1 antibodies and 3 IgM/5 IgG bands on Lyme Western Blot. The patient began treatment with 28 days of intravenous ceftriaxone. On follow-up, patient had regained full strength of her extremities with no sensory deficits. Inflammatory borrelia radiculitis usually presents with pain in the distribution of the affected nerves and nerve roots. The novelty of this case report rests on (1) the absence of primary borreliosis symptomatology preceding the radiculitis and (2) the painless and bilateral clinical presentation in a patient with suspected Lyme radiculitis.

The Preflight Photometric Calibration of the Extreme-Ultraviolet Imaging Telescope EIT

NASA Technical Reports Server (NTRS)

Dere, K. P.; Moses, J. D.; Delaboudiniere, J. -P.; Brunaud, J.; Carabetian, C.; Hochedez, J. -F.; Song, X. Y.; Catura, R. C.; Clette, F.; Defise, J. -M.

2000-01-01

This paper presents the preflight photometric calibration of the Extreme-ultraviolet Imaging Telescope (EIT) aboard the Solar and Heliospheric Observatory (SOHO). The EIT consists of a Ritchey-Chretien telescope with multilayer coatings applied to four quadrants of the primary and secondary mirrors, several filters and a backside-thinned CCD detector. The quadrants of the EIT optics were used to observe the Sun in 4 wavelength bands that peak near 171, 195, 284, and 304 . Before the launch of SOHO, the EIT mirror reflectivities, the filter transmissivities and the CCD quantum efficiency were measured and these values are described here. The instrumental throughput in terms of an effective area is presented for each of the various mirror quadrant and filter wheel combinations. The response to a coronal plasma as a function of temperature is also determined and the expected count rates are compared to the count rates observed in a coronal hole, the quiet Sun and an active region.

Variability of carbon and water fluxes following climate extremes over a tropical forest in southwestern Amazonia.

PubMed

Zeri, Marcelo; Sá, Leonardo D A; Manzi, Antônio O; Araújo, Alessandro C; Aguiar, Renata G; von Randow, Celso; Sampaio, Gilvan; Cardoso, Fernando L; Nobre, Carlos A

2014-01-01

The carbon and water cycles for a southwestern Amazonian forest site were investigated using the longest time series of fluxes of CO2 and water vapor ever reported for this site. The period from 2004 to 2010 included two severe droughts (2005 and 2010) and a flooding year (2009). The effects of such climate extremes were detected in annual sums of fluxes as well as in other components of the carbon and water cycles, such as gross primary production and water use efficiency. Gap-filling and flux-partitioning were applied in order to fill gaps due to missing data, and errors analysis made it possible to infer the uncertainty on the carbon balance. Overall, the site was found to have a net carbon uptake of ≈5 t C ha(-1) year(-1), but the effects of the drought of 2005 were still noticed in 2006, when the climate disturbance caused the site to become a net source of carbon to the atmosphere. Different regions of the Amazon forest might respond differently to climate extremes due to differences in dry season length, annual precipitation, species compositions, albedo and soil type. Longer time series of fluxes measured over several locations are required to better characterize the effects of climate anomalies on the carbon and water balances for the whole Amazon region. Such valuable datasets can also be used to calibrate biogeochemical models and infer on future scenarios of the Amazon forest carbon balance under the influence of climate change.

A case of cervico-brachial disorder due to tactile interpretation for deaf-blind persons.

PubMed

Kitahara, Teruyo; Nakamura, Kenji; Taoda, Kazushi; Shigeta, Hiromasa; Hirata, Mamoru

2012-01-01

We herein report a case of cervico-brachial disorder (CBD) due to long-term tactile interpreting. The patient was interviewed to investigate her past history, occupational history, work conditions and clinical course in detail. The case was diagnosed in accordance with the "Diagnostic Criteria for CBD 2007" established by the Research Association for CBD of the Japanese Society for Occupational Health. The patient was a 49-year-old female who has worked as a regular occupational instructor at a welfare work activity center for deaf people since April 22, 2010. Her primary job is to instruct and aid others in learning confectionery manufacturing and coffee shop tasks. She also performs tactile interpreting for two deaf-blind workers during a morning health check and during any meetings. On September 3, 2010, she interpreted by tactile signing for about three hours alone during a meeting, due to the absence of other interpreters. She developed severe pain in her back immediately after carrying out this interpretation, and the pain thereafter continued and developed in the upper extremities. She was diagnosed with a severe and prolonged case of the non-specific type of CBD. Interpretation by tactile signing may impose a heavier burden on the upper extremities, shoulders and neck than that imposed by common sign language. A shorter time of interpretation, ensuring the availability of rest time and supporting tools or methods for the upper extremities, are therefore considered to be necessary to prevent the incidence of CBD among interpreters using tactile signing.

Variability of Carbon and Water Fluxes Following Climate Extremes over a Tropical Forest in Southwestern Amazonia

PubMed Central

Zeri, Marcelo; Sá, Leonardo D. A.; Manzi, Antônio O.; Araújo, Alessandro C.; Aguiar, Renata G.; von Randow, Celso; Sampaio, Gilvan; Cardoso, Fernando L.; Nobre, Carlos A.

2014-01-01

The carbon and water cycles for a southwestern Amazonian forest site were investigated using the longest time series of fluxes of CO2 and water vapor ever reported for this site. The period from 2004 to 2010 included two severe droughts (2005 and 2010) and a flooding year (2009). The effects of such climate extremes were detected in annual sums of fluxes as well as in other components of the carbon and water cycles, such as gross primary production and water use efficiency. Gap-filling and flux-partitioning were applied in order to fill gaps due to missing data, and errors analysis made it possible to infer the uncertainty on the carbon balance. Overall, the site was found to have a net carbon uptake of ≈5 t C ha−1 year−1, but the effects of the drought of 2005 were still noticed in 2006, when the climate disturbance caused the site to become a net source of carbon to the atmosphere. Different regions of the Amazon forest might respond differently to climate extremes due to differences in dry season length, annual precipitation, species compositions, albedo and soil type. Longer time series of fluxes measured over several locations are required to better characterize the effects of climate anomalies on the carbon and water balances for the whole Amazon region. Such valuable datasets can also be used to calibrate biogeochemical models and infer on future scenarios of the Amazon forest carbon balance under the influence of climate change. PMID:24558378

Suppression of Metastasis by Primary Tumor and Acceleration of Metastasis Following Primary Tumor Resection: A Natural Law?

PubMed

Hanin, Leonid; Rose, Jason

2018-03-01

We study metastatic cancer progression through an extremely general individual-patient mathematical model that is rooted in the contemporary understanding of the underlying biomedical processes yet is essentially free of specific biological assumptions of mechanistic nature. The model accounts for primary tumor growth and resection, shedding of metastases off the primary tumor and their selection, dormancy and growth in a given secondary site. However, functional parameters descriptive of these processes are assumed to be essentially arbitrary. In spite of such generality, the model allows for computing the distribution of site-specific sizes of detectable metastases in closed form. Under the assumption of exponential growth of metastases before and after primary tumor resection, we showed that, regardless of other model parameters and for every set of site-specific volumes of detected metastases, the model-based likelihood-maximizing scenario is always the same: complete suppression of metastatic growth before primary tumor resection followed by an abrupt growth acceleration after surgery. This scenario is commonly observed in clinical practice and is supported by a wealth of experimental and clinical studies conducted over the last 110 years. Furthermore, several biological mechanisms have been identified that could bring about suppression of metastasis by the primary tumor and accelerated vascularization and growth of metastases after primary tumor resection. To the best of our knowledge, the methodology for uncovering general biomedical principles developed in this work is new.

Representing Extremes in Agricultural Models

NASA Technical Reports Server (NTRS)

Ruane, Alex

2015-01-01

AgMIP and related projects are conducting several activities to understand and improve crop model response to extreme events. This involves crop model studies as well as the generation of climate datasets and scenarios more capable of capturing extremes. Models are typically less responsive to extreme events than we observe, and miss several forms of extreme events. Models also can capture interactive effects between climate change and climate extremes. Additional work is needed to understand response of markets and economic systems to food shocks. AgMIP is planning a Coordinated Global and Regional Assessment of Climate Change Impacts on Agricultural Production and Food Security with an aim to inform the IPCC Sixth Assessment Report.

Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries.

PubMed

Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

2015-01-01

Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6-32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6-11) and 9.24 (range 6-11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4-7) and 5.19 (range 3-8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively. MESS is not predictive in combat related extremity injuries especially if between a score of 6-8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation.

Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries

PubMed Central

Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

2015-01-01

Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative predictive values were calculated as 95.45% and 90.2%, respectively. Conclusion: MESS is not predictive in combat related extremity injuries especially if between a score of 6–8. Limb ischemia and presence or absence of shock can be used in initial decision-making for amputation. PMID:26806974

Role of contralesional hemisphere in paretic arm reaching in patients with severe arm paresis due to stroke: A preliminary report.

PubMed

Mohapatra, Sambit; Harrington, Rachael; Chan, Evan; Dromerick, Alexander W; Breceda, Erika Y; Harris-Love, Michelle

2016-03-23

Stroke is highly prevalent and a leading cause of serious, long-term disability among American adults. Impaired movement (i.e. paresis) of the stroke-affected arm is a major contributor to post-stroke disability, yet the mechanisms of upper extremity motor recovery are poorly understood, particularly in severely impaired patients who lack hand function. To address this problem, we examined the functional relevance of the contralesional hemisphere in paretic arm motor performance in individuals with severe arm paresis. Twelve individuals with severe stroke-induced arm paresis (Upper Extremity Fugl-Meyer Assessment=17.1 ± 8.5; maximum score=66) participated in the study. Participants performed a reaching response time task with their paretic arm. At varying time intervals following a 'Go' cue, a pair of transcranial magnetic stimulation (TMS) pulses were delivered to contralesional hemisphere primary motor (M1) or dorsal pre-motor cortex (PMd) to momentarily disrupt the pattern of neural firing. Response time components and hand-path characteristics were compared across the 2 sites for trials with and without TMS disruption. There was no significant effect of TMS disruption on overall Response time or Reaction time, but Movement time was significantly longer (i.e. slower) with disruption of the contralesional hemisphere (p=0.015), regardless of which area was stimulated. Peak hand-path velocity and hand-path smoothness were also significantly lower (p=0.005 and p<0.0001, respectively) with TMS disruption of the contralesional hemisphere. The data from this study provide evidence supporting a functionally relevant role of contralesional hemisphere motor areas in paretic arm reaching movements in individuals with severe post-stroke arm impairment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of the DSM-5 Severity Indicator for Bulimia Nervosa

PubMed Central

Grilo, Carlos M.; Ivezaj, Valentina; White, Marney A.

2015-01-01

This study examined the DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors. 199 community volunteers classified with BN were categorized using DSM-5 severity levels and compared on demographic and clinical variables. 77 (39%) participants were categorized as mild, 68 (34%) as moderate, 32 (16%) as severe, and 22 (11%) as extreme. The severity groups did not differ significantly in demographic variables or body mass index. Shape and Weight concerns did not differ significantly across severity groups. Binge eating differed with the extreme group having higher frequency than the severe, moderate, and mild groups, which did not differ from each other. Restraint differed with the extreme group having significantly higher levels than the mild group. Eating concerns differed with the extreme group having higher levels than moderate and mild groups. Depression differed with the extreme group having higher levels than severe, moderate, and mild groups, which did not differ from each other. Findings from this non-clinical group provide new, albeit modest, support for DSM-5 severity rating for BN based on frequency of inappropriate weight compensatory behaviors. Statistical findings indicate that differences in collateral clinical variables associated with the DSM-5 severity ratings reflect small effect sizes. Further research is needed with treatment-seeking patient groups with BN to establish the validity of the DSM-5 severity specifier and should include broader clinical and functional validators. PMID:25744910

Evaluation of the DSM-5 severity indicator for bulimia nervosa.

PubMed

Grilo, Carlos M; Ivezaj, Valentina; White, Marney A

2015-04-01

This study examined the DSM-5 severity criterion for bulimia nervosa (BN) based on the frequency of inappropriate weight compensatory behaviors. 199 community volunteers classified with BN were categorized using DSM-5 severity levels and compared on demographic and clinical variables. 77 (39%) participants were categorized as mild, 68 (34%) as moderate, 32 (16%) as severe, and 22 (11%) as extreme. The severity groups did not differ significantly in demographic variables or body mass index. Shape and Weight concerns did not differ significantly across severity groups. Binge eating differed with the extreme group having significantly higher frequency than the severe, moderate, and mild groups, which did not differ from each other. Restraint differed with the extreme group having significantly higher levels than the mild group. Eating concerns differed with the extreme group having significantly higher levels than moderate and mild groups. Depression differed with the extreme group having significantly higher levels than severe, moderate, and mild groups, which did not differ from each other. Findings from this non-clinical group provide new, albeit modest, support for DSM-5 severity rating for BN based on frequency of inappropriate weight compensatory behaviors. Statistical findings indicate that differences in collateral clinical variables associated with the DSM-5 severity ratings reflect small effect sizes. Further research is needed with treatment-seeking patient groups with BN to establish the validity of the DSM-5 severity specifier and should include broader clinical and functional validators. Copyright © 2015 Elsevier Ltd. All rights reserved.

A retrospective cohort study examining the association between body mass index and mortality in severe sepsis.

PubMed

Gaulton, Timothy Glen; Marshall MacNabb, C; Mikkelsen, Mark Evin; Agarwal, Anish Kumar; Cham Sante, S; Shah, Chirag Vinay; Gaieski, David Foster

2015-06-01

Body mass index (BMI) is an easily calculated indicator of a patient's body mass including muscle mass and body fat percentage and is used to classify patients as underweight or obese. This study is to determine if BMI extremes are associated with increased 28-day mortality and hospital length of stay (LOS) in emergency department (ED) patients presenting with severe sepsis. We performed a retrospective chart review at an urban, level I trauma center of adults admitted with severe sepsis between 1/2005 and 10/2007, and collected socio-demographic variables, comorbidities, initial and most severe vital signs, laboratory values, and infection sources. The primary outcome variables were mortality and LOS. We performed bivariable analysis, logistic regression and restricted cubic spline regression to determine the association between BMI, mortality, and LOS. Amongst 1,191 severe sepsis patients (median age, 57 years; male, 54.7%; median BMI, 25.1 kg/m(2)), 28-day mortality was 19.9% (95% CI 17.8-22.4) and 60-day mortality was 24.4% (95% CI 21.5-26.5). Obese and morbidly obese patients were younger, less severely ill, and more likely to have soft tissue infections. There was no difference in adjusted mortality for underweight patients compared to the normal weight comparator (OR 0.74; CI 0.42-1.39; p = 0.38). The obese and morbidly obese experienced decreased mortality risk, vs. normal BMI; however, after adjustment for baseline characteristics, this was no longer significant (OR 0.66; CI 0.42-1.03; p = 0.06). There was no significant difference in LOS across BMI groups. Neither LOS nor adjusted 28-day mortality was significantly increased or decreased in underweight or obese patients with severe sepsis. Morbidly obese patients may have decreased 28-day mortality, partially due to differences in initial presentation and source of infection. Larger, prospective studies are needed to validate these findings related to BMI extremes in patients with severe sepsis.

Primary extraskeletal Ewing's sarcoma/primitive neuroectodermal tumour of breast.

PubMed

Ikhwan, S M; Kenneth, V K T; Seoparjoo, A; Zin, A A M

2013-06-21

Primary primitive neuroectodermal tumour (PNET) and extraskeletal Ewing's sarcoma belongs to the Ewing's family of tumours. Primary tumours arising from breast are very rare. There are only a few case reports published on primary extraskeletal Ewing's sarcoma and PNET arising from breast. We present an extremely rare case of an inoperable primary Ewing's sarcoma arising from left breast with contralateral breast, lymphatic and lung metastasis.

Unstructured Cartesian/prismatic grid generation for complex geometries

NASA Technical Reports Server (NTRS)

Karman, Steve L., Jr.

1995-01-01

The generation of a hybrid grid system for discretizing complex three dimensional (3D) geometries is described. The primary grid system is an unstructured Cartesian grid automatically generated using recursive cell subdivision. This grid system is sufficient for computing Euler solutions about extremely complex 3D geometries. A secondary grid system, using triangular-prismatic elements, may be added for resolving the boundary layer region of viscous flows near surfaces of solid bodies. This paper describes the grid generation processes used to generate each grid type. Several example grids are shown, demonstrating the ability of the method to discretize complex geometries, with very little pre-processing required by the user.

Rare Skeletal Complications in the Setting of Primary Hyperparathyroidism

PubMed Central

Sabanis, Nikos; Gavriilaki, Eleni; Paschou, Eleni; Kalaitzoglou, Asterios; Papanikolaou, Dimitrios; Ioannidou, Pinelopi; Vasileiou, Sotirios

2015-01-01

Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations which vary from asymptomatic patients to severe complications of hypercalcemia or parathyrotoxicosis while skeletal involvement is rather common. Herein we aimed at presenting a unique case of a young patient with rare aggressive skeletal complications of parathyroid cancer that initially were misdiagnosed. Ossification of the cervical ligamentum flavum and skull tumor illustrates erosive bonny lesions of hyperparathyroidism that in association with previous medical history of recurrent nephrolithiasis and biochemical findings guide the diagnosis. We suggest that increased awareness and holistic approach are needed in order to recognize and further investigate signs and symptoms of hyperparathyroidism. PMID:26664767

Rare Skeletal Complications in the Setting of Primary Hyperparathyroidism.

PubMed

Sabanis, Nikos; Gavriilaki, Eleni; Paschou, Eleni; Kalaitzoglou, Asterios; Papanikolaou, Dimitrios; Ioannidou, Pinelopi; Vasileiou, Sotirios

2015-01-01

Parathyroid carcinoma represents an extremely rare neoplasm with diverse clinical manifestations which vary from asymptomatic patients to severe complications of hypercalcemia or parathyrotoxicosis while skeletal involvement is rather common. Herein we aimed at presenting a unique case of a young patient with rare aggressive skeletal complications of parathyroid cancer that initially were misdiagnosed. Ossification of the cervical ligamentum flavum and skull tumor illustrates erosive bonny lesions of hyperparathyroidism that in association with previous medical history of recurrent nephrolithiasis and biochemical findings guide the diagnosis. We suggest that increased awareness and holistic approach are needed in order to recognize and further investigate signs and symptoms of hyperparathyroidism.

The focal plane adaptive optics test box of the Observatoire du Mont-Mégantic

NASA Astrophysics Data System (ADS)

Deschênes, William; Brousseau, Denis; Lavigne, Jean-Francois; Thibault, Simon; Véran, Jean-Pierre

2014-08-01

With the upcoming construction of Extremely Large Telescopes, several existing technologies are being pushed beyond their performance limit and it becomes essential to develop and evaluate new alternatives. The "Observatoire du Mont Mégantic" (OMM) hosts a telescope having a 1.6-meter diameter primary. The OMM telescope is known to be an excellent location to develop and test precursor instruments which are then upscaled to larger telescopes (ex. SPIOMM which led to SITELLE at the CFHT). We present a specifically designed focal plane box for the OMM which will allow to evaluate, directly on-sky, the performance of a number of next generation adaptive optics related technologies The system will able us to compare the performance of several new wavefront sensors in contrast with the current standard, the Shack-Hartman wavefront sensor.

Global patterns of drought recovery

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

Schwalm, Christopher R.; Anderegg, William R. L.; Michalak, Anna M.

Drought is a recurring multi-factor phenomenon with major impacts on natural and human systems1-3. Drought is especially important for land carbon sink variability, influencing climate regulation of the terrestrial biosphere4. While 20th Century trends in drought regime are ambiguous, “more extreme extremes” as well as more frequent and severe droughts3,7 are expected in the 21st Century. Recovery time, the length of time an ecosystem requires to revert to its pre-drought functional state, is a critical metric of drought impact. Yet the spatiotemporal patterning and controls of drought recovery are largely unknown. Here we use three distinct global datasets of grossmore » primary productivity to show that across diverse terrestrial ecosystems drought recovery times are driven by biological productivity and biodiversity, with drought length and severity of secondary importance. Recovery time, especially for extreme droughts, and the areal extent of ecosystems in recovery from drought generally increase over the 20th Century, supporting an increase globally in drought impact8. Our results indicate that if future Anthropocene droughts become more widespread as expected, that droughts will become more frequent relative to recovery time. This increases the risk of entering a new regime where vegetation never recovers to its original state and widespread degradation of the land carbon sink ensues.« less

Myxedema coma of both primary and secondary origin, with non-classic presentation and extremely elevated creatine kinase.

PubMed

Benvenga, S; Squadrito, S; Saporito, F; Cimino, A; Arrigo, F; Trimarchi, F

2000-09-01

Myxedema coma is a rare, often fatal endocrine emergency that concerns elderly patients with long-standing primary hypothyroidism; myxedema coma of central origin is exceedingly rare. Here, we report a 37-year-old woman in whom classical symptoms of hypothyroidism had been absent. Six years earlier, she had severe obstetric hemorrhage and, shortly after, two subsequent episodes of pericardial effusion. On the day of admission, pericardiocentesis was performed for the third episode of pericardial effusion. Because of the subsequent grave arrhythmias and unconsciousness, she was transferred to our ICU. Prior to the endocrine consultation, a silent myocardial infarction had been suspected, based on the extremely high serum levels of creatine kinase (CK) and isoenzyme CK-MB. However, based on thyroid sonography, pituitary computed tomography, elevated titers of antithyroid antibodies and pituitary stimulation tests, the final diagnosis was myxedema coma of dual origin: an atrophic variant of Hashimoto's thyroiditis and post-necrotic pituitary atrophy (Sheehan syndrome). Substitutive therapy caused a prompt clinical amelioration and normalization of CK levels. Our patient is the first case of myxedema coma of double etiology, and illustrates how its presentation deviates markedly from the one endocrinologists and physicians at ICU are prepared to encounter. In addition, cardiac problems as those of our patient should not discourage from substitutive treatment (using L-thyroxine and the gastrointestinal route of absorption), if the age is relatively low.

Early spring, severe frost events, and drought induce rapid carbon loss in high elevation meadows.

PubMed

Arnold, Chelsea; Ghezzehei, Teamrat A; Berhe, Asmeret Asefaw

2014-01-01

By the end of the 20th century, the onset of spring in the Sierra Nevada mountain range of California has been occurring on average three weeks earlier than historic records. Superimposed on this trend is an increase in the presence of highly anomalous "extreme" years, where spring arrives either significantly late or early. The timing of the onset of continuous snowpack coupled to the date at which the snowmelt season is initiated play an important role in the development and sustainability of mountain ecosystems. In this study, we assess the impact of extreme winter precipitation variation on aboveground net primary productivity and soil respiration over three years (2011 to 2013). We found that the duration of snow cover, particularly the timing of the onset of a continuous snowpack and presence of early spring frost events contributed to a dramatic change in ecosystem processes. We found an average 100% increase in soil respiration in 2012 and 2103, compared to 2011, and an average 39% decline in aboveground net primary productivity observed over the same time period. The overall growing season length increased by 57 days in 2012 and 61 days in 2013. These results demonstrate the dependency of these keystone ecosystems on a stable climate and indicate that even small changes in climate can potentially alter their resiliency.

More tornadoes in the most extreme U.S. tornado outbreaks

NASA Astrophysics Data System (ADS)

Tippett, Michael K.; Lepore, Chiara; Cohen, Joel E.

2016-12-01

Tornadoes and severe thunderstorms kill people and damage property every year. Estimated U.S. insured losses due to severe thunderstorms in the first half of 2016 were $8.5 billion (US). The largest U.S. effects of tornadoes result from tornado outbreaks, which are sequences of tornadoes that occur in close succession. Here, using extreme value analysis, we find that the frequency of U.S. outbreaks with many tornadoes is increasing and that it is increasing faster for more extreme outbreaks. We model this behavior by extreme value distributions with parameters that are linear functions of time or of some indicators of multidecadal climatic variability. Extreme meteorological environments associated with severe thunderstorms show consistent upward trends, but the trends do not resemble those currently expected to result from global warming.

Cranio-orbital primary intraosseous haemangioma.

PubMed

Gupta, T; Rose, G E; Manisali, M; Minhas, P; Uddin, J M; Verity, D H

2013-11-01

Primary intraosseous haemangioma (IOH) is a rare benign neoplasm presenting in the fourth and fifth decades of life. The spine and skull are the most commonly involved, orbital involvement is extremely rare. We describe six patients with cranio-orbital IOH, the largest case series to date. Retrospective review of six patients with histologically confirmed primary IOH involving the orbit. Clinical characteristics, imaging features, approach to management, and histopathological findings are described. Five patients were male with a median age of 56. Pain and diplopia were the most common presenting features. A characteristic 'honeycomb' pattern on CT imaging was demonstrated in three of the cases. Complete surgical excision was performed in all cases with presurgical embolisation carried out in one case. In all the cases, histological studies identified cavernous vascular spaces within the bony tissue. These channels were lined by single layer of cytologically normal endothelial cells. IOCH of the cranio-orbital region is rare; in the absence of typical imaging features, the differential diagnosis includes chondroma, chondrosarcoma, bony metastasis, and lymphoma. Surgical excision may be necessary to exclude more sinister pathology. Intraoperative haemorrhage can be severe and may be reduced by preoperative embolisation.

SALGOT - Stroke Arm Longitudinal study at the University of Gothenburg, prospective cohort study protocol

PubMed Central

2011-01-01

Background Recovery patterns of upper extremity motor function have been described in several longitudinal studies, but most of these studies have had selected samples, short follow up times or insufficient outcomes on motor function. The general understanding is that improvements in upper extremity occur mainly during the first month after the stroke incident and little if any, significant recovery can be gained after 3-6 months. The purpose of this study is to describe the recovery of upper extremity function longitudinally in a non-selected sample initially admitted to a stroke unit with first ever stroke, living in Gothenburg urban area. Methods/Design A sample of 120 participants with a first-ever stroke and impaired upper extremity function will be consecutively included from an acute stroke unit and followed longitudinally for one year. Assessments are performed at eight occasions: at day 3 and 10, week 3, 4 and 6, month 3, 6 and 12 after onset of stroke. The primary clinical outcome measures are Action Research Arm Test and Fugl-Meyer Assessment for Upper Extremity. As additional measures, two new computer based objective methods with kinematic analysis of arm movements are used. The ABILHAND questionnaire of manual ability, Stroke Impact Scale, grip strength, spasticity, pain, passive range of motion and cognitive function will be assessed as well. At one year follow up, two patient reported outcomes, Impact on Participation and Autonomy and EuroQol Quality of Life Scale, will be added to cover the status of participation and aspects of health related quality of life. Discussion This study comprises a non-selected population with first ever stroke and impaired arm function. Measurements are performed both using traditional clinical assessments as well as computer based measurement systems providing objective kinematic data. The ICF classification of functioning, disability and health is used as framework for the selection of assessment measures. The study design with several repeated measurements on motor function will give us more confident information about the recovery patterns after stroke. This knowledge is essential both for optimizing rehabilitation planning as well as providing important information to the patient about the recovery perspectives. Trial registration ClinicalTrials.gov: NCT01115348 PMID:21612620

Telemedicine at the top of the world: the 1998 and 1999 Everest extreme expeditions.

PubMed

Angood, P B; Satava, R; Doarn, C; Merrell, R

2000-01-01

The National Aeronautics and Space Administration (NASA) initially established a Commercial Space Center (CSC) in the Department of Surgery at Yale University School of Medicine to further develop and evaluate technologies in information systems, telecommunications applied to medicine, and physiologic sensors. The CSC is known as the Medical Informatics and Technology Applications Consortium (MITAC). The overall purpose for this NASA program is to leverage technology, innovation, and resources from industry and academia through collaborative partnerships. The Yale-NASA CSC/MITAC organized the Everest Extreme Expeditions (E3) for the spring Himalayan climbing seasons in the years 1998 and 1999. The primary mission was to deliver advanced medical support with global telemedicine capabilities to one of the world's most remote and hostile settings--Mount Everest. The purpose was both humanitarian (providing medical support) and scientific (conducting medical and technology research). The Yale team provided medical care for the Everest Base Camp community; conducted validation experiments for several types of advanced medical technologies in this remote, hostile environment; and performed real-time monitoring of selected climbers, while also assessing the basic science of altitude physiology. Additionally, the teams conducted outreach medical care to the citizens of Nepal and provided several educational forums for a variety of medical and nonmedical personnel--including school-age children. As part of the project's mission, the E3 medical teams at both Nepal and New Haven were on a 24-hour emergency call system to deliver medical care in the event of a crisis. Unlike most of the teams at Everest, the mission of E3 was not to climb the 29,028-foot mountain the Nepalese call Sagarmatha ("Sky Head"). The mountain served as an extreme testing ground for telemedicine. The lessons learned from this testbed are reviewed here and further clarify the abilities to provide better health care in remote and extreme environments--which for some may even be their home environment during/after a medical illness.

Acute symptomatic hypocalcemia from immune checkpoint therapy-induced hypoparathyroidism.

PubMed

Win, Myint Aung; Thein, Kyaw Zin; Qdaisat, Aiham; Yeung, Sai-Ching Jim

2017-07-01

Ipilimumab (a monoclonal antibody against CTLA-4) and nivolumab (a humanized antibody against PD-1) target these immune checkpoint pathways and are used for treatment of melanoma and an increasing number of other cancers. However, they may cause immune-related adverse effects (IRAEs). Although many endocrinopathies are known to be IRAEs, primary hypoparathyroidism with severe hypocalcemia has never been reported. This is the first case of hypoparathyroidism as an IRAE presenting to an Emergency Department with acute hypocalcemia. A 73-year-old man with metastatic melanoma presented to the Emergency Department for the chief complaints of imbalance, general muscle weakness, abdominal pain and tingling in extremities. He had wide spread metastasis, and begun immunotherapy with concurrent ipilimumab and nivolumab 1.5months ago. At presentation, he had ataxia, paresthesia in the hands and feet, and abdominal cramping. Magnetic resonance imaging of the brain was unremarkable. He was found to be hypocalcemic with undetectable plasma parathyroid hormone. He was admitted for treatment of symptomatic hypocalcemia and was diagnosed with primary hypoparathyroidism. Shortly afterwards, he had thyrotoxicosis manifesting as tachycardia and anxiety, followed by development of primary hypothyroidism. At 4months after the Emergency Department visit, his parathyroid function and thyroid function had not recovered, and required continued thyroid hormone replacement and calcium and vitamin D treatment for hypocalcemia. Primary hypoparathyroidism caused by ipilimumab and nivolumab may acute manifest with severe symptomatic hypocalcemia. Emergency care providers should be aware of hypoparathyroidism as a new IRAE in this new era of immuno-oncology. Copyright © 2017 Elsevier Inc. All rights reserved.

Theoretical study of mixing in liquid clouds – Part 1: Classical concepts

DOE PAGES

Korolev, Alexei; Khain, Alex; Pinsky, Mark; ...

2016-07-28

The present study considers final stages of in-cloud mixing in the framework of classical concept of homogeneous and extreme inhomogeneous mixing. Simple analytical relationships between basic microphysical parameters were obtained for homogeneous and extreme inhomogeneous mixing based on the adiabatic consideration. It was demonstrated that during homogeneous mixing the functional relationships between the moments of the droplets size distribution hold only during the primary stage of mixing. Subsequent random mixing between already mixed parcels and undiluted cloud parcels breaks these relationships. However, during extreme inhomogeneous mixing the functional relationships between the microphysical parameters hold both for primary and subsequent mixing.more » The obtained relationships can be used to identify the type of mixing from in situ observations. The effectiveness of the developed method was demonstrated using in situ data collected in convective clouds. It was found that for the specific set of in situ measurements the interaction between cloudy and entrained environments was dominated by extreme inhomogeneous mixing.« less

Strategies of arteriovenous dialysis access.

PubMed

Weiswasser, Jonathan M; Kellicut, Dwight; Arora, Subodh; Sidawy, Anton N

2004-03-01

Surgical management of the patient who requires hemodialysis access, while continuing to demand more attention from the vascular surgeon, suffers from discrepancies of approach and strategy. With the increase in incidence of dialysis dependent renal failure among our population, many have attempted to present a uniform, logical strategy with which the vascular surgeon can most effectively treat the hemodialysis patient in the long term. Most notably, the multidisciplinary Dialysis Outcomes Quality Initiative (DOQI) guidelines present the surgeon with a rough outline of hemodialysis access insertion strategy, and it has become nationally recognized as an acceptable summary of treatment strategy and goals. The decision as to the most appropriate surgical access to offer a patient depends on immediate need for hemodialysis, history and physical examination findings, and suitability of available veins in the extremity. While percutaneous, catheter based access affords the luxury of immediate access, these devices suffer from several complicating factors, such as infection, and damage to large, proximal veins. For long-term access, the autogenous access, while perhaps less successful in the immediate short term, is always the preferred access type given its favorable longevity. The surgeons should focus on sites distally on the extremity, reserving proximal sites for potential future access insertions should the primary access fail. In the absence of suitable vein, prosthetic access may be considered. When both the upper and lower aspects of both upper extremities have been exhausted, the surgeon should consider access insertion elsewhere, such as the lower extremity.

Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery.

PubMed

Popma, Jeffrey J; Adams, David H; Reardon, Michael J; Yakubov, Steven J; Kleiman, Neal S; Heimansohn, David; Hermiller, James; Hughes, G Chad; Harrison, J Kevin; Coselli, Joseph; Diez, Jose; Kafi, Ali; Schreiber, Theodore; Gleason, Thomas G; Conte, John; Buchbinder, Maurice; Deeb, G Michael; Carabello, Blasé; Serruys, Patrick W; Chenoweth, Sharla; Oh, Jae K

2014-05-20

This study sought to evaluate the safety and efficacy of the CoreValve transcatheter heart valve (THV) for the treatment of severe aortic stenosis in patients at extreme risk for surgery. Untreated severe aortic stenosis is a progressive disease with a poor prognosis. Transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis is a potentially effective therapy. We performed a prospective, multicenter, nonrandomized investigation evaluating the safety and efficacy of self-expanding TAVR in patients with symptomatic severe aortic stenosis with prohibitive risks for surgery. The primary endpoint was a composite of all-cause mortality or major stroke at 12 months, which was compared with a pre-specified objective performance goal (OPG). A total of 41 sites in the United States recruited 506 patients, of whom 489 underwent attempted treatment with the CoreValve THV. The rate of all-cause mortality or major stroke at 12 months was 26.0% (upper 2-sided 95% confidence bound: 29.9%) versus 43.0% with the OPG (p < 0.0001). Individual 30-day and 12-month events included all-cause mortality (8.4% and 24.3%, respectively) and major stroke (2.3% and 4.3%, respectively). Procedural events at 30 days included life-threatening/disabling bleeding (12.7%), major vascular complications (8.2%), and need for permanent pacemaker placement (21.6%). The frequency of moderate or severe paravalvular aortic regurgitation was lower 12 months after self-expanding TAVR (4.2%) than at discharge (10.7%; p = 0.004 for paired analysis). TAVR with a self-expanding bioprosthesis was safe and effective in patients with symptomatic severe aortic stenosis at prohibitive risk for surgical valve replacement. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

More tornadoes in the most extreme U.S. tornado outbreaks.

PubMed

Tippett, Michael K; Lepore, Chiara; Cohen, Joel E

2016-12-16

Tornadoes and severe thunderstorms kill people and damage property every year. Estimated U.S. insured losses due to severe thunderstorms in the first half of 2016 were $8.5 billion (US). The largest U.S. effects of tornadoes result from tornado outbreaks, which are sequences of tornadoes that occur in close succession. Here, using extreme value analysis, we find that the frequency of U.S. outbreaks with many tornadoes is increasing and that it is increasing faster for more extreme outbreaks. We model this behavior by extreme value distributions with parameters that are linear functions of time or of some indicators of multidecadal climatic variability. Extreme meteorological environments associated with severe thunderstorms show consistent upward trends, but the trends do not resemble those currently expected to result from global warming. Copyright © 2016, American Association for the Advancement of Science.

Severe capillary leak syndrome after inner ear decompression sickness in a recreational scuba diver.

PubMed

Gempp, Emmanuel; Lacroix, Guillaume; Cournac, Jean-Marie; Louge, Pierre

2013-07-01

Post-decompression shock with plasma volume deficit is a very rare event that has been observed under extreme conditions of hypobaric and hyperbaric exposure in aviators and professional divers. We report a case of severe hypovolemic shock due to extravasation of plasma in a recreational scuba diver presenting with inner ear decompression sickness. Impaired endothelial function can lead to capillary leak with hemoconcentration and hypotension in severe cases. This report suggests that decompression-induced circulating bubbles may have triggered the endothelial damage, activating the classic inflammatory pathway of increased vascular permeability. This observation highlights the need for an accurate diagnosis of this potentially life-threatening condition at the initial presentation in the Emergency Department after a diving-related injury. An elevated hematocrit in a diver should raise the suspicion for the potential development of capillary leak syndrome requiring specific treatment using albumin infusion as primary fluid replacement. Copyright © 2013 Elsevier Inc. All rights reserved.

A Multinational Cluster Randomised Controlled Trial to Assess the Efficacy of '11+ Kids': A Warm-Up Programme to Prevent Injuries in Children's Football.

PubMed

Rössler, Roland; Junge, Astrid; Bizzini, Mario; Verhagen, Evert; Chomiak, Jiri; Aus der Fünten, Karen; Meyer, Tim; Dvorak, Jiri; Lichtenstein, Eric; Beaudouin, Florian; Faude, Oliver

2018-06-01

The objective of this study was to assess the efficacy of a newly developed warm-up programme ('11+ Kids') regarding its potential to reduce injuries in children's football. Children's football teams (under 9 years, under 11 years, and under 13 years age groups) from Switzerland, Germany, the Czech Republic and the Netherlands were invited. Clubs were randomised to an intervention group and a control group, and followed for one season. The intervention group replaced their usual warm-up by '11+ Kids', while the control group warmed up as usual. The primary outcome was the overall risk of football-related injuries. Secondary outcomes were the risks of severe and lower extremity injuries. We calculated hazard ratios using extended Cox models, and performed a compliance analysis. In total, 292,749 h of football exposure of 3895 players were recorded. The mean age of players was 10.8 (standard deviation 1.4) years. During the study period, 374 (intervention group = 139; control group = 235) injuries occurred. The overall injury rate in the intervention group was reduced by 48% compared with the control group (hazard ratio 0.52; 95% confidence interval 0.32-0.86). Severe (74% reduction, hazard ratio 0.26; 95% confidence interval 0.10-0.64) and lower extremity injuries (55% reduction, hazard ratio 0.45; 95% confidence interval 0.24-0.84) were also reduced. Injury incidence decreased with increasing compliance. '11+ Kids' is efficacious in reducing injuries in children's football. We observed considerable effects for overall, severe and lower extremity injuries. The programme should be performed at least once per week to profit from an injury preventive effect. However, two sessions per week can be recommended to further increase the protective benefit. ClinicalTrials.gov identifier: NCT02222025.

Accuracy of a disability instrument to identify workers likely to develop upper extremity musculoskeletal disorders.

PubMed

Stover, Bert; Silverstein, Barbara; Wickizer, Thomas; Martin, Diane P; Kaufman, Joel

2007-06-01

Work related upper extremity musculoskeletal disorders (MSD) result in substantial disability, and expense. Identifying workers or jobs with high risk can trigger intervention before workers are injured or the condition worsens. We investigated a disability instrument, the QuickDASH, as a workplace screening tool to identify workers at high risk of developing upper extremity MSDs. Subjects included workers reporting recurring upper extremity MSD symptoms in the past 7 days (n = 559). The QuickDASH was reasonably accurate at baseline with sensitivity of 73% for MSD diagnosis, and 96% for symptom severity. Specificity was 56% for diagnosis, and 53% for symptom severity. At 1-year follow-up sensitivity and specificity for MSD diagnosis was 72% and 54%, respectively, as predicted by the baseline QuickDASH score. For symptom severity, sensitivity and specificity were 86% and 52%. An a priori target sensitivity of 70% and specificity of 50% was met by symptom severity, work pace and quality, and MSD diagnosis. The QuickDASH may be useful for identifying jobs or workers with increased risk for upper extremity MSDs. It may provide an efficient health surveillance screening tool useful for targeting early workplace intervention for prevention of upper extremity MSD problems.

76 FR 75845 - Approval and Promulgation of Implementation Plans; State of Tennessee: Prevention of Significant...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-05

... major stationary thresholds (marginal, moderate, serious, severe, and extreme NAA classifications) and... offset ratios for marginal, moderate, serious, severe, and extreme ozone NAA. EPA finalized regulations...

Development of Grave's disease seven months after Hashimoto's thyroiditis: a rare occurrence.

PubMed

Bravo-Llerena, Wilfredo Eddy; Valderrabano-Wagner, Rodrigo J; Quevedo-Quevedo, Juan; Reyes-Ortiz, Luis M

2010-01-01

Hashimoto's thyroiditis (HT) and Graves' disease (GD) are two opposite poles in the spectrum of autoimmune thyroid disease. On one extreme, HT or Chronic Lymphocytic thyroiditis (CLT) courses, as its name implies, with lymphocytic infiltrates replacing thyroid follicles, resulting in a loss of hormone-producing cells and, thus, primary hypothyroidism. On the other extreme, GD is characterized by primary hyperthyroidism due to stimulating autoantibodies against thyroid-stimulating hormone receptors (TSHRs) localized on thyrocytes' membranes of intact thyroid follicles. The presence of HT after GD or the concomitant combination of these two autoimmune entities ending in HT-depending hypothyroid state is well known. However, occurrence of GD after primary hypothyroidism due to CLT is very rare since thyrocytes with their TSHRs are promptly lost. We report a case in which hyperthyroidism occurred seven months after presentation of primary hypothyroidism and discuss potential mechanisms involved.

[Organization and contents of the specialized surgical care in multiprofile military hospitals of the 1st level during counter-terrorist operations on the northern Caucasus (report V)].

PubMed

Gumanenko, E K; Samokhvalov, I M; Trusov, A A; Badalov, V I

2006-03-01

The principle difference of the work of multiprofile military hospitals (MMH) of the Ist level during the armed conflicts on the Northern Caucasus, particularly during the second, was rendering specialized surgical care to the primary contingent of the wounded, evacuated during the nearest hours after a wound. The incoming flow to MMH of the 1st level - in connection with the primary entering of the wounded practically from a battle field - was characterized by severity (one third of the wounded had severe and extremely severe wounds) and the significant number of the wounded with multiple and combined injuries (up to 60% of the wounded). Effective treatment of the above-mentioned wounded can only be carried by specially trained surgeons in appropriately-equipped multiprofile medical hospitals. The rendered volume of specialized surgical care in MMH of the 1st level included the following operations: neurosurgical (2,4%), thoracoabdominal (19,8%), traumatologic (17,0%), angiosurgical (8,2%), special (otorhinolaryngologic, maxillofacial, ophthalmologic, urologic) - 17,7%, general surgery (35,4%). During the armed conflict of 1999-2002 due to the introduction of the early specialized surgical care concept three MMH of the 1st level in the advanced way executed 86,4 % of all complex operations in medical units and hospitals of the combat zone.

Pain as a Comorbidity of Pediatric Obesity

PubMed Central

Hainsworth, Keri R.; Miller, Lawrence A.; Stolzman, Stacy C.; Fidlin, Brian M.; Davies, W. Hobart; Weisman, Steven J.; Skelton, Joseph A.

2014-01-01

The purpose of this study was to document the prevalence and characteristics of physical pain in a sample of severely obese children and adolescents. In this retrospective chart review, primary measures included current and past pain, pain intensity, and pain characteristics during a 5-minute walk test. Pain assessments for 74 patients (mean age 11.7 years; 53% female; 41% African American) were conducted by a physical therapist. Past pain was reported by 73% of the sample, with 47% reporting pain on the day of program enrollment. Although average pain intensity was moderate (M = 5.5/10), alarmingly, 42% of those with current pain reported severe pain (6/10 to 10/10). Overall, pain occurred primarily in the lower extremities and with physical activity. Patients reporting current pain had a significantly higher body mass index than those reporting no pain. These findings suggest that pain is common in severely obese youth, and furthermore, that pain should be recognized as a comorbidity of pediatric obesity. Routinely screening severely obese children and adolescents for pain presence and intensity is recommended. PMID:24723992

Effectiveness of community psychosocial and pharmacological treatments for alcohol use disorder: A national observational cohort study in England.

PubMed

Peacock, Amy; Eastwood, Brian; Jones, Andrew; Millar, Tim; Horgan, Patrick; Knight, Jonathan; Randhawa, Kulvir; White, Martin; Marsden, John

2018-05-01

This was a national English observational cohort study using administrative data to estimate the effectiveness of community pharmacological and psychosocial treatment for alcohol use disorder (AUD). All adults commencing AUD treatment in the community reported to the National Drug Treatment Monitoring System (April 1 2014-March 31 2015; N = 52,499). Past 28-day admission drinking pattern included drinks per drinking day (DDD): 0 ('Abstinent'), 1-15 ('Low-High'), 16-30 ('High-Extreme') and over 30 DDD ('Extreme'). The primary outcome was successful completion of treatment within 12 months of commencement with no re-presentation (SCNR) in the subsequent six months, analysed by multi-level, mixed effects, multivariable logistic regression. The majority reported DDD in the 'Low-High' (n = 17,698, 34%) and 'High-Extreme' (n = 21,383, 41%) range. Smaller proportions were categorised 'Extreme' (n = 7759, 15%) and 'Abstinent' (n = 5661, 11%). Three-fifths (58%) achieved SCNR. Predictors of SCNR were older age, black/minority ethnic group, employment, criminal justice system referral, and longer treatment exposure. Predictors of negative outcome were AUD treatment history, lower socio-economic status, housing problems, and 'Extreme' drinking at admission. In addition to psychosocial interventions, pharmacological interventions and recovery support increased the likelihood of SCNR. Pharmacological treatment was only beneficial for the 'Low-High' groups with recovery support. Over half of all patients admitted for community AUD treatment in England are reported to successfully complete treatment within 12 months and are not re-admitted for further treatment in the following 6 months. Study findings underscore efforts to tailor AUD treatment to the severity of alcohol consumption and using recovery support. Copyright © 2018 Elsevier B.V. All rights reserved.

Delayed and reduced carbon uptake in a subarctic peatland following an extreme winter event

NASA Astrophysics Data System (ADS)

Parmentier, F. J. W.; Rasse, D. P.; Lund, M.; Bjerke, J. W.; Drake, B. G.; Weldon, S.; Tømmervik, H. A.; Hansen, G.

2017-12-01

An increase in the frequency of extreme winter events in the Arctic may lead to more widespread damage to shrub-dominated ecosystems, including peatlands. In principle, such damage should reduce carbon uptake in the following summer, but the resilience of northern ecosystems to extreme winter events remains unclear due to a dearth of flux measurements from affected areas. In this talk, therefore, we report CO2 fluxes measured with eddy covariance from a peatland in northern Norway and show that vegetation productivity was delayed and reduced during the summer of 2014, following an extreme winter event. Strong frost and the absence of a protective snow cover in January of that year - its combined intensity unprecedented in the local climate record - led to severe dieback of the shrub species Calluna vulgaris and Empetrum nigrum. Similar vegetation damage was reported at the time along 1000 km of coastal Norway, indicating the widespread impact of this frost drought event. Consequently, gross primary production (GPP) showed a strong delayed response to temperature, from snowmelt up to the peak of summer, potentially reducing carbon uptake by 15 (0-24) g C m-2 ( 13% of GPP in that period). The delayed response of the vegetation was also exhibited in remotely-sensed NDVI values, with a maximum two weeks later than normal and at the lowest level in more than a decade. Photosynthesis was eventually stimulated by the warm and sunny summer, but ecosystem respiration increased as well - which limited net carbon uptake. This study shows that damage from a single extreme winter event can have a profound impact on ecosystem CO2 uptake, and it highlights the importance of including winter-induced shrub damage in terrestrial ecosystem models to accurately predict vegetation and carbon sequestration trends in the arctic and boreal region.

Neuromuscular exercises prevent severe knee injury in adolescent team handball players.

PubMed

Achenbach, Leonard; Krutsch, Volker; Weber, Johannes; Nerlich, Michael; Luig, Patrick; Loose, Oliver; Angele, Peter; Krutsch, Werner

2017-10-20

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players. Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury. Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01-0.90), p = 0.019. Other injuries to the lower extremities showed no significant difference between the two groups. Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

Primary signet ring cell adenocarcinoma of the uterine cervix - A rare neoplasm that raises the question of metastasis to the cervix.

PubMed

Cracchiolo, Bernadette; Kuhn, Theresa; Heller, Debra

2016-04-01

Primary signet ring cell adenocarcinoma is extremely rare. Signet ring cell carcinoma is more commonly primary in the stomach or breast, and the more likely metastatic disease to the cervix needs to be ruled out. We present a case of primary signet ring cell carcinoma of the cervix and review the literature.

ARkStorm@Tahoe: Stakeholder perspectives on vulnerabilities and preparedness for an extreme storm event in the greater Lake Tahoe, Reno, and Carson City region

USGS Publications Warehouse

Albano, Christine M.; Cox, Dale A.; Dettinger, Michael; Shaller, Kevin; Welborn, Toby L.; McCarthy, Maureen

2014-01-01

Atmospheric rivers (ARs) are strongly linked to extreme winter precipitation events in the Western U.S., accounting for 80 percent of extreme floods in the Sierra Nevada and surrounding lowlands. In 2010, the U.S. Geological Survey developed the ARkStorm extreme storm scenario for California to quantify risks from extreme winter storms and to allow stakeholders to better explore and mitigate potential impacts. To explore impacts on natural resources and communities in montane and adjacent environments, we downscaled the scenario to the greater Lake Tahoe, Reno and Carson City region of northern Nevada and California. This ArkStorm@Tahoe scenario was presented at six stakeholder meetings, each with a different geographic and subject matter focus. Discussions were facilitated by the ARkStorm@Tahoe team to identify social and ecological vulnerabilities to extreme winter storms, science and information needs, and proactive measures that might minimize impacts from this type of event. Information collected in these meetings was used to develop a tabletop emergency response exercise and set of recommendations for increasing resilience to extreme winter storm events in both Tahoe and the downstream communities of Northern Nevada.Over 300 individuals participated in ARkStorm@Tahoe stakeholder meetings and the emergency response exercise, including representatives from emergency response, natural resource and ecosystem management, health and human services, public utilities, and businesses. Interruption of transportation, communications, and lack of power and backup fuel supplies were identified as the most likely and primary points of failure across multiple sectors and geographies, as these interruptions have cascading effects on natural and human systems by impeding emergency response efforts. Other key issues that arose in discussions included contamination risks to water supplies and aquatic ecosystems, especially in the Tahoe Basin and Pyramid Lake, interagency coordination, credentialing, flood management, and coordination of health and human services during such an event. Mitigation options were identified for each of the key issues. Several science needs were identified, particularly the need for improved flood inundation maps. Finally, key lessons learned were identified and may help to increase preparedness, response and recovery from extreme storms in the future.

Dryland ecosystem responses to precipitation extremes and wildfire at a long-term rainfall manipulation experiment

NASA Astrophysics Data System (ADS)

Brown, R. F.; Collins, S. L.

2017-12-01

Climate is becoming increasingly more variable due to global environmental change, which is evidenced by fewer, but more extreme precipitation events, changes in precipitation seasonality, and longer, higher severity droughts. These changes, combined with a rising incidence of wildfire, have the potential to strongly impact net primary production (NPP) and key biogeochemical cycles, particularly in dryland ecosystems where NPP is sequentially limited by water and nutrient availability. Here we utilize a ten-year dataset from an ongoing long-term field experiment established in 2007 in which we experimentally altered monsoon rainfall variability to examine how our manipulations, along with naturally occurring events, affect NPP and associated biogeochemical cycles in a semi-arid grassland in central New Mexico, USA. Using long-term regional averages, we identified extremely wet monsoon years (242.8 mm, 2013), and extremely dry monsoon years (86.0 mm, 2011; 80.0 mm, 2015) and water years (117.0 mm, 2011). We examined how changes in precipitation variability and extreme events affected ecosystem processes and function particularly in the context of ecosystem recovery following a 2009 wildfire. Response variables included above- and below-ground plant biomass (ANPP & BNPP) and abundance, soil nitrogen availability, and soil CO2 efflux. Mean ANPP ranged from 3.6 g m-2 in 2011 to 254.5 g m-2 in 2013, while BNPP ranged from 23.5 g m-2 in 2015 to 194.2 g m-2 in 2013, demonstrating NPP in our semi-arid grassland is directly linked to extremes in both seasonal and annual precipitation. We also show increased nitrogen deposition positively affects NPP in unburned grassland, but has no significant impact on NPP post-fire except during extremely wet monsoon years. While soil respiration rates reflect lower ANPP post-fire, patterns in CO2 efflux have not been shown to change significantly in that efflux is greatest following large precipitation events preceded by longer drying periods. Current land surface models poorly represent dryland ecosystems, which frequently undergo extreme weather events. Our long-term experiment provides key insights into ecosystem processes and function, thereby providing capacity for model improvement particularly in the context of future environmental change.

Amniotic Constriction Bands: Secondary Deformities and Their Treatments.

PubMed

Drury, Benjamin T; Rayan, Ghazi M

2018-01-01

The purpose of this study was to report the surgical treatment experience of patients with amniotic constriction bands (ACB) over a 35-year interval and detail consequential limb deformities with emphasis on hands and upper extremities, along with the nature and frequency of their surgical treatment methods. Fifty-one patients were identified; 26 were males and 25 females. The total number of deformities was listed. The total number of operations, individual procedures, and operations plus procedures that were done for each patient and their frequency were recorded. The total number of operations was 117, and total number of procedures was 341. More procedures were performed on the upper extremity (85%) than the lower extremity (15%). Including the primary deformity ACB, 16 different hand deformities secondary to ACB were encountered. Sixteen different surgical methods for the upper extremity were utilized; a primary procedure for ACB and secondary reconstructions for all secondary deformities. Average age at the time of the first procedure was 9.3 months. The most common procedures performed, in order of frequency, were excision of ACB plus Z-plasty, release of partial syndactyly, release of fenestrated syndactyly, full-thickness skin grafts, resection of digital bony overgrowth from amputation stumps, and deepening of first and other digital web spaces. Many hand and upper extremity deformities secondary to ACB are encountered. Children with ACB may require more than one operation including multiple procedures. Numerous surgical methods of reconstruction for these children's secondary deformities are necessary in addition to the customary primary procedure of excision of ACB and Z-plasty.

Severe viral respiratory infections in children with IFIH1 loss-of-function mutations

PubMed Central

Schlapbach, Luregn J.; Anchisi, Stéphanie; Hammer, Christian; Bartha, Istvan; Junier, Thomas; Mottet-Osman, Geneviève; Posfay-Barbe, Klara M.; Longchamp, David; Stocker, Martin; Cordey, Samuel; Kaiser, Laurent; Riedel, Thomas; Kenna, Tony; Long, Deborah; Schibler, Andreas; Tapparel, Caroline; Garcin, Dominique

2017-01-01

Viral respiratory infections are usually mild and self-limiting; still they exceptionally result in life-threatening infections in previously healthy children. To investigate a potential genetic cause, we recruited 120 previously healthy children requiring support in intensive care because of a severe illness caused by a respiratory virus. Using exome and transcriptome sequencing, we identified and characterized three rare loss-of-function variants in IFIH1, which encodes an RIG-I-like receptor involved in the sensing of viral RNA. Functional testing of the variants IFIH1 alleles demonstrated that the resulting proteins are unable to induce IFN-β, are intrinsically less stable than wild-type IFIH1, and lack ATPase activity. In vitro assays showed that IFIH1 effectively restricts replication of human respiratory syncytial virus and rhinoviruses. We conclude that IFIH1 deficiency causes a primary immunodeficiency manifested in extreme susceptibility to common respiratory RNA viruses. PMID:28716935

Genetic association studies in β-hemoglobinopathies.

PubMed

Thein, Swee Lay

2013-01-01

Characterization of the molecular basis of the β-thalassemias and sickle cell disease (SCD) clearly showed that individuals with the same β-globin genotypes can have extremely diverse clinical severity. Two key modifiers, an innate ability to produce fetal hemoglobin and coinheritance of α-thalassemia, both derived from family and population studies, affect the pathophysiology of both disorders at the primary level. In the past 2 decades, scientific research had applied genetic approaches to identify additional genetic modifiers. The review summarizes recent genetic studies and key genetic modifiers identified and traces the story of fetal hemoglobin genetics, which has led to an emerging network of globin gene regulation. The discoveries have provided insights on new targets for therapeutic intervention and raise possibilities of developing fetal hemoglobin predictive diagnostics for predicting disease severity in the newborn and for integration into prenatal diagnosis to better inform genetic counseling.

Stoichiometric and kinetic analysis of extreme halophilic Archaea on various substrates in a corrosion resistant bioreactor.

PubMed

Lorantfy, Bettina; Seyer, Bernhard; Herwig, Christoph

2014-01-25

Extreme halophilic Archaea are extremophile species which can thrive in hypersaline environments of up to 3-5 M sodium chloride concentration. Although their ecology and physiology are widely identified on the microbiological level, little emphasis has been laid on quantitative bioprocess development with extreme halophiles. The goal of this study was to establish, on the one hand, a methodological basis for quantitative bioprocess analysis of extreme halophilic Archaea with an extreme halophilic strain as an example. Firstly, as a novel usage, a corrosion resistant bioreactor setup for extreme halophiles has been implemented. Then, paying special attention to total bioprocess quantification approaches, an indirect method for biomass quantification using on-line process signals was introduced. Subsequently, robust quantitative data evaluation methods for halophiles could be developed, providing defined and controlled cultivation conditions in the bioreactor and therefore obtaining suitable quality of on-line as well as off-line datasets. On the other hand, new physiological results of extreme halophiles in bioreactor have also been obtained based on the quantitative methodological tools. For the first time, quantitative data on stoichiometry and kinetics were collected and evaluated on different carbon sources. The results on various substrates were interpreted, with proposed metabolic mechanisms, by linking to the reported primary carbon metabolism of extreme halophilic Archaea. Moreover, results of chemostat cultures demonstrated that extreme halophilic organisms show Monod-kinetics on different sole carbon sources. A diauxic growth pattern was described on a mixture of substrates in batch cultivations. In addition, the methodologies presented here enable one to characterize the utilized strain Haloferax mediterranei (HFX) as a potential new host organism. Thus, this study offers a strong methodological basis as well as a fundamental physiological assessment for bioreactor quantification of extreme halophiles that can serve as primary knowledge for applications of extreme halophiles in biotechnology. Copyright © 2013 Elsevier B.V. All rights reserved.

Secondary stressors and extreme events and disasters: a systematic review of primary research from 2010-2011.

PubMed

Lock, Sarah; Rubin, G James; Murray, Virginia; Rogers, M Brooke; Amlôt, Richard; Williams, Richard

2012-10-29

Introduction Extreme events and disasters, such as earthquakes and floods, cause distress and are associated with some people developing mental disorders. Primary stressors inherent in many disasters can include injuries sustained or watching someone die. The literature recognises the distress which primary stressors cause and their association with mental disorders. Secondary stressors such as a lack of financial assistance, the gruelling process of submitting an insurance claim, parents' worries about their children, and continued lack of infrastructure can manifest their effects shortly after a disaster and persist for extended periods of time. Secondary stressors, and their roles in affecting people's longer-term mental health, should not be overlooked. We draw attention in this review to the nature of secondary stressors that are commonly identified in the literature, assess how they are measured, and develop a typology of these stressors that often affect people after extreme events. Methods We searched for relevant papers from 2010 and 2011 using MEDLINE®, Embase and PsycINFO®. We selected primary research papers that evaluated the associations between secondary stressors and distress or mental disorders following extreme events, and were published in English. We extracted information on which secondary stressors were assessed, and used thematic analysis to group the secondary stressors into a typology. Results Thirty-two relevant articles published in 2010 and 2011 were identified. Many secondary stressors were poorly defined and difficult to differentiate from primary stressors or other life events. We identified 11 categories of secondary stressors, though some extend over more than one category. The categories include: economic stressors such as problems with compensation, recovery of and rebuilding homes; loss of physical possessions and resources; health-related stressors; stress relating to education and schooling; stress arising from media reporting; family and social stressors; stress arising from loss of leisure and recreation; and stress related to changes in people's views of the world or themselves. Limitations in this review include its focus on studies published in 2010 and 2011, which may have led to some secondary stressors being excluded. Assumptions have been made about whether certain items are secondary stressors, if unclear definitions made it difficult to differentiate them from primary stressors. Conclusions This is the first review, to our knowledge, that has developed a typology of secondary stressors that occur following extreme events. We discuss the differing natures of these stressors and the criteria that should be used to differentiate primary and secondary stressors. Some secondary stressors, for example, are entities in themselves, while others are persisting primary stressors that exert their effects through failure of societal responses to disasters to mitigate their immediate impacts. Future research should aim to define secondary stressors and investigate the interactions between stressors. This is essential if we are to identify which secondary stressors are amenable to interventions which might reduce their impacts on the psychosocial resilience and mental health of people who are affected by disasters. Corresponding Author: Dr Sarah Lock, Extreme Events and Health Protection, London, 151 Buckingham Palace Road, London, SW1W 9SZ. E-mail: sarah.lock@hpa.org.uk.

Secondary stressors and extreme events and disasters: a systematic review of primary research from 2010-2011

PubMed Central

Lock, Sarah; Rubin, G. James; Murray, Virginia; Rogers, M. Brooke; Amlôt, Richard; Williams, Richard

2012-01-01

Introduction Extreme events and disasters, such as earthquakes and floods, cause distress and are associated with some people developing mental disorders. Primary stressors inherent in many disasters can include injuries sustained or watching someone die. The literature recognises the distress which primary stressors cause and their association with mental disorders. Secondary stressors such as a lack of financial assistance, the gruelling process of submitting an insurance claim, parents’ worries about their children, and continued lack of infrastructure can manifest their effects shortly after a disaster and persist for extended periods of time. Secondary stressors, and their roles in affecting people’s longer-term mental health, should not be overlooked. We draw attention in this review to the nature of secondary stressors that are commonly identified in the literature, assess how they are measured, and develop a typology of these stressors that often affect people after extreme events. Methods We searched for relevant papers from 2010 and 2011 using MEDLINE®, Embase and PsycINFO®. We selected primary research papers that evaluated the associations between secondary stressors and distress or mental disorders following extreme events, and were published in English. We extracted information on which secondary stressors were assessed, and used thematic analysis to group the secondary stressors into a typology. Results Thirty-two relevant articles published in 2010 and 2011 were identified. Many secondary stressors were poorly defined and difficult to differentiate from primary stressors or other life events. We identified 11 categories of secondary stressors, though some extend over more than one category. The categories include: economic stressors such as problems with compensation, recovery of and rebuilding homes; loss of physical possessions and resources; health-related stressors; stress relating to education and schooling; stress arising from media reporting; family and social stressors; stress arising from loss of leisure and recreation; and stress related to changes in people’s views of the world or themselves. Limitations in this review include its focus on studies published in 2010 and 2011, which may have led to some secondary stressors being excluded. Assumptions have been made about whether certain items are secondary stressors, if unclear definitions made it difficult to differentiate them from primary stressors. Conclusions This is the first review, to our knowledge, that has developed a typology of secondary stressors that occur following extreme events. We discuss the differing natures of these stressors and the criteria that should be used to differentiate primary and secondary stressors. Some secondary stressors, for example, are entities in themselves, while others are persisting primary stressors that exert their effects through failure of societal responses to disasters to mitigate their immediate impacts. Future research should aim to define secondary stressors and investigate the interactions between stressors. This is essential if we are to identify which secondary stressors are amenable to interventions which might reduce their impacts on the psychosocial resilience and mental health of people who are affected by disasters. Corresponding Author: Dr Sarah Lock, Extreme Events and Health Protection, London, 151 Buckingham Palace Road, London, SW1W 9SZ. E-mail: sarah.lock@hpa.org.uk PMID:23145350

Severe upper extremity injuries in frontal automobile crashes: the effects of depowered airbags.

PubMed

Jernigan, M Virginia; Rath, Amber L; Duma, Stefan M

2005-03-01

The purpose of this study was to determine the effects of depowered frontal airbags on the incidence of severe upper extremity injuries. The National Automotive Sampling System database files from 1993 to 2000 were examined in a study that included 2,413,347 occupants who were exposed to an airbag deployment in the United States. Occupants exposed to a depowered airbag deployment were significantly more likely to sustain a severe upper extremity injury (3.9%) than those occupants exposed to a full-powered airbag deployment (2.5%) (P=.01). Full-powered systems resulted in an injury distribution of 89.2% fractures and 7.9% dislocations compared with depowered systems with 55.3% fractures and 44.3% dislocations. Although depowered airbags were designed to reduce the risk of injuries, they appear to have increased the overall incidence of severe upper extremity injuries through a shift from long bone fractures to joint dislocations.

Soft-Tissue Injuries Associated With High-Energy Extremity Trauma: Principles of Management.

