Surficial Geologic Map of the Flaherty 7.5-Minute Quadrangle, Kentucky

The Flaherty 7.5-minute quadrangle is located southwest of Louisville and northwest of Elizabethtown along the boundary between Hardin and Meade Counties. The quadrangle includes mostly the Pennyroyal region of the Mississippian Plateau and also smaller areas of the Mammoth Cave plateau and the highly dissected Dripping Springs escarpment in the western half of the map area (McDowell, 1986). Topography is mostly characterized by pervasive sinkhole development in a lower elevation and low-relief plain, and high-relief plateaus, ridges, and knobs of the Dripping Springs escarpment scattered along the west side of the quadrangle. Swadley (1963) mapped the bedrock geology of the quadrangle, which was later digitized by Crawford (2002). Mississippian bedrock is exposed throughout the quadrangle and is cut by several normal faults in the south. The St. Louis Limestone and overlying Ste. Genevieve Limestone are the oldest and lowest (stratigraphy and elevation) map units in Flaherty, and underlie the Pennyroyal region. The higher elevation landforms characterizing the Dripping Springs escarpment are predominantly underlain by the Paoli Limestone, Beaver Bend Limestone, and Sample Sandstone, from oldest to youngest respectively. The Mooretown Formation is stratigraphically above the Paoli Limestone and below the Beaver Bend Limestone, and is only exposed along Sand Ridge, a prominent landform in the quadrangle trending northeast to southwest. Previously mapped surficial deposits include alluvium in Otter Creek, Flippin Creek, and a large karst basin, and “slumped sandstone” (colluvium) along Sand Ridge and other smaller areas throughout the quadrangle (Swadley, 1963)

Surficial Geologic Map of the Big Clifty 7.5-Minute Quadrangle, Kentucky

The Big Clifty 7.5-minute quadrangle is located south of Louisville and west of Elizabethtown along the boundary between Hardin and Grayson Counties. The quadrangle lies within the Mammoth Cave plateau of the Mississippian Plateau physiographic region (McDowell, 1986). Topography is characterized by a low relief plain sitting at elevations between 650 to 850 ft above sea level, which is dissected and incised by Rough River, Meeting Creek, Clifty Creek, and their tributaries to below 500 ft. Swadley (1962) mapped the bedrock geology of the quadrangle, which was later digitized by Conley (2002). Mississippian bedrock is exposed throughout the quadrangle and is cut by several vertical faults in the southeast. The oldest bedrock units include the Beaver Bend and Paoli Limestones, Sample Sandstone, and Reelsville Limestone from oldest to youngest, respectively, and are exposed in the lowest sections of river valleys on the west side of the quadrangle. The Golconda Formation (Beech Creek Limestone, Big Clifty Sandstone, and Haney Limestone Members) is primarily exposed along steep slopes of those same river valleys, which lead up to the top of the plateau. The majority of the broad Mammoth Cave plateau is underlain by Hardinsburg Sandstone with local exposures of Glen Dean Limestone and Leitchfield Formation occurring in the southwest corner of the quadrangle. Previously mapped surficial deposits include scattered areas of alluvium in Meeting Creek, Little Meeting Creek, and Clifty Creek (Swadley, 1962)

Surficial Geologic Map of the Millerstown 7.5-Minute Quadrangle, Kentucky

The Millerstown 7.5-minute quadrangle is located south of Louisville and southwest of Elizabethtown along the boundaries between Hardin, Grayson, and Hart Counties and within the Mississippian Plateau physiographic region (McDowell, 1986). Topography is characterized by the low relief Pennyroyal plain that sits at altitudes below about 650 ft above sea level, the low relief Mammoth Cave plateau at altitudes above about 650 ft, and steep slopes of and isolated knobs of the incised Dripping Springs escarpment that separates the two plains. Moore (1965) mapped the bedrock geology of the quadrangle, which was later digitized by Johnson (2006). Mississippian bedrock and local areas of Pennsylvanian bedrock are exposed throughout most of the quadrangle, all, of which, are cut by several vertical faults. The Ste. Genevieve Limestone is the oldest lithology and underlies the Pennyroyal region in the northeast and southwest corners of the quadrangle, and locally along the Nolin River. The Beaver Bend Limestone, Mooretown Formation, Paoli Limestone, Sample Sandstone, and Reelsville Limestone stratigraphic sequence underlie most of the remaining Pennyroyal plain and several steep slopes of the Dripping Springs escarpment. The Beech Creek Limestone, Big Clifty Sandstone, and Haney Limestone Members of the Golconda Formation are exposed along the Dripping Springs escarpment the edges of the Mammoth Cave plateau region. Most of the Mammoth Cave plateau is underlain by the Hardinsburg Limestone, and, locally in the southwest corner of the quadrangle, the Glen Dean Limestone, Leitchfield Formation, and Pennsylvanian Caseyville Formation. Previously mapped surficial deposits include minor areas of alluvium in tributaries across the Millerstown quadrangle (Moore, 1964)

