Age and structure of the Shyok Suture in the Ladakh region of Northwestern India: Implications for slip on the Karakoram Fault System

A precise age for the collision of the Kohistan-Ladakh block with Eurasia along the Shyok suture zone (SSZ) is one key to understanding the accretionary history of Tibet and the tectonics of Eurasia during the India-Eurasia collision. Knowing the age of the SSZ also allows the suture to be used as a piercing line for calculating total offset along the Karakoram Fault, which effectively represents the SE border of the Tibetan Plateau and has played a major role in plateau evolution. We present a combined structural, geochemical, and geochronologic study of the SSZ as it is exposed in the Nubra region of India to test two competing hypotheses: that the SSZ is of Late Cretaceous or, alternatively, of Eocene age. Coarse-continental strata of the Saltoro Molasse, mapped in this area, contain detrital zircon populations suggestive of derivation from Eurasia despite the fact that the molasse itself is deposited unconformably onto Kohistan-Ladakh rocks, indicating that the molasse is postcollisional. The youngest population of detrital zircons in these rocks (approximately 92 Ma) and a U/Pb zircon date for a dike that cuts basal molasse outcrops (approximately 85 Ma) imply that deposition of the succession began in the Late Cretaceous. This establishes a minimum age for the SSZ and rules out the possibility of an Eocene collision between Kohistan-Ladakh and Eurasia. Our results support correlation of the SSZ with the Bangong suture zone in Tibet, which implies a total offset across the Karakoram Fault of approximately 130–190 km

A Balint curriculum's effect on family medicine resident empathy and psychological skills

Balint groups are comprised of physicians who regularly gather to present and reflect on clinical cases with the goal of improving the physician-patient relationship by enhancing the physician's interpersonal and communication skills, patient care, and professionalism. The goal of this study was to assess the effect on empathy and psychological skills of a voluntary Balint curriculum in the University of Missouri Family Medicine Residency program since initiation in 2010

Smoking patterns and stimulus control in intermittent and daily smokers

Intermittent smokers (ITS) - who smoke less than daily - comprise an increasing proportion of adult smokers. Their smoking patterns challenge theoretical models of smoking motivation, which emphasize regular and frequent smoking to maintain nicotine levels and avoid withdrawal, but yet have gone largely unexamined. We characterized smoking patterns among 212 ITS (smoking 4-27 days per month) compared to 194 daily smokers (DS; smoking 5-30 cigarettes daily) who monitored situational antecedents of smoking using ecological momentary assessment. Subjects recorded each cigarette on an electronic diary, and situational variables were assessed in a random subset (n = 21,539 smoking episodes); parallel assessments were obtained by beeping subjects at random when they were not smoking (n = 26,930 non-smoking occasions). Compared to DS, ITS' smoking was more strongly associated with being away from home, being in a bar, drinking alcohol, socializing, being with friends and acquaintances, and when others were smoking. Mood had only modest effects in either group. DS' and ITS' smoking were substantially and equally suppressed by smoking restrictions, although ITS more often cited self-imposed restrictions. ITS' smoking was consistently more associated with environmental cues and contexts, especially those associated with positive or "indulgent" smoking situations. Stimulus control may be an important influence in maintaining smoking and making quitting difficult among ITS. © 2014 Shiffman et al

The immune cell infiltrate populating meningiomas is composed of mature, antigen-experienced T and B cells

BACKGROUND: Meningiomas often harbor an immune cell infiltrate that can include substantial numbers of T and B cells. However, their phenotype and characteristics remain undefined. To gain a deeper understanding of the T and B cell repertoire in this tumor, we characterized the immune infiltrate of 28 resected meningiomas representing all grades. METHODS: Immunohistochemistry was used to grossly characterize and enumerate infiltrating lymphocytes. A molecular analysis of the immunoglobulin variable region of tumor-infiltrating B cells was used to characterize their antigen experience. Flow cytometry of fresh tissue homogenate and paired peripheral blood lymphocytes was used to identify T cell phenotypes and characterize the T cell repertoire. RESULTS: A conspicuous B and T cell infiltrate, primarily clustered in perivascular spaces, was present in the microenvironment of most tumors examined. Characterization of 294 tumor-infiltrating B cells revealed clear evidence of antigen experience, in that the cardinal features of an antigen-driven B cell response were present. Meningiomas harbored populations of antigen-experienced CD4+ and CD8+ memory/effector T cells, regulatory T cells, and T cells expressing the immune checkpoint molecules PD-1 and Tim-3, indicative of exhaustion. All of these phenotypes were considerably enriched relative to their frequency in the circulation. The T cell repertoire in the tumor microenvironment included populations that were not reflected in paired peripheral blood. CONCLUSION: The tumor microenvironment of meningiomas often includes postgerminal center B cell populations. These tumors invariably include a selected, antigen-experienced, effector T cell population enriched by those that express markers of an exhausted phenotype