PubMed

Norris; Kellam

1997-01-01

The management of high-energy extremity trauma has evolved over the past several decades, and appropriate treatment of associated soft-tissue injuries has proved to be an important factor in achieving a satisfactory outcome. Early evaluation of the severely injured extremity is crucial. Severe closed injuries require serial observation of the soft tissues and early skeletal stabilization. Open injuries require early aggressive debridement of the soft tissues followed by skeletal stabilization. Temporary wound dressings should remain in place until definitive soft-tissue coverage has been obtained. Definitive soft-tissue closure will be expedited by serial debridements performed every 48 to 72 hours in a sterile environment. Skeletal union is facilitated by early bone grafting and/or modification of the stabilizing device. Aggressive rehabilitation, includ-ing early social reintegration, are crucial for a good functional outcome. Adherence to protocols is especially beneficial in the management of salvageable severely injured extremities.

HE 0430-2457: a post-merger extremely low-mass pre-white dwarf in a wide binary posing as an extreme horizontal branch star

NASA Astrophysics Data System (ADS)

Vos, Joris; Zorotovic, Monica; Vučković, Maja; Schreiber, Matthias R.; Østensen, Roy

2018-06-01

We report the discovery of HE 0430-2457, the first extremely low-mass pre-white dwarf (ELM pre-WD) in a long period binary (P = 771 ± 3 d). The spectroscopic parameters of the primary are determined to be Teff = 26 200 ± 1500 K and log g = 5.40 ± 0.35, placing it in the region occupied by core He-burning hot subdwarf B stars. By comparing the spectroscopic parameters of the K-type companion to stellar models, and using the mass ratio, the mass of the hot primary is determined to be 0.23 M⊙. Given that this is too low for core He-burning, the primary in HE 0430-2457 is not an extreme horizontal branch (EHB) star but a pre-WD of the ELM type. As the lifetime of ELM pre-WDs in this region of the Hertzsprung Russel diagram populated by EHBs is thought to be very short, they are not considered to be part of the observed EHBs. However, the discovery of this system indicates that the percentage of ELM pre-WDs in the observed EHB population might be higher than previously thought. Binary evolution models indicate that HE 0430-2457 is likely formed by a merger of the inner binary in a hierarchical triple system.

The Influence of Terrestrial Environment on Meteorite Magnetic Records

NASA Astrophysics Data System (ADS)

Kohout, T.; Kletetschka, G.; Kobr, M.; Pruner, P.; Wasilewski, P. J.

2003-04-01

In early solar system history there are several electromagnetic processes expected that may be capable of magnetizing the primitive solid particles condensating from the Solar Nebula. The record of these magnetic events can be observed during laboratory studies of meteorites found on the Earth. Different terrestrial processes can affect the magneto mineralogy, can cause changes in magnetic parameters, and can overprint the primary magnetic record. The effect of surface heating (when falling through the atmosphere) was the subject of the study with the Murchison meteorite. Using the Allende meteorite we studied the effect of the shock pressure generated by the friction of the atmosphere during the meteorite fall. Some of the meteorites are found several days after the fall, some of them are deposited in the desert or on the Antarctic ice for thousands of years. Most of them contain visible traces of terrestrial oxidation and weathering. We used the sample of the LL chondrite found in the Libya desert (perhaps thousands years ago), sample of the iron meteorite Campo del Cielo (found in Argentina 5000 years after the fall), and sample of the H 5 Zebrak meteorite (found only several days after the fall) for weathering simulations. To document the results of our experiments we used low and high temperature measurements of magnetic susceptibility, measurements of magnetic remanence and its stability and hysteresis parameters. The results tell us, that the terrestrial processes are efficient factor in changing magnetic properties and can overprint the primary magnetic record. Therefore extreme care has to be taken when selecting samples for primary magnetic component study. Acknowledgements: This work is supported by Charles University Grant Agency, Czech Republic and would not be possible without the help of following people: Jakub Haloda, Petr Jakes, Marcela Bukovanska, Jaroslav Kadlec, Libuse Kohoutova, Vladimir Kohout.

Extreme hyperphosphatemia and hypocalcemic coma associated with phosphate enema.

PubMed

Hsu, Heng Jung; Wu, Mai-Szu

2008-01-01

Fleet enema (sodium phosphate, C.B. Fleet Co., Inc., Lynchburg, Virginia) is widely used for bowel preparation or constipation relief in the hospital and over the counter. The potential risks, including hyperphosphatemia and hypocalcemic coma should be kept in mind of primary care physician. The patients with older age, bowel obstruction, small intestinal disorders, poor gut motility, and renal disease are contraindicated or should be administered with caution. We present a patient with old age and chronic renal failure who developed severe hyperphosphatemia and hypocalcemic tetany with coma after sodium phosphate enema. We recommend the use of alternative enema preparations, such as simple tap water or saline solution enemas, which can prevent fatal complications in high risk patients.

Remission of alcohol dependency following deep brain stimulation of the nucleus accumbens: valuable therapeutic implications?

PubMed Central

Kuhn, Jens; Lenartz, Doris; Huff, Wolfgang; Lee, Sun-Hee; Koulousakis, Athanasios; Klosterkoetter, Joachim; Sturm, Volker

2009-01-01

Chronic consumption of alcohol represents one of the greatest health and socioeconomic problems worldwide. We report on a 54-year-old patient with a severe anxiety disorder and secondary depressive disorder in whom bilateral deep brain stimulation (DBS) of the nucleus accumbens was carried out. Despite the absence of desired improvement in his primary disorder, we observed a remarkable although not primarily intended alleviation of the patient’s comorbid alcohol dependency. Our case report demonstrates the extremely effective treatment of alcohol dependency by means of DBS of the nucleus accumbens and may reveal new prospects in overcoming therapy resistance in dependencies in general. PMID:21686755

[Primary cutaneous aspergillosis complicated with invasive aspergillosis in an extremely preterm infant: case report and literature review].

PubMed

Stock, C; Veyrier, M; Magnin-Verschelde, S; Duband, S; Lavocat, M-P; Teyssier, G; Berthelot, P

2010-10-01

Aspergillus is a ubiquitous fungus that can cause primary cutaneous aspergillosis in extremely low-birth-weight (ELBW) neonates, then be invasive and lead to death. ELBW neonates are particularly at risk because of decreased qualitative immune defenses and defects in the skin barrier. Broad-spectrum antimicrobial therapy and corticosteroids, often used in these patients, contribute to increased risk. We present a fatal case of primary cutaneous aspergillosis complicated with invasive aspergillosis, confirmed by autopsy, in an ELBW infant. The source of contamination was probably non-sterile disposable latex gloves used for neonatal care. The early recognition of this source led to its eviction for other hospitalized ELBW infants and no outbreak was observed. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Systematic influences of gamma-ray spectrometry data near the decision threshold for radioactivity measurements in the environment.

PubMed

Zorko, Benjamin; Korun, Matjaž; Mora Canadas, Juan Carlos; Nicoulaud-Gouin, Valerie; Chyly, Pavol; Blixt Buhr, Anna Maria; Lager, Charlotte; Aquilonius, Karin; Krajewski, Pawel

2016-07-01

Several methods for reporting outcomes of gamma-ray spectrometric measurements of environmental samples for dose calculations are presented and discussed. The measurement outcomes can be reported as primary measurement results, primary measurement results modified according to the quantification limit, best estimates obtained by the Bayesian posterior (ISO 11929), best estimates obtained by the probability density distribution resembling shifting, and the procedure recommended by the European Commission (EC). The annual dose is calculated from the arithmetic average using any of these five procedures. It was shown that the primary measurement results modified according to the quantification limit could lead to an underestimation of the annual dose. On the other hand the best estimates lead to an overestimation of the annual dose. The annual doses calculated from the measurement outcomes obtained according to the EC's recommended procedure, which does not cope with the uncertainties, fluctuate between an under- and overestimation, depending on the frequency of the measurement results that are larger than the limit of detection. In the extreme case, when no measurement results above the detection limit occur, the average over primary measurement results modified according to the quantification limit underestimates the average over primary measurement results for about 80%. The average over best estimates calculated according the procedure resembling shifting overestimates the average over primary measurement results for 35%, the average obtained by the Bayesian posterior for 85% and the treatment according to the EC recommendation for 89%. Copyright © 2016 Elsevier Ltd. All rights reserved.

Misdiagnosis of primary pleural DLBCL as tuberculosis: A case report and literature review.

PubMed

Yang, Xinmei; Xu, Xiaofang; Song, Binbin; Zhou, Qiang; Zheng, Ying

2018-06-01

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL). DLBCL presents with pleural involvement at an advanced stage; however, primary pleural lymphomas without any other site of involvement are rare, and the possibility of misdiagnosis is high, particularly in developing countries, where tuberculosis or other severe pulmonary infections remain a major health concern. Furthermore, lymphoma and tuberculosis share a number of common clinical characteristics, such as fever, night sweats, feeling of satiety after a small meal, fatigue and unexplained weight loss, among others. We herein describe a case of misdiagnosis of primary pleural lymphoma as tuberculosis in a 49-year-old male patient who presented with pleural effusion and high adenosine deaminase (ADA) level in the pleural fluid. Anti-tuberculosis treatment was administered for 1 month, but the patient's condition deteriorated. A surgical biopsy was performed and was diagnostic of DLBCL. CHOP chemotherapy was administered with a significant delay due to the misdiagnosis, and it was not efficient, as rituximab was not added to the regimen. The therapeutic efficacy was monitored by computed tomography scans, which revealed that the lesion had shrunk slightly. The overall survival of the patient was ~1 year and he eventually succumbed to severe thoracic infection and pleural effusion. Suspicion should be raised when a patient presents with pleural effusion and extremely high ADA levels, as ADA activity of >250 U/L should raise the suspicion of empyema or lymphoma rather than tuberculosis.

[Meta-analysis of percutaneous transluminal atherectomy in the treatment for in-stent restenosis of lower extremity peripheral artery disease].

PubMed

Li, Weihao; Zhang, Tao; Liu, Yunfeng; Zhang, Yongbao; Li, Qingle; Zhang, Xiaoming; Shen, Chenyang

2015-11-24

To evaluate the clinical safety and efficacy of percutaneous transluminal atherectomy for in-stent restenosis (ISR) in patients with low extremity peripheral arterial diseases (PAD). PubMed, Elsevier, EBSCO, Spring databases and Cochrane Library were searched for relevant articles. Based on the different mechanisms of atherectomy, the patients were divided into mechanic atherectomy group and laser atherectomy group. The safety end points included the rate of distal embolism and severe arterial wall injuries. And the efficacy end points included primary patency rate and freedom from target vessel revascularization (TVR-free) 6 months and 12 months after surgery. A total of 9 studies and 620 patients (published between 2006 and 2014) were accepted. The rate of distal embolism was 4.2% (95% confidence interval (CI): 1.7%-6.7%), while that of severe arterial wall injuries was 1.9% (95%CI: 0.9%-3.0%), respectively. Laser atherectomy was responsible for more distal embolism (6.8%) compared to mechanic atherectomy (2.0%), which was significantly different (Q=21.66, P=0.010). At 6-month follow-up, primary patency rate and rate of TVR-free were 63.0% (95% CI: 55.5%-70.6%) and 80.4% (95% CI: 70.5%-90.3%), while at 12-month follow-up were 43.5% (95%CI: 32.2%-54.9%) and 58.0% (95% CI: 52.1%-63.9%), respectively. The free-TVR rate at 6 months follow-up in mechanical atherectomy group was 77.9%, and was inferior to that in laser atherectomy group (80.8%, Q=13.49, P=0.009). Published bias was discovered at the analysis of 12-month TVR-free rate by means of Begg Test (P=0.039). Meta analysis concerned about the 3 randomized controlled trials demonstrated that there was no significant improvement using atherectomy for ISR comparing to standard balloon at 6-month TVR-free rate (OR=1.34, 95% CI: 0.86-2.07, P=0.196). To treat ISR lesion in lower extremities, laser atherectomy has a lower free-TVR rate in the middle term follow-up.A higher rate of distal embolism is noted though. On balance, percutaneous transluminal atherectomy demonstrates no significant improvement compared to plain balloon angioplasty for ISR lesions.

Intraoperative electron radiation therapy combined with external beam radiation therapy and limb sparing surgery in extremity soft tissue sarcoma: a retrospective single center analysis of 183 cases.

PubMed

Roeder, Falk; Lehner, Burkhard; Saleh-Ebrahimi, Ladan; Hensley, Frank W; Ulrich, Alexis; Alldinger, Ingo; Mechtersheimer, Gunhild; Huber, Peter E; Krempien, Robert; Bischof, Marc; Debus, Juergen; Uhl, Matthias

2016-04-01

To report our experience with limb-sparing surgery, IOERT and EBRT in extremity STS. 183 patients were retrospectively analyzed. 78% presented in primary situation, with 80% located in the lower limb. Stage at presentation was: I: 6%, IIa: 25%, IIb: 21%, III: 42%, IV: 7%. The majority showed high-grade lesions (grade 1: 5%, 2: 31%, 3: 64%). IOERT was applied to the tumor bed (median 15Gy) and preceded (9%) or followed (91%) by EBRT (median 45Gy) in all patients. Median follow-up was 64months (78months in survivors). Surgery was complete in 68%, while 32% had microscopic residual disease. 5- and 10-year-LC was 86% and 84%, respectively. LC was significantly higher in primary compared to recurrent disease and tended to be higher after complete resection. Estimated 5- and 10-year-DC was 68% and 66%, while corresponding OS was 77% and 66%, respectively. OS was significantly affected by grading and stage. Severe postoperative complications and late toxicities were observed in 19% and 20%, respectively. Limb-preservation rate was 95% with good function in 83%. Combination of limb-sparing surgery, IOERT and EBRT achieved encouraging LC and OS in this unfavorable patient group with acceptable postoperative complications and low rates of late toxicities resulting in a high limb-preservation rate and good functional outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Gastric B-cell mucosa associated lymphoid tissue lymphoma: a clinicopathological study in 56 patients.

PubMed Central

Castrillo, J M; Montalban, C; Obeso, G; Piris, M A; Rivas, M C

1992-01-01

Clinico-pathological features of 56 patients with primary gastric lymphoma were evaluated retrospectively. All cases were regraded according to a classification of Isaacson et al into high grade and low grade B-cell mucosa associated lymphoid tissue lymphoma. A third group of mixed grade was recognised in 11 patients with low grade who also had occasional areas of high grade. Low grade and mixed grade patients had a 100% actuarial survival at 156 months, which was significantly better (p < 0.01) than that of 52% for patients with high grade disease. Different treatment methods--surgery, chemotherapy, or a combination of both--did not significantly affect survival. Low grade tumours occurred mainly in men with a history of several years, and who presented with non-specific gastric symptoms without remarkable exploratory or laboratory findings: most patients were in stage IE-IIE and achieved remission and cure. High grade can have a shorter history, systemic symptoms, abnormal exploratory and laboratory findings, gastric tumour masses, stage IV disease, and a worse outcome. The only significant prognostic factors for survival were the type of lymphoma and stage IV disease. These findings support the Isaacson classification system which separates two extreme groups of gastric lymphomas with different morphology, behaviour, and outcome. The presence of limited areas of high grade in a specimen showing low grade does not change the outcome but suggests that primary gastric lymphoma forms a continuum between these extreme types. PMID:1446850

Factors Associated with Increased Pain in Primary Dysmenorrhea: Analysis Using a Multivariate Ordered Logistic Regression Model.

PubMed

Tomás-Rodríguez, María I; Palazón-Bru, Antonio; Martínez-St John, Damian R J; Navarro-Cremades, Felipe; Toledo-Marhuenda, José V; Gil-Guillén, Vicente F

2017-04-01

In the literature about primary dysmenorrhea (PD), either a pain gradient has been studied just in women with PD or pain was assessed as a binary variable (presence or absence). Accordingly, we decided to carry out a study in young women to determine possible factors associated with intense pain. A cross-sectional observational study. A Spanish University in 2016. A total of 306 women, aged 18-30 years. A questionnaire was filled in by the participants to assess associated factors with dysmenorrhoea. Our outcome measure was the Andersch and Milsom scale (grade from 0 to 3). grade 0 (menstruation is not painful and daily activity is unaffected), grade 1 (menstruation is painful but seldom inhibits normal activity, analgesics are seldom required, and mild pain), grade 2 (daily activity affected, analgesics required and give relief so that absence from work or school is unusual, and moderate pain), and grade 3 (activity clearly inhibited, poor effect of analgesics, vegetative symptoms and severe pain). Factors significantly associated with more extreme pain: a higher menstrual flow (odds ratio [OR], 2.11; P < .001), a worse quality of life (OR, 0.97; P < .001) and use of medication for PD (OR, 8.22; P < .001). We determined factors associated with extreme pain in PD in a novel way. Further studies are required to corroborate our results. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Extreme precipitation patterns and reductions of terrestrial ecosystem production across biomes

Treesearch

Yongguang Zhang; M. Susan Moran; Mark A. Nearing; Guillermo E. Ponce Campos; Alfredo R. Huete; Anthony R. Buda; David D. Bosch; Stacey A. Gunter; Stanley G. Kitchen; W. Henry McNab; Jack A. Morgan; Mitchel P. McClaran; Diane S. Montoya; Debra P.C. Peters; Patrick J. Starks

2013-01-01

Precipitation regimes are predicted to shift to more extreme patterns that are characterized by more heavy rainfall events and longer dry intervals, yet their ecological impacts on vegetation production remain uncertain across biomes in natural climatic conditions. This in situ study investigated the effects of these climatic conditions on aboveground net primary...

A Case of Scurvy-Uncommon Disease-Presenting as Panniculitis, Purpura, and Oligoarthritis.

PubMed

Mintsoulis, Danielle; Milman, Nataliya; Fahim, Simone

2016-11-01

Scurvy remains prevalent in certain populations, including addicts, people of low socioeconomic status, and the severely malnourished. It classically presents as follicular hyperkeratosis and perifollicular hemorrhage of the lower extremities, as well as bleeding in other areas such as the gingiva and joints. This case presentation and literature review highlights the common pathophysiological findings associated with scurvy and current methods of diagnosis and treatment. The patient described in this case presented with sudden oligoarthritis and purpura of the lower extremities. Following progression of the patient's symptoms and a low vitamin C serum concentration, the patient was treated with vitamin C supplementation and dramatically improved. This was considered to be the result of an underlying vitamin C deficiency secondary to insufficient fruit and vegetable intake due to allergies. This case highlights the importance of maintaining a high index of suspicion for scurvy in atypical presentations of purpura not better explained by another disease or in additional populations at high risk of vitamin C deficiency. Early diagnosis by either a primary care physician or dermatologist can expedite the treatment process and improve patient prognosis. © The Author(s) 2016.

[Paget-Schroetter síndrome associated with hyperhomocsyteinemia].

PubMed

González, C I; Cires, M; Rubio, T; Jiménez, F; Sarasíbar, E; Gaztelu, M T; González, V

2007-01-01

Venous thromboembolic disease (VTED) in the upper extremities is an infrequent entity, although its incidence has increased in relation to the use of central venous catheters. Its etiology can be primary (idiopathic, spontaneous, due to effort or traumatic) or secondary (related to tumours, central venous catheters, etc.). We present a case of primary venous thrombosis of the upper right extremity, also called the Paget-Schroetter syndrome. This clinical picture is usually associated with intensive and/or repetitive exercise or effort of the affected extremity, anatomical alterations in the zone, or it can be the first manifestation of a previously unknown thrombophilic state, as in the case that concerns us. The clinical picture usually consists of pain in the affected extremity, frequently accompanied by edema and collateral circulation. Echography-Doppler frequently presents false negatives, and it is recommendable to carry out CAT, due to its greater specificity and for evaluating the neighbouring structures, although flebography continues to be the cardinal test for diagnosing this picture. There is no unanimity of opinion concerning treatment, and it is recommendable that this should be individualised in accordance with the characteristics of each case.

[Penetrating injury of the lungs and multiple injuries of lower extremities caused by aircraft bombs splinters].

PubMed

Golubović, Zoran; Stanić, Vojkan; Trenkić, Srbobran; Stojiljković, Predrag; Stevanović, Goran; Lesić, Aleksandar; Golubović, Ivan; Milić, Dragan; Visnjić, Aleksandar; Najman, Stevo

2010-08-01

Injuries caused by aircraft bombs cause severe damages to the human body. They are characterized by massive destruction of injured tissues and organs, primary contamination by polymorph bacterial flora and modified reactivity of the body. Upon being wounded by aircraft bombs projectiles a victim simultaneously sustains severe damages of many organs and organ systems due to the fact that a large number of projectiles at the same time injure the chest, stomach, head and extremities. We presented a patient, 41 years of age, injured by aircraft bomb with hemo-pneumothorax and destruction of the bone and soft tissue structures of the foot, as well as the treatment result of such heavy injuries. After receiving thoracocentesis and short reanimation, the patient underwent surgical procedure. The team performed thoracotomy, primary treatment of the wound and atypical resection of the left lung. Thoracic drains were placed. The wounds on the lower leg and feet were treated primarily. Due to massive destruction of bone tissue of the right foot by cluster bomb splinters, and impossibility of reconstruction of the foot, guillotine amputation of the right lower leg was performed. Twelve days after the wounding caused by cluster bomb splinters, soft tissue of the left lower leg was covered by Tirsch free transplant and the defect in the area of the left foot was covered by dorsalis pedis flap. The transplant and flap were accepted and the donor sites were epithelized. Twenty-six days following the wounding reamputation was performed and amputation stump of the right lower leg was closed. The patient was given a lower leg prosthesis with which he could move. Upon being wounded by aircraft bomb splinters, the injured person sustains severe wounds of multiple organs and organ systems due to simultaneous injuries caused by a large number of projectiles. It is necessary to take care of the vital organs first because they directly threaten the life of the wounded patient. Despite adequate surgical treatment of war wounds of the feet, because of massive defect of bone and soft tissue, amputation may be the only rational solution of the treatment. The resection of the lung may be succesfull method for the severe destruction of the lung.

Effects of Single and Repeated Exposure to a 50-Hz 2-mT Electromagnetic Field on Primary Cultured Hippocampal Neurons.

PubMed

Zeng, Ying; Shen, Yunyun; Hong, Ling; Chen, Yanfeng; Shi, Xiaofang; Zeng, Qunli; Yu, Peilin

2017-06-01

The prevalence of domestic and industrial electrical appliances has raised concerns about the health risk of extremely low-frequency magnetic fields (ELF-MFs). At present, the effects of ELF-MFs on the central nervous system are still highly controversial, and few studies have investigated its effects on cultured neurons. Here, we evaluated the biological effects of different patterns of ELF-MF exposure on primary cultured hippocampal neurons in terms of viability, apoptosis, genomic instability, and oxidative stress. The results showed that repeated exposure to 50-Hz 2-mT ELF-MF for 8 h per day after different times in culture decreased the viability and increased the production of intracellular reactive oxidative species in hippocampal neurons. The mechanism was potentially related to the up-regulation of Nox2 expression. Moreover, none of the repeated exposure patterns had significant effects on DNA damage, apoptosis, or autophagy, which suggested that ELF-MF exposure has no severe biological consequences in cultured hippocampal neurons.

Asymmetric responses of primary productivity to altered precipitation simulated by ecosystem models across three long-term grassland sites

NASA Astrophysics Data System (ADS)

Wu, Donghai; Ciais, Philippe; Viovy, Nicolas; Knapp, Alan K.; Wilcox, Kevin; Bahn, Michael; Smith, Melinda D.; Vicca, Sara; Fatichi, Simone; Zscheischler, Jakob; He, Yue; Li, Xiangyi; Ito, Akihiko; Arneth, Almut; Harper, Anna; Ukkola, Anna; Paschalis, Athanasios; Poulter, Benjamin; Peng, Changhui; Ricciuto, Daniel; Reinthaler, David; Chen, Guangsheng; Tian, Hanqin; Genet, Hélène; Mao, Jiafu; Ingrisch, Johannes; Nabel, Julia E. S. M.; Pongratz, Julia; Boysen, Lena R.; Kautz, Markus; Schmitt, Michael; Meir, Patrick; Zhu, Qiuan; Hasibeder, Roland; Sippel, Sebastian; Dangal, Shree R. S.; Sitch, Stephen; Shi, Xiaoying; Wang, Yingping; Luo, Yiqi; Liu, Yongwen; Piao, Shilong

2018-06-01

Field measurements of aboveground net primary productivity (ANPP) in temperate grasslands suggest that both positive and negative asymmetric responses to changes in precipitation (P) may occur. Under normal range of precipitation variability, wet years typically result in ANPP gains being larger than ANPP declines in dry years (positive asymmetry), whereas increases in ANPP are lower in magnitude in extreme wet years compared to reductions during extreme drought (negative asymmetry). Whether the current generation of ecosystem models with a coupled carbon-water system in grasslands are capable of simulating these asymmetric ANPP responses is an unresolved question. In this study, we evaluated the simulated responses of temperate grassland primary productivity to scenarios of altered precipitation with 14 ecosystem models at three sites: Shortgrass steppe (SGS), Konza Prairie (KNZ) and Stubai Valley meadow (STU), spanning a rainfall gradient from dry to moist. We found that (1) the spatial slopes derived from modeled primary productivity and precipitation across sites were steeper than the temporal slopes obtained from inter-annual variations, which was consistent with empirical data; (2) the asymmetry of the responses of modeled primary productivity under normal inter-annual precipitation variability differed among models, and the mean of the model ensemble suggested a negative asymmetry across the three sites, which was contrary to empirical evidence based on filed observations; (3) the mean sensitivity of modeled productivity to rainfall suggested greater negative response with reduced precipitation than positive response to an increased precipitation under extreme conditions at the three sites; and (4) gross primary productivity (GPP), net primary productivity (NPP), aboveground NPP (ANPP) and belowground NPP (BNPP) all showed concave-down nonlinear responses to altered precipitation in all the models, but with different curvatures and mean values. Our results indicated that most models overestimate the negative drought effects and/or underestimate the positive effects of increased precipitation on primary productivity under normal climate conditions, highlighting the need for improving eco-hydrological processes in those models in the future.

Renal Extra Skeletal Mesenchymal Chondrosarcoma: A Case Report.

PubMed

Salehipour, Mehdi; Hosseinzadeh, Masood; Sisakhti, Afshin Molaei; Parvin, Vahid Abdol Mohammadi; Sadraei, Amin; Adib, Ali

2017-05-01

Primary mesenchymal chondrosarcoma of the Kidney is an extremely rare entity and very few cases have been reported in literature. We report a 22-year-old male with a right renal mass; after radical nephrectomy, pathologic examination revealed primary extra skeletal mesenchymal chondrosarcoma.

Urinary Incontinence Symptoms and Impact on Quality of Life in Patients Seeking Outpatient Physical Therapy Services

PubMed Central

Alappattu, Meryl; Neville, Cynthia; Beneciuk, Jason; Bishop, Mark

2016-01-01

Objective The objective of this study was to examine the frequency and types of urinary incontinence (UI) in patients seeking outpatient physical therapy for neuro-musculoskeletal conditions. Design Retrospective cross-sectional analysis. Patients A convenience sample of patients that positively responded to a UI screening question were included in this study. Methods Data were collected for age, sex, and primary treatment condition classified into one of the following (i.e. urinary dysfunction; fecal dysfunction; pelvic pain; spine; neurological disorders; or extremity disorders); UI type (i.e. mixed, urge, stress, or insensible); UI symptom severity; and quality of life impact. Main Outcome Measures Frequency of UI type, symptom severity, health-related quality of life (HRQoL) impact, and pad use were compared between treatment groups. Results The mean age of the sample (n=599) was 49.8 years (SD=18.5) and 94.7% were female. The urinary dysfunction group comprised 44.2% of the total sample, followed by the spine group with 25.7%, and pelvic pain with 17.2%. The urinary dysfunction group scored significantly higher on UI symptom severity and impact on quality of life compared to the pelvic pain and spine groups, but not compared to the extremity disorders, fecal dysfunction, or neurological disorders group. Conclusion These preliminary data indicate that UI is a condition afflicting many individuals who present to outpatient physical therapy beyond those seeking care for UI. We recommend using a simple screening measure for UI and its impact on HRQoL as part of a routine initial evaluation in outpatient physical therapy settings. PMID:26863987

Urinary incontinence symptoms and impact on quality of life in patients seeking outpatient physical therapy services.

PubMed

Alappattu, Meryl; Neville, Cynthia; Beneciuk, Jason; Bishop, Mark

2016-01-01

The objective of this study was to examine the frequency and types of urinary incontinence (UI) in patients seeking outpatient physical therapy for neuro-musculoskeletal conditions. Retrospective cross-sectional analysis. A convenience sample of patients that positively responded to a UI screening question was included in this study. Data were collected for age, sex, and primary treatment condition classified into one of the following (i.e., urinary dysfunction, fecal dysfunction, pelvic pain, spine, neurological disorders, or extremity disorders); UI type (i.e., mixed, urge, stress, or insensible); UI symptom severity; and quality of life (QoL) impact. Frequency of UI type, symptom severity, health-related quality of life (HRQoL) impact, and pad use were compared between treatment groups. The mean age of the sample (n = 599) was 49.8 years (SD = 18.5) and 94.7% were female. The urinary dysfunction group comprised 44.2% of the total sample, followed by the spine group with 25.7% and pelvic pain with 17.2%. The urinary dysfunction group scored significantly higher on UI symptom severity and impact on QoL compared to the pelvic pain and spine groups, but not compared to the extremity disorders, fecal dysfunction, or neurological disorder group. These preliminary data indicate that UI is a condition afflicting many individuals who present to outpatient physical therapy beyond those seeking care for UI. We recommend using a simple screening measure for UI and its impact on HRQoL as part of a routine initial evaluation in outpatient physical therapy settings.

Mechanisms of Short-Term Training-Induced Reaching Improvement in Severely Hemiparetic Stroke Patients: A TMS Study

PubMed Central

Harris-Love, Michelle L.; Morton, Susanne M.; Perez, Monica A.; Cohen, Leonardo G.

2011-01-01

Background The neurophysiological mechanisms underlying improved upper-extremity motor skills have been partially investigated in patients with good motor recovery but are poorly understood in more impaired individuals, the majority of stroke survivors. Objective The authors studied changes in primary motor cortex (M1) excitability (motor evoked potentials [MEPs], contralateral and ipsilateral silent periods [CSPs and ISPs] using transcranial magnetic stimulation [TMS]) associated with training-induced reaching improvement in stroke patients with severe arm paresis (n = 11; Upper-Extremity Fugl-Meyer score (F-M) = 27 ± 6). Methods All patients underwent a single session of reaching training focused on moving the affected hand from a resting site to a target placed at 80% of maximum forward reaching amplitude in response to a visual “GO” cue. Triceps contribute primarily as agonist and biceps primarily as antagonist to the trained forward reaching movement. Response times were recorded for each reaching movement. Results Preceding training (baseline), greater interhemispheric inhibition (measured by ISP) in the affected triceps muscle, reflecting inhibition from the nonlesioned to the lesioned M1, was observed in patients with lower F-M scores (more severe motor impairment). Training-induced improvements in reaching were greater in patients with slower response times at baseline. Increased MEP amplitudes and decreased ISPs and CSPs were observed in the affected triceps but not in the biceps muscle after training. Conclusion These results indicate that along with training-induced motor improvements, training-specific modulation of intrahemispheric and interhemispheric mechanisms occurs after reaching practice in chronic stroke patients with substantial arm impairment. PMID:21343522

The home stroke rehabilitation and monitoring system trial: a randomized controlled trial.

PubMed

Linder, Susan M; Rosenfeldt, Anson B; Reiss, Aimee; Buchanan, Sharon; Sahu, Komal; Bay, Curtis R; Wolf, Steven L; Alberts, Jay L

2013-01-01

Because many individuals poststroke lack access to the quality and intensity of rehabilitation to improve upper extremity motor function, a home-based robotic-assisted upper extremity rehabilitation device is being paired with an individualized home exercise program. The primary aim of this project is to determine the effectiveness of robotic-assisted home therapy compared with a home exercise program on upper extremity motor recovery and health-related quality of life for stroke survivors in rural and underserved locations. The secondary aim is to explore whether initial degree of motor function of the upper limb may be a factor in predicting the extent to which patients with stroke may be responsive to a home therapy approach. We hypothesize that the home exercise program intervention, when enhanced with robotic-assisted therapy, will result in significantly better outcomes in motor function and quality of life. A total of 96 participants within six-months of a single, unilateral ischemic, or hemorrhagic stroke will be recruited in this prospective, single-blind, multisite randomized clinical trial. The primary outcome is the change in upper extremity function using the Action Research Arm Test. Secondary outcomes include changes in: upper extremity function (Wolf Motor Function Test), upper extremity impairment (upper extremity portion of the Fugl-Meyer Test), self-reported quality of life (Stroke Impact Scale), and affect (Centers for Epidemiologic Studies Depression Scale). Similar or greater improvements in upper extremity function using the combined robotic home exercise program intervention compared with home exercise program alone will be interpreted as evidence that supports the introduction of in-home technology to augment the recovery of function poststroke. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Cervical Myelopathy in a Patient Referred for Lower Extremity Symptoms.

PubMed

Jackson, Steven M

2017-07-01

The patient was a 38-year-old male referred to physical therapy with complaints of right lower extremity radicular pain and left lower extremity weakness. Following physical therapy examination, the primary care physician referred the patient to a neurologist, who performed electromyography and nerve conduction studies and ordered a magnetic resonance image. Cervical spine imaging revealed a C5-6 disc extrusion with myelopathy. J Orthop Sports Phys Ther 2017;47(7):510. doi:10.2519/jospt.2017.5071.

PM-1 NUCLEAR POWER PROGRAM. VOLUME II. PLANT PERFORMANCE STUDIES. Final Periodic Report, September 1, 1962 to December 31, 1962

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

None

1963-04-01

Data obtained during the performance testing of the PM-1 plant were compiled and evaluated. The plant powers an Air Defense Command radar station located at Sundance, Wyoming, and is required to supply extremely high-quality electrical power (minimum of frequency and voltage fluctuations) even during severe load transients. The data obtained were compiled into the following format: (1) operating requirements; (2) startup requirements; (3) plant as an energy source; (4) plant radiation levels and health physics; (5) plant instrumentation and control; (6) reactor characteristics; (7) primary system characteristics; (8) secondary system characteristics; and (9) malfunction reports. It was concluded from themore » data that the plant performance in general meets or exceeds specification. Transient and steady-state electrical fluctuations are well within specified limitations. Heat balance data for both the primary and secondary system agree reasonably well with design predictions. Radiation levels are below those anticipated. Coolant activity in the primary system is approximately at anticipated levels; secondary system coolant activity is negligible. The core life was re-estimated based on asbuilt core characteristics. A lifetime of 16.6 Mw-yr is predicted. (auth)« less

Cranio-orbital primary intraosseous haemangioma

PubMed Central

Gupta, T; Rose, G E; Manisali, M; Minhas, P; Uddin, J M; Verity, D H

2013-01-01

Purpose Primary intraosseous haemangioma (IOH) is a rare benign neoplasm presenting in the fourth and fifth decades of life. The spine and skull are the most commonly involved, orbital involvement is extremely rare. We describe six patients with cranio-orbital IOH, the largest case series to date. Patients and methods Retrospective review of six patients with histologically confirmed primary IOH involving the orbit. Clinical characteristics, imaging features, approach to management, and histopathological findings are described. Results Five patients were male with a median age of 56. Pain and diplopia were the most common presenting features. A characteristic ‘honeycomb' pattern on CT imaging was demonstrated in three of the cases. Complete surgical excision was performed in all cases with presurgical embolisation carried out in one case. In all the cases, histological studies identified cavernous vascular spaces within the bony tissue. These channels were lined by single layer of cytologically normal endothelial cells. Discussion IOCH of the cranio-orbital region is rare; in the absence of typical imaging features, the differential diagnosis includes chondroma, chondrosarcoma, bony metastasis, and lymphoma. Surgical excision may be necessary to exclude more sinister pathology. Intraoperative haemorrhage can be severe and may be reduced by preoperative embolisation. PMID:23989119

A rare case of primary bone lymphoma mimicking a pelvic abscess

PubMed Central

Al Wattar, BH; Mohanty, K

2011-01-01

Primary bone lymphoma (PBL) is a rare, malignant, neoplastic disorder of the skeleton that accounts for less than 5% of all primary bone tumours. We present an extremely rare case of PBL mimicking a pelvic abscess around the sacroiliac joint, which has never been reported in the medical literature, and discuss learning points highlighted from this case. PMID:22004625

A prospective study for upper-extremity cumulative trauma disorders of workers in aircraft manufacturing.

PubMed

Melhorn, J M

1996-12-01

Occupational diseases affect 15 to 20% of all Americans. Cumulative trauma disorders (CTDs) account for 56% of all occupational injuries. The recognition and control of occupational injuries has become a major concern of employees, employers, medicine, and the federal government because of health risk and related costs. Upper-extremity CTDs are identified by the National Institute for Occupational Safety and Health as one of the ten most significant occupational health problems in the United States. It is estimated by the year 2000 that 50 cents on the dollar will be spent on CTDs. Although enlightened aircraft employers have developed primary prevention strategies, primary prevention can never be expected to eliminate 100% of the cases. To evaluate several preventive activities, a CTD risk-assessment program was developed and implemented in cooperation with a major aircraft manufacturer employing over 8000 workers. This program was focused on objectively identifying the relationship of work and other activities to an individual worker experiencing CTDs. Early identification has been linked, when applicable, to intervention algorithms for medical care, job task modification, workplace accommodation, and training. A prospective study group of 212 workers who used rivet guns was placed into a four-way experimental design for ergonomic posture training, exercise training, and rivet-gun type (primary factors). A statistical model was developed for the level of CTD risk and evaluated using the SAS software program (SAS Institute, Inc, Carry, NC). Statistical analysis of the primary factors without regard to associated variables (covariates) demonstrated that only posture training had a beneficial risk reduction for the individual. The impact (beneficial or detrimental) for exercise training and for vibration-dampening rivet guns was probably obscured because of the large variability of the responses regarding the associated variables (covariates). When the covariates were analyzed in conjunction with the four experimental groups, a positive benefit from ergonomic posture training and exercise training was demonstrated for the following groups: the dominant han, time spend in an awkward position, number of standard rivets bucked, number of parts routed, number of parts ground, number of vibration-dampening rivets bucked, and newly hired individuals. A negative effect (increase in individual risk level) for current employees using a vibration-dampening rivet gun was demonstrated. This prospective study helps to identify the possible benefit of education and training for controlling CTDs and demonstrates the usefulness of being able to evaluate materials, methods, machines, and environments as they relate to the individual's risk level for the development of upper-extremity CTDs.

A case of myxedema coma caused by isolated thyrotropin stimulating hormone deficiency and Hashimoto's thyroiditis.

PubMed

Iida, Keiji; Hino, Yasuhisa; Ohara, Takeshi; Chihara, Kazuo

2011-01-01

Myxedema coma (MC) is a rare, but often fatal endocrine emergency. The majority of cases that occur in elderly women with long-standing primary hypothyroidism are caused by particular triggers. Conversely, MC of central origin is extremely rare. Here, we report a case of MC with both central and primary origins. A 56-year-old woman was transferred to our hospital due to loss of consciousness; a chest x-ray demonstrated severe cardiomegaly. Low body temperature, bradycardia, and pericardial effusion suggested the presence of hypothyroidism. Endocrinological examination revealed undetectable levels of serum free thyroxine (T(4)) and free triiodothyronine (T(3)), whereas serum thyroid-stimulating hormone (TSH) levels were not elevated. The woman's serum anti-thyroid peroxidase antibody and anti-thyroglobulin antibody tests were positive, indicating that she had Hashimoto's thyroiditis. Provocative tests to the anterior pituitary revealed that she had TSH and growth hormone (GH) deficiency; however, GH levels were restored after supplementation with levothyroxine for 5 months. This was not only a rare case of MC with TSH deficiency and Hashimoto's thyroiditis; the patient also developed severe osteoporosis and possessed transient elevated levels of serum carcinoembryonic antigen (CEA). This atypical case may suggest the role of anterior pituitary hormone deficiencies, as well as hypothyroidism, in the regulation of bone metabolism.

76 FR 38360 - Workshop-Monitoring Changes in Extreme Storm Statistics: State of Knowledge; Notice of Open...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-30

... Changes in Extreme Storm Statistics: State of Knowledge; Notice of Open Public Workshop AGENCY: National... .) SUPPLEMENTARY INFORMATION: This workshop will provide an update to the climate science surrounding extreme... storms. Specific topics include: Severe Thunderstorms (and associated hail and winds), tornadoes, extreme...

Opto-mechanical design and development of a 460mm diffractive transmissive telescope

NASA Astrophysics Data System (ADS)

Qi, Bo; Wang, Lihua; Cui, Zhangang; Bian, Jiang; Xiang, Sihua; Ma, Haotong; Fan, Bin

2018-01-01

Using lightweight, replicated diffractive optics, we can construct extremely large aperture telescopes in space.The transmissive primary significantly reduces the sensitivities to out of plane motion as compared to reflective systems while reducing the manufacturing time and costs. This paper focuses on the design, fabrication and ground demonstration of a 460mm diffractive transmissive telescope the primary F/# is 6, optical field of view is 0.2° imagine bandwidth is 486nm 656nm.The design method of diffractive optical system was verified, the ability to capture a high-quality image using diffractive telescope collection optics was tested.The results show that the limit resolution is 94lp/mm, the diffractive system has a good imagine performance with broad bandwidths. This technology is particularly promising as a means to achieve extremely large optical primaries from compact, lightweight packages.

Extreme Hafnium Values in Archean Banded Iron Formations: Evidence for Sedimentary Lu/Hf Fractionation at 3.2 Ga or Diagenesis?

NASA Astrophysics Data System (ADS)

Foster, I. S.; Agranier, A.; Heubeck, C. E.; Köhler, I.; Homann, M.; Tripati, A. K.; Nonnotte, P.; Ponzevera, E.; Lalonde, S.

2017-12-01

The emergence of continental crust above sea level in the early Precambrian would have created the first terrestrial habitats, and initiated atmosphere-driven weathering of the continents, yet the history of continental emergence is largely unknown[1]. Precambrian chemical sediments, specifically Banded Iron Formation (BIF), appear to have sampled the Hf-Nd isotope composition of ancient seawater, and may preserve a historical record of the emergence of the continental landmass[2] via Lu/Hf fractionation induced by subaerial differential weathering[3,4]. However, paired Hf-Nd isotope data are available for only one BIF to date, indicating appreciable emerged continental landmass ca. 2.7 Ga[2]. Our work extends this record back into the Eo- and Meso-Archean using samples of 3.8 Ga BIF from Isua, Greenland, and 3.2 Ga BIF from the Moodies Group, S. Africa. Isua samples appear to have been altered by amphibolite-grade metamorphism, however Moodies Group samples appear primary, having experienced significantly lower metamorphic grades. Moodies samples appear to retain their primary seawater signatures, however, their range of ˜Hf(i) values, from -54.6 to +40.7, is among the most extreme ever reported. Such extreme values may be indicative of one of several possibilities: unusual and intense sedimentary Lu/Hf fractionation during the Mesoarchean relative to today, sampling of a continuum of compositions from two sources with distinct Hf-compositions, or the result of early diagenetic processes occurring soon after the deposition of the Moodies Group BIF. These results suggest that interpretation of ˜Hf and ˜Nd data from BIF is not as straightforward as previously suggested[2], and positive ˜Hf values are not necessarily indicative of emerged continental crust. [1] Flament et al. (2013), Precambrian Research, 229, 177-188. [2] Veihmann et al. (2014), Geology, 42, 115-118. [3] Bayon et al. (2006), Geology, 34, 433-436. [4] Vervoort et al. (2011), Geochimica et Cosmochimica Acta, 75, 5903-5926.

Upper-extremity phocomelia reexamined: a longitudinal dysplasia.

PubMed

Goldfarb, Charles A; Manske, Paul R; Busa, Riccardo; Mills, Janith; Carter, Peter; Ezaki, Marybeth

2005-12-01

In contrast to longitudinal deficiencies, phocomelia is considered a transverse, intercalated segmental dysplasia. Most patients demonstrate severe, but not otherwise classifiable, upper-extremity deformities, which usually cannot be placed into one of three previously described phocomelia groups. Additionally, these phocomelic extremities do not demonstrate true segmental deficits; the limb is also abnormal proximal and distal to the segmental defect. The purpose of this investigation was to present evidence that upper-extremity abnormalities in patients previously diagnosed as having phocomelia in fact represent a proximal continuum of radial or ulnar longitudinal dysplasia. The charts and radiographs of forty-one patients (sixty extremities) diagnosed as having upper-extremity phocomelia were reviewed retrospectively. On the basis of the findings on the radiographs, the disorders were categorized into three groups: (1) proximal radial longitudinal dysplasia, which was characterized by an absent proximal part of the humerus, a nearly normal distal part of the humerus, a completely absent radius, and a radial-sided hand dysplasia; (2) proximal ulnar longitudinal dysplasia, characterized by a short one-bone upper extremity that bifurcated distally and by severe hand abnormalities compatible with ulnar dysplasia; and (3) severe combined dysplasia, with type A characterized by an absence of the forearm segment (i.e., the radius and ulna) and type B characterized by absence of the arm and forearm (i.e., the hand attached to the thorax). Twenty-nine limbs in sixteen patients could be classified as having proximal radial longitudinal dysplasia. Systemic medical conditions such as thrombocytopenia-absent radius syndrome were common in those patients, but additional musculoskeletal conditions were rare. Twenty limbs in seventeen patients could be classified as having proximal ulnar longitudinal dysplasia. Associated musculoskeletal abnormalities, such as proximal femoral focal deficiency, were common in those patients. Eleven limbs in ten patients were identified as having severe combined dysplasia, which was type A in seven of them and type B in four. Four patients with severe combined dysplasia had congenital cardiac anomalies, and four had associated musculoskeletal abnormalities. Three of the four patients with the type-B disorder had a contralateral ulnar longitudinal dysplasia. We propose that cases previously classified as upper-extremity phocomelia represent a spectrum of severe longitudinal dysplasia, as none of the sixty extremities that we studied demonstrated a true intercalary deficiency. These findings have both developmental and genetic implications.

Spontaneous Coronary Artery Dissection

MedlinePlus

... blood vessels. Fibromuscular dysplasia occurs more often in women than it does in men. Extreme physical exercise. People who recently participated in extreme or intense exercises, such as extreme aerobic activities, may be at higher risk of SCAD. Severe ...

[The optimization of restoration approaches of advanced hand activity using the sensorial glove and the mCIMT method].

PubMed

Mozheiko, E Yu; Prokopenko, S V; Alekseevich, G V

To reason the choice of methods of restoration of advanced hand activity depending on severity of motor disturbance in the top extremity. Eighty-eight patients were randomized into 3 groups: 1) the mCIMT group, 2) the 'touch glove' group, 3) the control group. For assessment of physical activity of the top extremity Fugl-Meyer Assessment Upper Extremity, Nine-Hole Peg Test, Motor Assessment Scale were used. Assessment of non-use phenomenon was carried out with the Motor Activity Log scale. At a stage of severe motor dysfunction, there was a restoration of proximal departments of a hand in all groups, neither method was superior to the other. In case of moderate severity of motor deficiency of the upper extremity the most effective was the method based on the principle of biological feedback - 'a touch glove'. In the group with mild severity of motor dysfunction, the best recovery was achieved in the mCIMT group.

Exploring the heavy air pollution in Beijing in the fourth quarter of 2015: assessment of environmental benefits for red alerts

NASA Astrophysics Data System (ADS)

Nie, Teng; Nie, Lei; Zhou, Zhen; Wang, Zhanshan; Xue, Yifeng; Gao, Jiajia; Wu, Xiaoqing; Fan, Shoubin; Cheng, Linglong

2018-06-01

In recent years, Beijing has experienced severe air pollution which has caused widespread public concern. Compared to the same period in 2014, the first three quarters of 2015 exhibited significantly improved air quality. However, the air quality sharply declined in the fourth quarter of 2015, especially in November and December. During that time, Beijing issued the first red alert for severe air pollution in history. In total, 2 red alerts, 3 orange alerts, 3 yellow alerts, and 3 blue alerts were issued based on the adoption of relatively temporary emergency control measures to mitigate air pollution. This study explored the reasons for these variations in air quality and assessed the effectiveness of emergency alerts in addressing severe air pollution. A synthetic analysis of emission variations and meteorological conditions was performed to better understand these extreme air pollution episodes in the fourth quarter of 2015. The results showed that compared to those in the same period in 2014, the daily average emissions of air pollutants decreased in the fourth quarter of 2015. However, the emission levels of primary pollutants were still relatively high, which was the main intrinsic cause of haze episodes, and unfavorable meteorological conditions represented important external factors. Emergency control measures for heavy air pollution were implemented during this red alert period, decreasing the emissions of primary air pollutants by approximately 36% and the PM2.5 concentration by 11%‒21%.

A new therapeutic application of brain-machine interface (BMI) training followed by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy for patients with severe hemiparetic stroke: A proof of concept study.

PubMed

Kawakami, Michiyuki; Fujiwara, Toshiyuki; Ushiba, Junichi; Nishimoto, Atsuko; Abe, Kaoru; Honaga, Kaoru; Nishimura, Atsuko; Mizuno, Katsuhiro; Kodama, Mitsuhiko; Masakado, Yoshihisa; Liu, Meigen

2016-09-21

Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy improved paretic upper extremity motor function in patients with severe to moderate hemiparesis. We hypothesized that brain machine interface (BMI) training would be able to increase paretic finger muscle activity enough to apply HANDS therapy in patients with severe hemiparesis, whose finger extensor was absent. The aim of this study was to assess the efficacy of BMI training followed by HANDS therapy in patients with severe hemiparesis. Twenty-nine patients with chronic stroke who could not extend their paretic fingers were participated this study. We applied BMI training for 10 days at 40 min per day. The BMI detected the patients' motor imagery of paretic finger extension with event-related desynchronization (ERD) over the affected primary sensorimotor cortex, recorded with electroencephalography. Patients wore a motor-driven orthosis, which extended their paretic fingers and was triggered with ERD. When muscle activity in their paretic fingers was detected with surface electrodes after 10 days of BMI training, we applied HANDS therapy for the following 3 weeks. In HANDS therapy, participants received closed-loop, electromyogram-controlled, neuromuscular electrical stimulation (NMES) combined with a wrist-hand splint for 3 weeks at 8 hours a day. Before BMI training, after BMI training, after HANDS therapy and 3month after HANDS therapy, we assessed Fugl-Meyer Assessment upper extremity motor score (FMA) and the Motor Activity Log14-Amount of Use (MAL-AOU) score. After 10 days of BMI training, finger extensor activity had appeared in 21 patients. Eighteen of 21 patients then participated in 3 weeks of HANDS therapy. We found a statistically significant improvement in the FMA and the MAL-AOU scores after the BMI training, and further improvement was seen after the HANDS therapy. Combining BMI training with HANDS therapy could be an effective therapeutic strategy for severe UE paralysis after stroke.

Retrograde nail for tibiotalocalcaneal arthrodesis as a limb salvage procedure for open distal tibia and talus fractures with severe bone loss.

PubMed

Ochman, Sabine; Evers, Julia; Raschke, Michael J; Vordemvenne, Thomas

2012-01-01

The treatment of complex fractures of the distal tibia, ankle, and talus with soft tissue damage, bone loss, and nonreconstructable joints for which the optimal timing for reduction and fixation has been missed is challenging. In such cases primary arthrodesis might be a treatment option. We report a series of multi-injured patients with severe soft tissue damage and bone loss, who were treated with a retrograde tibiotalocalcaneal arthrodesis nail as a minimally invasive treatment option for limb salvage. After a median follow-up of 5.4 years, all patients returned to their former profession. The ankle and bone fusion was complete, with moderate functional results and quality of life. Calcaneotibial arthrodesis using a retrograde nail is a good treatment option for nonreconstructable fractures of the ankle joint with severe bone loss and poor soft tissue quality in selected patients with multiple injuries, in particular, those involving both lower extremities, as a salvage procedure. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Extreme Environments Capabilities at Glenn Research Center

NASA Technical Reports Server (NTRS)

Balcerski, Jeffrey; Kremic, Tibor; Arnett, Lori; Vento, Dan; Nakley, Leah

2016-01-01

The NASA Glenn Research Center has several facilities that can provide testing for extreme evironments of interest to the New Frontiers community. This includes the Glenn Extreme Enivironments Rig (GEER) which can duplicate the atmospheric chemistry and conditions for the Venus surface or any other planet with a hot environment. GRC also has several cryogenic facilities which have the capability to run with hydrogen atmospheres, hydrocarbon atmosphere, CO2 based atmospheres or nitrogen atmospheres. The cryogenic facilities have the capability to emulate Titan lakes.

[Coexistence of coeliac disease and inflammatory bowel disease in children].

PubMed

Krawiec, Paulina; Pawłowska-Kamieniak, Agnieszka; Pac-Kożuchowska, Elżbieta; Mroczkowska-Juchkiewcz, Agnieszka; Kominek, Katarzyna

2016-01-01

Coeliac disease and inflammatory bowel disease are chronic inflammatory conditions of gastrointestinal tract with complex aetiology with genetic, environmental and immunological factors contributing to its pathogenesis. It was noted that immune-mediated disorders often coexist. There is well-known association between coeliac disease and type 1 diabetes and ulcerative colitis and primary sclerosing cholangitis. However, growing body of literature suggests the association between coeliac disease and inflammatory bowel disease, particularly ulcerative colitis. This is an extremely rare problem in paediatric gastroenterology. To date there have been reported several cases of children with coexisting coeliac disease and inflammatory bowel disease. Herewith we present review of current literature on coexistence of coeliac disease and inflammatory bowel disease in children. © 2016 MEDPRESS.

Murine macrophages: a technical approach.

PubMed

Martinez-Pomares, Luisa; Gordon, Siamon

2008-01-01

In this chapter, we describe current protocols used for the characterization of macrophages (MPhi) in mouse tissues and in cell suspensions from spleen and lymph nodes. Also, we include a brief description of a complementary approach: culture of primary MPhi. Although culture MPhi are extremely useful for analysing the basic biology of MPhi and their receptors, it should not be forgotten that the term MPhi encompasses a wide range of different types of cells with phenotypic characteristics dependent on their activation state and tissue of origin. In our view, there is no perfect MPhi marker and analysis of the expression profile of several markers, and functional studies are required to make an informed guess of the cellular characteristics and function of the MPhi population of interest.

A phase II randomized clinical trial on cerebral near-infrared spectroscopy plus a treatment guideline versus treatment as usual for extremely preterm infants during the first three days of life (SafeBoosC): study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Every year in Europe about 25,000 infants are born extremely preterm. These infants have a 20% mortality rate, and 25% of survivors have severe long-term cerebral impairment. Preventative measures are key to reduce mortality and morbidity in an extremely preterm population. The primary objective of the SafeBoosC phase II trial is to examine if it is possible to stabilize the cerebral oxygenation of extremely preterm infants during the first 72 hours of life through the application of cerebral near-infrared spectroscopy (NIRS) oximetry and implementation of an clinical treatment guideline based on intervention thresholds of cerebral regional tissue saturation rStO2. Methods/Design SafeBoosC is a randomized, blinded, multinational, phase II clinical trial. The inclusion criteria are: neonates born more than 12 weeks preterm; decision to conduct full life support; parental informed consent; and possibility to place the cerebral NIRS oximeter within 3 hours after birth. The infants will be randomized into one of two groups. Both groups will have a cerebral oximeter monitoring device placed within three hours of birth. In the experimental group, the cerebral oxygenation reading will supplement the standard treatment using a predefined treatment guideline. In the control group, the cerebral oxygenation reading will not be visible and the infant will be treated according to the local standards. The primary outcome is the multiplication of the duration and magnitude of rStO2 values outside the target ranges of 55% to 85%, that is, the ‘burden of hypoxia and hyperoxia’ expressed in ‘%hours’. To detect a 50% difference between the experimental and control group in %hours, 166 infants in total must be randomized. Secondary outcomes are mortality at term date, cerebral ultrasound score, and interburst intervals on an amplitude-integrated electroencephalogram at 64 hours of life and explorative outcomes include neurodevelopmental outcome at 2 years corrected age, magnetic resonance imaging at term, blood biomarkers at 6 and 64 hours after birth, and adverse events. Discussion Cerebral oximetry guided interventions have the potential to improve neurodevelopmental outcome in extremely preterm infants. It is a logical first step to test if it is possible to reduce the burden of hypoxia and hyperoxia. Trial registration ClinicalTrial.gov, NCT01590316 PMID:23782447

Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE): a randomized controlled trial protocol.

PubMed

Winstein, Carolee J; Wolf, Steven L; Dromerick, Alexander W; Lane, Christianne J; Nelsen, Monica A; Lewthwaite, Rebecca; Blanton, Sarah; Scott, Charro; Reiss, Aimee; Cen, Steven Yong; Holley, Rahsaan; Azen, Stanley P

2013-01-11

Residual disability after stroke is substantial; 65% of patients at 6 months are unable to incorporate the impaired upper extremity into daily activities. Task-oriented training programs are rapidly being adopted into clinical practice. In the absence of any consensus on the essential elements or dose of task-specific training, an urgent need exists for a well-designed trial to determine the effectiveness of a specific multidimensional task-based program governed by a comprehensive set of evidence-based principles. The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Stroke Initiative is a parallel group, three-arm, single blind, superiority randomized controlled trial of a theoretically-defensible, upper extremity rehabilitation program provided in the outpatient setting.The primary objective of ICARE is to determine if there is a greater improvement in arm and hand recovery one year after randomization in participants receiving a structured training program termed Accelerated Skill Acquisition Program (ASAP), compared to participants receiving usual and customary therapy of an equivalent dose (DEUCC). Two secondary objectives are to compare ASAP to a true (active monitoring only) usual and customary (UCC) therapy group and to compare DEUCC and UCC. Following baseline assessment, participants are randomized by site, stratified for stroke duration and motor severity. 360 adults will be randomized, 14 to 106 days following ischemic or hemorrhagic stroke onset, with mild to moderate upper extremity impairment, recruited at sites in Atlanta, Los Angeles and Washington, D.C. The Wolf Motor Function Test (WMFT) time score is the primary outcome at 1 year post-randomization. The Stroke Impact Scale (SIS) hand domain is a secondary outcome measure.The design includes concealed allocation during recruitment, screening and baseline, blinded outcome assessment and intention to treat analyses. Our primary hypothesis is that the improvement in log-transformed WMFT time will be greater for the ASAP than the DEUCC group. This pre-planned hypothesis will be tested at a significance level of 0.05. ICARE will test whether ASAP is superior to the same number of hours of usual therapy. Pre-specified secondary analyses will test whether 30 hours of usual therapy is superior to current usual and customary therapy not controlled for dose. www.ClinicalTrials.gov Identifier: NCT00871715

8. VIEW SOUTH OF PRIMARY REDUCING GEARS; HORIZONTAL ARM AT ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

8. VIEW SOUTH OF PRIMARY REDUCING GEARS; HORIZONTAL ARM AT CENTER OF PHOTOGRAPH IS A PART OF LEVER MECHANISM THAT LOCKS MECHANICAL BRAKE; 75 LB. COUNTERWEIGHT IS AT EXTREME LEFT CENTER - East Washington Avenue Bridge, Spanning Pequonnock River at East Washington Avenue, Bridgeport, Fairfield County, CT

Pushed to the Margins--Sex and Relationships in Greek Primary Textbooks

ERIC Educational Resources Information Center

Gerouki, Margarita

2008-01-01

In 2001, the Greek Government introduced sex and gender relationships education as a thematic unit for interdisciplinary Health Education activities. However, the diffusion of such programmes remains extremely limited. The present paper discusses how sex and relationships issues are presented in contemporary Greek primary school textbooks since…

Report on the Hemodialysis Reliable Outflow (HeRO) experience in dialysis patients with central venous occlusions.

PubMed

Wallace, Justin R; Chaer, Rabih A; Dillavou, Ellen D

2013-09-01

The Hemodialysis Reliable Outflow (HeRO) graft (Hemosphere/CryoLife Inc, Eden Prairie, Minn) has provided an innovative means to obtain hemodialysis access for patients with severe central venous occlusive disease. The outcomes of this novel treatment modality in a difficult population have yet to be clearly established. A retrospective review of HeRO graft placement from June 2010 to January 2012 was performed. Patient hemodialysis access history, clinical complexity, complications, and outcomes were analyzed. Categoric data were described with counts and proportions, and continuous data with means, ranges and, when appropriate, standard deviations. Patency rates were analyzed using life-table analysis, and patency rate comparisons were made with a two-group proportion comparison calculator. HeRO graft placement was attempted 21 times in 19 patients (52% women), with 18 of 21 (86%) placed successfully. All but one was placed in the upper extremity. Mean follow-up after successful placement has been 7 months (range, 0-23 months). The primary indication for all HeRO graft placements except one was central vein occlusion(s) and need for arteriovenous access. Patients averaged 2.0 previous (failed) accesses and multiple catheters. Four HeRO grafts (24%), all in women, required ligation and removal for severe steal symptoms in the immediate postoperative period (P < .01 vs men). Three HeROs were placed above fistulas for rescue. All thrombosed <4 months, although the fistulas remained open. An infection rate of 0.5 bacteremic events per 1000 HeRO-days was observed. At a mean follow-up of 7 months, primary patency was 28% and secondary patency was 44%. The observed 12-month primary and secondary patency rates were 11% and 32%, respectively. Secondary patency was maintained in four patients for a mean duration of 10 months (range, 6-18 months), with an average of 4.0 ± 2.2 thrombectomies per catheter. HeRO graft placement, when used as a last-resort measure, has been able to provide upper extremity access in patients who otherwise would not have this option. There is a high complication rate, however, including a very high incidence of steal in women. HeRO grafts should continue to be used as a last resort. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Development of a new USDA plant hardiness zone map for the United States

Treesearch

C. Daly; M.P. Widrlechner; M.D. Halbleib; J.I. Smith; W.P. Gibson

2012-01-01

In many regions of the world, the extremes of winter cold are a major determinant of the geographic distribution of perennial plant species and of their successful cultivation. In the United States, the U.S. Department of Agriculture (USDA) Plant Hardiness Zone Map (PHZM) is the primary reference for defining geospatial patterns of extreme winter cold for the...

An exclusive human milk-based diet in extremely premature infants reduces the probability of remaining on total parenteral nutrition: A reanalysis of the data

USDA-ARS?s Scientific Manuscript database

We have previously shown that an exclusively human-milk-based diet is beneficial for extremely premature infants who are at risk for necrotizing enterocolitis (NEC). However, no significant difference in the other primary study endpoint, the length of time on total parenteral nutrition (TPN), was fo...

Lightning and severe thunderstorms in event management.

PubMed

Walsh, Katie M

2012-01-01

There are a few national position stands/guidelines that address environmental conditions in athletics, yet they do not govern all outdoor sports. Extreme heat and cold, lightning, and severe wind can all be fatal, yet the majority of outdoor sports have no published guidelines addressing these conditions in relation to activity. Available research on extreme heat and cold conditions in athletics provides prevention strategies, to include acclimatization. Lightning and severe wind are two environmental conditions to which humans cannot accommodate, and they both can be deadly. There are strong positions on extreme heat/cold and lightning safety in athletics, but none affiliated with severe winds. Medical personnel involved in planning large outdoor sporting events must know of the presence of nationally published weather-related documents and apply them to their event. In addition, research needs to be expanded in the realm of establishing guidelines for safety to participants and spectators in severe wind conditions.

Violence, victimization, criminal justice involvement, and substance use among drug-involved men.

PubMed

Golder, Seana; Logan, T K

2014-01-01

This research identified three subgroups of drug-involved men based on severity of self-reported violence perpetration against intimate or nonintimate partners among a sample of 148 men selected from a subsample of participants in the Kentucky National Institute on Drug Abuse (NIDA) AIDS Cooperative Agreement. Men in the No Violence group accounted for approximately 19% of the total respondents, men in the Moderate Violence Severity and Extreme Violence Severity groups comprises 56% and 25% of the sample, respectively. Men in the Extreme Violence Severity group experienced significantly more psychological victimization as children and more frequent physical childhood abuse than did their peers. Men in the Extreme Violence Severity group reported having earlier involvement in the criminal justice system and lawbreaking behavior; they also reported higher frequency of marijuana and crack use. Implications for treatment and future research are presented.

Evaluation of the DSM-5 severity indicator for binge eating disorder in a clinical sample

PubMed Central

Grilo, Carlos M.; Ivezaj, Valentina; White, Marney A.

