Long term nitrate removal in a denitrification wall

Nitrogen (N) inputs to groundwater are one of the most widespread environmental problems globally. However, as N is important for crop production to support the current global population, it is difficult to limit N input to an extent where groundwater contamination is completely avoided. Researchers have been testing new ways to remove N (in the form of nitrate (NO3-)) from groundwater, primarily through enhancing microbial denitrification. One technology utilizing this microbial process is a denitrification wall, which is an inexpensive, low-maintenance technology compared to other options to treat NO3--contaminated groundwater. Denitrification walls have been shown to be effective for removing NO3- from groundwater through denitrification for seven years in New Zealand, nine years in Iowa, and 15 years in Canada; however, long-term data on the efficacy of denitrification walls remain limited. In order to understand how these systems function in the long term, the performance of a New Zealand denitrification wall installed in 1996 was examined. Field sampling was carried out during the winter of 2010 at the denitrification wall at Bardowie Farm in Cambridge, New Zealand. This farm had received relatively high N inputs from spray-irrigation of effluent from the nearby Hautapu Dairy Factory for over 30 years. The denitrification wall was originally constructed by mixing 40 m3 Pinus radiata sawdust with soil down to a depth of 1.5 m where it intercepted groundwater flow. Groundwater samples were collected from wells installed upslope and within the wall and samples were analyzed for NO3- concentrations on five occasions. Soil samples were collected on four occasions from below the water table and analyzed for denitrifying enzyme activity (DEA), total carbon (C), available C, and microbial biomass C. Results were compared to previous measurements. Groundwater NO3- concentrations entering the wall averaged 2.6 mg N L-1, which was a decrease from 2002 where NO3- entered the wall at an average of 9 mg N L-1. Despite this decrease, NO3- concentrations within the wall averaged 0.2 mg N L-1, which corresponded to 92% NO3- removal. DEA rates in the wall were nearly as high as the first year of construction. In contrast, total C and microbial biomass C had decreased by half, while available C remained the same as measured two years after construction. Denitrification in the wall remained NO3- limited suggesting that C was still sufficiently available to the denitrifiers. These data indicated that the denitrification wall was still effective after 14 years. To predict denitrification wall longevity, a first-order decay curve was fitted to the total C data through time (R2 = 0.92; p < 0.05). The decay curve was used to predict the time until total C reached 0.1%, although it is unclear at what %C denitrification will become C limited. Using this decay curve, it was estimated that C in the wall would not be depleted for 66 years, although it is possible that C will become limiting to denitrifiers before that time. This long-term study suggested that denitrification walls are cost-effective solutions to removing NO3- from groundwater as they can be effective for a number of years without any maintenance

Automated Device to Enable Passive Pronation and Supination Activities of the Hand for Experimental Testing with Cadaveric Specimens: A Collaboration Between The University of New Mexico and New Mexico Institute of Mining and Technology

In cadaveric research, reproducing physiological conditions under which the specimens would be loaded in vivo is essential to achieve clinical applicability. This is a collaborative study bringing together engineers from The University of New Mexico and New Mexico Institute of Mining and Technology. We describe development of an automated device to enable passive pronation and supination of the hand (rotation achieved through direct manipulation) for use in cadaveric experimental testing of the hand, wrist, forearm, or elbow. We present a brief motivation for development of this device, design details, an overview of one possible application, and ways to use this device for active pronation and supination activities (rotation achieved through tendon loading). We aim to provide the necessary information for reproduction of this device by other institutions for similar testing purposes

Increased Myocardial Extracellular Volume in Active Idiopathic Systemic Capillary Leak Syndrome

