Rapid physical and biological particle mixing on an intertidal sandflat

Sediment mixing processes were investigated using inert tracer experiments, benthic macrofaunal community analysis, and surveys of ray feeding pits to quantify the relative rates and controls of physical and biological reworking on Debidue Flat, an intertidal sandflat in South Carolina. Sediment reworking on Debidue Flat was rapid, with both advective and biodiffusive mixing operating over different vertical spatial scales. Physical reworking by tidal currents dominated initial transport of the tracer in the top 5-10 cm on timescales of ~30 days. Although the exact mechanism of tracer transport is unclear, it is most likely due to active fluidization of surface sediments during stages of the tide followed by a density-driven settling of tracer resulting in a steady downward transport to the depth of bedform reworking. Biodiffusive mixing was evident throughout the sampled interval (~30 cm) and dominated reworking at depths greater than 10 cm. Estimated biodiffusive mixing coefficients (Db) were high all year (0.15-0.28 cm2d-1), and were comparable to values reported for coastal bioturbated muds. The haustoriid amphipod Pseudohaustorius caroliniensis was most likely responsible for tracer dispersal in the 10 -30 cm interval based on its distribution, abundance, size, and observed burrow structures. Ray pit excavation and infilling were seasonal disturbances that contributed ~12-22% to spatially averaged advective transport rates but were locally intense and capable alone of turning over the entire upper ~15 cm of the flat in ~100 -1000 d. We propose that the mixing processes on Debidue Flat promote an unconstricted, open sediment matrix that maintains the high permeability required for the rapid porewater exchange to 25 cm noted for this system. Thus, in addition to redistributing organic substrates, physical and biological particle mixing play important roles in controlling permeability of flat deposits and quantification of these processes is important to understand controls on permeability and biogeochemical cycling of solutes in sandy systems

Glacier response to North Atlantic climate variability during the Holocene

Small glaciers and ice caps respond rapidly to climate variations, and records of their past extent provide information on the natural envelope of past climate variability. Millennial-scale trends in Holocene glacier size are well documented and correspond with changes in Northern Hemisphere summer insolation. However, there is only sparse and fragmentary evidence for higher-frequency variations in glacier size because in many Northern Hemisphere regions glacier advances of the past few hundred years were the most extensive and destroyed the geomorphic evidence of ice growth and retreat during the past several thousand years. Thus, most glacier records have been of limited use for investigating centennial-scale climate forcing and feedback mechanisms. Here we report a continuous record of glacier activity for the last 9.5 ka from southeast Greenland derived from high-resolution measurements on a proglacial lake sediment sequence. Physical and geochemical parameters show that the glaciers responded to previously documented Northern Hemisphere climatic excursions, including the \u278.2 ka\u27 cooling event, the Holocene Thermal Maximum, Neoglacial cooling, and 20th century warming. In addition, the sediments indicate centennial-scale oscillations in glacier size during the late Holocene. Beginning at 4.1 ka, a series of abrupt glacier advances occurred, each lasting similar to 100 years and followed by a period of retreat, that were superimposed on a gradual trend toward larger glacier size. Thus, while declining summer insolation caused long-term cooling and glacier expansion during the late Holocene, climate system dynamics resulted in repeated episodes of glacier expansion and retreat on multi-decadal to centennial timescales. These episodes coincided with ice rafting events in the North Atlantic Ocean and periods of regional ice cap expansion, which confirms their regional significance and indicates that considerable glacier activity on these timescales is a normal feature of the cryosphere. The data provide a longer-term perspective on the rate of 20th century glacier retreat and indicate that recent anthropogenic-driven warming has already impacted the regional cryosphere in a manner outside the natural range of Holocene variability

False in Name Only-Gastroduodenal Artery Pseudoaneurysm in a Recurrently Bleeding Patient: Case Report and Literature Review.

INTRODUCTION: Although the diagnosis of visceral pseudoaneurysm is unusual, it requires emergent attention due to the risk of rupture. We describe a 70-year old man with a gastroduodenal artery (GDA) pseudoaneurysm manifest as recurrent hæmorrhage. AREAS COVERED: We highlight the possible ætiologies, clinical presentations, diagnostic tools and treatment options for this condition. In this instance, the patient was successfully treated by selective angio-embolization. EXPERT COMMENTARY: A visceral pseudoaneurysm should be considered in patients with abdominal pain and GI hæmorrhage. At present, angio-embolization is first-line therapy

How Well Can We Assess the Validity of Non-Randomised Studies of Medications? A Systematic Review of Assessment Tools

