Hypoxaemia in patients with pulmonary arterial hypertension during simulated air travel

SummaryBackgroundRecent air travel recommendations suggest patients with precapillary pulmonary hypertension (PCPH) in New York Heart Association (NYHA) functional class 3 and 4 should have in-flight oxygen without the need for pre-flight testing. However it remains unclear as to how best to determine patients fitness to fly.MethodsThis study (i) investigates the effect of hypoxic challenge testing (HCT) on the arterial oxygen levels in a cohort of 36 patients with PCPH and (ii) compares the relative frequency with which FC and HCT predict the requirement for in-flight oxygen.ResultsThe degree of arterial hypoxaemia induced by HCT (fall in partial pressure of oxygen in arterial blood (PaO2) 2.36 kPa, 95% CI 2.06–2.66 kPa) was similar to the drop observed in other published studies of chronic respiratory diseases.Following current air travel recommendations based on FC, 25 patients of the cohort would require in-flight oxygen whilst 10 subjects failed the HCT. Fourteen subjects had flown post-diagnosis. Of these, nine subjects should have had in-flight oxygen based on FC but were asymptomatic without. Also one who passed the HCT had developed symptoms during the flight whilst three who failed the HCT were asymptomatic flying without in-flight oxygen.ConclusionsHypoxaemia induced by simulated air travel in patients with PCPH is similar to that seen in published studies of patients with other chronic respiratory diseases. HCT failed to predict correctly who had developed symptoms during an aircraft flight in a significant minority of the study subjects. Similarly guidelines based on functional class result in a major increase in the proportion of patients being advised to use oxygen, many of whom had been asymptomatic on previous flights without it. More work is required to improve prediction of need for in-flight oxygen in patients with PCPH

Biological control of an agricultural pest protects tropical forests

Though often perceived as an environmentally-risky practice, biological control of invasive species can restore crop yields, ease land pressure and thus contribute to forest conservation. Here, we show how biological control against the mealybug Phenacoccus manihoti (Hemiptera) slows deforestation across Southeast Asia. In Thailand, this newly-arrived mealybug caused an 18% decline in cassava yields over 2009–2010 and an escalation in prices of cassava products. This spurred an expansion of cassava cropping in neighboring countries from 713,000 ha in 2009 to > 1 million ha by 2011: satellite imagery reveals 388%, 330%, 185% and 608% increases in peak deforestation rates in Cambodia, Lao PDR, Myanmar and Vietnam focused in cassava crop expansion areas. Following release of the host-specific parasitoid Anagyrus lopezi (Hymenoptera) in 2010, mealybug outbreaks were reduced, cropping area contracted and deforestation slowed by 31–95% in individual countries. Hence, when judiciously implemented, insect biological control can deliver substantial environmental benefits

Mid-Miocene cooling and the extinction of tundra in continental Antarctica

A major obstacle in understanding the evolution of Cenozoic climate has been the lack of well dated terrestrial evidence from high-latitude, glaciated regions. Here, we report the discovery of exceptionally well preserved fossils of lacustrine and terrestrial organisms from the McMurdo Dry Valleys sector of the Transantarctic Mountains for which we have established a precise radiometric chronology. The fossils, which include diatoms, palynomorphs, mosses, ostracodes, and insects, represent the last vestige of a tundra community that inhabited the mountains before stepped cooling that first brought a full polar climate to Antarctica. Paleoecological analyses, 40Ar/39Ar analyses of associated ash fall, and climate inferences from glaciological modeling together suggest that mean summer temperatures in the region cooled by at least 8°C between 14.07 ± 0.05 Ma and 13.85 ± 0.03 Ma. These results provide novel constraints for the timing and amplitude of middle-Miocene cooling in Antarctica and reveal the ecological legacy of this global climate transition

Trends in sexually transmitted infections in general practice 1990-2000: population based study using data from the UK general practice research database

