756 research outputs found

    Ultrahigh-temperature granulite-facies metamorphism and exhumation of deep crust in a migmatite dome during late- to post-orogenic collapse and extension in the central Adirondack Highlands (New York, USA)

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    This study combines field observations, mineral and whole-rock geochemistry, phase equilibrium modeling, and U-Pb sensitive high-resolution ion microprobe (SHRIMP) zircon geochronology to investigate sillimanite-bearing felsic migmatites exposed on Ledge Mountain in the central Adirondack Highlands (New York, USA), part of an extensive belt of mid-crustal rocks comprising the hinterland of the Mesoproterozoic Grenville orogen. Phase equilibrium modeling suggests minimum peak metamorphic conditions of 960-1025 °C and 11-12.5 kbar during the Ottawan orogeny—sig-nificantly higher pressure-temperature conditions than previously determined—followed by a period of near-isothermal decompression, then isobaric cooling. Petrography reveals abundant melt-related microstructures, and pseudosection models show the presence of at least ~15%-30% melt during buoyancy-driven exhumation and decompression. New zircon data document late Ottawan (re)crys-tallization at ca. 1047 ± 5 to 1035 ± 2 Ma following ultrahigh-temperature (UHT) metamorphism and anatexis on the retrograde cooling path. Inherited zircon cores give a mean date of 1136 ± 5 Ma, which suggests derivation of these felsic granulites by partial melting of older igneous rocks. The ferroan, anhydrous character of the granulites is similar to that of the ca. 1050 Ma Lyon Mountain Granite and consistent with origin in a late- to post-Ottawan extensional environment. We present a model for development of a late Ottawan migmatitic gneiss dome in the central Adirondacks that exhumed deep crustal rocks including the Snowy Mountain and Oregon anorthosite massifs with UHT Ledge Mountain migmatites. Recognition of deep crustal meta-plutonic rocks recording UHT metamorphism in a migmatite gneiss dome has significant implications for crustal behavior in this formerly thickened orogen

    Do high-risk medicines alerts influence practice?

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    Background: Medicine-related adverse events are prevalent, costly and mostly preventable. The High Risk Medicines Working Party (Victoria) developed and distributed three highrisk medicines alerts &ndash; wrong route of administration of oral medicines, subcutaneous insulin and unfractionated heparin &ndash; and accompanying audit tools in 2008 and 2009.Aims: To determine the impact of the three high-risk medicines alerts on Victorian health services; to assess the clinical relevance and utility of the audit tools; to identify barriers to implementing recommendations; and to obtain feedback and suggestions for future alert topics.Method: A cross-sectional survey was undertaken from 6 to 31 July 2009 using an online questionnaire. The questionnaire was distributed to 90 metropolitan, regional and rural public health services in Victoria and approximately 200 members of the Quality Use of Medicines Network (Victoria).Results: Most of the 90 respondents were pharmacists (53%) and nurses (31%). 53 (59%) respondents reported making changes as a result of receiving the high-risk medicines alerts &ndash; 21 (40%) concerned the wrong route of administration, 12 (23%) subcutaneous insulin and 7 (13%) unfractionated heparin. Barriers to implementation included time constraints, inadequate staff and resources, excessive paperwork and competing priorities. A minority of respondents indicated some alerts were not relevant to small rural services. Suggestions forimproving the audit tools included making them less labour intensive, enabling electronic responses and ensuring their distribution is coordinated with other medicine-related tools.Conclusion: High-risk medicines alerts and the accompanying audit tools facilitated change but there were some barriers to their implementation, such as time and resource constraints. Not all alerts and audit tools were relevant to all health services.<br /

    A Randomized Phase II Trial of Pioglitazone for Lung Cancer Chemoprevention in High Risk Current and Former Smokers

