Difficulties in the treatment of recurring diffuse alveolar hemorrhage accompanying primary antiphospholipid syndrome: a case report and literature review

Pulmonary embolism is the most common pulmonary manifestation of primary antiphospholipid syndrome (PAPS). However, PAPS may manifest in the respiratory system also due to non-thrombotic processes. In the following paper we present a case of PAPS-related diffuse alveolar hemorrhage (DAH). Because of sparse literature and a lack of randomized controlled trials, there are currently no recommendations regarding the optimal choice of steroid-sparing agent in treating PAPS-related DAH. In our patient, treatment with cyclophosphamide or mycophenolate mofetil along with low dose prednisone was ineffective, partially because of infectious complications, whereas addition of monthly intravenous immunoglobulin to mycophenolate mofetil and prednisone, appears to control the disease

Tracheobronchopathia osteochondroplastica — case report and literature review

Tracheobronchopatia osteochondroplastyczna (TBO) jest rzadką chorobą o niejasnej etiologii, charakteryzującą się powstawaniem mnogich, chrzęstnych i chrzęstno-kostnych guzków w błonie podśluzowej tchawicy i dużych oskrzeli. Przebieg kliniczny choroby jest zwykle łagodny, ale zwężenie dróg oddechowych może powodować przewlekłe, niespecyficzne objawy kliniczne. Przedstawiono przypadek 50-letniego mężczyzny z przewlekłą dusznością wysiłkową i widocznym w badaniach obrazowych zwężeniem tchawicy. Przyczyną objawów była TBO.Tracheobronchopathia osteochondroplastica (TBO) is a rare disease of unknown etiology characterised by a formation of multiple, cartilaginous and osteocartilaginous submucosal nodules in the trachea and major bronchi. The course of the disease is usually benign but the narrowing of the respiratory tract can lead to chronic non-specific clinical symptoms. We present a case of a 50-year old man with chronic exertional dyspnoea and stenosis of the trachea visible in imaging tests, in whom the symptoms were caused by TBO

Climate change adaptation strategies and approaches for outdoor recreation

Climate change will alter opportunities and demand for outdoor recreation through altered winter weather conditions and season length, climate-driven changes in user preferences, and damage to recreational infrastructure, among other factors. To ensure that outdoor recreation remains sustainable in the face of these challenges, natural resource managers may need to adapt their recreation management. One of the major challenges of adapting recreation to climate change is translating broad concepts into specific, tangible actions. Using a combination of in-depth interviews of recreational managers and a review of peer-reviewed literature and government reports, we developed a synthesis of impacts, strategies, and approaches, and a tiered structure that organizes this information. Six broad climate adaptation strategies and 25 more specific approaches were identified and organized into a “recreation menu”. The recreation menu was tested with two national forests in the US in multi-day workshops designed to integrate these concepts into real-world projects that were at the beginning stages of the planning process. We found that the recreation menu was broad yet specific enough to be applied to recreation-focused projects with different objectives and climate change impacts. These strategies and approaches serve as stepping stones to enable natural resource and recreation managers to translate broad concepts into targeted and prescriptive actions for implementing adaptation

Adaptation strategies and approaches for forested watersheds

Intentional climate adaptation planning for ecosystems has become a necessary part of the job for natural resource managers and natural resource professionals in this era of non-stationarity. One of the major challenges in adapting ecosystems to climate change is in the translation of broad adaptation concepts to specific, tangible actions. Addressing management goals and values while considering the long-term risks associated with local climate change can make forested watershed management plans more robust to uncertainty and changing conditions. We provide a menu of tiered adaptation strategies, which we developed with a focus on forests of the Midwest and Northeastern U.S., as part of a flexible framework to support the integration of climate change considerations into forested watershed management and conservation activities. This menu encapsulates ideas from the literature into statements that signify climate adaptation intention and provide examples of associated tactics to help ground the concepts in specific actions. Finally, we describe two demonstration projects, shared through the Northern Institute of Applied Climate Science’s Climate Change Response Framework, that have used this Forested Watershed Adaptation Menu and Adaptation Workbook in project-level planning

Trudności w leczeniu nawracającego rozlanego krwawienia pęcherzykowego w przebiegu pierwotnego zespołu antyfosfolipidowego: opis przypadku i przegląd literatury

