Fire in Southern Appalachians: Fuels, Stand Structure and Oaks

Managers responsible for maintaining the diversity and productivity of Southern Appalachian forests are increasingly turning to prescribed fire as an important management tool in oak dominated forests. The decision to use fire with increasing frequency and spatial extent is based, in part, on an emerging sense of the prehistoric significance of fire in this landscape and its potential to control the proliferation of fire-sensitive competitors in contemporary forests. While it is well documented that fire has been an important ecological force in Southern Appalachian forests for a very long time, there has been little research to demonstrate that prescribed fire effectively controls fire-sensitive competitors, promotes regeneration of desirable species, or maintains and promotes healthy forest stands. In the face of increased management burning there is a need to address these questions, and to quantify the role of existing and residual fuels in fire management following repeated fire of differing intervals. Two studies were initiated in 1995 and 2002 in upland forests on the Cumberland Plateau of Kentucky to examine the effectiveness of prescribed fire to maintain oak dominance by altering stand structure and enhancing oak seedling establishment and development. We hypothesized that fire would: (1) reduce midstory stem density, and that these changes to stand structure and light availability would lead to improved performance of oak seedlings; and (2) control oak competitors. On ridgetop sites on the escarpment of the Cumberland Plateau, we measured stand structure and tree regeneration on 48 plots in 6 treatment areas over an 11-year period. Four units were burned 3-4 times and two units serve as fire-excluded references. On the topographically-dissected landscape of the Cumberland Plateau we recorded stand structure and multiple aspects of the tree regeneration process on 9 study sites (93 plots), with three sites burned four times, three sites burned twice, and three fire-excluded sites. Prescribed fire reduced midstory stem density and basal area, and increased light availability which was transitory due to understory sprouting. Seedling population studies revealed that oaks and maple seedlings responded to stem kill by re-sprouting, with increased height and diameter. However, red maple seedlings grew more than oaks after burning. Burning reduced seedling density of potential competitor species, yet high fecundity of some species (e.g., red maple) and strong sprouting response of others (e.g., sassafras), suggests that multiple fires have provided neither the stand structural changes nor competition control that would lead to the development of more competitive oak advance reproduction. An oak mast event revealed a potentially positive role for fire in reducing the depth of the litter layer and enhancing oak seedling establishment and growth. Overall, our results suggest a modest role for prescribed fire in enhancing the establishment, growth and persistence of oak advance regeneration

That Which Keeps on Giving - A Case of Class IV Diffuse Proliferative Lupus Nephritis in a Hispanic Woman with underlying Systemic Lupus Erythematosus

Background: Glomerulonephritis is the primary cause of morbidity and mortality of systemic lupus erythematosus (SLE). Lupus nephritis is characterized by immune complex deposition in the mesangium leading to complement activation and hypocomplementemia. Studies show that up to 60% of adults with lupus develop renal involvement and it has been well established that Hispanic patients show poorer outcomes than Caucasians despite advances in treatment. Preserved kidney function with new-onset proteinuria should raise clinical suspicion for acute lupus nephritis. Further evaluation with a kidney biopsy is paramount in establishing a diagnosis, helping to define treatment strategy, and determining response to treatment. Case Presentation: A 41-yo-Hispanic-Woman with a PMH SLE without previous renal involvement, secondary Sjogren\u27s, hypertension, heart failure and cirrhosis presented to the ER with a worsening SOB, difficulty swallowing, and anasarca over two weeks. On evaluation, the patient was hypertensive, tachypneic, had positive JVD, wheezing in lung bases, +1 pitting edema in the lower extremities and skin hyperpigmentation on the face, neck, and upper extremities. Laboratory studies revealed leukocytosis of 11.1 th/uL, Hgb 10 gm/dL, platelets 192 th/uL, Cr 0.9 mg/dL, BUN 17 mg/dL, bicarbonate 19 mmo/L, sedimentation rate 94 mm/hr, and CRP 4.5 mg/L. A urinalysis was performed, which showed 3+ proteinuria with hematuria with a subsequent protein to creatinine ratio demonstrating 2,000 mg/gm. The workup for nephritic range proteinuria revealed an ANA 10U, anti-dsDNA 2.7 IU/mL, negative ANCA, anti-cardiolipin Ab IgMMPL, anti-cardiolipin Ab IgG 14 GPL, and non-reactive HIV, Hepatitis C, and Hepatitis B panels. Despite negative glomerulonephritis workup including anti-dsDNA antibody, a kidney biopsy was pursued and revealed class IV diffuse proliferative lupus nephritis with a component of thrombotic microangiopathy. Conclusion: Kidney biopsies are imperative when establishing a cause of new-onset proteinuria in a patient with a history of SLE. The goal of treatment is induction with immunosuppressive agents to reduce kidney inflammation promptly and prevent flares, decreasing the long-term risk of renal failure. Despite early recognition strategies and advances in treatment, Hispanic patients are likely to be diagnosed with more severe disease at presentation, specifically with class IV or V lupus nephritis. Subsequently, these patients are more likely to develop chronic renal failure compared to Caucasian patients. This case highlights the importance of screening urinalysis for proteinuria for early detection of renal involvement in patients with SLE