Ecological and socioeconomic impacts of invasive alien species in island ecosystems

Minimizing the impact of invasive alien species (IAS) on islands and elsewhere requires researchers to provide cogent information on the environmental and socioeconomic consequences of IAS to the public and policy makers. Unfortunately, this information has not been readily available owing to a paucity of scientific research and the failure of the scientific community to make their findings readily available to decision makers. This review explores the vulnerability of islands to biological invasion, reports on environmental and socioeconomic impacts of IAS on islands and provides guidance and information on technical resources that can help minimize the effects of IAS in island ecosystems. This assessment is intended to provide a holistic perspective on island-IAS dynamics, enable biologists and social scientists to identify information gaps that warrant further research and serve as a primer for policy makers seeking to minimize the impact of IAS on island systems. Case studies have been selected to reflect the most scientifically-reliable information on the impacts of IAS on islands. Sufficient evidence has emerged to conclude that IAS are the most significant drivers of population declines and species extinctions in island ecosystems worldwide. Clearly, IAS can also have significant socioeconomic impacts directly (for example human health) and indirectly through their effects on ecosystem goods and services.These impacts are manifest at all ecological levels and affect the poorest, as well as richest, island nations. The measures needed to prevent and minimize the impacts of IAS on island ecosystems are generally known. However, many island nations and territories lack the scientific and technical information, infrastructure and human and financial resources necessary to adequately address the problems caused by IAS. Because every nation is an exporter and importer of goods and services, every nation is also a facilitator and victim of the invasion of alien species.Wealthy nations therefore need to help raise the capacity of island nations and territories to minimize the spread and impact of IAS

The Evolution and Sustainability of Environmental Health Services in the Azraq Refugee Camp, Jordan: A Qualitative Study

The Syrian civil war displaced more than half of the Syrian population, including over 660,000 registered refugees who fled to neighboring Jordan. Environmental health services (e.g., water, sanitation, hygiene, and solid waste management) are critical for refugee health. Still, they may strain resources in host communities and must evolve in protracted crises. We studied environmental health services in the Azraq refugee camp in Jordan to identify the stakeholders and their roles in service provision, assess stakeholder communication and coordination, and evaluate sustainability. We conducted 25 interviews with stakeholders involved in environmental health service provision. We found that non-governmental and United Nations organizations had well-defined responsibilities, but the roles of donors, the Jordanian government, refugees, and the host community needed clarification. Conflicting standards and mismatched donor expectations with on-the-ground needs sometimes created challenges for coordinated and efficient service provision. The basic needs of refugees were generally met and services improved somewhat over time, but political obstacles and inadequate resources complicated the path toward sustainable services. Early incorporation of sustainability in planning and increased efforts to build the capacity of refugees to contribute and take ownership of environmental health services will likely enhance long-term environmental health service provision and development outcomes

Improved Classification of Alzheimer's Disease Data via Removal of Nuisance Variability

Diagnosis of Alzheimer's disease is based on the results of neuropsychological tests and available supporting biomarkers such as the results of imaging studies. The results of the tests and the values of biomarkers are dependent on the nuisance features, such as age and gender. In order to improve diagnostic power, the effects of the nuisance features have to be removed from the data. In this paper, four types of interactions between classification features and nuisance features were identified. Three methods were tested to remove these interactions from the classification data. In stratified analysis, a homogeneous subgroup was generated from a training set. Data correction method utilized linear regression model to remove the effects of nuisance features from data. The third method was a combination of these two methods. The methods were tested using all the baseline data from the Alzheimer's Disease Neuroimaging Initiative database in two classification studies: classifying control subjects from Alzheimer's disease patients and discriminating stable and progressive mild cognitive impairment subjects. The results show that both stratified analysis and data correction are able to statistically significantly improve the classification accuracy of several neuropsychological tests and imaging biomarkers. The improvements were especially large for the classification of stable and progressive mild cognitive impairment subjects, where the best improvements observed were 6% units. The data correction method gave better results for imaging biomarkers, whereas stratified analysis worked well with the neuropsychological tests. In conclusion, the study shows that the excess variability caused by nuisance features should be removed from the data to improve the classification accuracy, and therefore, the reliability of diagnosis making

The Evolution and Sustainability of Environmental Health Services in the Azraq Refugee Camp, Jordan: A Qualitative Study