Surficial Geologic Map of the Summit 7.5-Minute Quadrangle, Kentucky

The Summit 7.5-minute quadrangle is located south of Louisville and west of Elizabethtown along the boundary between Hardin and Grayson Counties and within the Mississippian Plateau physiographic region (McDowell, 1986). Topography is characterized by the low relief Pennyroyal region that sits at elevations between 560 to 650 ft above sea level, the low relief Mammoth Cave plateau at elevations between 750 to 900 ft, and the steep Dripping Springs escarpment that separates the two plains. Moore (1964) mapped the bedrock geology of the quadrangle, which was later digitized by Conley (2002). Mississippian bedrock is exposed throughout the quadrangle and is cut by several vertical faults. The St. Louis Limestone and overlying Ste. Genevieve Limestone underlie the Pennyroyal region and are the oldest bedrock units in the quadrangle. The Beaver Bend and Paoli Limestones, Sample Sandstone, Reelsville Limestone, and Beech Creek Limestone Member of the Golconda Formation are exposed along the Dripping Springs escarpment. The Mammoth Cave plateau region is underlain by the Big Clifty Sandstone and, locally, Haney Limestone Members of the Golconda Formation east of the Summit Fault, and Hardinsburg Sandstone west of the fault. Previously mapped surficial deposits include minor areas of alluvium in tributaries across the Summit quadrangle, and areas of “slumped sandstone” (colluvium) in the Pennyroyal region (Moore, 1964)

Surficial Geologic Map of the Upton 7.5-Minute Quadrangle, Kentucky

The Upton 7.5-minute quadrangle is located south of Elizabethtown along the boundaries between Hardin, Hart, and Larue Counties and within the Mississippian Plateau physiographic region (McDowell, 1986). Topography is characterized by the low relief Pennyroyal plain that sits at altitudes below about 750 ft above sea level, the ridges, spurs, and isolated knobs of the intensely dissected Dripping Springs escarpment; the low relief cap of the escarpment landforms is part of the Mammoth Cave plateau region. Moore (1972) mapped the bedrock geology of the quadrangle, which was later digitized by Toth (2006). Mississippian bedrock is exposed throughout most of the quadrangle and is cut by several northwest-southeast trending vertical faults. The Ste. Genevieve Limestone is the oldest lithology and underlies most of the Pennyroyal region. The Beaver Bend Limestone and Paoli Limestone, Sample Sandstone, and Reelsville Limestone stratigraphic sequence underlie the remaining areas of the Pennyroyal, as well as the lower slopes of the Dripping Spring escarpment. The Beech Creek Limestone, Big Clifty Sandstone, and Haney Limestone Members of the Golconda Formation are exposed along the upper slopes of the Dripping Springs escarpment the upper plains of the Mammoth Cave plateau. The Upper Mississippian Hardinsburg Limestone is exposed on the highest ridges of the Dripping Springs, and the Pennsylvanian Caseyville Formation is locally exposed around the highest peak in the southern part of the Upton quadrangle. Previously mapped surficial deposits include minor areas of alluvium in major tributaries, and “slumped” areas across the quadrangle (Moore, 1972)

Efficacy of a movement control injury-prevention programme in an adult community rugby union population; a cluster randomised controlled trial

Background Exercise programmes aimed at reducing injury have been shown to be efficacious for some non-collision sports, but evidence in collision sports such as rugby union is lacking. Objective To evaluate the efficacy of an evidence-informed injury prevention exercise programme in reducing match injuries in adult community rugby union players. Design Prospective cluster randomised (single-blind) controlled trial. Clubs were the unit of randomisation. Setting English adult community clubs (2015–2016 season) with a formally qualified medical professional to diagnose and report match-injuries. Participants 860 clubs were invited to participate of which 81 volunteered and were randomly assigned. Data was received from 41 clubs (control, 19; intervention, 22). Interventions A 42-week exercise programme comprising 6-week graduated exercise blocks was introduced during pre-season. The control programme reflected ‘normal practice’ exercises, whereas the intervention focused on proprioception, balance, cutting, landing, and resistance exercises. Main Outcome Measurements Match-injury incidence and burden for: all ≥8 days time-loss injuries and targeted (lower-limb, shoulder, head and neck, excluding fractures and lacerations) ≥8 days time-loss injuries. Results Poisson regression identified unclear differences between groups for overall injury incidence (rate ratio (RR), 90% confidence interval (CI)=0.9, 0.6–1.3) and injury burden (RR, 90% CI=0.8, 0.5–1.4). A likely beneficial difference in targeted injury incidence (RR, 90% CI=0.6, 0.4–1.0) was identified, with ∼40% lower lower-limb incidence (RR, 90% CI=0.6, 0.4–1.0) and ∼60% lower concussion incidence (RR, 90%CI=0.36, 0.18–0.70) in the intervention group. Completing the intervention at least once per week was associated with a likely beneficial difference between groups (intervention n=15, control n=13; RR, 90% CI=0.7, 0.4–1.0). Conclusions This movement-control injury-prevention programme appeared efficacious, with likely beneficial differences for lower-limb injuries and concussion for the treatment clubs. Targeted injury incidence was ∼30% lower when 1 or more intervention sessions were completed each wee

