Synoptic composites of tornadic and nontornadic outbreaks

Tornadic and nontornadic outbreaks occur within the United States and elsewhere around the world each year with devastating effect. However, few studies have considered the physical differences between these two outbreak types. To address this issue, synoptic-scale pattern composites of tornadic and nontornadic outbreaks are formulated over North America using a rotated principal component analysis (RPCA). A cluster analysis of the RPC loadings group similar outbreak events, and the resulting map types represent an idealized composite of the constituent cases in each cluster. These composites are used to initialize aWeather Research and Forecasting Model (WRF) simulation of each hypothetical composite outbreak type in an effort to determine the WRF's capability to distinguish the outbreak type each composite represents. Synoptic-scale pattern analyses of the composites reveal strikingly different characteristics within each outbreak type, particularly in the wind fields. The tornado outbreak composites reveal a strong low- and midlevel cyclone over the eastern Rockies, which is likely responsible for the observed surface low pressure system in the plains. Composite soundings from the hypothetical outbreak centroids reveal significantly greater bulk shear and storm-relative environmental helicity values in the tornado outbreak environment, whereas instability fields are similar between the two outbreak types. The WRF simulations of the map types confirm results observed in the composite soundings. © 2012 American Meteorological Society

An assessment of areal coverage of severe weather parameters for severe weather outbreak diagnosis

The areal extent of severeweather parameters favorable for significant severeweather is evaluated as a means of identifying major severe weather outbreaks. The first areal coverage method uses kernel density estimation (KDE) to identify severeweather outbreak locations. Aselected severeweather parameter value is computed at each grid point within the region identified by KDE. The average, median, or sum value is used to diagnose the event's severity. The second areal coverage method finds the largest contiguous region where a severe weather parameter exceeds a specified threshold that intersects theKDEregion. The severeweather parameter values at grid points within the parameter exceedance region are computed, with the average, median, or sumvalue used to diagnose the event's severity. A total of 4057 severe weather outbreaks from 1979 to 2008 are analyzed. An event is considered a major outbreak if it exceeds a selected ranking index score (developed in previous work), and is a minor event otherwise. The areal coverage method is also compared to Storm Prediction Center (SPC) day-1 convective outlooks from 2003 to 2008. Comparisons of the SPC forecasts and areal coverage diagnoses indicate the areal coverage methods have similar skill to SPC convective outlooks in discriminating major and minor severe weather outbreaks. Despite a seemingly large sample size, the rare-events nature of the dataset leads to sample size sensitivities. Nevertheless, the findings of this study suggest that areal coverage should be tested in a forecasting environment as a means of providing guidance in future outbreak scenarios. © 2012 American Meteorological Society

Regulation of neutrophilic inflammation by proteinase-activated receptor 1 during bacterial pulmonary infection

Neutrophils are key effector cells of the innate immune response to pathogenic bacteria, but excessive neutrophilic inflammation can be associated with bystander tissue damage. The mechanisms responsible for neutrophil recruitment to the lungs during bacterial pneumonia are poorly defined. In this study, we focus on the potential role of the major high-affinity thrombin receptor, proteinase-activated receptor 1 (PAR-1), during the development of pneumonia to the common lung pathogen Streptococcus pneumoniae. Our studies demonstrate that neutrophils were indispensable for controlling S. pneumoniae outgrowth but contributed to alveolar barrier disruption. We further report that intra-alveolar coagulation (bronchoalveolar lavage fluid thrombin-antithrombin complex levels) and PAR-1 immunostaining were increased in this model of bacterial lung infection. Functional studies using the most clinically advanced PAR-1 antagonist, SCH530348, revealed a key contribution for PAR-1 signaling in influencing neutrophil recruitment to lung airspaces in response to both an invasive and noninvasive strain of S. pneumoniae (D39 and EF3030) but that PAR-1 antagonism did not impair the ability of the host to control bacterial outgrowth. PAR-1 antagonist treatment significantly decreased pulmonary levels of IL-1β, CXCL1, CCL2, and CCL7 and attenuated alveolar leak. Ab neutralization studies further demonstrated a nonredundant role for IL-1β, CXCL1, and CCL7 in mediating neutrophil recruitment in response to S. pneumoniae infection. Taken together, these data demonstrate a key role for PAR-1 during S. pneumoniae lung infection that is mediated, at least in part, by influencing multiple downstream inflammatory mediators

The anti-fibrotic effect of inhibition of TGFβ-ALK5 signalling in experimental pulmonary fibrosis in mice is attenuated in the presence of concurrent γ-herpesvirus infection.

