Publication date: Available online 1 December 2017
Source:Journal of Surgical Education
Author(s): Brenessa Lindeman, Emil Petrusa, Sophia McKinley, Daniel A. Hashimoto, Denise Gee, Douglas S. Smink, John T. Mullen, Roy Phitayakorn
ObjectivesBurnout is common among surgical residents and may be related to personality characteristics, emotional intelligence (EI), or work experiences.DesignLongitudinal cohort study over 1 year.SettingTertiary academic medical centers in the Northeast.ParticipantsAll general surgery residents in 2 programs (n = 143) were invited to complete an electronic survey at 3 time points; 88, 64, and 69 residents completed the survey (overall response rate 52%).ResultsSevere burnout was observed in 51% of residents (n = 41). Higher scores were associated with female sex (p = 0.02). Burnout scores were highest at the beginning and end of the academic year; EI and personality scores remained stable. On bivariate analysis, high EI score (p < 0.001), agreeableness and emotional stability personality features (p = 0.003), and positive job experiences (p < 0.01) were protective against burnout. Higher EI and positive work experiences were independent predictors of lower burnout (p < 0.01) after multivariable adjustment.ConclusionsSurgical residents have high levels of burnout. Higher EI and positive work experiences are associated with lower burnout. Focused interventions to improve EI and optimize the work environment may prevent or lessen burnout.
http://ift.tt/2itSNMa
Πέμπτη 30 Νοεμβρίου 2017
Association of Burnout With Emotional Intelligence and Personality in Surgical Residents: Can We Predict Who Is Most at Risk?
Numéro 10/2017. Questions
Source:Revue des Maladies Respiratoires
http://ift.tt/2zUcsMJ
Microangiopathie thrombotique tumorale pulmonaire
Source:Revue des Maladies Respiratoires
Author(s): M. Merad, A. Alibay, S. Ammari, S. Antoun, A. Bouguerba, S. Ayed, F. Vincent
Le syndrome de microangiopathie thrombotique tumorale pulmonaire est une entité clinicopathologique rare où des micro-emboles de cellules tumorales dans la microcirculation pulmonaire induisent une microangiopathie thrombotique, une insuffisance respiratoire et un tableau de cœur pulmonaire aigus ou subaigus. Ses caractéristiques histologiques comprennent des micro-emboles tumoraux dans les petites artères et artérioles du poumon, associés à une prolifération fibrocellulaire et fibromusculaire de l'intima et parfois à la formation de thrombus. Le diagnostic est extrêmement difficile avant le décès. Ainsi, un grand nombre des observations rapportées reposent sur des données autopsiques. De très rares observations de diagnostics réalisés avant le décès suggèrent l'éventuelle efficacité d'une chimiothérapie. De nombreux détails restent à élucider, la recherche interdisciplinaire étant une priorité avec une étroite collaboration entre pathologistes et cliniciens afin de mieux comprendre ce syndrome le plus souvent mortel. Grâce à cette collaboration, il est éventuellement possible que ce syndrome ne soit plus considéré comme toujours ultimement fatal, l'utilisation de thérapeutiques ciblées permettant des survies de plusieurs mois après le diagnostic.Pulmonary tumor thrombotic microangiopathy syndrome is a rare clinicopathological entity in which tumor cell micro-emboli in the pulmonary microcirculation induced thrombotic microangiopathy. This can cause respiratory failure, and acute or sub-acute right heart failure. Histological features include micro tumor emboli in the small arteries and arterioles of the lung associated with thrombus formation and fibro-cellular and fibro-muscular intimal proliferation. The diagnosis is however extremely difficult to make before death. Thus, most of the observations reported are based on autopsy data. Very rare diagnostic observations made before death suggest the potential effectiveness of chemotherapy. Many details remain to be elucidated, interdisciplinary research is a priority with close collaboration between pathologists and clinicians to better understand this, often fatal, syndrome. It may be that the use of targeted therapies will improve the very poor prognosis allowing survival of several weeks or months after diagnosis.
http://ift.tt/2itNKLo
Éditorial : série moisissures intérieures
Source:Revue des Maladies Respiratoires
Author(s): D. Caillaud, D. Charpin
http://ift.tt/2zUcnZr
Numéro 10/2017. Réponses
Source:Revue des Maladies Respiratoires
http://ift.tt/2ivQwzV
Editorial board
Source:Revue des Maladies Respiratoires, Volume 34, Issue 9
http://ift.tt/2zUx5Ip
Squamous cell carcinoma arising from a keratocystic odontogenic tumor: a case report
The term "primary intraosseous squamous cell carcinoma" was introduced in 2005 by the World Health Organization with three subcategories. Squamous cell carcinoma arising from the lining of an odontogenic cyst ...
http://ift.tt/2j6F8Yf
Evidence of the efficacy and safety of house dust mite subcutaneous immunotherapy in elderly allergic rhinitis patients: a randomized, double-blind placebo-controlled trial
Allergen specific immunotherapy (AIT) in elderly patients is controversial, and there is still little evidence supporting the safety and efficacy of this treatment in this population. The study objective was t...
http://ift.tt/2nhyy5P
The effectiveness of vibrational stimulus to accelerate orthodontic tooth movement: a systematic review
Abstract
Background
In recent years, it has been a hot research topic to accelerate orthodontic tooth movement (OTM) through vibration. This review was therefore aimed to systematically evaluate the available evidences on the efficacy of vibrational stimulus to accelerate OTM.
Methods
Randomized controlled trials and controlled clinical trials that evaluated the efficacy of vibration on OTM acceleration were searched through electronic and manual search. Two review authors independently conducted the study inclusion, quality assessment and data extraction. The quality of synthesized evidence was assessed according to GRADE system.
Results
Eight clinical trials were included in this systematic review. Four studies found that vibration did not enhance the rate of OTM during alignment phase. Two studies revealed that the use of vibratory stimulation accelerated canine retraction. No deleterious effects including pain perceptions and root resorptions were reported.
Conclusions
Within the limitations of this review, weak evidence indicates that vibrational stimulus is effective for accelerating canine retraction but not for alignment. The effects of vibration on pain intensity and root resorption during orthodontic treatment are inconclusive. Future high-quality clinical trials are needed before warranting recommendations to clinical application.
http://ift.tt/2i3G8vj
Evidence of the efficacy and safety of house dust mite subcutaneous immunotherapy in elderly allergic rhinitis patients: a randomized, double-blind placebo-controlled trial
Allergen specific immunotherapy (AIT) in elderly patients is controversial, and there is still little evidence supporting the safety and efficacy of this treatment in this population. The study objective was t...
http://ift.tt/2nhyy5P
Correction to: Adaptation in toxic environments: comparative genomics of loci carrying antibiotic resistance genes derived from acid mine drainage waters
Abstract
The original version of this article unfortunately contains a mistake.
http://ift.tt/2niVHoh
Complete heart block as the presenting feature in subarachnoid haemorrhage
Cardiac manifestations of subarachnoid haemorrhage (SAH) are well-documented phenomena that can complicate the treatment of this devastating condition. Here, we present a case of SAH presenting as complete heart block on initial assessment, an extremely rare event.
A 53-year-old woman presented with a witnessed fall, sustaining a mild head injury. She denied any symptoms of SAH. Initial ECG revealed complete heart block, for which the patient was accepted under the cardiology team. For completion, a CT head scan was requested, this demonstrated significant SAH blood load in an aneurysmal rather than traumatic pattern. CT angiogram and subsequent digital subtraction angiography confirmed a posterior communicating artery aneurysm as the cause of the SAH. This case highlights the importance of considering neurological diagnoses in patients with collapse even with concomitant cardiac abnormalities, as the two are often inextricably linked.
http://ift.tt/2i8mAG1
Ringed telangiectasias: an unusual presentation of telangiectasia macularis eruptiva perstans
Telangiectasia macularis eruptiva perstans (TMEP) is a rare form of cutaneous mastocytosis. While most cutaneous mastocytoses occur in children and are asymptomatic, TMEP occurs predominantly in adults and is associated with systemic manifestations, requiring medical management. TMEP is typically characterised by scattered red-brown macules on the trunk and extremities, but must be differentiated from other telangiectatic conditions such as scleroderma, hereditary haemorrhagic telangiectasia and telangiectasias secondary to cirrhosis. Practitioners must be aware that variants to the classic presentation of TMEP exist, such as the ringed telangiectasias we describe. Diagnostic workup including tissue biopsy must be considered in such patients after a thorough history and physical have been performed and other telangiectatic processes have been ruled out. The treatment of cutaneous mastocytosis aims at controlling symptoms and preventing mast cell degranulation. Cosmetic treatment includes the use ofPsoralen and ultraviolet A (PUVA) therapy, total skin electron beam radiation and flashlamp pulsed-dye laser treatment.
http://ift.tt/2jA8ygQ
Paradoxic eczema in infants after heart transplantation
Abstract
New-onset psoriasis in patients receiving tumor necrosis factor inhibitors is well recognized in children and adults. We describe three children who underwent cardiac transplantation and developed an analogous form of paradoxic eczema occurring 2-48 months after starting systemic tacrolimus, a drug widely used topically to treat eczema. Anecdotal reports and our experience suggest that tacrolimus taper with alternative systemic antirejection immunosuppressant may lead to skin clearance. Pending additional insight, treatment should include optimizing skin barrier function, minimizing microbial and allergic triggers, and coordinating care to choose the best-tolerated systemic immunosuppressant regimen at the lowest effective dose.