Najczęstszą płucną manifestacją pierwotnego zespołu antyfosfolipidowego (PAPS) jest zatorowość płucna. Zespół może się objawiać w układzie oddechowym nie tylko na drodze powikłań zakrzepowych. W niniejszej pracy przedstawiono przypadek rozlanego krwawienia pęcherzykowego (DAH) w przebiegu PAPS. Ze względu na niewielką literaturę przedmiotu oraz brak badań randomizowanych, kontrolowanych placebo nie istnieją obecnie wytyczne co do profilaktyki nawrotu DAH. W przypadku opisywanego pacjenta leczenie cyklofosfamidem, a następnie mykofenolanem mofetylu, razem z prednizonem w małej dawce było nieefektywne, częściowo z powodu powikłań infekcyjnych, przy czym, dodanie comiesięcznych wlewów dożylnych immunoglobulin do terapii mykofenolanem mofetylu i prednizonem wydaje się zapewniać optymalną kontrolę choroby.Najczęstszą płucną manifestacją pierwotnego zespołu antyfosfolipidowego (PAPS) jest zatorowość płucna. Zespół może się objawiać w układzie oddechowym nie tylko na drodze powikłań zakrzepowych. W niniejszej pracy przedstawiono przypadek rozlanego krwawienia pęcherzykowego (DAH) w przebiegu PAPS. Ze względu na niewielką literaturę przedmiotu oraz brak badań randomizowanych, kontrolowanych placebo nie istnieją obecnie wytyczne co do profilaktyki nawrotu DAH. W przypadku opisywanego pacjenta leczenie cyklofosfamidem, a następnie mykofenolanem mofetylu, razem z prednizonem w małej dawce było nieefektywne, częściowo z powodu powikłań infekcyjnych, przy czym, dodanie comiesięcznych wlewów dożylnych immunoglobulin do terapii mykofenolanem mofetylu i prednizonem wydaje się zapewniać optymalną kontrolę choroby

Beyond planning tools: Experiential learning in climate adaptation planning and practices

In the past decade, several dedicated tools have been developed to help natural resources professionals integrate climate science into their planning and implementation; however, it is unclear how often these tools lead to on-the-ground climate adaptation. Here, we describe a training approach that we developed to help managers effectively plan to execute intentional, climate-informed actions. This training approach was developed through the Climate Change Response Framework (CCRF) and uses active and focused work time and peer-to-peer interaction to overcome observed barriers to using adaptation planning tools. We evaluate the effectiveness of this approach by examining participant evaluations and outlining the progress of natural resources projects that have participated in our trainings. We outline a case study that describes how this training approach can lead to place and context-based climate-informed action. Finally, we describe best practices based on our experience for engaging natural resources professionals and helping them increase their comfort with climate-informed planning

Oral History Interview: Maria Janowiak (1626)

Interviewed by Emily Hutcheso

Minimum tree size and interpretation of stand structure in uneven-aged northern hardwoods

Uneven-aged management of northern hardwoods frequently relies on diameter distributions in evaluating and controlling stand structure. However, the minimum tree diameter used to analyze diameter distributions varies among studies and may affect the interpretation of distribution shapes and, subsequently, stand structure. It has been suggested that the use of larger minimum diameters in the construction of these distributions would cause rotated sigmoid stand structures to exhibit a negative exponential distribution shape. To test this hypothesis, we constructed diameter distributions using minimum diameters of 3.0 and 13.0 cm for seven northern hardwood stands. Differences in distribution shape were observed only in unmanaged stands, in which three distribution shapes classified as rotated sigmoid using a 3.0-cm minimum diameter were classified as increasing-q when the 13.0-cm minimum diameter was used. Copyright © 2010 by the Society of American Foresters

Stand structure and composition in a Northern Hardwood forest after 40 years of single-tree selection

Uneven-aged northern hardwoods of the Great Lakes region are managed primarily through single-tree selection harvesting. We quantified species composition and stand structure after 40 years of single-tree selection in five stands as compared with three stands that were untreated for 40 years. Relative density and importance value of sugar maple significantly increased under single-tree selection, whereas relative density of yellow birch significantly decreased and eastern hemlock remained unchanged. Contemporary seedling and saplings layers were dominated by sugar maple regardless of treatment, but unmanaged stands contained more species. Diameter distribution varied over time and between unmanaged and managed stands. Increasing-q was the most common distribution shape in 2004, and there was no clear trend toward a negative exponential or rotated sigmoid distribution over time. Our results suggest that long-term single-tree selection may result in regeneration of fewer tree species commonly found in this forest type, with potential implications for future stand structure. Copyright © 2007 by the Society of American Foresters