Anthropocene Sea Level Change: A History of Recent Trends Observed in the U.S. East, Gulf, and West Coast Regions

Relative sea level (RSL) observations since 1969 at U.S. tide stations exhibit trends in RSL rise rate and acceleration that vary in response to both global and regional processes. Trend histories display a high degree of similarity between locations in coastal regions that are experiencing similar processes. With the exception of the U.S. Northeast Coast and Alaska,every other coastal location in the continental U.S. has experienced an upturn in RSL rise rate since 2013-2014 despite wide differences in the magnitude and trending direction of RSL acceleration. High RSL acceleration along the U.S. Northeast Coast has trended downward since 2011 while low RSL acceleration along the U.S Southeast Coast has recently trended upward in response to changes likely associated with ocean dynamics and ice sheet loss. RSL change in the sedimentary basins of the central U.S. Gulf Coast region is highly dependent on local rates of vertical land movement (VLM). VLM here varies over relatively short time scales amid changing patterns of subsurface water and hydrocarbons extraction.RSL rise rates of 5 mm/year or more aided by weak acceleration in Louisiana and Texas project a total RSL rise of between 0.4 and 0.5 meters above 1992 MSL by the year 2050; other Gulf and East Coast locations will experience equal or greater rise if upward trends in acceleration continue. Low and mostly downward trends in RSL rise rate at central U.S. West Coast locations have recently reverted to a pattern of upward trends with higher rise rates. Rise rates prior to 2013 appear to have been restrained by deceleration now trending toward acceleration. A combination of tectonic plate convergence and glacial isostatic adjustment makes the non-contiguous U.S. coastal state of Alaska unique with regard to RSL trends. Land emergence, rather than subsidence, produces consistent trends of falling RSL in Alaska

Defending your competency model: Sit back, relax and get comfortable

While commonly used in practice, some researchers have objected that competency models are not rigorously developed. The current study examines the utilization of development methods and the influence on the level of comfort with legally defending the competency model. Results indicated practitioners were more comfortable legally defending a model that was developed through SME interviews

Interrupting the Axis: A Case of IgG-4 Related Hypophysitis in a Young Hispanic Male

Background: Hypophysitis refers to inflammation of the pituitary gland that can lead to the disruption of the hypothalamic-pituitary-adrenal axis. Primary hypophysitis has five variants differentiated by histologic findings: lymphocytic, granulomatous, xanthomatous, IgG4-related, and necrotizing. IgG4-related hypophysitis is very rare and is commonly a manifestation of a multi-organ systemic disorder. We present a case of a 43-year-old man presenting with severe headache and symptomatic hyponatremia in the setting of isolated IgG-4 related hypophysitis. Case Presentation: A 43-year-old male presented with a two-day history of severe posterior headache associated with several episodes of vomiting, photophobia, generalized weakness and fatigue. Patient had no history of headaches and denied any recent trauma, focal weakness, altered mentation, changes in vision or seizure activity. Vitals on admission were remarkable for BP 179/99 mmHg. Neurological examination was non-focal, cranial nerves were grossly intact. Labs showed unremarkable CBC, sodium 117 mmol/L, potassium 3.3 mmol/L, chloride 84 mmol/L, glucose 244 mg/d, TSH 0.6 uIU/mL, cortisol 4.6 ug/dL, urine osmolality 540, serum osmolality 259 and prolactin level 7.8. CT head without contrast showed a mass-like enlargement of the Sella measuring 1.6 cm x 1.4 cm suspicious for macroadenoma. Patient was started on hypertonic saline, fludrocortisone, hydrocortisone, and salt tablets in the setting of suspected macroadenoma. Once the patient was stabilized, he underwent transsphenoidal resection of pituitary lesion. Pathology of the lesion showed a small area rich in plasma cells with positive IgG4 immunostaining in most of the plasma cells, consistent with IgG4-related pituitary hypophysitis. Conclusion: IgG4 hypophysitis usually presents in a context of multiple organ IgG4 involvement, however isolated hypophysitis has been reported. The patients present with mass effect symptoms and/or anterior hypopituitarism. When histologic diagnosis is obtained via biopsy, IgG4 hypophysitis can be managed exclusively with corticosteroids