2015-01-01

Objective This study tested the new DSM-5 severity criterion for binge eating disorder (BED) based on frequency of binge-eating in a clinical sample. This study also tested overvaluation of shape/weight as an alternative severity specifier. Method Participants were 834 treatment-seeking adults diagnosed with DSM-5 BED using semistructured diagnostic and eating-disorder interviews. Participants sub-grouped based on DSM-5 severity levels and on overvaluation of shape/weight were compared on demographic and clinical variables. Results Based on DSM-5 severity definitions, 331 (39.7%) participants were categorized as mild, 395 (47.5%) as moderate, 83 (10.0%) as severe, and 25 (3.0%) as extreme. Analyses comparing three (mild, moderate, and severe/extreme) severity groups revealed no significant differences in demographic variables or body mass index (BMI). Analyses revealed significantly higher eating-disorder psychopathology in the severe/extreme than moderate and mild groups and higher depression in moderate and severe/extreme groups than the mild group; effect sizes were small. Participants characterized with overvaluation (N = 449; 54%) versus without overvaluation (N = 384; 46%) did not differ significantly in age, sex, BMI, or binge-eating frequency, but had significantly greater eating-disorder psychopathology and depression. The robustly greater eating-disorder psychopathology and depression levels (medium-to-large effect sizes) in the overvaluation group was observed without attenuation of effect sizes after adjusting for ethnicity/race and binge-eating severity/frequency. Conclusions Our findings provide support for overvaluation of shape/weight as a severity specifier for BED as it provides stronger information about the severity of homogeneous groupings of patients than the DSM-5 rating based on binge-eating. PMID:26114779

Base Oil-Extreme Pressure Additive Synergy in Lubricants

USDA-ARS?s Scientific Manuscript database

Extreme pressure (EP) additives are those containing reactive elements such as sulfur, phosphorus, and chlorine. In lubrication processes that occur under extremely severe conditions (e.g., high pressure and/or slow speed), these elements undergo chemical reactions generating new materials (tribofi...

Primary goitrous hypothyroidism in a young adult domestic longhair cat: diagnosis and treatment monitoring

PubMed Central

Peterson, Mark E

2015-01-01

Case summary Primary goitrous hypothyroidism was diagnosed in a 12-month-old cat examined because of small stature, mental dullness, severe lethargy, generalized weakness and gait abnormalities. Radiographs of the long bones and spine revealed delayed epiphyseal ossification and epiphyseal dysgenesis. Diagnosis of primary hypothyroidism was confirmed by low serum concentrations of total and free thyroxine (T4) with high thyroid-stimulating hormone (TSH) concentrations. Thyroid scintigraphy revealed severe enlargement of both thyroid lobes, as evidenced by a seven-fold increase in calculated thyroid volume above the reference interval. In addition, this bilateral goiter had an extremely high radionuclide uptake, about 10-fold higher than the normal feline thyroid gland. Treatment with twice-daily levothyroxine (L-T4), administered on an empty stomach, resulted in increased alertness, playfulness, strength and improvement in gait, as well as an increase in body length and weight. L-T4 replacement also led to normalization of serum thyroid hormone and TSH concentrations, and complete resolution of goiter. Relevance and novel information Spontaneous hypothyroidism is rarely reported in cats, with congenital hypothyroidism in kittens diagnosed most frequently. Despite the fact that this cat was a young adult, it likely had a form of congenital hypothyroidism caused by dyshormonogenesis (defect in thyroid hormone synthesis) that led to compensatory development of goiter. In hypothyroid cats, treatment with L-T4 is best given twice daily on an empty stomach to ensure adequate absorption. Normalization of serum TSH and shrinkage of goiter, as well as improvement in clinical signs, is the goal of treatment for cats with goitrous hypothyroidism. PMID:28491394

Primary goitrous hypothyroidism in a young adult domestic longhair cat: diagnosis and treatment monitoring.

PubMed

Peterson, Mark E

2015-01-01

Primary goitrous hypothyroidism was diagnosed in a 12-month-old cat examined because of small stature, mental dullness, severe lethargy, generalized weakness and gait abnormalities. Radiographs of the long bones and spine revealed delayed epiphyseal ossification and epiphyseal dysgenesis. Diagnosis of primary hypothyroidism was confirmed by low serum concentrations of total and free thyroxine (T4) with high thyroid-stimulating hormone (TSH) concentrations. Thyroid scintigraphy revealed severe enlargement of both thyroid lobes, as evidenced by a seven-fold increase in calculated thyroid volume above the reference interval. In addition, this bilateral goiter had an extremely high radionuclide uptake, about 10-fold higher than the normal feline thyroid gland. Treatment with twice-daily levothyroxine (L-T4), administered on an empty stomach, resulted in increased alertness, playfulness, strength and improvement in gait, as well as an increase in body length and weight. L-T4 replacement also led to normalization of serum thyroid hormone and TSH concentrations, and complete resolution of goiter. Spontaneous hypothyroidism is rarely reported in cats, with congenital hypothyroidism in kittens diagnosed most frequently. Despite the fact that this cat was a young adult, it likely had a form of congenital hypothyroidism caused by dyshormonogenesis (defect in thyroid hormone synthesis) that led to compensatory development of goiter. In hypothyroid cats, treatment with L-T4 is best given twice daily on an empty stomach to ensure adequate absorption. Normalization of serum TSH and shrinkage of goiter, as well as improvement in clinical signs, is the goal of treatment for cats with goitrous hypothyroidism.

Primary extraskeletal myxoid chondrosarcoma of pulmonary arteries: a rare mimic of acute pulmonary thromboembolism.

PubMed

Gadabanahalli, Karthik; Belaval, Vinay V; Bhat, Venkatraman; Gorur, Imran M

2015-04-01

Primary extraskeletal myxoid chondrosarcoma of the pulmonary arteries is a very rare entity. Multimodality imaging reports on this entity are few. Myxoid chondrosarcoma is characterized by chondroid and neurogenic differentiation in extraskeletal locations. These tumours represent fewer than 2.5% of all soft-tissue sarcomas, and are most commonly found in the lower extremities, limb girdles, distal extremities and trunk. We report an unusual case of a 31-year old man with histopathologically proven extraskeletal myxoid chondrosarcoma of the pulmonary arteries mimicking acute pulmonary thromboembolism. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Combining primary and piggyback intraocular lenses to treat extreme myopic astigmatism in stable keratoconus following cataract surgery.

PubMed

Goh, Yi Wei; Misra, Stuti; Patel, Dipika V; McGhee, Charles N J

2013-03-01

The majority of those with keratoconus can maximise visual acuity with spectacle or contact lens correction as they age; however, as subjects enter their sixties, cataracts may supervene and contact lens tolerance diminishes with consequent reduction in visual acuity. Following cataract extraction, the complex refractive error associated with keratoconus may not be readily corrected by an intraocular lens alone. This report highlights the planned implantation of a primary posterior chamber toric intraocular lens with a secondary piggyback, sulcus-based, intraocular lens in advanced but stable keratoconus with extreme myopic astigmatism and cataract. © 2013 The Authors. Clinical and Experimental Optometry © 2013 Optometrists Association Australia.

Variation in vulnerability to extreme-temperature-related mortality in Japan: A 40-year time-series analysis.

PubMed

Onozuka, Daisuke; Hagihara, Akihito

2015-07-01

Although the impact of extreme heat and cold on mortality has been documented in recent years, few studies have investigated whether variation in susceptibility to extreme temperatures has changed in Japan. We used data on daily total mortality and mean temperatures in Fukuoka, Japan, for 1973-2012. We used time-series analysis to assess the effects of extreme hot and low temperatures on all-cause mortality, stratified by decade, gender, and age, adjusting for time trends. We used a multivariate meta-analysis with a distributed lag non-linear model to estimate pooled non-linear lag-response relationships associated with extreme temperatures on mortality. The relative risk of mortality increased during heat extremes in all decades, with a declining trend over time. The mortality risk was higher during cold extremes for the entire study period, with a dispersed pattern across decades. Meta-analysis showed that both heat and cold extremes increased the risk of mortality. Cold effects were delayed and lasted for several days, whereas heat effects appeared quickly and did not last long. Our study provides quantitative evidence that extreme heat and low temperatures were significantly and non-linearly associated with the increased risk of mortality with substantial variation. Our results suggest that timely preventative measures are important for extreme high temperatures, whereas several days' protection should be provided for extreme low temperatures. Copyright © 2015 Elsevier Inc. All rights reserved.

Truncation of POC1A associated with short stature and extreme insulin resistance.

PubMed

Chen, Jian-Hua; Segni, Maria; Payne, Felicity; Huang-Doran, Isabel; Sleigh, Alison; Adams, Claire; Savage, David B; O'Rahilly, Stephen; Semple, Robert K; Barroso, Inês

2015-10-01

We describe a female proband with primordial dwarfism, skeletal dysplasia, facial dysmorphism, extreme dyslipidaemic insulin resistance and fatty liver associated with a novel homozygous frameshift mutation in POC1A, predicted to affect two of the three protein products of the gene. POC1A encodes a protein associated with centrioles throughout the cell cycle and implicated in both mitotic spindle and primary ciliary function. Three homozygous mutations affecting all isoforms of POC1A have recently been implicated in a similar syndrome of primordial dwarfism, although no detailed metabolic phenotypes were described. Primary cells from the proband we describe exhibited increased centrosome amplification and multipolar spindle formation during mitosis, but showed normal DNA content, arguing against mitotic skipping, cleavage failure or cell fusion. Despite evidence of increased DNA damage in cells with supernumerary centrosomes, no aneuploidy was detected. Extensive centrosome clustering both at mitotic spindles and in primary cilia mitigated the consequences of centrosome amplification, and primary ciliary formation was normal. Although further metabolic studies of patients with POC1A mutations are warranted, we suggest that POC1A may be added to ALMS1 and PCNT as examples of centrosomal or pericentriolar proteins whose dysfunction leads to extreme dyslipidaemic insulin resistance. Further investigation of links between these molecular defects and adipose tissue dysfunction is likely to yield insights into mechanisms of adipose tissue maintenance and regeneration that are critical to metabolic health. © 2015 Society for Endocrinology.

Air pollution or global warming: Attribution of extreme precipitation changes in eastern China—Comments on "Trends of extreme precipitation in Eastern China and their possible causes"

NASA Astrophysics Data System (ADS)

Wang, Yuan

2015-10-01

The recent study "Trends of Extreme Precipitation in Eastern China and Their Possible Causes" attributed the observed decrease/increase of light/heavy precipitation in eastern China to global warming rather than the regional aerosol effects. However, there exist compelling evidence from previous long-term observations and numerical modeling studies, suggesting that anthropogenic pollution is closely linked to the recent changes in precipitation intensity because of considerably modulated cloud physical properties by aerosols in eastern China. Clearly, a quantitative assessment of the aerosol and greenhouse effects on the regional scale is required to identify the primary cause for the extreme precipitation changes.

Primary Sjögren syndrome that initially presented with repeated hypergammaglobulinemic purpura after prolonged sitting: A case report.

PubMed

Zhou, Zhihua; Jiang, Weiqiang; Wang, Ming; Liu, Yongyuan; Zhang, Wei; Huang, Manping; Liang, Donghui

2017-12-01

Purpura is a common dermatologic manifestation in Sjögren syndrome (SS). When a patient presents with sicca symptoms, the diagnosis of SS is not difficult. Here, we reported a case of a 52-year-old Chinese woman who initially presented with nonpalpable purpura on both lower extremities, and these lesions had developed soon after prolonged sitting. In the past 2 years, she had repeated cutaneous nonpalpable purpura 4 times. She had no sicca symptoms, dry eyes, or dry mouth. Combining the laboratory findings, Schirmer test, and labial gland biopsy, primary SS was confirmed. The patient was placed on a trial of hydroxychloroquine (200 mg once daily). The purpura on both lower extremities had faded at the sixth day after onset and at the third day after hydroxychloroquine treatment. These case was not easy to diagnosis primary SS because she had no sicca symptoms. A patient with primary SS who initially presented with recurrent purpura associated with prolonged sitting. Prolonged sitting had been a possible aggravating factor for the cutaneous purpura of this patient with primary SS. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Primary Sjögren syndrome that initially presented with repeated hypergammaglobulinemic purpura after prolonged sitting

PubMed Central

Zhou, Zhihua; Jiang, Weiqiang; Wang, Ming; Liu, Yongyuan; Zhang, Wei; Huang, Manping; Liang, Donghui

2017-01-01

Abstract Rationale: Purpura is a common dermatologic manifestation in Sjögren syndrome (SS). When a patient presents with sicca symptoms, the diagnosis of SS is not difficult. Patient concerns: Here, we reported a case of a 52-year-old Chinese woman who initially presented with nonpalpable purpura on both lower extremities, and these lesions had developed soon after prolonged sitting. In the past 2 years, she had repeated cutaneous nonpalpable purpura 4 times. She had no sicca symptoms, dry eyes, or dry mouth. Diagnoses: Combining the laboratory findings, Schirmer test, and labial gland biopsy, primary SS was confirmed. Interventions: The patient was placed on a trial of hydroxychloroquine (200 mg once daily). Outcomes: The purpura on both lower extremities had faded at the sixth day after onset and at the third day after hydroxychloroquine treatment. Lessons: These case was not easy to diagnosis primary SS because she had no sicca symptoms. A patient with primary SS who initially presented with recurrent purpura associated with prolonged sitting. Prolonged sitting had been a possible aggravating factor for the cutaneous purpura of this patient with primary SS. PMID:29390329

Combination therapies for primary hepatic neuroendocrine carcinoma: a case report.

PubMed

Nakatake, Richi; Ishizaki, Morihiko; Matui, Kosuke; Yanagimoto, Hiroaki; Inoue, Kentaro; Kaibori, Masaki; Kawaguchi, Yusai; Kon, Masanori

2017-09-11

Primary hepatic neuroendocrine carcinomas are extremely rare. Because of the rarity of PHNEC, its clinical features and treatment outcomes are not well understood. A proper diagnosis and the correct therapeutic approach therefore remain clinically challenging. A 67-year-old man was admitted to our department because of a liver tumor. Computed tomography revealed a single liver tumor 50 mm in diameter and located in the S3 region. Biopsy and imaging findings resulted in a diagnosis of primary hepatic neuroendocrine carcinoma. Left lateral segmentectomy was performed. Immunohistochemically, the tumor cells were positive for synaptophysin, chromogranin A, and CD56. Ki-67 was positive in > 90% of the tumor cells. The final diagnosis was primary hepatic neuroendocrine carcinoma. The patient suffered two episodes of lymph node recurrence. Nonetheless, the tumor was excised to prolong survival. Thus, after lymphadenectomy, he received adjuvant chemotherapy for 6 months. Two years after surgery, the patient remains alive and in good general condition. In most cases, primary hepatic neuroendocrine carcinoma, while extremely rare, has a poor prognosis. At present, surgical resection is a priority for curative treatment, but in patients with recurrence, combined therapies are recommended.

Characteristics of Extreme Geoelectric Fields and Their Possible Causes: Localized Peak Enhancements

NASA Astrophysics Data System (ADS)

Pulkkinen, A. A.; Ngwira, C. M.; Bernabeu, E.; Eichner, J.; Viljanen, A.; Crowley, G.

2015-12-01

One of the major challenges pertaining to extreme geomagnetic storms is to understand the basic processes associated with the development of dynamic magnetosphere-ionosphere currents, which generate large induced surface geoelectric fields. Previous studies point out the existence of localized peak geoelectric field enhancements during extreme storms. We examined induced global geoelectric fields derived from ground-based magnetometer recordings for 12 extreme geomagnetic storms between the years 1982--2005. However for the present study, an in-depth analysis was performed for two important extreme storms, October 29, 2003 and March 13, 1989. The primary purpose of this paper is to provide further evidence on the existence of localized peak geoelectric field enhancements, and to show that the structure of the geoelectric field during these localized extremes at single sites can differ greatly from globally and regionally averaged fields. Although the physical processes that govern the development of these localized extremes are still not clear, we discuss some possible causes.

Multilevel extreme lateral interbody fusion (XLIF) and osteotomies for 3-dimensional severe deformity: 25 consecutive cases

PubMed Central

McAfee, Paul C.; Shucosky, Erin; Chotikul, Liana; Salari, Ben; Chen, Lun; Jerrems, Dan

2013-01-01

Background This is a retrospective review of 25 patients with severe lumbar nerve root compression undergoing multilevel anterior retroperitoneal lumbar interbody fusion and posterior instrumentation for deformity. The objective is to analyze the outcomes and clinical results from anterior interbody fusions performed through a lateral approach and compare these with traditional surgical procedures. Methods A consecutive series of 25 patients (78 extreme lateral interbody fusion [XLIF] levels) was identified to illustrate the primary advantages of XLIF in correcting the most extreme of the 3-dimensional deformities that fulfilled the following criteria: (1) a minimum of 40° of scoliosis; (2) 2 or more levels of translation, anterior spondylolisthesis, and lateral subluxation (subluxation in 2 planes), causing symptomatic neurogenic claudication and severe spinal stenosis; and (3) lumbar hypokyphosis or flat-back syndrome. In addition, the majority had trunks that were out of balance (central sacral vertical line ≥2 cm from vertical plumb line) or had sagittal imbalance, defined by a distance between the sagittal vertical line and S1 of greater than 3 cm. There were 25 patients who had severe enough deformities fulfilling these criteria that required supplementation of the lateral XLIF with posterior osteotomies and pedicle screw instrumentation. Results In our database, with a mean follow-up of 24 months, 85% of patients showed evidence of solid arthrodesis and no subsidence on computed tomography and flexion/extension radiographs. The complication rate remained low, with a perioperative rate of 2.4% and postoperative rate of 12.2%. The lateral listhesis and anterior spondylolisthetic subluxation were anatomically reduced with minimally invasive XLIF. The main finding in these 25 cases was our isolation of the major indication for supplemental posterior surgery: truncal decompensation in patients who are out of balance by 2 cm or more, in whom posterior spinal osteotomies and segmental pedicle screw instrumentation were required at follow up. No patients were out of sagittal balance (sagittal vertical line <3 cm from S1) postoperatively. Segmental instrumentation with osteotomies was also more effective for restoration of physiologic lumbar lordosis compared with anterior stand-alone procedures. Conclusions This retrospective study supports the finding that clinical outcomes (coronal/sagittal alignment) improve postoperatively after minimally invasive surgery with multilevel XLIF procedures and are improved compared with larger extensile thoracoabdominal anterior scoliosis procedures. PMID:25694908

What is the safest mode of birth for extremely preterm breech singleton infants who are actively resuscitated? A systematic review and meta-analyses.

PubMed

Grabovac, M; Karim, J N; Isayama, T; Liyanage, S Korale; McDonald, S D

2018-05-01

The safest delivery mode of extremely preterm breech singletons is unknown. To determine safest delivery mode of actively resuscitated extremely preterm breech singletons. We searched Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov from January 1994 to May 2017. We included studies comparing outcomes by delivery mode in actively resuscitated breech infants between 23 +0 and 27 +6 weeks. We synthesised data using random effects, generated odds ratios, 95% confidence intervals and number-needed-to-treat (NNT). Our primary outcomes were death (neonatal, before discharge, or by 6 months) and severe intraventricular haemorrhage (grades III/IV), stratified by gestational age (23 +0 -24 +6 , 25 +0 -26 +6 , 27 +0 -27 +6 weeks). We included 15 studies with 12 335 infants. We found that caesarean section was associated with a 41% decrease in odds of death between 23 +0 and 27 +6 weeks [odds ratio (OR) 0.59, 95% CI 0.36-0.95, NNT 8], with the greatest decrease at 23 +0 -24 +6 weeks (OR 0.58, 95% CI 0.44-0.75, NNT 7). The OR at 25 +0 -26 +6 and 27 +0 -27 +6 weeks were 0.72 (95% CI 0.34-1.52) and 2.04 (95% CI 0.20-20.62), respectively. We found that caesarean section was associated with 49% decrease in odds of severe intraventricular haemorrhage between 23 +0 and 27 +6 weeks (OR 0.51, 95% CI 0.29-0.91, NNT 12), whereas the OR at 25 +0 -26 +6 and 27 +0 -27 +6 was 0.29 (95% CI 0.07-1.12) and 0.91 (95% CI 0.27-3.05), respectively. Caesarean section was associated with reductions in the odds of death by 41% and of severe intraventricular haemorrhage by 49% in actively resuscitated breech singletons < 28 weeks of gestation. The data are mostly observational, which may be inherently biased, and scarce on other morbidities, necessitating thorough discussion between parents and clinicians. Caesarean section associated with lower odds of death and severe intraventricular haemorrhage in actively resuscitated breech singletons <28 weeks. © 2017 Royal College of Obstetricians and Gynaecologists.

Hand grips strength effect on motor function in human brain using fMRI: a pilot study

NASA Astrophysics Data System (ADS)

Ismail, S. S.; Mohamad, M.; Syazarina, S. O.; Nafisah, W. Y.

2014-11-01

Several methods of motor tasks for fMRI scanning have been evolving from simple to more complex tasks. Motor tasks on upper extremity were applied in order to excite the increscent of motor activation on contralesional and ipsilateral hemispheres in brain. The main objective of this study is to study the different conditions for motor tasks on upper extremity that affected the brain activation. Ten healthy right handed with normal vision (3 male and 7 female, age range=20-30 years, mean=24.6 years, SD=2.21) participated in this study. Prior to the scanning, participants were trained on hand grip tasks using rubber ball and pressure gauge tool outside the scanner. During fMRI session, a block design with 30-s task blocks and alternating 30-s rest periods was employed while participants viewed a computer screen via a back projection-mirror system and instructed to follow the instruction by gripping their hand with normal and strong grips using a rubber ball. Statistical Parametric mapping (SPM8) software was used to determine the brain activation. Both tasks activated the primary motor (M1), supplementary motor area (SMA), dorsal and ventral of premotor cortex area (PMA) in left hemisphere while in right hemisphere the area of primary motor (M1) somatosensory was activated. However, the comparison between both tasks revealed that the strong hand grip showed the higher activation at M1, PMA and SMA on left hemisphere and also the area of SMA on right hemisphere. Both conditions of motor tasks could provide insights the functional organization on human brain.

Are Extremes of Consumption in Eating Disorders Related to an Altered Balance between Reward and Inhibition?

PubMed

Wierenga, Christina E; Ely, Alice; Bischoff-Grethe, Amanda; Bailer, Ursula F; Simmons, Alan N; Kaye, Walter H

2014-01-01

The primary defining characteristic of a diagnosis of an eating disorder (ED) is the "disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food" (DSM V; American Psychiatric Association, 2013). There is a spectrum, ranging from those who severely restrict eating and become emaciated on one end to those who binge and overconsume, usually accompanied by some form of compensatory behaviors, on the other. How can we understand reasons for such extremes of food consummatory behaviors? Recent work on obesity and substance use disorders has identified behaviors and neural pathways that play a powerful role in human consummatory behaviors. That is, corticostriatal limbic and dorsal cognitive neural circuitry can make drugs and food rewarding, but also engage self-control mechanisms that may inhibit their use. Importantly, there is considerable evidence that alterations of these systems also occur in ED. This paper explores the hypothesis that an altered balance of reward and inhibition contributes to altered extremes of response to salient stimuli, such as food. We will review recent studies that show altered sensitivity to reward and punishment in ED, with evidence of altered activity in corticostriatal and insula processes with respect to monetary gains or losses, and tastes of palatable foods. We will also discuss evidence for a spectrum of extremes of inhibition and dysregulation behaviors in ED supported by studies suggesting that this is related to top-down self-control mechanisms. The lack of a mechanistic understanding of ED has thwarted efforts for evidence-based approaches to develop interventions. Understanding how ED behavior is encoded in neural circuits would provide a foundation for developing more specific and effective treatment approaches.

A patient with progressive myelopathy and antibodies to human T-cell leukemia virus type I and human immunodeficiency virus type 1 in serum and cerebrospinal fluid.

PubMed

Aboulafia, D M; Saxton, E H; Koga, H; Diagne, A; Rosenblatt, J D

1990-04-01

A 52-year-old human immunodeficiency virus type 1-seropositive bisexual black man was evaluated at UCLA because of the recent onset of progressive lower-extremity weakness. Initial neurologic examination showed that the patient's distal weakness was greater than his proximal weakness, with bilateral foot drop and electrophysiologic evidence of denervation in the distal lower extremities. Magnetic resonance imaging of the brain and spinal cord disclosed no abnormalities. Subsequent neurologic evaluation 8 months later showed a myelopathy, with progression of lower-extremity weakness, spasticity, and flexor spasms, and urinary incontinence, as well as the peripheral neuropathy noted previously. A second magnetic resonance imaging scan of the brain showed patchy foci of increased signal intensity in white matter and cortex, with mild generalized cerebral and cerebellar atrophy and no lesions in the spinal cord. Specimens of the patient's serum and cerebrospinal fluid contained antibodies to human immunodeficiency virus type 1. Additionally, specimens of his serum and cerebrospinal fluid were tested for antibody to human T-cell leukemia virus type I by Western blotting and radioimmunoprecipitation, and found to be positive for human T-cell leukemia virus type I gag, env, and tax antibodies. The primary cause of severe myelopathy in this patient may be infection with human T-cell leukemia virus type I rather than with human immunodeficiency virus type 1. Treatment with prednisolone resulted in improvement of the lower-extremity weakness, reduction in flexor spasms, and slower but significant improvement in urinary symptoms. Patients who are infected with human immunodeficiency virus type 1 and have unusual motor findings should be tested for concomitant human T-cell leukemia virus type I infection.

Low Biotoxicity of Mars Analog Soils Suggests that the Surface of Mars May be Habitable for Terrestrial Microorganisms

NASA Technical Reports Server (NTRS)

Schuerger, A. C.; Ming, Douglas W.; Golden, D. C.

2012-01-01

Recent studies on the interactive effects of hypobaria, low temperatures, and CO2-enriched anoxic atmospheres on the growth of 37 species of mesophilic bacteria identified 14 potential biocidal agents that might affect microbial survival and growth on the martian surface. Biocidal or inhibitory factors include (not in priority): (1) solar UV irradiation, (2) low pressure, (3) extreme desiccating conditions, (4) extreme diurnal temperature fluctuations, (5) solar particle events, (6) galactic cosmic rays, (7) UV-glow discharge from blowing dust, (8) solar UV-induced volatile oxidants [e.g., O2(-), O(-), H2O2, O3], (9) globally distributed oxidizing soils, (10) extremely high salts levels [e.g., MgCl2, NaCl, FeSO4, and MgSO4] in surficial soils at some sites on Mars, (11) high concentrations of heavy metals in martian soils, (12) likely acidic conditions in martian fines, (13) high CO2 concentrations in the global atmosphere, and (14) perchlorate-rich soils. Despite these extreme conditions several studies have demonstrated that dormant spores or vegetative cells of terrestrial microorganisms can survive simulated martian conditions as long as they are protected from UV irradiation. What has not been explored in depth are the effects of potential biotoxic geochemical components of the martian regolith on the survival and growth of microorganisms. The primary objectives of the research included: (1) prepare and characterize Mars analog soils amended with potential biotoxic levels of sulfates, salts, acidifying minerals, etc.; and (2) use the simulants to conduct biotoxicity assays to determine if terrestrial microorganisms from spacecraft can survive direct exposure to the analog soils.

Gram stain microbiological pattern of upper extremities suppuration at Baptist Medical Centre, Ogbomoso Nigeria: a fifteen month review.

PubMed

Oke, A J; Olaolorun, D A; Meier, D E; Tarpley, J L

2011-06-01

Sixty-eight (68) patients with serious upper extremity suppurative infections, presenting within a period of fifteen (15) months, were prospectively studied clinically, Gram stain of aspirates/pus were performed, specimen cultured, planted, and where indicated glucose levels and haemoglobin genotype determined. Half of the patients had hand infections. Staphylococcus aureus was isolated from thirty-nine (39) patients. Gram Negative bacilli, including Salmonella were more isolated from patients with diabetes mellitus or Hgb SS or SC. The Gram stain results correlated with the culture result 90%. When Gram Positive cocci were demonstrated in the primary microscopic examination, cultures were not mandatory. When no organism was demonstrated on primary Gram stain or the patient was diabetic or a sickler, cultures of the specimens were done. The Gram stain, well performed, remains a useful, inexpensive, technologically appropriate laboratory test for abetting decision making in patients with upper extremity suppurative infections. Organisms encountered in this study included: Staphylococcus aureus, Streptococcus pyogenes, Salmonella typhi, Proteus mirabilis, Pseudomonas aeruginosa, and Coliforms.

Severe hypertriglyceridemia does not protect from ischemic brain injury in gene-modified hypertriglyceridemic mice.

PubMed

Chen, Yong; Liu, Ping; Qi, Rong; Wang, Yu-Hui; Liu, George; Wang, Chun

2016-05-15

Hypertriglyceridemia (HTG) is a weak risk factor in primary ischemic stroke prevention. However, clinical studies have found a counterintuitive association between a good prognosis after ischemic stroke and HTG. This "HTG paradox" requires confirmation and further explanation. The aim of this study was to experimentally assess this paradox relationship using the gene-modified mice model of extreme HTG. We first used the human Apolipoprotein CIII transgenic (Tg-ApoCIII) mice and non-transgenic (Non-Tg) littermates to examine the effect of HTG on stroke. To our surprise, infarct size, neurological deficits, brain edema, BBB permeability, neuron density and lipid peroxidation were the same in Tg-ApoCIII mice and Non-Tg mice after temporary middle cerebral artery occlusion (tMCAO). In the late phase (21 days after surgery), no differences were found in brain atrophy, neurological dysfunctions, weight and mortality between the two groups. To confirm the results in Tg-ApoCIII mice, Glycosylphosphatidylinositol-anchored high-density lipoprotein-binding protein 1(GPIHBP1) knockout mice, another severe HTG mouse model, were used and yielded similar results. Our study demonstrates for the first time that extreme HTG does not affect ischemic brain injuries in the tMCAO mouse model, indicating that the association between HTG and good outcomes after ischemic stroke probably represents residual unmeasured confounding. Further clinical and prospective population-based studies are needed to explore variables that contribute to the paradox. Copyright © 2016 Elsevier B.V. All rights reserved.

Vulnerability and resilience of the carbon exchange of a subarctic peatland to an extreme winter event

NASA Astrophysics Data System (ADS)

Parmentier, Frans-Jan W.; Rasse, Daniel P.; Lund, Magnus; Bjerke, Jarle W.; Drake, Bert G.; Weldon, Simon; Tømmervik, Hans; Hansen, Georg H.

2018-06-01

Extreme winter events that damage vegetation are considered an important climatic cause of arctic browning—a reversal of the greening trend of the region—and possibly reduce the carbon uptake of northern ecosystems. Confirmation of a reduction in CO2 uptake due to winter damage, however, remains elusive due to a lack of flux measurements from affected ecosystems. In this study, we report eddy covariance fluxes of CO2 from a peatland in northern Norway and show that vegetation CO2 uptake was delayed and reduced in the summer of 2014 following an extreme winter event earlier that year. Strong frost in the absence of a protective snow cover—its combined intensity unprecedented in the local climate record—caused severe dieback of the dwarf shrub species Calluna vulgaris and Empetrum nigrum. Similar vegetation damage was reported at the time along ~1000 km of coastal Norway, showing the widespread impact of this event. Our results indicate that gross primary production (GPP) exhibited a delayed response to temperature following snowmelt. From snowmelt up to the peak of summer, this reduced carbon uptake by 14 (0–24) g C m‑2 (~12% of GPP in that period)—similar to the effect of interannual variations in summer weather. Concurrently, remotely-sensed NDVI dropped to the lowest level in more than a decade. However, bulk photosynthesis was eventually stimulated by the warm and sunny summer, raising total GPP. Species other than the vulnerable shrubs were probably resilient to the extreme winter event. The warm summer also increased ecosystem respiration, which limited net carbon uptake. This study shows that damage from a single extreme winter event can have an ecosystem-wide impact on CO2 uptake, and highlights the importance of including winter-induced shrub damage in terrestrial ecosystem models to accurately predict trends in vegetation productivity and carbon sequestration in the Arctic and sub-Arctic.

A case report: a young waiter with Paget-Schroetter syndrome.

PubMed

Drakos, Nicholas; Gausche-Hill, Marianne

2013-03-01

Paget-Schroetter syndrome (PSS) is a rare presentation of primary axillary subclavian vein thrombosis that classically occurs in young men with a degree of underlying thoracic outlet syndrome after a period of upper extremity exertion. The primary complication of PSS is post-thrombotic syndrome, a result of chronic venous hypertension. To educate Emergency Physicians on this condition to potentiate timely diagnosis and appropriate disposition. A 29-year-old right-handed restaurant waiter presented with 3 days of non-painful, gradual-onset right upper extremity swelling with normal vital signs. The patient's history was otherwise notable for subjective fevers and a right forearm abrasion. Upon examination, the right upper extremity was neurovascularly intact and remarkable for uniform edema and erythema extending distally from the level of the mid-humerus. The primary differential diagnoses were deep venous thrombosis (DVT) vs. soft tissue infection. Venous phase contrast computed tomography did not reveal evidence of underlying soft tissue infection and was inconclusive regarding a DVT. Ultrasound demonstrated a right subclavian vein DVT. The patient was admitted and underwent thrombolysis, venolysis, and first rib resection and initiation of warfarin. PSS is a rare presentation of upper-extremity DVT occurring classically in patients without commonly recognized pro-thrombotic risk factors. PSS carries the potential of significant morbidity in the form of post-thrombotic syndrome and pulmonary embolism. Current literature suggests that optimal outcomes are achieved when treatment is initiated within 6 weeks of onset. The treatment paradigm calls for thrombolysis and, frequently, a first rib resection. Copyright © 2013 Elsevier Inc. All rights reserved.

Extremal Correlators in the Ads/cft Correspondence

NASA Astrophysics Data System (ADS)

D'Hoker, Eric; Freedman, Daniel Z.; Mathur, Samir D.; Matusis, Alec; Rastelli, Leonardo

The non-renormalization of the 3-point functions

Impacts of climate extremes on gross primary productivity of terrestrial ecosystems in conterminous USA

NASA Astrophysics Data System (ADS)

Wu, X.; Xiao, X.; Zhang, Y.; Zhang, G.

2016-12-01

By offsetting one-third of anthropogenic carbon emissions, terrestrial carbon uptake mitigates atmospheric CO2 concentration and consequent global warming. However, the current global warming trend is inducing more climate extremes, which in turn cause large changes in terrestrial carbon uptake. Here we report the seasonal and regional anomalies of gross primary productivity (GPP) across the conterminous USA (CONUS) in response to two contrasting climate extremes: the cool and wet 2009 versus the warm and dry 2012. We used the Vegetation Photosynthesis Model (VPM, Xiao et al., 2006), MODIS images and NCEP/NARR climate data to estimate GPP from 2009-2014, and evaluated the VPM-predicted GPP with the estimated GPP from the CO2 eddy flux tower sites (24 sites). We analyze the correlation between the anomalies of the continental GPP and the anomalies of temperature and precipitation. The results show a substantial, negative GPP anomaly in 2009, in addition to the positive GPP anomaly in 2012, which was already reported in a previous study (Wolf et al., 2016). We also found that GPP anomalies of different climate regions in four seasons are controlled by either temperature or precipitation. Our study shows the robustness of the VPM to simulate GPP under the condition of climate extremes, and highlights the need of investigating the impacts of cooling events on the terrestrial carbon cycle. Our finding also suggests that there is no uniform pattern for terrestrial ecosystems responding to climate extremes, and that climate extremes should be studied in a case-by-case, location-based approach.

STS-69 postflight presentation

NASA Astrophysics Data System (ADS)

1995-10-01

A postflight conference of the STS-69 mission is presented. The flightcrew ('The Dog Team') consisted of Cmdr. David Walker, Pilot Kenneth Cockrell, Payload Cmdr. James Voss, and Mission Specialists James Newman and Michael Gernhardt. The mission's primary objective was the deployment and retrieval of the SPARTAN-201 satellite, which investigated the interaction between the Sun and it's solar wind. Other secondary experiments and shuttle payloads included the Wake Shield Facility (WSF), which grew several layers of semiconductor films, the International Extreme Ultraviolet Hitchhiker (IEH-1), the Capillary Pumped Loop-2/Gas Bridge Assembly (CAPL-2/GBA), several Get Away Specials (GAS) experiments, the Electrolysis Performance Improvement Concept Study (EPICS), the Thermal Energy Storage (TES-2) experiment, the Commercial Generic Bioprocessing Apparatus-7 (CGBA-7), the National Institutes of Health-Cells 4 (NIH-C4) experiment, and the Biological Research in Canister-6 (BRIC-6) experiment. Earth views consisted of Saudi Arabia water wells, uncommon vortices over Oman, the Amazon River, the Bahamas, Somalia, a sunset over the Earth's horizon, and two hurricanes, Luis and Marilyn.

Updated Intensity - Duration - Frequency Curves Under Different Future Climate Scenarios

NASA Astrophysics Data System (ADS)

Ragno, E.; AghaKouchak, A.

2016-12-01

Current infrastructure design procedures rely on the use of Intensity - Duration - Frequency (IDF) curves retrieved under the assumption of temporal stationarity, meaning that occurrences of extreme events are expected to be time invariant. However, numerous studies have observed more severe extreme events over time. Hence, the stationarity assumption for extreme analysis may not be appropriate in a warming climate. This issue raises concerns regarding the safety and resilience of the existing and future infrastructures. Here we employ historical and projected (RCP 8.5) CMIP5 runs to investigate IDF curves of 14 urban areas across the United States. We first statistically assess changes in precipitation extremes using an energy-based test for equal distributions. Then, through a Bayesian inference approach for stationary and non-stationary extreme value analysis, we provide updated IDF curves based on climatic model projections. This presentation summarizes the projected changes in statistics of extremes. We show that, based on CMIP5 simulations, extreme precipitation events in some urban areas can be 20% more severe in the future, even when projected annual mean precipitation is expected to remain similar to the ground-based climatology.

Responses of gross primary production of grasslands and croplands under drought, pluvial, and irrigation conditions during 2010-2016, Oklahoma, USA

USDA-ARS?s Scientific Manuscript database

To accurately estimate carbon cycling and food production, it is essential to understand how gross primary production (GPP) of irrigated and non-irrigated grasslands and croplands respond to drought and pluvial events. Oklahoma experienced extreme drought in 2011 and record-breaking precipitation in...

Primary pericranial Ewing's sarcoma on the temporal bone: A case report.

PubMed

Kawano, Hiroto; Nitta, Naoki; Ishida, Mitsuaki; Fukami, Tadateru; Nozaki, Kazuhiko

2016-01-01

Primary Ewing's sarcoma originating in the pericranium is an extremely rare disease entity. A 9-year-old female patient was admitted to our department due to a left temporal subcutaneous mass. The mass was localized under the left temporal muscle and attached to the surface of the temporal bone. Head computed tomography revealed a mass with bony spicule formation on the temporal bone, however, it did not show bone destruction or intracranial invasion. F-18 fluorodeoxyglucose positron emission tomography showed no lesions other than the mass on the temporal bone. Magnetic resonance imaging showed that the mass was located between the temporal bone and the pericranium. The mass was completely resected with the underlying temporal bone and the overlying deep layer of temporal muscle, and was diagnosed as primary Ewing's sarcoma. Because the tumor was located in the subpericranium, we created a new classification, "pericranial Ewing's sarcoma," and diagnosed the present tumor as pericranial Ewing's sarcoma. We herein present an extremely rare case of primary pericranial Ewing's sarcoma that developed on the temporal bone.

Asymmetric responses of primary productivity to precipitation extremes: A synthesis of grassland precipitation manipulation experiments

DOE PAGES

Wilcox, Kevin R.; Shi, Zheng; Gherardi, Laureano A.; ...

2017-04-02

Climatic changes are altering Earth's hydrological cycle, resulting in altered precipitation amounts, increased interannual variability of precipitation, and more frequent extreme precipitation events. These trends will likely continue into the future, having substantial impacts on net primary productivity (NPP) and associated ecosystem services such as food production and carbon sequestration. Frequently, experimental manipulations of precipitation have linked altered precipitation regimes to changes in NPP. Yet, findings have been diverse and substantial uncertainty still surrounds generalities describing patterns of ecosystem sensitivity to altered precipitation. Additionally, we do not know whether previously observed correlations between NPP and precipitation remain accurate when precipitationmore » changes become extreme. We synthesized results from 83 case studies of experimental precipitation manipulations in grasslands worldwide. Here, we used meta-analytical techniques to search for generalities and asymmetries of aboveground NPP (ANPP) and belowground NPP (BNPP) responses to both the direction and magnitude of precipitation change. Sensitivity (i.e., productivity response standardized by the amount of precipitation change) of BNPP was similar under precipitation additions and reductions, but ANPP was more sensitive to precipitation additions than reductions; this was especially evident in drier ecosystems. Additionally, overall relationships between the magnitude of productivity responses and the magnitude of precipitation change were saturating in form. The saturating form of this relationship was likely driven by ANPP responses to very extreme precipitation increases, although there were limited studies imposing extreme precipitation change, and there was considerable variation among experiments. Finally, this highlights the importance of incorporating gradients of manipulations, ranging from extreme drought to extreme precipitation increases into future climate change experiments. Additionally, policy and land management decisions related to global change scenarios should consider how ANPP and BNPP responses may differ, and that ecosystem responses to extreme events might not be predicted from relationships found under moderate environmental changes.« less

Asymmetric responses of primary productivity to precipitation extremes: A synthesis of grassland precipitation manipulation experiments.

PubMed

Wilcox, Kevin R; Shi, Zheng; Gherardi, Laureano A; Lemoine, Nathan P; Koerner, Sally E; Hoover, David L; Bork, Edward; Byrne, Kerry M; Cahill, James; Collins, Scott L; Evans, Sarah; Gilgen, Anna K; Holub, Petr; Jiang, Lifen; Knapp, Alan K; LeCain, Daniel; Liang, Junyi; Garcia-Palacios, Pablo; Peñuelas, Josep; Pockman, William T; Smith, Melinda D; Sun, Shanghua; White, Shannon R; Yahdjian, Laura; Zhu, Kai; Luo, Yiqi

2017-10-01

Climatic changes are altering Earth's hydrological cycle, resulting in altered precipitation amounts, increased interannual variability of precipitation, and more frequent extreme precipitation events. These trends will likely continue into the future, having substantial impacts on net primary productivity (NPP) and associated ecosystem services such as food production and carbon sequestration. Frequently, experimental manipulations of precipitation have linked altered precipitation regimes to changes in NPP. Yet, findings have been diverse and substantial uncertainty still surrounds generalities describing patterns of ecosystem sensitivity to altered precipitation. Additionally, we do not know whether previously observed correlations between NPP and precipitation remain accurate when precipitation changes become extreme. We synthesized results from 83 case studies of experimental precipitation manipulations in grasslands worldwide. We used meta-analytical techniques to search for generalities and asymmetries of aboveground NPP (ANPP) and belowground NPP (BNPP) responses to both the direction and magnitude of precipitation change. Sensitivity (i.e., productivity response standardized by the amount of precipitation change) of BNPP was similar under precipitation additions and reductions, but ANPP was more sensitive to precipitation additions than reductions; this was especially evident in drier ecosystems. Additionally, overall relationships between the magnitude of productivity responses and the magnitude of precipitation change were saturating in form. The saturating form of this relationship was likely driven by ANPP responses to very extreme precipitation increases, although there were limited studies imposing extreme precipitation change, and there was considerable variation among experiments. This highlights the importance of incorporating gradients of manipulations, ranging from extreme drought to extreme precipitation increases into future climate change experiments. Additionally, policy and land management decisions related to global change scenarios should consider how ANPP and BNPP responses may differ, and that ecosystem responses to extreme events might not be predicted from relationships found under moderate environmental changes. © 2017 John Wiley & Sons Ltd.

Impacts of climate extremes on gross primary production under global warming

DOE PAGES

Williams, I. N.; Torn, M. S.; Riley, W. J.; ...

2014-09-24

The impacts of historical droughts and heat-waves on ecosystems are often considered indicative of future global warming impacts, under the assumption that water stress sets in above a fixed high temperature threshold. Historical and future (RCP8.5) Earth system model (ESM) climate projections were analyzed in this study to illustrate changes in the temperatures for onset of water stress under global warming. The ESMs examined here predict sharp declines in gross primary production (GPP) at warm temperature extremes in historical climates, similar to the observed correlations between GPP and temperature during historical heat-waves and droughts. However, soil moisture increases at themore » warm end of the temperature range, and the temperature at which soil moisture declines with temperature shifts to a higher temperature. The temperature for onset of water stress thus increases under global warming and is associated with a shift in the temperature for maximum GPP to warmer temperatures. Despite the shift in this local temperature optimum, the impacts of warm extremes on GPP are approximately invariant when extremes are defined relative to the optimal temperature within each climate period. The GPP sensitivity to these relative temperature extremes therefore remains similar between future and present climates, suggesting that the heat- and drought-induced GPP reductions seen recently can be expected to be similar in the future, and may be underestimates of future impacts given model projections of increased frequency and persistence of heat-waves and droughts. The local temperature optimum can be understood as the temperature at which the combination of water stress and light limitations is minimized, and this concept gives insights into how GPP responds to climate extremes in both historical and future climate periods. Both cold (temperature and light-limited) and warm (water-limited) relative temperature extremes become more persistent in future climate projections, and the time taken to return to locally optimal climates for GPP following climate extremes increases by more than 25% over many land regions.« less

Impacts of climate extremes on gross primary production under global warming

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

Williams, I. N.; Torn, M. S.; Riley, W. J.

The impacts of historical droughts and heat-waves on ecosystems are often considered indicative of future global warming impacts, under the assumption that water stress sets in above a fixed high temperature threshold. Historical and future (RCP8.5) Earth system model (ESM) climate projections were analyzed in this study to illustrate changes in the temperatures for onset of water stress under global warming. The ESMs examined here predict sharp declines in gross primary production (GPP) at warm temperature extremes in historical climates, similar to the observed correlations between GPP and temperature during historical heat-waves and droughts. However, soil moisture increases at themore » warm end of the temperature range, and the temperature at which soil moisture declines with temperature shifts to a higher temperature. The temperature for onset of water stress thus increases under global warming and is associated with a shift in the temperature for maximum GPP to warmer temperatures. Despite the shift in this local temperature optimum, the impacts of warm extremes on GPP are approximately invariant when extremes are defined relative to the optimal temperature within each climate period. The GPP sensitivity to these relative temperature extremes therefore remains similar between future and present climates, suggesting that the heat- and drought-induced GPP reductions seen recently can be expected to be similar in the future, and may be underestimates of future impacts given model projections of increased frequency and persistence of heat-waves and droughts. The local temperature optimum can be understood as the temperature at which the combination of water stress and light limitations is minimized, and this concept gives insights into how GPP responds to climate extremes in both historical and future climate periods. Both cold (temperature and light-limited) and warm (water-limited) relative temperature extremes become more persistent in future climate projections, and the time taken to return to locally optimal climates for GPP following climate extremes increases by more than 25% over many land regions.« less

Simulated trends of extreme climate indices for the Carpathian basin using outputs of different regional climate models

NASA Astrophysics Data System (ADS)

Pongracz, R.; Bartholy, J.; Szabo, P.; Pieczka, I.; Torma, C. S.

2009-04-01

Regional climatological effects of global warming may be recognized not only in shifts of mean temperature and precipitation, but in the frequency or intensity changes of different climate extremes. Several climate extreme indices are analyzed and compared for the Carpathian basin (located in Central/Eastern Europe) following the guidelines suggested by the joint WMO-CCl/CLIVAR Working Group on climate change detection. Our statistical trend analysis includes the evaluation of several extreme temperature and precipitation indices, e.g., the numbers of severe cold days, winter days, frost days, cold days, warm days, summer days, hot days, extremely hot days, cold nights, warm nights, the intra-annual extreme temperature range, the heat wave duration, the growing season length, the number of wet days (using several threshold values defining extremes), the maximum number of consecutive dry days, the highest 1-day precipitation amount, the greatest 5-day rainfall total, the annual fraction due to extreme precipitation events, etc. In order to evaluate the future trends (2071-2100) in the Carpathian basin, daily values of meteorological variables are obtained from the outputs of various regional climate model (RCM) experiments accomplished in the frame of the completed EU-project PRUDENCE (Prediction of Regional scenarios and Uncertainties for Defining EuropeaN Climate change risks and Effects). Horizontal resolution of the applied RCMs is 50 km. Both scenarios A2 and B2 are used to compare past and future trends of the extreme climate indices for the Carpathian basin. Furthermore, fine-resolution climate experiments of two additional RCMs adapted and run at the Department of Meteorology, Eotvos Lorand University are used to extend the trend analysis of climate extremes for the Carpathian basin. (1) Model PRECIS (run at 25 km horizontal resolution) was developed at the UK Met Office, Hadley Centre, and it uses the boundary conditions from the HadCM3 GCM. (2) Model RegCM3 (run at 10 km horizontal resolution) was developed by Giorgi et al. and it is available from the ICTP (International Centre for Theoretical Physics). Analysis of the simulated daily temperature datasets suggests that the detected regional warming is expected to continue in the 21st century. Cold temperature extremes are projected to decrease while warm extremes tend to increase significantly. Expected changes of annual precipitation indices are small, but generally consistent with the detected trends of the 20th century. Based on the simulations, extreme precipitation events are expected to become more intense and more frequent in winter, while a general decrease of extreme precipitation indices is expected in summer.

Treatment considerations in hutchinson-gilford progeria syndrome: a case report.

PubMed

Hazan-Molina, H; Aizenbud, D; Dror, Aizenbud D

2015-01-01

Hutchinson-Guilford progeria syndrome is an extremely rare condition classified as one of the premature ageing syndromes. This case presents a 16-year-old Israeli female patient, suffering from a variant of Hutchinson-Guilford progeria with a history of treatment with oral biphosphnates. The patient presented with typical cranial and facial features of the syndrome including delayed teeth eruption and root development probably due to insufficient jaw growth and severs retrognatic position of the maxilla and mandible. Orthodontic treatment considerations are described along with those required in light of the previous treatment by oral biphosphonates.All primary teeth were extracted in three appointments while creating as minimal trauma as possible to the surrounding tissue and alveolar bone. For now, the patient refuses to begin the orthodontic treatment course. There are no limitations to conduct any dental procedures in progeria patients, however, extreme caution must be exercised during oral surgery due to the inelasticity of tissues and dermal atrophy. Orthodontic procedure commencement should be early enough to manage the delayed development and eruption of teeth. Patients taking oral biphosphonates should be advised of this potential complication. If orthodontic treatment is considered appropriate, plans should be assessed and modified to include compromises.

Predicting Extreme Droughts in Savannah Africa: A Comparison of Proxy and Direct Measures in Detecting Biomass Fluctuations, Trends and Their Causes.

PubMed

Western, David; Mose, Victor N; Worden, Jeffrey; Maitumo, David

2015-01-01

We monitored pasture biomass on 20 permanent plots over 35 years to gauge the reliability of rainfall and NDVI as proxy measures of forage shortfalls in a savannah ecosystem. Both proxies are reliable indicators of pasture biomass at the onset of dry periods but fail to predict shortfalls in prolonged dry spells. In contrast, grazing pressure predicts pasture deficits with a high degree of accuracy. Large herbivores play a primary role in determining the severity of pasture deficits and variation across habitats. Grazing pressure also explains oscillations in plant biomass unrelated to rainfall. Plant biomass has declined steadily and biomass per unit of rainfall has fallen by a third, corresponding to a doubling in grazing intensity over the study period. The rising probability of forage deficits fits local pastoral perceptions of an increasing frequency of extreme shortfalls. The decline in forage is linked to sedentarization, range loss and herbivore compression into drought refuges, rather than climate change. The results show that the decline in rangeland productivity and increasing frequency of pasture shortfalls can be ameliorated by better husbandry practices and reinforces the need for ground monitoring to complement remote sensing in forecasting pasture shortfalls.

ARkStorm@Tahoe: Science as a foundation for discussing, recognizing and mitigating storm-disaster vulnerabilities in mountain and downstream communities

NASA Astrophysics Data System (ADS)

McCarthy, M.; Dettinger, M. D.; Kauneckis, D. L.; Cox, D. A.; Albano, C.; Welborn, T.

2014-12-01

Atmospheric rivers (ARs) have historically caused ~80% of the most extreme winter storms and largest floods in California and parts of northwestern Nevada. In 2010, the U.S. Geological Survey developed the ARkStorm extreme-storm scenario to quantify risks from extreme winter storms and to allow stakeholders to explore and mitigate potential impacts. The scenario was constructed by concatenating two historical AR sequences and quantified by simulating them using a regional-weather model nested within global weather fields, resulting in a climatologically plausible 23-day storm sequence. The ARkStorm@Tahoe scenario was presented at six meetings with over 300 participants from local agencies, first-responders and local communities, each meeting having a different geographic or sectoral focus. These stakeholder meetings and an 18-question survey identified a wide range of social and ecological vulnerabilities to extreme winter storms, science and information needs to prepare and mitigate consequenses, and proactive measures to minimize impacts. Interruption of transportation, communications, and lack of power and backup fuel supplies were identified as the most likely and primary points of failure across multiple sectors and geographies, as these interruptions have cascading effects on natural and human environments by impeding emergency response efforts. Natural resource impacts of greatest concern include flooding, impacts to water quality, spread and establishment of invasive species, and interactions with other disturbance types (e.g., fire, landslides). Science needs include improved monitoring and models to facilitate better prediction and response, real-time and forecast inundation mapping to understand flood risks, and vulnerability assessments related to geomorphic hazards and water quality impacts. Results from this effort highlight several opportunities for increasing the resilience of communities and the environment to extreme storm events. Information collected in these meetings was used to develop a "tabletop" emergency-response exercise with over 120 participants in March 2014, as well as reports back to the community including specific recommendations for increasing preparedness, response, recovery, and resilience to extreme winter storm events.

An Examination of Extreme Fire Behavior and its Impact on Smoke Injection Altitude using Remote Sensing and Meteorological Data

NASA Astrophysics Data System (ADS)

Peterson, D. A.; Hyer, E. J.; Campbell, J. R.; Fromm, M. D.; Hair, J. W.; Butler, C. F.; Fenn, M. A.

2014-12-01

A variety of regional smoke forecasting applications are currently available to identify air quality, visibility, and societal impacts during large fire events. However, these systems typically assume persistent fire activity, and therefore can have large errors before, during, and after short-term periods of extreme fire behavior. This study employs a wide variety of ground, airborne, and satellite observations, including data collected during a major NASA airborne and field campaign, to examine the conditions required for both extreme spread and pyrocumulonimbus (pyroCb) development. Results highlight the importance of upper-level and nocturnal meteorology, as well as the limitations of traditional fire weather indices. Increasing values of fire radiative power (FRP) at the pixel and sub-pixel level are shown to systematically correspond to higher altitude smoke plumes, and an increased probability of injection above the boundary layer. Lidar data collected during the 2013 Rim Fire, one of the most severe fire events in California's history, show that high FRP observed during extreme spread can facilitate long-distance smoke transport, but fails to loft smoke to the altitude of a large pyroCb. The most extreme fire spread was also observed on days without pyroCb activity or significant regional convection. By incorporating additional fire events across North America, conflicting hypotheses surrounding the primary source of moisture during pyroCb development are examined. The majority of large pyroCbs, and therefore the highest direct injection altitude of smoke particles, is shown to occur with conditions very similar to those that produce dry thunderstorms. The current suite of automated forecasting applications predict only general trends in fire behavior, and specifically do not predict (1) extreme fire spread events and (2) injection of smoke to high altitudes. While (1) and (2) are related, results show that they are not predicted by the same set of conditions and variables. The combination of meteorology from numerical forecast models and satellite observations exhibits great potential for improving regional forecasts of fire behavior and smoke production in automated systems, especially in remote areas where detailed observations are unavailable

Virtual field trips: exploring a new approach to ocean education

NASA Astrophysics Data System (ADS)

Cary, C.; Bryant, T.

2003-04-01

During the past four years with primary support from the National Science Foundation, the University of Delaware College of Marine Studies has launched the "Extreme series" of virtual field trips to get students and the public excited -- and learning -- about science by enabling them to follow along with researchers as they explore hydrothermal vents in the Pacific Ocean. The Extreme series has blossomed from a small pilot project involving about 800 students in 14 schools primarily in Delaware, to a thriving program that last year welcomed aboard more than 500 schools representing over 42,000 students from across the United States and in several foreign countries. Participants range from small, rural schools on American Indian reservations and in the landlocked states of America's "heartland," to large public schools in major coastal cities such as New York and Los Angeles. Each participating teacher receives a resource package containing student guides, curricula, evaluation tools, and a documentary video. During the expedition, an interactive Web site serves as the program's "lifeline." Education coordinators aboard ship -- a UD graduate student and a schoolteacher -- post daily journals, conduct experiments submitted by classrooms, and relay photos and video clips back to shore each day for uploading to the Web site. The project also involves selected classrooms in teleconferences with scientists working live on the seafloor aboard the submersible Alvin. Evaluated for its educational quality and impact, the Extreme series continues to grow and develop with the enthusiastic support of teachers.

Surviving in a frozen desert: environmental stress physiology of terrestrial Antarctic arthropods.

PubMed

Teets, Nicholas M; Denlinger, David L

2014-01-01

Abiotic stress is one of the primary constraints limiting the range and success of arthropods, and nowhere is this more apparent than Antarctica. Antarctic arthropods have evolved a suite of adaptations to cope with extremes in temperature and water availability. Here, we review the current state of knowledge regarding the environmental physiology of terrestrial arthropods in Antarctica. To survive low temperatures, mites and Collembola are freeze-intolerant and rely on deep supercooling, in some cases supercooling below -30°C. Also, some of these microarthropods are capable of cryoprotective dehydration to extend their supercooling capacity and reduce the risk of freezing. In contrast, the two best-studied Antarctic insects, the midges Belgica antarctica and Eretmoptera murphyi, are freeze-tolerant year-round and rely on both seasonal and rapid cold-hardening to cope with decreases in temperature. A common theme among Antarctic arthropods is extreme tolerance of dehydration; some accomplish this by cuticular mechanisms to minimize water loss across their cuticle, while a majority have highly permeable cuticles but tolerate upwards of 50-70% loss of body water. Molecular studies of Antarctic arthropod stress physiology are still in their infancy, but several recent studies are beginning to shed light on the underlying mechanisms that govern extreme stress tolerance. Some common themes that are emerging include the importance of cuticular and cytoskeletal rearrangements, heat shock proteins, metabolic restructuring and cell recycling pathways as key mediators of cold and water stress in the Antarctic.

Significantly Increased Extreme Precipitation Expected in Europe and North America from Extratropical Storms

NASA Astrophysics Data System (ADS)

Hawcroft, M.; Hodges, K.; Walsh, E.; Zappa, G.

2017-12-01

For the Northern Hemisphere extratropics, changes in circulation are key to determining the impacts of climate warming. The mechanisms governing these circulation changes are complex, leading to the well documented uncertainty in projections of the future location of the mid-latitude storm tracks simulated by climate models. These storms are the primary source of precipitation for North America and Europe and generate many of the large-scale precipitation extremes associated with flooding and severe economic loss. Here, we show that in spite of the uncertainty in circulation changes, by analysing the behaviour of the storms themselves, we find entirely consistent and robust projections across an ensemble of climate models. In particular, we find that projections of change in the most intensely precipitating storms (above the present day 99th percentile) in the Northern Hemisphere are substantial and consistent across models, with large increases in the frequency of both summer (June-August, +226±68%) and winter (December-February, +186±34%) extreme storms by the end of the century. Regionally, both North America (summer +202±129%, winter +232±135%) and Europe (summer +390±148%, winter +318±114%) are projected to experience large increases in the frequency of intensely precipitating storms. These changes are thermodynamic and driven by surface warming, rather than by changes in the dynamical behaviour of the storms. Such changes in storm behaviour have the potential to have major impacts on society given intensely precipitating storms are responsible for many large-scale flooding events.

Treatment of Palmar Plantar Erythrodysesthesia (PPE) with Topical Sildenafil: A Pilot Study

PubMed Central

Meadows, Kellen L.; Rushing, Christel; Honeycutt, Wanda; Latta, Kenneth; Howard, Leigh; Arrowood, Christy A.; Niedzwiecki, Donna; Hurwitz, Herbert I.

2016-01-01

Purpose Palmar-plantar erythrodysethesia (PPE) is a common chemotherapy and anti-VEGF multi-kinase inhibitor class-related toxicity that often results in debilitating skin changes and often limits the use of active anti-cancer regimens. Mechanistic and anecdotal clinical evidence suggested that topical application of sildenafil cream may help reduce the severity of PPE. Therefore, we conducted a randomized, double-blind, placebo-controlled pilot study to evaluate the feasibility, safety and efficacy of topical sildenafil cream for the treatment of PPE. Methods Eligible subjects were required to have grade 1–3 PPE associated with either capecitabine or sunitinib. Subjects were randomized to receive 1% topical sildenafil cream to the left extremities or right extremities and placebo cream on the opposite extremity. 0.5 mL of cream was applied to each affected hand/foot two times per day. The primary endpoint was improvement in PPE grading at any point on study. Clinical assessments were evaluated by NCI-CTC 4.0 grading and patient self-reported pain. Results Ten subjects were enrolled; 9 were evaluable for safety and efficacy. Five of nine subjects reported some improvement in foot pain and 3 of 8 subjects for hand pain improvement. One of these subjects noted specific improvement in tactile function. No treatment-related toxicities were observed. Conclusions In this limited, single center study, topical cream containing 1% sildenafil is feasible to administer, is well-tolerated, and may mitigate PPE-related symptoms due to anti-cancer therapeutic agents. Further validation is necessary. PMID:25341548

A Randomized, Controlled Trial of Mirror Therapy for Upper Extremity Phantom Limb Pain in Male Amputees.

PubMed

Finn, Sacha B; Perry, Briana N; Clasing, Jay E; Walters, Lisa S; Jarzombek, Sandra L; Curran, Sean; Rouhanian, Minoo; Keszler, Mary S; Hussey-Andersen, Lindsay K; Weeks, Sharon R; Pasquina, Paul F; Tsao, Jack W

2017-01-01

Phantom limb pain (PLP) is prevalent in patients post-amputation and is difficult to treat. We assessed the efficacy of mirror therapy in relieving PLP in unilateral, upper extremity male amputees. Fifteen participants from Walter Reed and Brooke Army Medical Centers were randomly assigned to one of two groups: mirror therapy ( n  = 9) or control ( n  = 6, covered mirror or mental visualization therapy). Participants were asked to perform 15 min of their assigned therapy daily for 5 days/week for 4 weeks. The primary outcome was pain as measured using a 100-mm Visual Analog Scale. Subjects in the mirror therapy group had a significant decrease in pain scores, from a mean of 44.1 (SD = 17.0) to 27.5 (SD = 17.2) mm ( p  = 0.002). In addition, there was a significant decrease in daily time experiencing pain, from a mean of 1,022 (SD = 673) to 448 (SD = 565) minutes ( p  = 0.003). By contrast, the control group had neither diminished pain ( p  = 0.65) nor decreased overall time experiencing pain ( p  = 0.49). A pain decrement response seen by the 10th treatment session was predictive of final efficacy. These results confirm that mirror therapy is an effective therapy for PLP in unilateral, upper extremity male amputees, reducing both severity and duration of daily episodes. NCT0030144 ClinicalTrials.gov.

Secondary abdominal compartment syndrome after complicated traumatic lower extremity vascular injuries.

PubMed

Macedo, F I B; Sciarretta, J D; Otero, C A; Ruiz, G; Ebler, D J; Pizano, L R; Namias, N

2016-04-01

Secondary abdominal compartment syndrome (ACS) can occur in trauma patients without abdominal injuries. Surgical management of patients presenting with secondary ACS after isolated traumatic lower extremity vascular injury (LEVI) continues to evolve, and associated outcomes remain unknown. From January 2006 to September 2011, 191 adult trauma patients presented to the Ryder Trauma Center, an urban level I trauma center in Miami, Florida with traumatic LEVIs. Among them 10 (5.2 %) patients were diagnosed with secondary ACS. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications, and outcomes. Mean age was 37.4 ± 18.0 years (range 16-66 years), and the majority of patients were males (8 patients, 80 %). There were 7 (70 %) penetrating injuries (5 gunshot wounds and 2 stab wounds), and 3 blunt injuries with mean Injury Severity Score (ISS) 21.9 ± 14.3 (range 9-50). Surgical management of LEVIs included ligation (4 patients, 40 %), primary repair (1 patient, 10 %), reverse saphenous vein graft (2 patients, 20 %), and PTFE interposition grafting (3 patients, 30 %). The overall mortality rate in this series was 60 %. The association between secondary ACS and lower extremity vascular injuries carries high morbidity and mortality rates. Further research efforts should focus at identifying parameters to accurately determine resuscitation goals, and therefore, prevent such a devastating condition.

Additional support for the TDK/MABL computer program

NASA Technical Reports Server (NTRS)

Nickerson, G. R.; Dunn, Stuart S.

1993-01-01

An advanced version of the Two-Dimensional Kinetics (TDK) computer program was developed under contract and released to the propulsion community in early 1989. Exposure of the code to this community indicated a need for improvements in certain areas. In particular, the TDK code needed to be adapted to the special requirements imposed by the Space Transportation Main Engine (STME) development program. This engine utilizes injection of the gas generator exhaust into the primary nozzle by means of a set of slots. The subsequent mixing of this secondary stream with the primary stream with finite rate chemical reaction can have a major impact on the engine performance and the thermal protection of the nozzle wall. In attempting to calculate this reacting boundary layer problem, the Mass Addition Boundary Layer (MABL) module of TDK was found to be deficient in several respects. For example, when finite rate chemistry was used to determine gas properties, (MABL-K option) the program run times became excessive because extremely small step sizes were required to maintain numerical stability. A robust solution algorithm was required so that the MABL-K option could be viable as a rocket propulsion industry design tool. Solving this problem was a primary goal of the phase 1 work effort.