BACKGROUND: The Systemic Capillary Leak Syndrome (SCLS) is a rare disorder of unknown etiology presenting as recurrent episodes of shock and peripheral edema due to leakage of fluid into soft tissues. Insights into SCLS pathogenesis are few due to the scarcity of cases, and the etiology of vascular barrier disruption in SCLS is unknown. Recent advances in cardiovascular magnetic resonance (CMR) allow for the quantitative assessment of the myocardial extracellular volume (ECV), which can be increased in conditions causing myocardial edema. We hypothesized that measurement of myocardial ECV may detect myocardial vascular leak in patients with SCLS. METHODS: Fifty-six subjects underwent a standard CMR examination at the NIH Clinical Center from 2009 until 2014: 20 patients with acute intermittent SCLS, six subjects with chronic SCLS, and 30 unaffected controls. Standard volumetric measurements; late gadolinium enhancement imaging and pre- and post-contrast T1 mapping were performed. ECV was calculated by calibration of pre- and post-contrast T1 values with blood hematocrit. RESULTS: Demographics and cardiac parameters were similar in both groups. There was no significant valvular disorder in either group. Subjects with chronic SCLS had higher pre-contrast myocardial T1 compared to healthy controls (T1: 1027 ± 44 v. 971 ± 41, respectively; p = 0.03) and higher myocardial ECV than patients with acute intermittent SCLS or controls: 33.8 ± 4.6, 26.9 ± 2.6, 26 ± 2.4, respectively; p = 0.007 v. acute intermittent; P = 0.0005 v. controls). When patients with chronic disease were analyzed together with five patients with acute intermittent disease who had just experienced an acute SCLS flare, ECV values were significantly higher than in subjects with acute intermittent SCLS in remission or age-matched controls and (31.2 ± 4.6 %, 26.5 ± 2.7 %, 26 ± 2.4 %, respectively; p = 0.01 v. remission, p = 0.001 v. controls). By contrast, T1 values did not distinguish these three subgroups (1008 ± 40, 978 ± 40, 971 ± 41, respectively, p = 0.2, active v. remission; p = 0.06 active v. controls). Abundant myocardial edema without evidence of acute inflammation was detected in cardiac tissue postmortem in one patient. CONCLUSIONS: Patients with active SCLS have significantly higher myocardial ECV than age-matched controls or SCLS patients in remission, which correlated with histopathological findings in one patient

Automated tracking of level of consciousness and delirium in critical illness using deep learning

Over- and under-sedation are common in the ICU, and contribute to poor ICU outcomes including delirium. Behavioral assessments, such as Richmond Agitation-Sedation Scale (RASS) for monitoring levels of sedation and Confusion Assessment Method for the ICU (CAM-ICU) for detecting signs of delirium, are often used. As an alternative, brain monitoring with electroencephalography (EEG) has been proposed in the operating room, but is challenging to implement in ICU due to the differences between critical illness and elective surgery, as well as the duration of sedation. Here we present a deep learning model based on a combination of convolutional and recurrent neural networks that automatically tracks both the level of consciousness and delirium using frontal EEG signals in the ICU. For level of consciousness, the system achieves a median accuracy of 70% when allowing prediction to be within one RASS level difference across all patients, which is comparable or higher than the median technician-nurse agreement at 59%. For delirium, the system achieves an AUC of 0.80 with 69% sensitivity and 83% specificity at the optimal operating point. The results show it is feasible to continuously track level of consciousness and delirium in the ICU

Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Answer questions and earn CME/CNETo update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8‐1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors “microscopic” and “macroscopic” for regional node metastasis are redefined as “clinically occult” and “clinically apparent”; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA‐IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in‐transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor‐involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence‐based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472‐492. © 2017 American Cancer Society.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139981/1/caac21409_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139981/2/caac21409-sup-0001-suppinfo01.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139981/3/caac21409.pd

Would a rose by any other name really smell as sweet? Framing our work in infection prevention

To the Editor—From consumerism to politics to health care, the way we label or frame an issue plays a huge role in how we understand and respond to it. This is why we now shop for “preowned” cars and “dried plums” rather than used cars and prunes and buy “tall” (not small) coffees at Starbucks. Realtors are also excellent at framing. A cottage home seems more marketable when described as “cozy” or “charming” than as “tiny” or “cramped.” Cognitive linguist and professor George Lakoff has pointed out how critical framing is in politics as well, from how initiatives are named (eg, “The Clear Skies Initiative” or “No Child Left Behind”) to how concepts are described (eg, “drilling for oil” vs “exploring for energy” or “undocumented workers” vs “illegal aliens”)

