Determination and impact of surface radiative processes for TOGA COARE

Experiments using atmospheric general circulation models have shown that the atmospheric circulation is very sensitive to small changes in sea surface temperature in the tropical western Pacific Ocean warm pool region. The mutual sensitivity of the ocean and the atmosphere in the warm pool region places stringent requirements on models of the coupled ocean atmosphere system. At present, the situation is such that diagnostic studies using available data sets have been unable to balance the surface energy budget in the warm pool region to better than 50 to 80 W/sq m. The Tropical Ocean Global Atmosphere (TOGA) Coupled Ocean Atmosphere Response Experiment (COARE) is an observation and modelling program that aims specifically at the elucidation of the physical process which determine the mean and transient state of the warm pool region and the manner in which the warm pool interacts with the global ocean and atmosphere. This project focuses on one very important aspect of the ocean atmosphere interface component of TOGA COARE, namely the temporal and spatial variability of surface radiative fluxes in the warm pool region

An objective determination of tropical cyclone warning positions.

A technique has been developed to determine objectively the location of a tropical cyclone at warning time and reduce the short-term forecast errors due to errors in the warning position. The western North Pacific CLIPER (CLImatology and PERsistence) forecast scheme is used to generate a potential track, from each fix, and a smooth curve is fit to the future and past positions. When multiple fixes are available, weighting functions are applied to account for fix platform accuracy and time of receipt. A set of 836 cases from 30 storms during 1981-1983 was evaluated. Using the objective scheme, 16 of the 30 tropical cyclones had reduced warning position errors compared to the Joint Typhoon Warning Center official warning position. For 11 of the 30 storms, the objective warning positions resulted in more accurate 24-h forecasts with the CLIPER technique than the official warning positions. This technique appears to provide an efficient, interactive tool to the forecaster to use in establishing the warning position.http://archive.org/details/objectivedetermi00currLieutenant Commander, United States NavyApproved for public release; distribution is unlimited

Data constraints on glacial Atlantic Water mass geometry and properties

© The Author(s), 2018. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Paleoceanography and Paleoclimatology 33 (2018): 1013-1034, doi:10.1029/2018PA003408.The chemical composition of benthic foraminifera from marine sediment cores provides information on how glacial subsurface water properties differed from modern, but separating the influence of changes in the origin and end‐member properties of subsurface water from changes in flows and mixing is challenging. Spatial gaps in coverage of glacial data add to the uncertainty. Here we present new data from cores collected from the Demerara Rise in the western tropical North Atlantic, including cores from the modern tropical phosphate maximum at Antarctic Intermediate Water (AAIW) depths. The results suggest lower phosphate concentration and higher carbonate saturation state within the phosphate maximum than modern despite similar carbon isotope values, consistent with less accumulation of respired nutrients and carbon, and reduced air‐sea gas exchange in source waters to the region. An inversion of new and published glacial data confirms these inferences and further suggests that lower preformed nutrients in AAIW, and partial replacement of this still relatively high‐nutrient AAIW with nutrient‐depleted, carbonate‐rich waters sourced from the region of the modern‐day northern subtropics, also contributed to the observed changes. The results suggest that glacial preformed and remineralized phosphate were lower throughout the upper Atlantic, but deep phosphate concentration was higher. The inversion, which relies on the fidelity of the paleoceanographic data, suggests that the partial replacement of North Atlantic sourced deep water by Southern Ocean Water was largely responsible for the apparent deep North Atlantic phosphate increase, rather than greater remineralization.National Science Foundation (NSF) Grant Numbers: OCE‐0750880, OCE‐1335191, OCE‐1558341, OCE‐1536380; Woods Hole Oceanographic Institution (WHOI) Grant Numbers: 27007592, 2700080

Medication intensification in diabetes in rural primary care: a cluster-randomised effectiveness trial

