Clinically Actionable Hypercholesterolemia and Hypertriglyceridemia in Children with Nonalcoholic Fatty Liver Disease

OBJECTIVE: To determine the percentage of children with nonalcoholic fatty liver disease (NAFLD) in whom intervention for low-density lipoprotein cholesterol or triglycerides was indicated based on National Heart, Lung, and Blood Institute guidelines. STUDY DESIGN: This multicenter, longitudinal cohort study included children with NAFLD enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Nonalcoholic Steatohepatitis Clinical Research Network. Fasting lipid profiles were obtained at diagnosis. Standardized dietary recommendations were provided. After 1 year, lipid profiles were repeated and interpreted according to National Heart, Lung, and Blood Institute Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction. Main outcomes were meeting criteria for clinically actionable dyslipidemia at baseline, and either achieving lipid goal at follow-up or meeting criteria for ongoing intervention. RESULTS: There were 585 participants, with a mean age of 12.8 years. The prevalence of children warranting intervention for low-density lipoprotein cholesterol at baseline was 14%. After 1 year of recommended dietary changes, 51% achieved goal low-density lipoprotein cholesterol, 27% qualified for enhanced dietary and lifestyle modifications, and 22% met criteria for pharmacologic intervention. Elevated triglycerides were more prevalent, with 51% meeting criteria for intervention. At 1 year, 25% achieved goal triglycerides with diet and lifestyle changes, 38% met criteria for advanced dietary modifications, and 37% qualified for antihyperlipidemic medications. CONCLUSIONS: More than one-half of children with NAFLD met intervention thresholds for dyslipidemia. Based on the burden of clinically relevant dyslipidemia, lipid screening in children with NAFLD is warranted. Clinicians caring for children with NAFLD should be familiar with lipid management

Unconformities and Age Relationships, Tongue River and Older Members of the Fort Union Formation (Paleocene), Western Williston Basin, U.S.A.

An unconformable relationship is observed within the Paleocene Fort Union Formation in the western Williston Basin at the contact between the Tongue River Member and the underlying Lebo and Ludlow Members. Isotopic dates and pollen biozone data reported here are integrated with previously published data. A new correlation of these facies results in a revised history of localized depositional and tectonic events. One unconformity occurs at this lithological contact in the Pine Hills (PH), Terry Badlands (TB), and Ekalaka (E) areas west of the Cedar Creek anticline (CCA), and another unconformity occurs at the same lithological contact in the Little Missouri River (LMR) area east of the CCA. The two unconformities differ in age by about two million years. The older is the U2 and the younger is the U3 , which initially were recognized in the Ekalaka area of southeastern Montana (Belt et al., 2002). The U2 crops out in the TB, PH, and E areas, where at least 85 m of Tongue River strata bearing palynomorphs characteristic of biozone P-3 are found above the unconformity. Radiometric dates from strata (bearing palynomorphs characteristic of biozone P-2) below the U2 range in age from 64.0 to 64.73 Ma. The U2 unconformity west of the CCA thus occurs in strata near the base of the lower P-3 biozone. The U3 crops out in the LMR area (east of the CCA), where only 13 m of strata characterized by the P-3 pollen biozone occur above it. Radiometric dates from an ash \u3c1 m above the U3 in that area range in age from 61.03 to 61.23 Ma, and the P-3/P-4 pollen biozone boundary is located 13 m above the ashes. The U3 thus occurs in strata characterized by upper parts of the P-3 pollen biozone east of the CCA. The U3 is also identifiable in the middle of the ca. 200 m-thick Tongue River Member west of the CCA, where mammal sites 40 to 80 m above it are Tiffanian-3 in age. The strata below this unconformity are tilted gently to the northwest; strata above the unconformity are flat lying. This mid Tongue River unconformity probably correlates with the unconformity at the base of the Tongue River Member in the LMR area east of the CCA, where a Ti-2 mammal site (the “X-X” locality) occurs \u3c10 m above it. Depositional and tectonic events can be summarized using North American Mammal Age nomenclature as a relative time scale. From latest Cretaceous through Puercan time, paleodrainage was toward the east or southeast, in the direction of the Cannonball Sea. The Black Hills did not serve as an obstruction at that time. During early Torrejonian time, the Miles City arch (MCA) and Black Hills were uplifted and partially eroded, leading to the U2 unconformity. When deposition resumed, paleodrainages shifted to a northeasterly course. During middle and late Torrejonian time, facies of the lower Tongue River (“Dominy”) sequence and the Ekalaka Member of the Fort Union Formation were deposited in the middle of a subbasin between the MCA and the CCA. Simultaneously, smectite-rich components of the Ludlow Member were being deposited east of the CCA. During latest Torrejonian time, uplift of the Black Hills tilted the “Dominy” sequence toward the northwest and local erosion led to the U3 unconformity. Following this tilting, during Tiffanian time, deposition of the upper Tongue River (“Knobloch”) sequence shows continuity from western North Dakota across eastern Montana and into the northern Powder River Basin

Evidence for Marine Influence on a Low-Gradient Coastal Plain: Ichnology and Invertebrate Paleontology of the Lower Tongue River Member (Fort Union Formation, Middle Paleocene), Western Williston Basin, U.S.A.

