Environmental snapshots from ACE‐Asia

On five occasions spanning the Asian Pacific Regional Aerosol Characterization Experiment (ACE‐Asia) field campaign in spring 2001, the Multiangle Imaging Spectroradiometer spaceborne instrument took data coincident with high‐quality observations by instruments on two or more surface and airborne platforms. The cases capture a range of clean, polluted, and dusty aerosol conditions. With a three‐stage optical modeling process, we synthesize the data from over 40 field instruments into layer‐by‐layer environmental snapshots that summarize what we know about the atmospheric and surface states at key locations during each event. We compare related measurements and discuss the implications of apparent discrepancies, at a level of detail appropriate for satellite retrieval algorithm and aerosol transport model validation. Aerosols within a few kilometers of the surface were composed primarily of pollution and Asian dust mixtures, as expected. Medium‐ and coarse‐mode particle size distributions varied little among the events studied; however, column aerosol optical depth changed by more than a factor of 4, and the near‐surface proportion of dust ranged between 25% and 50%. The amount of absorbing material in the submicron fraction was highest when near‐surface winds crossed Beijing and the Korean Peninsula and was considerably lower for all other cases. Having simultaneous single‐scattering albedo measurements at more than one wavelength would significantly reduce the remaining optical model uncertainties. The consistency of component particle microphysical properties among the five events, even in this relatively complex aerosol environment, suggests that global, satellite‐derived maps of aerosol optical depth and aerosol mixture (air‐mass‐type) extent, combined with targeted in situ component microphysical property measurements, can provide a detailed global picture of aerosol behavior

Atmospheric sampling of Supertyphoon Mireille with NASA DC-8 aircraft on September 27, 1991, during PEM-West A

The DC‐8 mission of September 27, 1991, was designed to sample air flowing into Typhoon Mireille in the boundary layer, air in the upper tropospheric eye region, and air emerging from the typhoon and ahead of the system, also in the upper troposphere. The objective was to find how a typhoon redistributes trace constituents in the West Pacific region and whether any such redistribution is important on the global scale. The boundary layer air (300 m), in a region to the SE of the eye, contained low mixing ratios of the tracer species O3, CO, C2H6, C2H2, C3H8, C6H6 and CS2 but high values of dimethylsulfide (DMS). The eye region relative to the boundary layer, showed somewhat elevated levels of CO, substantially increased levels of O3, CS2 and all nonmethane hydrocarbons (NMHCs), and somewhat reduced levels of DMS. Ahead of the eye, CO and the NMHCs remained unchanged, O3 and CS2 showed a modest decrease, and DMS showed a substantial decrease. There was no evidence from lidar cross sections of ozone for the downward entrainment of stratospheric air into the eye region; these sections show that low ozone values were measured in the troposphere. The DMS data suggest substantial entrainment of boundary layer air into the system, particularly into the eye wall region. Estimates of the DMS sulphur flux between the boundary layer and the free troposphere, based on computations of velocity potential and divergent winds, gave values of about 69 μg S m−2 d−1 averaged over a 17.5° grid square encompassing the typhoon. A few hours after sampling with the DC‐8, Mireille passed over Oki Island, just to the north of Japan, producing surface values of ozone of 5.5 ppbv. These O3 levels are consistent with the low tropospheric values found by lidar and are more typical of equatorial regions. We suggest that the central eye region may act like a Taylor column which has moved poleward from low latitudes. The high‐altitude photochemical environment within Typhoon Mireille was found to be quite active as evidenced by significant levels of measured gas phase H2O2 and CH3OOH and model‐computed levels of OH

Synchronous Adenocarcinoma and Gastrointestinal Stromal Tumor of the Stomach Treated by a Combination of Laparoscopy-assisted Distal Gastrectomy and Wedge Resection

The simultaneous occurrence of a gastrointestinal stromal tumor (GIST) and a gastric adenocarcinoma is uncommon, and has rarely been reported in the literature. The present report describes the case of a 74-year-old male patient who initially presented with an adenocarcinoma that had invaded the antral mucosa. Computed tomography then revealed the presence of a suspected GIST, in the form of a 2×2 cm mass at the hilum of the spleen. In view of the advanced age of the patient, a surgical approach that would minimize risk and maximize quality of life was preferred. The patient therefore underwent simultaneous laparoscopy-assisted distal gastrectomy for the adenocarcinoma and wedge resection for the GIST. This approach was only chosen after confirming that it would be possible to preserve three or more of the short gastric arteries that supply the area below the wedge resection site. This may be considered a feasible approach to the management of the simultaneous occurrence of a mid-to-low gastric body adenocarcinoma and a high gastric body GIST

Flares in patients with Systemic Lupus Erythematosus (SLE)

Objective: Systemic lupus erythematosus (SLE) is characterised by relapses and remissions. This study describes the frequency, type and time to flare in a cohort of SLE patients. Methods: SLE patients with one or more “A” or “B” BILAG2004 systems meeting flare criteria (“new” or ”worse” items) and requiring an increase in immunosuppression were recruited from nine UK centres and assessed at baseline and monthly for nine months. Subsequent flares were defined as: severe (any “A” irrespective of number of “Bs”), moderate (≥2 “Bs” without any “As”) and mild (one “B”). Results: Of the 100 patients, 94% were female, 61% white Caucasians, mean age (SD) was 40.7 years (12.7) and mean disease duration (SD) 9.3 years (8.1). A total of 195 flares re-occurred in 76 patients over 781 monthly assessments (flare rate of 0.25/patient-month). There were 37 severe flares, 32 moderate flares and 126 mild flares. By month one, 22% had a mild/moderate/severe flare and 22% had a severe flare by 7 months. The median time to any “A” or “B” flare was 4 months. Severe/moderate flares tend to be in the system/s affected at baseline whereas mild flares can affect any system. Conclusion: In a population with active SLE we observed an ongoing rate of flares from early in the follow-up period with moderate-severe flares being due to an inability to fully control the disease. This real-world population study demonstrates the limitations of current treatments and provides a useful reference population from which to inform future clinical trial design