Journal ArticleTGFβ-ALK5 pro-fibrotic signalling and herpesvirus infections have been implicated in the pathogenesis and exacerbation of pulmonary fibrosis. In this study we addressed the role of TGFβ-ALK5 signalling during the progression of fibrosis in a two-hit mouse model of murine γ-herpesvirus 68 (MHV-68) infection on the background of pre-existing bleomycin-induced pulmonary fibrosis. Assessment of total lung collagen levels in combination with ex vivo micro-computed tomography (µCT) analysis of whole lungs demonstrated that MHV-68 infection did not enhance lung collagen deposition in this two-hit model but led to a persistent and exacerbated inflammatory response. Moreover, µCT reconstruction and analysis of the two-hit model revealed distinguishing features of diffuse ground-glass opacities and consolidation superimposed on pre-existing fibrosis that were reminiscent of those observed in acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF). Virally-infected murine fibrotic lungs further displayed evidence of extensive inflammatory cell infiltration and increased levels of CCL2, TNFα, IL-1β and IL-10. Blockade of TGFβ-ALK5 signalling attenuated lung collagen accumulation in bleomycin-alone injured mice, but this anti-fibrotic effect was reduced in the presence of concomitant viral infection. In contrast, inhibition of TGFβ-ALK5 signalling in virally-infected fibrotic lungs was associated with reduced inflammatory cell aggregates and increased levels of the antiviral cytokine IFNγ. These data reveal newly identified intricacies for the TGFβ-ALK5 signalling axis in experimental lung fibrosis, with different outcomes in response to ALK5 inhibition depending on the presence of viral infection. These findings raise important considerations for the targeting of TGFβ signalling responses in the context of pulmonary fibrosis.MRCNovartis CASE studentshi

Evidence for chemokine synergy during neutrophil migration in ARDS.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterised by pulmonary oedema, respiratory failure and severe inflammation. ARDS is further characterised by the recruitment of neutrophils into the lung interstitium and alveolar space. OBJECTIVES: The factors that regulate neutrophil infiltration into the inflamed lung and our understanding of the pathomechanisms in ARDS remain incomplete. This study aimed at determining the role of the chemokine (C-C motif) ligand (CCL)2 and CCL7 in ARDS. METHODS: CCL2 and CCL7 protein levels were measured in bronchoalveolar lavage (BAL) fluid obtained from lipopolysaccharide(LPS)-challenged human volunteers and two separate cohorts of patients with ARDS. Neutrophil chemotaxis to ARDS BAL fluid was evaluated and the contribution of each was assessed and compared with chemokine (C-X-C motif) ligand 8 (CXCL8). Chemokine receptor expression on neutrophils from blood or BAL fluid of patients with ARDS was analysed by flow cytometry. RESULTS: CCL2 and CCL7 were significantly elevated in BAL fluid recovered from LPS-challenged volunteers and patients with ARDS. BAL fluid from patients with ARDS was highly chemotactic for human neutrophils and neutralising either CCL2 or CCL7 attenuated the neutrophil chemotactic response. Moreover, CCL2 and CCL7 synergised with CXCL8 to promote neutrophil migration. Furthermore, neutrophils isolated from the blood or BAL fluid differentially regulated the cell surface expression of chemokine (C-X-C motif) receptor 1 and C-C chemokine receptor type 2 during ARDS. CONCLUSION: This study highlights important inflammatory chemokines involved in regulating neutrophil migration, which may have potential value as therapeutic targets for the treatment of ARDS

Foot pathology in patients with Paget’s disease of bone

The characteristic bone deformities associated with advanced Paget’sdisease of bone may result in abnormal gait and plantar foot pressures,which contribute to the development of pressure-related skin problems.This study aimed to characterize the foot problems and foot-care needsin this patient group and to investigate the effect of disease distributionon the occurrence of foot pathology. One hundred thirty-four patientswith Paget’s disease were assessed clinically, and the Foot StructureIndex was completed for each patient. Patients completed self-administeredquestionnaires concerning foot function (Foot Function Index) andquality of life (12-Item Short Form). The results of this study suggest thatfoot-health and footwear problems are common in patients with Paget’sdisease. Forty percent of the patients required professional foot care inaddition to those already receiving it. The site of pagetic involvement didnot affect the occurrence of foot pathology. Further research is requiredon the impact of the extent of any femoral or tibial deformity on footsymptoms and pathology. Biomechanical studies of the forces and motionin the foot related to different degrees of femoral and tibial deformitymight also help determine the impact of deformity on foot pathology

