Whole Atmosphere Climate Change: Dependence on Solar Activity

We conducted global simulations of temperature change due to anthropogenic trace gas emissions, which extended from the surface, through the thermosphere and ionosphere, to the exobase. These simulations were done under solar maximum conditions, in order to compare the effect of the solar cycle on global change to previous work using solar minimum conditions. The Whole Atmosphere Community Climate Model‐eXtended was employed in this study. As in previous work, lower atmosphere warming, due to increasing anthropogenic gases, is accompanied by upper atmosphere cooling, starting in the lower stratosphere, and becoming dramatic, almost 2 K per decade for the global mean annual mean, in the thermosphere. This thermospheric cooling, and consequent reduction in density, is less than the almost 3 K per decade for solar minimum conditions calculated in previous simulations. This dependence of global change on solar activity conditions is due to solar‐driven increases in radiationally active gases other than carbon dioxide, such as nitric oxide. An ancillary result of these and previous simulations is an estimate of the solar cycle effect on temperatures as a function of altitude. These simulations used modest, five‐member, ensembles, and measured sea surface temperatures rather than a fully coupled ocean model, so any solar cycle effects were not statistically significant in the lower troposphere. Temperature change from solar minimum to maximum increased from near zero at the tropopause to about 1 K at the stratopause, to approximately 500 K in the upper thermosphere, commensurate with the empirical evidence, and previous numerical models

Whole Atmosphere Simulation of Anthropogenic Climate Change

We simulated anthropogenic global change through the entire atmosphere, including the thermosphere and ionosphere, using the Whole Atmosphere Community Climate Model‐eXtended. The basic result was that even as the lower atmosphere gradually warms, the upper atmosphere rapidly cools. The simulations employed constant low solar activity conditions, to remove the effects of variable solar and geomagnetic activity. Global mean annual mean temperature increased at a rate of +0.2 K/decade at the surface and +0.4 K/decade in the upper troposphere but decreased by about −1 K/decade in the stratosphere‐mesosphere and −2.8 K/decade in the thermosphere. Near the mesopause, temperature decreases were small compared to the interannual variation, so trends in that region are uncertain. Results were similar to previous modeling confined to specific atmospheric levels and compared favorably with available measurements. These simulations demonstrate the ability of a single comprehensive numerical model to characterize global change throughout the atmosphere

Predicting erythropoietin resistance in hemodialysis patients with type 2 diabetes

<p>Background: Resistance to ESAs (erythropoietin stimulating agents) is highly prevalent in hemodialysis patients with diabetes and associated with an increased mortality. The aim of this study was to identify predictors for ESA resistance and to develop a prediction model for the risk stratification in these patients.</p> <p>Methods: A post-hoc analysis was conducted of the 4D study, including 1015 patients with type 2 diabetes undergoing hemodialysis. Determinants of ESA resistance were identified by univariate logistic regression analyses. Subsequently, multivariate models were performed with stepwise inclusion of significant predictors from clinical parameters, routine laboratory and specific biomarkers.</p> <p>Results: In the model restricted to clinical parameters, male sex, shorter dialysis vintage, lower BMI, history of CHF, use of ACE-inhibitors and a higher heart rate were identified as independent predictors of ESA resistance. In regard to routine laboratory markers, lower albumin, lower iron saturation, higher creatinine and higher potassium levels were independently associated with ESA resistance. With respect to specific biomarkers, higher ADMA and CRP levels as well as lower Osteocalcin levels were predictors of ESA resistance.</p> <p>Conclusions: Easily obtainable clinical parameters and routine laboratory parameters can predict ESA resistance in diabetic hemodialysis patients with good discrimination. Specific biomarkers did not meaningfully further improve the risk prediction of ESA resistance. Routinely assessed data can be used in clinical practice to stratify patients according to the risk of ESA resistance, which may help to assign appropriate treatment strategies.</p&gt

A mixed methods approach to evaluating community drug distributor performance in the control of neglected tropical diseases

BACKGROUND: Trusted literate, or semi-literate, community drug distributors (CDDs) are the primary implementers in integrated preventive chemotherapy (IPC) programmes for Neglected Tropical Disease (NTD) control. The CDDs are responsible for safely distributing drugs and for galvanising communities to repeatedly, often over many years, receive annual treatment, create and update treatment registers, monitor for side-effects and compile treatment coverage reports. These individuals are 'volunteers' for the programmes and do not receive remuneration for their annual work commitment. METHODS: A mixed methods approach, which included pictorial diaries to prospectively record CDD use of time, structured interviews and focus group discussions, was used to triangulate data on how 58 CDDs allocated their time towards their routine family activities and to NTD Programme activities in Uganda. The opportunity costs of CDD time were valued, performance assessed by determining the relationship between time and programme coverage, and CDD motivation for participating in the programme was explored. RESULTS: Key findings showed approximately 2.5 working weeks (range 0.6-11.4 working weeks) were spent on NTD Programme activities per year. The amount of time on NTD control activities significantly increased between the one and three deliveries that were required within an IPC campaign. CDD time spent on NTD Programme activities significantly reduced time available for subsistence and income generating engagements. As CDDs took more time to complete NTD Programme activities, their treatment performance, in terms of validated coverage, significantly decreased. Motivation for the programme was reported as low and CDDs felt undervalued. CONCLUSIONS: CDDs contribute a considerable amount of opportunity cost to the overall economic cost of the NTD Programme in Uganda due to the commitment of their time. Nevertheless, programme coverage of at least 75 %, as required by the World Health Organisation, is not being achieved and vulnerable individuals may not have access to treatment as a consequence of sub-optimal performance by the CDDs due to workload and programmatic factors