http://ift.tt/2AuxOj3
Editorial Board
Source:Dental Materials, Volume 33, Issue 12
http://ift.tt/2ivh6Ji
Bone Marrow Myeloid Cells Regulate Myeloid-Biased Hematopoietic Stem Cells via a Histamine-Dependent Feedback Loop
Publication date: Available online 30 November 2017
Source:Cell Stem Cell
Author(s): Xiaowei Chen, Huan Deng, Michael J. Churchill, Larry L. Luchsinger, Xing Du, Timothy H. Chu, Richard A. Friedman, Moritz Middelhoff, Hongxu Ding, Yagnesh H. Tailor, Alexander L.E. Wang, Haibo Liu, Zhengchuan Niu, Hongshan Wang, Zhenyu Jiang, Simon Renders, Siu-Hong Ho, Spandan V. Shah, Pavel Tishchenko, Wenju Chang, Theresa C. Swayne, Laura Munteanu, Andrea Califano, Ryota Takahashi, Karan K. Nagar, Bernhard W. Renz, Daniel L. Worthley, C. Benedikt Westphalen, Yoku Hayakawa, Samuel Asfaha, Florence Borot, Chyuan-Sheng Lin, Hans-Willem Snoeck, Siddhartha Mukherjee, Timothy C. Wang
Myeloid-biased hematopoietic stem cells (MB-HSCs) play critical roles in recovery from injury, but little is known about how they are regulated within the bone marrow niche. Here we describe an auto-/paracrine physiologic circuit that controls quiescence of MB-HSCs and hematopoietic progenitors marked by histidine decarboxylase (Hdc). Committed Hdc+ myeloid cells lie in close anatomical proximity to MB-HSCs and produce histamine, which activates the H2 receptor on MB-HSCs to promote their quiescence and self-renewal. Depleting histamine-producing cells enforces cell cycle entry, induces loss of serial transplant capacity, and sensitizes animals to chemotherapeutic injury. Increasing demand for myeloid cells via lipopolysaccharide (LPS) treatment specifically recruits MB-HSCs and progenitors into the cell cycle; cycling MB-HSCs fail to revert into quiescence in the absence of histamine feedback, leading to their depletion, while an H2 agonist protects MB-HSCs from depletion after sepsis. Thus, histamine couples lineage-specific physiological demands to intrinsically primed MB-HSCs to enforce homeostasis.
Graphical abstract
Teaser
Chen et al. show that histidine decarboxylase (Hdc) marks quiescent myeloid-biased HSCs (MB-HSCs). Daughter myeloid cells form a spatial cluster with Hdc+ MB-HSCs and secrete histamine to enforce their quiescence and protect them from depletion, following activation by a variety of physiologic insults.http://ift.tt/2ivcLWH
Hypoxic Induction of Vasorin Regulates Notch1 Turnover to Maintain Glioma Stem-like Cells
Publication date: Available online 30 November 2017
Source:Cell Stem Cell
Author(s): Jianghong Man, Xingjiang Yu, Haidong Huang, Wenchao Zhou, Chaomei Xiang, Haohao Huang, Lucio Miele, Zhenggang Liu, Gurkan Bebek, Shideng Bao, Jennifer S. Yu
Tumor hypoxia is associated with poor patient survival and is a characteristic of glioblastoma. Notch signaling is implicated in maintaining glioma stem-like cells (GSCs) within the hypoxic niche, although the molecular mechanisms linking hypoxia to Notch activation have not been clearly delineated. Here we show that Vasorin is a critical link between hypoxia and Notch signaling in GSCs. Vasorin is preferentially induced in GSCs by a HIF1α/STAT3 co-activator complex and stabilizes Notch1 protein at the cell membrane. This interaction prevents Numb from binding Notch1, rescuing it from Numb-mediated lysosomal degradation. Thus, Vasorin acts as a switch to augment Notch signaling under hypoxic conditions. Vasorin promotes tumor growth and reduces survival in mouse models of glioblastoma, and its expression correlates with increased aggression of human gliomas. These findings provide mechanistic insights into how hypoxia promotes Notch signaling in glioma and identify Vasorin as a potential therapeutic target.
Graphical abstract
Teaser
Man et al. show that hypoxia preferentially augments Notch signaling in glioma stem-like cells by inducing the HIF1/STAT3 target gene Vasorin. Vasorin functions as a competitive inhibitor of Numb to reduce Notch turnover, augmenting Notch signaling under hypoxic stress.http://ift.tt/2ivcIKv
Dye-Independent Methods Reveal Elevated Mitochondrial Mass in Hematopoietic Stem Cells
Publication date: Available online 30 November 2017
Source:Cell Stem Cell
Author(s): Mariana Justino de Almeida, Larry L. Luchsinger, David J. Corrigan, Linda J. Williams, Hans-Willem Snoeck
Hematopoietic stem cells (HSCs) produce most cellular energy through glycolysis rather than through mitochondrial respiration. Consistent with this notion, mitochondrial mass has been reported to be low in HSCs. However, we found that staining with MitoTracker Green, a commonly used dye to measure mitochondrial content, leads to artefactually low fluorescence specifically in HSCs because of dye efflux. Using mtDNA quantification, enumeration of mitochondrial nucleoids, and fluorescence intensity of a genetically encoded mitochondrial reporter, we unequivocally show here that HSCs and multipotential progenitors (MPPs) have higher mitochondrial mass than lineage-committed progenitors and mature cells. Despite similar mitochondrial mass, respiratory capacity of MPPs exceeds that of HSCs. Furthermore, although elevated mitophagy has been invoked to explain low mitochondrial mass in HSCs, we observed that mitochondrial turnover capacity is comparatively low in HSCs. We propose that the role of mitochondria in HSC biology may have to be revisited in light of these findings.
Graphical abstract
Teaser
Snoeck and colleagues show that efflux of a mitochondrial content-reporting dye leads to the erroneous conclusion that HSCs have low mitochondrial content. Using alternative methodologies, they show that HSCs exhibit high mitochondrial content yet possess limited respiratory and turnover capacity. Mitochondria likely perform an essential yet unknown function in HSCs.http://ift.tt/2ivcEKL
Advancing our understanding of the neurobiology of anorexia nervosa: translation into treatment
Abstract
A wealth of studies has investigated the neurobiological underpinnings of anorexia nervosa. In our letter to the editor, we point to a number of ways in which the advances in our understanding of the neurobiology of anorexia nervosa - focusing on neuroimaging studies of brain structure and function - can be translated into treatment. We point to how such advances can: inform psychological treatment, be implemented in psychoeducation, point to novel therapeutic targets, lead to the identification of biomarkers, and expand our vocabulary for how we think and talk about anorexia nervosa.
http://ift.tt/2nknd4X
Comparative Efficacy of Daratumumab Monotherapy and Pomalidomide Plus Low‐Dose Dexamethasone in the Treatment of Multiple Myeloma: A Matching Adjusted Indirect Comparison
AbstractBackground.Daratumumab (a human CD38‐directed monoclonal antibody) and pomalidomide (an immunomodulatory drug) plus dexamethasone are both relatively new treatment options for patients with heavily pretreated multiple myeloma. A matching adjusted indirect comparison (MAIC) was used to compare absolute treatment effects of daratumumab versus pomalidomide + low‐dose dexamethasone (LoDex; 40 mg) on overall survival (OS), while adjusting for differences between the trial populations.Materials and Methods.The MAIC method reduces the risk of bias associated with naïve indirect comparisons. Data from 148 patients receiving daratumumab (16 mg/kg), pooled from the GEN501 and SIRIUS studies, were compared separately with data from patients receiving pomalidomide + LoDex in the MM‐003 and STRATUS studies.Results.The MAIC‐adjusted hazard ratio (HR) for OS of daratumumab versus pomalidomide + LoDex was 0.56 (95% confidence interval [CI], 0.38–0.83; p = .0041) for MM‐003 and 0.51 (95% CI, 0.37–0.69; p < .0001) for STRATUS. The treatment benefit was even more pronounced when the daratumumab population was restricted to pomalidomide‐naïve patients (MM‐003: HR, 0.33; 95% CI, 0.17–0.66; p = .0017; STRATUS: HR, 0.41; 95% CI, 0.21–0.79; p = .0082). An additional analysis indicated a consistent trend of the OS benefit across subgroups based on M‐protein level reduction (≥50%, ≥25%, and <25%).Conclusion.The MAIC results suggest that daratumumab improves OS compared with pomalidomide + LoDex in patients with heavily pretreated multiple myeloma.Implications for Practice.This matching adjusted indirect comparison of clinical trial data from four studies analyzes the survival outcomes of patients with heavily pretreated, relapsed/refractory multiple myeloma who received either daratumumab monotherapy or pomalidomide plus low‐dose dexamethasone. Using this method, daratumumab conferred a significant overall survival benefit compared with pomalidomide plus low‐dose dexamethasone. In the absence of head‐to‐head trials, these indirect comparisons provide useful insights to clinicians and reimbursement authorities around the relative efficacy of treatments.