The Paleocene Tongue River Member of the Fort Union Formation contains trace-fossil associations indicative of marine influence in otherwise freshwater facies. The identified ichnogenera include: Arenicolites, Diplocraterion, Monocraterion, Ophiomorpha, Rhizocorallium, Skolithos linearis, Teichichnus, Thalassinoides, and one form of uncertain affinity. Two species of the marine diatom Coscinodiscus occur a few meters above the base of the member. The burrows occur in at least five discrete, thin, rippled, fine-grained sandstone beds within the lower 85 m of the member west of the Cedar Creek anticline (CCA) in the Signal Butte, Terry Badlands, and Pine Hills areas. Two discrete burrowed beds are found in the lower 10 m of the member east of the CCA in the little Missouri River area. Abundant freshwater ostracodes include Bisulcocypridea arvadensis, Candona, and Cypridopsis. Freshwater bivalves include Plesielliptio and Pachydon mactriformis. We recognize four fossil assemblages that represent fluvio-lacustrine, proximal estuarine, central estuarine, and distal estuarine environments. Biostratal alternations between fresh- and brackish-water assemblages indicate that the Tongue River Member was deposited along a low-gradient coastal plain that was repeatedly inundated from the east by the Cannonball Sea. The existence of marine-influenced beds in the Tongue River Member invalidates the basis for the Slope Formation

Radiative capture of protons by deuterons

The differential cross section for radiative capture of protons by deuterons is calculated using different realistic NN interactions. We compare our results with the available experimental data below $E_x = 20 MeV$. Excellent agreement is found when taking into account meson exchange currents, dipole and quadrupole contributions, and the full initial state interaction. There is only a small difference between the magnitudes of the cross sections for the different potentials considered. The angular distributions, however, are practically potential independent.Comment: 4 pages (twocolumn), 4 postscript figures included, submitted for publication, revised versio

Bewijs voor effectiviteit van Comprehensive Geriatric Assessment in de thuissituatie nog mager: een literatuurreview

Achtergrond De meeste ouderen vinden het belangrijk zo lang mogelijk zelfstandig te blijven functioneren. Gerichte opsporing en behandeling van factoren die de functionele zelfstandigheid bedreigen, middels een comprehensive geriatric assessment (CGA), kan het zelfstandig functioneren mogelijk bevorderen. Dit artikel doet verslag van een literatuurstudie naar het effect van comprehensive geriatric assessment in de thuissituatie. Methode In Pubmed (1977–2012) is gezocht naar RCT’s die de effectiviteit van multidisciplinaire, multidimensionele CGA bij ouderen in de thuissituatie onderzocht hebben. Er werden data geëxtraheerd over effectiviteit, kosten en factoren die het effect van het CGA positief of negatief hebben beïnvloed. Resultaten Negen RCT’s werden geïncludeerd. Op één studie na was de kwaliteit matig tot goed. In drie van de zes studies naar functionele status en in twee van de vier studies naar kwaliteit van leven werd een positief effect gevonden. Geen effect werd gevonden op het aantal ziekenhuisopnames en verpleeghuisopnames of op mortaliteit. De meeste studies lieten een stijging zien van de totale gezondheidszorgkosten. Conclusie CGA thuis heeft een beperkt gunstig effect op functionele status en kwaliteit van leven. Er zijn aanwijzingen dat CGA thuis het meeste effect heeft bij relatief goed functionerende ouderen

Sea ice dynamics across the Mid-Pleistocene transition in the Bering Sea.

Sea ice and associated feedback mechanisms play an important role for both long- and short-term climate change. Our ability to predict future sea ice extent, however, hinges on a greater understanding of past sea ice dynamics. Here we investigate sea ice changes in the eastern Bering Sea prior to, across, and after the Mid-Pleistocene transition (MPT). The sea ice record, based on the Arctic sea ice biomarker IP25 and related open water proxies from the International Ocean Discovery Program Site U1343, shows a substantial increase in sea ice extent across the MPT. The occurrence of late-glacial/deglacial sea ice maxima are consistent with sea ice/land ice hysteresis and land-glacier retreat via the temperature-precipitation feedback. We also identify interactions of sea ice with phytoplankton growth and ocean circulation patterns, which have important implications for glacial North Pacific Intermediate Water formation and potentially North Pacific abyssal carbon storage

Sea-ice-free Arctic during the Last Interglacial supports fast future loss

The Last Interglacial (LIG), a warmer period 130-116 ka before present, is a potential analog for future climate change. Stronger LIG summertime insolation at high northern latitudes drove Arctic land summer temperatures 4-5 °C higher than the preindustrial era. Climate model simulations have previously failed to capture these elevated temperatures, possibly because they were unable to correctly capture LIG sea-ice changes. Here, we show the latest version of the fully-coupled UK Hadley Center climate model (HadGEM3) simulates a more accurate Arctic LIG climate, including elevated temperatures. Improved model physics, including a sophisticated sea-ice melt-pond scheme, result in a complete simulated loss of Arctic sea ice in summer during the LIG, which has yet to be simulated in past generations of models. This ice-free Arctic yields a compelling solution to the longstanding puzzle of what drove LIG Arctic warmth and supports a fast retreat of future Arctic summer sea ice

Faddeev Calculations of Proton-Deuteron Radiative Capture with Exchange Currents

pd capture processes at various energies have been analyzed based on solutions of 3N-Faddeev equations and using modern NN forces. The application of the Siegert theorem is compared to the explicit use of $\pi$- and $\rho$-like exchange currents connected to the AV18 NN interaction. Overall good agreement with cross sections and spin observables has been obtained but leaving room for improvement in some cases. Feasibility studies for 3NF's consistently included in the 3N continuum and the 3N bound state have been performed as well.Comment: Minor changes in notation, ps files for figure