Quality Improvement Intervention for Reduction of Redundant Testing

Laboratory data are critical to analyzing and improving clinical quality. In the setting of residual use of creatine kinase M and B isoenzyme testing for myocardial infarction, we assessed disease outcomes of discordant creatine kinase M and B isoenzyme +/troponin I (−) test pairs in order to address anticipated clinician concerns about potential loss of case-finding sensitivity following proposed discontinuation of routine creatine kinase and creatine kinase M and B isoenzyme testing. Time-sequenced interventions were introduced. The main outcome was the percentage of cardiac marker studies performed within guidelines. Nonguideline orders dominated at baseline. Creatine kinase M and B isoenzyme testing in 7496 order sets failed to detect additional myocardial infarctions but was associated with 42 potentially preventable admissions/quarter. Interruptive computerized soft stops improved guideline compliance from 32.3% to 58% (P \u3c .001) in services not receiving peer leader intervention and to \u3e80% (P \u3c .001) with peer leadership that featured dashboard feedback about test order performance. This successful experience was recapitulated in interrupted time series within 2 additional services within facility 1 and then in 2 external hospitals (including a critical access facility). Improvements have been sustained postintervention. Laboratory cost savings at the academic facility were estimated to be ≥US$635 000 per year. National collaborative data indicated that facility 1 improved its order patterns from fourth to first quartile compared to peer norms and imply that nonguideline orders persist elsewhere. This example illustrates how pathologists can provide leadership in assisting clinicians in changing laboratory ordering practices. We found that clinicians respond to local laboratory data about their own test performance and that evidence suggesting harm is more compelling to clinicians than evidence of cost savings. Our experience indicates that interventions done at an academic facility can be readily instituted by private practitioners at external facilities. The intervention data also supplement existing literature that electronic order interruptions are more successful when combined with modalities that rely on peer education combined with dashboard feedback about laboratory order performance. The findings may have implications for the role of the pathology laboratory in the ongoing pivot from quantity-based to value-based health care

HIP 67506 C: MagAO-X Confirmation of a New Low-Mass Stellar Companion to HIP 67506 A

We report the confirmation of HIP 67506 C, a new stellar companion to HIP 67506 A. We previously reported a candidate signal at 2$\lambda$/D (240~mas) in L$^{\prime}$ in MagAO/Clio imaging using the binary differential imaging technique. Several additional indirect signals showed that the candidate signal merited follow-up: significant astrometric acceleration in Gaia DR3, Hipparcos-Gaia proper motion anomaly, and overluminosity compared to single main sequence stars. We confirmed the companion, HIP 67506 C, at 0.1" with MagAO-X in April, 2022. We characterized HIP 67506 C MagAO-X photometry and astrometry, and estimated spectral type K7-M2; we also re-evaluated HIP 67506 A in light of the close companion. Additionally we show that a previously identified 9" companion, HIP 67506 B, is a much further distant unassociated background star. We also discuss the utility of indirect signposts in identifying small inner working angle candidate companions.Comment: 10 pages, 9 figures, 4 tables, accepted to MNRA

The Prognostic and Predictive Value of Melanoma-related MicroRNAs Using Tissue and Serum: A MicroRNA Expression Analysis

The overall 5-year survival for melanoma is 91%. However, if distant metastasis occurs (stage IV), cure rates are = 82%) when = 4 miRNAs were expressed. Moreover, the 'MELmiR-7' panel characterised overall survival of melanoma patients better than both serum LDH and S100B (delta log likelihood=11, p < 0.001). This panel was found to be superior to currently used serological markers for melanoma progression, recurrence, and survival; and would be ideally suited to monitor tumour progression in patients diagnosed with early metastatic disease (stages IIIa-c/IV M1a-b) to detect relapse following surgical or adjuvant treatment. (C) 2015 The Authors. Published by Elsevier B. V