Warmer weather as a risk factor for hospitalisations due to urinary tract infections.

PubMed

Simmering, J E; Cavanaugh, J E; Polgreen, L A; Polgreen, P M

2018-02-01

The incidence of urinary tract infections (UTIs) is seasonal, and this seasonality may be explained by changes in weather, specifically, temperature. Using data from the Nationwide Inpatient Sample, we identified the geographic location for 581 813 hospital admissions with the primary diagnosis of a UTI and 56 630 773 non-UTI hospitalisations in the United States. Next, we used data from the National Climatic Data Center to estimate the monthly average temperature for each location. Using a case-control design, we modelled the odds of a hospital admission having a primary diagnosis of UTI as a function of demographics, payer, location, patient severity, admission month, year and the average temperature for the admission month. We found, after controlling for patient factors and month of admission, the odds of a UTI diagnosis increased with higher temperatures in a dose-dependent manner. For example, relative to months with average temperatures of 5-7.5 °C, an admission in a month with an average temperature of 27.5-30 °C has 20% higher odds of a primary diagnosis of UTI. However, in months with extremely high average temperatures (above 30 °C), the odds of a UTI admissions decrease, perhaps due to changes in behaviour. Thus, at a population level, UTI-related hospitalisations are associated with warmer weather.

Prevalence and change of malocclusions from primary to early permanent dentition: a longitudinal study.

PubMed

Dimberg, Lillemor; Lennartsson, Bertil; Arnrup, Kristina; Bondemark, Lars

2015-09-01

To follow a group of children from primary to early permanent dentition and determine the prevalence, self-correction, and new development of malocclusions; the need for orthodontic treatment; and the possible influences of habits, breathing disturbances, and allergies. Two hundred and seventy-seven children were followed at 3, 7, and 11.5 years of age. Malocclusions and orthodontic treatment need were determined by clinical examinations. Data on sucking habits, breathing disturbances, allergies, dental trauma, and orthodontic treatments were collected from a questionnaire and dental records. Malocclusions were found in 71% of participants at 3 years of age, 56% at 7 years of age, and 71% at 11.5 years of age. Self-correction was noted for anterior open bite, sagittal malocclusions, and posterior crossbite, while deep bite developed. A high number of contact point displacements and spacings contributed to the prevalence of malocclusion rate of 71% at 11.5 years. Severe or extreme orthodontic treatment need was apparent in 22%. Habits, allergies, or breathing disturbances found at 3 years of age had no associations with malocclusions at 11.5 years of age. This sample revealed a significant percentage of malocclusions and orthodontic treatment need. A substantial number of self-corrections and establishment of new malocclusions occurred during the transition from primary to early permanent dentition.

Crash analysis of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts.

PubMed

Bennett, Tellen D; Kaufman, Robert; Schiff, Melissa; Mock, Charles; Quan, Linda

2006-09-01

The mechanism, crash characteristics, and spectrum of lower extremity injuries in children restrained in forward-facing car seats during front and rear impacts have not been described. We identified in two databases children who sustained lower extremity injuries while restrained in forward-facing car seats. To identify the mechanism, we analyzed crash reconstructions from three frontal-impact cases from the Crash Injury Research and Engineering Network. To further describe the crash and injury characteristics we evaluated children between 1 and 4 years of age with lower extremity injuries from front or rear impacts in the National Automotive Sampling System (NASS) Crashworthiness Data System (CDS) database. Crash reconstruction data demonstrated that the likely mechanism of lower extremity injury was contact between the legs and the front seatbacks. In the CDS database, we identified 15 children with lower extremity injuries in a forward-facing child seat, usually (13 out of 15) placed in the rear seat, incurred in frontal impacts (11 out of 15). Several (5 out of 15) children were in unbelted or improperly secured forward-facing car seats. Injury Severity Scores varied widely (5-50). Children in forward-facing car seats involved in severe front or rear crashes may incur a range of lower extremity injury from impact with the car interior component in front of them. Crash scene photography can provide useful information about anatomic sites at risk for injury and alert emergency department providers to possible subtle injury.

Case of streptococcal toxic shock syndrome caused by rapidly progressive group A hemolytic streptococcal infection during postoperative chemotherapy for cervical cancer.

PubMed

Nogami, Yuya; Tsuji, Kousuke; Banno, Kouji; Umene, Kiyoko; Katakura, Satomi; Kisu, Iori; Tominaga, Eiichiro; Aoki, Daisuke

2014-01-01

Streptococcal toxic shock syndrome (STSS) is a severe infectious disease caused by group A hemolytic streptococcus (Streptococcus pyogenes). This condition is a serious disease that involves rapidly progressive septic shock. We experienced a case of STSS caused by primary peritonitis during treatment with paclitaxel and cisplatin (TP therapy) as postoperative chemotherapy for cervical cancer. STSS mostly develops after extremity pain, but initial influenza-like symptoms of fever, chill, myalgia and gastrointestinal symptoms may also occur. TP therapy is used to treat many cancers, including gynecological cancer, but may cause adverse reactions of neuropathy and nephrotoxicity and sometimes fever, arthralgia, myalgia, abdominal pain and general malaise. The case reported here indicates that development of STSS can be delayed after chemotherapy and that primary STSS symptoms may be overlooked because they may be viewed as adverse reactions to chemotherapy. To our knowledge, this is the first report of a case of STSS during chemotherapy. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

[Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: a case report].

PubMed

Golubović, Ivan; Vukašinović, Zoran; Stojiljković, Predrag; Golubović, Zoran; Stojiljković, Danilo; Radovanović, Zoran; Ilić, Nenad; Najman, Stevo; Višnjić, Aleksandar; Arsić, Stojanka

2012-01-01

The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. Contamination and devitalization of the soft-tissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury.

Unusual presentation of a metastatic uveal melanoma in a cat.

PubMed

Planellas, Marta; Pastor, Josep; Torres, Ma Dolores; Peña, Teresa; Leiva, Marta

2010-11-01

A 10 year-old, spayed female Domestic Short-Haired (DSH) cat was diagnosed with a large primary uveal melanoma and exenteration was recommended. Thoracic radiographs, abdominal ultrasonography, and complete blood count and serum biochemistry panel did not reveal any abnormality compatible with metastatic disease and surgery was performed. Histopathologic study of the eye confirmed a diffuse iris melanoma. Five months later, the cat presented with a lameness of the right anterior extremity. On physical exam the right elbow was swollen and painful. Radiographs showed a severe osteolysis of the radial head and proximal diaphysis. Fine needle aspiration of the radius head identified a round cell neoplasm with scattered cells containing intracytoplasmatic pigmented granules, compatible with metastatic melanoma. The owners decided not to treat the patient with chemotherapy and declined a biopsy. Two months later, the cat died and necropsy was performed confirming bone metastasis of the uveal melanoma. A diagnosis of generalized metastasis from primary diffuse iris melanoma was made. This report describes, for the first time, long bone metastasis from an uveal melanoma in a cat. © 2010 American College of Veterinary Ophthalmologists.

A review of the risk factors for lower extremity overuse injuries in young elite female ballet dancers.

PubMed

Bowerman, Erin Anne; Whatman, Chris; Harris, Nigel; Bradshaw, Elizabeth

2015-06-01

The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers.

Contrasting impacts of continuous moderate drought and episodic severe droughts on the aboveground-biomass increment and litterfall of three coexisting Mediterranean woody species.

PubMed

Liu, Daijun; Ogaya, Romà; Barbeta, Adrià; Yang, Xiaohong; Peñuelas, Josep

2015-11-01

Climate change is predicted to increase the aridity in the Mediterranean Basin and severely affect forest productivity and composition. The responses of forests to different timescales of drought, however, are still poorly understood because extreme and persistent moderate droughts can produce nonlinear responses in plants. We conducted a rainfall-manipulation experiment in a Mediterranean forest dominated by Quercus ilex, Phillyrea latifolia, and Arbutus unedo in the Prades Mountains in southern Catalonia from 1999 to 2014. The experimental drought significantly decreased forest aboveground-biomass increment (ABI), tended to increase the litterfall, and decreased aboveground net primary production throughout the 15 years of the study. The responses to the experimental drought were highly species-specific. A. unedo suffered a significant reduction in ABI, Q. ilex experienced a decrease during the early experiment (1999-2003) and in the extreme droughts of 2005-2006 and 2011-2012, and P. latifolia was unaffected by the treatment. The drought treatment significantly increased branch litterfall, especially in the extremely dry year of 2011, and also increased overall leaf litterfall. The drought treatment reduced the fruit production of Q. ilex, which affected seedling recruitment. The ABIs of all species were highly correlated with SPEI in early spring, whereas the branch litterfalls were better correlated with summer SPEIs and the leaf and fruit litterfalls were better correlated with autumn SPEIs. These species-specific responses indicated that the dominant species (Q. ilex) could be partially replaced by the drought-resistant species (P. latifolia). However, the results of this long-term study also suggest that the effect of drought treatment has been dampened over time, probably due to a combination of demographic compensation, morphological and physiological acclimation, and epigenetic changes. However, the structure of community (e.g., species composition, dominance, and stand density) may be reordered when a certain drought threshold is reached. © 2015 John Wiley & Sons Ltd.

Contralaterally Controlled Functional Electrical Stimulation Improves Hand Dexterity in Chronic Hemiparesis: A Randomized Trial.

PubMed

Knutson, Jayme S; Gunzler, Douglas D; Wilson, Richard D; Chae, John

2016-10-01

It is unknown whether one method of neuromuscular electrical stimulation for poststroke upper limb rehabilitation is more effective than another. Our aim was to compare the effects of contralaterally controlled functional electrical stimulation (CCFES) with cyclic neuromuscular electrical stimulation (cNMES). Stroke patients with chronic (>6 months) moderate to severe upper extremity hemiparesis (n=80) were randomized to receive 10 sessions/wk of CCFES- or cNMES-assisted hand opening exercise at home plus 20 sessions of functional task practice in the laboratory for 12 weeks. The task practice for the CCFES group was stimulation assisted. The primary outcome was change in Box and Block Test (BBT) score at 6 months post treatment. Upper extremity Fugl-Meyer and Arm Motor Abilities Test were also measured. At 6 months post treatment, the CCFES group had greater improvement on the BBT, 4.6 (95% confidence interval [CI], 2.2-7.0), than the cNMES group, 1.8 (95% CI, 0.6-3.0), between-group difference of 2.8 (95% CI, 0.1-5.5), P=0.045. No significant between-group difference was found for the upper extremity Fugl-Meyer (P=0.888) or Arm Motor Abilities Test (P=0.096). Participants who had the largest improvements on BBT were <2 years post stroke with moderate (ie, not severe) hand impairment at baseline. Among these, the 6-month post-treatment BBT gains of the CCFES group, 9.6 (95% CI, 5.6-13.6), were greater than those of the cNMES group, 4.1 (95% CI, 1.7-6.5), between-group difference of 5.5 (95% CI, 0.8-10.2), P=0.023. CCFES improved hand dexterity more than cNMES in chronic stroke survivors. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00891319. © 2016 American Heart Association, Inc.

[Effect of disease severity on upper extremity muscle strength, exercise capacity, and activities of daily living in individuals with pulmonary arterial hypertension].

PubMed

Özcan Kahraman, Buse; Özsoy, İsmail; Acar, Serap; Özpelit, Ebru; Akdeniz, Bahri; Sevinç, Can; Savcı, Sema

2017-07-01

Pulmonary arterial hypertension (PAH) is a rare disease. Although muscle strength, exercise capacity, quality of life, and activities of daily living of patients with PAH are affected, it is not known how they are affected by disease severity. The purpose of the present study was to investigate effects of disease severity on upper extremity muscle strength, exercise capacity, and performance of activities of daily living in patients with PAH. Twenty-five patients with disease severity classified according to the New York Heart Association (NYHA) as functional class II (n=14) or class III (n=11) were included in the study. Upper-extremity exercise capacity and limitations in performing activities of daily living were assessed with 6-minute pegboard and ring test (6PBRT) and the Milliken activities of daily living scale (MAS), respectively. Shoulder flexion, elbow extension, elbow flexion muscle strength, and handgrip strength were measured with dynamometer. There were no significant differences in age, gender, body mass index, or mean pulmonary artery pressure between groups (p>0.05). The 6PBRT, MAS, and elbow flexion (right) and grip strength (right and left) results were significantly lower in NYHA III group than in NYHA II group (p=0.004, p=0.002, p=0.043, p=0.002 and p=0.003, respectively). There was no significant difference in shoulder flexion, elbow flexion (left), or elbow extension between groups (p>0.05). Results suggest that upper extremity exercise capacity, elbow flexion muscle strength (right), and handgrip strength decrease and that limitations in activities of daily living grow as disease severity increases in patients with PAH. When planning rehabilitation programs, disease severity should be considered and evaluations and treatments for the upper extremities should be included.

Association Between Intermittent Hypoxemia or Bradycardia and Late Death or Disability in Extremely Preterm Infants.

PubMed

Poets, Christian F; Roberts, Robin S; Schmidt, Barbara; Whyte, Robin K; Asztalos, Elizabeth V; Bader, David; Bairam, Aida; Moddemann, Diane; Peliowski, Abraham; Rabi, Yacov; Solimano, Alfonso; Nelson, Harvey

2015-08-11

Extremely preterm infants may experience intermittent hypoxemia or bradycardia for many weeks after birth. The prognosis of these events is uncertain. To determine the association between intermittent hypoxemia or bradycardia and late death or disability. Post hoc analysis of data from the inception cohort assembled for the Canadian Oxygen Trial in 25 hospitals in Canada, the United States, Argentina, Finland, Germany, and Israel, including 1019 infants with gestational ages of 23 weeks 0 days through 27 weeks 6 days who were born between December 2006 and August 2010 and survived to a postmenstrual age of 36 weeks. Follow-up assessments occurred between October 2008 and August 2012. Episodes of hypoxemia (pulse oximeter oxygen saturation <80%) or bradycardia (pulse rate <80/min) for 10 seconds or longer. Values were sampled every 10 seconds within 24 hours after birth until at least 36 weeks' postmenstrual age. The primary outcome was a composite of death after 36 weeks' postmenstrual age, motor impairment, cognitive or language delay, severe hearing loss, or bilateral blindness at 18 months' corrected age. Secondary outcomes were motor impairment, cognitive or language delay, and severe retinopathy of prematurity. Downloaded saturation and pulse rate data were available for a median of 68.3 days (interquartile range, 56.8-86.0 days). Mean percentages of recorded time with hypoxemia for the least and most affected 10% of infants were 0.4% and 13.5%, respectively. Corresponding values for bradycardia were 0.1% and 0.3%. The primary outcome was ascertained for 972 infants and present in 414 (42.6%). Hypoxemic episodes were associated with an estimated increased risk of late death or disability at 18 months of 56.5% in the highest decile of hypoxemic exposure vs 36.9% in the lowest decile (modeled relative risk, 1.53; 95% CI, 1.21-1.94). This association was significant only for prolonged hypoxemic episodes lasting at least 1 minute (relative risk, 1.66; 95% CI, 1.35-2.05 vs for shorter episodes, relative risk, 1.01; 95% CI, 0.77-1.32). Relative risks for all secondary outcomes were similarly increased after prolonged hypoxemia. Bradycardia did not alter the prognostic value of hypoxemia. Among extremely preterm infants who survived to 36 weeks' postmenstrual age, prolonged hypoxemic episodes during the first 2 to 3 months after birth were associated with adverse 18-month outcomes. If confirmed in future studies, further research on the prevention of such episodes is needed.

Salvage of mangled upper extremity using the Masquelet technique in a child: A case report.

PubMed

Alassaf, Nabil; Alhoukail, Amro; Alsahli, Abdullah; Althubaiti, Ghazi

2017-01-01

To report our experience with the Masquelet concept in a pediatric upper extremity following an open injury to the elbow. A case report and literature review. An 11-year-old boy was transferred to our institution after a motor vehicle collision. There was a primary loss of the ulnohumeral articulation and the surrounding soft tissues as well as the ulnar nerve. Reconstruction used the Masquelet-induced membrane technique and a soft tissue flap. At the 30-month follow-up, the extremity was pain free and functional. This case highlights the value of the Masquelet technique in pediatric extremity injuries, where there is a loss of a major articular segment, as well as significant soft tissue compromise.

Primary mucinous cystadenocarcinoma of the breast with endocervical-like mucinous epithelium.

PubMed

Lin, Dong-Liang; Hu, Ji-Lin; Shao, Shi-Hong; Sun, Dong-Mei; Wang, Ji-Gang

2013-12-01

Primary mucinous cystadenocarcinoma of the breast is an extremely rare entity. To the best of our knowledge, only 17 patients have been described in the PubMed database. Here, we report a primary breast mucinous cystadenocarcinoma with endocervical-like mucinous epithelium in a 62-year-old woman. The patient was followed for 5 months without any adjuvant treatment and she continues to be disease free. Primary breast mucinous cystadenocarcinoma usually displays unique pathologic and immunohistochemical characteristics simulating its ovarian counterparts; it seems to have a good prognosis after complete resection.

Fetal primary small bowel volvulus in a child without intestinal malrotation.

PubMed

Chung, Jae Hee; Lim, Gye-Yeon; We, Ji Sun

2013-07-01

Fetal primary small bowel volvulus without atresia or malrotation is an extremely rare but life-threatening surgical emergency. We report a case of primary small bowel volvulus that presented as sudden fetal distress and was diagnosed on the basis of the 'whirl-pool sign' of fetal sonography. This diagnosis led to emergency operation after birth at the third trimester with a good outcome. Although the pathogenesis of fetal primary small bowel volvulus is unclear, ganglion cell immaturity may play a role in the etiology. Copyright © 2013 Elsevier Inc. All rights reserved.

Primary Mural Endocarditis Without Valvular Involvement.

PubMed

Tahara, Mai; Nagai, Tomoo; Takase, Yoshiyuki; Takiguchi, Shunichi; Tanaka, Yoshiaki; Kunihara, Takashi; Arakawa, Junko; Nakaya, Kazuhiro; Hamabe, Akira; Gatate, Youdou; Kujiraoka, Takehiko; Tabata, Hirotsugu; Katsushika, Shuichi

2017-03-01

Primary mural endocarditis is an extremely rare infection in which nonvalvular endocardial involvement is seen without any cardiac structural abnormalities such as ventricular septal defects. The rapid and precise diagnosis of this disease remains challenging. We present 2 cases (67- and 47-year-old male patients) of pathologically confirmed primary mural endocarditis that could have been detected by initial transthoracic echocardiography in the emergency department. Transthoracic echocardiography and transesophageal echocardiography play critical roles in the early recognition and confirmation of primary mural endocarditis. © 2017 by the American Institute of Ultrasound in Medicine.

The problem of extreme events in paired-watershed studies

Treesearch

James W. Hornbeck

1973-01-01

In paired-watershed studies, the occurrence of an extreme event during the after-treatment period presents a problem: the effects of treatment must be determined by using greatly extrapolated regression statistics. Several steps are presented to help insure careful handling of extreme events during analysis and reporting of research results.

Large-scale disturbance legacies and the climate sensitivity of primary Picea abies forests.

PubMed

Schurman, Jonathan S; Trotsiuk, Volodymyr; Bače, Radek; Čada, Vojtěch; Fraver, Shawn; Janda, Pavel; Kulakowski, Dominik; Labusova, Jana; Mikoláš, Martin; Nagel, Thomas A; Seidl, Rupert; Synek, Michal; Svobodová, Kristýna; Chaskovskyy, Oleh; Teodosiu, Marius; Svoboda, Miroslav

2018-05-01

Determining the drivers of shifting forest disturbance rates remains a pressing global change issue. Large-scale forest dynamics are commonly assumed to be climate driven, but appropriately scaled disturbance histories are rarely available to assess how disturbance legacies alter subsequent disturbance rates and the climate sensitivity of disturbance. We compiled multiple tree ring-based disturbance histories from primary Picea abies forest fragments distributed throughout five European landscapes spanning the Bohemian Forest and the Carpathian Mountains. The regional chronology includes 11,595 tree cores, with ring dates spanning the years 1750-2000, collected from 560 inventory plots in 37 stands distributed across a 1,000 km geographic gradient, amounting to the largest disturbance chronology yet constructed in Europe. Decadal disturbance rates varied significantly through time and declined after 1920, resulting in widespread increases in canopy tree age. Approximately 75% of current canopy area recruited prior to 1900. Long-term disturbance patterns were compared to an historical drought reconstruction, and further linked to spatial variation in stand structure and contemporary disturbance patterns derived from LANDSAT imagery. Historically, decadal Palmer drought severity index minima corresponded to higher rates of canopy removal. The severity of contemporary disturbances increased with each stand's estimated time since last major disturbance, increased with mean diameter, and declined with increasing within-stand structural variability. Reconstructed spatial patterns suggest that high small-scale structural variability has historically acted to reduce large-scale susceptibility and climate sensitivity of disturbance. Reduced disturbance rates since 1920, a potential legacy of high 19th century disturbance rates, have contributed to a recent region-wide increase in disturbance susceptibility. Increasingly common high-severity disturbances throughout primary Picea forests of Central Europe should be reinterpreted in light of both legacy effects (resulting in increased susceptibility) and climate change (resulting in increased exposure to extreme events). © 2018 John Wiley & Sons Ltd.

Extreme Space Weather Events: From Cradle to Grave

NASA Astrophysics Data System (ADS)

Riley, Pete; Baker, Dan; Liu, Ying D.; Verronen, Pekka; Singer, Howard; Güdel, Manuel

2018-02-01

Extreme space weather events, while rare, can have a substantial impact on our technologically-dependent society. And, although such events have only occasionally been observed, through careful analysis of a wealth of space-based and ground-based observations, historical records, and extrapolations from more moderate events, we have developed a basic picture of the components required to produce them. Several key issues, however, remain unresolved. For example, what limits are imposed on the maximum size of such events? What are the likely societal consequences of a so-called "100-year" solar storm? In this review, we summarize our current scientific understanding about extreme space weather events as we follow several examples from the Sun, through the solar corona and inner heliosphere, across the magnetospheric boundary, into the ionosphere and atmosphere, into the Earth's lithosphere, and, finally, its impact on man-made structures and activities, such as spacecraft, GPS signals, radio communication, and the electric power grid. We describe preliminary attempts to provide probabilistic forecasts of extreme space weather phenomena, and we conclude by identifying several key areas that must be addressed if we are better able to understand, and, ultimately, predict extreme space weather events.

Extraskeletal Ewing's Sarcoma: insight into a ten years follow-up.

PubMed

Zitelli, A; Manfredelli, S; Brunotti, G; Marcantonio, M; Pontone, S; Angelici, A

2013-01-01

Extraskeletal Ewing's sarcoma is a rare malignant soft tissue tumor, classified within the Ewing's Sarcoma Family Tumors. While the classical Ewing's Sarcoma affects mainly the bone during youth, the Extraskeletal histotype differs for age incidence, primary location and prognosis. Peak incidence and typical location are during adolescence and in the extremities respectively. We report a 30 year old woman case with a positive outcome after ten years from first diagnosis of Extraskeletal Ewing's sarcoma. Treatment was achieved through surgical resection plus adjuvant chemoradiotherapy derived from EW93 and IRS III trials. Conclusion. Our report represents an unusual case due to age of presentation, neoplasm location and long survival reached. In last decades several trials results demonstrated that long survival could be achieved by combined surgery and adjuvant multi-drug treatment.

Design of Cryocoolers for Microwatt Superconducting Devices

NASA Technical Reports Server (NTRS)

Zimmerman, J. E.

1985-01-01

The primary applications of the cryocoolers are for cooling various Josephson devices such as SQUID magnetometers and amplifiers, voltage standards, and microwave mixers and detectors. The common feature of these devices is their extremely low inherent bias power requirement, of the order of 10/1 W per junction. This provides the possibility of designing compact, low-power cryocoolers for these applications. Several concepts were explored and a number of laboratory model cryocoolers were built. These include low-power nonmagnetic regenerative machines of the Stirling or Gifford-McMahon type, three or four-stage Joule-Thomson machines, liquid-helium dewars with integral small cryocoolers to reduce the evaporation rate, and liquid-helium dewars with integral continuously or intermittently operated small helium liquefiers to permit operation of cryogenic devices for indefinite time periods.

Global patterns of extreme drought-induced loss in land primary production: Identifying ecological extremes from rain-use efficiency.

PubMed

Du, Ling; Mikle, Nathaniel; Zou, Zhenhua; Huang, Yuanyuan; Shi, Zheng; Jiang, Lifen; McCarthy, Heather R; Liang, Junyi; Luo, Yiqi

2018-07-01

Quantifying the ecological patterns of loss of ecosystem function in extreme drought is important to understand the carbon exchange between the land and atmosphere. Rain-use efficiency [RUE; gross primary production (GPP)/precipitation] acts as a typical indicator of ecosystem function. In this study, a novel method based on maximum rain-use efficiency (RUE max ) was developed to detect losses of ecosystem function globally. Three global GPP datasets from the MODIS remote sensing data (MOD17), ground upscaling FLUXNET observations (MPI-BGC), and process-based model simulations (BESS), and a global gridded precipitation product (CRU) were used to develop annual global RUE datasets for 2001-2011. Large, well-known extreme drought events were detected, e.g. 2003 drought in Europe, 2002 and 2011 drought in the U.S., and 2010 drought in Russia. Our results show that extreme drought-induced loss of ecosystem function could impact 0.9% ± 0.1% of earth's vegetated land per year and was mainly distributed in semi-arid regions. The reduced carbon uptake caused by functional loss (0.14 ± 0.03 PgC/yr) could explain >70% of the interannual variation in GPP in drought-affected areas (p ≤ 0.001). Our results highlight the impact of ecosystem function loss in semi-arid regions with increasing precipitation variability and dry land expansion expected in the future. Copyright © 2018 Elsevier B.V. All rights reserved.

Extremely Nonthermal Monoenergetic Precipitation in the Auroral Acceleration Region: In Situ Observations

NASA Astrophysics Data System (ADS)

Hatch, S.; Chaston, C. C.; Labelle, J. W.

2017-12-01

We report in situ measurements through the auroral acceleration region that reveal extremely nonthermal monoenergetic electron distributions. These auroral primaries are indicative of source populations in the plasma sheet well described as kappa distributions with κ ≲ 2. We show from observations and modeling how this large deviation from Maxwellian form may modify the acceleration potential required to drive current closure through the auroral ionosphere.

Responses of gross primary production of grasslands and croplands to drought and pluvial events and irrigation during 2010-2016, Oklahoma, USA

USDA-ARS?s Scientific Manuscript database

To accurately estimate carbon cycling and food production, it is essential to understand how gross primary production (GPP) of irrigated and non-irrigated grasslands and croplands respond to drought and pluvial events. Oklahoma experienced extreme drought in 2011 and record-breaking precipitation in...

Exploring Primary School CLIL Perceptions in Catalonia: Students', Teachers' and Parents' Opinions and Expectations

ERIC Educational Resources Information Center

Pladevall-Ballester, Elisabet

2015-01-01

Analysing participants' perceptions of a Content and Language Integrated Learning (CLIL) experience is essential in order to provide a clear picture of whether CLIL is effectively implemented. This becomes extremely relevant in primary school contexts, where the way the different groups involved in an educational experience feel tends to be highly…

Movement-Dependent Stroke Recovery: A Systematic Review and Meta-Analysis of TMS and fMRI Evidence

ERIC Educational Resources Information Center

Richards, Lorie G.; Stewart, Kim C.; Woodbury, Michelle L.; Senesac, Claudia; Cauraugh, James H.

2008-01-01

Evidence indicates that experience-dependent cortical plasticity underlies post-stroke motor recovery of the impaired upper extremity. Motor skill learning in neurologically intact individuals is thought to involve the primary motor cortex, and the majority of studies in the animal literature have studied changes in the primary sensorimotor cortex…

Flap reconstruction does not increase complication rates following surgical resection of extremity soft tissue sarcoma.

PubMed

Slump, Jelena; Hofer, Stefan O P; Ferguson, Peter C; Wunder, Jay S; Griffin, Anthony M; Hoekstra, Harald J; Bastiaannet, Esther; O'Neill, Anne C

2018-02-01

Flap reconstruction plays an essential role in the surgical management of extremity soft tissue sarcoma (ESTS) for many patients. But flaps increase the duration and complexity of the surgery and their contribution to overall morbidity is unclear. This study directly compares the complication rates in patients with ESTS undergoing either flap reconstruction or primary wound closure and explores contributing factors. Eight hundred and ninety-seven patients who underwent ESTS resection followed by primary closure (631) or flap reconstruction (266) were included in this study. Data on patient, tumour and treatment variables and post-operative medical and surgical complications were collected. Univariate and multivariate regression analyses were performed to identify independent predictors of complications. Post-operative complications occurred in 33% of patients. Flap patients were significantly older, had more advanced disease and were more likely to require neoadjuvant chemo- and radiotherapy. There was no significant difference in complication rates following flap reconstruction compared to primary closure on multivariate analysis (38 vs 30.9% OR 1.12, CI 0.77-1.64, p = 0.53). Pre-operative radiation and distal lower extremity tumour location were significant risk factors in patients who underwent primary wound closure but not in those who had flap reconstruction. Patients with comorbidities, increased BMI and systemic disease were at increased risk of complications following flap reconstruction. Flap reconstruction is not associated with increased post-operative complications following ESTS resection. Flaps may mitigate the effects of some risk factors in selected patients. Copyright © 2017. Published by Elsevier Ltd.

Panhypopituitarism with empty sella a sequel of pituitary hyperplasia due to chronic primary hypothyroidism.

PubMed

Dutta, Deep; Maisnam, Indira; Ghosh, Sujoy; Mukhopadhyay, Pradip; Mukhopadhyay, Satinath; Chowdhury, Subhankar

2012-12-01

Asymptomatic reversible pituitary hyperplasia is common in patients with untreated primary hypothyroidism. Occurrence of empty sella (ES) in this scenario is extremely rare (only three reports till the date) and panhypopituitarism has not been reported in such patients. We report a 27 year man with severe short stature (height-133 cm; standard deviation score-7.36) and delayed puberty who had symptoms suggestive of hypothyroidism along with chronic persistent headache since 6 years of age. Pituitary imaging done for headache at 11 years age showed pituitary hyperplasia. He was diagnosed of primary hypothyroidism for the 1(st) time at 21 year age, a diagnosis which was likely missed for 15 years. Levothyroxine therapy leads to resolution of all symptoms and a height gain of 28 cm over last 6 years. Evaluation for lack of progression of puberty along with chronic nausea, vomiting, fatigue and weight loss for the last 1 year revealed secondary hypocortisolism (9 am cortisol-4.8 mcg/dl; ACTH-3.2 pg/ml), growth hormone deficiency (IGF-1: 65 ng/ml; normal: 117-325 ng/ml) and hypogonadotrophic hypogonadism (9 am testosterone: 98 ng/dl; [280-1500] LH-0.01 mIU/L [1.14-5.75]) with ES on magnetic resonance imaging (MRI) brain. Uncontrolled thyrotroph hyperplasia due to chronic untreated primary hypothyroidism for 15 years may have been damaging the adjacent corticotrophs, somatotrophs and gonadotrophs resulting in panhypopituitarism and empty sella. This is perhaps the first report of panhypopituitarism with empty sella syndrome developing in a patient with pituitary hyperplasia, a sequel of chronic untreated primary hypothyroidism.

Tongue metastasis mimicking an abscess.

PubMed

Mavili, Ertuğrul; Oztürk, Mustafa; Yücel, Tuba; Yüce, Imdat; Cağli, Sedat

2010-03-01

Primary tumors metastasizing to the oral cavity are extremely rare. Lung is one of the most common primary sources of metastases to the tongue. Although the incidence of lung cancer is increasing, tongue metastasis as the initial presentation of the tumor remains uncommon. Due to the rarity of tongue metastasis, little is known about its imaging findings. Herein we report the magnetic resonance imaging and clinical findings of a lingual metastasis, mimicking an abscess, from a primary lung cancer.

Severe soft tissue infection of the lower extremity caused by Haemophilus influenzae (serotype f, biotype II) in an adult patient.

PubMed

Hagiya, Hideharu; Murase, Tomoko; Naito, Hiromichi; Hagioka, Shingo; Morimoto, Naoki

2012-01-01

The infection caused by non-b-type Haemophilus influenzae has been increasing in this Hib (H.influenzae serotype b) vaccination era. H.influenzae serotype f (Hif) is considered as one of those emerging pathogens. In general, H.influenzae is a common pathogen of such as pneumonia, otitis media, and meningitis, but is rare in soft tissue infection, especially at the extremity. We report a rare case of severe soft tissue infection caused by Hif which occurred at the lower extremity of immunocompetent adult patient.

Hypothyroid-induced acute compartment syndrome in all extremities.

PubMed

Musielak, Matthew C; Chae, Jung Hee

2016-12-20

Acute compartment syndrome (ACS) is an uncommon complication of uncontrolled hypothyroidism. If unrecognized, this can lead to ischemia, necrosis and potential limb loss. A 49-year-old female presented with the sudden onset of bilateral lower and upper extremity swelling and pain. The lower extremity anterior compartments were painful and tense. The extensor surface of the upper extremities exhibited swelling and pain. Motor function was intact, however, limited due to pain. Bilateral lower extremity fasciotomies were performed. Postoperative Day 1, upper extremity motor function decreased significantly and paresthesias occurred. She therefore underwent bilateral forearm fasciotomies. The pathogenesis of hypothyroidism-induced compartment syndrome is unclear. Thyroid-stimulating hormone-induced fibroblast activation results in increased glycosaminoglycan deposition. The primary glycosaminoglycan in hypothyroid myxedematous changes is hyaluronic acid, which binds water causing edema. This increases vascular permeability, extravasation of proteins and impaired lymphatic drainage. These contribute to increased intra-compartmental pressure and subsequent ACS. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

Extreme startle and photomyoclonic response in severe hypocalcaemia.

PubMed

Moccia, Marcello; Erro, Roberto; Nicolella, Elvira; Striano, Pasquale; Striano, Salvatore

2014-03-01

We report the case of 62-year-old woman referred to our department because of a clinical suspicion of tonic-clonic seizures. Clinical examination revealed an exaggerated startle reflex, EEG showed a photomyoclonic response, and blood tests indicated severe hypocalcaemia. Additional clinical data, treatment strategies, and long-term follow-up visits were reported. The present report discusses the difficulties in distinguishing between epileptic and non-epileptic startles, and shows, for the first time, exaggerated startle reflex and extreme photomyoclonic response due to severe hypocalcaemia.

Primary (de novo) dedifferentiated liposarcoma in the extremities: a multi-institution Tohoku Musculoskeletal Tumor Society study of 18 cases in northern Japan.

PubMed

Okada, Kyoji; Hasegawa, Tadashi; Kawai, Akira; Ogose, Akira; Nishida, Jun; Yanagisawa, Michiro; Morita, Tetsuro; Tajino, Takahiro; Tsuchiya, Takashi

2011-09-01

Dedifferentiated liposarcomas usually occur in the retroperitoneal space and relatively rarely in the extremities. We identified 18 patients with primary dedifferentiated liposarcoma in the extremities from the files of Tohoku Musculoskeletal Tumor Society and analyzed demographics, histologic findings, treatments and prognostic factors. The average follow-up period was 58 months. The subjects were 12 men and 6 women with a mean age of 65 years. All tumors were in the thigh. Nine patients noticed a rapid enlargement of the long-standing tumor. Histologic subtypes of the dedifferentiated area were undifferentiated pleomorphic sarcoma (n = 12), osteosarcoma (n = 2), rhabdomyosarcoma (n = 2), leiomyosarcoma (n = 1) and malignant peripheral nerve sheath tumor (n = 1). In the patient with rhabdomyosarcoma-like dedifferentiated area, extensive necrosis was observed after the preoperative chemotherapy. One patient who underwent marginal excision developed a local recurrence, but inadequate surgical margin was not associated with a risk of local recurrence. Three patients had lung metastasis at initial presentation, and four other patients developed lung metastases during the follow-up period. The overall survival rate was 61.1% at 5 years. On univariate analyses, large size of the dedifferentiated area (>8 cm), high MIB-1-labeling index (>30%) for the dedifferentiated area and lung metastasis at initial presentation were significantly associated with poor prognosis. Primary dedifferentiated liposarcoma in the extremities predominantly occurred in the thigh and a rapid enlargement of long-standing tumors was a characteristic symptom. Although the local behavior of these tumors was less aggressive than that of retroperitoneal dedifferentiated liposarcomas, they had a relatively high metastatic potential.

Plethysmography

MedlinePlus

... ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 27. Fowler GC, Reddy B. Noninvasive venous and arterial studies of the lower extremities. In: Pfenninger JL, Fowler GC, eds. Pfenninger & Fowler's Procedures for Primary Care . ...

Seasonal temperature extremes in Potsdam

NASA Astrophysics Data System (ADS)

Kundzewicz, Zbigniew; Huang, Shaochun

2010-12-01

The awareness of global warming is well established and results from the observations made on thousands of stations. This paper complements the large-scale results by examining a long time-series of high-quality temperature data from the Secular Meteorological Station in Potsdam, where observation records over the last 117 years, i.e., from January 1893 are available. Tendencies of change in seasonal temperature-related climate extremes are demonstrated. "Cold" extremes have become less frequent and less severe than in the past, while "warm" extremes have become more frequent and more severe. Moreover, the interval of the occurrence of frost has been decreasing, while the interval of the occurrence of hot days has been increasing. However, many changes are not statistically significant, since the variability of temperature indices at the Potsdam station has been very strong.

Upper extremity pain and computer use among engineering graduate students.

PubMed

Schlossberg, Eric B; Morrow, Sandra; Llosa, Augusto E; Mamary, Edward; Dietrich, Peter; Rempel, David M

2004-09-01

The objective of this study was to investigate risk factors associated with persistent or recurrent upper extremity and neck pain among engineering graduate students. A random sample of 206 Electrical Engineering and Computer Science (EECS) graduate students at a large public university completed an online questionnaire. Approximately 60% of respondents reported upper extremity or neck pain attributed to computer use and reported a mean pain severity score of 4.5 (+/-2.2; scale 0-10). In a final logistic regression model, female gender, years of computer use, and hours of computer use per week were significantly associated with pain. The high prevalence of upper extremity pain reported by graduate students suggests a public health need to identify interventions that will reduce symptom severity and prevent impairment.

The impact of heat on mortality and morbidity in the Greater Metropolitan Sydney Region: a case crossover analysis.

PubMed

Wilson, Leigh Ann; Morgan, Geoffrey Gerard; Hanigan, Ivan Charles; Johnston, Fay H; Abu-Rayya, Hisham; Broome, Richard; Gaskin, Clive; Jalaludin, Bin

2013-11-15

This study examined the association between unusually high temperature and daily mortality (1997-2007) and hospital admissions (1997-2010) in the Sydney Greater Metropolitan Region (GMR) to assist in the development of targeted health programs designed to minimise the public health impact of extreme heat. Sydney GMR was categorized into five climate zones. Heat-events were defined as severe or extreme. Using a time-stratified case-crossover design with a conditional logistic regression model we adjusted for influenza epidemics, public holidays, and climate zone. Odds ratios (OR) and 95% confidence intervals were estimated for associations between daily mortality and hospital admissions with heat-event days compared to non-heat event days for single and three day heat-events. All-cause mortality overall had similar magnitude associations with single day and three day extreme and severe events as did all cardiovascular mortality. Respiratory mortality was associated with single day and three day severe events (95th percentile, lag0: OR = 1.14; 95%CI: 1.04 to 1.24). Diabetes mortality had similar magnitude associations with single day and three day severe events (95th percentile, lag0: OR = 1.22; 95%CI: 1.03 to 1.46) but was not associated with extreme events. Hospital admissions for heat related injuries, dehydration, and other fluid disorders were associated with single day and three day extreme and severe events. Contrary to our findings for mortality, we found inconsistent and sometimes inverse associations for extreme and severe events with cardiovascular disease and respiratory disease hospital admissions. Controlling for air pollutants did not influence the mortality associations but reduced the magnitude of the associations with hospital admissions particularly for ozone and respiratory disease. Single and three day events of unusually high temperatures in Sydney are associated with similar magnitude increases in mortality and hospital admissions. The trend towards an inverse association between cardio-vascular admissions and heat-events and the strong positive association between cardio-vascular mortality and heat-events suggests these events may lead to a rapid deterioration in persons with existing cardio-vascular disease resulting in death. To reduce the adverse effects of high temperatures over multiple days, and less extreme but more frequent temperatures over single days, targeted public health messages are critical.

The impact of heat on mortality and morbidity in the Greater Metropolitan Sydney Region: a case crossover analysis

PubMed Central

2013-01-01

Background This study examined the association between unusually high temperature and daily mortality (1997–2007) and hospital admissions (1997–2010) in the Sydney Greater Metropolitan Region (GMR) to assist in the development of targeted health programs designed to minimise the public health impact of extreme heat. Methods Sydney GMR was categorized into five climate zones. Heat-events were defined as severe or extreme. Using a time-stratified case-crossover design with a conditional logistic regression model we adjusted for influenza epidemics, public holidays, and climate zone. Odds ratios (OR) and 95% confidence intervals were estimated for associations between daily mortality and hospital admissions with heat-event days compared to non-heat event days for single and three day heat-events. Results All-cause mortality overall had similar magnitude associations with single day and three day extreme and severe events as did all cardiovascular mortality. Respiratory mortality was associated with single day and three day severe events (95thpercentile, lag0: OR = 1.14; 95%CI: 1.04 to 1.24). Diabetes mortality had similar magnitude associations with single day and three day severe events (95thpercentile, lag0: OR = 1.22; 95%CI: 1.03 to 1.46) but was not associated with extreme events. Hospital admissions for heat related injuries, dehydration, and other fluid disorders were associated with single day and three day extreme and severe events. Contrary to our findings for mortality, we found inconsistent and sometimes inverse associations for extreme and severe events with cardiovascular disease and respiratory disease hospital admissions. Controlling for air pollutants did not influence the mortality associations but reduced the magnitude of the associations with hospital admissions particularly for ozone and respiratory disease. Conclusions Single and three day events of unusually high temperatures in Sydney are associated with similar magnitude increases in mortality and hospital admissions. The trend towards an inverse association between cardio-vascular admissions and heat-events and the strong positive association between cardio-vascular mortality and heat-events suggests these events may lead to a rapid deterioration in persons with existing cardio-vascular disease resulting in death. To reduce the adverse effects of high temperatures over multiple days, and less extreme but more frequent temperatures over single days, targeted public health messages are critical. PMID:24238064

Prevalence of disability in a composite ≥75 year-old population in Spain: A screening survey based on the International Classification of Functioning

PubMed Central

2011-01-01

Background The prevalence and predictors of functional status and disability of elderly people have been studied in several European countries including Spain. However, there has been no population-based study incorporating the International Classification of Functioning, Disability and Health (ICF) framework as the basis for assessing disability. The present study reports prevalence rates for mild, moderate, and severe/extreme disability by the domains of activities and participation of the ICF. Methods Nine populations surveyed in previous prevalence studies contributed probabilistic and geographically defined samples in June 2005. The study sample was composed of 503 subjects aged ≥75 years. We implemented a two-phase screening design using the MMSE and the World Health Organization-Disability Assessment Schedule 2nd edition (WHO-DAS II, 12 items) as cognitive and disability screening tools, respectively. Participants scoring within the positive range of the disability screening were administered the full WHO-DAS II (36 items; score range: 0-100) assessing the following areas: Understanding and communication, Getting along with people, Life activities, Getting around, Participation in society, and Self-care. Each disability area assessed by WHO-DAS II (36 items) was reported according to the ICF severity ranges (No problem, 0-4; Mild disability, 5-24; Moderate disability, 25-49; Severe/Extreme disability, 50-100). Results The age-adjusted disability prevalence figures were: 39.17 ± 2.18%, 15.31 ± 1.61%, and 10.14 ± 1.35% for mild, moderate, and severe/extreme disability, respectively. Severe and extreme disability prevalence in mobility and life activities was three times higher than the average, and highest among women. Sex variations were minimal, although life activities for women of 85 years and over had more severe/extreme disability as compared to men (OR = 5.15 95% CI 3.19-8.32). Conclusions Disability is highly prevalent among the Spanish elderly. Sex- and age-specific variations of disability are associated with particular disability domains. PMID:21429194

Long-term Changes in Extreme Air Pollution Meteorology and the Implications for Air Quality.

PubMed

Hou, Pei; Wu, Shiliang

2016-03-31

Extreme air pollution meteorological events, such as heat waves, temperature inversions and atmospheric stagnation episodes, can significantly affect air quality. Based on observational data, we have analyzed the long-term evolution of extreme air pollution meteorology on the global scale and their potential impacts on air quality, especially the high pollution episodes. We have identified significant increasing trends for the occurrences of extreme air pollution meteorological events in the past six decades, especially over the continental regions. Statistical analysis combining air quality data and meteorological data further indicates strong sensitivities of air quality (including both average air pollutant concentrations and high pollution episodes) to extreme meteorological events. For example, we find that in the United States the probability of severe ozone pollution when there are heat waves could be up to seven times of the average probability during summertime, while temperature inversions in wintertime could enhance the probability of severe particulate matter pollution by more than a factor of two. We have also identified significant seasonal and spatial variations in the sensitivity of air quality to extreme air pollution meteorology.

Fatal Sarcoptes scabiei infection of blue sheep (Pseudois nayaur) in Pakistan.

PubMed

Dagleish, M P; Ali, Qurban; Powell, R K; Butz, D; Woodford, M H

2007-07-01

Sarcoptes scabiei was detected for the first time in skin scrapings, hair pluckings, and histologic sections from a blue sheep (Pseudois nayaur) from the Shimshali Pamir in the Karakorum range of the western Himalaya in Pakistan (36 degrees 28'N, 75 degrees 36'E). Local reports suggest many hundred animals have been affected by a severe skin disease over a 10-yr period, but the shy nature of this species and the extreme climate that they inhabit meant only a single affected animal was available for detailed evaluation. The severe skin lesions were confined to the forelegs and brisket, and many Sarcoptes scabiei mites were present in all the samples examined. Histologic preparations of the skin showed hyperkeratotic and parakeratotic hyperkeratosis of the epidermis with a severe exudative dermatosis with many polymorphonuclear neutrophils and gram-positive cocci, yet no eosinophils. These findings might suggest the lack of an appropriate immune response to the parasite or other coping strategies because there has been no abatement of the clinical signs in affected animals over several years. Treatment options are limited due to the behavior of the species and its habitat. The blue sheep is a primary source of prey for the endangered snow leopard (Panthera uncia) and continued depletion could have serious consequences for the survival of the latter.

Small but Powerful, the Primary Endosymbiont of Moss Bugs, Candidatus Evansia muelleri, Holds a Reduced Genome with Large Biosynthetic Capabilities

PubMed Central

Santos-Garcia, Diego; Latorre, Amparo; Moya, Andrés; Gibbs, George; Hartung, Viktor; Dettner, Konrad; Kuechler, Stefan Martin; Silva, Francisco J.

2014-01-01

Moss bugs (Coleorrhyncha: Peloridiidae) are members of the order Hemiptera, and like many hemipterans, they have symbiotic associations with intracellular bacteria to fulfill nutritional requirements resulting from their unbalanced diet. The primary endosymbiont of the moss bugs, Candidatus Evansia muelleri, is phylogenetically related to Candidatus Carsonella ruddii and Candidatus Portiera aleyrodidarum, primary endosymbionts of psyllids and whiteflies, respectively. In this work, we report the genome of Candidatus Evansia muelleri Xc1 from Xenophyes cascus, which is the only obligate endosymbiont present in the association. This endosymbiont possesses an extremely reduced genome similar to Carsonella and Portiera. It has crossed the borderline to be considered as an autonomous cell, requiring the support of the insect host for some housekeeping cell functions. Interestingly, in spite of its small genome size, Evansia maintains enriched amino acid (complete or partial pathways for ten essential and six nonessential amino acids) and sulfur metabolisms, probably related to the poor diet of the insect, based on bryophytes, which contains very low levels of nitrogenous and sulfur compounds. Several facts, including the congruence of host (moss bugs, whiteflies, and psyllids) and endosymbiont phylogenies and the retention of the same ribosomal RNA operon during genome reduction in Evansia, Portiera, and Carsonella, suggest the existence of an ancient endosymbiotic Halomonadaceae clade associated with Hemiptera. Three possible scenarios for the origin of these three primary endosymbiont genera are proposed and discussed. PMID:25115011

The role of iodine in human growth and development.

PubMed

Zimmermann, Michael B

2011-08-01

Iodine is an essential component of the hormones produced by the thyroid gland. Thyroid hormones, and therefore iodine, are essential for mammalian life. Iodine deficiency is a major public health problem; globally, it is estimated that two billion individuals have an insufficient iodine intake. Although goiter is the most visible sequelae of iodine deficiency, the major impact of hypothyroidism due to iodine deficiency is impaired neurodevelopment, particularly early in life. In the fetal brain, inadequate thyroid hormone impairs myelination, cell migration, differentiation and maturation. Moderate-to-severe iodine deficiency during pregnancy increases rates of spontaneous abortion, reduces birth weight, and increases infant mortality. Offspring of deficient mothers are at high risk for cognitive disability, with cretinism being the most severe manifestation. It remains unclear if development of the offspring is affected by mild maternal iodine deficiency. Moderate-to-severe iodine deficiency during childhood reduces somatic growth. Correction of mild-to-moderate iodine deficiency in primary school aged children improves cognitive and motor function. Iodine prophylaxis of deficient populations with periodic monitoring is an extremely cost effective approach to reduce the substantial adverse effects of iodine deficiency throughout the life cycle. Copyright © 2011 Elsevier Ltd. All rights reserved.

Monitoring aeolian desertification process in Hulunbir grassland during 1975-2006, Northern China.

PubMed

Guo, Jian; Wang, Tao; Xue, Xian; Ma, Shaoxiu; Peng, Fei

2010-07-01

The Hulunbir grassland experienced aeolian desertification expansion during 1975-2000, but local rehabilitation during 2000-2006. Northern China suffered severe aeolian desertification during the past 50 years. Hulunbir grassland, the best stockbreeding base in Northern China, was also affected by aeolian desertification. To evaluate the evolution and status of aeolian desertification, as well as its causes, satellite images (acquired in 1975, 1984, 2000, and 2006) and meteorological and socioeconomic data were interpreted and analyzed. The results show there was 2,345.7, 2,899.8, 4,053.9, and 3,859.6 km(2) of aeolian desertified land in 1975, 1984, 2000, and 2006, respectively. The spatial pattern dynamic had three stages: stability during 1975-1984, fast expansion during 1984-2000, and spatial transfer during 2000-2006. The dynamic degree of aeolian desertification is negatively related to its severity. Comprehensive analysis shows that the human factor is the primary cause of aeolian desertification in Hulunbir grassland. Although aeolian desertified land got partly rehabilitated, constant increase of extremely severe aeolian desertified land implied that current measures were not effective enough on aeolian desertification control. Alleviation of grassland pressure may be an effective method.

Limb plethysmography

MedlinePlus

... ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 58. Fowler GC, Reddy B. Noninvasive venous and arterial studies of the lower extremities. In: Pfenninger JL, Fowler GC, eds. Pfenninger & Fowler's Procedures for Primary Care . ...

Cyclones and extreme windstorm events over Europe under climate change: Global and regional climate model diagnostics

NASA Astrophysics Data System (ADS)

Leckebusch, G. C.; Ulbrich, U.

2003-04-01

More than any changes of the climate system mean state conditions, the development of extreme events may influence social, economic and legal aspects of our society. This linkage results from the impact of extreme climate events (natural hazards) on environmental systems which again are directly linked to human activities. Prominent examples from the recent past are the record breaking rainfall amounts of August 2002 in central Europe which produced widespread floodings or the wind storm Lothar of December 1999. Within the MICE (Modelling the Impact of Climate Extremes) project framework an assessment of the impact of changes in extremes will be done. The investigation is carried out for several different impact categories as agriculture, energy use and property damage. Focus is laid on the diagnostics of GCM and RCM simulations under different climate change scenarios. In this study we concentrate on extreme windstorms and their relationship to cyclone activity in the global HADCM3 as well as in the regional HADRM3 model under two climate change scenarios (SRESA2a, B2a). In order to identify cyclones we used an objective algorithm from Murry and Simmonds which was widely tested under several different conditions. A slight increase in the occurrence of systems is identified above northern parts of central Europe for both scenarios. For more severe systems (core pressure < 990 hPa) we find an increase for western Europe. Strong wind events can be defined via different percentile values of the windspeed (e.g. above the 95 percentile). By this means the relationship between strong wind events and cyclones is also investigated. For several regions (e.g. Germany, France, Spain) a shift to more deep cyclones connected with an increasing number of strong wind events is found.

Cortical disconnection of the ipsilesional primary motor cortex is associated with gait speed and upper extremity motor impairment in chronic left hemispheric stroke.

PubMed

Peters, Denise M; Fridriksson, Julius; Stewart, Jill C; Richardson, Jessica D; Rorden, Chris; Bonilha, Leonardo; Middleton, Addie; Gleichgerrcht, Ezequiel; Fritz, Stacy L

2018-01-01

Advances in neuroimaging have enabled the mapping of white matter connections across the entire brain, allowing for a more thorough examination of the extent of white matter disconnection after stroke. To assess how cortical disconnection contributes to motor impairments, we examined the relationship between structural brain connectivity and upper and lower extremity motor function in individuals with chronic stroke. Forty-three participants [mean age: 59.7 (±11.2) years; time poststroke: 64.4 (±58.8) months] underwent clinical motor assessments and MRI scanning. Nonparametric correlation analyses were performed to examine the relationship between structural connectivity amid a subsection of the motor network and upper/lower extremity motor function. Standard multiple linear regression analyses were performed to examine the relationship between cortical necrosis and disconnection of three main cortical areas of motor control [primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA)] and motor function. Anatomical connectivity between ipsilesional M1/SMA and the (1) cerebral peduncle, (2) thalamus, and (3) red nucleus were significantly correlated with upper and lower extremity motor performance (P ≤ 0.003). M1-M1 interhemispheric connectivity was also significantly correlated with gross manual dexterity of the affected upper extremity (P = 0.001). Regression models with M1 lesion load and M1 disconnection (adjusted for time poststroke) explained a significant amount of variance in upper extremity motor performance (R 2  = 0.36-0.46) and gait speed (R 2  = 0.46), with M1 disconnection an independent predictor of motor performance. Cortical disconnection, especially of ipsilesional M1, could significantly contribute to variability seen in locomotor and upper extremity motor function and recovery in chronic stroke. Hum Brain Mapp 39:120-132, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Extreme Ultraviolet Explorer Science Operation Center

NASA Technical Reports Server (NTRS)

Wong, G. S.; Kronberg, F. A.; Meriwether, H. D.; Wong, L. S.; Grassi, C. L.

1993-01-01

The EUVE Science Operations Center (ESOC) is a satellite payload operations center for the Extreme Ultraviolet Explorer project, located on the Berkeley campus of the University of California. The ESOC has the primary responsibility for commanding the EUVE telescopes and monitoring their telemetry. The ESOC is one of a very few university-based satellite operations facilities operating with NASA. This article describes the history, operation, and advantages of the ESOC as an on-campus operations center.

Salvage of mangled upper extremity using the Masquelet technique in a child: A case report

PubMed Central

Alassaf, Nabil; Alhoukail, Amro; Alsahli, Abdullah; Althubaiti, Ghazi

2017-01-01

Aim: To report our experience with the Masquelet concept in a pediatric upper extremity following an open injury to the elbow. Methods: A case report and literature review. Results: An 11-year-old boy was transferred to our institution after a motor vehicle collision. There was a primary loss of the ulnohumeral articulation and the surrounding soft tissues as well as the ulnar nerve. Reconstruction used the Masquelet-induced membrane technique and a soft tissue flap. At the 30-month follow-up, the extremity was pain free and functional. Conclusion: This case highlights the value of the Masquelet technique in pediatric extremity injuries, where there is a loss of a major articular segment, as well as significant soft tissue compromise. PMID:29201370

The Efficacy of Crotalidae Polyvalent Immune Fab (Ovine) Antivenom Versus Placebo Plus Optional Rescue Therapy on Recovery From Copperhead Snake Envenomation: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial.

PubMed

Gerardo, Charles J; Quackenbush, Eugenia; Lewis, Brandon; Rose, S Rutherfoord; Greene, Spencer; Toschlog, Eric A; Charlton, Nathan P; Mullins, Michael E; Schwartz, Richard; Denning, David; Sharma, Kapil; Kleinschmidt, Kurt; Bush, Sean P; Ryan, Samantha; Gasior, Maria; Anderson, Victoria E; Lavonas, Eric J

2017-08-01

Copperhead snake (Agkistrodon contortrix) envenomation causes limb injury resulting in pain and disability. It is not known whether antivenom administration improves limb function. We determine whether administration of antivenom improves recovery from limb injury in patients envenomated by copperhead snakes. From August 2013 through November 2015, we performed a multicenter, randomized, double-blind, placebo-controlled, clinical trial to evaluate the effect of ovine Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) antivenom therapy on recovery of limb function in patients with copperhead snake envenomation at 14 days postenvenomation. The study setting was 18 emergency departments in regions of the United States where copperhead snakes are endemic. Consecutive patients aged 12 years or older with mild- to moderate-severity envenomation received either FabAV or placebo. The primary outcome was limb function 14 days after envenomation, measured by the Patient-Specific Functional Scale. Additional outcomes included the Patient-Specific Functional Scale at other points; the Disorders of the Arm, Shoulder, and Hand, Lower Extremity Functional Scale, and Patient's Global Impression of Change instruments; grip strength; walking speed; quality of life (Patient-Reported Outcomes Measurement Information System Physical Fucntion-10); pain; and analgesic use. Seventy-four patients received study drug (45 FabAV, 29 placebo). Mean age was 43 years (range 12 to 86 years). Fifty-three percent were men, 62% had lower extremity envenomation, and 88% had mild initial severity. The primary outcome, the least square mean Patient-Specific Functional Scale score at 14 days postenvenomation, was 8.6 for FabAV-treated subjects and 7.4 for placebo recipients (difference 1.2; 95% confidence interval 0.1 to 2.3; P=.04). Additional outcome assessments generally favored FabAV. More FabAV-treated subjects experienced treatment-emergent adverse events (56% versus 28%), but few were serious (1 in each group). Treatment with FabAV reduces limb disability measured by the Patient-Specific Functional Scale 14 days after copperhead envenomation. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Primary Pulmonary Mucinous Cystadenocarcinoma: A Case Report

PubMed Central

Efstathiou, Andreas; Asteriou, Christos; Barbetakis, Nikolaos; Miliaras, Dimosthenis; Kleontas, Athanassios; Karvelas, Christos; Lalountas, Miltiadis

2011-01-01

Primary pulmonary mucinous cystadenocarcinoma (PMCAC) is an extremely rare cystic neoplasm. A case of a 56-year-old male with a cystic lesion of the right lower lobe is described. Preoperative fine needle aspiration cytology and bronchoscopy were inconclusive. The patient underwent a formal right lower lobectomy and mediastinal lymph node dissection. Diagnosis was established intraoperatively. The biological behavior of primary PMCAC is unknown. Therefore, careful long-term follow-up is considered necessary because of lack of experience globally. PMID:21541179

Primary Hepatic Malignant Fibrous Histiocytoma on PET/CT.

PubMed

Liu, Yachao; Xu, Baixuan

2018-06-01

Malignant fibrous histiocytoma is mainly presented in extremities, less commonly in posterior peritoneum, but primary presented in liver is very rare and often with a poor prognosis because of its high aggression. The features of clinical presentations and images are variable and the pre-operative diagnosis is difficult. Here, we report a primary hepatic malignant fibrous histiocytoma patient with no distant metastasis showed on pre-operative F-FDG PET/CT, however with many metastases showed on the post-operative F-FDG PET/CT.

Clinical factors associated with extreme sleep apnoea [AHI>100 events per hour] in Peruvian patients: A case-control study–A preliminary report

PubMed Central

Rey de Castro, Jorge; Huamaní, Charles; Escobar-Córdoba, Franklin; Liendo, Cesar

2015-01-01

Purpose The severity of obstructive sleep apnoea (OSA) ranges from mild or moderate to severe sleep apnoea. However, there is no information available on the clinical characteristics associated with cases involving more than 100 events per hour. This is a preliminary report and our goal was to characterise the demographics and sleep characteristics of patients with Extreme OSA and compare with patients with sleep apnoea of lesser severity. We hypothesised that patients with Extreme OSA (AHI>100) is associated with an increased comorbidities and/or risk factors. Methods We carried out a case-control study on male patients with OSA who were seen in a private hospital in Lima, Peru between 2006 and 2012. Cases were identified if their apnoea/hypopnea index (AHI) was higher than 100 (Extreme OSA), and four controls were selected per case: two with 15–29 AHI and two with 30–50 AHI, matched according to case diagnosis dates. We evaluated demographic, past medical history, and oxygen saturation variables Results We identified 19 cases that were matched with 54 controls. In the multivariate model, only arterial hypertension, neck circumference, age, and over 10% in SatO2Hb≤90% in total sleep time (T90) were associated with Extreme OSA. Arterial hypertension had an OR=6.31 (CI95%: 1.71–23.23) of Extreme OSA. Each 5-cm increment in neck circumference was associated with an increase of OR=4.34 (CI95%: 1.32–14.33), while T90>10% had an OR=19.68 (CI95%: 4.33–89.49). Age had a marginal relevance (OR=0.95; CI95%: 0.92–0.99) Conclusion Our results suggest that arterial hypertension, neck circumference, and over 10% SatO2Hb≤90% in total sleep time were associated with a higher probability of Extreme OSA. We recommend investigators to study this population of Extreme OSA looking for an early diagnosis and the identification of prognostic factors in comparison with moderate to severe levels. PMID:26483940

Learning to Read Against All Odds: Using Precision Reading to Enhance Literacy in Students with Cognitive Impairments, Extreme Academic Deficits, and Severe Social, Emotional, and Psychiatric Problems

ERIC Educational Resources Information Center

Freeze, Rick; Cook, Paula

2005-01-01

The purpose of this study was to assess the efficacy and practicality of precision reading, a constructive reading intervention, with students with cognitive impairments, extreme academic deficits in reading, and severe social, emotional, and psychiatric problems. As precision reading had shown promise with students with low achievement, learning…

Necrotizing Fasciitis of the Upper Extremity, Case Report and Review of the Literature

PubMed Central

Nazerani, Shahram; Maghari, Ahmad; Kalantar Motamedi, Mohammad Hosein; Vahedian Ardakani, Jalal; Rashidian, Nikdokht; Nazerani, Tina

2012-01-01

ABSTRACT Necrotizing fasciitis is a rare, life-threatening infection most commonly seen in patients with diabetes mellitus, intravenous drug abuse, and immunocompromised conditions. The extremities are the primary sites of involvement in as many as two thirds of the cases. In a significant proportion of patients, the extremities are involved as a result of trauma, needle puncture or extravasation of drugs. The infection is usually polymicrobial. Treatment involves broad-spectrum antibiotics and multiple surgical debridements or amputation. We present a patient with necrotizing fasciitis of the upper limb and present our experience with this often lethal condition. PMID:24350113

Improving simulated long-term responses of vegetation to temperature and precipitation extremes using the ACME land model

NASA Astrophysics Data System (ADS)

Ricciuto, D. M.; Warren, J.; Guha, A.

2017-12-01

While carbon and energy fluxes in current Earth system models generally have reasonable instantaneous responses to extreme temperature and precipitation events, they often do not adequately represent the long-term impacts of these events. For example, simulated net primary productivity (NPP) may decrease during an extreme heat wave or drought, but may recover rapidly to pre-event levels following the conclusion of the extreme event. However, field measurements indicate that long-lasting damage to leaves and other plant components often occur, potentially affecting the carbon and energy balance for months after the extreme event. The duration and frequency of such extreme conditions is likely to shift in the future, and therefore it is critical for Earth system models to better represent these processes for more accurate predictions of future vegetation productivity and land-atmosphere feedbacks. Here we modify the structure of the Accelerated Climate Model for Energy (ACME) land surface model to represent long-term impacts and test the improved model against observations from experiments that applied extreme conditions in growth chambers. Additionally, we test the model against eddy covariance measurements that followed extreme conditions at selected locations in North America, and against satellite-measured vegetation indices following regional extreme events.