The Syrian civil war displaced more than half of the Syrian population, including over 660,000 registered refugees who fled to neighboring Jordan. Environmental health services (e.g., water, sanitation, hygiene, and solid waste management) are critical for refugee health. Still, they may strain resources in host communities and must evolve in protracted crises. We studied environmental health services in the Azraq refugee camp in Jordan to identify the stakeholders and their roles in service provision, assess stakeholder communication and coordination, and evaluate sustainability. We conducted 25 interviews with stakeholders involved in environmental health service provision. We found that non-governmental and United Nations organizations had well-defined responsibilities, but the roles of donors, the Jordanian government, refugees, and the host community needed clarification. Conflicting standards and mismatched donor expectations with on-the-ground needs sometimes created challenges for coordinated and efficient service provision. The basic needs of refugees were generally met and services improved somewhat over time, but political obstacles and inadequate resources complicated the path toward sustainable services. Early incorporation of sustainability in planning and increased efforts to build the capacity of refugees to contribute and take ownership of environmental health services will likely enhance long-term environmental health service provision and development outcomes

The effect of sets and repetitions of the spirometer by flow in cardiorespiratory parameters

IntroductionThe incentive spirometer helps pulmonary ventilation and the cardiorespiratory changes of its use are controversial. ObjectiveTo evaluate the effect of sets and repetitions on cardiorespiratory parameters using a spirometer alinear flow (SAF). The sample group consisted of 50 young people, healthy and sedentary. The evaluated parameters were: systolic blood pressure (SBP), diastolic (DBP), heart rate (HR), respiratory rate (RR), oxygen saturation (SaO2), minute volume (VE), tidal volume (VT), vital capacity (VC), maximal inspiratory pressure (Pimax), maximal expiratory pressure (Pemax), and peak expiratory flow (PEF). The moments of study were: initial evaluations (M1); 3 sets of 10 repetitions using SAF (M2); 3 sets of 15 repetitions using SAF (M3); and final evaluation (M4). Statistical analysis was made by t test, ANOVA and Tukey test (p < 0.05). ResultSBP and HR decreased in M2 after the 2nd set. In the 3rd set, SBP and RR decreased. Comparing the initial and final variables in M2, SBP and RR decreased, and Pemax increased. After 1st set in M3, SBP and SaO2 decreased. The 2nd set: SBP, HR, RR, and SaO2 decreased. After the 3rd set: SBP, HR, SaO2, and RR decreased. Comparing the initial and final variables in M3, SBP, HR, RR decreased, and Pimax and Pemax increased. Comparing M4 to M1, Pimax, Pemax, and VC increased, and RR decreased. ConclusionThere are changes in cardiorespiratory parameters after the use of a spirometer alinear flow, especially in the sets with more repetitions.Introdução Os incentivadores respiratórios auxiliam na ventilação pulmonar e as modificações cardiorrespiratórias mediante seu uso ainda são discutidas. Objetivo Avaliar efeito das séries e repetições com uso do inspirômetro alinear a fluxo (IAF) nos parâmetros cardiorrespiratórios. Materiais e métodos A amostra foi composta de 50 jovens, saudáveis e sedentários. Os parâmetros avaliados foram: pressão arterial (PA), frequência de pulso (FP), frequência respiratória (FR), saturação (SatO2), volume minuto (VM), volume corrente (VC), capacidade vital (CV), pressão inspiratória (Pimáx), pressão expiratória (Pemáx) e fluxometria. Os momentos foram: avaliações inicial (M1); uso do IAF em 3 séries de 10 repetições (M2); 3 séries de 15 repetições (M3); avaliação final (M4). A análise estatística se deu pelo teste “t” de Student, ANOVA e Teste de Tukey (p < 0,05). Resultados No M2, após a 2ª série houve diminuição da PAS e FP; na 3ª série: diminuição da PAS e FR. Comparando as variáveis iniciais e finais do M2, houve diminuição da PAS e FR, e aumento da Pemáx. No M3, 1ª série, houve diminuição da PAS e SatO2. Na 2ª série: diminuição da PAS, FP, FR e SatO2. Após a 3ª série: diminuição da PAS, FP, SatO2 e FR. Comparando as variáveis iniciais e finais do M3, houve diminuição da PAS, FP, FR; aumento da Pimáx e Pemáx. Comparando M4 com M1, houve aumento da Pimáx e Pemáx, diminuição da FR e aumento da CV. Conclusão Há alterações nos parâmetros cardiorrespiratórios após utilização do IAF, principalmente nas séries com maiores repetições.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Unesp Faculdade de Medicina de BotucatuUniversidade do Sagrado CoraçãoUniversidade Estadual PaulistaUnesp Faculdade de Medicina de BotucatuUniversidade Estadual Paulist