Toward regional hazard risk assessment: a method to geospatially inventory critical coastal infrastructure applied to the Caribbean

Hurricanes and sea level rise pose significant threats to infrastructure and critical services (e.g., air and sea travel, water treatment), and can hinder sustainable development of major economic sectors (e.g., tourism, agriculture, and international commerce). Planning for a disaster-resilient future requires high-resolution, standardized data. However, few standardized approaches exist for identifying, inventorying, and quantifying infrastructure lands at risk from natural hazards. This research presents a cost effective, standardized and replicable method to geospatially inventory critical coastal infrastructure land use and components, for use in risk assessments or other regional analyses. While traditional approaches to geospatial inventorying rely on remote sensing or techniques, such as object-based image analysis (OBIA) to estimate land use, the current approach utilizes widely available satellite imagery and a “standard operating procedure” that guides individual mappers through the process, ensuring replicability and confidence. As a pilot study to develop an approach that can be replicated for other regions, this manuscript focuses on the Caribbean. Small islands rely heavily on a small number of critical coastal infrastructure (airports, seaports, power plants, water and wastewater treatment facilities) and climate related hazards threaten sustainable development and economic growth. The Caribbean is a large and diverse area, and gaps exist between countries in the resources required for planning but much of the region lacks a comprehensive inventory of the land, infrastructure, and assets at risk. Identifying and prioritizing infrastructure at risk is the first step towards preserving the region’s economy and planning for a disaster resilient future. This manuscript uses high resolution satellite imagery to identify and geo-spatially classify critical infrastructure land area and assets, such as structures, equipment, and impervious surfaces. We identified 386 critical coastal infrastructure facilities across 28 Caribbean nations/territories, with over 19,000 ha of coastal land dedicated to critical infrastructure. The approach establishes a new standard for the creation of geospatial data to assess land use change, risk, and other research questions suitable for the regional scale, but with sufficient resolution such that individual facilities can utilize the data for local-scale analysis

A method for regional estimation of climate change exposure of coastal infrastructure: Case of USVI and the influence of digital elevation models on assessments

Objective: This study tests the impacts of Digital Elevation Model (DEM) data on an exposure assessment methodology developed to quantify flooding of coastal infrastructure from storms and sea level rise on a regional scale. The approach is piloted on the United States Virgin Islands (USVI) for a one-hundred-year storm event in 2050 under the IPCC\u27s 8.5 emission scenario (RCP 8,5). Method: Flooding of individual infrastructure was tested against three different digital elevation models using a GIS-based coastal infrastructure database created specifically for the project using aerial images. Inundation for extreme sea levels is based on dynamic simulations using Lisflood-ACC (LFP). Results: The model indicates transport and utility infrastructure in the USVI are considerably exposed to sea level rise and modeled storm impacts from climate change. Prediction of flood extent was improved with a neural network processed SRTM, versus publicly available SRTM (~30 m) seamless C-band DEM but both SRTM based models underestimate flooding compared to LIDAR DEM. The modeled scenario, although conservative, showed significant flood exposure to a large number of access roads to facilities, 113/176 transportation related buildings, and 29/66 electric utility and water treatment buildings including six electric power transformers and six waste water treatment clarifiers. Conclusion: The method bridges a gap between large-scale non-specific flood assessments and single-facility detailed assessments and can be used to efficiently quantify and prioritize parcels and large structures in need of further assessment for regions that lack detailed data to assess climate exposure to sea level rise and flooding caused by waves. The method should prove particularly useful for assessment of Small Island Developing State regions that lack LIDAR data, such as the Caribbean

Tachycardia Related Cardiomyopathy: Response to Control of the Arrhythmia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75609/1/j.1540-8183.1989.tb00780.x.pd

Intraoperative Mapping and Radiofrequency Ablation of the His Bundle in a Patient with Complex Congenital Heart Disease and Intractable Atrial Arrhythmias Following the Fontan Operation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75047/1/j.1540-8159.1993.tb01741.x.pd

Two-dimensional and Doppler echocardiographic evaluation after arterial switch repair in infancy for complete transposition of the great arteries