Objective To determine whether assessment tools for non-randomised studies (NRS) address critical elements that influence the validity of NRS findings for comparative safety and effectiveness of medications. Design Systematic review and Delphi survey. Data sources We searched PubMed, Embase, Google, bibliographies of reviews and websites of influential organisations from inception to November 2019. In parallel, we conducted a Delphi survey among the International Society for Pharmacoepidemiology Comparative Effectiveness Research Special Interest Group to identify key methodological challenges for NRS of medications. We created a framework consisting of the reported methodological challenges to evaluate the selected NRS tools. Study selection Checklists or scales assessing NRS. Data extraction Two reviewers extracted general information and content data related to the prespecified framework. Results Of 44 tools reviewed, 48% (n=21) assess multiple NRS designs, while other tools specifically addressed case–control (n=12, 27%) or cohort studies (n=11, 25%) only. Response rate to the Delphi survey was 73% (35 out of 48 content experts), and a consensus was reached in only two rounds. Most tools evaluated methods for selecting study participants (n=43, 98%), although only one addressed selection bias due to depletion of susceptibles (2%). Many tools addressed the measurement of exposure and outcome (n=40, 91%), and measurement and control for confounders (n=40, 91%). Most tools have at least one item/question on design-specific sources of bias (n=40, 91%), but only a few investigate reverse causation (n=8, 18%), detection bias (n=4, 9%), time-related bias (n=3, 7%), lack of new-user design (n=2, 5%) or active comparator design (n=0). Few tools address the appropriateness of statistical analyses (n=15, 34%), methods for assessing internal (n=15, 34%) or external validity (n=11, 25%) and statistical uncertainty in the findings (n=21, 48%). None of the reviewed tools investigated all the methodological domains and subdomains. Conclusions The acknowledgement of major design-specific sources of bias (eg, lack of new-user design, lack of active comparator design, time-related bias, depletion of susceptibles, reverse causation) and statistical assessment of internal and external validity is currently not sufficiently addressed in most of the existing tools. These critical elements should be integrated to systematically investigate the validity of NRS on comparative safety and effectiveness of medications

A Hypothetical New Challenging Use for Indocyanine Green Fluorescence during Laparoscopic Appendectomy: A Mini-Series of Our Experience and Literary Review

Laparoscopic appendectomy (LA) is a well-standardized surgical procedure, but there are still controversies about the different devices to be used for the appendiceal stump closure and the related postoperative complications. Indocyanine green (ICG) fluorescence angiography (FA) has already been shown to be helpful in elective and emergency surgery, providing intraoperative information on tissue and organ perfusion, thus guiding the surgical decisions and the technical strategies. According to these two aspects, we report a mini-series of the first five patients affected by gangrenous and flegmonous acute appendicitis intraoperatively evaluated with ICG-FA during LA. The patients were admitted to the Emergency Department with an usual range of symptoms for acute appendicitis. The patients were successfully managed by fully LA with the help of a new hypothetical challenging use of ICG-FA

The Risk of Malignant Degeneration of Müllerian Derivatives in PMDS: A Review of the Literature

Persistent Müllerian Duct Syndrome (PMDS) is a rare autosomal recessive disorder of sex development characterized by the presence of fallopian tubes, uterus and upper one-third of the vagina in individuals with XY genotype and normal male phenotype. The main complications of PMDS are infertility and the rare risk of malignant degeneration of both testicular and Müllerian derivatives. We report the case of a 49-year-old man who, during repair of an incisional hernia, was incidentally found to have a uterine-like structure posterior to the bladder. In the past at the age of 18 months, he had undergone bilateral orchidopexies for bilateral cryptorchidism. The intraoperative decision was to preserve the uterine-like structure and make a more accurate diagnosis postoperatively. Evaluation revealed an XY chromosome and imaging consistent with PMDS. The patient was informed about the risk of neoplastic transformation of the residual Müller ducts and was offered surgical treatment, which he declined. Subsequent follow-up imaging studies, including testicular and pelvic ultrasound, were negative for findings suggestive of malignant testicular and Mullerian derivative degeneration. A review of the international literature showed that, when a decision is taken to remove the Mullerian derivatives, laparoscopy and especially robotic surgery allow for the successful removal of Müllerian derivatives. Whenever the removal of these structures is not possible or the patient refuses to undergo surgery, it is necessary to inform the patient of the need for adequate follow-up. Patients should undergo regular pelvic imaging examination and MRI might be a better method for that purpose

Transforming Ovarian Cancer Care by Targeting Minimal Residual Disease

Frontline treatment and resultant cure rates in patients with advanced ovarian cancer have changed little over the past several decades. Here, we outline a multidisciplinary approach aimed at gaining novel therapeutic insights by focusing on the poorly understood minimal residual disease phase of ovarian cancer that leads to eventual incurable recurrences

Accuracy, realism and general applicability of European forest models

Forest models are instrumental for understanding and projecting the impact of climate change on forests. A considerable number of forest models have been developed in the last decades. However, few systematic and comprehensive model comparisons have been performed in Europe that combine an evaluation of modelled carbon and water fluxes and forest structure. We evaluate 13 widely used, state-of-the-art, stand-scale forest models against field measurements of forest structure and eddy-covariance data of carbon and water fluxes over multiple decades across an environmental gradient at nine typical European forest stands. We test the models\u27 performance in three dimensions: accuracy of local predictions (agreement of modelled and observed annual data), realism of environmental responses (agreement of modelled and observed responses of daily gross primary productivity to temperature, radiation and vapour pressure deficit) and general applicability (proportion of European tree species covered). We find that multiple models are available that excel according to our three dimensions of model performance. For the accuracy of local predictions, variables related to forest structure have lower random and systematic errors than annual carbon and water flux variables. Moreover, the multi-model ensemble mean provided overall more realistic daily productivity responses to environmental drivers across all sites than any single individual model. The general applicability of the models is high, as almost all models are currently able to cover Europe\u27s common tree species. We show that forest models complement each other in their response to environmental drivers and that there are several cases in which individual models outperform the model ensemble. Our framework provides a first step to capturing essential differences between forest models that go beyond the most commonly used accuracy of predictions. Overall, this study provides a point of reference for future model work aimed at predicting climate impacts and supporting climate mitigation and adaptation measures in forests