Record-Breaking Eclipsing Binary

NASA Astrophysics Data System (ADS)

Kohler, Susanna

2016-05-01

A new record holder exists for the longest-period eclipsing binary star system: TYC-2505-672-1. This intriguing system contains a primary star that is eclipsed by its companion once every 69 years with each eclipse lasting several years!120 Years of ObservationsIn a recent study, a team of scientists led by Joseph Rodriguez (Vanderbilt University) characterizes the components of TYC-2505-672-1. This binary star system consists of an M-type red giant star that undergoes a ~3.45-year-long, near-total eclipse with a period of ~69.1 years. This period is more than double that of the previous longest-period eclipsing binary!Rodriguez and collaborators combined photometric observations of TYC-2505-672-1 by the Kilodegree Extremely Little Telescope (KELT) with a variety of archival data, including observations by the American Association of Variable Star Observers (AAVSO) network and historical data from the Digital Access to a Sky Century @ Harvard (DASCH) program.In the 120 years spanned by these observations, two eclipses are detected: one in 1942-1945 and one in 2011-2015. The authors use the observations to analyze the components of the system and attempt to better understand what causes its unusual light curve.Characterizing an Unusual SystemObservations of TYC-2505-672-1 plotted from 1890 to 2015 reveal two eclipses. (The blue KELT observations during the eclipse show upper limits only.) [Rodriguez et al. 2016]By modeling the systems emission, Rodriguez and collaborators establish that TYC-2505-672-1 consists of a 3600-K primary star thats the M giant orbited by a small, hot, dim companion thats a toasty 8000 K. But if the companion is small, why does the eclipse last several years?The authors argue that the best model of TYC-2505-672-1 is one in which the small companion star is surrounded by a large, opaque circumstellar disk. Rodriguez and collaborators suggest that the companion could be a former red giant whose atmosphere was stripped from it, leaving behind the small, hot core shrouded by a large, cool disk of stripped gas. The large size of the disk causes the eclipse of the primary to last for years, as viewed from Earth.The authors estimate the properties such a disk would need to produce the observed light curve. They find that if the companion were surrounded by a disk several AU in diameter, it could orbit at a distance of ~20-30 AU from the primary and reproduce the emission we see.The next eclipse of TYC-2505-672-1 will begin in April 2080. We neednt wait until then to gather more information about this system, however! Radial velocity measurements will help establish the masses of the two components, and high-cadence UV observations could reveal more about the evolutionary state of the system. Studying this extreme binary provides an excellent opportunity to learn more about the environments in late-life star systems.CitationJoseph E. Rodriguez et al 2016 AJ 151 123. doi:10.3847/0004-6256/151/5/123

Applied extreme-value statistics

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

Kinnison, R.R.

1983-05-01

The statistical theory of extreme values is a well established part of theoretical statistics. Unfortunately, it is seldom part of applied statistics and is infrequently a part of statistical curricula except in advanced studies programs. This has resulted in the impression that it is difficult to understand and not of practical value. In recent environmental and pollution literature, several short articles have appeared with the purpose of documenting all that is necessary for the practical application of extreme value theory to field problems (for example, Roberts, 1979). These articles are so concise that only a statistician can recognise all themore » subtleties and assumptions necessary for the correct use of the material presented. The intent of this text is to expand upon several recent articles, and to provide the necessary statistical background so that the non-statistician scientist can recognize and extreme value problem when it occurs in his work, be confident in handling simple extreme value problems himself, and know when the problem is statistically beyond his capabilities and requires consultation.« less

Increasing water cycle extremes in California and in relation to ENSO cycle under global warming

NASA Astrophysics Data System (ADS)

Yoon, Jin-Ho; Wang, S.-Y. Simon; Gillies, Robert R.; Kravitz, Ben; Hipps, Lawrence; Rasch, Philip J.

2015-10-01

Since the winter of 2013-2014, California has experienced its most severe drought in recorded history, causing statewide water stress, severe economic loss and an extraordinary increase in wildfires. Identifying the effects of global warming on regional water cycle extremes, such as the ongoing drought in California, remains a challenge. Here we analyse large-ensemble and multi-model simulations that project the future of water cycle extremes in California as well as to understand those associations that pertain to changing climate oscillations under global warming. Both intense drought and excessive flooding are projected to increase by at least 50% towards the end of the twenty-first century; this projected increase in water cycle extremes is associated with a strengthened relation to El Niño and the Southern Oscillation (ENSO)--in particular, extreme El Niño and La Niña events that modulate California's climate not only through its warm and cold phases but also its precursor patterns.

Increasing water cycle extremes in California and in relation to ENSO cycle under global warming.

PubMed

Yoon, Jin-Ho; Wang, S-Y Simon; Gillies, Robert R; Kravitz, Ben; Hipps, Lawrence; Rasch, Philip J

2015-10-21

Since the winter of 2013-2014, California has experienced its most severe drought in recorded history, causing statewide water stress, severe economic loss and an extraordinary increase in wildfires. Identifying the effects of global warming on regional water cycle extremes, such as the ongoing drought in California, remains a challenge. Here we analyse large-ensemble and multi-model simulations that project the future of water cycle extremes in California as well as to understand those associations that pertain to changing climate oscillations under global warming. Both intense drought and excessive flooding are projected to increase by at least 50% towards the end of the twenty-first century; this projected increase in water cycle extremes is associated with a strengthened relation to El Niño and the Southern Oscillation (ENSO)--in particular, extreme El Niño and La Niña events that modulate California's climate not only through its warm and cold phases but also its precursor patterns.

Increasing water cycle extremes in California and in relation to ENSO cycle under global warming

PubMed Central

Yoon, Jin-Ho; Wang, S-Y Simon; Gillies, Robert R.; Kravitz, Ben; Hipps, Lawrence; Rasch, Philip J.

2015-01-01

Since the winter of 2013–2014, California has experienced its most severe drought in recorded history, causing statewide water stress, severe economic loss and an extraordinary increase in wildfires. Identifying the effects of global warming on regional water cycle extremes, such as the ongoing drought in California, remains a challenge. Here we analyse large-ensemble and multi-model simulations that project the future of water cycle extremes in California as well as to understand those associations that pertain to changing climate oscillations under global warming. Both intense drought and excessive flooding are projected to increase by at least 50% towards the end of the twenty-first century; this projected increase in water cycle extremes is associated with a strengthened relation to El Niño and the Southern Oscillation (ENSO)—in particular, extreme El Niño and La Niña events that modulate California's climate not only through its warm and cold phases but also its precursor patterns. PMID:26487088

Primary Mucinous Cystadenocarcinoma of the Breast with Endocervical-Like Mucinous Epithelium

PubMed Central

Lin, Dong-Liang; Hu, Ji-Lin; Shao, Shi-Hong; Sun, Dong-Mei; Wang, Ji-Gang

2013-01-01

Summary Background Primary mucinous cystadenocarcinoma of the breast is an extremely rare entity. To the best of our knowledge, only 17 patients have been described in the PubMed database. Case Report Here, we report a primary breast mucinous cystadenocarcinoma with endocervical-like mucinous epithelium in a 62-year-old woman. The patient was followed for 5 months without any adjuvant treatment and she continues to be disease free. Conclusions Primary breast mucinous cystadenocarcinoma usually displays unique pathologic and immunohistochemical characteristics simulating its ovarian counterparts; it seems to have a good prognosis after complete resection. PMID:24550753

Synergy effects of combined multichannel EMG-triggered electrical stimulation and mirror therapy in subacute stroke patients with severe or very severe arm/hand paresis.

PubMed

Schick, Thomas; Schlake, Hans-Peter; Kallusky, Juliane; Hohlfeld, Günter; Steinmetz, Maria; Tripp, Florian; Krakow, Karsten; Pinter, Michaela; Dohle, Christian

2017-01-01

Neurorehabilitation requires the development of severity-dependent and successful therapies for arm/hand rehabilitation in stroke patients. To evaluate the effectiveness of adding mirror therapy to bilateral EMG-triggered multi-channel electrostimulation for the treatment of severe arm/hand paresis in stroke patients. The subjects of this randomized, controlled, multicentre study were stroke patients who had suffered their first insult between 1 and 6 months before study start and had severe or very severe arm/hand paresis, as classified by Fugl-Meyer-Assessment. Subjects were randomly allocated to an intervention group (n = 16) or control group (n = 17). Both groups were treated for 3 weeks (5x week, 30 minutes) with bilateral EMG-triggered multi-channel electrostimulation. The intervention group additionally received mirror feedback of the unaffected limb. The primary outcome measure was motor recovery of the upper extremities, as measured by the Fugl-Meyer Assessment. The Intervention Group with very severe paresis had significantly better motor recovery in total Fugl-Meyer Assessment (p = 0.017) at a medium effect size (Cohen) of d = 0.7, due to a significant recovery of shoulder and elbow function (p = 0.003) in the Fugl-Meyer Assessment Part A subtest. For subjects with severe paresis, additional mirror therapy did not significantly influence outcome. Additional mirror therapy in combination with EMG-triggered multi-channel electrostimulation is therapeutically beneficial for post-acute stroke patients with very severe arm/hand paresis.

Manual physical therapy combined with high-intensity functional rehabilitation for severe lower extremity musculoskeletal injuries: a case series*

PubMed Central

Crowell, Michael S.; Deyle, Gail D.; Owens, Johnny; Gill, Norman W.

2016-01-01

Objectives Severe lower extremity trauma accounts for large healthcare costs and often results in elective amputation and poor long-term outcomes. The purpose of this case series is to describe an orthopedic manual physical therapy (OMPT) approach combined with a return to run (RTR) clinical pathway consisting of high-intensity functional rehabilitation with a custom energy-storing orthosis. Methods Three consecutive male patients, aged 21–23 years, with severe lower extremity musculoskeletal injuries were treated with a combined intervention that included a mean (SD) of 12 (2·1) OMPT sessions and 24 (8·7) functional rehabilitation sessions over a mean of 6 weeks (1·0). Additional training with a custom energy-storing orthosis consisted of a mean of 15 (1·2) additional sessions over 4 weeks. Patient self-report outcome measures and a variety of physical performance tests captured change in function. Results Baseline lower extremity functional scale (LEFS) and foot and ankle ability measure activities of daily living subscale (FAAM-ADL) scores indicated severe disability. All patients exceeded the minimal clinically important difference (MCID) in at least one self-report outcome or physical performance test without a brace. Two of three patients exceeded the MCID for at least two physical performance tests after training with and utilizing a custom energy-storing orthosis. Discussion Clinically meaningful changes in self-reported function or physical performance were observed in all patients. A multi-modal approach, including manual therapy and functional exercise, may address the entire spectrum of impairments in patients with severe lower extremity trauma, resulting in improvements in both braced and un-braced function. PMID:27252581

Denitrification by extremely halophilic bacteria

NASA Technical Reports Server (NTRS)

Hochstein, L. I.; Tomlinson, G. A.

1985-01-01

Extremely halophilic bacteria were isolated from widely separated sites by anaerobic enrichment in the presence of nitrate. The anaerobic growth of several of these isolates was accompanied by the production of nitrite, nitrous oxide, and dinitrogen. These results are a direct confirmation of the existence of extremely halophilic denitrifying bacteria, and suggest that such bacteria may be common inhabitants of hypersaline environments.

Breaks in MODIS time series portend vegetation change: verification using long-term data in an arid grassland ecosystem

USDA-ARS?s Scientific Manuscript database

Frequency and severity of extreme climatic events are forecast to increase in the 21st century. Predicting how managed ecosystems may respond to climatic extremes is intensified by uncertainty associated with knowing when, where, and how long effects of the extreme events will be manifest in the eco...

Nonmaximality of known extremal metrics on torus and Klein bottle

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

Karpukhin, M A

2013-12-31

The El Soufi-Ilias theorem establishes a connection between minimal submanifolds of spheres and extremal metrics for eigenvalues of the Laplace-Beltrami operator. Recently, this connection was used to provide several explicit examples of extremal metrics. We investigate the properties of these metrics and prove that none of them is maximal. Bibliography: 24 titles.

Spatial extreme value analysis to project extremes of large-scale indicators for severe weather

PubMed Central

Gilleland, Eric; Brown, Barbara G; Ammann, Caspar M

2013-01-01

Concurrently high values of the maximum potential wind speed of updrafts (Wmax) and 0–6 km wind shear (Shear) have been found to represent conducive environments for severe weather, which subsequently provides a way to study severe weather in future climates. Here, we employ a model for the product of these variables (WmSh) from the National Center for Atmospheric Research/United States National Center for Environmental Prediction reanalysis over North America conditioned on their having extreme energy in the spatial field in order to project the predominant spatial patterns of WmSh. The approach is based on the Heffernan and Tawn conditional extreme value model. Results suggest that this technique estimates the spatial behavior of WmSh well, which allows for exploring possible changes in the patterns over time. While the model enables a method for inferring the uncertainty in the patterns, such analysis is difficult with the currently available inference approach. A variation of the method is also explored to investigate how this type of model might be used to qualitatively understand how the spatial patterns of WmSh correspond to extreme river flow events. A case study for river flows from three rivers in northwestern Tennessee is studied, and it is found that advection of WmSh from the Gulf of Mexico prevails while elsewhere, WmSh is generally very low during such extreme events. © 2013 The Authors. Environmetrics published by JohnWiley & Sons, Ltd. PMID:24223482

[Injury mechanisms in extreme violence settings].

PubMed

Arcaute-Velazquez, Fernando Federico; García-Núñez, Luis Manuel; Noyola-Vilallobos, Héctor Faustino; Espinoza-Mercado, Fernando; Rodríguez-Vega, Carlos Eynar

2016-01-01

Extreme violence events are consequence of current world-wide economic, political and social conditions. Injury patterns found among victims of extreme violence events are very complex, obeying several high-energy injury mechanisms. In this article, we present the basic concepts of trauma kinematics that regulate the clinical approach to victims of extreme violence events, in the hope that clinicians increase their theoretical armamentarium, and reflecting on obtaining better outcomes. Copyright © 2016. Published by Masson Doyma México S.A.

Upper Extremity Amputations and Prosthetics

PubMed Central

Ovadia, Steven A.; Askari, Morad

2015-01-01

Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions. PMID:25685104

Sensitivity of UK butterflies to local climatic extremes: which life stages are most at risk?

PubMed

McDermott Long, Osgur; Warren, Rachel; Price, Jeff; Brereton, Tom M; Botham, Marc S; Franco, Aldina M A

2017-01-01

There is growing recognition as to the importance of extreme climatic events (ECEs) in determining changes in species populations. In fact, it is often the extent of climate variability that determines a population's ability to persist at a given site. This study examined the impact of ECEs on the resident UK butterfly species (n = 41) over a 37-year period. The study investigated the sensitivity of butterflies to four extremes (drought, extreme precipitation, extreme heat and extreme cold), identified at the site level, across each species' life stages. Variations in the vulnerability of butterflies at the site level were also compared based on three life-history traits (voltinism, habitat requirement and range). This is the first study to examine the effects of ECEs at the site level across all life stages of a butterfly, identifying sensitive life stages and unravelling the role life-history traits play in species sensitivity to ECEs. Butterfly population changes were found to be primarily driven by temperature extremes. Extreme heat was detrimental during overwintering periods and beneficial during adult periods and extreme cold had opposite impacts on both of these life stages. Previously undocumented detrimental effects were identified for extreme precipitation during the pupal life stage for univoltine species. Generalists were found to have significantly more negative associations with ECEs than specialists. With future projections of warmer, wetter winters and more severe weather events, UK butterflies could come under severe pressure given the findings of this study. © 2016 The Authors. Journal of Animal Ecology © 2016 British Ecological Society.

Upper Extremity Function in Multiple Sclerosis Patients With Advanced Disability Treated With Ocrevus

ClinicalTrials.gov

2018-06-18

Multiple Sclerosis; Pathologic Processes; Demyelinating Diseases; Demyelinating Autoimmune Diseases; Nervous System Diseases; Autoimmune Diseases; Immune System Diseases; Primary Progressive Multiple Sclerosis; Relapsing Remitting Multiple Sclerosis

Exorcising Boredom

ERIC Educational Resources Information Center

O'Connor, Constance

1976-01-01

Boredom relates to many areas within a society: crime, child abuse, suicide, extreme loneliness, family tension, depression, violence, alcoholism, and drug abuse; a primary concern of the leisure services should be the alleviation of boredom. (JD)

Incidence of Pulmonary Embolus in Combat Casualties With Extremity Amputations and Fractures

DTIC Science & Technology

2011-09-01

digits/ ankles /feet) are at increased risk of developing a PE than those suffering long-bone fracture without an asso- ciated amputation. MATERIALS AND...Amputations and extremity fractures limited in level to or distal to the wrist or ankle were excluded from analysis. The primary outcome measured was...vigorous physical therapy and rehab . Immobility has been shown to be a risk factor for the development of PE, espe- cially in the trauma setting. 13

[Influence of three-level collaboration network of pediatric burns treatment in Anhui province on treatment effects of burn children].

PubMed

Xia, Z G; Zhou, X L; Kong, W C; Li, X Z; Song, J H; Fang, L S; Hu, D L; Cai, C; Tang, Y Z; Yu, Y X; Wang, C H; Xu, Q L

2018-03-20

Objective: To explore the influence of three-level collaboration network of pediatric burns in Anhui province on treatment effects of burn children. Methods: The data of medical records of pediatric burn children transferred from Lu'an People's Hospital and Fuyang People's Hospital to the First Affiliated Hospital of Anhui Medical University from January 2014 to December 2015 and January 2016 to September 2017 (before and after establishing three-level collaboration network of pediatric burns treatment) were analyzed: percentage of transferred burn children to hospitalized burn children in corresponding period, gender, age, burn degree, treatment method, treatment result, occurrence and treatment result of shock, and operative and non-operative treatment time and cost. Rehabilitation result of burn children transferred back to local hospitals in 2016 and 2017. Data were processed with t test, chi-square test, Mann-Whitney U test, and Fisher's exact test. Results: (1) Percentage of burn children transferred from January 2014 to December 2015 was 34.3% (291/848) of the total number of hospitalized burn children in the same period of time, which was close to 30.4% (210/691) of burn children transferred from January 2016 to September 2017 ( χ (2)=2.672, P >0.05). (2) Gender, age, burn degree, and treatment method of burn children transferred from the two periods of time were close ( χ (2)=3.382, Z =-1.917, -1.911, χ (2)=3.133, P >0.05). (3) Cure rates of children with mild, moderate, and severe burns transferred from January 2016 to September 2017 were significantly higher than those of burn children transferred from January 2014 to December 2015 ( χ (2)=11.777, 6.948, 4.310, P <0.05). Cure rates of children with extremely severe burns transferred from the two periods of time were close ( χ (2)=1.181, P >0.05). (4) Children with mild and moderate burns transferred from the two periods of time were with no shock. The incidence of shock of children with severe burns transferred from January 2014 to December 2015 was 6.0% (4/67), and 3 children among them were cured. The incidence of shock of children with severe burns transferred from January 2016 to September 2017 was 3.9% (2/51), and both children were cured. The incidences and cures of shock of children with severe burns transferred from the two periods of time were close ( χ (2)=0.006, P >0.05). Incidence of shock of children with extremely severe burns transferred from January 2014 to December 2015 was 57.1% (32/56), significantly higher than that of burn children transferred from January 2016 to September 2017 [34.5% (10/29), χ (2)=3.925, P <0.05]. Shock of 25 children with extremely severe burns transferred from January 2014 to December 2015 were cured, and shock of 9 children with extremely severe burns transferred from January 2016 to September 2017 were cured. The cures of shock of children with extremely severe burns transferred from the two periods of time were close ( χ (2)=0.139, P >0.05). (5) Time of operative treatment of children with moderate, severe, and extremely severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 ( t =2.335, 2.065, 2.310, P <0.05). Time of operative treatment of children with mild burns transferred from the two periods of time was close ( Z =-0.417, P >0.05). Costs of operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were significantly more than those of burn children transferred from January 2016 to September 2017 ( Z =-3.324, t =2.167, P <0.05). Costs of operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close ( t =0.627, 0.808, P >0.05). (6)Time of non-operative treatment of children with mild, moderate, and severe burns transferred from January 2014 to December 2015 was obviously longer than that of burn children transferred from January 2016 to September 2017 ( t =2.335, Z =-2.095, t =2.152, P <0.05). Time of non-operative treatment of children with extremely severe burns transferred from the two periods of time was close ( t =0.450, P >0.05). Costs of non-operative treatment of children with moderate and severe burns transferred from January 2014 to December 2015 were obviously higher than those of burn children transferred from January 2016 to September 2017 ( Z =-2.164, t =2.040, P <0.05). Costs of non-operative treatment of children with mild and extremely severe burns transferred from the two periods of time were close ( t =0.146, 1.235, P >0.05). (7) Sixty-seven burn children transferred from January 2016 to September 2017 were transferred back to local hospitals for rehabilitation under the guidance of experts of the First Affiliated Hospital of Anhui Medical University, with 25 patients in 2016 and 42 patients in 2017. Effective rehabilitation rates of burn children transferred back to local hospitals for rehabilitation in 2016 and 2017 were both 100%. Conclusions: The three-level collaboration network of pediatric burns treatment in Anhui province can effectively increase cure rate of children with mild, moderate, and severe burns, reduce incidence of shock of children with extremely severe burns, shorten time of operative treatment of burn children with moderate, severe, and extremely severe burns, and time of non-operative treatment of children with mild, moderate, and severe burns, reduce treatment costs of children with moderate and severe burns, and improve rehabilitation effectiveness of children transferred from Lu'an People's Hospital and Fuyang People's Hospital to the the First Affiliated Hospital of Anhui Medical University.

Malignant Melanoma Presenting as a Mediastinal Malignant Melanoma Presenting as a Mediastinal Unknown Primary Origin?

PubMed

Pujani, Mukta; Hassan, Mohd Jaseem; Jetley, Sujata; Raina, Prabhat Kumar; Kumar, Mukesh

2017-01-01

The most common site of primary malignant melanoma is the skin, however, virtually any organ system may be involved. Metastatic melanoma of unknown primary origin accounts for approximately 2-6% of all melanoma cases. The mediastinum as the site for malignant melanoma is extremely rare, both as a primary or metastatic lesion. Primary malignant melanoma of mediastinum is very rare with only a handful of reports in the literature. We hereby report a rare case of malignant melanoma of mediastinum in a 31 year old male who was initially misdiagnosed on fine needle aspiration cytology as adenocarcinoma for which he received chemotherapy with clinical deterioration. Even on extensive meticulous search, no primary was discovered.

Bio-artificial pleura using an autologous dermal fibroblast sheet

NASA Astrophysics Data System (ADS)

Kanzaki, Masato; Takagi, Ryo; Washio, Kaoru; Kokubo, Mami; Yamato, Masayuki

2017-10-01

Air leaks (ALs) are observed after pulmonary resections, and without proper treatment, can produce severe complications. AL prevention is a critical objective for managing patients after pulmonary resection. This study applied autologous dermal fibroblast sheets (DFS) to close ALs. For sealing ALs in a 44-year-old male human patient with multiple bullae, a 5 × 15-mm section of skin was surgically excised. From this skin specimen, primary dermal fibroblasts were isolated and cultured for 4 weeks to produce DFSs that were harvested after a 10-day culture. ALs were completely sealed using surgical placement of these autologous DFSs. DFS were found to be a durable long-term AL sealant, exhibiting requisite flexibility, elasticity, durability, biocompatibility, and usability, resulting reliable AL closure. DFS should prove to be an extremely useful tissue-engineered pleura substitute.

Discovery of potent HIV-1 non-nucleoside reverse transcriptase inhibitors from arylthioacetanilide structural motif.

PubMed

Li, Wenxin; Li, Xiao; De Clercq, Erik; Zhan, Peng; Liu, Xinyong

2015-09-18

The poor pharmacokinetics, side effects and particularly the rapid emergence of drug resistance compromise the efficiency of the clinically used anti-HIV drugs. Therefore, the discovery of novel and effective NNRTIs is still an extremely primary mission. Arylthioacetanilide family is one of the highly active HIV-1 NNRTIs against wide-type (WT) HIV-1 and a wide range of drug-resistant mutant strains. Especially, VRX-480773 and RDEA806 have been chosen as candidates for further clinical studies. In this article, we review the discovery and development of the arylthioacetanilides, and, especially, pay much attention to the structural modifications, SARs conclusions and molecular modeling. Moreover, several medicinal chemistry strategies to overcome drug resistance involved in the optimization process of arylthioacetanilides are highlighted, providing valuable clues for further investigations. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

E-ELT M1 test facility

NASA Astrophysics Data System (ADS)

Dimmler, M.; Marrero, J.; Leveque, S.; Barriga, P.; Sedghi, B.; Mueller, M.

2012-09-01

During the advanced design phase of the European Extremely Large Telescope (E-ELT) several critical components have been prototyped. During the last year some of them have been tested in dedicated test stands. In particular, a representative section of the E-ELT primary mirror has been assembled with 2 active and 2 passive segments. This test stand is equipped with complete prototype segment subunits, i.e. including support mechanisms, glass segments, edge sensors, position actuators as well as additional metrology for monitoring. The purpose is to test various procedures such as calibration, alignment and handling and to study control strategies. In addition the achievable component and subsystem performances are evaluated, and interface issues are identified. In this paper an overview of the activities related to the E-ELT M1 Test Facility will be given. Experiences and test results are presented.

Molecular parameters of head and neck cancer metastasis

PubMed Central

Bhave, Sanjay L.; Teknos, Theodoros N.; Pan, Quintin; James, Arthur G.; Solove, Richard J.

2011-01-01

Metastasis remains a major cause of mortality in patients with head and neck squamous cell carcinoma (HNSCC). HNSCC patients with metastatic disease have extremely poor prognosis with survival rate of less than a year. Metastasis is an intricate sequential process which requires a discrete population of tumor cells to possess the capacity to intravasate from the primary tumor into systemic circulation, survive in circulation, extravasate at a distant site, and proliferate in a foreign hostile environment. Literature has accumulated to provide mechanistic insight into several signal transduction pathways, receptor tyrosine kinases (RTKs), signal transducer and activator of transcription 3 (Stat3), Rho GTPases, protein kinase Cε (PKCε), and nuclear factor-κB (NF-κB), that are involved in mediating a metastatic tumor cell phenotype in HNSCC. Here we highlight accrued information regarding the key molecular parameters of HNSCC metastasis. PMID:22077153

Primary leiomyoma of the lung: an exceptional localization.

PubMed

Zidane, Abdelfettah; Elktaibi, Abderahim; Benjelloun, Amine; Arsalane, Adil; Afandi, Oussama; Bouchentouf, Rachid

2016-05-01

Leiomyoma is a benign smooth muscle tumor usually encountered in the uterus. Primary pulmonary localization is extremely rare in adults and children. However, it must be included in the differential diagnosis of any nodular lung lesion. Its treatment is surgical, with good long-term results. Here, we report a case of leiomyoma of lung parenchyma diagnosed in a 26-year-old man. © The Author(s) 2016.

Overt Skeletal Metastases in a Patient of Occult (Microscopic) Follicular Thyroid Carcinoma: a Rare Case.

PubMed

Jha, Chandan Kumar; Agrawal, Vinita; Mishra, Anjali; Pradhan, P K

2018-03-01

Occult follicular thyroid carcinoma (FTC) presenting as distant metastases is a rare occurrence. However, despite being occult in majority of these cases, primary tumor can be detected on thyroid imaging or during surgery. Here, we present an extremely rare case of an occult FTC with overt skeletal metastases in which primary tumor was discernible only on microscopic examination.

Are recent severe floods in Xiang River basin of China linked with the increase extreme precipitation?

NASA Astrophysics Data System (ADS)

Cheng, L.; Du, J.

2015-12-01

The Xiang River, a main tributary of the Yangtze River, is subjected to high floods frequently in recent twenty years. Climate change, including abrupt shifts and fluctuations in precipitation is an important factor influencing hydrological extreme conditions. In addition, human activities are widely recognized as another reasons leading to high flood risk. With the effects of climate change and human interventions on hydrological cycle, there are several questions that need to be addressed. Are floods in the Xiang River basin getting worse? Whether the extreme streamflow shows an increasing tendency? If so, is it because the extreme rainfall events have predominant effect on floods? To answer these questions, the article detected existing trends in extreme precipitation and discharge using Mann-Kendall test. Continuous wavelet transform method was employed to identify the consistency of changes in extreme precipitation and discharge. The Pearson correlation analysis was applied to investigate how much degree of variations in extreme discharge can be explained by climate change. The results indicate that slightly upward trends can be detected in both extreme rainfalls and discharge in the upper region of Xiang River basin. For the most area of middle and lower river basin, the extreme rainfalls show significant positive trends, but the extreme discharge displays slightly upward trends with no significance at 90% confidence level. Wavelet transform analysis results illustrate that highly similar patterns of signal changes can be seen between extreme precipitation and discharge in upper section of the basin, while the changes in extreme precipitation for the middle and lower reaches do not always coincide with the extreme streamflow. The correlation coefficients of the wavelet transforms for the precipitation and discharge signals in most area of the basin pass the significance test. The conclusion may be drawn that floods in recent years are not getting worse in Xiang River basin. The similar signal patterns and positive correlation between extreme discharge and precipitation indicate that the variability of extreme precipitation has an important effect on extreme discharge of flood, although the intensity of human impacts in lower section of Xiang River basin has increased markedly.

Case report: severe melorheostosis involving the ipsilateral extremities.

PubMed

Long, Hai-Tao; Li, Kang-Hua; Zhu, Yong

2009-10-01

Melorheostosis is a rare, noninheritable bone dysplasia characterized by its classic radiographic feature of flowing hyperostosis resembling dripping candle wax, generally on one side of the long bone. The condition originally was described by Leri and Joanny in 1922. Its etiology remains speculative, and treatment in most instances has been symptomatic. Melorheostosis usually affects one limb, more often the lower extremity, and rarely the axial skeleton. We report a rare case of severe melorheostosis in the ipsilateral upper and lower extremities with normal contralateral extremities. The plain radiographs revealed almost all the bones in the affected extremities, from clavicle and scapula to distal phalanges of the fingers and from femur to distal phalanges of the toes, presented extensive, dense hyperostosis and heterotopic ossification in the periarticular soft tissue. Physical examination showed considerable swelling and deformities of the left limbs, stiffness and distortion of the joints, and anesthesia in the left ulnar regions of the forearm and hand. The examination of the right side was normal. Computed tomography scans showed multiple areas of classic candle wax-like hyperostosis and narrowing or disappearance of the medullary cavity. Histologic analysis confirmed the clinical and imaging diagnosis and revealed extremely dense sclerotic bone of cortical pattern.

Determining relative contributions of vegetation and topography to burn severity from LANDSAT imagery.

PubMed

Wu, Zhiwei; He, Hong S; Liang, Yu; Cai, Longyan; Lewis, Bernard J

2013-10-01

Fire is a dominant process in boreal forest landscapes and creates a spatial patch mosaic with different burn severities and age classes. Quantifying effects of vegetation and topography on burn severity provides a scientific basis on which forest fire management plans are developed to reduce catastrophic fires. However, the relative contribution of vegetation and topography to burn severity is highly debated especially under extreme weather conditions. In this study, we hypothesized that relationships of vegetation and topography to burn severity vary with fire size. We examined this hypothesis in a boreal forest landscape of northeastern China by computing the burn severity of 24 fire patches as the difference between the pre- and post-fire Normalized Difference Vegetation Index obtained from two Landsat TM images. The vegetation and topography to burn severity relationships were evaluated at three fire-size levels of small (<100 ha, n = 12), moderate (100-1,000 ha, n = 9), and large (>1,000 ha, n = 3). Our results showed that vegetation and topography to burn severity relationships were fire-size-dependent. The burn severity of small fires was primary controlled by vegetation conditions (e.g., understory cover), and the burn severity of large fires was strongly influenced by topographic conditions (e.g., elevation). For moderate fires, the relationships were complex and indistinguishable. Our results also indicated that the pattern trends of relative importance for both vegetation and topography factors were not dependent on fire size. Our study can help managers to design fire management plans according to vegetation characteristics that are found important in controlling burn severity and prioritize management locations based on the relative importance of vegetation and topography.

Determining Relative Contributions of Vegetation and Topography to Burn Severity from LANDSAT Imagery

NASA Astrophysics Data System (ADS)

Wu, Zhiwei; He, Hong S.; Liang, Yu; Cai, Longyan; Lewis, Bernard J.

2013-10-01

Fire is a dominant process in boreal forest landscapes and creates a spatial patch mosaic with different burn severities and age classes. Quantifying effects of vegetation and topography on burn severity provides a scientific basis on which forest fire management plans are developed to reduce catastrophic fires. However, the relative contribution of vegetation and topography to burn severity is highly debated especially under extreme weather conditions. In this study, we hypothesized that relationships of vegetation and topography to burn severity vary with fire size. We examined this hypothesis in a boreal forest landscape of northeastern China by computing the burn severity of 24 fire patches as the difference between the pre- and post-fire Normalized Difference Vegetation Index obtained from two Landsat TM images. The vegetation and topography to burn severity relationships were evaluated at three fire-size levels of small (<100 ha, n = 12), moderate (100-1,000 ha, n = 9), and large (>1,000 ha, n = 3). Our results showed that vegetation and topography to burn severity relationships were fire-size-dependent. The burn severity of small fires was primary controlled by vegetation conditions (e.g., understory cover), and the burn severity of large fires was strongly influenced by topographic conditions (e.g., elevation). For moderate fires, the relationships were complex and indistinguishable. Our results also indicated that the pattern trends of relative importance for both vegetation and topography factors were not dependent on fire size. Our study can help managers to design fire management plans according to vegetation characteristics that are found important in controlling burn severity and prioritize management locations based on the relative importance of vegetation and topography.

Operative Treatment of Lymphedema Using Suction-Assisted Lipectomy.

PubMed

Greene, Arin K; Maclellan, Reid A

2016-09-01

Surgical management of lymphedema includes removal of affected tissues (excisional procedures), or operations that create new lymphatic connections (physiologic procedures). The purpose of this study was to determine the efficacy of one type of excisional procedure, suction-assisted lipectomy, for extremity lymphedema. Patients treated in our Lymphedema Program between 2007 and 2015 with liposuction that had postoperative follow-up were reviewed. The diagnosis of lymphedema was made by history/physical examination and confirmed with lymphoscintigraphy. Patient sex, age, type of lymphedema (primary or secondary), location of disease, infection history, volume of lipoaspirate, and reduction of extremity volume were recorded. Fifteen patients were included, mean age was 45 years (range, 17-71). Six patients had secondary upper extremity lymphedema, and 9 patients had lower limb disease. Eight patients had a history of repeated cellulitis involving the lymphedematous extremity. Mean lipoaspirate volume was 1612 mL (range, 1200-2800) for the upper extremity and 2902 mL (range, 2000-4800) for the lower limb. Postoperative follow-up averaged 3.1 years. The mean reduction in excess extremity volume was 73% (range, 48% to 94%), and patients reported improvement in their quality of life. Suction-assisted lipectomy is an effective technique to reduce extremity volume for patients with lymphedema.

Multiple Primary Merkel Cell Carcinomas Presenting as Pruritic, Painful Lower Leg Tumors

PubMed Central

Blumenthal, Laura; VandenBoom, Timothy; Melian, Edward; Peterson, Anthony; Hutchens, Kelli A.

2015-01-01

Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine tumor of the skin which almost exclusively presents as a solitary tumor. It is most often seen on sun-exposed regions, historically almost exclusively on the head and neck, with only rare case reports on the extremities. Although recent studies have shown increased incidence with up to 20% on the extremities, here we present one of these rare emerging presentations, with the addition of a unique treatment option. Our patient is an 80-year-old male with a 3-month history of multiple raised, rapidly enlarging tumors on the right ankle. Two separate biopsies were performed and demonstrated sheets and clusters of small blue cells filling the dermis with scant cytoplasm, dusty chromatin, and nuclear molding. Subsequent immunohistochemical stains confirmed the diagnosis of multiple primary MCC. Despite the characteristic immunohistochemical profile of primary MCC, the possibility of a metastatic neuroendocrine carcinoma from an alternate primary site was entertained, given his unusual clinical presentation. A complete clinical workup including CT scans of the chest, abdomen, and pelvis showed no evidence of disease elsewhere. Instead of amputation, the patient opted for nonsurgical treatment with radiation therapy alone, resulting in a rapid and complete response. This case represents an unusual presentation of primary MCC and demonstrates further evidence that radiation as monotherapy is an effective local treatment option for inoperable MCC. PMID:26594171

Climatic extremes improve predictions of spatial patterns of tree species

USGS Publications Warehouse

Zimmermann, N.E.; Yoccoz, N.G.; Edwards, T.C.; Meier, E.S.; Thuiller, W.; Guisan, Antoine; Schmatz, D.R.; Pearman, P.B.

2009-01-01

Understanding niche evolution, dynamics, and the response of species to climate change requires knowledge of the determinants of the environmental niche and species range limits. Mean values of climatic variables are often used in such analyses. In contrast, the increasing frequency of climate extremes suggests the importance of understanding their additional influence on range limits. Here, we assess how measures representing climate extremes (i.e., interannual variability in climate parameters) explain and predict spatial patterns of 11 tree species in Switzerland. We find clear, although comparably small, improvement (+20% in adjusted D2, +8% and +3% in cross-validated True Skill Statistic and area under the receiver operating characteristics curve values) in models that use measures of extremes in addition to means. The primary effect of including information on climate extremes is a correction of local overprediction and underprediction. Our results demonstrate that measures of climate extremes are important for understanding the climatic limits of tree species and assessing species niche characteristics. The inclusion of climate variability likely will improve models of species range limits under future conditions, where changes in mean climate and increased variability are expected.

Primary Hyperoxaluria Type 1: A Cause for Infantile Renal Failure and Massive Nephrocalcinosis.

PubMed

Kurt-Sukur, E D; Özçakar, Z B; Fitöz, S; Yilmaz, S; Hoppe, B; Yalçinkaya, F

2015-09-01

Primary hyperoxaluria type 1 is a rare autosomal-recessive disease caused by the deficient activity of the liver specific enzyme alanine-glyoxylate aminotransferase. Increased endogenous oxalate production induces severe hyperoxaluria, recurrent urolithiasis, progressive nephrocalcinosis and renal failure. Here we report a 6 month old boy who presented with vomiting and decreased urine volume. He was diagnosed with chronic kidney failure at 4 months of age and peritoneal dialysis was introduced at a local hospital. His parents were third degree cousins and family history revealed 2 maternal cousins who developed end stage renal disease during childhood. When he was admitted to our hospital, laboratory studies were consistent with end stage renal disease, ultrasound showed bilateral massive nephrocalcinosis. As clinical presentation was suggestive for primary hyperoxaluria type 1, plasma oxalate was determined and found extremely elevated. Genetic testing proved diagnosis by showing a disease causing homozygous mutation (AGXT-gene: c.971_972delT). The patient was put on pyridoxine treatment and aggressive dialysis programme. In conclusion; progressive renal failure in infancy with massive nephrocalcinosis, especially if accompanied by consanguinity and family history, should always raise the suspicion of PH type 1. Increased awareness of the disease would help physicians in both treating the patients and guiding the families who have diseased children and plan to have further pregnancies. © Georg Thieme Verlag KG Stuttgart · New York.

Preliminary Analysis of Effect of Random Segment Errors on Coronagraph Performance

NASA Technical Reports Server (NTRS)

Stahl, Mark T.; Shaklan, Stuart B.; Stahl, H. Philip

2015-01-01

Are we alone in the Universe is probably the most compelling science question of our generation. To answer it requires a large aperture telescope with extreme wavefront stability. To image and characterize Earth-like planets requires the ability to block 10(exp 10) of the host stars light with a 10(exp -11) stability. For an internal coronagraph, this requires correcting wavefront errors and keeping that correction stable to a few picometers rms for the duration of the science observation. This requirement places severe specifications upon the performance of the observatory, telescope and primary mirror. A key task of the AMTD project (initiated in FY12) is to define telescope level specifications traceable to science requirements and flow those specifications to the primary mirror. From a systems perspective, probably the most important question is: What is the telescope wavefront stability specification? Previously, we suggested this specification should be 10 picometers per 10 minutes; considered issues of how this specification relates to architecture, i.e. monolithic or segmented primary mirror; and asked whether it was better to have few or many segmented. This paper reviews the 10 picometers per 10 minutes specification; provides analysis related to the application of this specification to segmented apertures; and suggests that a 3 or 4 ring segmented aperture is more sensitive to segment rigid body motion that an aperture with fewer or more segments.

Where do ocean microseisms come from? A study of Love-to-Rayleigh wave ratios

NASA Astrophysics Data System (ADS)

Juretzek, C.; Hadziioannou, C.

2016-09-01

Our knowledge of the origin of Love waves in the ambient seismic noise is extremely limited. This applies in particular to constraints on source locations and source mechanisms for Love waves in the secondary microseism. Here three-component beamforming is used to distinguish between the differently polarized wave types in the primary and secondary microseismic noise fields, recorded at several arrays across Europe. We compare characteristics of Love and Rayleigh wave noise, such as source directions and frequency content, measure Love to Rayleigh wave ratios for different back azimuths, and look at the seasonal behavior of our measurements by using a full year of data in 2013. The beamforming results confirm previous observations that back azimuths for Rayleigh and Love waves in both microseismic bands mainly coincide. However, we observe differences in relative directional noise strength between both wave types for the primary microseism. At those frequencies, Love waves dominate on average, with kinetic Love-to-Rayleigh energy ratios ranging from 0.6 to 2.0. In the secondary microseism, the ratios are lower, between 0.4 and 1.2. The wave type ratio is directionally homogeneous, except for locations far from the coast. In the primary microseism, our results support the existence of different generation mechanisms. The contribution of a shear traction-type source mechanism is likely.

[Analysis of the pathogenic characteristics of 162 severely burned patients with bloodstream infection].

PubMed

Gong, Y L; Yang, Z C; Yin, S P; Liu, M X; Zhang, C; Luo, X Q; Peng, Y Z

2016-09-20

To analyze the distribution and drug resistance of pathogen isolated from severely burned patients with bloodstream infection, so as to provide reference for the clinical treatment of these patients. Blood samples of 162 severely burned patients (including 120 patients with extremely severe burn) with bloodstream infection admitted into our burn ICU from January 2011 to December 2014 were collected. Pathogens were cultured by fully automatic blood culture system, and API bacteria identification panels were used to identify pathogen. Kirby-Bauer paper disk diffusion method was used to detect the drug resistance of major Gram-negative and -positive bacteria to 37 antibiotics including ampicillin, piperacillin and teicoplanin, etc. (resistance to vancomycin was detected by E test), and drug resistance of fungi to 5 antibiotics including voriconazole and amphotericin B, etc. Modified Hodge test was used to further identify imipenem and meropenem resistant Klebsiella pneumonia. D test was used to detect erythromycin-induced clindamycin resistant Staphylococcus aureus. The pathogen distribution and drug resistance rate were analyzed by WHONET 5.5. Mortality rate and infected pathogens of patients with extremely severe burn and patients with non-extremely severe burn were recorded. Data were processed with Wilcoxon rank sum test. (1) Totally 1 658 blood samples were collected during the four years, and 339 (20.4%) strains of pathogens were isolated. The isolation rate of Gram-negative bacteria, Gram-positive bacteria, and fungi were 68.4% (232/339), 24.5% (83/339), and 7.1% (24/339), respectively. The top three pathogens with isolation rate from high to low were Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa in turn. (2) Except for the low drug resistance rate to polymyxin B and minocycline, drug resistance rate of Acinetobacter baumannii to the other antibiotics were relatively high (81.0%-100.0%). Pseudomonas aeruginosa was sensitive to polymyxin B but highly resistant to other antibiotics (57.7%-100.0%). Enterobacter cloacae was sensitive to imipenem and meropenem, while its drug resistance rates to ciprofloxacin, levofloxacin, cefoperazone/sulbactam, cefepime, piperacillin/tazobactam were 25.0%-49.0%, and those to the other antibiotics were 66.7%-100.0%. Drug resistance rates of Klebsiella pneumoniae to cefoperazone/sulbactam, imipenem, and meropenem were low (5.9%-15.6%, two imipenem- and meropenem-resistant strains were identified by modified Hodge test), while its drug resistance rates to amoxicillin/clavulanic acid, piperacillin/tazobactam, cefepime, cefoxitin, amikacin, levofloxacin were 35.3%-47.1%, and those to the other antibiotics were 50.0%-100.0%. (3) Drug resistance rates of methicillin-resistant Staphylococcus aureus (MRSA) to most of the antibiotics were higher than those of the methicillin-sensitive Staphylococcus aureus (MSSA). MRSA was sensitive to linezolid, vancomycin, and teicoplanin, while its drug resistance rates to compound sulfamethoxazole, clindamycin, minocycline, and erythromycin were 5.3%-31.6%, and those to the other antibiotics were 81.6%-100.0%. Except for totally resistant to penicillin G and tetracycline, MSSA was sensitive to the other antibiotics. Fourteen Staphylococcus aureus strains were resistant to erythromycin-induced clindamycin. Enterococcus was sensitive to vancomycin and teicoplanin, while its drug resistance rates to linezolid, chloramphenicol, nitrofurantoin, and high unit gentamicin were low (10.0%-30.0%), and those to ciprofloxacin, erythromycin, minocycline, and ampicillin were high (60.0%-80.0%). Enterococcus was fully resistant to rifampicin. (4) Fungi was sensitive to amphotericin B, and drug resistance rates of fungi to voriconazole, fluconazole, itraconazole, and ketoconazole were 7.2%-12.5%. (5) The mortality of patients with extremely severe burn was higher than that of patients with non-extremely severe burn. The variety of infected pathogens in patients with extremely severe burn significantly outnumbered that in patients with non-extremely severe burn (Z=-2.985, P=0.005). The variety of pathogen in severely burned patients with bloodstream infection is wide, with the main pathogens as Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa, and the drug resistance situation is grim. The types of infected pathogen in patients with extremely severe burn are more complex, and the mortality of these patients is higher when compared with that of patients with non-extremely severe burn.

[High voltage accidents, characteristics and treatment].

PubMed

Hülsbergen-Krüger, S; Pitzler, D; Partecke, B D

1995-04-01

High-voltage injuries cause localised entrance and exit burns, extensive arc, flame and flash burns and, even more dangerous, necrosis of the underlying muscles on the pathway of the current through the body. Therefore it should be recognized that the ensuing disease is more like a crush injury than a thermal burn. The extent of injury cannot be judged by the percentage and depth of the skin burn. Diagnostic fasciotomies, radical debridement, and in many cases early amputation are necessary to prevent life-threatening complications. Over a period of 10 years, 43 patients with high-voltage injuries have been treated at the Hamburg Burn Center, 36 of them in primary care. Common causes of injury were accidents in railway areas (28%), using portable aluminium ladders near overhead power lines (9.3%), and working on electrical equipment (30.2%). Six of the primary care patients died (16.6%), and 34.9% had an amputation of one or more extremities. Nearly all patients underwent several debridement and split-skin graft procedures. In 30% of cases additional free and pedicled flaps were needed to cover soft tissue defects. Ten patients (23.3%) sustained fractures and other injuries from falls, seven (16.3%) of them severe polytrauma. Initial cardiac arrhythmics were diagnosed in 16.6% of the primarily treated patients. Thirty per cent of our patients had neurological complications such as peripheral paresis, tetraplegia and paraplegia, 20.7% of these caused solely by the electric current.

Chemotherapy-induced alopecia in mice. Induction by cyclophosphamide, inhibition by cyclosporine A, and modulation by dexamethasone.

PubMed Central

Paus, R.; Handjiski, B.; Eichmüller, S.; Czarnetzki, B. M.

1994-01-01

We introduce cyclophosphamide-induced alopecia (CYP-IA) in C57BL-6 mice as a clinically relevant model for studying the biology of chemotherapy-induced alopecia and for developing anti-alopecia drugs. One injection of CYP to mice with all back skin follicles in anagen VI induces severe alopecia that strikingly reproduces the follicle response, recovery, and histopathology seen in human CYP-IA. CYP dose-dependently induces abnormal follicular melanogenesis and dystrophic anagen or, in more severely damaged follicles, dystrophic catagen. Both dystrophy forms are followed by an extremely shortened telogen phase, but differ in the associated hair loss and in recovery patterns, which determines hair regrowth. This follicular response to CYP can be manipulated pharmacologically: systemic cyclosporine A shifts it toward a mild form of dystrophic anagen, thus retarding CYP-IA and prolonging "primary recovery". Topical dexamethasone, in contrast, forces follicles into dystrophic catagen, which augments CYP-IA, but accelerates the regrowth of normally pigmented hair ("secondary recovery"). Images Figure 2 Figure 3 Figure 4 Figure 6 Figure 7 Figure 8 Figure 10 PMID:8160773

Segment phasing experiments on the High Order Test bench

NASA Astrophysics Data System (ADS)

Aller-Carpentier, E.; Kasper, M.; Martinez, P.

The segmented primary mirror of the E-ELT imposes particular requirements on an Extreme Adaptive Optics (XAO) system. At present, there are already several AO systems working on segmented telescopes but the achieved performances are too low to draw conclusions for XAO systems aiming at some 90% Strehl ratio in the NIR. On other hand, several analytical studies and simulations were done, but laboratory studies are required to confirm the corrections expected. The goal of the present study is to determina the capability of XAO systems to deal with segmentation piston errors. In particular, the effects on the AO performance and the ability of the AO system to correct the segmentation piston errors were studied. The experiments were carried out on the High Order Test Bench at ESO (Munich) using a Shack-Hartmann wave front sensor and under most realistic conditions with phase screens simulating atmospheric turbulence and segmentation piston errors. Segment geometry was chosen such that about 6 actuators of the XAO DM cover one segment representing the design of EPICS at the EELT.

Cornea and anterior eye assessment with slit lamp biomicroscopy, specular microscopy, confocal microscopy, and ultrasound biomicroscopy

PubMed Central

Martin, Raul

2018-01-01

Current corneal assessment technologies make the process of corneal evaluation extremely fast and simple, and several devices and technologies show signs that help in identification of different diseases thereby, helping in diagnosis, management, and follow-up of patients. The purpose of this review is to present and update readers on the evaluation of cornea and ocular surface. This first part reviews a description of slit lamp biomicroscopy (SLB), endothelial specular microscopy, confocal microscopy, and ultrasound biomicroscopy examination techniques and the second part describes the corneal topography and tomography, providing up-to-date information on the clinical recommendations of these techniques in eye care practice. Although the SLB is a traditional technique, it is of paramount importance in clinical diagnosis and compulsory when an eye test is conducted in primary or specialist eye care practice. Different techniques allow the early diagnosis of many diseases, especially when clinical signs have not yet become apparent and visible with SLB. These techniques also allow for patient follow-up in several clinical conditions or diseases, facilitating clinical decisions and improving knowledge regarding the corneal anatomy. PMID:29380757

Extreme coastal erosion enhanced by anomalous extratropical storm wave direction.

PubMed

Harley, Mitchell D; Turner, Ian L; Kinsela, Michael A; Middleton, Jason H; Mumford, Peter J; Splinter, Kristen D; Phillips, Matthew S; Simmons, Joshua A; Hanslow, David J; Short, Andrew D

2017-07-20

Extratropical cyclones (ETCs) are the primary driver of large-scale episodic beach erosion along coastlines in temperate regions. However, key drivers of the magnitude and regional variability in rapid morphological changes caused by ETCs at the coast remain poorly understood. Here we analyze an unprecedented dataset of high-resolution regional-scale morphological response to an ETC that impacted southeast Australia, and evaluate the new observations within the context of an existing long-term coastal monitoring program. This ETC was characterized by moderate intensity (for this regional setting) deepwater wave heights, but an anomalous wave direction approximately 45 degrees more counter-clockwise than average. The magnitude of measured beach volume change was the largest in four decades at the long-term monitoring site and, at the regional scale, commensurate with that observed due to extreme North Atlantic hurricanes. Spatial variability in morphological response across the study region was predominantly controlled by alongshore gradients in storm wave energy flux and local coastline alignment relative to storm wave direction. We attribute the severity of coastal erosion observed due to this ETC primarily to its anomalous wave direction, and call for greater research on the impacts of changing storm wave directionality in addition to projected future changes in wave heights.

GISOT: a giant solar telescope

NASA Astrophysics Data System (ADS)

Hammerschlag, Robert H.; von der Lühe, Oskar F.; Bettonvil, Felix C.; Jägers, Aswin P.; Snik, Frans

2004-10-01

A concept is presented for an extremely large high-resolution solar telescope with an aperture of 11 m and diffraction limited for visual wavelengths. The structure of GISOT will be transparent to wind and placed on a transparent stiff tower. For efficient wind flushing, all optics, including the primary mirror, will be located above the elevation axis. The aperture will be of the order of 11 m, not rotatively symmetrical, but of an elongated shape with dimensions 11 x 4 m. It consists of a central on-axis 4 m mirror with on both sides 3 pieces of 2 m mirrors. The optical layout will be kept simple to guarantee quality and minimize stray light. A Coudé room for instruments is planned below the telescope. The telescope will not be housed in a dome-like construction, which interferes with the open principle. Instead the telescope will be protected by a foldable tent construction with a diameter of the order of 30 m, which doesn"t form any obstruction during observations, but can withstand the severe weather circumstances on mountain sites. Because of the nature of the solar scene, extremely high resolution in only one dimension is sufficient to solve many exciting problems in solar physics and in this respect the concept of GISOT is very promising.

Bioclimatic conditions of the winter months in Western Kazakhstan and their dynamics in relation to climate change

NASA Astrophysics Data System (ADS)

Nyssanbayeva, Aiman S.; Cherednichenko, Alexandr V.; Cherednichenko, Vladimir S.; Abayev, Nurlan N.; Madibekov, Azamat S.

2018-03-01

The territory of West Kazakhstan is an intensively developing region. The main oil and gas fields are concentrated there. In addition, this region is well-known as a region of nomad cattle breeding. Both of industry and agriculture demand a lot of employees, working in the open air in wintertime. Severe winter conditions, primary very low temperatures, and strong winds characterize the region. In this work, we calculated and analyzed the spatial and temporal distributions of effective temperatures in the region and their dynamics due to the global warming in the last decades. To calculate the equivalent temperature (WCET) was used the method of OFCM 2003. Nowadays, it is known as a common method for similar studies. It was shown that in the observed region, WCET is significantly lower than the ambient temperature. Repeatability of WCET, corresponding to «increasing risk», «high risk» is high in the main part of the region. Global warming in the region results in returning extremely high temperatures of the air, decreasing repeatability of the average gradation of WCET approximately on 4%, but there is no any visible changing repeatability of extreme WCET. Obtained results can be used for planning any construction work in the open air and agriculture branches.

Bioclimatic conditions of the winter months in Western Kazakhstan and their dynamics in relation to climate change.

PubMed

Nyssanbayeva, Aiman S; Cherednichenko, Alexandr V; Cherednichenko, Vladimir S; Abayev, Nurlan N; Madibekov, Azamat S

2018-03-05

The territory of West Kazakhstan is an intensively developing region. The main oil and gas fields are concentrated there. In addition, this region is well-known as a region of nomad cattle breeding. Both of industry and agriculture demand a lot of employees, working in the open air in wintertime. Severe winter conditions, primary very low temperatures, and strong winds characterize the region. In this work, we calculated and analyzed the spatial and temporal distributions of effective temperatures in the region and their dynamics due to the global warming in the last decades. To calculate the equivalent temperature (WCET) was used the method of OFCM 2003. Nowadays, it is known as a common method for similar studies. It was shown that in the observed region, WCET is significantly lower than the ambient temperature. Repeatability of WCET, corresponding to «increasing risk», «high risk» is high in the main part of the region. Global warming in the region results in returning extremely high temperatures of the air, decreasing repeatability of the average gradation of WCET approximately on 4%, but there is no any visible changing repeatability of extreme WCET. Obtained results can be used for planning any construction work in the open air and agriculture branches.

Projecting climate change impacts on hydrology: the potential role of daily GCM output

NASA Astrophysics Data System (ADS)

Maurer, E. P.; Hidalgo, H. G.; Das, T.; Dettinger, M. D.; Cayan, D.

2008-12-01

A primary challenge facing resource managers in accommodating climate change is determining the range and uncertainty in regional and local climate projections. This is especially important for assessing changes in extreme events, which will drive many of the more severe impacts of a changed climate. Since global climate models (GCMs) produce output at a spatial scale incompatible with local impact assessment, different techniques have evolved to downscale GCM output so locally important climate features are expressed in the projections. We compared skill and hydrologic projections using two statistical downscaling methods and a distributed hydrology model. The downscaling methods are the constructed analogues (CA) and the bias correction and spatial downscaling (BCSD). CA uses daily GCM output, and can thus capture GCM projections for changing extreme event occurrence, while BCSD uses monthly output and statistically generates historical daily sequences. We evaluate the hydrologic impacts projected using downscaled climate (from the NCEP/NCAR reanalysis as a surrogate GCM) for the late 20th century with both methods, comparing skill in projecting soil moisture, snow pack, and streamflow at key locations in the Western United States. We include an assessment of a new method for correcting for GCM biases in a hybrid method combining the most important characteristics of both methods.

Predicting Extreme Droughts in Savannah Africa: A Comparison of Proxy and Direct Measures in Detecting Biomass Fluctuations, Trends and Their Causes

PubMed Central

2015-01-01

We monitored pasture biomass on 20 permanent plots over 35 years to gauge the reliability of rainfall and NDVI as proxy measures of forage shortfalls in a savannah ecosystem. Both proxies are reliable indicators of pasture biomass at the onset of dry periods but fail to predict shortfalls in prolonged dry spells. In contrast, grazing pressure predicts pasture deficits with a high degree of accuracy. Large herbivores play a primary role in determining the severity of pasture deficits and variation across habitats. Grazing pressure also explains oscillations in plant biomass unrelated to rainfall. Plant biomass has declined steadily and biomass per unit of rainfall has fallen by a third, corresponding to a doubling in grazing intensity over the study period. The rising probability of forage deficits fits local pastoral perceptions of an increasing frequency of extreme shortfalls. The decline in forage is linked to sedentarization, range loss and herbivore compression into drought refuges, rather than climate change. The results show that the decline in rangeland productivity and increasing frequency of pasture shortfalls can be ameliorated by better husbandry practices and reinforces the need for ground monitoring to complement remote sensing in forecasting pasture shortfalls. PMID:26317512

Dry seasons identified in oak tree-ring chronology in the Czech Lands over the last millennium

NASA Astrophysics Data System (ADS)

Dobrovolny, Petr; Brazdil, Rudolf; Büntgen, Ulf; Rybnicek, Michal; Kolar, Tomas; Reznickova, Ladislava; Valasek, Hubert; Kotyza, Oldrich

2015-04-01

There is growing evidence on amplification of hydrological regimes as a consequence of rising temperatures, increase in evaporation and changes in circulation patterns. These processes may be responsible for higher probability of hydroclimatic extremes occurrence in regional scale. Extreme events such as floods or droughts are rare from their definition and for better understanding of possible changes in the frequency and intensity of their occurrence, long-term proxy archives may be analysed. Recently several tree ring width chronologies were compiled from hardwood species occurring in lowland positions and their analysis proved that they are moisture-sensitive and suitable for hydroclimate reconstructions. Here, we introduce a new oak (Quercus sp) ring width (RW) dataset for the Czech Republic and the last 1250 years. We explain the process of oak chronology standardization that was based on several only slightly different de-trending techniques and subsequent chronology development steps. We hypothesize that the most severe RW increment reductions (negative extremes) reflect extremely dry spring-summer conditions. Negative extremes were assigned for years in which transformed oak RWs were lower than the minus 1.5 standard deviation. To verify our hypothesis, we compare typical climatic conditions in negative extreme years with climatology of the reference period 1961-1990. Comparison was done for various instrumental measurements (1805-2012), existing proxy reconstructions (1500-1804) and also for documentary evidence from historical archives (before 1500). We found that years of negative extremes are characterized with distinctly above average spring (MAM) and summer (JJA) air temperatures and below average precipitation amounts. Typical sea level pressure spatial distribution in those years shows positive pressure anomaly over British Isles and Northern Sea, the pattern that synoptically corresponds to blocking anticyclone bringing to Central Europe warm air from SW and low precipitation totals with higher probability of drought occurrence. Our results provide consistent physical explanation of extremely dry seasons occurring in Central Europe. However, direct comparisons of individual RW extreme seasons with existing documentary evidence show the complexity the problem as some extremes identified in oak RW chronology were not confirmed in documentary archives and vice versa. We discuss possible causes of such differences related to the fact that various proxies may have problems to record real intensity or duration of extreme events e.g. due to non-linear response of proxy data to climate drivers or due to shift in seasonality.

Deep learning in the small sample size setting: cascaded feed forward neural networks for medical image segmentation

NASA Astrophysics Data System (ADS)

Gaonkar, Bilwaj; Hovda, David; Martin, Neil; Macyszyn, Luke

2016-03-01

Deep Learning, refers to large set of neural network based algorithms, have emerged as promising machine- learning tools in the general imaging and computer vision domains. Convolutional neural networks (CNNs), a specific class of deep learning algorithms, have been extremely effective in object recognition and localization in natural images. A characteristic feature of CNNs, is the use of a locally connected multi layer topology that is inspired by the animal visual cortex (the most powerful vision system in existence). While CNNs, perform admirably in object identification and localization tasks, typically require training on extremely large datasets. Unfortunately, in medical image analysis, large datasets are either unavailable or are extremely expensive to obtain. Further, the primary tasks in medical imaging are organ identification and segmentation from 3D scans, which are different from the standard computer vision tasks of object recognition. Thus, in order to translate the advantages of deep learning to medical image analysis, there is a need to develop deep network topologies and training methodologies, that are geared towards medical imaging related tasks and can work in a setting where dataset sizes are relatively small. In this paper, we present a technique for stacked supervised training of deep feed forward neural networks for segmenting organs from medical scans. Each `neural network layer' in the stack is trained to identify a sub region of the original image, that contains the organ of interest. By layering several such stacks together a very deep neural network is constructed. Such a network can be used to identify extremely small regions of interest in extremely large images, inspite of a lack of clear contrast in the signal or easily identifiable shape characteristics. What is even more intriguing is that the network stack achieves accurate segmentation even when it is trained on a single image with manually labelled ground truth. We validate this approach,using a publicly available head and neck CT dataset. We also show that a deep neural network of similar depth, if trained directly using backpropagation, cannot acheive the tasks achieved using our layer wise training paradigm.

Evaluating teams in extreme environments: from issues to answers.

PubMed

Bishop, Sheryl L

2004-07-01

The challenge to effectively evaluating teams in extreme environments necessarily involves a wide range of physiological, psychological, and psychosocial factors. The high reliance on technology, the growing frequency of multinational and multicultural teams, and the demand for longer duration missions all further compound the complexity of the problem. The primary goal is the insurance of human health and well-being with expectations that such priorities will naturally lead to improved chances for performance and mission success. This paper provides an overview of some of the most salient immediate challenges for selecting, training, and supporting teams in extreme environments, gives exemplars of research findings concerning these challenges, and discusses the need for future research.

Neoadjuvant radiation in primary extremity liposarcoma: correlation of MRI features with histopathology.

PubMed

Wortman, Jeremy R; Tirumani, Sree Harsha; Tirumani, Harika; Shinagare, Atul B; Jagannathan, Jyothi P; Hornick, Jason L; Ramaiya, Nikhil H

2016-05-01

To evaluate MRI features of response of primary extremity liposarcoma (LPS) to neoadjuvant radiation therapy (RT) with histopathologic correlation. In this IRB-approved study including 125 patients with extremity LPS treated with neoadjuvant RT from 2000 to 2013, MRI of the primary tumour in 18 patients (5 pleomorphic LPS, 13 myxoid LPS) before and after RT were reviewed by two radiologists by consensus. Histopathology of the surgical specimens was reviewed by a pathologist with expertise in sarcomas. In the pleomorphic LPS cohort, 3/5 tumours increased in size; 3/5 decreased in enhancing component; and 3/5 increased in peritumoral oedema, intratumoral haemorrhage, and necrosis. In the myxoid LPS cohort, 12/13 tumours decreased in size, 8/13 decreased in enhancing component, and 5/13 increased in internal fat following RT. Histopathology showed ≥50% residual tumour in 1/5 pleomorphic LPS and 2/13 myxoid LPS. Hyalinization/necrosis of ≥75% was noted in 4/5 pleomorphic LPS and 11/13 myxoid LPS. Cytodifferentiation was noted in 1/5 pleomorphic and 9/13 myxoid LPS. While pleomorphic LPS showed an increase in size, peritumoral oedema, intratumoral haemorrhage, and necrosis on MRI following neoadjuvant RT, myxoid LPS showed a decrease in size and enhancement with an increase in internal fat. • Pleomorphic LPS commonly increase in size and necrosis on MRI following RT. • Myxoid LPS commonly decrease in size and enhancement on MRI following RT. • Myxoid LPS often increase in fatty component on MRI following RT.

Early Diagnosis and Intervention Strategies for Post-Traumatic Heterotopic Ossification in Severely Injured Extremities

DTIC Science & Technology

2013-10-01

therapies for prevention or mitigation of HO can be optimally targeted. This study seeks to contribute to advancement in each of these key areas...NOTES 14. ABSTRACT This study will recruit wounded warriors with severe extremity trauma, which places them at high risk for heterotopic... therapies for prevention or mitigation of HO. 15. SUBJECT TERMS Wound healing 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18

Early Diagnosis and Intervention Strategies for Post-Traumatic Heterotopic Ossification in Severely Injured Extremities

DTIC Science & Technology

2013-10-01

so that therapies for prevention or mitigation of HO can be optimally targeted. This study seeks to contribute to advancement in each of these key...SUPPLEMENTARY NOTES 14. ABSTRACT This study will recruit wounded warriors with severe extremity trauma, which places them at high risk for...define potential therapies for prevention or mitigation of HO. 15. SUBJECT TERMS Wound healing 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF

Will the warmer temperature bring the more intensity precipitation?