Effects of Cannabidiol on exercise physiology and bioenergetics : a randomised controlled pilot trial

Background: Cannabidiol (CBD) has demonstrated anti-inflammatory, analgesic, anxiolytic and neuroprotective effects that have the potential to benefit athletes. This pilot study investigated the effects of acute, oral CBD treatment on physiological and psychological responses to aerobic exercise to determine its practical utility within the sporting context. Methods: On two occasions, nine endurance-trained males (mean±SD V̇O2max: 57.4±4.0 mL·min−1 ·kg−1 ) ran for 60 min at a fixed intensity (70% V̇O2max) (RUN 1) before completing an incremental run to exhaustion (RUN 2). Participants received CBD (300 mg; oral) or placebo 1.5 h before exercise in a randomised, double-blind design. Respiratory gases (V̇O2), respiratory exchange ratio (RER), heart rate (HR), blood glucose (BG) and lactate (BL) concentrations, and ratings of perceived exertion (RPE) and pleasure–displeasure were measured at three timepoints (T1–3) during RUN 1. V̇O2max, RERmax, HRmax and time to exhaustion (TTE) were recorded during RUN 2. Venous blood was drawn at Baseline, Pre- and Post-RUN 1, Post-RUN 2 and 1 h Post-RUN 2. Data were synthesised using Cohen’s dz effect sizes and 85% confidence intervals (CIs). Effects were considered worthy of further investigation if the 85% CI included±0.5 but not zero. Results: CBD appeared to increase V̇O2 (T2:+38±48 mL·min−1, dz: 0.25–1.35), ratings of pleasure (T1:+0.7±0.9, dz: 0.22–1.32; T2:+0.8±1.1, dz: 0.17–1.25) and BL (T2:+3.3±6.4 mmol·L−1, dz:>0.00–1.03) during RUN 1 compared to placebo. No differences in HR, RPE, BG or RER were observed between treatments. CBD appeared to increase V̇O2max (+119±206 mL·min−1, dz: 0.06–1.10) and RERmax (+0.04±0.05 dz: 0.24–1.34) during RUN 2 compared to placebo. No differences in TTE or HRmax were observed between treatments. Exercise increased serum interleukin (IL)-6, IL-1β, tumour necrosis factor-α, lipopolysaccharide and myoglobin concentrations (i.e. Baseline vs. Post-RUN 1, Post-RUN 2 and/or 1-h Post-RUN 2, p’s<0.05). However, the changes were small, making it difficult to reliably evaluate the effect of CBD, where an effect appeared to be present. Plasma concentrations of the endogenous cannabinoid, anandamide (AEA), increased Post-RUN 1 and Post-RUN 2, relative to Baseline and Pre-RUN 1 (p’s<0.05). CBD appeared to reduce AEA concentrations Post-RUN 2, compared to placebo (−0.95±0.64 pmol·mL−1, dz: −2.19, −0.79). Conclusion: CBD appears to alter some key physiological and psychological responses to aerobic exercise without impairing performance. Larger studies are required to confirm and better understand these preliminary findings

An automated software system to promote anticoagulation and reduce stroke risk: cluster-randomized controlled trial