OBJECTIVE: To determine the effectiveness of a provider-based intervention to improve medication intensification among patients with diabetes. DESIGN: Effectiveness cluster-randomised trial. Baseline and follow-up cross-sections of diabetes physicians\u27 patients. SETTING: Eleven U.S. Southeastern states, 2006-2008. PARTICIPANTS: 205 Rural primary care physicians, 95 completed the study. INTERVENTION: Multicomponent interactive intervention including web-based continuing medical education (CME), performance feedback and quality improvement tools. PRIMARY OUTCOME MEASURES: Medication intensification, a dose increase of an existing medication or the addition of a new class of medication for glucose, blood pressure and lipids control on any of the three most recent office visits. RESULTS: Of 364 physicians attempting to register, 102 were randomised to the intervention and 103 to the control arms; 95 physicians (intervention, n=48; control, n=47) provided data on their 1182 of their patients at baseline (intervention, n=715; control, n=467) and 945 patients at follow-up (intervention, n=479; control, n=466). For A1c control, medication intensification increased in both groups (intervention, pre 26.4% vs post 32.6%, p=0.022; control, pre 24.8% vs post 31.1%, p=0.033) (intervention, adjusted OR (AOR) 1.37; 95% CI 1.06 to 1.76; control, AOR 1.41 (95% CI 1.06 to 1.89)); however, we observed no incremental benefit solely due to the intervention (group-by-time interaction, p=0.948). Among patients with the worst glucose control (A1c \u3e9%), intensification increased in both groups (intervention, pre 34.8% vs post 62.5%, p=0.002; control, pre 35.7% vs post 61.4%, p=0.008). CONCLUSIONS: A wide-reach, low-intensity, web-based interactive multicomponent intervention had no significant incremental effect on medication intensification for control of glucose, blood pressure or lipids for patients with diabetes of physicians practising in the rural Southeastern USA. TRIAL REGISTRATION: NCT00403091

Postoperative Intensive Care Unit Requirements After Elective Craniotomy

Objective: Commonly, patients undergoing craniotomy are admitted to an intensive care setting post-operatively to allow for close monitoring. We aim to determine the frequency with which patients who have undergone elective craniotomies require intensive care unit level interventions or experience significant complications during the post-operative period to identify a subset of patients for whom an alternative to ICU level care may be appropriate. Methods: Following Institutional Review Board approval, a prospective, consecutive cohort of adult patients undergoing elective craniotomy was established at the Massachusetts General Hospital between the dates of April 2010 and March 2011. Inclusion criteria were intradural operations requiring craniotomy performed on adults (18 years of age or greater). Exclusion criteria were cases of an urgent or emergent nature, patients who remained intubated post-operatively, and patients who had a ventriculostomy drain in place at the conclusion of the case. Results: 400 patients were analyzed. Univariate analysis revealed that diabetics (p = 0.00047), patients who required intra-operative blood product administration (p = 0.032), older patients (p < 0.0001), patients with higher intra-operative blood losses (p = 0.041), and patients who underwent longer surgical procedures (p = 0.021) were more likely to require ICU-level interventions or experience significant post-operative complications. Multivariate analysis only found diabetes (p = 0.0005) and age (p = 0.0091) to be predictive of a patient’s need for post-operative intensive care unit admission. Conclusions: Diabetes and older age predict the need for ICU-level intervention after elective craniotomy. Properly selected patients may not require post-craniotomy ICU monitoring. Further study of resource utilization is necessary to validate these preliminary findings, particularly in different hospital types

Adam Smith’s Green Thumb and Malthus’ Three Horsemen: Cautionary tales from classical political economy

This essay identifies a contradiction between the flourishing interest in the environmental economics of the classical period and a lack of critical parsing of the works of its leading representatives. Its focus is the work of Adam Smith and Thomas Malthus. It offers a critical analysis of their contribution to environmental thought and surveys the work of their contemporary devotees. It scrutinizes Smith's contribution to what Karl Polanyi termed the "economistic fallacy," as well as his defenses of class hierarchy, the "growth imperative" and consumerism. It subjects to critical appraisal Malthus's enthusiasm for private property and the market system, and his opposition to market regulation. While Malthus's principal attraction to ecological economists lies in his having allegedly broadened the scope of economics, and in his narrative of scarcity, this article shows that he, in fact, narrowed the scope of the discipline and conceptualized scarcity in a reified and pseudo-scientific way

Clinical features of brain metastasis from salivary gland tumors

Salivary gland tumors comprise a group of 24 tumor subtypes with a wide range of clinical behaviors and propensities for metastasis. Several prognostic factors have been identified that help predict the development of systemic metastases, most commonly to the lung, liver, or bone. Metastases to the brain are rare. To better understand the behavior of salivary gland tumors that metastasise to the brain, we performed a retrospective cohort analysis on a series of patients to highlight features of their medical and surgical management. From 2007 to 2011, a database of 4117 elective craniotomies were queried at a single institution to identify patients surgically treated for salivary gland metastases to the brain. Three patients were identified. Histologic subtypes included salivary duct carcinoma, poorly differentiated carcinoma, and papillary mucinous adenocarcinoma. They had all undergone previous treatment for their primary malignancy. The mean time to intracranial metastasis was 48 months from initial diagnosis (range, 14–91 months). Treatment for intracranial metastases included surgical resection, whole brain radiation, stereotactic radiosurgery, and chemotherapy. Intracranial metastases from salivary gland tumors are rare, present years after diagnosis of the primary tumor, and are treatable with multimodality therapy