http://ift.tt/2j46ka6
Pre‐ and Postoperative Chemotherapy in Localized Extremity Soft Tissue Sarcoma: A European Organization for Research and Treatment of Cancer Expert Survey
AbstractBackground.The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre‐ and postoperative chemotherapy is unclear and debated among experts.Materials and Methods.Medical oncology experts of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group were asked to participate in this survey on the use of pre‐ and postoperative chemotherapy in STS. Experts from 12 centers in Belgium, France, Germany, Great Britain, Italy, Switzerland, and The Netherlands agreed to participate and provided their treatment algorithm. Answers were converted into decision trees based on the objective consensus methodology. The decision trees were used as a basis to identify consensus and discrepancies.Results.Several criteria used for decision‐making in extremity STS were identified: chemosensitivity, fitness, grading, location, and size. In addition, resectability and resection status were relevant in the pre‐ and postoperative setting, respectively. Preoperative chemotherapy is considered in most centers for marginally resectable tumors only. Yet, in some centers, neoadjuvant chemotherapy is used routinely and partially combined with hyperthermia. Although most centers do not recommend postoperative chemotherapy, some offer this treatment on a regular basis. Radiotherapy is an undisputed treatment modality in extremity STS.Conclusion.Due to lacking evidence on the utility of pre‐ and postoperative chemotherapy in localized extremity STS, treatment strategies vary considerably among European experts. The majority recommended neoadjuvant chemotherapy for marginally resectable grade 2–3 tumors; the majority did not recommend postoperative chemotherapy in any setting.Implications for Practice.The management of localized extremity soft tissue sarcomas (STS) is challenging and the role of pre‐ and postoperative chemotherapy is unclear and debated among experts. This study analyzed the decision‐making process among 12 European experts on systemic therapy for STS. A wide range of recommendations among experts regarding the use of perioperative chemotherapy was discovered. Discrepancies in the use of decision criteria were also uncovered, including the definition of what constitutes high‐risk cancer, which is a basis for many to recommend chemotherapy. Before any standardization is possible, a common use of decision criteria is necessary.
http://ift.tt/2j46gHo
The European Medicines Agency Review of Panobinostat (Farydak) for the Treatment of Adult Patients with Relapsed and/or Refractory Multiple Myeloma
AbstractOn August 28, 2015, a marketing authorization valid through the European Union was issued for panobinostat, in combination with bortezomib and dexamethasone, for the treatment of adult patients with relapsed and/or refractory multiple myeloma who have received at least two prior regimens including bortezomib and an immunomodulatory agent (IMiD).Panobinostat is an orally available histone deacetylase (HDAC) inhibitor that inhibits the enzymatic activity of HDAC proteins at nanomolar concentrations. HDAC proteins catalyze the removal of acetyl groups from the lysine residues of histones and some nonhistone proteins. Inhibition of HDAC activity results in increased acetylation of histone proteins, an epigenetic alteration that results in a relaxing of chromatin, leading to transcriptional activation. The recommended starting dose of panobinostat is 20 mg, taken orally in a cyclical manner for up to 48 weeks.The use of panobinostat in combination with bortezomib and dexamethasone was studied in a randomized, double‐blind, placebo‐controlled, multicenter phase III study (PANORAMA I) in 768 patients with relapsed or relapsed and refractory multiple myeloma who had received one to three prior lines of therapies. In the subgroup of patients who have received at least two prior regimens including bortezomib and an IMiD, there was a difference of 7.8 months in the progression‐free survival in favor of the experimental arm (12.5 months for panobinostat + bortezomib + dexamethasone vs. 4.7 months for placebo + bortezomib + dexamethasone; hazard ratio = 0.47, 95% confidence interal 0.31–0.72; log‐rank p value = .0003). The incidence of grade 3–4 adverse events suspected to be related to study drug was 76.9% vs. 51.2%, for the panobinostat and the placebo group, respectively. The most common side effects (grade 3–4) associated with panobinostat included diarrhea (18.9%), fatigue (14.7%), nausea (4.5%), vomiting (5.5%), thrombocytopenia (43.6%), anemia (7.9%), neutropenia (16.5%) and lymphopenia (8.1%).This article summarizes the scientific review of the application leading to regulatory approval in the European Union. The full scientific assessment report and product information, including the Summary of Product Characteristics, are available on the European Medicines Agency website (http://ift.tt/28Lv8Np).Implications for Practice.Farydak was approved in the European Union in combination with bortezomib and dexamethasone, for the treatment of adult patients with relapsed and/or refractory multiple myeloma who have received at least two prior regimens including bortezomib and an immunomodulatory agent (IMiD). The addition of panobinostat to bortezomib and dexamethasone resulted in a clinically meaningful and statistically significant improvement of progression‐free survival compared with bortezomib and dexamethasone, and an additional therapeutic option with a new mechanism of action was considered valuable. Although the toxicity associated with panobinostat combination was significant, at the time of the marketing authorization of panobinostat, it was considered that it was acceptable and that it should be left to the clinician and the patient to decide whether the panobinostat combination is the preferred treatment option or not.
http://ift.tt/2j4DK8A
Effects of hypothalamic leptin gene therapy on osteopetrosis in leptin-deficient mice
Impaired resorption of cartilage matrix deposited during endochondral ossification is a defining feature of juvenile osteopetrosis. Growing, leptin-deficient ob/ob mice exhibit a mild form of osteopetrosis. However, the extent to which the disease is (1) self-limiting and (2) reversible by leptin treatment is unknown. We addressed the first question by performing histomorphometric analysis of femurs in rapidly growing (2-month-old), slowly growing (4-month-old), and skeletally mature (6-month-old) wild type (WT) and ob/ob male mice. Absent by 6 months of age in WT mice, cartilage matrix persisted to varying extents in distal femur epiphysis, metaphysis and diaphysis in ob/ob mice, suggesting that the osteopetrotic phenotype is not entirely self-limiting. To address the second question, we employed hypothalamic recombinant adeno-associated virus (rAAV) gene therapy to restore leptin signaling in ob/ob mice. Two-month-old mice were randomized to one of three groups: (1) untreated control, (2) rAAV-Leptin, or (3) control vector rAAV-green fluorescent protein and vectors injected intracerebroventricularly. Seven months later, rAAV-Leptin-treated mice exhibited no cartilage in the metaphysis and greatly reduced cartilage in the epiphysis and diaphysis. At the cellular level, the reduction in cartilage was associated with increased bone turnover. These findings (1) support the concept that leptin is important for normal replacement of cartilage by bone, and (2) demonstrate that osteopetrosis in ob/ob mice is bone compartment specific and reversible by leptin at skeletal sites capable of undergoing robust bone turnover.
http://ift.tt/2ivSvEv
Congratulations Shannon O’Donnell, Diane Guerrero, Irina Potapova, and Shannon Doolittle, Student Success Fee Funding Recipients!
Undergraduate:
Shannon O'Donnell (Faculty Sponsor: Peter Torre): Excellence in SLHS Student Research
The goal for this proposed project is directly in line with the San Diego State University mission to have students, at all levels, be involved in research. This proposal is requesting travel support for students to independently present at a national conference.
MA Program:
Diane Guerrero (Faculty Sponsor: Sonja Pruitt-Lord): Speech Language Pathology CSHA Convention
Funds are requested to support 20 undergraduate, graduate and doctoral students in attending the 2018 CSHA Convention being held in Sacramento, CA, March 22-25, 2018. Funds will be used to pay for student registration, airfare, and hotel costs.
SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders:
Irina Potapova (Faculty Sponsor: Sonja Pruitt-Lord): Fourth Annual Speech, Language and Hearing Awareness and Information Day (SAID)
Professional development events for students in Speech, Language and Hearing Sciences and peers in related fields (e.g., Education, Public Health, Physical Therapy). The project includes a professional mentoring event and our fourth annual Speech, Language and Hearing Awareness and Information Day.
SDSU/UCSD Joint Doctoral Program in Audiology:
Shannon Doolittle (Faculty Sponsor: Laura Dreisbach-Hawe): Speech, Language, and Hearing Sciences Guest Speaker Event
Since 2003, the Student Academy of Audiology has invited internationally-recognized speakers to present their leading research to students of all levels, faculty, and professional members of the community through the generous support of IRA funds provided by the College of Health and Human Sciences.
http://ift.tt/2Ai5uji
Clinical Thyroidology High-Impact Articles
FREE ACCESS through December 14, 2017.
Read Now:
Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration
Stephanie A. Fish
Are Wider TSH Cutoffs for Reflex Testing of Free T4 Feasible, Safe and Cost-Effective?
Jacques Orgiazzi
Punctate Echogenic Foci on Thyroid Ultrasound Do Not Necessarily Represent Calcifications on Histopathology
Martin Biermann
Significant Variations of Thyroid Testing in the U.S. Argue for Improved Standardization of Practice Patterns
Angela M. Leung
The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.
http://ift.tt/2iuNGv4
Clinical Thyroidology High-Impact Articles
FREE ACCESS through December 14, 2017.
Read Now:
Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration
Stephanie A. Fish
Are Wider TSH Cutoffs for Reflex Testing of Free T4 Feasible, Safe and Cost-Effective?