Background and Purpose: Oral anticoagulants (OAC) substantially reduce risk of stroke in atrial fibrillation, but uptake is suboptimal. Electronic health records enable automated identification of people at risk but not receiving treatment. We investigated the effectiveness of a software tool (AURAS-AF [Automated Risk Assessment for Stroke in Atrial Fibrillation]) designed to identify such individuals during routine care through a cluster-randomized trial.Methods: Screen reminders appeared each time the electronic health records of an eligible patient was accessed until a decision had been taken over OAC treatment. Where OAC was not started, clinicians were prompted to indicate a reason. Control practices continued usual care. The primary outcome was the proportion of eligible individuals receiving OAC at 6 months. Secondary outcomes included rates of cardiovascular events and reports of adverse effects of the software on clinical decision-making.Results: Forty-seven practices were randomized. The mean proportion–prescribed OAC at 6 months was 66.3% (SD=9.3) in the intervention arm and 63.9% (9.5) in the control arm (adjusted difference 1.21% [95% confidence interval −0.72 to 3.13]). Incidence of recorded transient ischemic attack was higher in the intervention practices (median 10.0 versus 2.3 per 1000 patients with atrial fibrillation; P=0.027), but at 12 months, we found a lower incidence of both all cause stroke (P=0.06) and hemorrhage (P=0.054). No adverse effects of the software were reported.Conclusions: No significant change in OAC prescribing occurred. A greater rate of diagnosis of transient ischemic attack (possibly because of improved detection or overdiagnosis) was associated with a reduction (of borderline significance) in stroke and hemorrhage over 12 months.Clinical Trial Registration: URL: http://www.isrctn.com. Unique Identifier: ISRCTN55722437.%U http://stroke.ahajournals.org/content/strokeaha/early/2017/01/24/STROKEAHA.116.015468.full.pd

Barriers to a software reminder system for risk assessment of stroke in atrial fibrillation: a process evaluation of a cluster randomised trial in general practice

Background: Oral anticoagulants reduce the risk of stroke in patients with atrial fibrillation (AF), but are underused. AURAS-AF (AUtomated Risk Assessment for Stroke in AF) is a software tool designed to identify eligible patients and promote discussions within consultations about initiating anticoagulants.Aim: To investigate the implementation of the software in UK general practice.Design and setting: Process evaluation involving 23 practices randomly allocated to use AURAS-AF during a cluster randomised trial.Method: An initial invitation to discuss anticoagulation was followed by screen reminders appearing during consultations until a decision had been made. The reminders required responses, giving reasons for cases where an anticoagulant was not initiated. Qualitative interviews with clinicians and patients explored acceptability and usability.Results: In a sample of 476 patients eligible for the invitation letter, only 159 (33.4%) were considered suitable for invitation by their GPs. Reasons given were frequently based on frailty, and risk of falls or haemorrhage. Of those invited, 35 (22%) started an anticoagulant (7.4% of those originally identified). A total of 1695 main-screen reminders occurred in 940 patients. In 883 instances, the decision was taken not to initiate and a range of reasons offered. Interviews with 15 patients and seven clinicians indicated that the intervention was acceptable, though the issue of disruptive screen reminders was raised.Conclusion: Automated risk assessment for stroke in atrial fibrillation and prompting during consultations are feasible and generally acceptable, but did not overcome concerns about frailty and risk of haemorrhage as barriers to anticoagulant uptake

The Blood of Healthy Individuals Exhibits CD8 T Cells with a Highly Altered TCR Vb Repertoire but with an Unmodified Phenotype

CD8 T cell clonal expansions (TCE) have been observed in elderly, healthy individuals as well in old mice, and have been associated with the ageing process. Both chronic latent and non-persistent viral infections have been proposed to drive the development of distinct non-functional and functional TCE respectively. Biases in TCR Vβ repertoire diversity are also recurrently observed in patients that have undergone strong immune challenge, and are preferentially observed in the CD8 compartment. Healthy adults can also exhibit CD8 T cells with strong alterations of their CDR3 length distribution. Surprisingly, no specific investigations have been conducted to analyze the CD8 T cell repertoire in normal adults, to determine if such alterations in TCR Vβ repertoire share the features of TCE. In this study, we characterized the phenotype and function of the CD8 population in healthy individuals of 25–52 years of age. All but one of the EBV-positive HLA-B8 healthy volunteers that were studied were CMV-negative. Using a specific unsupervised statistical method, we identified Vβ families with altered CDR3 length distribution and increased TCR Vβ/HPRT transcript ratios in all individuals tested. The increase in TCR Vβ/HPRT transcript ratio was more frequently associated with an increase in the percentage of the corresponding Vβ+ T cells than with an absence of modification of their percentage. However, in contrast with the previously described TCE, these CD8+ T cells were not preferentially found in the memory CD8 subset, they exhibited normal effector functions (cytokine secretion and cytotoxic molecule expression) and they were not reactive to a pool of EBV/CMV/Flu virus peptides. Taken together, the combined analysis of transcripts and proteins of the TCR Vβ repertoire led to the identification of different types of CD8+ T cell clone expansion or contraction in healthy individuals, a situation that appears more complex than previously described in aged individuals