The most recent postoperative echocardiographic examinations of all children who underwent arterial switch repair of transposition of the great arteries from August 1985 to December 1987 were reviewed. The patients included 35 children whose age at operation was 12 +/- 16 days and whose weight was 3.6 +/- 0.4 kg. Thirty-three patients are alive and well; 1 died intraoperatively and 1 died immediately postoperatively. The time of the follow-up echocardiographic examination ranged from 1 day to 2.5 years (mean 9.2 months) with 11 patients examined >1 year after surgery. Complete examination of the repair site was possible in all patients. Echocardiographic visualization of distortion of the great arteries at the suture lines was seen in all patients; however, Doppler evidence of hemodynamically significant obstruction at the repair site was uncommon. On Doppler examination in the surviving 33 patients, 16 had no supravalvular pulmonary stenosis and 14 had mild to moderate supravalvular pulmonary stenosis with peak systolic pressure gradients ranging from 16 to 56 mm Hg (mean 31). Three patients had severe supravalvular pulmonary stenosis and peak systolic pressure gradients of 66, 74 and 77 mm Hg (2 have had reoperation, 1 is awaiting surgery). On Doppler examination, 4 patients had mild supravalvular aortic stenosis with peak systolic gradients ranging from 10 to 29 mm Hg. Doppler gradients were confirmed in 10 patients who had catheterization 12 +/- 3 months after surgery. Three patients had mild pulmonary regurgitation by Doppler examination, 5 had mild aortic regurgitation, 4 had mild tricuspid regurgitation and 2 had mild mitral regurgitation. In all 33 patients, ventricular dimensions, left ventricular shortening fraction (42 +/- 6%) and rate-corrected mean velocity of circumferential fiber shortening (1.25 +/- 0.24 circumference/s) were normal.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/28075/1/0000520.pd

Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle

The bidirectional Glenn operation may be particularly useful as an intermediate procedure before Fontan correction in high-risk patients. From October 1989 through February 1992, 50 patients 1 to 60 months old (median 12) have undergone a bidirectional Glenn operation. Diagnoses included hypoplastic left heart syndrome in 21 patients, pulmonary atresia with intact ventricular septum in 10, tricuspid valve atresia in 9, other complex univentricular heart defects in 9, and Ebstein's anomaly in 1. Mean pulmonary vascular resistance was 2.2 +/- 0.2 Wood U (range 0.5 to 7.3) and mean pulmonary artery area Nakata index was 318 +/- mm2/m2 (range 80 to 821). Additional procedures were performed in 17 patients, including pulmonary artery reconstruction in 15 (29%) and bilateral caval anastomoses in 5 (10%). There were 4 hospital deaths (8%). Two deaths resulted from myocardial infarction in patients with pulmonary atresia with intact ventricular septum and sinusoids and 1 from severe pulmonary vascular disease in a patient with hypoplastic left heart syndrome. There was 1 late death from pneumonia. Actuarial survival is 92 +/- 4% at 1 month and beyond, with a mean follow-up of 13.4 +/- 1 months. Risk factor analysis showed that pulmonary vascular resistance >3 Wood U and pulmonary artery distortion were associated with increased mortality. Twelve patients have undergone a Fontan procedure at a mean duration after bidirectional Glenn of 18 months with 1 death (8%). The bidirectional Glenn procedure provides excellent palliation in high-risk patients and appears useful as a staging procedure before Fontan correction.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30841/1/0000503.pd

Surgical management of children and young adults with the Wolff-Parkinson-White syndrome

The Wolff-Parkinson-White syndrome, as originally described, includes palpitations, tachycardia, and an abnormal electrocardiogram (short PR interval and wide QRS complex). The clinical manifestations are dependent upon a reentrant tachycardia supported by an accessory connection bridging the atrioventricular junction and frequently appear during the first two decades of life. Palpitations are the usual symptoms; less frequently, severe symptoms, such as syncope and sudden death, may result from very rapid atrioventricular conduction across the accessory connection during atrial fibrillation. We report the surgical management of 30 young patients with this syndrome, including 6 with life-threatening tachycardia. Surgical interruption of the accessory connection(s) was curative in 90% (27/30) of the patients; life-threatening symptoms were eliminated in the other three. Based on the limited knowledge of the natural history of the Wolff-Parkinson-White syndrome, the individual patient symptoms, and the electrophysiologic properties of each patient's accessory pathway(s), an algorithm is presented outlining the treatment options. This experience strongly suggests that surgical treatment of the Wolff-Parkinson-White syndrome is safe, effective, and possibly the preferred treatment for this disorder in selected young symptomatic patients.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41585/1/380_2005_Article_BF02058591.pd