Jacques Orgiazzi
Punctate Echogenic Foci on Thyroid Ultrasound Do Not Necessarily Represent Calcifications on Histopathology
Martin Biermann
Significant Variations of Thyroid Testing in the U.S. Argue for Improved Standardization of Practice Patterns
Angela M. Leung
The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.
http://ift.tt/2iuNGv4
Transformation of sulfaquinoxaline by chlorine and UV light in water: kinetics and by-product identification
Abstract
Sulfaquinoxaline (SQX) is an antimicrobial of the sulfonamide class, frequently detected at low levels in drinking and surface water as organic micropollutant. The main goal of the present study is the evaluation of SQX reactivity during chlorination and UV irradiations which are two processes mainly used in water treatment plants. The SQX transformation by chlorination and UV lights (254 nm) was investigated in purified water at common conditions used for water disinfection (pH = 7.2, temperature = 25 °C, [chlorine] = 3 mg L−1). The result shows a slow degradation of SQX during photolysis compared with chlorination process. Kinetic studies that fitted a fluence-based first-order kinetic model were used to determine the kinetic constants of SQX degradation; they were equal to 0.7 × 10−4 and 0.7 × 10−2 s−1corresponding to the half time lives of 162 and 1.64 min during photolysis and chlorination, respectively. In the second step, seven by-products were generated during a chlorination and photo-transformation of SQX and identified using liquid chromatography with electrospray ionization and tandem mass spectrometry (MS-MS). SO2 extrusion and direct decomposition were the common degradation pathway during photolysis and chlorination. Hydroxylation and isomerization were observed during photodegradation only while electrophilic substitution was observed during chlorination process.
http://ift.tt/2i5H2aS
Comparative studies on the performance and emissions of a direct injection diesel engine fueled with neem oil and pumpkin seed oil biodiesel with and without fuel preheater
Abstract
In the present experimental analysis, two non-edible oils namely neem oil and pumpkin seed oil were considered. They are converted into respective biodiesels namely neem oil methyl ester (B1) and pumpkin seed oil methyl ester (B2) through transesterification process and their physical and chemical properties were examined using ASTM standards. Diesel was used as a baseline fuel in Kirloskar TV1 model direct injection four stroke diesel engine. A fuel preheater was designed and fabricated to operate at various temperatures (60, 70, and 80 °C). Diesel showed higher brake thermal efficiency (BTE) than biodiesel samples. Lower brake specific fuel consumption (BSFC) was obtained with diesel than B1 sample. B1 exhibited lower BSFC than B2 sample without preheating process. High preheating temperature (80 °C) results in lower fuel consumption for B1 sample. The engine emission characteristics like carbon monoxide (CO), hydrocarbon (HC), and smoke were found lower with B1 sample than diesel and B2 except oxides of nitrogen (NOx) emission. In preheating of fuel, B1 sample with high preheating temperature showed lower CO, HC, and smoke emission (except NOx) than B2 sample.
http://ift.tt/2jBxchk
Effects of lead, cadmium, chromium, and arsenic on the sorption of lindane and norfloxacin by river biofilms, particles, and sediments
Abstract
The sorption of both classic and emerging organic contaminants onto aquatic solids is a critical process that controls their fate in natural waters. Sorption is affected by numerous factors, including coexisting heavy metals. The mechanisms of the influence of heavy metals, especially those occurring in acid radical anions, are still unclear. Here, the effects of Pb, Cd, Cr, and As on the sorption of lindane and norfloxacin (NOR) onto natural biofilms, suspended particles, and sediments from one river were investigated following batch equilibration methods. In addition, changes in representative components that have important roles in sorption from these solids in the presence and absence of metals were characterized by spectrum analyses. The results indicated that sorption of lindane and NOR on the three solids in the absence of heavy metals was highly linear and nonlinear, respectively. Pb and Cd promoted and Cr and As suppressed hydrophobic lindane sorption on the three solids. This was because Pb and Cd enhanced but Cr and As weakened the hydrophobicity of these solids. Pb, Cd, Cr, and As decreased NOR sorption on sediments and suspended particles at pH 5.7~6.3. This was due to electrostatic competition between cationic Pb/Cd and NORH2+, and the combination of Cr/As acid radicals with NORH2+, which suppressed its ion-exchange adsorption. Pb, Cd, Cr, and As generally increased the sorption of NOR onto the biofilms at pH 5.7~6.3. Pb and Cd strengthened the flocculation of dissolved organic matter combined with NORH2+ onto the biofilms. Cr and As enhanced the hydrophilicity of biofilms, and then increased their sorption of NOR with active hydrophilic groups. The mechanisms of how different heavy metals affect NOR sorption by biofilms were more complicated than the mechanisms affecting lindane sorption, as well as by sediments and particles.
http://ift.tt/2AlAcWJ
Citation for the 2016 BAOMS Surgery Prize - Kathleen Fan
The BAOMS Surgery Prize is awarded by the association to the fellow who in their first 10 years of consultant practice has made a major contribution to Oral and Maxillofacial Surgery.
http://ift.tt/2itoo0c
In reference to “Central nervous system anomalies in craniofacial microsomia: a systematic review”
We read with interest the in-depth review by Renkema and colleagues on central nervous system (CNS) involvement in patients affected by craniofacial microsomia1. In this article, the authors clearly showed that CNS abnormalities are commonly detected (2–69%), thus confirming that malformations in craniofacial microsomia go far beyond isolated skeletal abnormalities. The authors also underlined the need to investigate further the true prevalence rate of CNS involvement through the performance of dedicated studies, and attributed the wide range of CNS abnormality detection rates to selection bias, as patients with neurological symptoms are more likely to undergo neuroimaging studies.
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Anaesthetic efficacy of 4% articaine compared with 2% mepivacaine: a randomized, double-blind, crossover clinical trial
The aim of this study was to evaluate the clinical efficacy of 4% articaine (Ar4) compared to 2% mepivacaine (Me2), both in combination with 1:100,000 epinephrine, in a unique soft tissue model. This was a randomized, double-blind, crossover clinical trial. The anaesthetic was applied to the lower lip using a computerized local delivery system. The following were evaluated: blood flow, thermal sensation, pressure and proprioception, extent of anaesthesia, gradual elimination, and the final duration of the effect of the anaesthesia.
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Development of a fluorescence-image scoring system for assessing noncavitated occlusal caries
Source:Photodiagnosis and Photodynamic Therapy, Volume 21
Author(s): Eun-Ha Jung, Eun-Song Lee, Hoi-In Jung, Si-Mook Kang, Elbert de Josselin de Jong, Baek-Il Kim
BackgroundThis study aimed (1) to develop a scoring system based on a quantitative light-induced fluorescence (QLF) score for the occlusal caries (QS-Occlusal) that standardizes the fluorescence properties of noncavitated lesions from QLF images, (2) to confirm the validity and reliability of QS-Occlusal, and (3) to determine whether it is possible to replace existing clinical examinations by image evaluations based on the developed QS-Occlusal for assessing occlusal caries lesions.MethodsThis clinical study investigated 791 teeth of 94 subjects. The teeth were assessed by visual and tactile examinations using ICDAS criteria and quantitative light-induced fluorescence-digital (QLF-D) image examinations. QS-Occlusal was divided into four stages (from 0 to 3) based on the progression level of the lesion and the fluorescence loss and red fluorescence on captured QLF-D images. Two trained examiners who were not involved in the visual examination evaluated occlusal fluorescence images using QS-Occlusal. The maximum loss of fluorescence (|ΔFmax|) and the maximum change in the ratio of red and green fluorescence (ΔRmax) were quantitatively analyzed by the QA2 software to detect differences between the QS-Occlusal groups. The modalities were compared in terms of sensitivity, specificity, and area under the receiver operating characteristics (AUROC) curve for three different thresholds of the ICDAS codes: 0 vs 1–4 (D1), 0–2 vs 3/4 (D2), and 0–3 vs 4 (D3).Results|ΔFmax| increased significantly by about 4.7-fold (from 15.94 to 75.63) when QS-Occlusal increased from 0 to 3. ΔRmax was about 6.2-fold higher for QS-Occlusal=1 (49.74) than for QS-Occlusal=0 (8.04), and 21.6-fold higher for QS-Occlusal=3 (P<0.05). The new QS-Occlusal showed an excellent AUROC (ranging from 0.807 to 0.976) in detecting occlusal caries when optimum cutoff values were applied. The intra- and interexaminer agreements indicated excellent reliability, with ICC values of 0.94 and 0.86, respectively.ConclusionsThe QS-Occlusal proposed in this study can be used in the clinical detection of noncavitated lesions with an excellent diagnostic ability. This makes it possible to replace clinical examinations and intuitively evaluate the lesion severity and status relatively easily and objectively by applying this scoring system to fluorescence images.
http://ift.tt/2AuQM97
Intense phototoxic reactions to photodynamic therapy in immunosuppressed renal transplant patients
Source:Photodiagnosis and Photodynamic Therapy, Volume 21
Author(s): V.K. Ortner, M. Haedersdal, H.C. Wulf, K. Togsverd-Bo
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Infections in Early Life and Development of Celiac Disease
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Maternal Lifetime Stress and Prenatal Psychological Functioning and Decreased Placental Mitochondrial DNA Copy Number in the PRISM Study
http://ift.tt/2BpLOYi
Measuring the Impact of Disasters Using Publicly Available Data: Application to Hurricane Sandy (2012)
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Work-Related Biomechanical Exposure and Job Strain as Separate and Joint Predictors of Musculoskeletal Diseases: A 28-Year Prospective Follow-up Study
http://ift.tt/2Bo368g
Group-Based Trajectory of Body Shape From Ages 5 to 55 Years and Cardiometabolic Disease Risk in 2 US Cohorts
http://ift.tt/2j6cMNK
Advanced Maternal Age and the Risk of Low Birth Weight and Preterm Delivery: a Within-Family Analysis Using Finnish Population Registers
http://ift.tt/2BpROjD
Neighborhood Physical Environment and Changes in Body Mass Index: Results From the Multi-Ethnic Study of Atherosclerosis
http://ift.tt/2j6mzTY
Voice Profile Recovery and Quality of Life Changes After Microdirect Laryngoscopy in Three Categories of Glottis Lesions: Benign, Precancerous, and Malignant
The aim of the study was comparison of voice and life quality after microdirect laryngoscopy in three patient histopathological categories: benign, precancerous, and malignant glottic lesions. A totalnof 137 patients treated with microdirect laryngoscopy were included in the study. Each patient was evaluated with a multidimensional protocol before and 3, 6, and 12 months after treatment. Final 1-year evaluations were achieved in 74.5% (102). The assessment included laryngovideostroboscopy (LVS), perceptual (GRBAS) grading, aerodynamic measures including maximum phonation time and phonation quotient and acoustic measurements (Kay Elemetrics Multi-Speech program), Voice Handicap Index (VHI), Voice-Related Quality of Life questionnaire; and World Health Organization Quality of Life Scale-Brief Version (WHOQoL-BREF).