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    Lung cancer chemoprevention, especially in high-risk former smokers, has great potential to reduce lung cancer incidence and mortality. Thiazolidinediones prevent lung cancer in preclinical studies, and diabetics receiving thiazolidinediones have lower lung cancer rates which led to our double-blind, randomized, phase II placebo-controlled trial of oral pioglitazone in high risk current or former smokers with sputum cytologic atypia or known endobronchial dysplasia. Bronchoscopy was performed at study entry and after completing of six months of treatment. Biopsies were histologically scored, and primary endpoint analysis tested worst biopsy scores (Max) between groups; Dysplasia index (DI) and average score (Avg) changes were secondary endpoints. Biopsies also received an inflammation score. The trial accrued 92 subjects (47 pioglitazone, 45 placebo), and 76 completed both bronchoscopies (39 pioglitazone, 37 placebo). Baseline dysplasia was significantly worse for current smokers, and 64% of subjects had mild or greater dysplasia at study entry. Subjects receiving pioglitazone did not exhibit improvement in bronchial dysplasia. Former smokers treated with pioglitazone exhibited a slight improvement in Max, while current smokers exhibited slight worsening. While statistically significant changes in Avg and DI were not observed in the treatment group, former smokers exhibited a slight decrease in both Avg and DI. Negligible Avg and DI changes occurred in current smokers. A trend towards decreased Ki-67 labeling index occurred in former smokers with baseline dysplasia receiving pioglitazone. While pioglitazone did not improve endobronchial histology in this high-risk cohort, specific lesions showed histologic improvement and further study is needed to better characterize responsive dysplasia

    Legitimating space: art and the politics of place

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    Rock art, graffiti, and other emplaced works of art bring people together at specific places. This type of art allows for encounters between people in their absence, and thus presents a range of possibilities for making statements about specific places and those who occupy or visit. This opens the possibility for issues of legitimation to become implicitly or explicitly articulated. However, the legitimate use of space, and the legitimate employment of art, can vary drastically across different contexts. Here, the paper discusses a range of different strategies of art and legitimation in three case studies from India, California, and Spai

    De novo point mutations in patients diagnosed with ataxic cerebral palsy

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    Cerebral palsy is commonly attributed to perinatal asphyxia. However, Schnekenberg et al. describe here four individuals with ataxic cerebral palsy likely due to de novo dominant mutations associated with increased paternal age. Therefore, patients with cerebral palsy should be investigated for genetic causes before the disorder is ascribed to asphyxi

    Psoriasis and Hypertension Severity: Results from a Case-Control Study

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    BACKGROUND: Epidemiologic studies have provided new insights into the association between psoriasis and cardiovascular diseases. Previous population studies have examined hypertension frequency in psoriasis patients. However, the relationship between severity of hypertension and psoriasis has not been characterized. OBJECTIVE: We sought to investigate whether patients with psoriasis have more difficult-to-manage hypertension compared to non-psoriatic hypertensive patients. APPROACH: We performed a case-control study using the University of California Davis electronic medical records. The cases were defined as patients diagnosed with both psoriasis and hypertension, and controls were defined as patients with hypertension and without psoriasis. In this identified population, 835 cases were matched on age, sex, and body mass index (BMI) to 2418 control patients. KEY RESULTS: Treatment with multiple anti-hypertensives was significantly associated with the presence of psoriasis using univariate (p < 0.0001) and multivariable analysis, after adjusting for diabetes, hyperlipidemia, and race (p < 0.0001). Compared to hypertensive patients without psoriasis, psoriasis patients with hypertension were 5 times more likely to be on a monotherapy antihypertensive regimen (95% CI 3.607.05), 9.5 times more likely to be on dual antihypertensive therapy (95% CI 6.68-13.65), 16.5 times more likely to be on triple antihypertensive regimen (95% CI 11.01-24.84), and 19.9 times more likely to be on quadruple therapy or centrally-acting agent (95% CI 10.58-37.33) in multivariable analysis after adjusting for traditional cardiac risk factors. CONCLUSIONS: Psoriasis patients appear to have more difficult-to-control hypertension compared to non-psoriatic, hypertensive patients
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