Molecular mechanisms of cell death: recommendations of the Nomenclature Committee on Cell Death 2018.

Over the past decade, the Nomenclature Committee on Cell Death (NCCD) has formulated guidelines for the definition and interpretation of cell death from morphological, biochemical, and functional perspectives. Since the field continues to expand and novel mechanisms that orchestrate multiple cell death pathways are unveiled, we propose an updated classification of cell death subroutines focusing on mechanistic and essential (as opposed to correlative and dispensable) aspects of the process. As we provide molecularly oriented definitions of terms including intrinsic apoptosis, extrinsic apoptosis, mitochondrial permeability transition (MPT)-driven necrosis, necroptosis, ferroptosis, pyroptosis, parthanatos, entotic cell death, NETotic cell death, lysosome-dependent cell death, autophagy-dependent cell death, immunogenic cell death, cellular senescence, and mitotic catastrophe, we discuss the utility of neologisms that refer to highly specialized instances of these processes. The mission of the NCCD is to provide a widely accepted nomenclature on cell death in support of the continued development of the field

Case control study of the geographic variability of exposure to disinfectant byproducts and risk for rectal cancer

Abstract Background Levels of byproducts that result from the disinfection of drinking water vary within a water distribution system. This prompted us to question whether the risk for rectal cancer also varies, depending upon one's long term geographic location within the system. Such a geographic distribution in rectal cancer risk would follow naturally from an association between level of byproduct and rectal cancer risk. We assess the effects of estimated geographic variability in exposure to some of the components of the trihalomethane group of disinfectant byproducts (DBPs) on the odds ratios and probabilities for rectal cancer in white males in a case control study of 128 cases and 253 controls, conducted in Monroe County, Western New York State, U.S.A. The study was designed around health data initially collected at the University at Buffalo (Department of Social and Preventative Medicine) as part of the Upstate New York Diet Study, and trihalomethane (THM) data collected from a separate independent study of THMs conducted by Monroe County Department of Health. Case participants were chosen from hospital pathology records. The controls are disease-free white males between 35–90 years old, living in Monroe County, and chosen from control groups for studies from cancer of five other (unrelated) sites. Using a combination of case control methodology and spatial analysis, the spatial patterns of THMs and individual measures of tap water consumption provide estimates of the effects of ingestion of specific amounts of some DBPs on rectal cancer risk. Trihalomethane (THM) data were used to spatially interpolate levels at the taps of cases and controls, and odds ratios were estimated using logistic regression to assess the effects of estimated THM exposure dose on cancer risk, adjusting for alcohol, dietary beta carotene intake, tap water intake, and total caloric intake. Results Trihalomethane levels varied spatially within the county; although risk for rectal cancer did not increase with total level of trihalomethanes, increasing levels of the component bromoform (measured in ug/day) did correspond with an increase in odds ratios (OR = 1.85; 95% CI = 1.25 – 2.74) for rectal cancer. The highest quartiles of estimated consumption of bromoform (1.69–15.43 ug/day) led to increased risk for rectal cancer (OR = 2.32; 95% CI = 1.22–4.39). Two other THMs were marginally associated with an increase in risk – chlorodibromomethane (OR = 1.78, 95% CI = 1.00–3.19) and bromodichloromethane (OR = 1.15; 95% CI = 1.00–1.32). Conclusion Levels of THMs in the water distribution system exhibited spatial variation that was partially due to variation in water age. We also observed a geographic pattern of increased risk of rectal cancer in areas with the highest levels of bromoform in the county.</p