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Historical anthropogenic mercury in two lakes of Central Chile: comparison between an urban and rural lake
Abstract
Mercury concentrations in the environment tend to decrease in recent years due to environmental restrictions. Lakes store mercury in their sediments, making them potential secondary contamination sources. In South America, the occurrence of mercury in lake systems has been associated mainly with volcanic emissions and only few records anthropogenic contamination in the pre-Hispanic period. The objective of this research was to study historical anthropogenic mercury concentration in two lakes in Central Chile (La Señoraza and Pillo), in order to establish background mercury levels and their variations from preindustrial to modern periods. Different background levels and mercury concentrations were found in each lake, with significantly higher concentrations in Lake La Señoraza during the last 150 years. Mining-related activities during the nineteenth century could have a negligible influence on mercury concentrations. Later on, the use of coal railroads and subsequent employment of mercury in the cellulose industry were associated with three- and fourfold increases in mercury concentration over the nineteenth century background levels, which decrease once these activities ceased. However, in the case of Lake Pillo, an important increase in mercury concentration can be observed between 1990 and the early twenty-first century, which could be related to a higher watershed/lake area ratio, extensive agriculture, and volcanic emission, being the latter that could have contributed with mercury to both systems. Nevertheless, sedimentological characteristics in Lake Pillo can be favorable to retain mercury in this aquatic system up to the present day.
http://ift.tt/2AoIbCz
Spatio-temporal evaluation of emerging contaminants and their partitioning along a Brazilian watershed
Abstract
The occurrence, partitioning, and spatio-temporal distribution of seven pharmaceuticals for human use, three steroid hormones and one personal care product were determined in surface water, suspended particulate matter (SPM), and sediment of Piraí Creek and Jundiaí River (Jundiaí River Basin, São Paulo, Brazil). The maximum average detected concentrations of the compounds in the Piraí River samples were < 30 ng L−1, except for caffeine (222 ng L−1). In Jundiaí River samples, most of the compounds were frequently detected, wherein caffeine had the highest concentration, with maximum average concentrations of 14,050 ng L−1, followed by atenolol (431 ng L−1), ibuprofen (268 ng L−1) and diclofenac (214 ng L−1). Atenolol, propranolol, estrone, and triclosan were the contaminants most frequently detected in sediment and SPM samples. Triclosan had the highest average proportion of SPM as opposed to in the aqueous phase (> 75%). Contaminants with acid functional groups showed, in general, a lower tendency to bind to particulate matter and sediments. In addition, hydrophobicity had an important effect on their environmental partitioning. The spatial distribution of contaminants along the Jundiaí River was mainly affected by the higher concentration of contaminants in water samples collected downstream from a sewage treatment plant (STP). The results obtained here clearly showed the importance of the analysis of some contaminants in the whole water, meaning both dissolved and particulate compartments in the water, and that the partitioning is ruled by a set of parameters associated to the physicochemical characteristics of contaminants and the matrix properties of the studied, which need be considered in an integrated approach to understand the fate of emerging chemical contaminants in aquatic environments.
http://ift.tt/2AhN9Tu
Commentary to letter to the editor to manuscript “Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life”
We indeed appreciate the comments of Dr. Singh Bakshi and would like to take the opportunity to remark on them.
http://ift.tt/2zRdDfL
Commentary to letter to the editor to manuscript “Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life”
We indeed appreciate the comments of Dr. Singh Bakshi and would like to take the opportunity to remark on them.
http://ift.tt/2zRdDfL
Retrograde parotidectomy and facial nerve outcomes: A case series of 44 patients (Letter to Editor)
I read with interest about the nicely written article entitled "Retrograde Parotidectomy and Facial Nerve Outcomes: A case Series of 44 Patients" by Kligerman et al. [1]. I would like to congratulate the authors on their good results of retrograde parotidectomy. They demonstrated that the complications after retrograde parotidectomy, especially of facial nerve injury, are not inferior to the counterpart of antegrade parotidectomy. In addition, the former approach could achieve a low wound complication rate of 6.8% and facilitate outpatient surgery.
http://ift.tt/2AJYjSj
Pemphigus and hematologic malignancies: A population-based study of 11,859 patients
Hematologic malignancies have been reported sporadically in patients with pemphigus.In the current study, significant associations were observed between pemphigus and chronic leukemia, multiple myeloma, and non-Hodgkin lymphoma.Further research is needed to confirm these findings in other cohorts.
http://ift.tt/2BA4fKv
Mitotic Rate is Associated with Positive Lymph Nodes in Thin Melanomas
Mitotic rate will be removed from melanoma staging guidelines in 2018 Mitotic rate is strongly associated with lymph node status in patients with thin cutaneous melanoma Pathology reports should continue to report mitotic rate for cutaneous melanoma
http://ift.tt/2keKKDn
2017 Highlights
Patient Success Stories Otorhinolaryngology And Neurosurgery Team Up To Maximize The Outcome For A Patient With Pituitary Tumor Virtual Presurgical... Read the full article...
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Issue Highlights
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
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Contents
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
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Partial Contents of Volume 54, Number 1
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
http://ift.tt/2j3n6Gv
Blood Biomarkers for the Early Diagnosis of Stroke
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Heather Roesly
http://ift.tt/2Bq5Odj
Management of Pediatric Perforated Appendicitis
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Forrest Andersen
http://ift.tt/2j3lCMk
Physician, Interrupted: Workflow Interruptions and Patient Care in the Emergency Department
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Renaldo C. Blocker, Heather A. Heaton, Katherine L. Forsyth, Hunter J. Hawthorne, Nibras El-Sherif, M. Fernanda Bellolio, David M. Nestler, Thomas R. Hellmich, Kalyan S. Pasupathy, M. Susan Hallbeck
BackgroundIt is unclear how workflow interruptions impact emergency physicians at the point of care.ObjectivesOur study aimed to evaluate interruption characteristics experienced by academic emergency physicians.MethodsThis prospective, observational study collected interruptions during attending physician shifts. An interruption is defined as any break in performance of a human activity that briefly requires attention. One observer captured interruptions using a validated tablet PC-based tool that time stamped and categorized the data. Data collected included: 1) type, 2) priority of interruption to original task, and 3) physical location of the interruption. A Kruskal-Wallis H test compared interruption priority and duration. A chi-squared analysis examined the priority of interruptions in and outside of the patient rooms.ResultsA total of 2355 interruptions were identified across 210 clinical hours and 28 shifts (means = 84.1 interruptions per shift, standard deviation = 14.5; means = 11.21 interruptions per hour, standard deviation = 4.45). Physicians experienced face-to-face physician interruptions most frequently (26.0%), followed by face-to-face nurse communication (21.7%), and environment (20.8%). There was a statistically significant difference in interruption duration based on the interruption priority, χ2(2) = 643.98, p < 0.001, where durations increased as priority increased. Whereas medium/normal interruptions accounted for 53.6% of the total interruptions, 53% of the interruptions that occurred in the patient room (n = 162/308) were considered low priority (χ2 [2, n = 2355] = 78.43, p < 0.001).ConclusionsOur study examined interruptions over entire provider shifts and identified patient rooms as high risk for low-priority interruptions. Targeting provider-centered interventions to patient rooms may aid in mitigating the impacts of interruptions on patient safety and enhancing clinical care.
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Comparison of Lactic Acid Levels in Children with Suspected and Confirmed Intussusception
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Vanessa Tamas, Paul Ishimine
BackgroundCurrently, no laboratory test can identify children with intussusception. Lactic acid is a marker of ischemia in gastrointestinal emergencies.ObjectivesWe present a case series comparing lactic acid levels in children with suspected and confirmed intussusception.MethodsThis is a prospective single case series of 39 patients who had suspected intussusception. Patients were eligible if they underwent abdominal ultrasound screening for suspected intussusception. Blood collected at the time of peripheral intravenous line placement was analyzed for lactic acid levels before ultrasound.ResultsThirty-nine patients were enrolled; 16 were diagnosed with intussusception. Mean (± standard deviation) lactic acid levels were not significantly different between children with suspected (1.7 ± 0.69 mmol/L) and confirmed intussusception (1.93 ± 1.13 mmol/L).ConclusionsLactic acid levels cannot identify children with intussusception.