Objective: To describe the contribution of primary care to the diagnosis and management of sexually transmitted infections in the United Kingdom, 1990-2000, in the context of increasing incidence of infections in genitourinary medicine clinics. Design: Population based study. Setting: UK primary care. Participants: Patients registered in the UK general practice research database. Main outcome measures: Incidence of diagnosed sexually transmitted infections in primary care and estimation of the proportion of major such infections diagnosed in primary care. Results: An estimated 23.0% of chlamydia cases in women but only 5.3% in men were diagnosed and treated in primary care during 1998-2000, along with 49.2% cases of non-specific urethritis and urethral discharge in men and 5.7% cases of gonorrhoea in women and 2.9% in men. Rates of diagnosis in primary care rose substantially in the late 1990s. Conclusions: A substantial and increasing number of sexually transmitted infections are diagnosed and treated in primary care in the United Kingdom, with sex ratios differing from those in genitourinary medicine clinics. Large numbers of men are treated in primary care for presumptive sexually transmitted infections

Panton-Valentine leukocidin associated staphylococcal disease: a cross-sectional study at a London hospital, England

AbstractRecently, there has been international concern at the rapid emergence of highly pathogenic strains of Staphylococcus aureus associated with a toxin called Panton–Valentine leukocidin (PVL). In the UK, these strains are considered to be rare and mainly severe. We estimate the proportion of staphylococcal infections that are caused by strains containing the PVL genes, and describe risk factors for these infections. Three hundred and ninety consecutive S. aureus clinical isolates, submitted for routine diagnostic purposes were screened for PVL genes. Risk factors for infection were identified from the patient medical record. 9.7% (95% CI 7.0–13.1%) of clinical isolates and 20.8% of skin and soft tissue specimens contained the genes for PVL. Methicillin-resistant S. aureus with PVL was rare (0.8% of all isolates) but PVL with methicillin-sensitive S. aureus was common (9.0% of all specimens). PVL infection was more frequent in males (OR 3.0, 95% CI 1.3–7.0), and in young adults aged 20–39 years (OR 3.7, 95% CI 1.3–10.4). Over half of PVL positive S. aureus infections originated in patients based in the community. Community-onset PVL-associated disease is common in the UK and mainly causes skin and soft tissue infections that do not require admission to hospital. Consideration should be given to current infection control strategy, which advocates household contact screening and decolonization on the assumption that PVL-associated disease is rare

The Formation of Fragments at Corotation in Isothermal Protoplanetary Disks

Numerical hydrodynamics simulations have established that disks which are evolved under the condition of local isothermality will fragment into small dense clumps due to gravitational instabilities when the Toomre stability parameter $Q$ is sufficiently low. Because fragmentation through disk instability has been suggested as a gas giant planet formation mechanism, it is important to understand the physics underlying this process as thoroughly as possible. In this paper, we offer analytic arguments for why, at low $Q$, fragments are most likely to form first at the corotation radii of growing spiral modes, and we support these arguments with results from 3D hydrodynamics simulations.Comment: 21 pages, 1 figur

A burst from the direction of UZ Fornacis with XMM-Newton

The XMM-Newton pointing towards the magnetic cataclysmic variable UZ For finds the source to be a factor > 10^3 fainter than previous EXOSAT and ROSAT observations. The source was not detected for the majority of a 22 ksec exposure with the EPIC cameras, suggesting that the accretion rate either decreased, or stopped altogether. However a 1.1 ksec burst was detected from UZ For during the observation. Spectral fits favour optically thin, kT = 4.4 keV thermal emission. Detection of the burst by the on-board Optical Monitor indicates that this was most probably an accretion event. The 0.1-10 keV luminosity of 2.1 x 10^30 erg/s is typical for accretion shock emission from high state polars and would result from the potential energy release of ~ 10^16 g of gas. There is no significant soft excess due to reprocessing in the white dwarf atmosphere.Comment: 7 pages, 2 postscript figures, ApJL, in pres

Predicting concentrations of human pharmaceuticals throughout the river systems of Europe

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