Time-Series Analysis of Remotely-Sensed SeaWiFS Chlorophyll in River-Influenced Coastal Regions

The availability of a nearly-continuous record of remotely-sensed chlorophyll a data (chl a) from the Sea-viewing Wide Field-of-view Sensor (SeaWiFS) mission, now longer than ten years, enables examination of time-series trends for multiple global locations. Innovative data analysis technology available on the World Wide Web facilitates such analyses. In coastal regions influenced by river outflows, chl a is not always indicative of actual trends in phytoplankton chlorophyll due to the interference of colored dissolved organic matter and suspended sediments; significant chl a timeseries trends for coastal regions influenced by river outflows may nonetheless be indicative of important alterations of the hydrologic and coastal environment. Chl a time-series analysis of nine marine regions influenced by river outflows demonstrates the simplicity and usefulness of this technique. The analyses indicate that coastal time-series are significantly influenced by unusual flood events. Major river systems in regions with relatively low human impact did not exhibit significant trends. Most river systems with demonstrated human impact exhibited significant negative trends, with the noteworthy exception of the Pearl River in China, which has a positive trend

The Role of Nurse Practitioners in Meeting the Need for Child and Adolescent Services: a Statewide Survey

The high prevalence of child and adolescent mental health disorders coupled with shortages in ageappropriate mental health services pose a significant problem likely to be exacerbated over time. A survey was designed to identify the current status of and need for child and adolescent psychiatrists (CAPs) and mental health services, as well as strategies and recommendations to address identified needs in the state of New York. Key informants from each county and New York City were surveyed by telephone (N = 58). Most respondents identified a shortage of child and adolescent psychiatry services and reported that when CAPs are unavailable, nurse practitioners (NPs) are currently among the top four professional groups who prescribe and/or monitor psychotropic medication. Almost half of the respondents (48%) identified employing NPs with advanced certification in child and adolescent psychiatry as a promising strategy to improve access to care. Addressing the shortage of CAPs can provide an opportunity for the nursing profession to advance its role in the provision of mental health services to youth

The Role of Nurse Practitioners in Meeting the Need for Child and Adolescent Services: a Statewide Survey

The high prevalence of child and adolescent mental health disorders coupled with shortages in ageappropriate mental health services pose a significant problem likely to be exacerbated over time. A survey was designed to identify the current status of and need for child and adolescent psychiatrists (CAPs) and mental health services, as well as strategies and recommendations to address identified needs in the state of New York. Key informants from each county and New York City were surveyed by telephone (N = 58). Most respondents identified a shortage of child and adolescent psychiatry services and reported that when CAPs are unavailable, nurse practitioners (NPs) are currently among the top four professional groups who prescribe and/or monitor psychotropic medication. Almost half of the respondents (48%) identified employing NPs with advanced certification in child and adolescent psychiatry as a promising strategy to improve access to care. Addressing the shortage of CAPs can provide an opportunity for the nursing profession to advance its role in the provision of mental health services to youth

Designing comparative effectiveness trials of surgical ablation for atrial fibrillation: Experience of the Cardiothoracic Surgical Trials Network

ObjectiveSince the introduction of the cut-and-sew Cox maze procedure for atrial fibrillation, there has been substantial innovation in techniques for ablation. Use of alternative energy sources for ablation simplified the procedure and has resulted in dramatic increase in the number of patients with atrial fibrillation treated by surgical ablation. Despite its increasingly widespread adoption, there is lack of rigorous clinical evidence to establish this procedure as an effective clinical therapy.MethodsThis article describes a comparative effectiveness randomized trial, supported by the Cardiothoracic Surgical Clinical Trials Network, of surgical ablation with left atrial appendage closure versus left atrial appendage closure alone in patients with persistent and long-standing persistent atrial fibrillation undergoing mitral valve surgery. Nested within this trial is a further randomized comparison of 2 different lesions sets: pulmonary vein isolation and the full maze lesion set.ResultsThis article addresses trial design challenges, including how best to characterize the target population, operationalize freedom from atrial fibrillation as a primary end point, account for the impact of antiarrhythmic drugs, and measure and analyze secondary end points, such as postoperative atrial fibrillation load.ConclusionsThis article concludes by discussing how insights that emerge from this trial may affect surgical practice and guide future research in this area

