High-Resolution Analysis Products to Support Severe Weather and Cloud-to-Ground Lightning Threat Assessments over Florida

The Applied Meteorology Unit (AMU) located at the Kennedy Space Center (KSC)/Cape Canaveral Air Force Station (CCAFS) implemented an operational configuration of the Advanced Regional Prediction System (ARPS) Data Analysis System (ADAS), as well as the ARPS numerical weather prediction (NWP) model. Operational, high-resolution ADAS analyses have been produced from this configuration at the National Weather Service in Melbourne, FL (NWS MLB) and the Spaceflight Meteorology Group (SMG) over the past several years. Since that time, ADAS fields have become an integral part of forecast operations at both NWS MLB and SMG. To continue providing additional utility, the AMU has been tasked to implement visualization products to assess the potential for supercell thunderstorms and significant tornadoes, and to improve assessments of short-term cloud-to-ground (CG) lightning potential. This paper and presentation focuses on the visualization products developed by the AMU for the operational high-resolution ADAS and AR.PS at the NWS MLB and SMG. The two severe weather threat graphics implemented within ADAS/ARPS are the Supercell Composite Parameter (SCP) and Significant Tornado Parameter (SIP). The SCP was designed to identify areas with supercell thunderstorm potential through a combination of several instability and shear parameters. The SIP was designed to identify areas that favor supercells producing significant tornadoes (F2 or greater intensity) versus non-tornadic supercells. Both indices were developed by the NOAAINWS Storm Prediction Center (SPC) and were normalized by key threshold values based on previous studies. The indices apply only to discrete storms, not other convective modes. In a post-analysis mode, the AMU calculated SCP and SIP for graphical output using an ADAS configuration similar to the operational set-ups at NWS MLB and SMG. Graphical images from ADAS were generated every 15 minutes for 13 August 2004, the day that Hurricane Charley approached and made landfall on the Florida peninsula. Several tornadoes struck the interior of the Florida peninsula in advance of Hurricane Charley's landfall during the daylight hours of 13 August. Since SPC had previously examined this case using SCP and SIP graphics generated from output of the Rapid Update Cycle (RUC) model, this day served as a good benchmark to compare and validate the high-resolution ADAS graphics against the smoother RUC analyses, which serves as background fields to the ADAS analyses. The ADAS-generated SCP and STP graphics have been integrated into the suite of products examined operationally by NWS MLB forecasters and are used to provide additional guidance for assessment of the near-storm environment during convective situations

Appropriate inclusion of interactions was needed to avoid bias in multiple imputation

OBJECTIVE: Missing data are a pervasive problem, often leading to bias in complete records analysis (CRA). Multiple imputation (MI) via chained equations is one solution, but its use in the presence of interactions is not straightforward. STUDY DESIGN AND SETTING: We simulated data with outcome Y dependent on binary explanatory variables X and Z and their interaction XZ. Six scenarios were simulated (Y continuous and binary, each with no interaction, a weak and a strong interaction), under five missing data mechanisms. We use directed acyclic graphs to identify when CRA and MI would each be unbiased. We evaluate the performance of CRA, MI without interactions, MI including all interactions, and stratified imputation. We also illustrated these methods using a simple example from the National Child Development Study (NCDS). RESULTS: MI excluding interactions is invalid and resulted in biased estimates and low coverage. When XZ was zero, MI excluding interactions gave unbiased estimates but overcoverage. MI including interactions and stratified MI gave equivalent, valid inference in all cases. In the NCDS example, MI excluding interactions incorrectly concluded there was no evidence for an important interaction. CONCLUSIONS: Epidemiologists carrying out MI should ensure that their imputation model(s) are compatible with their analysis model

Multidetector CT improving surgical outcomes in breast cancer (MISO-BC) : a randomised controlled trial