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Emergency Coagulation Assessment During Treatment with Direct Oral Anticoagulants
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Krysia Crabtree
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Emergency Medicine Myths: Ectopic Pregnancy Evaluation, Risk Factors, and Presentation
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Jennifer J. Robertson, Brit Long, Alex Koyfman
BackgroundEctopic pregnancy (EP) is an important cause of morbidity and mortality in females of reproductive age. Proper diagnosis and treatment are critical, as complications such as rupture, hemorrhagic shock, and even death can occur.ObjectiveEP is a condition emergency physicians are trained to detect, yet there are multiple myths concerning its evaluation and diagnosis. This article reviews several of these myths in order to improve emergency department (ED) evaluation and diagnosis.DiscussionEP is a difficult diagnosis and may be missed on initial ED visit. While the diagnosis is often delayed simply due to very early presentations, it can also be missed because patients may not have all the same risk factors or demonstrate the same symptoms. They may also not demonstrate the same serum B-human chorionic gonadotropin levels and trends or have the same ultrasound findings at equivalent gestational ages. Some patients with early EP may have positive ultrasound findings with serum β-hCG levels under a defined discriminatory zone (DZ). On the other hand, some patients with an early viable intrauterine pregnancy may have no visible findings on initial ultrasound, but have serum β-hCG (quantitative) levels well above the DZ. Although rare, EP has even been demonstrated in women with negative urine β-hCG tests or low serum β-hCG levels.ConclusionsWhile EP may be a challenging diagnosis, understanding the myths surrounding EP may help emergency physicians consider it, even when patient risk factors, symptoms, or ED laboratory or imaging studies do not initially or easily define the diagnosis.
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Rotational Thromboelastometry Significantly Optimizes Transfusion Practices for Damage Control Resuscitation in Combat Casualties
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Heather Roesly
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Patterns and Outcomes Associated with Timeliness of Initial Crystalloid Resuscitation in Prospective Sepsis and Septic Shock Cohort
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Forrest Andersen
http://ift.tt/2BpFRuy
Unintentional Marijuana Exposure Presenting as Altered Mental Status in the Pediatric Emergency Department: A Case Series
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Anita A. Thomas, Suzan Mazor
BackgroundUnintentional tetrahydrocannabinol (THC) exposure in pediatric patients can present as altered mental status. Altered mental status in a pediatric patient often leads to invasive diagnostic testing.Case ReportThe following cases describe 3 pediatric patients in Washington state who presented to a tertiary care children's hospital emergency department (ED) with altered mental status, later found to have urine toxicology screening positive for inactive THC metabolite (positive THC toxicology screen). Case 1 is a 6-year-old boy who presented with vomiting, lethargy, and hallucinations. Case 2 is a 5-year-old girl who presented with nausea, slurred speech, ataxia, and lethargy in the setting of a minor head injury. Case 3 is a 7-month-old boy who presented with vomiting and lethargy in the setting of a minor fall the day prior to ED evaluation. All children had extensive work-ups before the diagnosis was made; 2 were discharged home and 1 was admitted to the pediatric intensive care unit.Why Should an Emergency Physician Be Aware of This?As access to marijuana increases with growing legalization, it is important to be familiar with state marijuana legislation, to consider and ask families about access to marijuana products as a potential contributor to altered mental status, and to be aware of potential caretaker reluctance regarding disclosure of marijuana use secondary to perceived stigma. Maintaining awareness of the clinical effects of THC exposure in children may limit invasive testing in a hemodynamically stable child with altered mental status.
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Klebsiella pneumoniae Invasive Liver Abscess Syndrome and Endophthalmitis
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Beuy Joob, Viroj Wiwanitkit
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Low Yield of Clinically Significant Injury With Head-To-Pelvis Computed Tomography in Blunt Trauma Evaluation
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Shelby P. Murphy, Noah Hawthorne, David Haase, Chika Chiku, Jason Wen, Robert M. Rodriguez
BackgroundMany trauma centers have adopted routine head-to-pelvis computed tomography (CT) imaging for the evaluation of adults with blunt trauma.ObjectiveWe sought to determine the yields of detecting clinically significant injuries (CSIs) with CT in >1 anatomic region.MethodsWe conducted this observational cohort study of all trauma activation patients >14 years of age who received CT imaging during blunt trauma evaluation at a Level 1 trauma center from April to October 2014. Expert panels determined the clinical significance of head, neck, chest, abdomen, and pelvis injuries seen on CT. We calculated yields of CSI, defined as the number of patients with CSI divided by the total number of patients who underwent CT imaging. The 3 specified anatomic regions considered were head/neck, chest, and abdomen/pelvis.ResultsThe median age of 1236 patients who had CT was 48 years; 69% were male; 51.2% were admitted; and hospital mortality was 4.4%. Yields of CSI with 95% confidence intervals (CIs) were: head/neck region injury 11.3% (9.6–13.3%); chest region injury only 7.9% (6.0–10.4%); abdomen/pelvis region injury only 5.1% (3.7–7.0%); both head/neck and chest CSI 2.8% (1.7–4.5%); both head/neck and abdomen/pelvis CSI 1.6% (0.9–2.9%); and both chest and abdomen/pelvis CSI 1.1% (0.5–2.4%). The yield of CSI in all 3 anatomic regions with head-to-pelvis CT was 0.6% (0.2–1.7%), and 76.7% (68.8–83.1%) of CSIs occurred in isolation.ConclusionsDuring multiple anatomic region CT imagng for adult blunt trauma evaluation, the yield for CSI in >1 region is low. In low-risk populations, selective CT imaging of anatomic regions (instead of reflexive head-to-pelvis CT imaging) may be more appropriate.
http://ift.tt/2BptfDo
Expedited Discharge from an Academic Emergency Department: A Pilot Program
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Andrew Goldsmith, Luis Ticona, Ryan Thompson, Benjamin A. White, Joan Strauss, Robert Seger, David F.M. Brown, Ali S. Raja, Brian J. Yun
BackgroundAs the numbers of emergency department (ED) visits and inpatient admissions continue to increase, there is growing interest in alternatives to inpatient hospitalization.ObjectiveOur aim was to investigate a novel approach to expediting discharges from the ED with multidisciplinary discharge services to prevent an avoidable admission into the hospital.MethodsThis pilot study was conducted at a large urban tertiary-care ED in 2016. All patients presenting to the ED with planned inpatient or observation admission were considered for discharge with enhanced discharge planning services. The patients selected, discharge diagnoses, and outcomes were analyzed by descriptive statistics. This study was approved by the study site's Institutional Review Board, including waiver of patient consent.ResultsDuring the pilot period, 57 out of 143 (40%) selected patients with planned admission were discharged with enhanced discharge planning services. Median ED length of stay was 17.2 h and mean patient age was 73 years old. Of these patients, 7 (12%) returned within 72 h and 4 (0.07%) were subsequently admitted to the hospital.ConclusionsIn this pilot study, a novel approach to expediting discharges from the ED with multidisciplinary discharge services was feasible and resulted in fewer admissions to the hospital.
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Health Care Usage and Suicide Risk Screening within 1 Year of Suicide Death
Source:The Journal of Emergency Medicine, Volume 53, Issue 6
Author(s): Amy R. Stuck, Michael P. Wilson, Christen E. Chalmers, Jonathan Lucas, Andrew Sarkin, Kyle Choi, Kimberly Center
BackgroundResearch indicates patients often seek medical care within 1 year of suicide. Health care encounters are a crucial opportunity for health professionals to identify patients at highest risk and provide preventative services.ObjectiveStudy aims were to determine the characteristics of persons seeking health care within 12 months of suicide death and evaluate suicide risk screening (SRS) frequency in the emergency department (ED) vs. clinic settings.MethodsMedical examiner and hospital data of patients who died by suicide from 2007 to 2013 were evaluated. Descriptive analyses included demographics and frequency of ED vs. clinic visits. We also compared SRS before and after implementation of The Joint Commission's recommendation to assess suicide risk.ResultsThe 224 deceased patients were primarily single white males (mean age 67 years). Mental health issues, substance abuse, and prior suicide attempts were present alone or in combination in 74%. Visits were primarily behavioral health or substance abuse problems in the ED, and medical issues in the clinic. After implementation of universal SRS in the ED, screening increased from 39% to 92%. Among patients screened in the ED, 73% (37 of 51) screened negative for suicide risk.ConclusionsUniversal SRS increased the number of people screened in the ED. However, negative SRS may not equate to reduced risk for future suicide within 1 year. Future studies might investigate targeted screening of individuals with known suicide risk factors, as well as alternatives to patient self-report of intent to self-harm for patients with mental health or substance abuse problems.
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The effect of time restricted visual sensory input on asymmetry of ground reaction force components in female children
Publication date: Available online 29 November 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Mozhgan Faraji Aylar, AmirAli Jafarnezhadgero, Fatemeh Salari Esker, Robert Barber, D.G.E. Robertson
The association between visual sensory and the asymmetry index of sit-to-stand ground reaction force characteristics is not fully understood. Therefore, the purpose of this study was to investigate asymmetry index of sit-to-stand ground reaction forces, their times–to-peak, vertical loading rate, impulses, and free moment in blind and sighted children. 15 female children with congenital blindness and 30 healthy girls with no visual impairments volunteered to participate in this study. The girls with congenital blindness were placed in one group and the girls with no visual impairments were randomly divided into two groups of 15. The two condition groups consisted of, one eyes open and the other, eyes closed. The participants in the eyes closed group were asked to close their eyes for 20 min before the test, whereas those in the eyes open group kept their eyes open. Kinematic and kinetic data were collected using an eight-camera motion analysis system synchronized with two force plates embedded in the floor. A MANOVA test was run for between-group comparisons. There were no distinctive biomechanical alternations in all axes of ground reaction forces and their times-to-peak, vertical loading rate, impulses and free moments in congenital blindness and eyes closed groups compared with the eyes open group. However, eyes closed was associated with increased total time and second phase duration of sit-to-stand performance by 69% (p = 0.008) and 62% (p = 0.008), respectively. These findings reveal that individuals who are visually restricted in the short term, do not develop stereotypical movement strategies for sit-to-stand.