NASA Astrophysics Data System (ADS)

Yutong, Z., II; Wang, T.

2017-12-01

Will the warmer temperature bring the more intensity precipitation?Over the past several decades, changes in climate are amplified over the Tibetan Plateau(TP), with warming trend almost being twice as large as the global average. In sharp contrast, there is a large spatial discrepancy of the variations in precipitation extremes, with increasing trends found in the southern and decreasing trends in central TP. These features motivate are urgent need for an observation-based understanding of how precipitation extremes respond to climate change. Here we examine the relation between precipitation intensity with atmospheric temperature, dew point temperature (Td) and convective available potential energy (CAPE) in Tibet Plateau. Owing to the influences of the westerlies and Indian monsoon on Tibetan climate, the stations can be divided into three sub-regions in TP: the westerlies region (north of 35°N, N = 28), the monsoon region (south of 30°N in TP, N = 31), and the transition region (located between 30°N and 35°N, N = 48). We found that the intensity precipitation does not follow the C-C relation and there is a mix of positive and negative slope. To better understand why different scaling occurs with temperature in district region, using the dew point temperature replace the temperature, although there is significant variability in relative humidity values, at most stations, there appears to be a general increase in relative humidity associated. It is likely that the observed rise in relative humidity can assist in explaining the negative scaling of extreme precipitation at westerlies domain and monsoon domain, with the primary reason why precipitation extremes expected to increase follows from the fact that a warmer atmosphere can "hold" more moisture. This suggests that not only on how much the moisture the atmosphere can hold, but on how much moisture exits in atmosphere. To understand the role of dynamic on extreme precipitation, we repeat the precipitation intense analysis using ln(CAPE) as regression. The CAPE is the vertical integral of parcel buoyancy between the level of free convection and level of neutral buoyancy. We find almost all pixels are positive and pass through the 0.05 confidence limit. We can conclude that the intensity of moist convection is an important for the extreme precipitation.

Climate extremes and the carbon cycle - a review using an integrated approach with regional examples for forests & native ecosystems -

NASA Astrophysics Data System (ADS)

Frank, D.; Reichstein, M.; Bahn, M.; Beer, C.; Ciais, P.; Mahecha, M.; Seneviratne, S. I.; Smith, P.; van Oijen, M.; Walz, A.

2012-04-01

The terrestrial carbon cycle provides an important biogeochemical feedback to climate and is itself particularly susceptible to extreme climate events. Climate extremes can override any (positive) effects of mean climate change as shown in European and recent US-American heat waves and dry spells. They can impact the structure, composition, and functioning of terrestrial ecosystems and have the potential to cause rapid carbon losses from accumulated stocks. We review how climate extremes like severe droughts, heat waves, extreme precipitation or storms can cause direct impacts on the CO2 fluxes [e.g. due to extreme temperature and/ or drought events] as well as lagged impacts on the carbon cycle [e.g. via an increased fire risk, or disease outbreaks and pest invasions]. The relative impact of the different climate extremes varies according to climate region and vegetation type. We present lagged effects on plant growth (and mortality) in the year(s) following an extreme event and their impacts on the carbon sequestration of forests and natural ecosystems. Comprehensive regional or even continental quantification with regard to extreme events is missing, and especially compound extreme events, the role of lagged effects and aspects of the return frequency are not studied enough. In a case study of a Mediterranean ecosystem we illustrate that the response of the net carbon balance at ecosystem level to regional climate change is hard to predict as interacting and partly compensating processes are affected and several processes which have the ability to substantially alter the carbon balance are not or not sufficiently represented in state-of-the-art biogeochemical models.

Calcified Suprasellar Xanthogranuloma Presenting with Primary Amenorrhea in a 17-Year-Old Girl: Case Report and Literature Review.

PubMed

Ben Nsir, Atef; Thai, Quoc-Anh; Chaieb, Larbi; Jemel, Hafedh

2015-09-01

Xanthogranuloma, also known as cholesterol granuloma, is an extremely rare intracranial neoplasm most commonly located in the middle ear, petrous apex, or choroid plexus. Exclusively suprasellar xanthogranulomas are exceptional and this report presents a very rare case in the pediatric population, particularly unique due to the presence of calcification. A 17-year-old girl presented with primary amenorrhea with computed tomography and magnetic resonance imaging showing a large calcified enhancing suprasellar mass, which was presumptively diagnosed as a craniopharyngioma on the basis of its clinical and radiologic appearance. Gross total resection of a well-encapsulated, exclusively suprasellar tumor was achieved, without postoperative neurologic deficits. Histologic examination found fibrous tissue with abundant cholesterol clefts, multinucleated giant cells, and hemosiderin deposits but no epithelial cells. The final histologic diagnosis was a xanthogranuloma. Xanthogranuloma, although extremely rare in the pediatric population, may present as a calcified suprasellar mass and manifest with primary amenorrhea. The prognosis after gross total resection is likely favorable; however, long-term follow-up is indicated for these rare neoplasms. Copyright © 2015 Elsevier Inc. All rights reserved.

The Effect of Lace-up Ankle Braces on Injury Rates in High School Football Players

PubMed Central

McGuine, Timothy A.; Hetzel, Scott; Wilson, John; Brooks, Alison

2013-01-01

Background Although a nkle injuries occur frequently in high school football players no prospective studies have been performed to determine if wearing lace-up ankle braces will reduce the incidence and severity of ankle and other lower extremity injuries in these athletes. Purpose Determine if lace-up ankle braces reduce the incidence and severity of lower extremity injuries sustained by high school football players. Design Cluster randomized controlled trial. Methods 2081 players from 50 high schools were randomly-assigned to braced or control group. Braced group subjects wore lace-up ankle braces during the 2010 football season. Athletic trainers recorded brace compliance, athletic exposures and injuries. Cox Proportional Hazards models were utilized to compare injury rates between groups. Injury severity (days lost) was tested with Wilcoxon Rank Sum. Results The rate of acute ankle injury (per 1,000 exposures) was 0.48 in the braced group compared to 1.12 in the control group (Cox Hazard Ratio (HR)=0.39, 95% Confidence Interval [CI] 0.24, 0.65, p<0.001). The severity (median days lost) of acute ankle injuries was the same (5 days) in both groups (p=0.985). The rate of acute knee injury was 0.70 in the braced group compared to 0.69 in the control group, (HR=0.92 [0.57, 1.47], p=0.721). There was no difference (p=0.242) in the severity of knee injuries between the groups (controls 11.5 days, braced =17 days. The rate of other lower extremity injuries was 0.95 in the braced group and 1.32 in the control group, (HR=0.72 [0.48, 1.09], p=0.117) while the severity was similar in both groups (6 days versus 7 days, p=0.295). Conclusions Players who used lace-up ankle braces had a lower incidence of acute ankle injuries but no difference in the incidence of acute knee or other lower extremity injuries. Braces did not reduce the severity of ankle, knee or other lower extremity injuries. PMID:21926383

The distinction between juvenile and adult-onset primary open-angle glaucoma

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

Wiggs, J.L.; Haines, J.L.; Damji, K.F.

1996-01-01

Because of the significant differences between the juvenile and adult forms of open-angle glaucoma, especially with regard to inheritance, prevalence, severity, and age of onset, we read with interest the recent publication by Morissette et al., describing a pedigree with a phenotype that overlaps the distinctive features of juvenile-onset open-angle glaucoma (JOAG) and adult-onset primary open-angle glaucoma (usually abbreviated as POAG or COAG). These authors conclude that a gene mapped to human chromosome 1q21-q31 (GLC1A) can be responsible for both juvenile and adult forms of open-angle glaucoma. The implications of such a result could be extremely important, in light ofmore » the high prevalence of the adult form of the disease. However, while the data presented in this report suggest that variable expressivity of the GLC1A gene may lead to a broader range of onset for this form of juvenile glaucoma, these data do not identify the GLC1A gene as an important cause of POAG. To prevent misleading interpretations of this and similar studies, we wish to clarify the distinction between the juvenile and adult forms of open-angle glaucoma. 8 refs.« less

Halite depositional facies in a solar salt pond: A key to interpreting physical energy and water depth in ancient deposits?

NASA Astrophysics Data System (ADS)

Robertson Handford, C.

1990-08-01

Subaqueous deposits of aragonite, gypsum, and halite are accumulating in shallow solar salt ponds constructed in the Pekelmeer, a sea-level sauna on Bonaire, Netherlands Antilles. Several halite facies are deposited in the crystallizer ponds in response to differences in water depth and wave energy. Cumulate halite, which originates as floating rafts, is present only along the protected, upwind margins of ponds where low-energy conditions foster their formation and preservation. Cornet crystals with peculiar mushroom- and mortarboard-shaped caps precipitate in centimetre-deep brine sheets within a couple of metres of the upwind or low-energy margins. Downwind from these margins, cornet and chevron halite precipitate on the pond floors in water depths ranging from a few centimetres to ˜60 cm. Halite pisoids with radial-concentric structure are precipitated in the swash zone along downwind high-energy shorelines where they form pebbly beaches. This study suggests that primary halite facies are energy and/or depth dependent and that some primary features, if preserved in ancient halite deposits, can be used to infer physical energy conditions, subenvironments such as low- to high-energy shorelines, and extremely shallow water depths in ancient evaporite basins.

The influence of nontraditional training modalities on physical performance: review of the literature.

PubMed

O'Hara, Reginald B; Serres, Jennifer; Traver, Kyle L; Wright, Bruce; Vojta, Chris; Eveland, Ed

2012-10-01

The primary purpose of this effort was to review several forms of nontraditional (NT) training programs, including heavy lower extremity strength training, CrossFit training, kettlebell training, and agility training, and discuss the effects of these exercise regimens on physical performance. The secondary purpose was to evaluate NT fitness training programs for evidence that they may provide beneficial options to help airmen improve their fitness scores. A search of the literature for 1980-2010 was performed using the Franzello Aeromedical Library, Public Medicine, and Air Force Institute of Technology search engines. There were 50 articles located and the authors selected 29 articles that specifically addressed the primary and secondary purposes of this literature review. This review indicates that an NT training approach is warranted in the general Air Force population. Heavy leg strength training and agility training show promise in enhancing aerobic fitness and improving fitness scores, particularly among members who have difficulty passing a physical fitness test. Most of the nontraditional forms of physical training are not supported in the scientific literature, with the exception of heavy leg strength training and agility training. However, even these NT forms of training require further investigation.

Nevoid melanoma of the vagina: report of one case diagnosed on thin layer cytological preparations.

PubMed

Fulciniti, Franco; Ascierto, Paolo Antonio; Simeone, Ester; Bove, Patrizia; Losito, Simona; Russo, Serena; Gallo, Maria Stella; Greggi, Stefano

2007-07-03

Primary melanoma of the vagina is an extremely rare neoplasm with approximately 250 reported cases in the world literature 1234. In its amelanotic variant this lesion may raise several differential diagnostic problems in cytological specimens 5. In this setting, the usage of thin layer cytopathological techniques (Liquid Based Preparations = LBP) may enhance the diagnostic sensitivity by permitting immunocytochemical study without having to repeat the sampling procedure. The aim of this paper is to describe the cytomorphological presentation of primary vaginal melanoma on LBP since it has not previously been reported up to now, to our knowledge. a 79-y-o female complaining of vulvar itching and yellowish vaginal discharge underwent a complete gynaecological evaluation during which a LBP cytological sample was taken from a suspicious whitish mass protruding into the vaginal lumen. A cytopathological diagnosis of amelanotic melanoma was rendered. The mass was radically excised and the patient was treated with alpha-Interferon. amelanotic melanoma may be successfully diagnosed on LBP cytological preparations. Thin layer preparations may enhance the diagnostic cytomorphological clues to its diagnosis and may permit an adequate immunocytochemical characterization of the neoplasm.

Validity and clinical utility of the DSM-5 severity specifier for bulimia nervosa: results from a multisite sample of patients who received evidence-based treatment.

PubMed

Dakanalis, Antonios; Bartoli, Francesco; Caslini, Manuela; Crocamo, Cristina; Zanetti, Maria Assunta; Riva, Giuseppe; Clerici, Massimo; Carrà, Giuseppe

2017-12-01

A new "severity specifier" for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (IWCBs), was added to the DSM-5 as a means of documenting heterogeneity and variability in the severity of the disorder. Yet, evidence for its validity in clinical populations, including prognostic significance for treatment outcome, is currently lacking. Existing data from 281 treatment-seeking patients with DSM-5 BN, who received the best available treatment for their disorder (manual-based cognitive behavioural therapy; CBT) in an outpatient setting, were re-analysed to examine whether these patients subgrouped based on the DSM-5 severity levels would show meaningful and consistent differences on (a) a range of clinical variables assessed at pre-treatment and (b) post-treatment abstinence from IWCBs. Results highlight that the mild, moderate, severe, and extreme severity groups were statistically distinguishable on 22 variables assessed at pre-treatment regarding eating disorder pathological features, maintenance factors of BN, associated (current) and lifetime psychopathology, social maladjustment and illness-specific functional impairment, and abstinence outcome. Mood intolerance, a maintenance factor of BN but external to eating disorder pathological features (typically addressed within CBT), emerged as the primary clinical variable distinguishing the severity groups showing a differential treatment response. Overall, the findings speak to the concurrent and predictive validity of the new DSM-5 severity criterion for BN and are important because a common benchmark informing patients, clinicians, and researchers about severity of the disorder and allowing severity fluctuation and patient's progress to be tracked does not exist so far. Implications for future research are outlined.

Heatshield for Extreme Entry Environment Technology (HEEET) for Missions to Saturn and Beyond

NASA Technical Reports Server (NTRS)

Ellerby, D.; Blosser, M.; Chinnapongse, R.; Fowler, M.; Gasch, M.; Hamm, K.; Kazemba, C.; Ma, J.; Milos, F.; Nishioka, O.;

Heatshield for Extreme Entry Environment Technology (HEEET) - Enabling Missions Beyond Heritage Carbon Phenolic

NASA Technical Reports Server (NTRS)

Ellerby, D.; Beerman, A.; Blosser, M.; Boghozian, T.; Chavez-Garcia, J.; Chinnapongse, R.; Fowler, M.; Gage, P.; Gasch, M.; Gonzales, G.;

Heatshield for Extreme Entry Environment Technology (HEEET) Enabling Missions Beyond Heritage Carbon Phenolic

NASA Technical Reports Server (NTRS)

Ellerby, D.; Beerman, A.; Blosser, M.; Boghozian, T.; Chavez-Garcia, J.; Chinnapongse, R.; Fowler, M.; Gage, P.; Gasch, M.; Gonzaes, G.;

Heatshield for Extreme Entry Environment Technology (HEEET) Development and Maturation Status for NF Missions

NASA Technical Reports Server (NTRS)

Ellerby, D.; Blosser, M.; Boghozian, T.; Chavez-Garcia, J.; Chinnapongse, R.; Fowler, M.; Gage, P.; Gasch, M.; Gonzales, G.; Hamm, K.;

Heatshield for Extreme Entry Environment Technology (HEEET) Development and Maturation Status

NASA Technical Reports Server (NTRS)

Ellerby, D.; Boghozian, T.; Driver, D.; Chavez-Garcia, J.; Fowler, M.; Gage, P.; Gasch, M.; Gonzales, G.; Kazemba, C.; Kellermann, C.;

The extreme ultraviolet explorer mission

NASA Technical Reports Server (NTRS)

Malina, R. F.; Bowyer, S.

1988-01-01

The science design goals and engineering implementation for the Extreme Ultraviolet Explorer (EUVE) science payload are discussed. The primary scientific goal of the EUVE payload is to carry out an all-sky survey in the 100- to 900-A band of the spectrum. Another goal of the mission is to demonstrate the use of a scientific platform in near-earth orbit. EUVE data will be used to study the distribution of EUV stars in the neighborhood of the sun and the emission physics responsible for the EUV mission.

A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency.

PubMed

Jones, Roy Wesley; Parkerson, Godfrey Ross; Ottinger, Mary; Rodriguez, Eduardo; Park, Brian

2017-01-01

We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning. A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity. Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks. Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.

Assessing Climate Change Impacts for Military Installations in the Southwest United States During the Warm Season

NASA Astrophysics Data System (ADS)

Castro, C.

2013-05-01

Arid and semi-arid regions are experiencing some of the most adverse impacts of climate change with increased heat waves, droughts, and extreme weather. These events will likely exacerbate socioeconomic and political instabilities in regions where the United States has vital strategic interests and ongoing military operations. The Southwest U.S. is strategically important in that it houses some of the most spatially expansive and important military installations in the country. The majority of severe weather events in the Southwest occur in association with the North American monsoon system (NAMS), and current observational record has shown a 'wet gets wetter and dry gets drier' global monsoon precipitation trend. We seek to evaluate the warm season extreme weather projection in the Southwest U.S., and how the extremes can affect Department of Defense (DoD) military facilities in that region. A baseline methodology is being developed to select extreme warm season weather events based on historical sounding data and moisture surge observations from Gulf of California. Numerical Weather Prediction (NWP)-type high resolution simulations will be performed for the extreme events identified from Weather Research and Forecast (WRF) model simulations initiated from IPCC GCM and NCAR Reanalysis data in both climate control and climate change periods. The magnitude in extreme event changes will be analyzed, and the synoptic forcing patterns of the future severe thunderstorms will provide a guide line to assess if the military installations in the Southwest will become more or less susceptible to severe weather in the future.

Association Between Brain-Derived Neurotrophic Factor Genotype and Upper Extremity Motor Outcome After Stroke.

PubMed

Chang, Won Hyuk; Park, Eunhee; Lee, Jungsoo; Lee, Ahee; Kim, Yun-Hee

2017-06-01

The identification of intrinsic factors for predicting upper extremity motor outcome could aid the design of individualized treatment plans in stroke rehabilitation. The aim of this study was to identify prognostic factors, including intrinsic genetic factors, for upper extremity motor outcome in patients with subacute stroke. A total of 97 patients with subacute stroke were enrolled. Upper limb motor impairment was scored according to the upper limb of Fugl-Meyer assessment score at 3 months after stroke. The prediction of upper extremity motor outcome at 3 months was modeled using various factors that could potentially influence this impairment, including patient characteristics, baseline upper extremity motor impairment, functional and structural integrity of the corticospinal tract, and brain-derived neurotrophic factor genotype. Multivariate ordinal logistic regression models were used to identify the significance of each factor. The independent predictors of motor outcome at 3 months were baseline upper extremity motor impairment, age, stroke type, and corticospinal tract functional integrity in all stroke patients. However, in the group with severe motor impairment at baseline (upper limb score of Fugl-Meyer assessment <25), the number of Met alleles in the brain-derived neurotrophic factor genotype was also an independent predictor of upper extremity motor outcome 3 months after stroke. Brain-derived neurotrophic factor genotype may be a potentially useful predictor of upper extremity motor outcome in patients with subacute stroke with severe baseline motor involvement. © 2017 American Heart Association, Inc.

Pharmacotherapeutic failure in a large cohort of patients with insomnia presenting to a sleep medicine center and laboratory: subjective pretest predictions and objective diagnoses.

PubMed

Krakow, Barry; Ulibarri, Victor A; McIver, Natalia D

2014-12-01

To measure the frequency of pharmacotherapeutic failure and its association with the diagnosis of sleep-disordered breathing among patients with chronic insomnia disorder. In a retrospective review of medical records from January 1, 2005, through December 31, 2012, we identified an inclusive, consecutive series of 1210 patients with insomnia disorder, 899 (74.3%) of whom used sleep aids either occasionally (168 [18.7%]) or regularly (731 [81.3%]). Patients presented to a community-based sleep medicine center in Albuquerque, New Mexico, with typical referral patterns: 743 (61.4%) were referred by primary care physicians, 211 (17.4%) by specialists, 117 (9.7%) by mental health professionals, and 139 (11.5%) by self-referral. Pharmacotherapeutic failure was assessed from subjective insomnia reports and a validated insomnia severity scale. Polysomnography with pressure transducer (an advanced respiratory technology not previously used in a large cohort of patients with insomnia) measured sleep-disordered breathing. Objective data yielded accuracy rates for 3 pretest screening tools used to measure risk for sleep-disordered breathing. Of the total sample of 1210 patients, all 899 (74.3%) who were taking over-the-counter or prescription sleep aids had pharmacotherapeutic failure. The 710 patients taking prescription drugs (79.0%) reported the most severe insomnia, the fewest sleep-associated breathing symptoms, and the most medical and psychiatric comorbidity. Of the 942 patients objectively tested (77.9%), 860 (91.3%) met standard criteria, on average, for a moderate to severe sleep-associated breathing disorder, yet pretest screening sensitivity for sleep-disordered breathing varied widely from 63.7% to 100%. Positive predictive values were high (about 90%) for all screens, but a tool commonly used in primary care misclassified 301 patients (32.0% false-negative results). Pharmacotherapeutic failure and sleep-disordered breathing were extremely common among treatment-seeking patients with chronic insomnia disorder. Screening techniques designed from the field of sleep medicine predicted high rates for sleep-disordered breathing, whereas a survey common to primary care yielded many false-negative results. Although the relationship between insomnia and sleep-disordered breathing remains undefined, this research raises salient clinical questions about the management of insomnia in primary care before sleep center encounters. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Hydro-meteorologic assessment of October 2015 extreme precipitation event on Santee Experimental Forest Watersheds, South Carolina

Treesearch

D.M. Amatya; C.A. Harrison; C.C. Trettin

2016-01-01

The extreme precipitation event on October 3-4, 2015, likely resulting from the convergence of a persistent deep easterly flow, the continuous supply of moisture, the terrain, and the circulation associated with Hurricane Joaquin off the eastern Atlantic Coast (http://cms.met.psu. edu/sref/severe/2015/04Oct2015.pdf) resulted in extreme and prolonged flooding in many...

Contribution of large-scale circulation anomalies to changes in extreme precipitation frequency in the United States

Treesearch

Lejiang Yu; Shiyuan Zhong; Lisi Pei; Xindi (Randy) Bian; Warren E. Heilman

2016-01-01

The mean global climate has warmed as a result of the increasing emission of greenhouse gases induced by human activities. This warming is considered the main reason for the increasing number of extreme precipitation events in the US. While much attention has been given to extreme precipitation events occurring over several days, which are usually responsible for...

Promoting transportation flexibility in extreme events through multi-modal connectivity.

DOT National Transportation Integrated Search

2014-06-01

Extreme events of all kinds are increasing in number, severity, or impacts. Transportation provides a vital support : service for people in such circumstances in the short-term for evacuation and providing supplies where evacuation is : not undertake...

Changes in the probability of co-occurring extreme climate events

NASA Astrophysics Data System (ADS)

Diffenbaugh, N. S.

2017-12-01

Extreme climate events such as floods, droughts, heatwaves, and severe storms exert acute stresses on natural and human systems. When multiple extreme events co-occur, either in space or time, the impacts can be substantially compounded. A diverse set of human interests - including supply chains, agricultural commodities markets, reinsurance, and deployment of humanitarian aid - have historically relied on the rarity of extreme events to provide a geographic hedge against the compounded impacts of co-occuring extremes. However, changes in the frequency of extreme events in recent decades imply that the probability of co-occuring extremes is also changing, and is likely to continue to change in the future in response to additional global warming. This presentation will review the evidence for historical changes in extreme climate events and the response of extreme events to continued global warming, and will provide some perspective on methods for quantifying changes in the probability of co-occurring extremes in the past and future.

Ectopic recurrence of craniopharyngioma: Reporting three new cases.

PubMed

Yang, Yang; Shrestha, David; Shi, Xiang-En; Zhou, Zhongqing; Qi, Xueling; Qian, Hai

2015-04-01

Ectopic recurrence of craniopharyngioma is extremely rare following transcranial procedures of primary tumour. Here we describe 3 new cases of ectopic recurrence along the surgical route after transcranial gross total resection of primary tumour. All 3 cases are male adults--2 of them had papillary-type tumour with the other being adamantinomatous. All ectopic tumours were safely resected via repeated craniotomy. Long-term surveillance of patients with resected craniopharyngioma is essential.

Syndrome of the anterior spinal artery as the primary manifestation of aspergillosis.

PubMed

Pfausler, B; Kampfl, A; Berek, K; Maier, H; Aichner, F; Schmutzhard, E

1995-01-01

Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly occurring in immunocompromised patients. Beside cerebral involvement spinal cord lesions are extremely rare. To our knowledge, aspergillosis initially presenting with acute paraplegia due to mycotic thrombosis of the anterior spinal artery in a formerly healthy patient has, so far, not been reported. Neither a primary focus nor an underlying disease had been detected.

Gas and Bloating-Controlling Emissions: A Case-Based Review for the Primary Care Provider.

PubMed

Cotter, Thomas G; Gurney, Mark; Loftus, Conor G

2016-08-01

The evaluation of the patient with gas and bloating can be complex and the treatment extremely challenging. In this article, a simplified approach to the history and relevant physical examination is presented and applied in a case-oriented manner, suitable for application in the primary care setting. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Primary Central Nervous System Fibrosarcoma.

PubMed

Vinodh, V P; Harun, Rahmat; Sellamuthu, Pulivendhan; Kandasamy, Regunath

2017-08-01

We report a rare case of a young female with primary brain fibrosarcoma, and to the best of our knowledge, we believe that only <50 cases have been reported or described worldwide so far. Fibrosarcoma is a malignant neoplasm, in which histologically the predominant cells are fibroblasts that divide excessively without cellular control and they can invade local tissues or metastasize. Primary central nervous system fibrosarcomas are very aggressive neoplasms and generally have a poor prognosis. This tumor is either from sarcomatous transformation of a meningioma or arises de novo within the brain parenchyma. Our patient, a 48-year-old woman, who presented with progressive speech disorder over the period of 4 months, showed a left temporoparietal lesion with surrounding edema and local mass effect. Total surgical resection was achieved. Histopathology revealed classical fibrosarcoma features and secondary screening revealed no other distant lesion as diagnosis of primary brain fibrosarcoma was established. This case is deemed to be extremely rare because most reports claim that recurrence is within 6 months with poor prognosis; however, this patient is currently recurrence-free at 3 years. This would suggest of the possibility for a relook into this disease's course and recurrence rate when complete excision is achieved. Due to extreme rarity of these tumors, more comparative studies will be needed to improve the disease outcome.

Telepsychiatry: Promise, potential, and challenges

PubMed Central

Malhotra, Savita; Chakrabarti, Subho; Shah, Ruchita

2013-01-01

Despite the high prevalence and potentially disabling consequences of mental disorders, specialized mental health services are extremely deficient, leading to the so-called ‘Mental Health Gap’. Moreover, the services are concentrated in the urban areas, further worsening the rural-urban and tertiary primary care divide. Strengthening of and expanding the existing human resources and infrastructure, and integrating mental health into primary care appear to be the two major solutions. However, both the strategies are riddled with logistic difficulties and have a long gestation period. In such a scenario, telepsychiatry or e-mental health, defined as the use of information and communication technology to provide or support psychiatric services across distances, appears to be a promising answer. Due to its enormous potential, a review of the existing literature becomes imperative. An extensive search of literature was carried out and has been presented to delineate the modes of communication, acceptability and satisfaction, reliability, outcomes, cost-effectiveness, and legal and ethical challenges related to telepsychiatry. Telepsychiatry has been applied for direct patient care (diagnosis and management), consultation, and training, education, and research purposes. Both real-time, live interaction (synchronous) and store–forward (asynchronous) types of technologies have been used for these purposes. A growing amount of literature shows that training, supervision, and consultation by specialists to primary care physicians through telepsychiatry has several advantages. In this background, we have further focused on the models of telepsychiatry best suited for India, considering that mental health care can be integrated into primary care and taken to the doorstep of patients in the community. PMID:23441027

Extremely high sulfate reduction, sediment oxygen demand and benthic nutrient flux associated with a large-scale artificial dyke and its implication to benthic-pelagic coupling in the Yeongsan River estuary, Yellow Sea.

PubMed

Kim, Sung-Han; Lee, Jae Seong; Hyun, Jung-Ho

2017-07-15

We investigated environmental impact of large-scale dyke on the sediment geochemistry, sulfate reduction rates (SRRs), sediment oxygen demand (SOD) and potential contribution of benthic nutrient flux (BNF) to primary production in the Yeongsan River estuary, Yellow Sea. The sediment near the dyke (YE1) with high organic carbon (C org ) content (>4%, dry wt.) was characterized by extremely high SOD (327mmolm -2 d -1 ) and SRRs (91-140mmolm -2 d -1 ). The sulfate reduction accounted for 73% of C org oxidation, and was responsible for strikingly high concentrations of NH 4 + (7.7mM), PO 4 3- (67μM) and HS - (487μM) in pore water. The BNF at YE1 accounted for approximately 200% of N and P required for primary production in the water column. The results present one of the most extreme cases that the construction of an artificial dyke may have profound impacts on the biogeochemical and ecological processes in coastal ecosystems. Copyright © 2017 Elsevier Ltd. All rights reserved.

Drought assessment in the Duero basin (Central Spain) by means of multivariate extreme value statistics

NASA Astrophysics Data System (ADS)

Kallache, M.

2012-04-01

Droughts cause important losses. On the Iberian Peninsula, for example, non-irrigated agriculture and the tourism sector are affected in regular intervals. The goal of this study is the description of droughts and their dependence in the Duero basin in Central Spain. To do so, daily or monthly precipitation data is used. Here cumulative precipitation deficits below a threshold define meteorological droughts. This drought indicator is similar to the commonly used standard precipitation index. However, here the focus lies on the modeling of severe droughts, which is done by applying multivariate extreme value theory (MEVT) to model extreme drought events. Data from several stations are assessed jointly, thus the uncertainty of the results is reduced. Droughts are a complex phenomenon, their severity, spatial extension and duration has to be taken into account. Our approach captures severity and spatial extension. In general we find a high correlation between deficit volumes and drought duration, thus the duration is not explicitely modeled. We apply a MEVT model with asymmetric logistic dependence function, which is capable to model asymptotic dependence and independence (cf. Ramos and Ledford, 2009). To summarize the information on the dependence in the joint tail of the extreme drought events, we utilise the fragility index (Geluk et al., 2007). Results show that droughts also occur frequently in winter. Moreover, it is very common for one site to suffer dry conditions, whilst neighboring areas experience normal or even humid conditions. Interpolation is thus difficult. Bivariate extremal dependence is present in the data. However, most stations are at least asymptotically independent. The according fragility indices are important information for risk calculations. The emerging spatial patterns for bivariate dependence are mostly influenced by topography. When looking at the dependence between more than two stations, it shows that joint extremes can occur more often than randomly for up to 6 stations, this depends on the distance between the stations.

Predicting Flood Hazards in Systems with Multiple Flooding Mechanisms

NASA Astrophysics Data System (ADS)

Luke, A.; Schubert, J.; Cheng, L.; AghaKouchak, A.; Sanders, B. F.

2014-12-01

Delineating flood zones in systems that are susceptible to flooding from a single mechanism (riverine flooding) is a relatively well defined procedure with specific guidance from agencies such as FEMA and USACE. However, there is little guidance in delineating flood zones in systems that are susceptible to flooding from multiple mechanisms such as storm surge, waves, tidal influence, and riverine flooding. In this study, a new flood mapping method which accounts for multiple extremes occurring simultaneously is developed and exemplified. The study site in which the method is employed is the Tijuana River Estuary (TRE) located in Southern California adjacent to the U.S./Mexico border. TRE is an intertidal coastal estuary that receives freshwater flows from the Tijuana River. Extreme discharge from the Tijuana River is the primary driver of flooding within TRE, however tide level and storm surge also play a significant role in flooding extent and depth. A comparison between measured flows at the Tijuana River and ocean levels revealed a correlation between extreme discharge and ocean height. Using a novel statistical method based upon extreme value theory, ocean heights were predicted conditioned up extreme discharge occurring within the Tijuana River. This statistical technique could also be applied to other systems in which different factors are identified as the primary drivers of flooding, such as significant wave height conditioned upon tide level, for example. Using the predicted ocean levels conditioned upon varying return levels of discharge as forcing parameters for the 2D hydraulic model BreZo, the 100, 50, 20, and 10 year floodplains were delineated. The results will then be compared to floodplains delineated using the standard methods recommended by FEMA for riverine zones with a downstream ocean boundary.

Sensitivity of vegetation indices and gross primary production of tallgrass prairie to severe drought

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

Wagle, Pradeep; Xiao, Xiangming; Torn, Margaret S.

2014-09-01

Drought affects vegetation photosynthesis and growth.Many studies have used the normalized difference vegetation index (NDVI), which is calculated as the normalized ratio between near infrared and red spectral bands in satellite images, to evaluate the response of vegetation to drought. In this study, we examined the impacts of drought on three vegetation indices (NDVI, enhanced vegetation index, EVI, and land surface water index, LSWI) and CO2 flux from three tallgrass prairie eddy flux tower sites in the U.S. Gross primary production (GPP) was also modeled using a satellite-based Vegetation Photosynthesis Model (VPM), and the modeled GPP (GPPVPM) was compared withmore » the GPP (GPPEC) derived from eddy covariance measurements. Precipitation at two sites in Oklahoma was 30% below the historical mean in both years of the study period (2005–2006), while the site in Illinois did not experience drought in the 2005–2007 study period. The EVI explained the seasonal dynamics of GPP better than did NDVI. The LSWI dropped below zero during severe droughts in the growing season, showing its potential to track drought. The result shows that GPP was more sensitive to drought than were vegetation indices, and EVI and LSWI were more sensitive than NDVI. We developed a modified function (Wscalar), calculated as a function of LSWI, to account for the effect of severe droughts on GPP in VPM. The GPPVPM from the modified VPM accounted for the rapid reduction in GPP during severe droughts and the seasonal dynamics of GPPVPM agreed reasonably well with GPPEC. Our analysis shows that 8-day averaged values (temperature, vapor-pressure deficit) do not reflect the short-term extreme climate events well, suggesting that satellite based models may need to be run at daily or hourly scales, especially under unfavorable climatic conditions.« less

The limits for life under multiple extremes.

PubMed

Harrison, Jesse P; Gheeraert, Nicolas; Tsigelnitskiy, Dmitry; Cockell, Charles S

2013-04-01

Life on Earth is limited by physical and chemical extremes that define the 'habitable space' within which it operates. Aside from its requirement for liquid water, no definite limits have been established for life under any extreme. Here, we employ growth data published for 67 prokaryotic strains to explore the limitations for microbial life under combined extremes of temperature, pH, salt (NaCl) concentrations, and pressure. Our review reveals a fundamental lack of information on the tolerance of microorganisms to multiple extremes that impedes several areas of science, ranging from environmental and industrial microbiology to the search for extraterrestrial life. Copyright © 2013 Elsevier Ltd. All rights reserved.

Relationship between morbidity and extreme values of body mass index in adolescents.

PubMed

Lusky, A; Barell, V; Lubin, F; Kaplan, G; Layani, V; Shohat, Z; Lev, B; Wiener, M

1996-08-01

Although the association between overweight and cardiovascular risk factors is well documented in cross-sectional and longitudinal studies, reports of adolescent morbidity associated with underweight in industrialized countries are rare. This population-based study includes approximately 110,000 17 year old Israeli Jewish males who underwent routine physical examination at army induction centres. Computerized data tapes include overall health profiles, specification of physical and mental conditions, and height and weight measurements. Medically significant conditions are those with sufficient severity to preclude service in a combat unit. Functional limitation is more prevalent at both extremes of the body mass index (BMI) distribution: 149.5/1000 among severely underweight individuals and 164.3/1000 among severely overweight subjects. Overweight was associated with hypertension (14.9/1000 among the severely overweight), as well as joint conditions of the lower extremities, mainly hip, ankle and knee disorders. Functional disorders associated with underweight are bronchial and lung conditions, including asthma (14.2 and 18.9/1000 in the mildly and severely underweight), scoliosis, intestinal conditions and emotional disorders (mainly neurosis). Both under- and overweight are associated with morbidity at age 17. Intervention programmes should begin at an early age.

[A case of favourable outcome of the treatment of extremely severe acute poisoning with methanol].

PubMed

Batotsyrenov, B V; Livanov, G A; Vasil'ev, S A; Fedorov, A V; Antrianov, A Iu

2013-01-01

A case of favourable outcome of the treatment of extremely severe acute poisoning after prolonged exposure to lethal doses of methanol is reported. The complex treatment included urgent and effective elimination of the poison (multiple gastric lavage, hemodialysis), antidote therapy (administration of ethanol), correction of decompensated metabolic acidosis (alkali therapy and infusion therapy with reamberin). These measures had beneficial effect on the clinical course of poisoning and ensured its favourable outcome.

Early Diagnosis and Intervention Strategies for Post-Traumatic Heterotopic Ossification in Severely Injured Extremities

DTIC Science & Technology

2013-10-01

study will recruit wounded warriors with severe extremity trauma, which places them at high risk for heterotopic ossification (HO); bone formation at...involved in HO; 2) to define accurate and practical methods to predict where HO will develop; and 3) to define potential therapies for prevention or...elicit HO. These tools also need to provide effective methods for early diagnosis or risk assessment (prediction) so that therapies for prevention or

Weak linkage between the heaviest rainfall and tallest storms.

PubMed

Hamada, Atsushi; Takayabu, Yukari N; Liu, Chuntao; Zipser, Edward J

2015-02-24

Conventionally, the heaviest rainfall has been linked to the tallest, most intense convective storms. However, the global picture of the linkage between extreme rainfall and convection remains unclear. Here we analyse an 11-year record of spaceborne precipitation radar observations and establish that a relatively small fraction of extreme convective events produces extreme rainfall rates in any region of the tropics and subtropics. Robust differences between extreme rainfall and convective events are found in the rainfall characteristics and environmental conditions, irrespective of region; most extreme rainfall events are characterized by less intense convection with intense radar echoes not extending to extremely high altitudes. Rainfall characteristics and environmental conditions both indicate the importance of warm-rain processes in producing extreme rainfall rates. Our results demonstrate that, even in regions where severe convective storms are representative extreme weather events, the heaviest rainfall events are mostly associated with less intense convection.

Grebe dysplasia - prenatal diagnosis based on rendered 3-D ultrasound images of fetal limbs.

PubMed

Goncalves, Luis F; Berger, Julie A; Macknis, Jacqueline K; Bauer, Samuel T; Bloom, David A

2017-01-01

Grebe dysplasia is a rare skeletal dysplasia characterized by severe acromesomelic shortening of the long bones in a proximal to distal gradient of severity, with bones of the hands and feet more severely affected than those of the forearms and legs, which in turn are more severely affected than the humeri and femora. In addition, the bones of the lower extremities tend to be more severely affected than the bones of the upper extremities. Despite the severe skeletal deformities, the condition is not lethal and surviving individuals can have normal intelligence. Herein we report a case of Grebe dysplasia diagnosed at 20 weeks of gestation. Rendered 3-D ultrasound images of the fetal limbs, particularly of the characteristic tiny and globular-looking fingers and toes, were instrumental in accurately characterizing the phenotype prenatally.

Impact of the extreme 2009 wildfire Victoria the wettability of naturally highly water repellent soils

NASA Astrophysics Data System (ADS)

Doerr, Stefan H.; Shakesby, Richard A.; Sheridan, Gary J.; Lane, Patrick Nj; Smith, Hugh G.; Bell, Tina; Blake, William H.

2010-05-01

The recent catastrophic wildfires near Melbourne, which peaked on Feb. 7 2009, burned ca 400,000 ha and caused the tragic loss of 173 people. They occurred during unprecedented extreme fire weather where dry northerly winds gusting up to 100 km/h coincided with the highest temperatures ever recorded in this region. These conditions, combined with the very high biomass of mature eucalypt forests, very low fuel moisture conditions and steep slopes, generated extreme burning conditions. A rapid response project was launched under the NERC Urgency Scheme aimed at determining the effects of this extreme event on soil properties. Three replicate sites each were sampled for extremely high burn severity, high burn severity and unburnt control terrain, within mature mixed-species eucalypt forests near Marysville in April 2009. Ash and surface soil (0-2.5 cm and 2.5-5 cm) were collected at 20 sample grid points at each site. Here we report on outcomes from Water Drop Penetration Time (WDPT) tests carried out on soil samples to determine the impact of this extreme event on the wettability of a naturally highly water repellent soil. Field assessment suggested that the impact of this extreme wildfire on the soil was less than might be supposed given the extreme burn severity (indicated by the complete elimination of the ground vegetation). This was confirmed by the laboratory results. No major difference in WDPT was detected between (i) burned and control samples, and (ii) between surface and subsurface WDPT patterns, indicating that soil temperatures in the top 0-2.5 cm did not exceed ~200° C. Seedling germination in burned soil was reduced by at least 2/3 compared to the control samples, however, this reduction is indicative an only modest heat input into the soil. The limited heat input into the soil stands in stark contrast to the extreme burn severity (based on vegetation destruction parameters). We speculate that limited soil heating resulted perhaps from the unusually fast-moving fire front and the resultant short fire residence time during this event. Thick ash layers were present at the time of sampling despite some significant earlier pre-sampling rainfall events. This suggests that the wettable ash (up to 15 cm thick) was able to store substantial amounts of water, which would otherwise have formed overland flow moving over the highly water repellent underlying mineral soil. Once this hydrological ‘sponge' is removed, the lack of ground cover is expected to lead to the underlying soil being susceptible to erosion until the ground cover becomes re-established. This ‘erosion window‘ is likely to be relatively brief over much of the burnt area as the vegetation is already showing a comparatively rapid regrowth response. This is supported by initial results from laboratory germination experiments, which showed seedling emergence from even the most severely burnt sites. The factors contributing to the fire impacts determined here are explored in conjunction with predictions for future burn severity under a changing climate. The soil samples collected represent a reference soil sample collection, which are available to the scientific community for further investigation.

77 FR 6016 - Approval and Promulgation of Implementation Plans; State of Tennessee: Prevention of Significant...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-07

..., and extreme nonattainment (NAA) classifications) and significant emission rates for the 8-hour ozone..., serious, severe, and extreme ozone NAA. \\4\\ On July 18, 1997, EPA promulgated a revised 8-hour ozone NAAQS...

Deforestation intensifies hot days

NASA Astrophysics Data System (ADS)

Stoy, Paul C.

2018-05-01

Deforestation often increases land-surface and near-surface temperatures, but climate models struggle to simulate this effect. Research now shows that deforestation has increased the severity of extreme heat in temperate regions of North America and Europe. This points to opportunities to mitigate extreme heat.

Severe and moderate haemophilia A and B in US females.

PubMed

Di Michele, D M; Gibb, C; Lefkowitz, J M; Ni, Q; Gerber, L M; Ganguly, A

2014-03-01

Haemophilia A and B are rare X-lined hemorrhagic disorders that typically affect men. Women are usually asymptomatic carriers, but may be symptomatic and, rarely, also express severe (factor VIII (FVIII) or factor IX (FIX) <0.01 U mL(-1)) or moderately severe (FVIII/FIX 0.01-0.05 U mL(-1)) phenotypes. However, data on clinical manifestations, genotype and the psychosocial ramifications of illness in severely affected females remain anecdotal. A national multi-centre retrospective study was conducted to collect a comprehensive data set on affected US girls and women, and to compare clinical observations to previously published information on haemophilic males of comparable severity and mildly affected haemophilic females. Twenty-two severe/moderate haemophilia A/B subjects were characterized with respect to clinical manifestations and disease complications; genetic determinants of phenotypic severity; and health-related quality of life (HR-QoL). Clinical data were compared as previously indicated. Female patients were older than male patients at diagnosis, but similarly experienced joint haemorrhage, disease- and treatment-related complications and access to treatment. Gynaecological and obstetrical bleeding was unexpectedly infrequent. F8 or F9 mutations, accompanied by extremely skewed X-chromosome inactivation pattern (XIP), were primary determinants of severity. HR-QoL was diminished by arthropathy and viral infection. Using systematic case verification of participants in a national surveillance registry, this study elucidated the genetics, clinical phenotype and quality of life issues in female patients with severe/moderate haemophilia. An ongoing international case-controlled study will further evaluate these observations. Novel mechanistic questions are raised about the relationship between XIP and both age and tissue-specific FVIII and FIX expression. © 2014 John Wiley & Sons Ltd.

Evidence of a reduction over time in the behavioral severity of autistic disorder diagnoses.

PubMed

Whitehouse, Andrew J O; Cooper, Matthew N; Bebbington, Keely; Alvares, Gail; Lin, Ashleigh; Wray, John; Glasson, Emma J

2017-01-01

The increasing prevalence of Autism Spectrum Disorders (ASD) may in part be due to a shift in the diagnostic threshold that has led to individuals with a less severe behavioral phenotype receiving a clinical diagnosis. This study examined whether there were changes over time in the qualitative and quantitative phenotype of individuals who received the diagnosis of Autistic Disorder. Data were from a prospective register of new diagnoses in Western Australia (n = 1252). From 2000 to 2006, we examined differences in both the percentage of newly diagnosed cases that met each criterion as well as severity ratings of the behaviors observed (not met, partially met, mild/moderate and extreme). Linear regression determined there was a statistically significant reduction from 2000 to 2006 in the percentage of new diagnoses meeting two of 12 criteria. There was also a reduction across the study period in the proportion of new cases rated as having extreme severity on six criteria. There was a reduction in the proportion of individuals with three or more criteria rated as extreme from 2000 (16.0%) to 2006 (1.6%), while percentage of new cases with no "extreme" rating on any criteria increased from 58.5% to 86.6% across the same period. This study provides the first clear evidence of a reduction over time in the behavioral severity of individuals diagnosed with Autistic Disorder during a period of stability in diagnostic criteria. A shift toward diagnosing individuals with less severe behavioral symptoms may have contributed to the increasing prevalence of Autistic Disorder diagnoses. Autism Res 2017, 10: 179-187. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Wintertime aerosol chemistry and haze evolution in an extremely polluted city of North China Plain: significant contribution from coal and biomass combustions

NASA Astrophysics Data System (ADS)

Li, Haiyan; Zhang, Qi; Zhang, Qiang; Chen, Chunrong; Wang, Litao; Wei, Zhe; Zhou, Shan; Parworth, Caroline; Zheng, Bo; Canonaco, Francesco; Prévôt, André; Chen, Ping; Zhang, Hongliang; He, Kebin

2017-04-01

The North China Plain (NCP) frequently encountered heavy haze pollution in recent years, particularly during wintertime. In 2015-2016 winter, the NCP region suffered several extremely severe haze episodes with air pollution red alerts issued in many cities. In this work, we investigated the sources and aerosol evolution processes of the severe pollution episodes in Handan, a typical industrialized city in the NCP region, using real-time measurements from an intensive field campaign during the winter of 2015-2016. The average (± 1σ) concentration of submicron aerosol (PM1) during December 3, 2015 - February 5, 2016 was 187.6 (± 137.5) μg m-3, with the hourly maximum reaching 700.8 μg m-3. Organic was the most abundant component, on average accounting for 45% of total PM1 mass, followed by sulfate (15%), nitrate (14%), ammonium (12%), chloride (9%) and BC (5%). Positive matrix factorization (PMF) with multi-linear engine (ME-2) identified four major organic aerosol (OA) sources, including traffic emissions represented by a hydrocarbon-like OA (HOA, 7% of total OA), industrial and residential burning of coal represented by a coal combustion OA (CCOA, 29% of total OA), open and domestic combustion of wood and crop residuals represented by a biomass burning OA (BBOA, 25% of total OA), and formation of secondary OA (SOA) in the atmosphere represented by an oxygenated OA (OOA, 39% of total OA). Emissions of primary OA (POA), which together accounted for 61% of total OA and 27% of PM1, are a major cause of air pollution in this region during the winter. Our analysis further uncovered that, primary emissions from coal combustion and biomass burning together with secondary formation of sulfate (mainly from SO2 emitted by coal combustion) are important driving factors for haze evolution. However, the bulk composition of PM1 showed comparatively small variations between less polluted periods (daily PM2.5 ≤ 75 μg m-3) and severely polluted periods (daily PM2.5 > 75 μg m-3), indicating relatively synchronous increases of all aerosol species during haze formation. The case study of a severe haze episode, which lasted 8 days starting with a steady build-up of aerosol pollution followed by a persistently high level of PM1 (326.7 - 700.8 μg m-3), revealed the significant influences of stagnant meteorological conditions on acerbating air pollution problems in the Handan region. The haze episode ended with a shift of wind which brought in cleaner air masses from the northwest of Handan and gradually reduced PM1 concentration to < 50 μg m-3 after 12 hours. Furthermore, aqueous-phase reactions under higher relative humidity (RH) were found to significantly promote the production of secondary inorganic species (especially sulfate), but showed little influence on SOA.

Detecting severe injuries of the upper body in multiple trauma patients.

PubMed

Horst, Klemens; Hildebrand, Frank; Kobbe, Philipp; Pfeifer, Roman; Lichte, Philipp; Andruszkow, Hagen; Lefering, Rolf; Pape, Hans Christoph

2015-12-01

The clavicle limits the upper thoracic cage and connects the body and upper extremities. The clavicle is easy to examine and is visible on standard emergency room radiographs. We hypothesized that clavicular fracture in polytrauma patients would indicate the presence of further injuries of the upper extremities, head, neck, and thorax. A population-based trauma registry was used. All patients were documented between 2002 and 2013. Inclusion criteria were age ≥16 y and injury severity score (ISS) ≥16. Patients were divided into two groups according to the presence or absence of a clavicular fracture (group C+ and group C-). Scoring was based on the abbreviated injury scale, ISS, and new injury severity score. Trauma mechanisms, demographics, and the posttraumatic clinical course were compared. In total, 4790 patients with clavicular fracture (C+) and 41,775 without (C-) were included; the mean ISS was 30 ± 11 (C+) versus 28 ± 12 (C-). Patients with clavicular fracture had a longer stay on the intensive care unit with 12 ± 14 versus 10 ± 13 d. Injuries to the thoracic wall, severe lung injuries as well as injuries to the cervical spine were significantly increased in C+ patients. Thoracic injuries as well as injuries of the shoulder girdle and/or arm showed an increased abbreviated injury scale in the C+ group. A clinically relevant coincidence of clavicular fractures with injuries of the chest and upper extremity was found. As clavicular fractures can be diagnosed easily, it might also help to reduce the incidence of missed injuries of the chest and upper extremity. Therefore, special attention should be paid on thoracic as well as upper extremity injures during the second and tertiary surveys in case of clavicular fractures. Copyright © 2015 Elsevier Inc. All rights reserved.

Detection of photosynthetic responses of cool-temperate forests following extreme climate events using Bayesian inversion

NASA Astrophysics Data System (ADS)

Toda, M.; Knohl, A.; Herbst, M.; Keenan, T. F.; Yokozawa, M.

2016-12-01

The increase in extreme climate events associated with ongoing global warming may create severe damage to terrestrial ecosystems, changing plant structure and the eco-physiological functions that regulate ecosystem carbon exchange. However, most damage is usually due to moderate, rather than catastrophic, disturbances. The nature of plant functional responses to such disturbances, and the resulting effects on the terrestrial carbon cycle, remain poorly understood. To unravel the scientific question, tower-based eddy covariance data in the cool-temperate forests were used to constrain plant eco-physiological parameters in a persimoneous ecosystem model that may have affected carbon dynamics following extreme climate events using the statistic Bayesian inversion approach. In the present study, we raised two types of extreme events relevant for cool-temperate regions, i.e. a typhoon with mechanistic foliage destraction and a heat wave with severe drought. With appropriate evaluation of parameter and predictive uncertainties, the inversion analysis shows annual trajectory of activated photosynthetic responses following climate extremes compared the pre-disturbance state in each forest. We address that forests with moderate disturbance show substantial and rapid photosynthetic recovery, enhanced productivity, and, thus, ecosystem carbon exchange, although the effect of extreme climatic events varies depending on the stand successional phase and the type, intensity, timing and legacy of the disturbance.

Asymmetric Responses of Primary Productivity to Altered Precipitation Simulated by Land Surface Models across Three Long-term Grassland Sites

NASA Astrophysics Data System (ADS)

Wu, D.; Ciais, P.; Viovy, N.; Knapp, A.; Wilcox, K.; Bahn, M.; Smith, M. D.; Ito, A.; Arneth, A.; Harper, A. B.; Ukkola, A.; Paschalis, A.; Poulter, B.; Peng, C.; Reick, C. H.; Hayes, D. J.; Ricciuto, D. M.; Reinthaler, D.; Chen, G.; Tian, H.; Helene, G.; Zscheischler, J.; Mao, J.; Ingrisch, J.; Nabel, J.; Pongratz, J.; Boysen, L.; Kautz, M.; Schmitt, M.; Krohn, M.; Zeng, N.; Meir, P.; Zhang, Q.; Zhu, Q.; Hasibeder, R.; Vicca, S.; Sippel, S.; Dangal, S. R. S.; Fatichi, S.; Sitch, S.; Shi, X.; Wang, Y.; Luo, Y.; Liu, Y.; Piao, S.

2017-12-01

Changes in precipitation variability including the occurrence of extreme events strongly influence plant growth in grasslands. Field measurements of aboveground net primary production (ANPP) in temperate grasslands suggest a positive asymmetric response with wet years resulting in ANPP gains larger than ANPP declines in dry years. Whether land surface models used for historical simulations and future projections of the coupled carbon-water system in grasslands are capable to simulate such non-symmetrical ANPP responses remains an important open research question. In this study, we evaluate the simulated responses of grassland primary productivity to altered precipitation with fourteen land surface models at the three sites of Colorado Shortgrass Steppe (SGS), Konza prairie (KNZ) and Stubai Valley meadow (STU) along a rainfall gradient from dry to wet. Our results suggest that: (i) Gross primary production (GPP), NPP, ANPP and belowground NPP (BNPP) show nonlinear response curves (concave-down) in all the models, but with different curvatures and mean values. In contrast across the sites, primary production increases and then saturates along increasing precipitation with a flattening at the wetter site. (ii) Slopes of spatial relationships between modeled primary production and precipitation are steeper than the temporal slopes (obtained from inter-annual variations). (iii) Asymmetric responses under nominal precipitation range with modeled inter-annual primary production show large uncertainties, and model-ensemble median generally suggests negative asymmetry (greater declines in dry years than increases in wet years) across the three sites. (iv) Primary production at the drier site is predicted to more sensitive to precipitation compared to wetter site, and median sensitivity consistently indicates greater negative impacts of reduced precipitation than positive effects of increased precipitation under extreme conditions. This study implies that most models overemphasize the drought effects or underestimate the watering impacts on primary production in the normal-state, with the direct consequence that carbon-water interactions need to be improved in future model generations with improved mechanistic representations.

Analysis of Chronic Illnesses and Disability in a Community-Based Sample of Elderly People in South-Eastern Poland.

PubMed

Ćwirlej-Sozańska, Agnieszka; Wilmowska-Pietruszyńska, Anna; Sozański, Bernard; Wiśniowska-Szurlej, Agnieszka

2018-03-07

BACKGROUND The proportion of elderly people living in Poland has risen in recent years. With rising life expectancy, there is likely to be a concurrent increase in the incidence of chronic diseases and disabilities. Therefore, this study aimed to analyze the prevalence of chronic diseases and disability of the elderly in order to help guide strategies of prevention and public health control. MATERIAL AND METHODS This was a cross-sectional study of 1,000 randomly-selected residents living in the Podkarpackie region of Poland. The WHODAS 2.0 questionnaire was used to assess the disability and functioning of the participants across six domains of functioning using the following scores: no disability (0-4%), mild disability (5-24%), moderate disability (25-49%), severe disability (50-95%), and extreme disability (96-100%). RESULTS The presence of at least one chronic disease was identified in 84.1% of participants. The most common diseases were: circulatory diseases (59.10%), spinal pain syndromes (51.50%), degenerative joint diseases (50.30%), and rheumatic diseases (23.90%). Severe or extreme disability was found in 8.46% of patients with circulatory disease, 9.32% of patients with spinal pain syndromes, 9.34% of patients with degenerative joint diseases, and 12.13% of patients with rheumatic diseases. CONCLUSIONS Based on our findings, we recommend an emphasis be placed on early diagnosis of chronic diseases. We also recommend implementing methods of primary and secondary prevention aimed at reducing or eliminating disability resulting from chronic diseases. Our research highlights the need to plan targeted support and prevention programs using strategies that optimize social participation of older people with various chronic diseases.

Analysis of Chronic Illnesses and Disability in a Community-Based Sample of Elderly People in South-Eastern Poland

PubMed Central

Wilmowska-Pietruszyńska, Anna; Sozański, Bernard; Wiśniowska-Szurlej, Agnieszka

2018-01-01

Background The proportion of elderly people living in Poland has risen in recent years. With rising life expectancy, there is likely to be a concurrent increase in the incidence of chronic diseases and disabilities. Therefore, this study aimed to analyze the prevalence of chronic diseases and disability of the elderly in order to help guide strategies of prevention and public health control. Material/Methods This was a cross-sectional study of 1,000 randomly-selected residents living in the Podkarpackie region of Poland. The WHODAS 2.0 questionnaire was used to assess the disability and functioning of the participants across six domains of functioning using the following scores: no disability (0–4%), mild disability (5–24%), moderate disability (25–49%), severe disability (50–95%), and extreme disability (96–100%). Results The presence of at least one chronic disease was identified in 84.1% of participants. The most common diseases were: circulatory diseases (59.10%), spinal pain syndromes (51.50%), degenerative joint diseases (50.30%), and rheumatic diseases (23.90%). Severe or extreme disability was found in 8.46% of patients with circulatory disease, 9.32% of patients with spinal pain syndromes, 9.34% of patients with degenerative joint diseases, and 12.13% of patients with rheumatic diseases. Conclusions Based on our findings, we recommend an emphasis be placed on early diagnosis of chronic diseases. We also recommend implementing methods of primary and secondary prevention aimed at reducing or eliminating disability resulting from chronic diseases. Our research highlights the need to plan targeted support and prevention programs using strategies that optimize social participation of older people with various chronic diseases. PMID:29512628

Treatment of Lymphedema with Saam Acupuncture in Patients with Breast Cancer: A Pilot Study

PubMed Central

Jeong, Young Ju; Kwon, Hyo Jung; Park, Young Sun; Kwon, Oh Chang; Shin, Im Hee

2015-01-01

Abstract Background: Lymphedema is a troublesome complication affecting quality of life (QoL) in many women after breast-cancer treatment. Recent studies have suggested that acupuncture can reduce symptoms of lymphedema in breast-cancer survivors. Objectives: This was a pilot study. It was designed to assess the feasibility and the safety of acupuncture with the Saam acupuncture method for treating lymphedema in Korean patients after surgical therapy for breast cancer. Materials and Methods: This was a prospective, single-arm, observational pilot study using before and after measurements. The study was conducted at the East-West Medical Center at the Daegu Catholic University Medical Center, in Daegu, Korea. The subjects were 9 patients with breast cancer who presented with lymphedema of the upper limb ipsilateral to surgery. Saam acupuncture was administered 3 times per week for 6 consecutive weeks, for 30±5 minutes at each session.The primary outcome measure was severity of lymphedema as assessed by stages of lymphedema, a visual analogue scale (VAS), and by circumferential measurements of the upper extremity. The secondary outcome measure was QoL, which was assessed by a self-administered questionnaire using the Short Form–36 questionnaire. Results: Acupuncture reduced severity of lymphedema significantly, as assessed by the VAS (P<0.001) as well as by circumferential measurements of the upper extremity. Four weeks after the final treatment, symptoms were not aggravated. SF-36 scores remained significant for health status at the end of treatment. Conclusions: The Saam acupuncture method appeared to provide reduction of lymphedema among women after they had undergone surgery for breast cancer. A randomized, controlled prospective study with a larger sample size is required to clarify the role of acupuncture for managing lymphedema in patients with breast cancer. PMID:26155321

Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with chronic stroke.

PubMed

McCombe Waller, Sandy; Whitall, Jill; Jenkins, Toye; Magder, Laurence S; Hanley, Daniel F; Goldberg, Andrew; Luft, Andreas R

2014-12-14

Recovering useful hand function after stroke is a major scientific challenge for patients with limited motor recovery. We hypothesized that sequential training beginning with proximal bilateral followed by unilateral task oriented training is superior to time-matched unilateral training alone. Proximal bilateral training could optimally prepare the motor system to respond to the more challenging task-oriented training. Twenty-six participants with moderate severity hemiparesis Intervention: PARTICIPANTS received either 6-weeks of bilateral proximal training followed sequentially by 6-weeks unilateral task-oriented training (COMBO) or 12-weeks of unilateral task-oriented training alone (SAEBO). A subset of 8 COMB0 and 9 SAEBO participants underwent three functional magnetic resonance imaging (fMRI) scans of hand and elbow movement every 6 weeks. Fugl-Meyer Upper extremity scale, Modified Wolf Motor Function Test, University of Maryland Arm Questionnaire for Stroke, Motor cortex activation (fMRI). The COMBO group demonstrated significantly greater gains between baseline and 12-weeks over all outcome measures (p = .018 based on a MANOVA test) and specifically in the Modified Wolf Motor Function test (time). Both groups demonstrated within-group gains on the Fugl-Meyer Upper Extremity test (impairment) and University of Maryland Arm Questionnaire for Stroke (functional use). fMRI subset analyses showed motor cortex (primary and premotor) activation during hand movement was significantly increased by sequential combination training but not by task-oriented training alone. Sequentially combining a proximal bilateral before a unilateral task-oriented training may be an effective way to facilitate gains in arm and hand function in those with moderate to severe paresis post-stroke compared to unilateral task oriented training alone.

Decreased Visual Function Scores on a Low Luminance Questionnaire Is Associated with Impaired Dark Adaptation.

PubMed

Yazdanie, Mohammad; Alvarez, Jason; Agrón, Elvira; Wong, Wai T; Wiley, Henry E; Ferris, Frederick L; Chew, Emily Y; Cukras, Catherine

2017-09-01

We investigate whether responses on a Low Luminance Questionnaire (LLQ) in patients with a range of age-related macular degeneration (AMD) severity are associated with their performance on focal dark adaptation (DA) testing and with choroidal thickness. Cross-sectional, single-center, observational study. A total of 113 participants older than 50 years of age with a range of AMD severity. Participants answered the LLQ on the same day they underwent DA testing using a focal dark adaptometer measuring rod intercept time (RIT). We performed univariable and multivariable analyses of the LLQ scores and age, RIT, AMD severity, subfoveal choroidal thickness [SFCT], phakic status, and best-corrected visual acuity. The primary outcome of this study was the score on the 32-question LLQ. Each item in the LLQ is designated to 1 of 6 subscales describing functional problems in low luminance: driving, emotional distress, mobility, extreme lighting, peripheral vision, and general dim lighting. Scores were computed for each subscale, in addition to a weighted total mean score. Responses from 113 participants (mean age, 76.2±9.3 years; 58.4% were female) and 113 study eyes were analyzed. Univariable analysis demonstrated that lower scores on all LLQ subscales were correlated with prolonged DA testing (longer RIT) and decreased choroidal thickness. All associations were statistically significant except for the association of choroidal thickness and "peripheral vision." The strongest association was the LLQ subscale of driving with RIT (r =-0.97, P < 0.001). Multivariable analysis for each of the LLQ subscale outcomes, adjusted for age, included RIT, with total LLQ score, "driving," "extreme lighting," and "mobility" also including choroidal thickness. In all multivariable analyses, RIT had a stronger association than choroidal thickness. This cross-sectional analysis demonstrates associations of patient-reported functional deficits, as assessed on the LLQ, with both reduced DA and reduced choroidal thickness, in a population of older adults with varying degrees of AMD severity and good visual acuity in at least 1 eye. These analyses suggest that local functional measurements of DA testing (RIT) and choroidal thickness are associated with patient-reported functional deficits. Published by Elsevier Inc.

Sex determination: balancing selection in the honey bee.

PubMed

Charlesworth, Deborah

2004-07-27

Sequences of alleles of the honey bee's primary sex-determining gene have extremely high diversity, with many amino acid variants, suggesting that different alleles of this gene have been maintained in populations for very long evolutionary times.

Controls on the distribution of productivity and organic resources in Antarctic Dry Valley soils.

PubMed

Hopkins, D W; Sparrow, A D; Novis, P M; Gregorich, E G; Elberling, B; Greenfield, L G

2006-11-07

The Antarctic Dry Valleys are regarded as one of the harshest terrestrial habitats on Earth because of the extremely cold and dry conditions. Despite the extreme environment and scarcity of conspicuous primary producers, the soils contain organic carbon and heterotrophic micro-organisms and invertebrates. Potential sources of organic compounds to sustain soil organisms include in situ primary production by micro-organisms and mosses, spatial subsidies from lacustrine and marine-derived detritus, and temporal subsidies ('legacies') from ancient lake deposits. The contributions from these sources at different sites are likely to be influenced by local environmental conditions, especially soil moisture content, position in the landscape in relation to lake level oscillations and legacies from previous geomorphic processes. Here we review the abiotic factors that influence biological activity in Dry Valley soils and present a conceptual model that summarizes mechanisms leading to organic resources therein.