Bioelectrochemical conversion of CO2 to value added product formate using engineered Methylobacterium extorquens

The conversion of carbon dioxide to formate is a fundamental step for building C1 chemical platforms. Methylobacterium extorquens AM1 was reported to show remarkable activity converting carbon dioxide into formate. Formate dehydrogenase 1 from M. extorquens AM1 (MeFDH1) was verified as the key responsible enzyme for the conversion of carbon dioxide to formate in this study. Using a 2% methanol concentration for induction, microbial harboring the recombinant MeFDH1 expressing plasmid produced the highest concentration of formate (26.6 mM within 21 hours) in electrochemical reactor. 60 ??M of sodium tungstate in the culture medium was optimal for the expression of recombinant MeFDH1 and production of formate (25.7 mM within 21 hours). The recombinant MeFDH1 expressing cells showed maximum formate productivity of 2.53 mM/g-wet cell/hr, which was 2.5 times greater than that of wild type. Thus, M. extorquens AM1 was successfully engineered by expressing MeFDH1 as recombinant enzyme to elevate the production of formate from CO2 after elucidating key responsible enzyme for the conversion of CO2 to formate

Temporal Variability of Atomic Hydrogen From the Mesopause to the Upper Thermosphere

We investigate atomic hydrogen (H) variability from the mesopause to the upper thermosphere, on time scales of solar cycle, seasonal, and diurnal, using measurements made by the Sounding of the Atmosphere using Broadband Emission Radiometry (SABER) instrument on the Thermosphere Ionosphere Mesosphere Energetics Dynamics satellite, and simulations by the National Center for Atmospheric Research Whole Atmosphere Community Climate Model‐eXtended (WACCM‐X). In the mesopause region (85 to 95 km), the seasonal and solar cycle variations of H simulated by WACCM‐X are consistent with those from SABER observations: H density is higher in summer than in winter, and slightly higher at solar minimum than at solar maximum. However, mesopause region H density from the Mass‐Spectrometer‐Incoherent‐Scatter (National Research Laboratory Mass‐Spectrometer‐Incoherent‐Scatter 00 (NRLMSISE‐00)) empirical model has reversed seasonal variation compared to WACCM‐X and SABER. From the mesopause to the upper thermosphere, H density simulated by WACCM‐X switches its solar cycle variation twice, and seasonal dependence once, and these changes of solar cycle and seasonal variability occur in the lower thermosphere (~95 to 130 km), whereas H from NRLMSISE‐00 does not change solar cycle and seasonal dependence from the mesopause through the thermosphere. In the upper thermosphere (above 150 km), H density simulated by WACCM‐X is higher at solar minimum than at solar maximum, higher in winter than in summer, and also higher during nighttime than daytime. The amplitudes of these variations are on the order of factors of ~10, ~2, and ~2, respectively. This is consistent with NRLMSISE‐00

A preliminary randomized double blind placebo-controlled trial of intravenous immunoglobulin for Japanese encephalitis in Nepal

BACKGROUND: Japanese encephalitis (JE) virus (JEV) is a mosquito-borne flavivirus found across Asia that is closely related to West Nile virus. There is no known antiviral treatment for any flavivirus. Results from in vitro studies and animal models suggest intravenous immunoglobulin (IVIG) containing virus-specific neutralizing antibody may be effective in improving outcome in viral encephalitis. IVIG's anti-inflammatory properties may also be beneficial. METHODOLOGY/PRINCIPAL FINDINGS: We performed a pilot feasibility randomized double-blind placebo-controlled trial of IVIG containing anti-JEV neutralizing antibody (ImmunoRel, 400mg/kg/day for 5 days) in children with suspected JE at two sites in Nepal; we also examined the effect on serum neutralizing antibody titre and cytokine profiles. 22 children were recruited, 13 of whom had confirmed JE; 11 received IVIG and 11 placebo, with no protocol violations. One child (IVIG group) died during treatment and two (placebo) subsequently following hospital discharge. Overall, there was no difference in outcome between treatment groups at discharge or follow up. Passive transfer of anti-JEV antibody was seen in JEV negative children. JEV positive children treated with IVIG had JEV-specific neutralizing antibody titres approximately 16 times higher than those treated with placebo (p=0.2), which was more than could be explained by passive transfer alone. IL-4 and IL-6 were higher in the IVIG group. CONCLUSIONS/SIGNIFICANCE: A trial of IVIG for JE in Nepal is feasible. IVIG may augment the development of neutralizing antibodies in JEV positive patients. IVIG appears an appealing option for JE treatment that warrants further study. TRIAL REGISTRATION: ClinicalTrials.gov NCT01856205