Potential pesticide transport in Colorado agriculture: a model comparison

.30 September 1989.Includes bibliographical references (pages [50]-52)Grant no. 14-08-0001-1551, Project no. 09; financed in part by the U.S. Department of the Interior, Geological Survey, through the Colorado Water Resources Research Institute

Floodwater Depth Estimation Tool - Coastal Version (FwDET-C)

No abstract availabl

It Is Not Pneumocystis jiroveci (PCP), It Is Cyclophosphamide-Induced Pneumonitis

Cyclophosphamide (CYC) is an immunosuppressive medication used to treat life-threatening complications of various rheumatic diseases like vasculitis and systemic lupus erythematosus. A rare side effect of this medication is pneumonitis, which occurs in less than 1% of patients. We describe a case of an 83-year-old woman with a past medical history of microscopic polyangiitis, who presented with progressive dyspnea at rest, exacerbated on exertion, and associated with orthopnea that was attributed to CYC-induced pneumonitis. Three months before this presentation, the patient was diagnosed with antineutrophil cytoplasmic antibodies (ANCA)-positive pauci-immune crescentic and necrotizing glomerulonephritis and started on CYC. On admission, a computed tomography (CT) chest showed worsening bilateral ground-glass opacities in a mosaic distribution and inter and intralobular septal thickening, not present on the CT performed three months prior. The patient underwent an extensive workup, which included an echocardiogram, bronchoscopy with bronchoalveolar lavage, and viral respiratory panel to rule out infectious and cardiac pathologies. She was started on empiric treatment with antibiotics and diuretics, however, despite these interventions, she continued with respiratory distress. A multidisciplinary team convened, and the diagnosis of CYC-induced lung injury was entertained. The CYC was discontinued, and the patient was started on prednisone with significant improvement in symptoms. This case highlights the importance of recognizing CYC as a rare cause of interstitial pneumonitis. When considering CYC-induced lung toxicity, other etiologies, such as opportunistic infections, cardiac etiologies, and diffuse alveolar hemorrhage, should be ruled out

Urine neutrophil gelatinase-associated lipocalin is an early marker of acute kidney injury in critically ill children: a prospective cohort study

INTRODUCTION: Serum creatinine is a late marker of acute kidney injury (AKI). Urine neutrophil gelatinase-associated lipocalin (uNGAL) is an early marker of AKI, where the timing of kidney injury is known. It is unknown whether uNGAL predicts AKI in the general critical care setting. We assessed the ability of uNGAL to predict AKI development and severity in critically ill children. METHODS: This was a prospective cohort study of critically ill children. Children aged between 1 month and 21 years who were mechanically ventilated and had a bladder catheter inserted were eligible. Patients with end-stage renal disease or who had just undergone kidney transplantation were excluded. Patients were enrolled within 24 to 48 hours of initiation of mechanical ventilation. Clinical data and serum creatinine were collected daily for up to 14 days from enrollment, and urine was collected once daily for up to 4 days for uNGAL measurement. AKI was graded using pRIFLE (pediatric modified Risk, Injury, Failure, Loss, End Stage Kidney Disease) criteria. Day 0 was defined as the day on which the AKI initially occurred, and pRIFLEmax was defined as the worst pRIFLE AKI grade recorded during the study period. The χ(2 )test was used to compare associations between categorical variables. Mann-Whitney and Kruskal-Wallis tests were used to compare continuous variables between groups. Diagnostic characteristics were evaluated by calculating sensitivity and specificity, and constructing receiver operating characteristic curves. RESULTS: A total of 140 patients (54% boys, mean ± standard deviation Pediatric Risk of Mortality II score 15.0 ± 8.0, 23% sepsis) were included. Mean and peak uNGAL concentrations increased with worsening pRIFLEmax status (P < 0.05). uNGAL concentrations rose (at least sixfold higher than in controls) in AKI, 2 days before and after a 50% or greater rise in serum creatinine, without change in control uNGAL. The parameter uNGAL was a good diagnostic marker for AKI development (area under the receiver operating characteristic curve [AUC] 0.78, 95% confidence interval [CI] 0.62 to 0.95) and persistent AKI for 48 hours or longer (AUC 0.79, 95% CI 0.61 to 0.98), but not for AKI severity, when it was recorded after a rise in serum creatinine had occurred (AUC 0.63, 95% CI 0.44 to 0.82). CONCLUSION: We found uNGAL to be a useful early AKI marker that predicted development of severe AKI in a heterogeneous group of patients with unknown timing of kidney injury