Solid variant of aneurysmal bone cyst of the thoracic spine: a case report

<p>Abstract</p> <p>Introduction</p> <p>The solid variant of aneurysmal bone cyst is rare, and only 13 cases involving the spine have been reported to date, including seven in the thoracic vertebrae. The diagnosis is difficult to secure radiographically before biopsy or surgery.</p> <p>Case report</p> <p>An 18-year-old Hispanic man presented to our facility with a one-year history of left chest pain without any significant neurological deficits. An MRI scan demonstrated a 6 cm diameter enhancing multi-cystic mass centered at the T6 vertebral body with involvement of the left proximal sixth rib and extension into the pleural cavity; the spinal cord was severely compressed with evidence of abnormal T2 signal changes. Our patient was taken to the operating room for a total spondylectomy of T6 with resection of the left sixth rib from a single-stage posterior-only approach. The vertebral column was reconstructed in a 360° manner with an expandable titanium cage and pedicle screw fixation. Histologically, the resected specimen showed predominant solid fibroblastic proliferation, with minor foci of reactive osteoid formation, an area of osteoclastic-like giant cells, and cyst-like areas filled with erythrocytes and focal hemorrhage, consistent with a predominantly solid variant of aneurysmal bone cyst. At 16 months after surgery, our patient remains neurologically intact with resolution of his chest and back pain.</p> <p>Conclusions</p> <p>Because of its rarity, location, and radical treatment approach, we considered this case worthy of reporting. The solid variant of aneurysmal bone cyst is difficult to diagnose radiologically before biopsy or surgery, and we hope to remind other physicians that it should be included in the differential diagnosis of any lytic expansile destructive lesion of the spine.</p

A guide to the South Plains of Texas

A compilation of essays and articles covering history, agriculture, educational institutions, and legends of the historic South Plains of Texas.[139] leaves ; 152 pdf pages.November 1935.Pictorial illustrations by Bess Hubbard.Mimeographed copy reproduced by the students of Lubbock High School with permission and assistance of the Texas Highway Dept.Plains of Texas / A.W. Evans -- The rock house on Blanco Canyon / R.B. Smith -- The story of the famous Old Yellow House Ranch / Lamb county news -- The T-Bar Ranch / R.B. Smith -- U-Lazy-S Ranch / E. Taylor -- The old Mackenzie Trail / W.L Chittenden -- Mackenzie's Indian campaigns on the Staked Plains / M.L. Cox -- Horse bones / R.G. Carter -- Old Man Singer's store / W.C. Holden -- Letter of long ago describes living conditions in days of first settles / M. Witt -- Shanties and dugouts / The Cattleman -- The legend of the sand hills / J. Mitchell -- Three notable landmarks in Lynn County / F.P. Hill -- Descriptions of South Plains cities and towns / V. Upton -- Elevation, population, and highway mileage maps / M.W. Hobbs -- Roadside divertissement / V. Upton

Sofosbuvir and Ribavirin Prevent Recurrence of HCV Infection After Liver Transplantation: An Open-Label Study

Background & AimsPatients with detectable hepatitis C virus (HCV) RNA at the time of liver transplantation universally experience recurrent HCV infection. Antiviral treatment before transplantation can prevent HCV recurrence, but existing interferon-based regimens are poorly tolerated and are either ineffective or contraindicated in most patients. We performed a trial to determine whether sofosbuvir and ribavirin treatment before liver transplantation could prevent HCV recurrence afterward.MethodsIn a phase 2, open-label study, 61 patients with HCV of any genotype and cirrhosis (Child–Turcotte–Pugh score, ≤7) who were on waitlists for liver transplantation for hepatocellular carcinoma, received up to 48 weeks of sofosbuvir (400 mg) and ribavirin before liver transplantation. The primary end point was the proportion of patients with HCV-RNA levels less than 25 IU/mL at 12 weeks after transplantation among patients with this HCV-RNA level at their last measurement before transplantation.ResultsSixty-one patients received sofosbuvir and ribavirin, and 46 received transplanted livers. The per-protocol efficacy population consisted of 43 patients who had HCV-RNA level less than 25 IU/mL at the time of transplantation. Of these 43 patients, 30 (70%) had a post-transplantation virologic response at 12 weeks, 10 (23%) had recurrent infection, and 3 (7%) died (2 from nonfunction of the primary graft and 1 from complications of hepatic artery thrombosis). Of all 61 patients given sofosbuvir and ribavirin, 49% had a post-transplantation virologic response. Recurrence was related inversely to the number of consecutive days of undetectable HCV RNA before transplantation. The most frequently reported adverse events were fatigue (in 38% of patients), headache (23%), and anemia (21%).ConclusionsAdministration of sofosbuvir and ribavirin before liver transplantation can prevent post-transplant HCV recurrence. ClinicalTrials.gov: NCT01559844