Tropical Cyclone Data Assimilation: Experiments with a Coupled Global-Limited-Area Analysis System

This study investigates the benefits of employing a limited-area data assimilation (DA) system to enhance lower-resolution global analyses in the Northwest Pacific tropical cyclone (TC) basin. Numerical experiments are carried out with a global analysis system at horizontal resolution T62 and a limited-area analysis system at resolutions from 200 km to 36 km. The global and limited-area DA systems, which are both based on the Local Ensemble Transform Kalman Filter algorithm, are implemented using a unique configuration, in which the global DA system provides information about the large-scale analysis and background uncertainty to the limited-area DA system. In experiments that address the global-to-limited-area resolution ratio, the limited-area analyses of the storm locations for experiments in which the ratio is 1:2 are, on average, more accurate than those from the global analyses. Increasing the resolution of the limited-area system beyond 100 km adds little direct benefit to the analysis of position or intensity, although 48 km analyses reduce boundary effects of coupling the models and may benefit analyses in which observations with larger representativeness error are assimilated. Two factors contribute to the higher accuracy of the limited-area analyses. First, the limited-area system improves the accuracy of the location estimates for strong storms, which is introduced when the background is updated by the global assimilation. Second, it improves the accuracy of the background estimate of the storm locations for moderate and weak storms. Improvements in the steering flow analysis due to increased resolution are modest and short-lived in the forecasts. Limited-area track forecasts are more accurate, on average, than global forecasts, independently of the strength of the storms up to five days. This forecast improvement is due to the more accurate analysis of the initial position of storms and the better representation of the interactions between the storms and their immediate environment. Experiments that test the treatment and quality control (QC) methods of TC observations show that significant gainful improvements can be achieved in the analyses and forecasts of TCs when observations with large representativeness error are not discarded in the online QC procedure. These experiments examine the impact of assimilating TCVitals SLP, QuikSCAT 10 m wind components, and reconnaissance dropsondes alongside the conventional observations assimilated by NCEP in real time. Implementing a Combined method that clips the special TC observations via Huberization when multiple observation types are unavailable, and keeping the TCVital observation when other special observations are present, showed significant systematic improvements for strong and moderate storm analyses and forecasts

Validity of neonatal POC glucose testing

Background: Glucose monitoring a common invasive intervention in newborn period •most commonly obtained laboratory value Appropriate identification of hypoglycemia is critical: •Severe hypoglycemia can lead to neurologic insult •Cerebral palsy, developmental delay, seizures, deat

What’s Happening to our Patients in their Final Year of Life?

We want to “die well” which includes: • Effective symptom management • Receiving care consistent with wishes Who achieves this, and how? • Primary care physicians (PCPs) – Insufficient time and training • Palliative care physicians – Better quality care and decreased health care cost in last years of life • “Surprise Question” – “Would you be surprised if this patient dies in the next year?” • To recognize our sickest patients and discuss goals of care and consult palliative care, if appropriate • “Advance care planning tab” – To record code status, advance directive, POLST forms, medical power of attorne

Signs of Psychosis Leading to a Diagnosis of Progressive Multifocal Leukoencephalopathy: A Case Report

Introduction: Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating process of the central nervous system that occurs in in the setting of severe immunocompromise. Patients with PML develop varying focal neurological deficits and mental status changes that have not been well-described previously. Clinical findings: We present a patient who was found by security wandering the lobby of this hospital. He was oriented only to self and unable to state a reason for presentation. Medical records were limited and included a visit to an outside hospital that documented a past medical history of HIV infection. He exhibited multiple signs of psychosis such as thought blocking and a disorganized thought process. Main diagnoses, therapeutic interventions, and outcomes: After thorough evaluation, he was diagnosed with HIV-associated PML based on a CD4 count of 68 cells/microliter, subcortical white matter signal abnormalities on brain MRI, and positive CSF PCR for JC polyomavirus. Despite initiation of antiretroviral therapy, he unfortunately clinically declined and was ultimately transitioned to hospice care. Conclusions: While survival from PML has significantly improved with the advent of antiretroviral therapy, the overall prognosis remains poor. This case report emphasizes that PML should be included in the differential diagnosis for any immunocompromised patients with mental status changes even if they do not present with overt focal neurological deficits. It also highlights the importance of continuous HIV medical care to minimize the risk of patients developing such devastating complications

Did racial representation change at our outpatient sports medicine clinic during the COVID-19 Pandemic?

