A Case of T-cell Lymphoma Found in the Liver

Elevation in liver enzymes can be due to a variety of reasons such as toxins, drugs, autoimmune process, sepsis, malignant infiltration, alcoholic hepatitis, viral hepatitis, and other causes. In this case study, our patient presented with an obstructive pattern of liver test abnormalities. The patient demonstrated alkaline phosphatase levels \u3e1000, with AST and ALT levels \u3c200. His T-bilirubin initially was 1.5 and increased to 12.4 by the end of his hospital stay. Workup to exclude other causes of liver injury was performed and eventually a liver biopsy was needed to establish etiology. The biopsy revealed a malignant infiltration of likely Peripheral T-Cell Lymphoma

Organic carbon accumulation in British saltmarshes

Funding: This research was financially supported by the Natural Environment Research Council funded Carbon Storage in Intertidal Environments (C-SIDE) project (grant NE/R010846/1) with additional support from the Scottish Blue Forum. Radiocarbon dating was supported by the National Environment Isotope Facility Radiocarbon (Environment) Laboratory (allocation 2351.0321).Saltmarshes are a crucial component of the coastal carbon (C) system and provide a natural climate regulation service through the accumulation and long-term storage of organic carbon (OC) in their soils. These coastal ecosystems are under growing pressure from a changing climate and increasing anthropogenic disturbance. To manage and protect these ecosystems for C and to allow their inclusion in emissions and natural-capital accounting, as well as carbon markets, accurate and reliable estimates of OC accumulation are required. However, globally, such data are rare or of varying quality. Here, we quantify sedimentation rates and OC densities for 21 saltmarshes in Great Britain (GB). We estimate that, on average, saltmarshes accumulate OC at a rate of 110.88 ± 43.12 g C m-2 yr-1. This is considerably less than widely applied global saltmarsh averages. It is therefore highly likely that the contribution of northern European saltmarshes to global saltmarsh OC accumulation has been significantly overestimated. Taking account of the climatic, geomorphological, oceanographic, and ecological characteristics of all GB saltmarshes and the areal extent of different saltmarsh zones, we estimate that the 451.65 km2 of GB saltmarsh accumulates 46,563 ± 4,353 tonnes of OC annually. These low OC accumulation rates underline the importance of the 5.20 ± 0.65 million tonnes of OC already stored in these vulnerable coastal ecosystems. Going forward the protection and preservation of the existing stores of OC in GB saltmarshes must be a priority for the UK as this will provide climate benefits through avoided emissions several times more significant than the annual accumulation of OC in these ecosystems.Peer reviewe

Saltmarsh blue carbon accumulation rates and their relationship with sea-level rise on a multi-decadal timescale in northern England

Feldwork and elemental and thermogravimetric analyses were conducted as a part of the NERC funded (NE/R010846/1) Carbon Storage in Intertidal Environments (C-SIDE) project (https://www.c-side.org/).Saltmarshes are widely thought to sequester carbon at rates significantly exceeding those found in terrestrial environments. This ability arises from the in-situ production of plant biomass and the effective trapping and storage of both autochthonous and allochthonous organic carbon. The role saltmarshes play in climate change mitigation, through accumulating ‘blue’ carbon, depends on both the rate at which carbon accumulates within sediments and the rapidity with which carbon is remineralised. It has been hypothesized that carbon accumulation rates, in turn, depend on the local rate of relative sea-level rise, with faster sea-level rise providing more accommodation space for carbon storage. This relationship has been investigated over long (millennial) and short (decadal) timescales but without accounting for the impact of higher quantities of labile carbon in more recently deposited sediment. This study addresses these three key aspects in a saltmarsh sediment study from Lindisfarne National Nature Reserve (NNR), northern England, where there is a comparatively pristine marsh. We quantify rates of carbon accumulation by combining a Bayesian age-depth model based on 210Pb and 137Cs activities with centimetre-resolution organic carbon density measurements. We also use thermogravimetric analyses to determine the relative proportions of labile and recalcitrant organic matter and calculate the net recalcitrant organic matter accumulation rate. Results indicate that during the 20th century more carbon accumulated at the Lindisfarne NNR saltmarsh during decades with relatively high rates of sea-level rise. The post-depositional loss of labile carbon down the core results in a weaker though still significant relationship between recalcitrant organic matter accumulation and sea-level change. Thus, increasing saltmarsh carbon accumulation driven by higher rates of sea-level rise is demonstrated over recent multi-decadal timescales.Peer reviewe