A perturbation approach for assessing trends in precipitation extremes across Iran

NASA Astrophysics Data System (ADS)

Tabari, Hossein; AghaKouchak, Amir; Willems, Patrick

2014-11-01

Extreme precipitation events have attracted a great deal of attention among the scientific community because of their devastating consequences on human livelihood and socio-economic development. To assess changes in precipitation extremes in a given region, it is essential to analyze decadal oscillations in precipitation extremes. This study examines temporal oscillations in precipitation data in several sub-regions of Iran using a novel quantile perturbation method during 1980-2010. Precipitation data from NASA's Modern-Era Retrospective Analysis for Research and Applications-Land (MERRA-Land) are used in this study. The results indicate significant anomalies in precipitation extremes in the northwest and southeast regions of Iran. Analysis of extreme precipitation perturbations reveals that perturbations for the monthly aggregation level are generally lower than the annual perturbations. Furthermore, high-oscillation and low-oscillation periods are found in extreme precipitation quantiles across different seasons. In all selected regions, a significant anomaly (i.e., extreme wet/dry conditions) in precipitation extremes is observed during spring.

A modified estimation distribution algorithm based on extreme elitism.

PubMed

Gao, Shujun; de Silva, Clarence W

2016-12-01

An existing estimation distribution algorithm (EDA) with univariate marginal Gaussian model was improved by designing and incorporating an extreme elitism selection method. This selection method highlighted the effect of a few top best solutions in the evolution and advanced EDA to form a primary evolution direction and obtain a fast convergence rate. Simultaneously, this selection can also keep the population diversity to make EDA avoid premature convergence. Then the modified EDA was tested by means of benchmark low-dimensional and high-dimensional optimization problems to illustrate the gains in using this extreme elitism selection. Besides, no-free-lunch theorem was implemented in the analysis of the effect of this new selection on EDAs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Rationale and design of the ARCUS: Effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function.

PubMed

Zwaan, Eva M; IJsselmuiden, Alexander J J; van Rosmalen, Joost; van Geuns, Robert-Jan M; Amoroso, Giovanni; Moerman, Esther; Ritt, Marco J P F; Schreuders, Ton A R; Kofflard, Marcel J M; Holtzer, Carlo A J

2016-12-01

The aim of this study is to provide a complete insight in the access-site morbidity and upper extremity function after Transradial Percutaneous Coronary Intervention (TR-PCI). In percutaneous coronary intervention the Transradial Approach (TRA) is gaining popularity as a default technique. It is a very promising technique with respect to post-procedure complications, but the exact effects of TRA on upper extremity function are unknown. The effects of trAnsRadial perCUtaneouS coronary intervention on upper extremity function (ARCUS) trial is a multicenter prospective cohort study that will be conducted in all patients admitted for TR-PCI. Clinical outcomes will be monitored during a follow-up of 6 months, with its primary endpoint at two weeks of follow-up. To investigate the complete upper extremity function, a combination of physical examinations and validated questionnaires will be used to provide information on anatomical integrity, strength, range of motion (ROM), coordination, sensibility, pain, and functioning in everyday life. Procedural and material specifications will be registered in order to include all possible aspects influencing upper extremity function. Results from this study will elucidate the effect of TR-PCI on upper extremity function. This creates the opportunity to further optimize TR-PCI, to make improvements in functional outcome and to prevent morbidity regarding full upper extremity function. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Severe hyperkalemia can be detected immediately by quantitative electrocardiography and clinical history in patients with symptomatic or extreme bradycardia: a retrospective cross-sectional study.

PubMed

Chon, Sung-Bin; Kwak, Young Ho; Hwang, Seung-Sik; Oh, Won Sup; Bae, Jun-Ho

2013-12-01

Detecting severe hyperkalemia is challenging. We explored its prevalence in symptomatic or extreme bradycardia and devised a diagnostic rule. This retrospective cross-sectional study included patients with symptomatic (heart rate [HR] ≤ 50/min with dyspnea, chest pain, altered mentality, dizziness/syncope/presyncope, general weakness, oliguria, or shock) or extreme (HR ≤ 40/min) bradycardia at an emergency department for 46 months. Risk factors for severe hyperkalemia were chosen by multiple logistic regression analysis from history (sex, age, comorbidities, and medications), vital signs, and electrocardiography (ECG; maximum precordial T-wave amplitude, PR, and QRS intervals). The derived diagnostic index was validated using bootstrapping method. Among the 169 participants enrolled, 87 (51.5%) were female. The mean (SD) age was 71.2 (12.5) years. Thirty-six (21.3%) had severe hyperkalemia. The diagnostic summed "maximum precordial T ≥ 8.5 mV (2)," "atrial fibrillation/junctional bradycardia (1)," "HR ≤ 42/min (1)," "diltiazem medication (2)," and "diabetes mellitus (1)." The C-statistics were 0.86 (0.80-0.93) and were validated. For scores of 4 or higher, sensitivity was 0.50, specificity was 0.92, and positive likelihood ratio was 6.02. The "ECG-only index," which sums the 3 ECG findings, had a sensitivity of 0.50, specificity of 0.90, and likelihood ratio (+) of 5.10 for scores of 3 or higher. Severe hyperkalemia is prevalent in symptomatic or extreme bradycardia and detectable by quantitative electrocardiographic parameters and history. © 2013.

Adjuvant chemotherapy for osteosarcoma.

PubMed

Eilber, F R; Rosen, G

1989-08-01

From this review of chemotherapy trials, several observations can be made. Osteosarcoma is a complex disease involving multiple histologies, each with a different prognosis. Prognostic factors that have been shown to be important include anatomic location of the primary tumor, stage at presentation (patients with metastatic or local recurrent disease fair far worse than those with primary disease), age at onset (children fair worse than the teenager with osteosarcoma), and location within the extremity (patients with more distal tumors fairing better than patients with more proximal tumors). There is convincing evidence for the efficacy of chemotherapeutic agents such as methotrexate in high doses (at least 8 g/m2 for adults, 12 g/m2 for children), Adriamycin, and cisplatin. The combination of Adriamycin and cisplatin appears to be more beneficial relative to either one of these agents alone. The efficacy of the combination of BCD as a triple-drug regimen, although useful in several different trials, has not been convincingly shown. Finally, from several of the recent randomized trials, it appears, that chemotherapeutic regimens containing an Adriamycin and cisplatin combination appear to be superior to those that do not include this combination. However, these observations are made from a historical perspective and have not been conclusively proven by randomized prospective investigations. The observations concerning the natural history of the disease and the activity of various chemotherapeutic agents suggest certain clinical practice algorithms. Essential staging procedures would include a bone scan looking for multifocal or metastatic disease, and CT scans of the chest looking for metastases to the lung. From all studies, it is apparent that surgery is mandatory for the primary tumor and should be an integral portion of all treatment methods. Chemotherapy should be considered for all patients with osteosarcoma, and the essential drugs in the regimen appear at present to minimally include high-dose methotrexate, Adriamycin, and cisplatin. It would also appear from several of these reports that not only is the adjuvant use of these chemotherapeutic agents indicated, but that the preoperative use of these agents has had significant advantages. The neoadjuvant chemotherapy begins the essential systemic chemotherapy at a very early stage, allows histologic assessment of treatment effect, permits altering drug regimens postoperative, and in many reported trials has allowed less than amputative surgery (limb salvage) to be performed. Finally, close follow-up of patients with osteosarcoma has therapeutic value.(ABSTRACT TRUNCATED AT 400 WORDS)

SSTO rockets. A practical possibility

NASA Technical Reports Server (NTRS)

Bekey, Ivan

1994-01-01

Most experts agree that single-stage-to-orbit (SSTO) rockets would become feasible if more advanced technologies were available to reduce the vehicle dry weight, increase propulsion system performance, or both. However, these technologies are usually judged to be very ambitious and very far off. This notion persists despite major advances in technology and vehicle design in the past decade. There appears to be four major misperceptions about SSTOs, regarding their mass fraction, their presumed inadequate performance margin, their supposedly small payloads, and their extreme sensitivity to unanticipated vehicle weight growth. These misperceptions can be dispelled for SSTO rockets using advanced technologies that could be matured and demonstrated in the near term. These include a graphite-composite primary structure, graphite-composite and Al-Li propellant tanks with integral reusable thermal protection, long-life tripropellant or LOX-hydrogen engines, and several technologies related to operational effectiveness, including vehicle health monitoring, autonomous avionics/flight control, and operable launch and ground handling systems.

SSTO rockets. A practical possibility

NASA Astrophysics Data System (ADS)

Bekey, Ivan

1994-07-01

Most experts agree that single-stage-to-orbit (SSTO) rockets would become feasible if more advanced technologies were available to reduce the vehicle dry weight, increase propulsion system performance, or both. However, these technologies are usually judged to be very ambitious and very far off. This notion persists despite major advances in technology and vehicle design in the past decade. There appears to be four major misperceptions about SSTOs, regarding their mass fraction, their presumed inadequate performance margin, their supposedly small payloads, and their extreme sensitivity to unanticipated vehicle weight growth. These misperceptions can be dispelled for SSTO rockets using advanced technologies that could be matured and demonstrated in the near term. These include a graphite-composite primary structure, graphite-composite and Al-Li propellant tanks with integral reusable thermal protection, long-life tripropellant or LOX-hydrogen engines, and several technologies related to operational effectiveness, including vehicle health monitoring, autonomous avionics/flight control, and operable launch and ground handling systems.

[THE ROLE OF THE CYTOKINE PROFILE IN TREATMENT IN WOMEN WITH ENDOMETRIAL CANCER FIRST STAGE].

PubMed

Dimitrov, T; Gorchev, G; Tomov, S

2015-01-01

Endometrial canceris the most common gynecological cancer. It is positive that more than 53% of diagnosed cases of endometrial cancer are in first stage when the therapeutic options are more successive. More and more gynecologists in addition to the normal clinical and histological tests expand the information for the neoplastic process with biochemical and immunological markers-tumor markers, hormones, lymphocyte population, cytokines, markers for lesion-inflammatory processes, etc. Several biological mechanisms track the connection between overweight and endometrial neoplastic risk. In the surgical practice is increasing the interest towards the cytokine group as independent prognostic factors, aggressiveness and options for treatment of the neoplastic process. The cytokine profile can be used as factor for evaluation of the primary neoplastic immune impairment as well as for a choice of surgical intervention. This is extremely important for obese patients because obesity is turning into worldwide medico-social problem.

CRACK GROWTH RESPONSE OF ALLOY 690 IN SIMULATED PWR PRIMARY WATER

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

Toloczko, Mychailo B.; Bruemmer, Stephen M.

2009-12-01

The stress corrosion crack growth response of three extruded alloy 690 CRDM tube heats was investigated in several thermomechanical conditions. Extremely low propagation rates (< 1 x 10{sup -9} mm/s) were observed under constant stress intensity factor (K) loading at 325-350 C in the as-received, thermally treated (TT) materials despite using a variety of transitioning techniques. Post-test observation of the crack-growth surfaces revealed only isolated intergranular (IG) cracking. One-dimensional cold rolling to 17% reduction and testing in the S-L orientation did not promote enhanced stress corrosion rates. However, somewhat higher propagation rates were observed in a 30% cold-rolled alloy 690TTmore » specimen tested in the T-L orientation. Cracking of the cold-rolled material was promoted on grain boundaries oriented parallel to the rolling plane with the % IG increasing with the amount of cold rolling.« less

Early photosynthetic microorganisms and environmental evolution

NASA Technical Reports Server (NTRS)

Golubic, S.

1980-01-01

Microfossils which are preserved as shrivelled kerogenous residues provide little information about cellular organization and almost none about the metabolic properties of the organisms. The distinction between prokaryotic vs eukaryotic, and phototrophic vs chemo- and organotrophic fossil microorganisms rests entirely on morphological comparisons with recent counterparts. The residual nature of the microbial fossil record promotes the conclusion that it must be biased toward (a) most abundant organisms, (b) those most resistant to degradation, and (c) those inhabiting environments with high preservation potential e.g., stromatolites. These criteria support the cyanophyte identity of most Precambrian microbial fossils on the following grounds: (1) as primary producers they dominate prokaryotic communities in modern extreme environments, e.g., intertidal zone; (2) several morphological counterparts of modern cyanophytes and microbial fossils have been established based on structure, cell division patterns and degradation sequences. The impact of anaerobic and oxygenic microbial photosynthesis on the evolution of Precambrian environments is discussed.

Control programme for cystic echinococcosis in Uruguay.

PubMed

Irabedra, Pilar; Ferreira, Ciro; Sayes, Julio; Elola, Susana; Rodríguez, Miriam; Morel, Noelia; Segura, Sebastian; Santos, Estela Dos; Guisantes, Jorge A

2016-05-24

Cystic echinococcosis is a highly endemic parasitic zoonosis that is present in the Southern Cone countries of America. For several decades, various prevention and control programmes have been implemented in different countries and regions, with varying results. In Uruguay, a new control programme was implemented in 2006 that employed new strategies for canine diagnosis and treatment, dog population control, diagnosis in humans, epidemiological surveillance, and health education, including community participation. The control programme in Uruguay addresses the control and surveillance of the disease from a holistic perspective based on Primary Health Care, which has strengthened the community's participation in developing and coordinating activities in an interdisciplinary manner. Similarly, the control programme that is currently implemented is based on a risk-focused approach. The surveillance and control measures were focused on small villages and extremely poor urban areas. In this study, the strategies used and the results obtained from 2008-2013 are analysed and discussed.

Preliminary results from the Stereo-SCIDAR at the VLT Observatory: extraction of reference atmospheric turbulence profiles for E-ELT adaptive optics instrument performance simulations

NASA Astrophysics Data System (ADS)

Sarazin, Marc S.; Osborn, James; Chacon-Oelckers, Arlette; Dérie, Frédéric J.; Le Louarn, Miska; Milli, Julien; Navarrete, Julio; Wilson, Richard R. W.

2017-09-01

The Stereo-SCIDAR (Scintillation Detection and Ranging) atmospheric turbulence profiler, built for ESO by Durham University, observes the scintillation patterns of binary elements with one of the four VLT-Interferometer 1.8m auxiliary telescopes at the ESO Paranal Observatory. The primary products are the vertical profiles of the index of refraction structure coefficient and of the wind velocity which allow to compute the wavefront coherence time and the isoplanatic angle with a vertical resolution of 250m. The several thousands of profiles collected during more than 30 nights of operation are grouped following criteria based on the altitude distribution or on principal component analysis. A set of reference profiles representative of the site is proposed as input for the various simulation models developed by the E-ELT (European Extremely Large Telescope) instruments Consortia.

A Perspective on Consumers 3.0: They Are Not Better Decision-Makers than Previous Generations

PubMed Central

Houdek, Petr

2016-01-01

This perspective article builds upon the theory of local thinking in interpretation and prediction of consumer behavior in a contemporary world of information overload. It is shown that even informed and socially and environmentally responsible consumers (consumers 3.0) exhibit selective recall, limited attention, and bounded search in the perception and interpretation of price and quality of purchases. Their decisions fall into local cognitive frames, which specifically focus attention only on a narrow structure and content of the choice. The cognitive frames can be established by recent or regular purchases, but also extreme or primary purchase experiences. The article includes a short conceptual review of car, food, clothing, insurance, drugs, paintings, and other product purchases showing that the local cognitive frames often lead to bad bargains across various sectors. The article presents several suggestions for future research. PMID:27375527

Pulsed Plasma Thruster Technology for Small Satellite Missions

NASA Technical Reports Server (NTRS)

Myers, Roger M.; Oleson, Steven R.; Mcguire, Melissa; Meckel, Nicole J.; Cassady, R. Joseph

1995-01-01

Pulsed plasma thrusters (PPT's) offer the combined benefits of extremely low average electric power requirements (1 to 150 W), high specific impulse (approximately 1000 s), and system simplicity derived from the use of an inert solid propellant. Potential applications range from orbit insertion and maintenance of small satellites to attitude control for large geostationary communications satellites. While PPT's have been used operationally on several spacecraft, there has been no new PPT technology development since the early 1970's. As result of the rapid growth in the small satellite community and the broad range of PPT applications, NASA has initiated a development program with the objective of dramatically reducing the PPT dry mass, increasing PPT performance, and demonstrating a flight ready system by October 1997. This paper presents the results of a series of near-Earth mission studies including both primary and auxiliary propulsion and attitude control functions and reviews the status of NASA's on-going development program.

A Perspective on Consumers 3.0: They Are Not Better Decision-Makers than Previous Generations.

PubMed

Houdek, Petr

2016-01-01

This perspective article builds upon the theory of local thinking in interpretation and prediction of consumer behavior in a contemporary world of information overload. It is shown that even informed and socially and environmentally responsible consumers (consumers 3.0) exhibit selective recall, limited attention, and bounded search in the perception and interpretation of price and quality of purchases. Their decisions fall into local cognitive frames, which specifically focus attention only on a narrow structure and content of the choice. The cognitive frames can be established by recent or regular purchases, but also extreme or primary purchase experiences. The article includes a short conceptual review of car, food, clothing, insurance, drugs, paintings, and other product purchases showing that the local cognitive frames often lead to bad bargains across various sectors. The article presents several suggestions for future research.

Advances in Proteomics of Mycobacterium leprae.

PubMed

Parkash, O; Singh, B P

2012-04-01

Although Mycobacterium leprae was the first bacterial pathogen identified causing human disease, it remains one of the few that is non-cultivable. Understanding the biology of M. leprae is one of the primary challenges in current leprosy research. Genomics has been extremely valuable, nonetheless, functional proteins are ultimately responsible for controlling most aspects of cellular functions, which in turn could facilitate parasitizing the host. Furthermore, bacterial proteins provide targets for most of the vaccines and immunodiagnostic tools. Better understanding of the proteomics of M. leprae could also help in developing new drugs against M. leprae. During the past nearly 15 years, there have been several developments towards the identification of M. leprae proteins employing contemporary proteomics tools. In this review, we discuss the knowledge gained on the biology and pathogenesis of M. leprae from current proteomic studies. © 2012 The Authors. Scandinavian Journal of Immunology © 2012 Blackwell Publishing Ltd.

Short stature/short limb skeletal dysplasia with severe combined immunodeficiency and bowing of the femora: report of two patients and review.

PubMed Central

MacDermot, K D; Winter, R M; Wigglesworth, J S; Strobel, S

1991-01-01

We report two patients with severe combined immunodeficiency and short stature/short limb skeletal dysplasia. Case 1 presented at birth with rhizomelic shortening of the extremities and bowing of the femora. She developed clinical signs of severe combined immunodeficiency at 13 months and died at 21 months. Case 2 had severe prenatal shortening and bowing of the extremities and a small, malformed chest. Symptoms of severe combined immunodeficiency and severe failure to thrive developed soon after birth and she died at 5 months. The diagnosis of severe combined immunodeficiency in our patients was based on their clinical course and necropsy findings, supported in case 1 by the results of immune function tests. The results of investigation of immune function (immunoglobulins, lymphocyte subpopulations, lymphocyte function) are very variable in this syndrome as in other variants of severe combined immunodeficiency. Bone histopathology in both patients showed grossly irregular costochondral junctions, but normal transition of proliferating to hypertrophic chondrocytes. These cases belong to early lethal type 1 short limb skeletal dysplasia with severe combined immunodeficiency. Review of previously published cases with severe combined immunodeficiency and well documented skeletal findings show eight patients with prenatal onset of bowing and shortening of the extremities and metaphyseal abnormalities. These include two sib pairs concordant for the skeletal changes. In these cases, adenosine deaminase levels were not reported. An additional four published cases with associated adenosine deaminase deficiency had only mild metaphyseal abnormalities, but subsequently showed no linear growth.(ABSTRACT TRUNCATED AT 250 WORDS) Images PMID:1999827

Primary hepatic carcinoid tumor: case report and literature review

PubMed Central

Camargo, Éden Sartor; Viveiros, Marcelo de Melo; Corrêa, Isaac José Felippe; Robles, Laercio; Rezende, Marcelo Bruno

2014-01-01

Primary hepatic carcinoid tumors are extremely rare neoplasms derived from hormone-producing neuroendocrine cells. It is difficult to make their diagnosis before biopsy, surgical resection or necropsy. A recent publication described only 94 cases of these tumors. There is no sex predilection and apparently it has no association with cirrhosis or preexisting hepatic disease. The most effective treatment is hepatectomy, and resection is determined by size and location of the lesions. PMID:25628206

Primary Intraosseous Hemangioma of the Orbital Roof: A Pitfall of Surgery.

PubMed

Wu, Chih-Ying; Huang, Hsiang-Ming; Chen, Der-Cherng; Cho, Der-Yang; Wei, Sung-Tai

2016-09-01

A primary intraosseous hemangioma (IOH) of the orbital bone is extremely rare. The preferred method of treatment for IOH is total surgical excision with reconstruction. Herein, the authors describe a patient with an orbital roof IOH and the unexpected complications of ptosis and deteriorated exophthalmos. These findings showed that the total surgical excision and subsequent reconstruction provided adequate decompression and prevented further ocular complications from the orbital wall defect.

Prevention and management of infections associated with combat-related extremity injuries.

PubMed

Murray, Clinton K; Hsu, Joseph R; Solomkin, Joseph S; Keeling, John J; Andersen, Romney C; Ficke, James R; Calhoun, Jason H

2008-03-01

Orthopedic injuries suffered by casualties during combat constitute approximately 65% of the total percentage of injuries and are evenly distributed between upper and lower extremities. The high-energy explosive injuries, environmental contamination, varying evacuation procedures, and progressive levels of medical care make managing combat-related injuries challenging. The goals of orthopedic injury management are to prevent infection, promote fracture healing, and restore function. It appears that 2% to 15% of combat-related extremity injuries develop osteomyelitis, although lower extremity injuries are at higher risk of infections than upper extremity. Management strategies of combat-related injuries primarily focus on early surgical debridement and stabilization, antibiotic administration, and delayed primary closure. Herein, we provide evidence-based recommendations from military and civilian data to the management of combat-related injuries of the extremity. Areas of emphasis include the utility of bacterial cultures, antimicrobial therapy, irrigation fluids and techniques, timing of surgical care, fixation, antibiotic impregnated beads, wound closure, and wound coverage with negative pressure wound therapy. Most of the recommendations are not supported by randomized controlled trials or adequate cohorts studies in a military population and further efforts are needed to answer best treatment strategies.

Within-summer variation in out-of-hospital cardiac arrest due to extremely long sunshine duration.

PubMed

Onozuka, Daisuke; Hagihara, Akihito

2017-03-15

Although several studies have reported the impacts of extremely high temperatures on cardiovascular diseases, no studies have examined whether variation in out-of-hospital cardiac arrest (OHCA) due to extremely long sunshine duration changes during the summer. We obtained daily data on all cases of OHCA and weather variations for all 47 prefectures of Japan during the summer (June to September) between 2005 and 2014. A distributed lag non-linear model combined with a quasi-Poisson regression model was used to estimate within-summer variation in OHCA due to extremely long sunshine duration for each prefecture. Then, multivariate random-effects meta-analysis was performed to derive overall effect estimates of sunshine duration at the national level. A total of 166,496 OHCAs of presumed cardiac origin met the inclusion criteria. The minimum morbidity percentile (MMP) was the 0th percentile of sunshine duration at the national level. The overall cumulative relative risk (RR) at the 99th percentile vs. the MMP was 1.15 (95% CI: 1.05-1.27) during the summer. The effect of extremely long sunshine duration on OHCA in early summer was acute and did not persist, whereas an identical effect was observed in late summer, but it was delayed and lasted for several days. During summer periods, excessive sunshine duration could increase the risk of OHCA. Timely preventive measures to reduce the OHCA risk due to extremely long sunshine duration are important in early summer, whereas these measures could include a wider time window of several days to reduce the risk in late summer. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Analytical studies assessing the association between extreme precipitation or temperature and drinking water-related waterborne infections: a review.

PubMed

Guzman Herrador, Bernardo R; de Blasio, Birgitte Freiesleben; MacDonald, Emily; Nichols, Gordon; Sudre, Bertrand; Vold, Line; Semenza, Jan C; Nygård, Karin

2015-03-27

Determining the role of weather in waterborne infections is a priority public health research issue as climate change is predicted to increase the frequency of extreme precipitation and temperature events. To document the current knowledge on this topic, we performed a literature review of analytical research studies that have combined epidemiological and meteorological data in order to analyze associations between extreme precipitation or temperature and waterborne disease.A search of the databases Ovid MEDLINE, EMBASE, SCOPUS and Web of Science was conducted, using search terms related to waterborne infections and precipitation or temperature. Results were limited to studies published in English between January 2001 and December 2013.Twenty-four articles were included in this review, predominantly from Asia and North-America. Four articles used waterborne outbreaks as study units, while the remaining articles used number of cases of waterborne infections. Results presented in the different articles were heterogeneous. Although most of the studies identified a positive association between increased precipitation or temperature and infection, there were several in which this association was not evidenced. A number of articles also identified an association between decreased precipitation and infections. This highlights the complex relationship between precipitation or temperature driven transmission and waterborne disease. We encourage researchers to conduct studies examining potential effect modifiers, such as the specific type of microorganism, geographical region, season, type of water supply, water source or water treatment, in order to assess how they modulate the relationship between heavy rain events or temperature and waterborne disease. Addressing these gaps is of primary importance in order to identify the areas where action is needed to minimize negative impact of climate change on health in the future.

Evaluation of NYC's Coastal Vulnerability and Potential Adaptation Strategies in the Wake of Hurricane Sandy

NASA Astrophysics Data System (ADS)

Miller, S. M.; Foti, R.; Montalto, F. A.

2015-12-01

New York City's coastlines are a mosaic of remnant natural habitat, man-made wetlands, manicured parkland, public beaches, housing, and industrial centers, all of which are extremely vulnerable to flooding, storm surge, and damaging wave action. Risks are projected to increase overtime as sea levels rise, population grows, and the frequency and severity of extreme events increases. In order to protect its citizens and infrastructure, New York City is planning to invest 20 billion into a coastal protection plan, including 200 million towards wetlands creation and restoration. Focusing on the role of wetlands and parkland in reducing damages during Hurricane Sandy, our study seeks to identify the primary causes of coastal vulnerability and to provide guidelines for the design of coastal protection measures. Our findings show that most of the small, fragmented NYC's wetlands did not provide significant protection from the violence of the hurricane. Large stretches of wetlands and parkland, on the other hand, were found to exacerbate storm surge along the coast, but did reduce surge penetration further inland. Much of the protection provided by wetlands and coastal green sites was in the form of cost avoidance. Wetlands existed in the most heavily hit areas and so averted damages that would have occurred if those areas had been developed. Our results suggest that, when positioned in the highest risk areas, coastal green infrastructure such as wetlands and parklands can reduce coastal flood risks associated with extreme events like Hurricane Sandy. Policy would ideally prioritize conservation, restoration, and enhancement of large contiguous areas of wetlands in the lowest elevation areas of the city. Where low-lying coastal development cannot be relocated, the risk of damage from storm surges is best reduced by elevating critical infrastructure.

Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke.

PubMed

Dawson, Jesse; Pierce, David; Dixit, Anand; Kimberley, Teresa J; Robertson, Michele; Tarver, Brent; Hilmi, Omar; McLean, John; Forbes, Kirsten; Kilgard, Michael P; Rennaker, Robert L; Cramer, Steven C; Walters, Matthew; Engineer, Navzer

2016-01-01

Recent animal studies demonstrate that vagus nerve stimulation (VNS) paired with movement induces movement-specific plasticity in motor cortex and improves forelimb function after stroke. We conducted a randomized controlled clinical pilot study of VNS paired with rehabilitation on upper-limb function after ischemic stroke. Twenty-one participants with ischemic stroke >6 months before and moderate to severe upper-limb impairment were randomized to VNS plus rehabilitation or rehabilitation alone. Rehabilitation consisted of three 2-hour sessions per week for 6 weeks, each involving >400 movement trials. In the VNS group, movements were paired with 0.5-second VNS. The primary objective was to assess safety and feasibility. Secondary end points included change in upper-limb measures (including the Fugl-Meyer Assessment-Upper Extremity). Nine participants were randomized to VNS plus rehabilitation and 11 to rehabilitation alone. There were no serious adverse device effects. One patient had transient vocal cord palsy and dysphagia after implantation. Five had minor adverse device effects including nausea and taste disturbance on the evening of therapy. In the intention-to-treat analysis, the change in Fugl-Meyer Assessment-Upper Extremity scores was not significantly different (between-group difference, 5.7 points; 95% confidence interval, -0.4 to 11.8). In the per-protocol analysis, there was a significant difference in change in Fugl-Meyer Assessment-Upper Extremity score (between-group difference, 6.5 points; 95% confidence interval, 0.4 to 12.6). This study suggests that VNS paired with rehabilitation is feasible and has not raised safety concerns. Additional studies of VNS in adults with chronic stroke will now be performed. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01669161. © 2015 The Authors.

Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke

PubMed Central

Pierce, David; Dixit, Anand; Kimberley, Teresa J.; Robertson, Michele; Tarver, Brent; Hilmi, Omar; McLean, John; Forbes, Kirsten; Kilgard, Michael P.; Rennaker, Robert L.; Cramer, Steven C.; Walters, Matthew; Engineer, Navzer

2016-01-01

Background and Purpose— Recent animal studies demonstrate that vagus nerve stimulation (VNS) paired with movement induces movement-specific plasticity in motor cortex and improves forelimb function after stroke. We conducted a randomized controlled clinical pilot study of VNS paired with rehabilitation on upper-limb function after ischemic stroke. Methods— Twenty-one participants with ischemic stroke >6 months before and moderate to severe upper-limb impairment were randomized to VNS plus rehabilitation or rehabilitation alone. Rehabilitation consisted of three 2-hour sessions per week for 6 weeks, each involving >400 movement trials. In the VNS group, movements were paired with 0.5-second VNS. The primary objective was to assess safety and feasibility. Secondary end points included change in upper-limb measures (including the Fugl–Meyer Assessment-Upper Extremity). Results— Nine participants were randomized to VNS plus rehabilitation and 11 to rehabilitation alone. There were no serious adverse device effects. One patient had transient vocal cord palsy and dysphagia after implantation. Five had minor adverse device effects including nausea and taste disturbance on the evening of therapy. In the intention-to-treat analysis, the change in Fugl–Meyer Assessment-Upper Extremity scores was not significantly different (between-group difference, 5.7 points; 95% confidence interval, −0.4 to 11.8). In the per-protocol analysis, there was a significant difference in change in Fugl–Meyer Assessment-Upper Extremity score (between-group difference, 6.5 points; 95% confidence interval, 0.4 to 12.6). Conclusions— This study suggests that VNS paired with rehabilitation is feasible and has not raised safety concerns. Additional studies of VNS in adults with chronic stroke will now be performed. Clinical Trial Registration— URL: https://www.clinicaltrials.gov. Unique identifier: NCT01669161. PMID:26645257

The Extreme Ultraviolet Normal Incidence Spectrograph (EUNIS)

NASA Technical Reports Server (NTRS)

Oegerle, William (Technical Monitor); Rabin, D.; Davila, J.; Thomas, R. J.; Engler, C.; Irish, S.; Keski-Kuha, R.; Novello, J.; Nowak, M.; Payne, L.;

Primary renal angiosarcoma with progressive clinical course despite surgical and adjuvant treatment: A case report

PubMed Central

CELEBI, FILIZ; PILANCI, KEZBAN NUR; SAGLAM, SEZER; BALCI, NUMAN CEM

2015-01-01

Angiosarcoma is an extremely rare, high-grade malignancy, which accounts for <2% of all soft-tissue sarcomas. Cases of primary renal angiosarcoma represent 1% of these. Angiosarcomas involving the kidney usually originate from metastatic skin lesions or primary visceral lesions and most often occur in the sixth and seventh decades of life. The present study describes a case of primary renal angiosarcoma that presented as a large right-sided renal mass with symptoms of flank pain. Despite surgical removal of the tumor, recurrent disease with associated lung metastases was identified at the surgical site following adjuvant chemotherapy. The patient succumbed to the disease 13 months after the diagnosis. PMID:25789072

Prognostic Factors and Expression of MDM2 in Patients with Primary Extremity Liposarcoma

PubMed Central

Júnior, Rosalvo Zósimo Bispo; de Camargo, Olavo Pires; de Oliveira, Cláudia Regina G. C. M.; Filippi, Renée Zon; Baptista, André Mathias; Caiero, Marcelo Tadeu

2008-01-01

OBJECTIVE The objective of this study was to investigate MDM2 (murine double minute 2) protein expression and evaluate its relationship with some anatomical and pathological aspects, aiming also to identify prognostic factors concerning local recurrence-free survival, metastasis-free survival and overall survival in patients with primary liposarcomas of the extremities. MATERIALS AND METHODS Of 50 patients with primary liposarcomas of the extremities admitted to a Reference Service, between 1968 and 2004, 25 were enrolled in the study, following eligibility and exclusion criteria. RESULTS The adverse factors that influenced the risk for local recurrence in the univariant analysis included male sex (P = 0.023), pleomorphic histological subtype (P = 0.027), and high histological grade (P = 0.007). Concerning metastasis-free survival, age less than 50 years (P = 0.040), male sex (P = 0.040), pleomorphic subtype (P < 0.001), and high histological grade (P = 0.003) had a worse prognosis. Adverse factors for overall survival were age under 50 years (P = 0.040), male sex (P = 0.040), pleomorphic subtype (P < 0.001), and high histological grade (P = 0.003). CONCLUSIONS There was no correlation between immunohistochemically observed MDM2 protein expressions and the anatomical and pathological variables studied. The immunohistochemical expression of MDM2 protein was not considered to have a prognostic value for any of the surviving patients in this study (local recurrence-free survival, metastasis-free survival, or overall survival). The immunoexpression of MDM2 protein was a frequent event in the different subtypes of liposarcomas. PMID:18438568

The efficacy of fuel treatment in mitigating property loss during wildfires: Insights from analysis of the severity of the catastrophic fires in 2009 in Victoria, Australia.

PubMed

Price, Owen F; Bradstock, Ross A

2012-12-30

Treatment of fuel (e.g. prescribed fire, logging) in fire-prone ecosystems is done to reduce risks to people and their property but effects require quantification, particularly under severe weather conditions when the destructive potential of fires on human infrastructure is maximised. We analysed the relative effects of fuel age (i.e. indicative of the effectiveness of prescribed fire) and logging on remotely sensed (SPOT imagery) severity of fires which occurred in eucalypt forests in Victoria, Australia in 2009. These fires burned under the most severe weather conditions recorded in Australia and caused large losses of life and property. Statistical models of the probability of contrasting extremes of severity (crown fire versus fire confined to the understorey) were developed based on effects of fuel age, logging, weather, topography and forest type. Weather was the primary influence on severity, though it was reduced at low fuel ages in Moderate but not Catastrophic, Very High or Low fire-weather conditions. Probability of crown fires was higher in recently logged areas than in areas logged decades before, indicating likely ineffectiveness as a fuel treatment. The results suggest that recently burnt areas (up to 5-10 years) may reduce the intensity of the fire but not sufficiently to increase the chance of effective suppression under severe weather conditions. Since house loss was most likely under these conditions (67%), effects of prescribed burning across landscapes on house loss are likely to be small when weather conditions are severe. Fuel treatments need to be located close to houses in order to effectively mitigate risk of loss. Copyright © 2012 Elsevier Ltd. All rights reserved.

Primary adenocarcinoma of the thymus: an immunohistochemical and molecular study with review of the literature.

PubMed

Maghbool, Maryam; Ramzi, Mani; Nagel, Inga; Bejarano, Pablo; Siebert, Reiner; Saeedzadeh, Abolfazl; Daneshbod, Yahya

2013-05-31

Primary adenocarcinoma of thymus is extremely rare. This is a case of primary adenocarcinoma with intestinal differentiation and focal mucin production in the thymus. Thymic cyst was associated with this tumor. Intestinal differentiation was confirmed by immunohistochemical stain with positivity for CDX-2, CK20, villin, MOC31 and focal positivity of CK7. Array comperative genomic hybridization (CGH) analysis showed a complex pattern of chromosomal imbalances including homozygous deletion at the HLA locus in chromosomal region 6p21.32. This rare tumor shows a similar genetic aberration with other studied thymic epithelial tumors.

A dynamical systems approach to studying midlatitude weather extremes

NASA Astrophysics Data System (ADS)

Messori, Gabriele; Caballero, Rodrigo; Faranda, Davide

2017-04-01

Extreme weather occurrences carry enormous social and economic costs and routinely garner widespread scientific and media coverage. The ability to predict these events is therefore a topic of crucial importance. Here we propose a novel predictability pathway for extreme events, by building upon recent advances in dynamical systems theory. We show that simple dynamical systems metrics can be used to identify sets of large-scale atmospheric flow patterns with similar spatial structure and temporal evolution on time scales of several days to a week. In regions where these patterns favor extreme weather, they afford a particularly good predictability of the extremes. We specifically test this technique on the atmospheric circulation in the North Atlantic region, where it provides predictability of large-scale wintertime surface temperature extremes in Europe up to 1 week in advance.

Extreme metabolic alkalosis with fludrocortisone therapy.

PubMed Central

Burns, A.; Brown, T. M.; Semple, P.

1983-01-01

We present an unusual case of extreme metabolic alkalosis resulting from severe hypokalaemia caused by unmonitored fludrocortisone therapy. Biochemical aspects of the disorder are discussed, as is the successful treatment with diuretics and potassium replacement. Some dangers of this therapy and necessary precautions are emphasized. PMID:6622340

Climate change impacts on extreme events in the United States: an uncertainty analysis

EPA Science Inventory

Extreme weather and climate events, such as heat waves, droughts and severe precipitation events, have substantial impacts on ecosystems and the economy. However, future climate simulations display large uncertainty in mean changes. As a result, the uncertainty in future changes ...

GWOT Vascular Injury Study 2 Supplemental Project: Impact of Prophylactic Fasciotomy

DTIC Science & Technology

2016-10-01

total #) 15 10% 5 7% Overall Average 8.27 9.00 Overall Range 8-9 9-9 3 Mangled Extremity Severity Score: The most widely used lower - limb ...trauma, crush, blunt trauma, burns, and fractures . Each of these injuries places the wounded Service members at risk for developing acute extremity... lower extremity vascular injury will be used to determine fasciotomy rates, wound management, and iatrogenic complications. The impact of injury and

Risk factors for lower extremity injury: a review of the literature

PubMed Central

Murphy, D; Connolly, D; Beynnon, B

2003-01-01

Prospective studies on risk factors for lower extremity injury are reviewed. Many intrinsic and extrinsic risk factors have been implicated; however, there is little agreement with respect to the findings. Future prospective studies are needed using sufficient sample sizes of males and females, including collection of exposure data, and using established methods for identifying and classifying injury severity to conclusively determine addtional risk factors for lower extremity injury. PMID:12547739

Archaebacteria: A New Primary Kingdom for Our Classrooms.

ERIC Educational Resources Information Center

Evans, Robert H.

1983-01-01

Characteristics of the archaebacteria (comprising the methanogenic, thermoacidophilic, and extreme halophilic bacteria) are discussed, including comparisons of molecular traits for archaebacteria, eubacteria, eukaryotes, and taxonomic considerations. Issues related to integrating the archaebacteria into biology curricula and teaching about the…

Data informatics for the Detection, Characterization, and Attribution of Climate Extremes

NASA Astrophysics Data System (ADS)

Collins, W.; Wehner, M. F.; O'Brien, T. A.; Paciorek, C. J.; Krishnan, H.; Johnson, J. N.; Prabhat, M.

2015-12-01

The potential for increasing frequency and intensity of extremephenomena including downpours, heat waves, and tropical cyclonesconstitutes one of the primary risks of climate change for society andthe environment. The challenge of characterizing these risks is thatextremes represent the "tails" of distributions of atmosphericphenomena and are, by definition, highly localized and typicallyrelatively transient. Therefore very large volumes of observationaldata and projections of future climate are required to quantify theirproperties in a robust manner. Massive data analytics are required inorder to detect individual extremes, accumulate statistics on theirproperties, quantify how these statistics are changing with time, andattribute the effects of anthropogenic global warming on thesestatistics. We describe examples of the suite of techniques the climate communityis developing to address these analytical challenges. The techniquesinclude massively parallel methods for detecting and trackingatmospheric rivers and cyclones; data-intensive extensions togeneralized extreme value theory to summarize the properties ofextremes; and multi-model ensembles of hindcasts to quantify theattributable risk of anthropogenic influence on individual extremes.We conclude by highlighting examples of these methods developed by ourCASCADE (Calibrated and Systematic Characterization, Attribution, andDetection of Extremes) project.

The incidences of and consultation rate for lower extremity complaints in general practice

PubMed Central

van der Waal, J M; Bot, S D M; Terwee, C B; van der Windt, D A W M; Schellevis, F G; Bouter, L M; Dekker, J

2006-01-01

Objective To estimate the incidence and consultation rate of lower extremity complaints in general practice. Methods Data were obtained from the Second Dutch National Survey of General Practice, in which 195 general practitioners (GPs) in 104 practices recorded all contacts with patients during 12 consecutive months in computerised patient records. GPs classified the symptoms and diagnosis for each patient at each consultation according to the International Classification of Primary Care (ICPC). Incidence densities and consultation rates for different complaints were calculated. Results During the registration period 63.2 GP consultations per 1000 person‐years were attributable to a new complaint of the lower extremities. Highest incidence densities were seen for knee complaints: 21.4 per 1000 person‐years for women and 22.8 per 1000 person‐years for men. The incidence of most lower extremity complaints was higher for women than for men and higher in older age. Conclusions Both incidences of and consultation rates for lower extremity complaints are substantial in general practice. This implies a considerable impact on the workload of the GP. PMID:16269430

Premenstrual symptoms: another look.

PubMed Central

Woods, N F

1987-01-01

A collection of over 200 symptoms has been labeled premenstrual syndrome. Common belief is that most women experience a marked increase in symptoms premenses. Cyclic variations in the prevalence of commonly cited perimenstrual symptoms were estimated from daily symptom recording. A community-based, multiethnic sample of 345 women recorded symptom severity from "not present" to "extreme" for 90 days. Maximum total reported symptom score occurred during menses, not during premenses. When individual symptoms are considered, the prevalence of those rated as moderate to extreme during menses is less than 15 percent. A method for identifying symptom severity patterns throughout the menstrual cycle is described. Six symptom severity patterns were identified. Only 13 percent of the women exhibited a pattern of increased symptom severity in the premenses. Another 13 percent had a pattern of decreased symptom severity in the premenses. PMID:3120207

Synoptic and Mesoscale Climatologies of Severe Local Storms for the American Midwest.

NASA Astrophysics Data System (ADS)

Arnold, David Leslie

This study investigates the synoptic and mesoscale environments associated with severe local storms (SELS) in the heart of the American Midwest. This region includes west-central Illinois, most of Indiana, the extreme western counties of Ohio, and a small part of northeastern Kentucky. The primary objectives of this study are to determine the surface and middle-tropospheric synoptic circulation patterns and thermodynamic and kinematic environments associated with SELS event types (tornadoes, hail, severe straight -line winds), and to assess the degree to which the synoptic circulation patterns and meso-beta scale kinematic and thermodynamic climatology of the Midwest differ from that of the Great Plains. A secondary objective is to investigate the possible role that land-surface atmosphere interactions play in the spatial distribution of SELS. A new subjective synoptic typing scheme is developed and applied to determine the synoptic-scale circulation patterns associated with the occurrence of SELS event types. This scheme is based on a combination of surface and middle -tropospheric patterns. Thermodynamic and kinematic parameters are analyzed to determine meso-scale environments favorable for the development of SELS. Results indicate that key synoptic-scale circulation patterns, and specific ranges of thermodynamic and kinematic parameters are related to specific SELS event types. These circulation types and ranges of thermodynamic and kinematic parameters may be used to help improve the medium-range forecasting of severe local storms. Results of the secondary objective reveal that the spatial distribution of SELS events is clustered within the study region, and most occur under a negative climate division-level soil moisture gradient; that is, a drier upwind division than the division in which the event occurs. Moreover, the spatial distribution of SELS events is compared against a map of soil types and vegetation. The resulting distribution depicts a visual correlation between the primary soil and vegetative boundaries and clusters of SELS. This supports the likely role of meso-scale land-surface-atmosphere interactions in severe weather development for humid lowlands of the Midwest United States.

Cerebrospinal fluid pressures resulting from experimental traumatic spinal cord injuries in a pig model.

PubMed

Jones, Claire F; Lee, Jae H T; Burstyn, Uri; Okon, Elena B; Kwon, Brian K; Cripton, Peter A

2013-10-01

Despite considerable effort over the last four decades, research has failed to translate into consistently effective treatment options for spinal cord injury (SCI). This is partly attributed to differences between the injury response of humans and rodent models. Some of this difference could be because the cerebrospinal fluid (CSF) layer of the human spine is relatively large, while that of the rodents is extremely thin. We sought to characterize the fluid impulse induced in the CSF by experimental SCIs of moderate and high human-like severity, and to compare this with previous studies in which fluid impulse has been associated with neural tissue injury. We used a new in vivo pig model (n = 6 per injury group, mean age 124.5 days, 20.9 kg) incorporating four miniature pressure transducers that were implanted in pairs in the subarachnoid space, cranial, and caudal to the injury at 30 mm and 100 mm. Tissue sparing was assessed with Eriochrome Cyanine and Neutral Red staining. The median peak pressures near the injury were 522.5 and 868.8 mmHg (range 96.7-1430.0) and far from the injury were 7.6 and 36.3 mmHg (range 3.8-83.7), for the moderate and high injury severities, respectively. Pressure impulse (mmHg.ms), apparent wave speed, and apparent attenuation factor were also evaluated. The data indicates that the fluid pressure wave may be sufficient to affect the severity and extent of primary tissue damage close to the injury site. However, the CSF pressure was close to normal physiologic values at 100 mm from the injury. The high injury severity animals had less tissue sparing than the moderate injury severity animals; this difference was statistically significant only within 1.6 mm of the epicenter. These results indicate that future research seeking to elucidate the mechanical origins of primary tissue damage in SCI should consider the effects of CSF. This pig model provides advantages for basic and preclinical SCI research due to its similarities to human scale, including the existence of a human-like CSF fluid layer.

Assessment of Severe Extremity Wound Bioburden at the Time of Definitive Wound Closure or Coverage: Correlation With Subsequent Postclosure Deep Wound Infection (Bioburden Study).

PubMed

Bosse, Michael J; Murray, Clinton K; Carlini, Anthony R; Firoozabadi, Reza; Manson, Theodore; Scharfstein, Daniel O; Wenke, Joseph C; Zadnik, Mary; Castillo, Renan C

2017-04-01

Infection remains the most common and significant complication after high-energy fractures. The Bioburden Study is a multicenter, prospective, observational cohort study of wound bacterial bioburden and antibiotic care in severe open lower extremity fractures. The aims of this study are to (1) characterize the contemporary extremity wound "bioburden" at the time of definitive wound closure; (2) determine the concordance between polymerase chain reaction results and hospital microbiology; (3) determine, among those who develop deep infections, the concordance between the pathogens at wound closure and at deep infection; and (4) compare the probability of deep infection between those who did and did not receive an appropriate course of antibiotics based on bioburden at the time of wound closure. To address these aims, sites collected tissue samples from severe lower extremity injuries at the time of wound closure and at first surgery for treatment of a deep infection, nonunion, flap failure, amputation, or other complications (because these surgeries may be due to undetected infection). Otherwise, if no further surgical treatment occurred, participants were followed for 12 months. The study was conducted at 38 US trauma centers and has enrolled 655 participants aged 18-64 years. This is the first large multi-institutional study evaluating the wound bioburden of severe open tibia fractures and correlating this bioburden with the risk of wound complications after definitive soft tissue closure.

Archaea were widespread in sediments of the Messinian Salinity Crisis

NASA Astrophysics Data System (ADS)

Birgel, Daniel; Peckmann, Jörn

2015-04-01

The Messinian salinity crisis (MSC) was among the most extreme and short-lived paleooceanographic events in Earth history and dramatically impacted the depositional environments of the Mediterranean. Many of the Messinian sedimentary sequences reflect environmental variability on extremely short time scales, typified by phenomena like evaporation and high salinities, anoxia, and desiccation. Only few organisms tolerate such severe conditions. Among those are archaea, many of which are especially well adapted to extreme conditions. We studied various MSC locations and deposits to shed light onto the role of archaea in the MSC, focusing on lipid biomarkers. These are (1) primary gypsum with abundant, yet problematic filamentous microfossils from various locations in the Mediterranean, (2) Calcare di Base, limestones from Sicily and Calabria, and (3) Calcare Solfifero, authigenic carbonates associated with native sulfur from Sicily. (1) Primary gypsum beds with abundant filamentous fossils are widespread in the Mediterranean. Archaea were found as important contributor of organic matter in these evaporites. The filaments, however, have previously been interpreted to represent cyanobacteria based on the extraction and amplification of cyanobacterial DNA. Cyanobacteria produce specific and long-lasting biomarkers, but no such compounds were found in the studied deposits, thus, the assignment of the filaments to cyanobacteria necessitates further verification. (2) The Calcare di Base are widespread, genetically heterogeneous Messinian limestones, which are particularly common in Sicily and Calabria. The environmental conditions during their deposition, as well as mechanisms and timing of formation are a matter of debate. The studied Calcare di Base samples were found to contain specific halophilic archaeal signatures and numerous pseudomorphs after halite. (3) The Calcare Solfifero, authigenic carbonates accompanied by elemental sulfur formed in the course of microbial sulfate reduction. One of the important processes fuelling authigenesis was microbial oxidation of methane. Lipid biomarker patterns reveal that a consortium of methanotrophic archaea and sulfate-reducing bacteria consumed methane in anoxic and hypersaline environments. Halophilic archaea other than those archaea involved in methane oxidation have been present in the depositional environment as well. This as to yet still somewhat random selection of examples provides evidence for the great diversity of environmental settings created during the MSC and the abundance of archaea in these environments, calling for more work on the geomicrobiology of the unrivaled archive of dramatic paleooceanographic change during the MSC.

Knowledge, attitudes and misconceptions of primary care physicians regarding fever in children: a cross sectional study

PubMed Central

2012-01-01

Background Fever is an extremely common sign in paediatric patients and the most common cause for a child to be taken to the doctor. The literature indicates that physicians and parents have too many misconceptions and conflicting results about fever management. In this study we aim to identify knowledge, attitudes and misconceptions of primary care physicians regarding fever in children. Methods This cross-sectional study was conducted in April-May 2010 involving primary care physicians (n=80). The physicians were surveyed using a self-administered questionnaire. Descriptive statistics were used. Results In our study only 10% of the physicians knew that a body temperature of above 37.2°C according to an auxiliary measurement is defined as fever. Only 26.2% of the physicians took into consideration signs and symptoms other than fever to prescribe antipyretics. 85% of the physicians prescribed antipyretics to control fever or prevent complications of fever especially febrile seizures. Most of the physicians (76.3%) in this study reported that the height of fever may be used as an indicator for severe bacterial infection. A great majority of physicians (91.3%) stated that they advised parents to alternate the use of ibuprofen and paracetamol. Conclusions There were misconceptions about the management and complications of fever. There is a perceived need to improve the recognition, assessment, and management of fever with regards to underlying illnesses in children. PMID:22950655

Primary Spinal Cord Melanoma: A Case Report and a Systemic Review of Overall Survival.

PubMed

Zhang, Mingzhe; Liu, Raynald; Xiang, Yi; Mao, Jianhui; Li, Guangjie; Ma, Ronghua; Sun, Zhaosheng

2018-06-01

The incidence of primary spinal cord melanoma (PSCM) is rare. Several case series and case reports have been published in the literature. However, the predictive factors of PSCM survival and management options are not discussed in detail. We present a case of PSCM; total resection was achieved and chemotherapy was given postoperatively. A comprehensive search was performed on PubMed's electronic database using the words "primary spinal cord melanoma." Survival rates with various gender, location, treatment, and metastasis condition were collected from the published articles and analyzed. Fifty nine cases were eligible for the survival analysis; 54% were male and 46% were female. Patient sex did not influence overall survival. The most common location was the thorax. Patient sex and tumor location did not influence overall survival. The major presenting symptoms were weakness and paresthesia of the extremities. Metastasis or dissemination was noted in 45.16% of 31 patients. In the Kaplan-Meier survival analysis, patients who had metastasis had the worst prognosis. Extent of resection was not related to mortality. Patients who received surgery and surgery with adjuvant therapy had a better median survival than did those who had adjuvant therapy alone. Prognosis was worst in those patients who underwent only adjuvant therapy without surgery (5 months). Surgery is the first treatment of choice in treating PSCM. The goal of tumor resection is to reduce symptoms. Adjuvant therapy after surgery had a beneficial effect on limiting the metastasis. Copyright © 2018 Elsevier Inc. All rights reserved.

Optical phased array configuration for an extremely large telescope.

PubMed

Meinel, Aden Baker; Meinel, Marjorie Pettit

2004-01-20

Extremely large telescopes are currently under consideration by several groups in several countries. Extrapolation of current technology up to 30 m indicates a cost of over dollars 1 billion. Innovative concepts are being explored to find significant cost reductions. We explore the concept of an Optical Phased Array (OPA) telescope. Each element of the OPA is a separate Cassegrain telescope. Collimated beams from the array are sent via an associated set of delay lines to a central beam combiner. This array of small telescope elements offers the possibility of starting with a low-cost array of a few rings of elements, adding structure and additional Cass elements until the desired diameter telescope is attained. We address the salient features of such an extremely large telescope and cost elements relative to more conventional options.

Response of shoal grass, Halodule wrightii, to extreme winter conditions in the Lower Laguna Madre, Texas

USGS Publications Warehouse

Hicks, D.W.; Onuf, C.P.; Tunnell, J.W.

1998-01-01

Effects of a severe freeze on the shoal grass, Halodule wrightii, were documented through analysis of temporal and spatial trends in below-ground biomass. The coincidence of the second lowest temperature (-10.6??C) in 107 years of record, 56 consecutive hours below freezing, high winds and extremely low water levels exposed the Laguna Madre, TX, to the most severe cold stress in over a century. H. wrightii tolerated this extreme freeze event. Annual pre- and post-freeze surveys indicated that below-ground biomass estimated from volume was Unaffected by the freeze event. Nor was there any post-freeze change in biomass among intertidal sites directly exposed to freezing air temperatures relative to subtidal sites which remained submerged during the freezing period.

Arctic Browning: vegetation damage and implications for carbon balance.

NASA Astrophysics Data System (ADS)

Treharne, Rachael; Bjerke, Jarle; Emberson, Lisa; Tømmervik, Hans; Phoenix, Gareth

2016-04-01

'Arctic browning' is the loss of biomass and canopy in Arctic ecosystems. This process is often driven by climatic and biological extreme events - notably extreme winter warm periods, winter frost-drought and severe outbreaks of defoliating insects. Evidence suggests that browning is becoming increasingly frequent and severe at the pan-arctic scale, a view supported by observations from more intensely observed regions, with major and unprecedented vegetation damage reported at landscape (>1000km2) and regional (Nordic Arctic Region) scales in recent years. Critically, the damage caused by these extreme events is in direct opposition to 'Arctic greening', the well-established increase in productivity and shrub abundance observed at high latitudes in response to long-term warming. This opposition creates uncertainty as to future anticipated vegetation change in the Arctic, with implications for Arctic carbon balance. As high latitude ecosystems store around twice as much carbon as the atmosphere, and vegetation impacts are key to determining rates of loss or gain of ecosystem carbon stocks, Arctic browning has the potential to influence the role of these ecosystems in global climate. There is therefore a clear need for a quantitative understanding of the impacts of browning events on key ecosystem carbon fluxes. To address this, field sites were chosen in central and northern Norway and in Svalbard, in areas known to have been affected by either climatic extremes or insect outbreak and subsequent browning in the past four years. Sites were chosen along a latitudinal gradient to capture both conditions already causing vegetation browning throughout the Norwegian Arctic, and conditions currently common at lower latitudes which are likely to become more damaging further North as climate change progresses. At each site the response of Net Ecosystem CO2 Exchange to light was measured using a LiCor LI6400 Portable Photosynthesis system and a custom vegetation chamber with artificial shading. These data allowed the impact of browning on plot-level Gross Primary Productivity (GPP), Net Ecosystem Exchange and ecosystem respiration to be calculated. Substantial site-level impacts were identified, with heavily damaged vegetation converted from a net CO2 sink to a net source. Plot-level spectral data were then used to establish a relationship between Leaf Area Index (LAI), as predicted from Normalised Differenced Vegetation Index (NDVI), and GPP. This builds on work demonstrating that NDVI-derived LAI can explain up to 80% of variation in GPP in healthy vegetation. Confirmation that this relationship holds true in browned vegetation validates its use for estimating browning impacts on Arctic carbon balance using remotely sensed data.

The measured contribution of whipping and springing on the fatigue and extreme loading of container vessels

NASA Astrophysics Data System (ADS)

Storhaug, Gaute

2014-12-01

Whipping/springing research started in the 50'ies. In the 60'ies inland water vessels design rules became stricter due to whipping/springing. The research during the 70-90'ies may be regarded as academic. In 2000 a large ore carrier was strengthened due to severe cracking from North Atlantic operation, and whipping/springing contributed to half of the fatigue damage. Measurement campaigns on blunt and slender vessels were initiated. A few blunt ships were designed to account for whipping/springing. Based on the measurements, the focus shifted from fatigue to extreme loading. In 2005 model tests of a 4,400 TEU container vessel included extreme whipping scenarios. In 2007 the 4400 TEU vessel MSC Napoli broke in two under similar conditions. In 2009 model tests of an 8,600 TEU container vessel container vessel included extreme whipping scenarios. In 2013 the 8,100 TEU vessel MOL COMFORT broke in two under similar conditions. Several classification societies have published voluntary guidelines, which have been used to include whipping/springing in the design of several container vessels. This paper covers results from model tests and full scale measurements used as background for the DNV Legacy guideline. Uncertainties are discussed and recommendations are given in order to obtain useful data. Whipping/springing is no longer academic.

Influence of extreme weather disasters on global crop production.

PubMed

Lesk, Corey; Rowhani, Pedram; Ramankutty, Navin

2016-01-07

In recent years, several extreme weather disasters have partially or completely damaged regional crop production. While detailed regional accounts of the effects of extreme weather disasters exist, the global scale effects of droughts, floods and extreme temperature on crop production are yet to be quantified. Here we estimate for the first time, to our knowledge, national cereal production losses across the globe resulting from reported extreme weather disasters during 1964-2007. We show that droughts and extreme heat significantly reduced national cereal production by 9-10%, whereas our analysis could not identify an effect from floods and extreme cold in the national data. Analysing the underlying processes, we find that production losses due to droughts were associated with a reduction in both harvested area and yields, whereas extreme heat mainly decreased cereal yields. Furthermore, the results highlight ~7% greater production damage from more recent droughts and 8-11% more damage in developed countries than in developing ones. Our findings may help to guide agricultural priorities in international disaster risk reduction and adaptation efforts.

Mechanical arm trainer for the treatment of the severely affected arm after a stroke: a single-blinded randomized trial in two centers.

PubMed

Hesse, S; Werner, C; Pohl, M; Mehrholz, J; Puzich, U; Krebs, H I

2008-10-01

To test whether training with a new mechanical arm trainer leads to better outcomes than electrical stimulation of the paretic wrist extensors in subacute stroke patients with severe upper limb paresis. Electrical stimulation is a standard and reimbursable form of therapy in Germany. Randomized controlled trial of 54 inpatients enrolled 4-8 wks from stroke onset, mean upper-extremity subsection of Fugl-Meyer assessment (0-66) at admission less than 18. In addition to standard care, all patients practiced 20-30 mins arm trainer or electrical stimulation every workday for 6 wks, totaling 30 sessions. Primary outcome was the Fugl-Meyer assessment, secondary outcomes were the Box and Block test, the Medical Research Council and the modified Ashworth scale, blindly assessed at enrollment, after 6 wks, and at 3-mo follow-up. Both groups were homogeneous at study onset. Shoulder pain occurred in two arm trainer patients. The primary Fugl-Meyer assessment outcome improved for both groups over time (P < 0.001), but this improvement did not differ between groups. The initial (terminal) mean Fugl-Meyer assessment scores were 8.8 +/- 4.8 (19.2 +/- 14.5) for the arm trainer and 8.6 +/- 3.5 (13.6 +/- 7.9) for the electrical stimulation group. No patient could transport a block initially, but at completion significantly more arm trainer patients were able to transport at least three blocks (five vs. zero, P = 0.023). No significant differences were observed between the groups on the secondary Box and Block outcome at follow-up (eight vs. four patients). All Box and Block responders had an initial Fugl-Meyer assessment > or =10. Arm trainer training did not lead to a superior primary outcome over electrical stimulation training. However, "good performers" on the secondary outcome seemed to benefit more from the arm trainer training.

A nationwide analysis of 30-day readmissions related to critical limb ischemia.

PubMed

Masoomi, Reza; Shah, Zubair; Quint, Clay; Hance, Kirk; Vamanan, Karthik; Prasad, Anand; Hoel, Andrew; Dawn, Buddhadeb; Gupta, Kamal

2018-06-01

Objectives There is paucity of information regarding critical limb ischemia-related readmission rates in patients admitted with critical limb ischemia. We studied 30-day critical limb ischemia-related readmission rate, its predictors, and clinical outcomes using a nationwide real-world dataset. Methods We did a secondary analysis of the 2013 Nationwide Readmissions Database. We included all patients with a primary diagnosis of extremity rest pain, ulceration, and gangrene secondary to peripheral arterial disease. From this group, all patients readmitted with similar diagnosis within 30 days were recorded. Results Of the total 25,111 index hospitalization for critical limb ischemia, 1270 (5%) were readmitted with a primary diagnosis of critical limb ischemia within 30 days. The readmission rate was highest (9.5%) for the group that did not have any intervention (revascularization or major amputation) and was lowest for surgical revascularization and major amputation groups (2.6% and 1.3%, P value <0.001 for all groups). Severity of critical limb ischemia at index admission was associated with a significantly higher rate of 30-day readmission. Critical limb ischemia-related readmission was associated with a higher rate of major amputation (29.6% vs. 16.2%, P<0.001), a lower rate of any revascularization procedure (46% vs. 62.6%, P<0.001), and a higher likelihood of discharge to a skilled nursing facility (43.2% vs. 32.2%, P<0.001) compared to index hospitalization. Conclusions In patients with primary diagnosis of critical limb ischemia, 30-day critical limb ischemia-related readmission rate was affected by initial management strategy and the severity of critical limb ischemia. Readmission was associated with a significantly higher rate of amputation, increased length of stay, and a more frequent discharge to an alternate care facility than index admission and thus may serve as a useful quality of care metric in critical limb ischemia patients.

Oxygen saturation targeting by pulse oximetry in the extremely low gestational age neonate: a quixotic quest.

PubMed

Cummings, James J; Lakshminrusimha, Satyan

2017-04-01

A collaboration of comparative effectiveness research trials of pulse oximeter saturation (SpO2) targeting in extremely low-gestational-age neonates have begun to report their aggregate results. We examine the results of those trials, collectively referred to as the Neonatal Oxygenation Prospective Meta-analysis or NeOProM. We also discuss the uncertainties that remain and the clinical challenges that lie ahead. The primary outcome from NeOProM was a composite of death or disability at 18-24 months corrected age. In 2016 the last of these reports was published. Although there were no differences in the primary outcome overall, analyses of secondary outcomes and data subsets following a pulse oximeter revision show significant treatment differences between targeting a lower compared with a higher SpO2. NeOProM represents the largest collaborative clinical research study of SpO2 targets in extremely low-gestational-age neonates. Although aggregate results give us some insight into the feasibility and efficacy of SpO2 targeting in this population, many questions remain. A patient-level analysis, tracking individual outcomes based on actual SpO2 experienced, may shed some light on these questions. However, finding a single optimal SpO2 range seems unlikely.

Impact of GHG warming on the mean and extreme loading of particulate matter pollution in a chemistry-climate model ensemble simulation

NASA Astrophysics Data System (ADS)

Xu, Y.; Lamarque, J. F.; Wu, X.

2017-12-01

Particulate matter with the diameter smaller than 2.5 micrometers (PM2.5) poses health threats to human populations. Regardless of efforts to regulate the pollution sources, it is unclear how climate change caused by greenhouse gases (GHGs) would affect PM2.5 levels. Using century-long ensemble simulations with Community Earth System Model 1 (CESM1), we show that, if the anthropogenic emissions would remain at the level in the year 2005, the global surface concentration and atmospheric column burden of sulfate, black carbon, and primary organic carbon would still increase by 5-10% at the end of 21st century (2090-2100) due to global warming alone. The decrease in the wet removal flux of PM2.5, despite an increase in global precipitation, is the primary cause for the increase in the PM2.5 column burden. Regionally over North America and East Asia, a shift of future precipitation toward more frequent heavy events contributes to weakened wet removal fluxes. Based on the daily model output, the frequency and intensity of extreme pollution events are also studied. We found that both stagnation frequency and rainfall changes serve to worsen extreme pollution in the future.

Extremely thermophilic microorganisms for biomass conversion: status and prospects.