Can psychosocial and socio-demographic questions help identify sexual risk among heterosexually-active women of reproductive age? Evidence from Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Background: Contraceptive advice and supply (CAS) and sexually transmitted infection (STI) testing are increasingly provided in primary care. Most risk assessment tools are based on sexual risk behaviours and socio-demographics, for use online or in specialist services. Combining socio-demographic and psychosocial questions (e.g. religious belief and formative experience) may generate an acceptable tool for targeting women in primary care who would benefit from intervention. We aimed to identify psychosocial and socio-demographic factors associated with reporting key sexual risk behaviours among women in the British general population. Methods: We undertook complex survey analysis of data from 4,911 hetero-sexually active women aged 16-44 years, who participated in Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a national probability sample survey undertaken 2010-2012. We used multivariable regression to examine associations between the available psychosocial and socio-demographic variables in Natsal-3 and reports of 3 key sexual behaviours: a) 2+ partners in the last year (2PP); b) non-use of condoms with 2+ partners in the last year (2PPNC); c) non-use of condoms at first sex with most recent sexual partner (FSNC). We adjusted for key socio-demographic factors: age, ethnicity and socio-economic status (measured by housing tenure). Results: Weekly binge drinking (6+ units on one occasion), and first sex before age 16 were each positively associated with all three sexual behaviours after adjustment. Current relationship status, reporting drug use (ever), younger age and living in rented accommodation were also associated with 2+ partners and 2+partners without condoms after adjustment. Currently being a smoker, older age and respondent ethnicity were associated with FSNC after adjustment for all other variables. Current smoking status, treatment for depression (last year), and living at home with both parents until the age of 14 were each associated with 1 or more of the behaviours. Conclusions: Reported weekly binge drinking, early sexual debut, and age group may help target STI testing and/or CAS among women. Further research is needed to examine the proportion of sexual risk explained by these factors, the acceptability of these questions to women in primary care and the need to customise them for community and other settings

Proteinase-Activated Receptor-1, CCL2 and CCL7 Regulate Acute Neutrophilic Lung Inflammation

PAR1 plays a central role in mediating the interplay between coagulation and inflammation, but its role in regulating acute neutrophilic inflammation is unknown. We report that antagonism of PAR1 was highly effective at reducing acute neutrophil accumulation in a mouse model of LPS-induced lung inflammation. PAR1 antagonism also reduced alveolar-capillary barrier disruption in these mice. This protection was associated with a reduction in the expression of the chemokines CCL2 and CCL7, but not the pro-inflammatory cytokines TNF and IL-6 or the classic neutrophil chemoattractants CXCL1 and CXCL2. Antibody neutralisation of CCL2 and CCL7 significantly reduced LPS-induced total leukocyte and neutrophil accumulation, recovered from the bronchoalveolar lavage fluid of challenged mice. Immunohistochemical analysis revealed CCL2 predominantly localised to alveolar macrophages and pulmonary epithelial cells, while CCL7 was restricted to the pulmonary epithelium. In keeping with these observations, the intranasal administration of rCCL2 and rCCL7 led to the accumulation of neutrophils within the lung airspaces of naïve mice in the absence of any underlying inflammation. Flow cytometry analysis further demonstrated an increase in Ly6Ghi neutrophils expressing the chemokine receptors CCR1 and CCR2 isolated from mouse lungs compared to circulating neutrophils. Conversely, the expression of CXCR2 decreased on neutrophils isolated from the lung compared to circulating neutrophils. Furthermore, this switch in chemokine receptor expression was accentuated following acute LPS-induced lung inflammation. Collectively, these findings reveal a novel role for PAR1 and the chemokines CCL2 and CCL7 during the early events of acute neutrophilic inflammation

Has Chlamydia trachomatis prevalence in young women in England, Scotland and Wales changed? Evidence from national probability surveys

We evaluate the utility of the National Surveys of Attitudes and Sexual Lifestyles (Natsal) undertaken in 2000 and 2010, before and after the introduction of the National Chlamydia Screening Programme, as an evidence source for estimating the change in prevalence of Chlamydia trachomatis (CT) in England, Scotland and Wales. Both the 2000 and 2010 surveys tested urine samples for CT by Nucleic Acid Amplification Tests (NAATs). We examined the sources of uncertainty in estimates of CT prevalence change, including sample size and adjustments for test sensitivity and specificity, survey non-response and informative non-response. In 2000, the unadjusted CT prevalence was 4.22% in women aged 18-24 years; in 2010, CT prevalence was 3.92%, a non-significant absolute difference of 0.30 percentage points (95% credible interval -2.8 to 2.0). In addition to uncertainty due to small sample size, estimates were sensitive to specificity, survey non-response or informative non-response, such that plausible changes in any one of these would be enough to either reverse or double any likely change in prevalence. Alternative ways of monitoring changes in CT incidence and prevalence over time are discussed