Background: Early diagnosis of malignant axillary nodes in breast cancer guides the extent of axillary surgery: patients with known axillary malignancy receive a more extensive single operation at the same time as surgery to their breast. A multicentre randomised controlled trial assessed whether a Computed Tomography (CT) scan of the axilla could more accurately diagnose malignant axillary lymph node involvement in patients with newly diagnosed breast cancer when compared to usual care. Methods: Patients with newly diagnosed breast cancer (identified via screening and symptomatic pathways) at two NHS Trusts in the North East of England were recruited and randomised in equal numbers. Both groups received routine diagnostic and surgical care. In addition, one group received a CT scan of their axilla on the same side as the breast cancer. The primary endpoint was the need to undergo a second axillary surgical procedure. Findings: The trial recruited 297 patients of whom 291 contributed to findings. The proportion of patients undergoing a second operation was similar (CT vs UC: 19.4% vs. 19.7%; CT-UC: −0.3%, 95%CI: = −9.5% to 8.9%, χ2 [1]: p = 1.00). Patients in the two groups were similar before treatment, had similar types and grade of cancer, experienced similar patterns of post-operative complications and reported similar experiences of care. Interpretation: CT scan-guided care did not result in a change in the number of patients requiring a second operation; similar numbers of patients needed further axillary surgery in both groups. New diagnostic imaging technologies regularly enter NHS centres. It is important these are evaluated rigorously before becoming routine care

In Vitro Assessment of Shiitake Mushroom (Lentinula edodes) Extract for Its Antigingivitis Activity

Gingivitis is a preventable disease characterised by inflammation of the gums due to the buildup of a microbial biofilm at the gingival margin. It is implicated as a precursor to periodontitis, a much more serious problem which includes associated bone loss. Unfortunately, due to poor oral hygiene among the general population, gingivitis is prevalent and results in high treatment costs. Consequently, the option of treating gingivitis using functional foods, which promote oral health, is an attractive one. Medicinal mushrooms, including shiitake, have long been known for their immune system boosting as well as antimicrobial effects; however, they have not been employed in the treatment of oral disease. In the current study, the effectiveness of shiitake mushroom extract was compared to that of the active component in the leading gingivitis mouthwash, containing chlorhexidine, in an artificial mouth model (constant depth film fermenter). The total bacterial numbers as well as numbers of eight key taxa in the oral community were investigated over time using multiplex qPCR. The results indicated that shiitake mushroom extract lowered the numbers of some pathogenic taxa without affecting the taxa associated with health, unlike chlorhexidine which has a limited effect on all taxa

Clinicans' perceptions of the quality of outsourced radiology and actions taken around perceived imaging errors in practice

Objectives: Outsourcing of radiological reporting services has fundamentally altered communication between radiologists and clinicians in clinical decision making, which relies heavily on diagnostic imaging. The aim of this study was to understand clinicians’ perspectives and experiences of interpretation of outsourced reports in clinical practice, if the author of imaging reports matters to clinicians, and actions taken to deal with perceived errors. Methods A printed survey was distributed to a purposive sample of 50 of the 250 senior medical and surgical staff of a large National Health Service hospital in the United Kingdom who regularly engaged with the Radiology Department between May – October 2017, representing 20% of this hospital workforce. The survey consisted of 10 questions examining clinicians’ opinions on radiology reporting, with comment options to encourage respondents to give further detail. Participants were requested to return the survey to the study investigators. Results: The survey elicited a 100% response rate (n=50). A constant comparative framework was used to guide analysis, revealing themes relevant to the ongoing inter-professional relationship between clinicians and radiologists. The disparity between in-house and externally sourced radiology reports and underlying issues of trust surrounding outsourced reports were the most significant themes identified. Conclusions: This study found outsourcing of radiology reporting needs multi-disciplinary team availability regarding the interpretation and discussions around capacity for effective communication. It raises important issues around often under-acknowledged additional workloads imposed on in-house radiologists. There are financial and pragmatic clinical aspects in pathways of radiology practice which require further research and examination

Impact of the SPOP Mutant Subtype on the Interpretation of Clinical Parameters in Prostate Cancer.