Introduction/Objective • COVID-19 pandemic has disproportionately affected Black, Indigenous, and People of Color (BIPOC) • Increased infection, hospitalization, and death rates1,2 • Black Americans unequal access to outpatient care vs. White Americans 3 • Inequity worsened during the COVID-19 Pandemic 4 • Maine population: 94.25% “White;” 1.42% “Black” 5 • July 2020 COVID cases: 66.8% “White;” 22% “Black” 6 • Did this disparity reflect in in our sports medicine clinic?https://knowledgeconnection.mainehealth.org/lambrew-retreat-2021/1006/thumbnail.jp

Fresh Fruits and Vegetables Really Do Keep the Doctor Away: Symptomatic Vitamin Deficiency in a Middle Aged Man

Introduction We present a clinical case of symptomatic vitamin deficiency typically seen only in resource limited environments or alcoholics, presenting in an adult male with frequent oral intake, but limited diet of prepared foods, as well as co-occurring pernicious anemia. Clinical Findings The patient presented with complaints of ascending paresthesia leading to near syncope, lower extremity edema and hyperpigmentation on his anterior legs bilaterally which had been present for years. Diagnosis and interventions He was found to have mixed B12, thiamine, and folate deficiency. These were attributed to a combination of nutritional deficiency due to a diet of exclusively cooked foods, and pernicious anemia. He was treated with parenteral and oral vitamin supplementation and noted to improve, but was lost to follow up. Conclusion This case highlights the importance of social and nutritional history in health maintenance, as well as the clinical significance of prolonged mixed vitamin deficiency

Testing a Coupled Global-limited-area Data Assimilation System Using Observations from the 2004 Pacific Typhoon Season

Tropical cyclone (TC) track and intensity forecasts have improved in recent years due to increased model resolution, improved data assimilation, and the rapid increase in the number of routinely assimilated observations over oceans. The data assimilation approach that has received the most attention in recent years is Ensemble Kalman Filtering (EnKF). The most attractive feature of the EnKF is that it uses a fully flow-dependent estimate of the error statistics, which can have important benefits for the analysis of rapidly developing TCs. We implement the Local Ensemble Transform Kalman Filter algorithm, a variation of the EnKF, on a reduced-resolution version of the National Centers for Environmental Prediction (NCEP) Global Forecast System (GFS) model and the NCEP Regional Spectral Model (RSM) to build a coupled global-limited area analysis/forecast system. This is the first time, to our knowledge, that such a system is used for the analysis and forecast of tropical cyclones. We use data from summer 2004 to study eight tropical cyclones in the Northwest Pacific. The benchmark data sets that we use to assess the performance of our system are the NCEP Reanalysis and the NCEP Operational GFS analyses from 2004. These benchmark analyses were both obtained by the Statistical Spectral Interpolation, which was the operational data assimilation system of NCEP in 2004. The GFS Operational analysis assimilated a large number of satellite radiance observations in addition to the observations assimilated in our system. All analyses are verified against the Joint Typhoon Warning Center Best Track data set. The errors are calculated for the position and intensity of the TCs. The global component of the ensemble-based system shows improvement in position analysis over the NCEP Reanalysis, but shows no significant difference from the NCEP operational analysis for most of the storm tracks. The regional component of our system improves position analysis over all the global analyses. The intensity analyses, measured by the minimum sea level pressure, are of similar quality in all of the analyses. Regional deterministic forecasts started from our analyses are generally not significantly different from those started from the GFS operational analysis. On average, the regional experiments performed better for longer than 48 h sea level pressure forecasts, while the global forecast performed better in predicting the position for longer than 48 h

Chronic parasitization by Nosema microsporidia causes global expression changes in core nutritional, metabolic and behavioral pathways in honey bee workers (Apis mellifera)

BACKGROUND: Chronic infections can profoundly affect the physiology, behavior, fitness and longevity of individuals, and may alter the organization and demography of social groups. Nosema apis and Nosema ceranae are two microsporidian parasites which chronically infect the digestive tract of honey bees (Apis mellifera). These parasites, in addition to other stressors, have been linked to increased mortality of individual workers and colony losses in this key pollinator species. Physiologically, Nosema infection damages midgut tissue, is energetically expensive and alters expression of immune genes in worker honey bees. Infection also accelerates worker transition from nursing to foraging behavior (termed behavioral maturation). Here, using microarrays, we characterized global gene expression patterns in adult worker honey bee midgut and fat body tissue in response to Nosema infection. RESULTS: Our results indicate that N. apis infection in young workers (1 and 2 days old) disrupts midgut development. At 2 and 7 days post-infection in the fat body tissue, N. apis drives metabolic changes consistent with energetic costs of infection. A final experiment characterizing gene expression in the fat bodies of 14 day old workers parasitized with N. apis and N. ceranae demonstrated that Nosema co-infection specifically alters conserved nutritional, metabolic and hormonal pathways, including the insulin signaling pathway, which is also linked to behavioral maturation in workers. Interestingly, in all experiments, Nosema infection did not appear to significantly regulate overall expression of canonical immune response genes, but infection did alter expression of acute immune response genes identified in a previous study. Comparative analyses suggest that changes in nutritional/metabolic processes precede changes in behavioral maturation and immune processes. CONCLUSIONS: These genome-wide studies of expression patterns can help us disentangle the direct and indirect effects of chronic infection, and understand the molecular pathways that regulate disease symptoms. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2164-14-799) contains supplementary material, which is available to authorized users