Dental students’ ability to locate emergency equipment‐lessons learned from aviation

PurposeThe purpose of this study was to evaluate the dental student’s ability to locate medical emergency equipment/items at the University of Michigan School of Dentistry clinic.MethodsA total of 138 second‐year dental students (traditional group) participated in this study as part of a simulation‐based medical emergencies rotation course held during the winter term of 2014 and 2015. Without prior training, students were tested on their ability to locate nine predetermined items on the clinic floor using a self‐reported checklist. Six months later, a convenience sample of 18 students (novel group) from the same cohort were later trained on their location and retested individually.ResultsOf the 138 students tested, only 10.14% students could locate seven of the nine items when compared to 100% in the novel group. Only 5.07% of students in the traditional group could locate all items initially, compared with 72.22% students in the novel group.ConclusionWhilst our students have lecture‐based knowledge about medical emergencies, the results of our study identified a gap of knowledge of emergency equipment/item location amongst students. Therefore, an intervention performed with a similar group of second‐year dental students supported that proper training may be used to achieve retention of knowledge. Based on our “novel group” results, we have incorporated targeted training in the dental curriculum that leads to students being better prepared in locating emergency equipment/items. This study suggests that other populations, such as faculty or staff, may also benefit from hands‐on training.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142451/1/eje12251.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142451/2/eje12251_am.pd

The diversification of Heliconius butterflies: what have we learned in 150 years?

Research into Heliconius butterflies has made a significant contribution to evolutionary biology. Here, we review our understanding of the diversification of these butterflies, covering recent advances and a vast foundation of earlier work. Whereas no single group of organisms can be sufficient for understanding life's diversity, after years of intensive study, research into Heliconius has addressed a wide variety of evolutionary questions. We first discuss evidence for widespread gene flow between Heliconius species and what this reveals about the nature of species. We then address the evolution and diversity of warning patterns, both as the target of selection and with respect to their underlying genetic basis. The identification of major genes involved in mimetic shifts, and homology at these loci between distantly related taxa, has revealed a surprising predictability in the genetic basis of evolution. In the final sections, we consider the evolution of warning patterns, and Heliconius diversity more generally, within a broader context of ecological and sexual selection. We consider how different traits and modes of selection can interact and influence the evolution of reproductive isolation.RMM is funded by a Junior Research Fellowship at King’s College, Cambridge. KMK is supported by the Balfour Studentship, University of Cambridge, SHMa by a Research Fellowship at St John's College, Cambridge, and SHMo by a Research Fellowship from the Royal Commission for the Exhibition of 1851. Our work on Heliconius has been additionally supported by the Agence Nationale de la Recherche (France), the Biology and Biotechnology Research Council (UK), the British Ecological Society, the European Research Council, the Natural Environment Research Council (UK), and the Smithsonian Tropical Research Institute.This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1111/jeb.1267

Exploring assessment of medical students\u27 competencies in pain medicine - A review

Introduction: Considering the continuing high prevalence and public health burden of pain, it is critical that medical students are equipped with competencies in the field of pain medicine. Robust assessment of student expertise is integral for effective implementation of competency-based medical education. Objective: The aim of this review was to describe the literature regarding methods for assessing pain medicine competencies in medical students. Method: PubMed, Medline, EMBASE, ERIC, and Google Scholar, and BEME data bases were searched for empirical studies primarily focusing on assessment of any domain of pain medicine competencies in medical students published between January 1997 and December 2016. Results: A total of 41 studies met the inclusion criteria. Most assessments were performed for low-stakes summative purposes and did not reflect contemporary theories of assessment. Assessments were predominantly undertaken using written tests or clinical simulation methods. The most common pain medicine education topics assessed were pain pharmacology and the management of cancer and low-back pain. Most studies focussed on assessment of cognitive levels of learning as opposed to more challenging domains of demonstrating skills and attitudes or developing and implementing pain management plans. Conclusion: This review highlights the need for more robust assessment tools that effectively measure the abilities of medical students to integrate pain-related competencies into clinical practice. A Pain Medicine Assessment Framework has been developed to encourage systematic planning of pain medicine assessment at medical schools internationally and to promote continuous multidimensional assessments in a variety of clinical contexts based on well-defined pain medicine competencies

Band profiles and band strengths in mixed H2O:CO ices

A laboratory study on the band profiles and band strengths of H2O in CO ice, and vice versa, is presented and interpreted in terms of two models. The results show that a mutual interaction takes place between the two species in the solid, which alters the band positions and band strengths. It is found that the band strengths of the H2O bulk stretch, bending and libration vibrational bands decrease linearly by a factor of up to 2 when the CO concentration is increased from 0 to 80%. By contrast, the band strength of the free OH stretch increases linearly. The results are compared to a recently performed quantitative study on H2O:CO2 ice mixtures. It is shown that for mixing ratios of 1:0.5 H2O:X and higher, the H2O bending mode offers a good tracer to distinguish between CO2 or CO in H2O ice. Additionally, it is found that the band strength of the CO fundamental remains constant when the water concentration is increased in the ice. The integrated absorbance of the 2152 cm-1 CO feature, with respect to the total integrated CO absorption feature, is found to be a good indicator of the degree of mixing of CO in the H2O:CO laboratory ice system. From the change in the H2O absorption band strength in laboratory ices upon mixing we conclude that astronomical water ice column densities on various lines of sight can be underestimated by up to 25% if significant amounts of CO and CO2 are mixed in.Comment: 9 pages, 10 figure