Organic carbon stocks of Great British saltmarshes

Coastal wetlands, such as saltmarshes, are globally widespread and highly effective at capturing and storing ‘blue carbon’ and have the potential to regulate climate over varying timescales. Yet only Australia and the United States of America have national inventories of organic carbon held within saltmarsh habitats, hindering the development of policies and management strategies to protect and preserve these organic carbon stores. Here we couple a new observational dataset with 4,797 samples from 26 saltmarshes across Great Britain to spatially model organic carbon stored in the soil and the above and belowground biomass of Great British saltmarshes. Using average values derived from the 26 marshes, we deliver first-order estimates of organic carbon stocks across Great Britain’s 448 saltmarshes (451.66 km2). The saltmarshes of Great Britain contain 5.20 ± 0.65 Mt of organic carbon, 93% of which is in the soil. On average, the saltmarshes store 11.55 ± 1.56 kg C m-2 with values ranging between 2.24 kg C m-2 and 40.51 kg C m-2 depending on interlinked factors such as geomorphology, organic carbon source, sediment type (mud vs sand), sediment supply, and relative sea level history. These findings affirm that saltmarshes represent the largest intertidal blue carbon store in Great Britain, yet remain an unaccounted for component of the United Kingdom’s natural carbon stores

Maximizing blue carbon stocks through saltmarsh restoration

Political discourse around coastal wetland restoration and blue carbon management strategies has increased in the past decade, yet carbon storage has neither been a reason for restoration, nor a criterion to measure the success of current saltmarsh restoration schemes in the UK. To maximise climate change mitigation through saltmarsh restoration, knowledge on the key drivers of carbon stock variability is required. We use restored saltmarshes of similar age, paired with adjacent natural marshes as references, to identify drivers of carbon stocks following managed realignment within an estuary in southeastern England. From surficial soil cores (top 30 cm), we measured carbon stock alongside environmental characteristics. Carbon stock between natural and restored sites were similar after ~ 30 years when restored sites were above mean high water neap (MHWN) tidal levels. Elevated marsh platforms likely provide suitable conditions for the development of mature plant communities associated with greater capture and production of organic carbon. The restored site at Tollesbury (Essex, UK) had a 2-fold lower carbon stock than other restored sites in the estuary. We attribute this to the site’s low position in the tidal frame, below MHWN tidal levels, coupled with low sediment supply and the dominance of pioneer plant communities. As blue carbon is anticipated to become an important facet of saltmarsh restoration, we recommend that sites above MHWN tidal levels are selected for managed realignment or that preference is given to coastlines with a high sediment supply that may rapidly elevate realignment sites above MHWN. Alternatively, elevation could be artificially raised prior to realignment. Restoration schemes aiming to maximise climate change mitigation should also encourage the establishment of key plant species (e.g., Atriplex portulacoides in our study) to enhance carbon stocks. However, the overall goal of restoration ought to be carefully considered as trade-offs in ecosystem services may ensue if restoration for climate change mitigation alone is pursued