PubMed

Blumer-Schuette, Sara E; Kataeva, Irina; Westpheling, Janet; Adams, Michael Ww; Kelly, Robert M

2008-06-01

Many microorganisms that grow at elevated temperatures are able to utilize a variety of carbohydrates pertinent to the conversion of lignocellulosic biomass to bioenergy. The range of substrates utilized depends on growth temperature optimum and biotope. Hyperthermophilic marine archaea (T(opt)>or=80 degrees C) utilize alpha- and beta-linked glucans, such as starch, barley glucan, laminarin, and chitin, while hyperthermophilic marine bacteria (T(opt)>or=80 degrees C) utilize the same glucans as well as hemicellulose, such as xylans and mannans. However, none of these organisms are able to efficiently utilize crystalline cellulose. Among the thermophiles, this ability is limited to a few terrestrial bacteria with upper temperature limits for growth near 75 degrees C. Deconstruction of crystalline cellulose by these extreme thermophiles is achieved by 'free' primary cellulases, which are distinct from those typically associated with large multi-enzyme complexes known as cellulosomes. These primary cellulases also differ from the endoglucanases (referred to here as 'secondary cellulases') reported from marine hyperthermophiles that show only weak activity toward cellulose. Many extremely thermophilic enzymes implicated in the deconstruction of lignocellulose can be identified in genome sequences, and many more promising biocatalysts probably remain annotated as 'hypothetical proteins'. Characterization of these enzymes will require intensive effort but is likely to generate new opportunities for the use of renewable resources as biofuels.

A health assessment for imperial Roman burials recovered from the necropolis of San Donato and Bivio CH, Urbino, Italy.

PubMed

Paine, Robert R; Vargiu, Rita; Signoretti, Carla; Coppa, Alfredo

2009-01-01

Imperial Roman burials recovered from the sites of San Donato and Bivio CH, located in the city of Urbino, Italy were examined for skeletal lesions. Observed pathologies include arthritis, trauma, periostitis, cranial pitting and enamel hypoplasia. All of the adults exhibited at least one enamel hypoplasia. In general, the adult males exhibit greater rates of skeletal pathologies than the females. Clearly, chronic health problems appear to be common among all adults; nearly 89% of them exhibit at least one form of skeletal lesion. This is in stark contrast to what is seen for the sub-adults. Only one sub-adult showed skeletal lesions. Acute health problems may have been the primary contributing factors for the death of the children recovered from the site. Despite previous research and attention to malaria as a critical health problem of Roman sub-adults, it does not seem to be an issue for this burial sample. We compare the frequency of cranial pitting and periostitis for the Urbino burials to several other Imperial Roman skeletal samples as a means to assess the potential for malaria and other casual factors for the observed lesions. In conclusion, we see the extreme rate of skeletal lesions for this community as indication of an extremely poor quality of life for these Romans.

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

Sole, Claudio V., E-mail: cvsole@uc.cl; School of Medicine, Complutense University, Madrid; Service of Radiation Oncology, Instituto de Radiomedicina, Santiago

Purpose: To perform a joint analysis of data from 3 contributing centers within the intraoperative electron-beam radiation therapy (IOERT)-Spanish program, to determine the potential of IOERT as an anticipated boost before external beam radiation therapy in the multidisciplinary treatment of pediatric extremity soft-tissue sarcomas. Methods and Materials: From June 1993 to May 2013, 62 patients (aged <21 years) with a histologic diagnosis of primary extremity soft-tissue sarcoma with absence of distant metastases, undergoing limb-sparing grossly resected surgery, external beam radiation therapy (median dose 40 Gy) and IOERT (median dose 10 Gy) were considered eligible for this analysis. Results: After a median follow-up ofmore » 66 months (range, 4-235 months), 10-year local control, disease-free survival, and overall survival was 85%, 76%, and 81%, respectively. In multivariate analysis after adjustment for other covariates, tumor size >5 cm (P=.04) and R1 margin status (P=.04) remained significantly associated with local relapse. In regard to overall survival only margin status (P=.04) retained association on multivariate analysis. Ten patients (16%) reported severe chronic toxicity events (all grade 3). Conclusions: An anticipated IOERT boost allowed for external beam radiation therapy dose reduction, with high local control and acceptably low toxicity rates. The combined radiosurgical approach needs to be tested in a prospective trial to confirm these results.« less

Vulnerability on the Roof of the World: Resilience to Climate Change and Natural Resource Policies on the Tibetan Plateau

NASA Astrophysics Data System (ADS)

Klein, J. A.; Hopping, K. A.; Yeh, E.; Hu, J.; Nyima, Y.; Boone, R.; Galvin, K.; Kang, S.; Ojima, D. S.

2010-12-01

Pastoralists on the Tibetan Plateau are a marginalized people living in an extreme environment and may be especially vulnerable as the system approaches critical thresholds. In Tibet, temperatures are increasing several times more than the global average while the frequency and severity of severe snowstorms is predicted to increase. Pastoralists are also experiencing reduced mobility and severe grazing restrictions. We are using interdisciplinary frameworks and methods that include a multifactor ecological experiment, household interviews, remote sensing, and a coupled ecosystem and household decision-making model to examine herder and ecosystem vulnerability to climate change and extreme weather events within the context of changing natural resource policies in China. The fully factorial ecological experiment includes two climate changes (warming and spring snow additions) and two types of grazing (yak and pika). We established the experiment in 2008 within the Tibet Autonomous Region (4,870 m) and are monitoring microclimate, vegetation, nutrient availability, carbon fluxes and stable isotopes. We are investigating the sensitivity of the system, whether it is likely to cross critical thresholds, and how resilient this system may be to predicted climate and land use changes. Semi-structured interviews on indigenous knowledge and vulnerability complement the ecological experimental work. We are asking herders about climatic and ecological change and vulnerability to snow disasters. To integrate our ecological and social findings, we are coupling an ecosystem model to an agent-based pastoral household model. Our results from the experiment and the indigenous knowledge study suggest that Kobresia pygmaea, the dominant species and primary grazing resource, is vulnerable to warming. Snow additions can partially mediate this effect. Herders throughout this region share common knowledge about both climatic and ecological changes, but appear to be more closely attuned to ecological shifts than to gradual climate changes. Herder perceptions about climate trends often contradict local weather station data, but herders tend to be in strong agreement that grassland health has declined. These results suggest that rangeland degradation has occurred, and that climate warming may be one driver responsible for these changes. While additional snow may improve ecological conditions, the warming-induced degradation may make the social-ecological system more vulnerable to large snowstorm events. Our findings suggest that climate adaptation strategies should address the effects of both warming and extreme weather events and should also encourage land use policies that will maintain these systems under change. The vulnerability of ecosystems on the roof of the world has implications for the 1x109 people living downstream and for feedbacks to the Earth’s climate system.

Zonisamide

MedlinePlus

... difficulty thinking of words or trouble speaking difficulty thinking or concentrating lack of coordination difficulty walking severe weakness severe muscle pain extreme tiredness loss of appetite fast, shallow breathing irregular heartbeat loss of consciousness Zonisamide ...

The Current State of Head and Neck Injuries in Extreme Sports

PubMed Central

Sharma, Vinay K.; Rango, Juan; Connaughton, Alexander J.; Lombardo, Daniel J.; Sabesan, Vani J.

2015-01-01

Background: Since their conception during the mid-1970s, international participation in extreme sports has grown rapidly. The recent death of extreme snowmobiler Caleb Moore at the 2013 Winter X Games has demonstrated the serious risks associated with these sports. Purpose: To examine the incidence and prevalence of head and neck injuries (HNIs) in extreme sports. Study Design: Descriptive epidemiological study. Methods: The National Electronic Injury Surveillance System (NEISS) was used to acquire data from 7 sports (2000-2011) that were included in the Winter and Summer X Games. Data from the NEISS database were collected for each individual sport per year and type of HNI. Cumulative data for overall incidence and injuries over the entire 11-year period were calculated. National estimates were determined using NEISS-weighted calculations. Incidence rates were calculated for extreme sports using data from Outdoor Foundation Participation Reports. Results: Over 4 million injuries were reported between 2000 and 2011, of which 11.3% were HNIs. Of all HNIs, 83% were head injuries and 17% neck injuries. The 4 sports with the highest total incidence of HNI were skateboarding (129,600), snowboarding (97,527), skiing (83,313), and motocross (78,236). Severe HNI (cervical or skull fracture) accounted for 2.5% of extreme sports HNIs. Of these, skateboarding had the highest percentage of severe HNIs. Conclusion: The number of serious injuries suffered in extreme sports has increased as participation in the sports continues to grow. A greater awareness of the dangers associated with these sports offers an opportunity for sports medicine and orthopaedic physicians to advocate for safer equipment, improved on-site medical care, and further research regarding extreme sports injuries. PMID:26535369

IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation

NASA Astrophysics Data System (ADS)

Field, C. B.; Stocker, T. F.; Barros, V. R.; Qin, D.; Ebi, K. L.; Midgley, P. M.

2011-12-01

The Summary for Policy Makers of the IPCC Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation will be approved by the world governments in November 2011. The focus of the Special Report is on climate change and its role in altering the frequency, severity, and impact of extreme events or disasters, and on the costs of both impacts and the actions taken to prepare for, respond to, and recover from extreme events and disasters. The emphasis is on understanding the factors that make people and infrastructure vulnerable to extreme events, on recent and future changes in the relationship between climate change and extremes, and on managing the risks of disasters over a wide range of spatial and temporal scales. The assessment considers a broad suite of adaptations and explores the limits to adaptation. The assessment was designed to build durable links and foundations for partnerships between the stakeholder communities focused on climate change and those focused on disaster risk reduction. The Special Report begins with material that frames the issues, followed by an assessment of the reasons that communities are vulnerable. Two chapters assess the role of past and future climate change in altering extremes and the impact of these on the physical environment and human systems. Three chapters assess available knowledge on impacts and adaptation, with separate chapters considering the literature, stakeholder relationships, and potential policy tools relevant to the local, national, and international scales. Longer-term components of adaptation to weather and climate extremes and disasters are assessed in the context of moving toward sustainability. The final chapter provides case studies that integrate themes across several chapters or are so unique that they need to be considered separately.

Hydro-metrologic assessment of October 2015 extreme precipitation event on Santee Experimental Forest Watersheds, SC

Treesearch

Devendra M. Amatya; Charles A. Harrison; Carl C. Trettin

2016-01-01

The extreme precipitation event on October 3-4, 2015, likely resulting from the convergence of a persistent the terrain, and thecirculation associated with Hurricane Joaquin off the eastern Atlantic Coast(http://cms.met.psu.edu/sref/severe/2015/04Oct2015.pdf) resulted...

Comparison of Extreme Pressure Additive Treat Rates in Soybean and Mineral Oils Under Boundary Lubrication Conditions

USDA-ARS?s Scientific Manuscript database

Traditionally, it is considered that, under boundary lubrication conditions, the reduction in friction and wear is mostly dependent on Extreme Pressure (EP) additives, rather than the basestock. However, several studies indicate that vegetable oils also contribute to the lubricity under this regime...

Enzyme Activity Dynamics in Response to Climate Change: 2011 Drought-Heat Wave

USDA-ARS?s Scientific Manuscript database

Extreme weather events such as severe droughts and heat waves may have permanent consequences on soil quality and functioning in agroecosystems. The Southern High Plains (SHP) region of Texas, U.S., a large cotton producing area, experienced a historically extreme drought and heat wave during 2011,...

Hybrid Architecture Active Wavefront Sensing and Control

NASA Technical Reports Server (NTRS)

Feinberg, Lee; Dean, Bruce; Hyde, Tupper

2010-01-01

A method was developed for performing relatively high-speed wavefront sensing and control to overcome thermal instabilities in a segmented primary mirror telescope [e.g., James Webb Space Telescope (JWST) at L2], by using the onboard fine guidance sensor (FGS) to minimize expense and complexity. This FGS performs centroiding on a bright star to feed the information to the pointing and control system. The proposed concept is to beam split the image of the guide star (or use a single defocused guide star image) to perform wavefront sensing using phase retrieval techniques. Using the fine guidance sensor star image for guiding and fine phasing eliminates the need for other, more complex ways of achieving very accurate sensing and control that is needed for UV-optical applications. The phase retrieval occurs nearly constantly, so passive thermal stability over fourteen days is not required. Using the FGS as the sensor, one can feed segment update information to actuators on the primary mirror that can update the primary mirror segment fine phasing with this frequency. Because the thermal time constants of the primary mirror are very slow compared to this duration, the mirror will appear extremely stable during observations (to the level of accuracy of the sensing and control). The sensing can use the same phase retrieval techniques as the JWST by employing an additional beam splitter, and having each channel go through a weak lens (one positive and one negative). The channels can use common or separate detectors. Phase retrieval can be performed onboard. The actuation scheme would include a coarse stage able to achieve initial alignment of several millimeters of range (similar to JWST and can use a JWST heritage sensing approach in the science camera) and a fine stage capable of continual updates.

Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing

PubMed Central

Wright, Caradee Y.; Street, Renée A.; Cele, Nokulunga; Kunene, Zamantimande; Balakrishna, Yusentha; Albers, Patricia N.; Mathee, Angela

2017-01-01

Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2–4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed ‘realfeel’ temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of ‘stuffiness’ and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat–health impact warning categories of ‘caution’ and ‘extreme caution’. PMID:28067816

[Studies on the novel association of human herpesvirus-7 with skin diseases].

PubMed

Vág, Tibor; Sonkoly, Enikó; Kemény, Béla; Kárpáti, Sarolta; Horváth, Attila; Ongrádi, József

2003-08-17

Human herpesvirus 7 in pityriasis rosea, this and other viruses in papular-purpuric gloves-and-socks syndrome have been implicated, but their primary or recurrent infections are still in question. In one available blood sample, therefore, IgM, IgG and its high avidity fraction characteristic for recurrent infections were quantitated by indirect immunofluorescence. Peripheral lymphocytes were subjected to nested polymerase chain reaction to detect viral DNA, or cocultivated with several cell cultures. One third of 33 pityriasis rosea patients had elevated IgM, another third had elevated IgG without high avidity molecules to human herpesvirus 7 suggesting primary infection. Thirty percent of controls, more than half of the patients had virtual DNA in their lymphocytes, but only one in 5 skin biopsy specimens were PCR positive. All three co-cultivation attempts yielded viruses extremely rapidly, verified by electron microscopy, polymerase chain reaction and monoclonal antibodies as human herpesvirus 7. These are the first isolates in the geographical regions of Hungary. These data suggest that pityriasis rosea is the consequence of a primary human herpesvirus 7 infection in seronegative adults, and only occasionally is due to virus reactivation. One patient with gloves-and-socks syndrome had an acute, another patient had a persistent coinfection with human herpesvirus 7 and parvovirus B19, two others had a primary herpesvirus 7 infection. Interestingly, this disease might be elicited by both viruses individually or in synergism. Neither human herpesvirus 7 nor parvovirus B19 infect skin cells, but both can be detected in the infiltrating lymphocytes of skin eruptions, in which they induce an altered mediator production, that might be responsible for the general and local symptoms.

Indoor Temperatures in Patient Waiting Rooms in Eight Rural Primary Health Care Centers in Northern South Africa and the Related Potential Risks to Human Health and Wellbeing.

PubMed

Wright, Caradee Y; Street, Renée A; Cele, Nokulunga; Kunene, Zamantimande; Balakrishna, Yusentha; Albers, Patricia N; Mathee, Angela

2017-01-06

Increased temperatures affect human health and vulnerable groups including infants, children, the elderly and people with pre-existing diseases. In the southern African region climate models predict increases in ambient temperature twice that of the global average temperature increase. Poor ventilation and lack of air conditioning in primary health care clinics, where duration of waiting time may be as long as several hours, pose a possible threat to patients seeking primary health care. Drawing on information measured by temperature loggers installed in eight clinics in Giyani, Limpopo Province of South Africa, we were able to determine indoor temperatures of waiting rooms in eight rural primary health care facilities. Mean monthly temperature measurements inside the clinics were warmer during the summer months of December, January and February, and cooler during the autumn months of March, April and May. The highest mean monthly temperature of 31.4 ± 2.7 °C was recorded in one clinic during February 2016. Maximum daily indoor clinic temperatures exceeded 38 °C in some clinics. Indoor temperatures were compared to ambient (outdoor) temperatures and the mean difference between the two showed clinic waiting room temperatures were higher by 2-4 °C on average. Apparent temperature (AT) incorporating relative humidity readings made in the clinics showed 'realfeel' temperatures were >4 °C higher than measured indoor temperature, suggesting a feeling of 'stuffiness' and discomfort may have been experienced in the waiting room areas. During typical clinic operational hours of 8h00 to 16h00, mean ATs fell into temperature ranges associated with heat-health impact warning categories of 'caution' and 'extreme caution'.

Impacts of extreme heat and drought on crop yields in China: an assessment by using the DLEM-AG2 model

NASA Astrophysics Data System (ADS)

Zhang, J.; Yang, J.; Pan, S.; Tian, H.

2016-12-01

China is not only one of the major agricultural production countries with the largest population in the world, but it is also the most susceptible to climate change and extreme events. Much concern has been raised about how extreme climate has affected crop yield, which is crucial for China's food supply security. However, the quantitative assessment of extreme heat and drought impacts on crop yield in China has rarely been investigated. By using the Dynamic Land Ecosystem Model (DLEM-AG2), a highly integrated process-based ecosystem model with crop-specific simulation, here we quantified spatial and temporal patterns of extreme climatic heat and drought stress and their impacts on the yields of major food crops (rice, wheat, maize, and soybean) across China during 1981-2015, and further investigated the underlying mechanisms. Simulated results showed that extreme heat and drought stress significantly reduced national cereal production and increased the yield gaps between potential yield and rain-fed yield. The drought stress was the primary factor to reduce crop yields in the semi-arid and arid regions, and extreme heat stress slightly aggravated the yield loss. The yield gap between potential yield and rain-fed yield was larger at locations with lower precipitation. Our results suggest that a large exploitable yield gap in response to extreme climatic heat-drought stress offers an opportunity to increase productivity in China by optimizing agronomic practices, such as irrigation, fertilizer use, sowing density, and sowing date.

Multicenter Randomized Trial of Robot-Assisted Rehabilitation for Chronic Stroke: Methods and Entry Characteristics for VA ROBOTICS

PubMed Central

Lo, Albert C.; Guarino, Peter; Krebs, Hermano I.; Volpe, Bruce T.; Bever, Christopher T.; Duncan, Pamela W.; Ringer, Robert J.; Wagner, Todd H.; Richards, Lorie G.; Bravata, Dawn M.; Haselkorn, Jodie K.; Wittenberg, George F.; Federman, Daniel G.; Corn, Barbara H.; Maffucci, Alysia D.; Peduzzi, Peter

2017-01-01

Background Chronic upper extremity impairment due to stroke has significant medical, psychosocial, and financial consequences, but few studies have examined the effectiveness of rehabilitation therapy during the chronic stroke period. Objective To test the safety and efficacy of the MIT-Manus robotic device for chronic upper extremity impairment following stroke. Methods The VA Cooperative Studies Program initiated a multicenter, randomized, controlled trial in November 2006 (VA ROBOTICS). Participants with upper extremity impairment ≥6 months poststroke were randomized to robot-assisted therapy (RT), intensive comparison therapy (ICT), or usual care (UC). RT and ICT consisted of three 1-hour treatment sessions per week for 12 weeks. The primary outcome was change in the Fugl-Meyer Assessment upper extremity motor function score at 12 weeks relative to baseline. Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale. Results A total of 127 participants were randomized: 49 to RT, 50 to ICT, and 28 to UC. The majority of participants were male (96%), with a mean age of 65 years. The primary stroke type was ischemic (85%), and 58% of strokes occurred in the anterior circulation. Twenty percent of the participants reported a stroke in addition to their index stroke. The average time from the index stroke to enrollment was 56 months (range, 6 months to 24 years). The mean Fugl-Meyer score at entry was 18.9. Conclusions VA ROBOTICS demonstrates the feasibility of conducting multicenter clinical trials to rigorously test new rehabilitative devices before their introduction to clinical practice. The results are expected in early 2010. PMID:19541917

The importance of extreme weight percentile in postoperative morbidity in children.

PubMed

Stey, Anne M; Moss, R Lawrence; Kraemer, Kari; Cohen, Mark E; Ko, Clifford Y; Lee Hall, Bruce

2014-05-01

Anthropometric data are important indicators of child health. This study sought to determine whether anthropometric data of extreme weight were significant predictors of perioperative morbidity in pediatric surgery. This was a cohort study of children 29 days up to 18 years of age undergoing surgical procedures at participating American College of Surgeons' NSQIP Pediatric hospitals in 2011 and 2012. The primary outcomes were composite morbidity and surgical site infection. The primary predictor of interest was weight percentile, which was divided into the following categories: ≤5(th) percentile, 6(th) to 94(th), or ≥95(th) percentile. A hierarchical multivariate logistic model, adjusting for procedure case mix, demographic, and clinical patient characteristic variables, was used to quantify the relationship between weight percentile category and outcomes. Children in the ≤5th weight percentile had 1.19-fold higher odds of overall postoperative morbidity developing than children in the nonextreme range (95% CI, 1.10-1.30) when controlling for clinical variables. Yet these children did not have higher odds of surgical site infection developing. Children in the ≥95(th) weight percentile did not have a significant increase in overall postoperative morbidity. However, they were at 1.35-fold increased odds of surgical site infection compared with those in the nonextreme range when controlling for clinical variables (95% CI, 1.16-1.57). Both extremely high and extremely low weight percentile scores can be associated with increased postoperative complications after controlling for clinical variables. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Thrombocytosis in splenic trauma: In-hospital course and association with venous thromboembolism.

PubMed

Chia, Tze L; Chesney, Tyler R; Isa, David; Mnatzakanian, Gevork; Colak, Errol; Belmont, Caio; Hirpara, Dhruvin; Veigas, Precilla V; Acuna, Sergio A; Rizoli, Sandro; Rezende-Neto, Joao

2017-01-01

Thrombocytosis is common following elective splenectomy and major trauma. However, little is known about the in-hospital course of platelet count (PC) and incidence of thrombocytosis after splenic trauma. Extreme thrombocytosis (PC>1000×10 9 ) is associated with increased risk of venous thromboembolism (VTE) in primary thrombocytosis leading to the use of acetylsalicylic acid (ASA) for risk reduction, but the need for this agent in splenic trauma is undefined. Retrospective cohort study of all patients with splenic trauma between April 1, 2010 and March 31, 2014. The in-hospital course of PC was assessed based on splenic injury management type. The association of management type with thrombocytosis was evaluated using a multivariable logistic regression model adjusting for potential confounders. The association of thrombocytosis, extreme thrombocytosis, and ASA use for the outcome of VTE was explored. 156 patients were eligible, PC initially increased in all patients with the highest peak after total splenectomy. The incidence of thrombocytosis was 41.0% (64/156). Thrombocytosis was more likely following splenectomy compared with spleen preserving strategies independent of length of stay, injury grade, ISS, age and transfusion (OR 7.58, 95% CI: 2.26-25.45). Splenectomy was associated with extreme thrombocytosis (OR 10.39, 95% CI: 3.59-30.07). Thrombocytosis in splenic trauma is more likely after splenectomy than with spleen preserving strategies. Splenectomy is associated with extreme thrombocytosis. There was insufficient data in our study to determine the use of ASA as primary prevention of VTE after splenic trauma. Copyright © 2016 Elsevier Ltd. All rights reserved.

Pediatric sports-related lower extremity fractures: hospital length of stay and charges: what is the role of the primary payer?

PubMed

Gao, Yubo; Johnston, Richard C; Karam, Matthew

2010-01-01

The purposes of this study were (a) to evaluate the distribution by primary payer (public vs. private) of U.S. pediatric patients aged 5-18 years who were hospitalized with a sports-related lower extremity fracture and (b) to discern the adjusted mean hospital length of stay and mean charge per day by payer type. Children who were aged 5 to 18 years and had diagnoses of lower extremity fracture and sports-related injury in the 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database were included. Lower extremity fractures are defined as International Classification of Diseases, 9th Revision, Clinical Modification codes 820-829 under Section "Injury and Poisoning (800-999)," while sports-related external cause of injury codes (E-codes) are E886.0, E917.0, and E917.5. Differences in hospital length of stay and cost per day by payer type were assessed via adjusted least square mean analysis. The adjusted mean hospital length of stay was 20% higher for patients with a public payer (2.50 days) versus a private payer (2.08 days). The adjusted mean charge per day differed about 10% by payer type (public, US$7,900; private, US$8,794). Further research is required to identify factors that are associated with different length of stay and mean charge per day by payer type, and explore whether observed differences in hospital length of stay are the result of private payers enhancing patient care, thereby discharging patients in a more efficient manner.

Two case studies on NARCCAP precipitation extremes

NASA Astrophysics Data System (ADS)

Weller, Grant B.; Cooley, Daniel; Sain, Stephan R.; Bukovsky, Melissa S.; Mearns, Linda O.

2013-09-01

We introduce novel methodology to examine the ability of six regional climate models (RCMs) in the North American Regional Climate Change Assessment Program (NARCCAP) ensemble to simulate past extreme precipitation events seen in the observational record over two different regions and seasons. Our primary objective is to examine the strength of daily correspondence of extreme precipitation events between observations and the output of both the RCMs and the driving reanalysis product. To explore this correspondence, we employ methods from multivariate extreme value theory. These methods require that we account for marginal behavior, and we first model and compare climatological quantities which describe tail behavior of daily precipitation for both the observations and model output before turning attention to quantifying the correspondence of the extreme events. Daily precipitation in a West Coast region of North America is analyzed in two seasons, and it is found that the simulated extreme events from the reanalysis-driven NARCCAP models exhibit strong daily correspondence to extreme events in the observational record. Precipitation over a central region of the United States is examined, and we find some daily correspondence between winter extremes simulated by reanalysis-driven NARCCAP models and those seen in observations, but no such correspondence is found for summer extremes. Furthermore, we find greater discrepancies among the NARCCAP models in the tail characteristics of the distribution of daily summer precipitation over this region than seen in precipitation over the West Coast region. We find that the models which employ spectral nudging exhibit stronger tail dependence to observations in the central region.

Posttraumatic stress disorder symptom severity and control beliefs as the predictors of academic burnout amongst adolescents following the Wenchuan Earthquake.

PubMed

Zhou, Xiao; Zhen, Rui; Wu, Xinchun

2017-01-01

Background : Previous studies indicate that posttraumatic stress disorder (PTSD) and control beliefs can affect burnout and their unique role in this situation has been examined, but fewer studies have examined their combined role in adolescent's academic burnout following traumatic events. Objective : This study examined the combined effect of PTSD symptom severity and control beliefs on academic burnout among adolescents, and assessed the moderating role of primary and secondary control beliefs in the relation between PTSD symptom severity and academic burnout. Methods : Seven hundred and forty-five adolescents were investigated using self-report questionnaires, and a series of regression equations examined the impact of PTSD severity and control beliefs on academic burnout. Results : PTSD symptom severity is associated positively with academic burnout, while primary and secondary control beliefs have a negative relation with academic burnout. In addition, primary control beliefs buffer the positive effects of PTSD symptom severity on academic burnout. We found that the positive relation between PTSD symptom severity and academic burnout in the low primary control beliefs group is more intense than that found in the high primary control beliefs group. Conclusions : PTSD symptom severity is a risk factor, whereas primary and secondary control beliefs are protective factors in academic burnout. In addition, PTSD symptom severity and primary control beliefs have a combined effect on academic burnout in adolescents following natural disasters.

Mycobacterium tuberculosis: Success through dormancy

PubMed Central

Gengenbacher, Martin; Kaufmann, Stefan H. E.

2012-01-01

Tuberculosis (TB) remains a major health threat, killing near to 2 million individuals around this globe, annually. The sole vaccine developed almost a century ago, provides limited protection only during childhood. After decades without the introduction of new antibiotics, several candidates are currently undergoing clinical investigation. Curing TB requires prolonged combination chemotherapy with several drugs. Moreover, monitoring the success of therapy is questionable due to the lack of reliable biomarkers. To substantially improve the situation, a detailed understanding of the crosstalk between human host and the pathogen Mycobacterium tuberculosis (Mtb) is vital. Principally, Mtb’s enormous success is based on three capacities: First, reprogramming of macrophages after primary infection/phagocytosis in order to prevent its own destruction; second, initiating the formation of well-organized granulomas, comprising different immune cells to create a confined environment for the host–pathogen standoff; third, the capability to shut down its own central metabolism, terminate replication and thereby transit into a stage of dormancy rendering itself extremely resistant to host defense and drug treatment. Here we review the molecular mechanisms underlying these processes, draw conclusions in a working model of mycobacterial dormancy and highlight gaps in our understanding to be addressed in future research. PMID:22320122

An uncommon presentation of non-small-cell lung cancer with acrometastases to the great toe and index finger.

PubMed

Reynolds, Jamie; Skandan, Savitri P

2016-03-01

Acrometastasis as initial presentation of metastatic cancer is an extremely rare finding. We describe an unusual case of late-stage non-small-cell lung cancer with metastatic lesions to the great toe and index fnger with associated pain in those areas as the only presenting symptom. A 71-year-old white woman was referred to the emergency department by her primary care physician for necrosis and swelling of the left great toe for work-up of possible osteomyelitis (Figure 1). Before she presented to her physician, she had been complaining of severe pain, swelling, and erythema of the left great toe that had lasted for 1-2 months. Infection was initially suspected. She completed 2 courses of oral antibiotics with no improvement. She was also complaining of similar symptoms on the left index finger and attributed her symptoms to an injury a month earlier (Figure 2). The pain was so severe that she was not able to bear weight on her left foot. An outpatient X-ray of her left great toe raised her physician's concerns that it might be osteomyelitis so she was referred to the emergency department. ©2016 Frontline Medical Communications.

SiC lightweight telescopes for advanced space applications. I - Mirror technology

NASA Technical Reports Server (NTRS)

Anapol, Michael I.; Hadfield, Peter

1992-01-01

A SiC based telescope is an extremely attractive emerging technology which offers the lightweight and stiffness features of beryllium, the optical performance of glass to diffraction limited visible resolution, superior optical/thermal stability to cryogenic temperatures, and the cost advantages of an aluminum telescope. SSG has developed various SiC mirrors with and without a silicon coating and tested these mirrors over temperature ranges from +50 C to -250 C. Our test results show less than 0.2 waves P-V in visible wavefront change and no hysteresis over this wide temperature range. Several SSG mirrors are representative of very lightweight SiC/Si mirrors including (1) a 9 cm diameter, high aspect ratio mirror weighing less than 30 grams and (2) a 23 cm diameter eggcrated mirror weighing less than 400 grams. SSG has also designed and analyzed a 0.6 meter SiC based, on axis, three mirror reimaging telescope in which the primary mirror weighs less than 6 kg and a 0.5 meter GOES-like scan mirror. SSG has also diamond turned several general aspheric SiC/Si mirrors with excellent cryo optical performance.

Rational CCL5 mutagenesis integration in a lactobacilli platform generates extremely potent HIV-1 blockers.

PubMed

Secchi, Massimiliano; Grampa, Valentina; Vangelista, Luca

2018-01-30

Efforts to improve existing anti-HIV-1 therapies or develop preventatives have identified CCR5 as an important target and CCL5 as an ideal scaffold to sculpt potent HIV-1 entry inhibitors. We created novel human CCL5 variants that exhibit exceptional anti-HIV-1 features using recombinant lactobacilli (exploited for live microbicide development) as a screening platform. Protein design, expression and anti-HIV-1 activity flowed in iterative cycles, with a stepwise integration of successful mutations and refinement of an initial CCL5 mutant battery towards the generation of two ultimate CCL5 derivatives, a CCR5 agonist and a CCR5 antagonist with similar anti-HIV-1 potency. The CCR5 antagonist was tested in human macrophages and against primary R5 HIV-1 strains, exhibiting cross-clade low picomolar IC 50 activity. Moreover, its successful combination with several HIV-1 inhibitors provided the ground for conceiving therapeutic and preventative anti-HIV-1 cocktails. Beyond HIV-1 infection, these CCL5 derivatives may now be tested against several inflammation-related pathologies where the CCL5:CCR5 axis plays a relevant role.

Combat ocular trauma and systemic injury.

PubMed

Weichel, Eric D; Colyer, Marcus H

2008-11-01

To review the recent literature regarding combat ocular trauma during hostilities in Operations Iraqi Freedom and Enduring Freedom, describe the classification of combat ocular trauma, and offer strategies that may assist in the management of eye injuries. Several recent publications have highlighted features of combat ocular trauma from Operation Iraqi Freedom. The most common cause of today's combat ocular injuries is unconventional fragmentary munitions causing significant blast injuries. These explosive munitions cause high rates of concomitant nonocular injuries such as traumatic brain injury, amputation, and other organ injuries. The most frequent ocular injuries include open-globe and adnexal lacerations. The extreme severity of combat-related open-globe injuries leads to high rates of primary enucleation and retained intraocular foreign bodies. Visual outcomes of intraocular foreign body injuries are similar to other series despite delayed removal, and no cases of endophthalmitis have occurred. Despite these advances, however, significant vision loss persists in cases of perforating globe injuries as well as open and closed-globe trauma involving the posterior segment. This review summarizes the recent literature describing ocular and systemic injuries sustained during Operations Iraqi and Enduring Freedom. An emphasis on classification of ocular injuries as well as a discussion of main outcome measures and complications is discussed.

Regenerative Gas Dryer for In-Situ Propellant Production

NASA Technical Reports Server (NTRS)

Paz, Aaron

2017-01-01

Rocket propellant can be produced anywhere that water is found by splitting it into hydrogen and oxygen, potentially saving several tons of mass per mission and enabling the long term presence of humans in space beyond LEO. When water is split into hydrogen and oxygen, the gaseous products can be very humid (several thousand ppm). Propellant-grade gases need to be extremely dry before being converted into cryogenic liquids (less than 26 ppm water for grade B Oxygen). The primary objective of this project is to design, build and test a regenerative gas drying system that can take humid gas from a water electrolysis system and provide dry gas (less than 26ppm water) to the inlet of a liquefaction system for long durations. State of the art work in this area attempted to use vacuum as a means to regenerate desiccant, but it was observed that water would migrate to the dry zone without a sweep gas present to direct the desorbed vapor. Further work attempted to use CO2 as a sweep gas, but this resulted in a corrosive carbonic acid. In order for in-situ propellant production to work, we need a way to continuously dry humid gas that addresses these issues.

Primary thyroid leiomyosarcoma: a case report and review of the literature

PubMed Central

CANU, G.L.; BULLA, J.S.; LAI, M.L.; MEDAS, F.; BAGHINO, G.; ERDAS, E.; MARIOTTI, S.

2018-01-01

Primary thyroid leiomyosarcoma (LMS) is an extremely rare tumor. We report a case of a 47-year-old male with a rapidly growing neck mass and disfagia. Preoperative investigations were diagnostic of anaplastic carcinoma. Total thyroidectomy with partial esophagectomy and dissection of right infrahyoid muscles was performed. Through histolological and immunohistochemical evaluations a primary thyroid high-grade LMS was diagnosed. At 2 months of follow-up a local recurrence was detected and consequently the patient was submitted to chemotherapy with partial response. He is still alive 9 months after surgery. Diagnosis of primary thyroid LMS is difficult due to its similarity to other more common thyroid tumors. To date, there is no standard therapy and prognosis is poor. PMID:29549682

Primary thyroid leiomyosarcoma: a case report and review of the literature.

PubMed

Canu, G L; Bulla, J S; Lai, M L; Medas, F; Baghino, G; Erdas, E; Mariotti, S; Calò, P G

2018-01-01

Primary thyroid leiomyosarcoma (LMS) is an extremely rare tumor. We report a case of a 47-year-old male with a rapidly growing neck mass and disfagia. Preoperative investigations were diagnostic of anaplastic carcinoma. Total thyroidectomy with partial esophagectomy and dissection of right infrahyoid muscles was performed. Through histolological and immunohistochemical evaluations a primary thyroid high-grade LMS was diagnosed. At 2 months of follow-up a local recurrence was detected and consequently the patient was submitted to chemotherapy with partial response. He is still alive 9 months after surgery. Diagnosis of primary thyroid LMS is difficult due to its similarity to other more common thyroid tumors. To date, there is no standard therapy and prognosis is poor.

HD 143 418 - An Interacting Binary with a Subsynchronously Rotating Primary

NASA Astrophysics Data System (ADS)

Mikulášek, Z.; Zverko, J.; Žižňovský, J.; Krtička, J.; Iliev, I. Kh.; Kudryavtsev, D. O.; Gráf, T.; Zejda, M.

2010-12-01

HD 143418 is a non-eclipsing double-lined close binary with orbital period Porb=2.282520 d. The photometrically and spectroscopically dominant primary component is a normal A5V star in the middle of its stay on the main sequence with extremely slow, subsynchronous rotation (Prot being about 14 days!). Its photometric monitoring since 1982 revealed orbitally modulated variations with changing form and amplitude. The advanced principal component analysis (APCA) disentangling extract-ed a steady part of light curves obviously caused by the ellipticity of the primary. Seasonal components of the light curves may be related to an expected incidence of circumstellar matter ejected from the tidally spinning up primary component. A possible scenario of the synchronisation process is also briefly discussed.

Same Abbreviated Injury Scale Values May Be Associated with Different Risks to Mortality in Trauma Patients: A Cross-Sectional Retrospective Study Based on the Trauma Registry System in a Level I Trauma Center.

PubMed

Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

2017-12-11

The Abbreviated Injury Scale (AIS) measures injury severity of a trauma patient with a numeric method for ranking anatomy-based specific injuries. The summation of the squares of the three most severe injuries in the AIS of six predefined body regions comprises the Injury Severity Score (ISS). It assumes that the mortality of a given AIS value is similar across all body regions. However, such an assumption is less explored in the literature. In this study, we aimed to compare the mortality rates of the patients with the same AIS value in different injured body regions in a level I trauma center. Hospitalized adult trauma patients with isolated serious to critical injury (AIS of 3 to 5) between 1 January 2009, and 31 December 2016, from the Trauma Registry System in a level I trauma center were grouped according to the injured body regions (including, the head/neck, thorax, abdomen, or extremities) and were exclusively compared according to their AIS stratum. Categorical data were compared using the two-sided Fisher exact or Pearson chi-square tests. ANOVA with Games-Howell post hoc test was performed to assess the differences in continuous data of the patients with injury in different body regions. The primary outcome of the study was in-hospital mortality. The adjusted odds ratios (AORs) were estimated using a stepwise selection of a multivariable regression model adjusted by controlling the confounding variables such as sex, age, comorbidities, and ISS. Survival curves were estimated with the Kaplan-Meier approach with a corresponding log-rank test. The patients with AIS of 5 for abdomen injury and those with AIS of 3 for extremity injury had a significantly lower odds of adjusted mortality (adjusted odds ratio (AOR) 0.1, 95% confidence interval (CI) 0.01-0.39, p = 0.004 and AOR 0.3, 95% CI 0.15-0.51, p < 0.001, respectively) than that of the patients with head/neck injury. However, the patients with AIS of 4 for extremity injury demonstrated significantly higher odds of adjusted mortality (AOR 8.4, 95% CI 2.84-25.07, p < 0.001) than the patients with head/neck injury. This study found that the risks to mortality in the patients with a given AIS value of serious to critical injury in different injured body regions were not the same, even after controlling for confounding variables such as sex, age, comorbidities, and ISS.

Same Abbreviated Injury Scale Values May Be Associated with Different Risks to Mortality in Trauma Patients: A Cross-Sectional Retrospective Study Based on the Trauma Registry System in a Level I Trauma Center

PubMed Central

Rau, Cheng-Shyuan; Wu, Shao-Chun; Kuo, Pao-Jen; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun

2017-01-01

The Abbreviated Injury Scale (AIS) measures injury severity of a trauma patient with a numeric method for ranking anatomy-based specific injuries. The summation of the squares of the three most severe injuries in the AIS of six predefined body regions comprises the Injury Severity Score (ISS). It assumes that the mortality of a given AIS value is similar across all body regions. However, such an assumption is less explored in the literature. In this study, we aimed to compare the mortality rates of the patients with the same AIS value in different injured body regions in a level I trauma center. Hospitalized adult trauma patients with isolated serious to critical injury (AIS of 3 to 5) between 1 January 2009, and 31 December 2016, from the Trauma Registry System in a level I trauma center were grouped according to the injured body regions (including, the head/neck, thorax, abdomen, or extremities) and were exclusively compared according to their AIS stratum. Categorical data were compared using the two-sided Fisher exact or Pearson chi-square tests. ANOVA with Games-Howell post hoc test was performed to assess the differences in continuous data of the patients with injury in different body regions. The primary outcome of the study was in-hospital mortality. The adjusted odds ratios (AORs) were estimated using a stepwise selection of a multivariable regression model adjusted by controlling the confounding variables such as sex, age, comorbidities, and ISS. Survival curves were estimated with the Kaplan–Meier approach with a corresponding log-rank test. The patients with AIS of 5 for abdomen injury and those with AIS of 3 for extremity injury had a significantly lower odds of adjusted mortality (adjusted odds ratio (AOR) 0.1, 95% confidence interval (CI) 0.01–0.39, p = 0.004 and AOR 0.3, 95% CI 0.15–0.51, p < 0.001, respectively) than that of the patients with head/neck injury. However, the patients with AIS of 4 for extremity injury demonstrated significantly higher odds of adjusted mortality (AOR 8.4, 95% CI 2.84–25.07, p < 0.001) than the patients with head/neck injury. This study found that the risks to mortality in the patients with a given AIS value of serious to critical injury in different injured body regions were not the same, even after controlling for confounding variables such as sex, age, comorbidities, and ISS. PMID:29232883

How do blockings relate to heavy precipitation events in Europe?

NASA Astrophysics Data System (ADS)

Lenggenhager, Sina; Romppainen, Olivia; Brönnimann, Stefan; Croci-Maspoli, Mischa

2017-04-01

Atmospheric blockings are quasi-stationary high pressure systems that persist for several days. Due to their longevity, blockings can be key features for extreme weather events. While several studies have shown their relevant role for temperatures extremes, the link between blockings and extreme precipitation and floods is still poorly understood. A case study of a Swiss lake flood event in the year 2000 reveals how different processes connected to blockings can favour the development of a flood. First upstream blocks helped to form strongly elongated troughs that are known to be associated with heavy precipitation events south of the Alps. Second recurrent precipitation events upstream of a block led to a moistening of the catchment and an increase of the lake level. Third the progression of the upstream weather systems was slowed and thereby the precipitation period over a catchment prolonged. Additionally, cloud diabatic processes in the flood region contributed to the establishment and maintenance of blocking anticyclones. Based on this case study we extend our analysis to all of Europe. Focusing on flood relevant precipitation events, i.e. extreme precipitation events that last for several days and affect larger areas, we show that different regions in Europe have very distinct seasonal precipitation patterns. Hence there is a strong seasonality in the occurrence of extreme events, depending on the geographical region. We further suggest that for different precipitation regimes, the preferred location of blockings varies strongly. Heavy precipitation events in southern France, for example, are often observed during Scandinavian blockings, while heavy precipitation events in south-eastern Europe coincide more often with eastern North-Atlantic blockings.

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

Lanciego, Carlos; Miguel, Silvia De; Padilla, Manuel

The purpose of this study was to evaluate, in a prospective, single-center study, the effectiveness of Song's polyurethane stents, modified 'in-house,' in the percutaneous management of epiphora. Patients (n = 170; age range 18-83, mean = 64; 50 male, 120 female) with severe epiphora had the modified stents inserted (183 eyes/195 stents) to treat unilateral/bilateral and complete/partial obstruction of the nasolacrimal system. The etiology of the obstruction was idiopathic in 119 cases (61%) and chronic dacryocystitis in 76 (39%). The set designed by Song was used in all patients but modified by us such that the extreme end is cone-shaped.more » The original technique was slightly modified by us and the procedure was conducted on an outpatient basis. The initial technical success rate of stent placement was 97%. Resolution of epiphora was complete in 180 eyes and partial in 3. On follow-up (mean = 18 months; range: 2 days to 24 months), 165 of 195 stents (85%) remained patent. Primary patency rates at follow-up were 86%, 84%, 84%, and 79% in the first 6 months, second and third 6 months, and the present (24 months), respectively. Stents became obstructed in 30 patients, but all but 2 were easily withdrawn and 20 of these patients remained asymptomatic for a mean of 14 months (secondary patency of 67%). Following stent removal, the withdrawn stent was replaced with a new stent in the same intervention on 14 occasions. In another six cases, patency was re-established without the need of a second stent. The procedure is simple and safe, both in stent insertion as well as in mechanical de-blocking and withdrawal when occluded. Success was >80 % in the short term (1-year follow-up). Stenting failure does not preclude other treatment because with the modification that we had introduced, the extreme end of the stent becomes more accessible to mechanical de-blocking, withdrawal, and relocation. The levels of primary and secondary patencies are promising and warrant more extensive investigation.« less

Will the Arctic Land Surface become Wetter or Drier in Response to a Warming Climate

NASA Astrophysics Data System (ADS)

Hinzman, L. D.; Rawlins, M.; Serreze, M.; Vorosmarty, C. J.; Walsh, J. E.

2015-12-01

There is much concern about a potentially "accelerated" hydrologic cycle, with associated extremes in weather and climate-related phenomena. Whether this translates into wetter or drier conditions across arctic landscapes remains an open question. Arctic ecosystems differ substantially from those in temperate regions, largely due to the interactions of extremes in climate and land surface characteristics. Ice-rich permafrost prevents percolation of rainfall or snowmelt water, often maintaining a moist to saturated active layer where the permafrost table is shallow. Permafrost may also block the lateral movement of groundwater, and act as a confining unit for water in sub- or intra-permafrost aquifers. However, as permafrost degrades, profound changes in interactions between groundwater and surface water occur that affect the partitioning among the water balance components with subsequent impacts to the surface energy balance and essential ecosystem processes. Most simulations of arctic climate project sustained increases in temperature and gradual increases in precipitation over the 21st century. However, most climatic models do not correctly represent the essential controls that permafrost exerts on hydrological, ecological, and climatological processes. If warming continues as projected, we expect large-scale changes in surface hydrology as permafrost degrades. Where groundwater gradients are downward (i.e. surface water will infiltrate to subsurface groundwater), as in most cases, we may expect improved drainage and drier soils, which would result in reduced evaporation and transpiration (ET). In some special cases, where the groundwater gradient is upward (as in many wetlands or springs) surface soils may become wetter or inundated as permafrost degrades. Further, since soil moisture is a primary factor controlling ecosystem processes, interactions between ecosystems, GHG emissions, and high-latitude climate must also be considered highly uncertain. These inter-dependent processes will exert primary controls on several important feedback processes and vary across space and time in some as yet, unknown way.

Advanced space optics development in freeform optics design, ceramic polishing, rapid and extreme freeform polishing

NASA Astrophysics Data System (ADS)

Geyl, R.; Leplan, H.; Ruch, E.

2017-09-01

In this paper Safran-Reosc wants to share with the space community its recent work performed in the domain of space optics. Our main topic is a study about the advantages that freeform optical surfaces can offer to advanced space optics in term of compactness or performances. We have separated smart and extreme freeform in our design exploration work. Our second topic is to answer about the immediate question following: can we manufacture and test these freeform optics? We will therefore present our freeform optics capability, report recent achievement in extreme aspheric optics polishing and introduce to the industrialisation process of large off axis optics polishing for the ESO Extremely Large Telescope primary mirror segments. Thirdly we present our R-SiC polishing layer technology for SiC material. This technique has been developed to reduce costs, risks and schedule in the manufacturing of advanced SiC optics for Vis and IR applications.

Fossil vs. non-fossil sources of fine carbonaceous aerosols in four Chinese cities during the extreme winter haze episode in 2013

NASA Astrophysics Data System (ADS)

Zhang, Y.-L.; Huang, R.-J.; El Haddad, I.; Ho, K.-F.; Cao, J.-J.; Han, Y.; Zotter, P.; Bozzetti, C.; Daellenbach, K. R.; Canonaco, F.; Slowik, J. G.; Salazar, G.; Schwikowski, M.; Schnelle-Kreis, J.; Abbaszade, G.; Zimmermann, R.; Baltensperger, U.; Prévôt, A. S. H.; Szidat, S.

2014-10-01

During winter 2013, extremely high concentrations (i.e. 4-20 times higher than the World Health Organization guideline) of PM2.5 (particulate matter with an aerodynamic diameter <2.5 μm) were reported in several large cities in China. In this work, source apportionment of fine carbonaceous aerosols during this haze episode was conducted at four major cities in China including Xian, Beijing, Shanghai and Guangzhou. An effective statistical analysis of a combined dataset from elemental carbon (EC) and organic carbon (OC), radiocarbon (14C) and biomass-burning marker measurements using Latin-hypercube sampling allowed a quantitative source apportionment of carbonaceous aerosols. We found that fossil emissions from coal combustion and vehicle exhaust dominated EC with a mean contribution of 75 ± 8% at all sites. The remaining 25 ± 8% was exclusively attributed to biomass combustion, consistent with the measurements of biomass-burning markers such as anhydrosugars (levoglucosan and mannosan) and water-soluble potassium (K+). With a combination of the levoglucosan-to-mannosan and levoglucosan-to-K+ ratios, the major source of biomass burning in winter in China is suggested to be combustion of crop residues. The contribution of fossil sources to OC was highest in Beijing (58 ± 5%) and decreased from Shanghai (49 ± 2%) to Xian (38 ± 3%) and Guangzhou (35 ± 7%). Generally, a larger fraction of fossil OC was rather from secondary origins than primary sources for all sites. Non-fossil sources accounted on average for 55 ± 10% and 48 ± 9% of OC and TC, respectively, which suggests that non-fossil emissions were very important contributors of urban carbonaceous aerosols in China. The primary biomass-burning emissions accounted for 40 ± 8%, 48 ± 18%, 53 ± 4% and 65 ± 26% of non-fossil OC for Xian, Beijing, Shanghai and Guangzhou, respectively. Other non-fossil sources excluding primary biomass-burning were mainly attributed to formation of secondary organic carbon (SOC) from non-fossil precursors such as biomass-burning emissions. For each site, we also compared samples from moderately with heavily polluted days according to particulate matter mass. Despite a significant increase of absolute mass concentrations of primary emissions from both, fossil and non-fossil sources, during the heavily polluted events, their relative contribution to TC was even decreased, whereas the portion of SOC was consistently increased at all sites. This observation indicates that SOC was an important fraction in the increment of carbonaceous aerosols during the haze episode in China.

Three-Dimensional Dendrite Growth Within the Shrouds of Single Crystal Blades of a Nickel-Based Superalloy

NASA Astrophysics Data System (ADS)

Wang, Fu; Wu, Zining; Huang, Can; Ma, Dexin; Jakumeit, Jürgen; Bührig-Polaczek, Andreas

2017-12-01

The effect of withdrawal rates on the three-dimensional dendrite growth within the shrouds of single crystal blades during directional solidification was studied by both experiments and numerical simulations. The results showed that at given withdrawal rates, the dendrite pattern within the shrouds comprised three zones: primary dendrite zone, secondary dendrite spread zone, and a higher-order dendrite branched zone. With increasing withdrawal rate, the average primary dendrite arm spacing in the primary dendrite zone and the average secondary dendrite arm spacings in both the secondary dendrite spread zone and the higher-order dendrite branched zone were reduced. Independent of the variation in withdrawal rate, two analogous dendrite growth routes were observed within the shrouds of the employed blade geometry. These routes originated from the primary dendrites in the primary dendrite zone and filled in the shrouds by directly spreading secondary or successively branching higher-order dendrites. Except for a withdrawal rate of 6 mm min-1, these dendrites impinged at the shroud's highest extremity and could be explained by the simulated moving isotherms. As the withdrawal rate was increased to 2.5 mm min-1, undercooling and contraction stress-related equiaxed grains were observed in the interdendritic region at the lowest shroud extremity. With increasing withdrawal rate, the amount of the defects was increased. Since the defects destroy the integrity of single crystal blades, the solidification condition within the shroud should be controlled to avoid their occurrence. Along the dendrite growth route, an accumulated misorientation of the dendrites was observed. At the same positions, this accumulation increased with increasing withdrawal rate.

Integrating a rangeland health assessment with successional management: A synergistic approach to EBIPM

USDA-ARS?s Scientific Manuscript database

Qualitative Rangeland Health Assessments are extremely useful because they provide a relative indication of resource problems on rangelands. Additionally, theSuccessional Management framework identifies three primary causes of plantcommunity change, ecological processes, and factors that modify thes...

Iowa's bridge and highway climate change and extreme weather vulnerability assessment pilot.

DOT National Transportation Integrated Search

2015-03-01

The Iowa Department of Transportation (DOT) is responsible for approximately 4,100 bridges and structures that are a part of the : states primary highway system, which includes the Interstate, US, and Iowa highway routes. A pilot study was conduct...

Is prescribed lower extremity weight-bearing status after geriatric lower extremity trauma associated with increased mortality?

PubMed

Gitajn, Ida Leah; Connelly, Daniel; Mascarenhas, Daniel; Breazeale, Stephen; Berger, Peter; Schoonover, Carrie; Martin, Brook; O'Toole, Robert V; Pensy, Raymond; Sciadini, Marcus

2018-02-01

Evaluate whether mortality after discharge is elevated in geriatric fracture patients whose lower extremity weight-bearing is restricted. Retrospective cohort study SETTING: Urban Level 1 trauma center PATIENTS/PARTICIPANTS: 1746 patients >65 years of age INTERVENTION: Post-operative lower extremity weight-bearing status MAIN OUTCOME MEASURE: Mortality, as determined by the Social Security Death Index RESULTS: Univariate analysis demonstrated that patients who were weight-bearing as tolerated on bilateral lower extremities (BLE) had significantly higher 5-year mortality compared to patients with restricted weight-bearing on one lower extremity and restricted weight-bearing on BLE (30%, 21% and 22% respectively, p < 0.001). Cox regression analysis controlling for variables including age, Charlson Comorbidity Index, Injury Severity Scale, combined UE/LE injury, injury mechanism (high vs low), sex, BMI and GCS demonstrated that, in comparison to patients who were weight bearing as tolerated on BLE, restricted weight-bearing on one lower extremity had a hazard ratio (HR) of 0.97 (95% confidence interval 0.78 to 1.20, p = 0.76) and restricted weight-bearing in BLE had a HR of 0.91 (95% confidence interval 0.60 to 1.36, p = 0.73). In geriatric patients, prescribed weight-bearing status did not have a statistically significant association with mortality after discharge, when controlling for age, sex, body mass index, medical comorbidities, Injury Severity Scale (ISS), mechanism of injury, nonoperative treatment and admission GCS. This remained true in when the analysis was restricted to operative injuries only. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Acute limb ischemia from the general surgeon's point of view. How much knowledge of vascular surgery is necessary?].

PubMed

Kopp, R; Weidenhagen, R; Hornung, H; Jauch, K W; Lauterjung, L

2003-12-01

The diagnosis of acute peripheral ischemia can be obtained based on clinical presentation, inspection, and palpation of the affected extremity. Unfractionated heparin as a single shot is immediately given followed by continuous infusion when diagnosis is clinically evident and contraindications are excluded. Thromboembolectomy using a Fogarty catheter is immediately performed in patients with evidence of arterial embolization and signs of advanced ischemia (TASC IIb/III) followed by intraoperative angiography. Patients with evidence of arterial thrombosis require urgent angiography followed by thrombectomy and probably subsequent endovascular or surgical interventions and vascular reconstruction. For patients with moderate ischemia (TASC IIa), initial diagnostic angiography is recommended followed by primary thrombectomy with subsequent intraoperative angiography and immediate endovascular or operative treatment of remaining vascular problems. As an alternative therapeutic option initial catheter-guided local thrombolysis can be performed in selected patients with the intention of subsequent limb revascularization or unmasking relevant vessel alterations leading to specific endovascular or surgically performed vascular reconstruction. Possible development of muscle ischemia because of increased compartment pressure should be considered and fasciotomy performed when indicated. Primary amputation of the severely ischemic limb after initial thrombectomy might be recommended in patients with life-threatening organ failure related to muscle necrosis.

Calcified Mass on Brain CT in a Teenager with Refractory Seizures.

PubMed

Khalatbari, Mahmoud Reza; Brunetti, Enrico; Shobeiri, Elham; Moharamzad, Yashar

2014-12-01

Cerebral echinococcosis is very rare, representing 2% of all cystic echinococcosis (CE) cases. Primary echinococcal cysts of the brain are extremely rare in pediatric patients. We report on a 16-year-old boy referred to our tertiary center with intractable epilepsy for the previous three years despite receiving full doses of three antiepileptic medications. Brain computed tomography (CT) showed a left frontal calcified mass. Magnetic resonance imaging (MRI) of the brain revealed a well-defined spherical mass in the left frontal lobe, slightly hypointense on T1-weighted and heterogeneous hyperintense on T2-weighted images with no contrast enhancement. With a broad differential list in mind, a surgical intervention was planned. During surgery, a primary calcified cerebral echinococcal cyst with severe adhesion to the adjacent dura of the frontal region was discovered and removed intact. Histopathology examination confirmed the diagnosis. Only phenobarbital was continued and no medical therapy for CE was administered. Two years after surgery, the patient remained free of seizures. In areas endemic for CE, cerebral echinococcal cyst should be included in the differential list of patients with intractable seizures. Though rare, this entity can present itself as a calcified mass on neuroimaging. Surgical removal of the calcified cyst is necessary for control and treatment of the epilepsy.

Making on-orbit structural repairs to Space Station

NASA Technical Reports Server (NTRS)

Haber, Harry S.; Quinn, Alberta

1989-01-01

One of the key factors dictating the safety and durability of the proposed U.S. Space Station is the ability to repair structural damage while remaining in orbit. Consequently, studies are conducted to identify the engineering problems associated with accomplishing structural repairs on orbit, due to zero gravity environment and exposure to extreme temperature variations. There are predominant forms of structural failure, depending on the metallic or composite material involved. Aluminum is the primary metallic material used in space vehicle applications. Welding processes on aluminum alloy structures were tested, resulting in final selection of electron beam welding as the primary technique for metallic material repair in Space. Several composite structure repair processes were bench-tested to define their applicability to on-orbit EVA requirements: induction heating prevailed. One of the unique problems identified as inherent in the on-orbit repair process is that of debris containment. The Maintenance Work Station concept provides means to prevent module contamination from repair debris and ensure the creation of a facility for crew members to work easily in a microgravity environment. Different technologies were also examined for application to EVA repair activities, and the concept selected was a spring-loaded, collapsible, box-like Debris Containement and Collection Device with incorporated fold-down tool boards and handholes in the front panel.

Numerical investigation of the dynamical environment of 65803 Didymos

NASA Astrophysics Data System (ADS)

Dell'Elce, L.; Baresi, N.; Naidu, S. P.; Benner, L. A. M.; Scheeres, D. J.

2017-03-01

The Asteroid Impact & Deflection Assessment (AIDA) mission is planning to visit the Didymos binary system in 2022 in order to perform the first demonstration ever of the kinetic impact technique. Binary asteroids are an ideal target for this since the deflection of the secondary body can be accurately measured by a satellite orbiting in the system. However, these binaries offer an extremely rich dynamical environment whose accurate investigation through analytical approaches is challenging at best and requires a significant number of restrictive assumptions. For this reason, a numerical investigation of the dynamical environment in the vicinity of the Didymos system is offered in this paper. After computing various families of periodic orbits, their robustness is assessed in a high-fidelity environment consisting of the perturbed restricted full three-body problem. The results of this study suggest that several nominally stable trajectories, including the triangular libration points, should not be considered as safe as a state vector perturbation may cause the spacecraft to drift from the nominal orbit and possibly impact one of the primary bodies within a few days. Nonetheless, there exist two safe solutions, namely terminator and interior retrograde orbits. The first one is adequate for observation purposes of the entire system and for communications. The second one is more suitable to perform close investigations of the primary body.

Carbon isotope variations in a solar pond microbial mat: Role of environmental gradients as steering variables

NASA Astrophysics Data System (ADS)

Schidlowski, Manfred; Gorzawski, Hendrik; Dor, Inka

1994-05-01

A biogeochemical traverse is presented for a juvenile benthic mat covering the depth profile of an artificially stratified and eutrophicated hypersaline heliothermal pond with known gradients of temperature, salinity, pH, and light transmission. It can be shown that visual mat development depends primarily on temperature and salinity as main environmental steering variables whose increase with depth goes along with the attenuation and final disappearance of a visible microbial film in the pond's hypolimnic compartment. Recorded biogeochemical parameters (C org content, cell numbers, chlorophyll-a content) evidently reflect, as either biomass- or productivity-related index functions, the visually perceptible growth gradient of the microbial ecosystem along the pond slope. The observed coincidence of maxima in these index functions with maxima in δ13Corg clearly identifies high rates of primary productivity as the agent ultimately responsible for the generation of isotopically heavy ( 13C-enriched) biomass in these and related environments. Extreme demands placed on the local feeder pool of dissolved inorganic carbon by high rates of primary productivity entertained by the mat-forming microbenthos obviously give rise to severe CO 2 limitation, enforcing the operation of a diffusion-(supply-)limited assimilatory pathway with an isotopically indiscriminate metabolization of the available CO 2 resources.

Measured and modelled leaf and stand-scale productivity across a soil moisture gradient and a severe drought.

PubMed

Wright, J K; Williams, M; Starr, G; McGee, J; Mitchell, R J

2013-02-01

Environmental controls on carbon dynamics operate at a range of interacting scales from the leaf to landscape. The key questions of this study addressed the influence of water and nitrogen (N) availability on Pinus palustris (Mill.) physiology and primary productivity across leaf and canopy scales, linking the soil-plant-atmosphere (SPA) model to leaf and stand-scale flux and leaf trait/canopy data. We present previously unreported ecophysiological parameters (e.g. V(cmax) and J(max)) for P. palustris and the first modelled estimates of its annual gross primary productivity (GPP) across xeric and mesic sites and under extreme drought. Annual mesic site P. palustris GPP was ∼23% greater than at the xeric site. However, at the leaf level, xeric trees had higher net photosynthetic rates, and water and light use efficiency. At the canopy scale, GPP was limited by light interception (canopy level), but co-limited by nitrogen and water at the leaf level. Contrary to expectations, the impacts of an intense growing season drought were greater at the mesic site. Modelling indicated a 10% greater decrease in mesic GPP compared with the xeric site. Xeric P. palustris trees exhibited drought-tolerant behaviour that contrasted with mesic trees' drought-avoidance behaviour. © 2012 Blackwell Publishing Ltd.

DNA-PKcs is critical for telomere capping

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

Gilley, David; Tanaka, Hiromi; Hande, M. Prakash

The DNA-dependent protein kinase catalytic subunit (DNA-PKcs) is critical for DNA repair via the non-homologous end joining (NHEJ) pathway. Previously, it was reported that bone marrow cells and spontaneously transformed fibroblasts from SCID (severe combined immunodeficiency) mice have defects in telomere maintenance. The genetically defective SCID mouse arose spontaneously from its parental strain CB17. One known genomic alteration in SCID mice is a truncation of the extreme carboxyl-terminus of DNA-PKcs, but other as yet unidentified alterations may also exist. We have used a defined system, the DNA-PKcs knockout mouse, to investigate specifically the role DNA-PKcs specifically plays in telomere maintenance.more » We report that primary mouse embryonic fibroblasts (MEFs) and primary cultured kidney cells from 6-8 month old DNA-PKcs deficient mice accumulate a large number of telomere fusions, yet still retain wildtype telomere length. Thus, the phenotype of this defect separates the two-telomere related phenotypes, capping and length maintenance. DNA-PKcs deficient MEFs also exhibit elevated levels of chromosome fragments and breaks, which correlate with increased telomere fusions. Based on the high levels of telomere fusions observed in DNA-PKcs deficient cells, we conclude that DNA-PKcs plays an important capping role at the mammalian telomere.« less

Manufacturing of super-polished large aspheric/freeform optics

NASA Astrophysics Data System (ADS)

Kim, Dae Wook; Oh, Chang-jin; Lowman, Andrew; Smith, Greg A.; Aftab, Maham; Burge, James H.

2016-07-01

Several next generation astronomical telescopes or large optical systems utilize aspheric/freeform optics for creating a segmented optical system. Multiple mirrors can be combined to form a larger optical surface or used as a single surface to avoid obscurations. In this paper, we demonstrate a specific case of the Daniel K. Inouye Solar Telescope (DKIST). This optic is a 4.2 m in diameter off-axis primary mirror using ZERODUR thin substrate, and has been successfully completed in the Optical Engineering and Fabrication Facility (OEFF) at the University of Arizona, in 2016. As the telescope looks at the brightest object in the sky, our own Sun, the primary mirror surface quality meets extreme specifications covering a wide range of spatial frequency errors. In manufacturing the DKIST mirror, metrology systems have been studied, developed and applied to measure low-to-mid-to-high spatial frequency surface shape information in the 4.2 m super-polished optical surface. In this paper, measurements from these systems are converted to Power Spectral Density (PSD) plots and combined in the spatial frequency domain. Results cover 5 orders of magnitude in spatial frequencies and meet or exceed specifications for this large aspheric mirror. Precision manufacturing of the super-polished DKIST mirror enables a new level of solar science.