Staphylococcus aureus small colony variants impair host immunity by activating host cell glycolysis and inducing necroptosis

Staphylococcus aureus small colony variants (SCVs) are frequently associated with chronic infection, yet they lack expression of many virulence determinants associated with the pathogenicity of wild-type strains. We found that both wild-type S. aureus and a ΔhemB SCV prototype potently activate glycolysis in host cells. Glycolysis and the generation of mitochondrial reactive oxygen species were sufficient to induce necroptosis, a caspase-independent mechanism of host cell death that failed to eradicate S. aureus and instead promoted ΔhemB SCV pathogenicity. To support ongoing glycolytic activity, the ΔhemB SCV induced over a 100-fold increase in the expression of fumC, which encodes an enzyme that catalyses the degradatin of fumarate, an inhibitor of glycolysis. Consistent with fumC-dependent depletion of local fumarate, the ΔhemB SCV failed to elicit trained immunity and protection from a secondary infectious challenge in the skin. The reliance of the S. aureus SCV population on glycolysis accounts for much of its role in the pathogenesis of S. aureus skin infection

The Relative Impact of Hypnosis and Suggestion on the Recovery of Pediatric Tonsillectomy Patients.

The purpose of this study was to investigate the effects of hypnosis and suggestion on improving the reactions of children to the stress of hospitalization and surgery. The subjects were thirty children between the ages of 5 years 0 months and 10 years 11 months who were scheduled to undergo an adenotonsillectomy or a tonsillectomy while hospitalized. The subjects were r and omly assigned to one of three groups. The subjects in the Hypnosis group were administered a hypnotic induction procedure and posthypnotic suggestions prior to surgery. The suggestions were worded to minimize postoperative anxiety, pain, bleeding and nausea/vomiting. Subjects in the Suggestion group were administered the same suggestions, although without the induction procedure. The Control group received no additional preparation for surgery beyond that routinely provided at the hospital. Data were collected from the hospital nurses, medical records, parents of subjects, and the subjects themselves. The nurses in the recovery unit and on the ward completed behavioral observation questionnaires describing the subjects' postoperative behavior. Information regarding medical complications was collected from the medical records. Data were collected from the parents and subjects in two home visits. In the pretest and posttest session the child was administered the Children's Manifest Anxiety Scale and the Michigan Pediatric picture Series. In the posttest session the parents completed Vernon's Posthospital Behavior Questionnaire. Seven hypotheses were generated with respect to: (1) predicted treatment effects on postoperative anxiety and medical complications, and (2) the relative impact of hypnosis and suggestion. These hypotheses were tested at the .05 level. The major finding of this study was that suggestions, administered either after a hypnotic induction procedure or without this procedure, did reduce the postoperative anxiety level of subjects as it was measured by the Children's Manifest Anxiety Scale and Vernon's Posthospital Behavior Questionnaire. However, no significant differences were found between the treatment and control groups on measures of medical complications or on behavior observations made by the nurses. No significant differences were found on the relative impact of hypnosis and suggestion on the recovery of these patients. Larger samples may have led to the rejection of these hypotheses.Ph.D.PsychologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/159126/1/8304432.pd

Synchronization of strongly coupled excitatory neurons: relating network behavior to biophysics

Abstract. Behavior of a network of neurons is closely tied to the properties of the individual neurons. We study this relationship in models of layer II stellate cells (SCs) of the medial entorhinal cortex. SCs are thought to contribute to the mammalian theta rhythm (4–12 Hz), and are notable for the slow ionic conductances that constrain them to fire at rates within this frequency range. We apply “spike time response ” (STR) methods, in which the effects of synaptic perturbations on the timing of subsequent spikes are used to predict how these neurons may synchronize at theta frequencies. Predictions from STR methods are verified using network simulations. Slow conductances often make small inputs “effectively large”; we suggest that this is due to reduced attractiveness or stability of the spiking limit cycle. When inputs are (effectively) large, changes in firing times depend nonlinearly on synaptic strength. One consequence of nonlinearity is to make a periodically firing model skip one or more beats, often leading to the elimination of the anti-synchronous state in bistable models. Biologically realistic membrane noise makes such “cycle skipping ” more prevalent, and thus can eradicate bistability. Membrane noise also supports “sparse synchrony, ” a phenomenon in which subthreshold behavior is uncorrelated, but there are brief periods of synchronous spiking