Maximizing blue carbon stocks through saltmarsh restoration

Political discourse around coastal wetland restoration and blue carbon management strategies has increased in the past decade, yet carbon storage has neither been a reason for restoration, nor a criterion to measure the success of current saltmarsh restoration schemes in the UK. To maximise climate change mitigation through saltmarsh restoration, knowledge on the key drivers of carbon stock variability is required. We use restored saltmarshes of similar age, paired with adjacent natural marshes as references, to identify drivers of carbon stocks following managed realignment within an estuary in southeastern England. From surficial soil cores (top 30 cm), we measured carbon stock alongside environmental characteristics. Carbon stock between natural and restored sites were similar after ~ 30 years when restored sites were above mean high water neap (MHWN) tidal levels. Elevated marsh platforms likely provide suitable conditions for the development of mature plant communities associated with greater capture and production of organic carbon. The restored site at Tollesbury (Essex, UK) had a 2-fold lower carbon stock than other restored sites in the estuary. We attribute this to the site’s low position in the tidal frame, below MHWN tidal levels, coupled with low sediment supply and the dominance of pioneer plant communities. As blue carbon is anticipated to become an important facet of saltmarsh restoration, we recommend that sites above MHWN tidal levels are selected for managed realignment or that preference is given to coastlines with a high sediment supply that may rapidly elevate realignment sites above MHWN. Alternatively, elevation could be artificially raised prior to realignment. Restoration schemes aiming to maximise climate change mitigation should also encourage the establishment of key plant species (e.g., Atriplex portulacoides in our study) to enhance carbon stocks. However, the overall goal of restoration ought to be carefully considered as trade-offs in ecosystem services may ensue if restoration for climate change mitigation alone is pursued

The development and evaluation of a common assessment form for physiotherapy practice education in Ireland.

A sub-group of Chartered Physiotherapists in Education (CPE) was formed in 2004 to consider the adoption of a common assessment form (CAF) for assessing practice education placements for students studying physiotherapy in the Republic of Ireland. Following agreement from the four heads of departments, the needs of users (academic staff, practice tutors and practice educators) were established. As none of the existing forms met sufficient needs of the users, a new CAF was developed. The top features required by practice educators/tutors and HEIs, the positives of the existing forms and the behaviours indicated int he work of Cross \u26 Hicks1 were taken into account when developing the CAF. Following extensive revisions it was piloted on a small number of sites, revised by the committee and then validated by comparing scores to those of the existing assessment forms. Its inter-rater reliability was established bny comparing students\u27 grades between practic educators and practice tutors. Construct validity (PCC 0.906) and reliability estimates (ICC 0.84) were found to be satisfactory. As the validity and reliability fo the CAF was found to be satisfactory and greater than that of existing forms, the CAF was adopted by all for HEIs for use in summer 2007

Assessment of ibrutinib plus rituximab in front-line CLL (FLAIR trial): study protocol for a phase III randomised controlled trial

Background Treatment of chronic lymphocytic leukaemia (CLL) has seen a substantial improvement over the last few years. Combination immunochemotherapy, such as fludarabine, cyclophosphamide and rituximab (FCR), is now standard first-line therapy. However, the majority of patients relapse and require further therapy, and so new, effective, targeted therapies that improve remission rates, reduce relapses, and have fewer side effects, are required. The FLAIR trial will assess whether ibrutinib plus rituximab (IR) is superior to FCR in terms of progression-free survival (PFS). Methods/design FLAIR is a phase III, multicentre, randomised, controlled, open, parallel-group trial in patients with previously untreated CLL. A total of 754 participants will be randomised on a 1:1 basis to receive standard therapy with FCR or IR. Participants randomised to FCR will receive a maximum of six 28-day treatment cycles. Participants randomised to IR will receive six 28-day cycles of rituximab, and ibrutinib taken daily for 6 years until minimal residual disease (MRD) negativity has been recorded for the same amount of time as it took to become MRD negative, or until disease progression. The primary endpoint is PFS according to the International Workshop on CLL (IWCLL) criteria. Secondary endpoints include: overall survival; proportion of participants with undetectable MRD; response to therapy by IWCLL criteria; safety and toxicity; health-related quality of life (QoL); and cost-effectiveness. Discussion The trial aims to provide evidence for the future first-line treatment of CLL patients by assessing whether IR is superior to FCR in terms of PFS, and whether toxicity rates are favourable. Trial registration ISRCTN01844152. Registered on 8 August 2014, EudraCT number 2013-001944-76. Registered on 26 April 2013