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An examination of the relationship between dynamic knee joint stiffness and gait pattern of children with cerebral palsy
Publication date: Available online 29 November 2017
Source:Journal of Bodywork and Movement Therapies
Author(s): Manuela Galli, Veronica Cimolin, Claudia Condoluci, Pier Francesco Costici, Reinald Brunner
Dynamic joint stiffness represents the resistance that a joint opposes to an applied moment. Stiffness arises in conditions of joint laxity, instability and increased co-contraction and is commonly utilized as a means to stabilize the joint. The knee joint seems to be crucial for determining the walking pattern. The aim of this study was to investigate the association between the gait pattern, globally quantified by the Gait Profile Score (GPS), which indicates the 'quality' of a particular walking strategy, and knee dynamic joint stiffness (Kk) in children with diplegia. Kk is expressed by plotting the values of the knee flexion-extension moment versus the knee flexion-extension angle during weight acceptance. In this interval, the linear regression was fitted. The angular coefficient of the linear regression corresponded to the joint stiffness index. Sixty-one children with diplegia and 18 healthy individuals took part in this study. From their gait analysis data, the GPS (with its Gait Variable Scores-GVSs) and the Kk were calculated. Data showed that GPS (p = 2.73 × 10−21) and GVSs values for the patients with diplegia were higher in comparison to healthy controls. The Kk values for patients were not statistically different from those of controls. The correlation between Kk and GPS did not show the presence of any significant relationship (r = −0.04; p > 0.05). Thus, the functional limitation in diplegic children does not seems to be strictly related to Kk.
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The Clinicopathological Study of Benign Lesions of Vocal Cords
Abstract
Benign vocal lesions are non-malignant growths of abnormal tissue on the vocal cords. The common benign lesions of vocal cord are singer's nodule, polyps, papilloma, polypoidal degeneration and cysts. The aim of this study was to analyze the demographics such as age, sex, occupation, symptomatology, site of involvement. An objective evaluation of voice handicap was done pre and postoperatively using VHI-10 scale to see improvement in patient's symptoms. In this prospective study, a total of 50 cases were selected with benign lesions in regional hospital of India. The pre and post operative assessment for voice handicap was assessed by VHI-10. Chi square test (SPSS 20.0 version) used to analyze result; value of p < 0.05 was taken significant. In this study of 50 patients, the benign lesions were most common in 20–29 age group. Male (70%) outnumbered females (30%). Most common was Vocal polyp (56%), followed by nodule (32%), cyst (10%) and papilloma (2%) respectively. All patients showed improvement after phonosurgery and postoperative speech therapy, being assessed by VHI-10 scale. The benign lesions of vocal cords produces symptoms which can vary from hoarseness to stridor, affect social functioning, work performance. Speech therapy following microlaryngeal surgery forms an essential part of treatment, to avoid recurrence. VHI-10 scale as found to be a useful and convenient tool in measuring patient voice handicap and to see improvement after surgery.
http://ift.tt/2AlSF5G
The Clinicopathological Study of Benign Lesions of Vocal Cords
Abstract
Benign vocal lesions are non-malignant growths of abnormal tissue on the vocal cords. The common benign lesions of vocal cord are singer's nodule, polyps, papilloma, polypoidal degeneration and cysts. The aim of this study was to analyze the demographics such as age, sex, occupation, symptomatology, site of involvement. An objective evaluation of voice handicap was done pre and postoperatively using VHI-10 scale to see improvement in patient's symptoms. In this prospective study, a total of 50 cases were selected with benign lesions in regional hospital of India. The pre and post operative assessment for voice handicap was assessed by VHI-10. Chi square test (SPSS 20.0 version) used to analyze result; value of p < 0.05 was taken significant. In this study of 50 patients, the benign lesions were most common in 20–29 age group. Male (70%) outnumbered females (30%). Most common was Vocal polyp (56%), followed by nodule (32%), cyst (10%) and papilloma (2%) respectively. All patients showed improvement after phonosurgery and postoperative speech therapy, being assessed by VHI-10 scale. The benign lesions of vocal cords produces symptoms which can vary from hoarseness to stridor, affect social functioning, work performance. Speech therapy following microlaryngeal surgery forms an essential part of treatment, to avoid recurrence. VHI-10 scale as found to be a useful and convenient tool in measuring patient voice handicap and to see improvement after surgery.
http://ift.tt/2AlSF5G
Peak Nasal Inspiratory Flow as an Objective Measure
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Length of Stay for Free Tissue Transfer to Head and Neck Defects
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Association of Hearing Loss and Otologic Outcomes With Fibrous Dysplasia
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Association of Lymph Node Density With Survival in Papillary Thyroid Cancer
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Asymptomatic Septal Mass
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Association of Hearing Loss and Otologic Outcomes With Fibrous Dysplasia
http://ift.tt/2Bz3gKL
Association of Lymph Node Density With Survival in Papillary Thyroid Cancer
http://ift.tt/2kd5ew5
Asymptomatic Septal Mass
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Indoor air quality of everyday use spaces dedicated to specific purposes—a review
Abstract
According to literature data, some of the main factors which significantly affect the quality of the indoor environment in residential households or apartments are human activities such as cooking, smoking, cleaning, and indoor exercising. The paper presents a literature overview related to air quality in everyday use spaces dedicated to specific purposes which are integral parts of residential buildings, such as kitchens, basements, and individual garages. Some aspects of air quality in large-scale car parks, as a specific type of indoor environment, are also discussed. All those areas are characterized by relatively short time use. On the other hand, high and very high concentration levels of xenobiotics can be observed, resulting in higher exposure risk. The main compounds or group of chemical compounds are presented and discussed. The main factors influencing the type and amount of chemical pollutants present in the air of such areas are indicated.
http://ift.tt/2AtjEyy
Water quality in simulated eutrophic shallow lakes in the presence of periphyton under different flow conditions
Abstract
Although the effects of periphyton on water quality and its relationship with flow conditions have been studied by researchers, our understanding about their combined action in eutrophic shallow lakes is poor. In this research, four aquatic model ecosystems with different water circulation rates and hydraulic conditions were constructed to investigate the effect of periphyton and flow condition on water quality. The concentrations of NH4+, TP, and chlorophyll–a and flow conditions were determined. The results show that, as a result of the rising nutrient level at the early stage and the decline in the lower limit, the presence of periphyton can make the ecosystem adaptable to a wider range of nutrients concentration. In terms of the flow condition, the circulation rate and hydraulic condition are influential factors for aquatic ecosystem. Higher circulation rate in the ecosystem, on one hand, facilitates the metabolism by accelerating nutrient cycling which is beneficial to water quality; on the other hand, high circulation rate leads to the nutrient lower limit rising which is harmful to water quality improvement. At low velocities, slight differences in hydraulic conditions, vertical velocity gradient and turbulence intensity gradient could affect the quantity of phytoplankton. Our study suggests that, considering environmental effect of periphyton, flow conditions and their combined action is essential for water quality improvement and ecological restoration in eutrophic shallow lakes.
http://ift.tt/2i499ac
The Clinicopathological Study of Benign Lesions of Vocal Cords
Abstract
Benign vocal lesions are non-malignant growths of abnormal tissue on the vocal cords. The common benign lesions of vocal cord are singer's nodule, polyps, papilloma, polypoidal degeneration and cysts. The aim of this study was to analyze the demographics such as age, sex, occupation, symptomatology, site of involvement. An objective evaluation of voice handicap was done pre and postoperatively using VHI-10 scale to see improvement in patient's symptoms. In this prospective study, a total of 50 cases were selected with benign lesions in regional hospital of India. The pre and post operative assessment for voice handicap was assessed by VHI-10. Chi square test (SPSS 20.0 version) used to analyze result; value of p < 0.05 was taken significant. In this study of 50 patients, the benign lesions were most common in 20–29 age group. Male (70%) outnumbered females (30%). Most common was Vocal polyp (56%), followed by nodule (32%), cyst (10%) and papilloma (2%) respectively. All patients showed improvement after phonosurgery and postoperative speech therapy, being assessed by VHI-10 scale. The benign lesions of vocal cords produces symptoms which can vary from hoarseness to stridor, affect social functioning, work performance. Speech therapy following microlaryngeal surgery forms an essential part of treatment, to avoid recurrence. VHI-10 scale as found to be a useful and convenient tool in measuring patient voice handicap and to see improvement after surgery.