Purpose: Molecular characterization of prostate cancer, including The Cancer Genome Atlas, has revealed distinct subtypes with underlying genomic alterations. One of these core subtypes, SPOP (speckle-type POZ protein) mutant prostate cancer, has previously only been identifiable via DNA sequencing, which has made the impact on prognosis and routinely used risk stratification parameters unclear. Methods: We have developed a novel gene expression signature, classifier (Subclass Predictor Based on Transcriptional Data), and decision tree to predict the SPOP mutant subclass from RNA gene expression data and classify common prostate cancer molecular subtypes. We then validated and further interrogated the association of prostate cancer molecular subtypes with pathologic and clinical outcomes in retrospective and prospective cohorts of 8,158 patients. Results: The subclass predictor based on transcriptional data model showed high sensitivity and specificity in multiple cohorts across both RNA sequencing and microarray gene expression platforms. We predicted approximately 8% to 9% of cases to be SPOP mutant from both retrospective and prospective cohorts. We found that the SPOP mutant subclass was associated with lower frequency of positive margins, extraprostatic extension, and seminal vesicle invasion at prostatectomy; however, SPOP mutant cancers were associated with higher pretreatment serum prostate-specific antigen (PSA). The association between SPOP mutant status and higher PSA level was validated in three independent cohorts. Despite high pretreatment PSA, the SPOP mutant subtype was associated with a favorable prognosis with improved metastasis-free survival, particularly in patients with high-risk preoperative PSA levels. Conclusion: Using a novel gene expression model and a decision tree algorithm to define prostate cancer molecular subclasses, we found that the SPOP mutant subclass is associated with higher preoperative PSA, less adverse pathologic features, and favorable prognosis. These findings suggest a paradigm in which the interpretation of common risk stratification parameters, particularly PSA, may be influenced by the underlying molecular subtype of prostate cancer

Effects of Fruit and Vegetable Low Molecular Mass Fractions on Gene Expression in Gingival Cells Challenged with Prevotella intermedia and Actinomyces naeslundii

Low molecular mass (LMM) fractions obtained from extracts of raspberry, red chicory, and Shiitake mushrooms have been shown to be an useful source of specific antibacterial, antiadhesion/coaggregation, and antibiofilm agent(s) that might be used for protection towards caries and gingivitis. In this paper, the effects of such LMM fractions on human gingival KB cells exposed to the periodontal pathogens Prevotella intermedia and Actinomyces naeslundii were evaluated. Expression of cytokeratin 18 (CK18) and β4 integrin (β4INT) genes, that are involved in cell proliferation/differentiation and adhesion, and of the antimicrobial peptide β2 defensin (HβD2) in KB cells was increased upon exposure to either live or heat-killed bacteria. All LMM fractions tested prevented or reduced the induction of gene expression by P. intermedia and A. naeslundii depending on the experimental conditions. Overall, the results suggested that LMM fractions could modulate the effects of bacteria associated with periodontal disease in gingival cells

Platinum-group minerals in the Skouries Cu-Au (Pd, Pt, Te) porphyry deposit

The Skouries deposit is a platinum-group element (PGE) enriched Cu-Au porphyry system located in the Chalkidiki peninsula, Greece, with associated Ag, Bi and Te enrichment. The deposit is hosted by multiple porphyritic monzonite and syenite intrusions, which originated from a magma chamber at depth. An initial quartz monzonite porphyritic intrusion contains a quartz–magnetite ± chalcopyrite–pyrite vein stockwork with intense potassic alteration. The quartz monzonite intrusion is cross cut by a set of syenite and mafic porphyry dykes and quartz–chalcopyrite–bornite ± magnetite veins which host the majority of the Cu and Au mineralisation. Late stage quartz–pyrite veins, with associated phyllic alteration crosscut all previous vein generations. Electron microprobe and scanning electron microscopy shows that the PGE are hosted by platinum-group minerals (PGM) in the quartz-chalcopyrite–bornite ± magnetite veins and within potassic alteration assemblages. The PGE mineralisation in Skouries is therefore part of the main high temperature hypogene mineralisation event. Platinum-group minerals at Skouries include: sopcheite [Ag4Pd3Te4], merenskyite [(Pd,Pt)(Te,Bi)2] and kotulskite [Pd(Te,Bi)], with rare telargpalite [(Pd,Ag)3Te], isomertieite [Pd11Sb2As2], naldrettite [Pd2Sb], testibiopalladite [PdTe(Sb,Te)] and sobolevskite [PdBi]. The most common platinum-group mineral is sopcheite. The PGM in Skouries are small, 52 µm2 on average, and occur as spherical grains on the boundaries between sulphides and silicates, and as inclusions within hydrothermal quartz and sulphides. These observations support a “semi-metal collector model” whereby an immiscible Bi-Te melt acts as a collector for PGE and other precious metals in high temperature hydrothermal fluids. This mechanism would allow the formation of PGM in porphyries without Pt and Pd fluid saturation