Rheumatoid arthritis patients receive less frequent acute reperfusion and secondary prevention therapy after myocardial infarction compared with the general population

INTRODUCTION: The 30-day case-fatality rate after acute myocardial infarction (MI) for rheumatoid arthritis (RA) patients is twice that of the general population. This study compared the frequency and timeliness of early reperfusion therapy and treatment with secondary prevention medications after acute MI in RA patients and controls. METHODS: We performed a structured medical chart review of RA patients and matched controls who had been admitted with acute MI to one of three hospitals in Victoria, Australia, between 1995 and 2005. The administration and timing of acute reperfusion therapy and in-hospital treatment with secondary prevention medications were compared between the two groups. Acute reperfusion was defined as thrombolysis or percutaneous coronary intervention (PCI) within 12 hours of the first symptom of MI. RESULTS: The medical charts of 90 RA patients and 90 matched controls were reviewed. The RA patients were significantly less likely to receive acute reperfusion compared with the controls (16% versus 37%: odds ratio (OR), 0.27; 95% confidence interval (CI), 0.10 to 0.64)), and this difference persisted after adjusting for type of MI, clinical setting of MI, and prior MI (OR, 0.2; 95% CI, 0.05 to 0.6). The RA patients also received less-frequent in-hospital treatment with beta blockers (71% versus 83%; OR, 0.42; 95% CI, 0.18 to 0.96) and lipid-lowering agents (40% versus 70%; OR, 0.21; 95% CI, 0.09 to 0.46). CONCLUSIONS: RA patients who experience acute MI receive acute reperfusion and secondary prevention medications less frequently than do controls. This may contribute to higher case-fatality rates after MI in RA patients

Where form and substance meet: using the narrative approach of re-storying to generate research findings and community rapprochement in (university) mathematics education

Storytelling is an engaging way through which lived experience can be shared and reflected upon, and a tool through which difference, diversity—and even conflict—can be acknowledged and elaborated upon. Narrative approaches to research bring the richness and vibrancy of storytelling into how data is collected and interpretations of it shared. In this paper, I demonstrate the potency of the narrative approach of re-storying for a certain type of university mathematics education research (non-deficit, non-prescriptive, context-specific, example-centred and mathematically focused) conducted at the interface of two communities: mathematics education and mathematics. I do so through reference to Amongst Mathematicians (Nardi, 2008), a study carried out in collaboration with 20 university mathematicians from six UK mathematics departments. The study deployed re-storying to present data and analyses in the form of a dialogue between two fictional, yet entirely data-grounded, characters—M, mathematician, and RME, researcher in mathematics education. In the dialogues, the typically conflicting epistemologies—and mutual perceptions of such epistemologies—of the two communities come to the fore as do the feasibility-of, benefits-from, obstacles-in and conditions-for collaboration between these communities. First, I outline the use of narrative approaches in mathematics education research. Then, I introduce the study and its use of re-storying, illustrating this with an example: the construction of a dialogue from interview data in which the participating mathematicians discuss the potentialities and pitfalls of visualisation in university mathematics teaching. I conclude by outlining re-storying as a vehicle for community rapprochement achieved through generating and sharing research findings—the substance of research—in forms that reflect the fundamental principles and aims that underpin this research. My conclusions resonate with sociocultural constructs that view mathematics teacher education as contemporary praxis and the aforementioned inter-community discussion as taking place within a third space

Evaluation of a communication skills program for first-year medical students at the University of Toronto

Abstract Background Effective doctor-patient communication has been linked to numerous benefits for both patient and physician. The purpose of this study was to evaluate the effectiveness of the University of Toronto's Therapeutic Communication Program (TCom) at improving first-year medical students' communication skills. Methods Data were collected during the 1996/97, 1997/98, 1998/99 and 1999/00 academic years. The study used a repeated measures design with a waiting list control group: students were randomly assigned to groups starting the educational intervention in either September (N = 38) or February (N = 41), with the latter being used as a control for the former. Communication skills were assessed at the pre- and post-intervention times and at the end of the academic year from the perspectives of student, standardized patient and external rater. Results Only the external rater, using an instrument designed to assess the students' empathy based on their written responses, showed a time × group interaction effect (p = 0.039), thereby partially supporting the hypothesis that TCom improved the students' communication skills. Students rated themselves less positively after participation in the program (p = 0.038), suggesting that self-evaluation was an ineffective measure of actual performance or that the program helped them learn to more accurately assess their abilities. Conclusion The lack of strong findings may be partly due to the study's small sample sizes. Further research at other medical or professional schools could assess the effectiveness of similar courses on students' communication skills and on other capacities that were not measured in this study, such as their understanding of and comfort with patients, their management of the doctor-patient relationship, and their ability to give and receive feedback