http://ift.tt/2AlSF5G
Trends in Cancer Survival by Health Insurance Status in California From 1997 to 2014
http://ift.tt/2nigpEL
Zoledronic Acid Dosing in Patients With Metastatic Breast Cancer
http://ift.tt/2zDHS5J
Lymph Node Burden and Mortality Risk in Hypopharynx and Larynx Cancer
http://ift.tt/2ngSghX
Metastatic Lymph Node Burden in Hypopharyngeal and Laryngeal Cancer
http://ift.tt/2zCehtq
Efficacy of Medicaid for Patients With Cancer in California
http://ift.tt/2nm5biX
Zoledronic Acid Dosing in Patients With Metastatic Breast Cancer—Reply
http://ift.tt/2zBQxpk
Zoledronic Acid Dosing in Patients With Metastatic Breast Cancer
http://ift.tt/2nfBkIN
The Clinicopathological Study of Benign Lesions of Vocal Cords
Abstract
Benign vocal lesions are non-malignant growths of abnormal tissue on the vocal cords. The common benign lesions of vocal cord are singer's nodule, polyps, papilloma, polypoidal degeneration and cysts. The aim of this study was to analyze the demographics such as age, sex, occupation, symptomatology, site of involvement. An objective evaluation of voice handicap was done pre and postoperatively using VHI-10 scale to see improvement in patient's symptoms. In this prospective study, a total of 50 cases were selected with benign lesions in regional hospital of India. The pre and post operative assessment for voice handicap was assessed by VHI-10. Chi square test (SPSS 20.0 version) used to analyze result; value of p < 0.05 was taken significant. In this study of 50 patients, the benign lesions were most common in 20–29 age group. Male (70%) outnumbered females (30%). Most common was Vocal polyp (56%), followed by nodule (32%), cyst (10%) and papilloma (2%) respectively. All patients showed improvement after phonosurgery and postoperative speech therapy, being assessed by VHI-10 scale. The benign lesions of vocal cords produces symptoms which can vary from hoarseness to stridor, affect social functioning, work performance. Speech therapy following microlaryngeal surgery forms an essential part of treatment, to avoid recurrence. VHI-10 scale as found to be a useful and convenient tool in measuring patient voice handicap and to see improvement after surgery.
http://ift.tt/2AlSF5G
Cancer of the Head of the Pancreas: Early Surgery or Preoperative Biliary Drainage?
Intervention: Device: Tannenbaum Fr 10 stent or WallFlex stent
Sponsor: Helsinki University Central Hospital
Recruiting
http://ift.tt/2Arredd
Pembrolizumab Plus Epacadostat, Pembrolizumab Monotherapy, and the EXTREME Regimen in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (KEYNOTE-669/ECHO-304)
Interventions: Drug: Pembrolizumab; Drug: Epacadostat; Drug: Cetuximab; Drug: Cisplatin; Drug: Carboplatin; Drug: 5-Fluorouracil
Sponsors: Incyte Corporation; Merck Sharp & Dohme Corp.
Not yet recruiting
http://ift.tt/2isbzDC
Radiotherapy vs Neck Dissection for Clinical T1/2N0 Supraglottic Cancer
Interventions: Radiation: Radiatherapy; Procedure: Selective neck dissection
Sponsors: Tianjin Medical University Cancer Institute and Hospital; Tianjin Medical University General Hospital; Tianjin Medical University Second Hospital
Not yet recruiting
http://ift.tt/2ArqV23
Cancer of the Head of the Pancreas: Early Surgery or Preoperative Biliary Drainage?
Intervention: Device: Tannenbaum Fr 10 stent or WallFlex stent
Sponsor: Helsinki University Central Hospital
Recruiting
http://ift.tt/2Arredd
Pembrolizumab Plus Epacadostat, Pembrolizumab Monotherapy, and the EXTREME Regimen in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (KEYNOTE-669/ECHO-304)
Interventions: Drug: Pembrolizumab; Drug: Epacadostat; Drug: Cetuximab; Drug: Cisplatin; Drug: Carboplatin; Drug: 5-Fluorouracil
Sponsors: Incyte Corporation; Merck Sharp & Dohme Corp.
Not yet recruiting
http://ift.tt/2isbzDC
Radiotherapy vs Neck Dissection for Clinical T1/2N0 Supraglottic Cancer
Interventions: Radiation: Radiatherapy; Procedure: Selective neck dissection
Sponsors: Tianjin Medical University Cancer Institute and Hospital; Tianjin Medical University General Hospital; Tianjin Medical University Second Hospital
Not yet recruiting
http://ift.tt/2ArqV23
A genome-wide DNA methylation analysis in peripheral blood from patients identifies risk loci associated with Graves’ orbitopathy
Abstract
Objective
Graves' orbitopathy (GO) is an inflammatory orbital disease of autoimmune origin with the potential to cause severe functional and psychosocial effects. The pathogenesis has not been fully elucidated. We investigated whether DNA methylation was associated with GO incidence in Chinese patients.
Materials and methods
Six GO patients and six age-matched controls were recruited, and genome-wide DNA methylation patterns were analyzed in their peripheral blood. t tests were performed to determine differential methylated sites in genomic regions and the univariable logistic regression analyses was performed to evaluate their risk with GO incidence. Cluster analysis and principal component analysis (PCA) were performed to determine the effects of the extracted differentially methylated sites.
Results
One hundred and forty-eight differentially methylated sites were identified, including CD14 (fold change = 4.31, p = 0.005), IL17RE (fold change = 2.128, p = 0.005), and DRD4 (fold change = 0.25, p = 0.004), and were supported by cluster and PCA analyses. Univariable logistic regression analyses showed that the methylation patterns at 12 loci were associated with GO incidence. The relative risk per 1% decrease in methylation at ZCCHC6 and GLI3 was 0.15 (95% CI 0.03–0.91; p = 0.039) and 0.65 (95% CI 0.42–0.98; p = 0.042), respectively. Pearson correlation analyses demonstrated that methylation levels at IL17RE were positively associated with Clinical Activity Score (CAS) (r = 0.967, p < 0.05).
Conclusions
Our results demonstrate that differential methylation levels at analyzed sites (genes) may be risk markers of GO. DNA methylation analysis could provide new insights into understanding the disease and provide new treatment strategies for GO in Chinese patients.
http://ift.tt/2zDdAAc
NAFLD/NASH in patients with type 2 diabetes and related treatment options
Abstract
Type 2 diabetes may reduce life expectancy and patients' quality of life due to its micro- and macro-vascular complications and to the higher risk of several types of cancer. An emerging important factor is represented by the hepatic involvement; it is recognized that excessive hepatic fat accumulation represents a typical feature of diabetic patients and that it also plays an important pathogenic role. It is now evident that non-alcoholic fatty liver disease (NAFLD), generally perceived as a benign condition, may have on the contrary an important deleterious impact for diabetic patients increasing the risk to develop cardiovascular complications but also serious hepatic diseases, in particular non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Lifestyle intervention, bariatric surgery and several drug therapies have now accumulated evidence of efficacy in treating NASH. On the other hand, their durability and safety in the long-term is yet to be proven and their use may be sometimes associated with side effects or higher risk of adverse events limiting the regular administration or contraindicating it. Professional health care providers, building awareness about the importance of these hepatic complications, should put more efforts in primary prevention using a behavioral therapy needing a multidisciplinary approach, in secondary prevention applying on a regular basis in the clinical setting available predictive algorithms to identify the patients at higher cardiovascular and hepatologic risk, and in tertiary prevention treating, when not contraindicated, the diabetic patients preferentially with drugs with proven benefit on NAFLD/NASH.
http://ift.tt/2nerhUe
Impact assessment of projected climate change on diffuse phosphorous loss in Xin’anjiang catchment, China
Abstract
Diffuse nutrient loss is a serious threat to water security and has severely deteriorated water quality throughout the world. Xin'anjiang catchment, as a main drinking water source for Hangzhou City, has been a national concern for water environment protection with payment for watershed services construction. Detection of diffuse phosphorous (DP) pollution dynamics under climate change is significant for sustainable water quality management. In this study, the impact of projected climate change on DP load was analyzed using SWAT to simulate the future changes of diffuse components (carriers: water discharge and sediment; nutrient: DP) at both station and sub-catchment scales under three climate change scenarios (RCP2.6, RCP4.5, and RCP8.5). Results showed that wetting and warming years were expected with increasing tendencies of both precipitation and temperature in the two future periods (2020s: 2021~2030, 2030s: 2031~2040) except in the 2020s in the RCP2.6 scenario, and the annual average increasing ratios of precipitation and temperature reached − 1.79~3.79% and 0.48~1.27 °C, respectively, comparing with those in the baseline (2000s: 2001~2010). Climate change evidently altered annual and monthly average water discharge and sediment load, while it has a remarkable impact on the timing and monthly value of DP load at station scale. DP load tended to increase in the non-flood season at Yuliang due to strengthened nutrient flushing from rice land into rivers with increasing precipitation and enhanced phosphorous cycle in soil layers with increasing temperature, while it tended to decrease in the flood season at Yuliang and in most months at Tunxi due to restricted phosphorous reaction with reduced dissolved oxygen content and enhanced dilution effect. Spatial variability existed in the changes of sediment load and DP load at sub-catchment scale due to climate change. DP load tended to decrease in most sub-catchments and was the most remarkable in the RCP8.5 scenario (2020s, − 9.00~2.63%; 2030s, − 11.16~7.89%), followed by RCP2.6 (2020s, − 10.00~2.90%; 2030s, − 9.00~6.63%) and RCP4.5 (2020s, − 6.81~5.49%, 2030s, − 10.00~9.09%) scenarios. Decreasing of DP load mainly aggregated in the western and eastern mountainous regions, while it tended to increase in the northern and middle regions. This study was expected to provide insights into diffuse nutrient loss control and management in Xin'anjiang catchment, and scientific references for the implementation of water environmental protection in China.
http://ift.tt/2kcr42I