Severe babesiosis in an asplenic patient requiring red cell exchange

Corresponding author: William N. Rose, Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and ClinicsBabesiosis is a rare, tick-borne infectious disease, caused mostly by the parasite Babesia microti in the United States. It is frequently transmitted through the bite of the Ixodes scapularis tick. Babesiosis is characterized by red cell disruption and intravascular hemolysis. Severe cases can be life-threatening and are associated with asplenia, advanced age, and other causes of impaired immune function. Treatment is typically with antibiotics. However, for severe cases, the use of red cell exchange has been reported with debate about its efficacy. Here, we report a complex case of babesiosis with a parasitemia of 22% that required two red cell exchange procedures and multiple antibiotics in a patient with a history of asplenia.Xiaoyan Yang, Margarita C. Consing Gangelhoff, William N. Rose (Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics)Includes bibliographical references

Partial anomalous pulmonary venous return mimics arterial positioning after central line placement for plasmapheresis

Case: A 61-year-old male who was status post right single lung transplant complicated by grade three primary graft dysfunction was admitted and mechanically ventilated for hypoxic respiratory failure. Donor specific antibody testing to human leukocyte antigens was positive. The protocol for antibody-mediated transplant rejection was initiated. One aspect of the protocol was a series of plasmapheresis procedures. In advance of the first plasmapheresis, central line placement was attempted via the left internal jugular vein. A chest x-ray showed a line that terminated to the left of the midline and raised concern for arterial placement (Figure 1). Blood gases from the line were: pH 7.72, pCO2 21 mmHg, pO2 369 mmHg, bicarbonate 28.4 mmol/L.Alex J. Griffith (Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital), Victoria Ray (MD, Department of Anesthesiology, University of Wisconsin Hospital), William N. Rose (MD, Department of Emergency Medicine, University of Wisconsin Hospital)Includes bibliographical reference

Obstetrics Emergency Labor and Delivery Case Simulations with Normal Vaginal Delivery Demonstration: A Hands-on Simulation for Clerkship Students

Introduction: Simulation is rarely used for medical student education in the field of obstetrics. This method is an effective model of learning for topics that are encountered in clinical situations and for topics that pose significant risk to patients when an untrained individual is involved. Methods: A 2-hour obstetric delivery simulation session was developed and incorporated into the third-year obstetrics and gynecology clerkship rotation at Wright State University Boonshoft School of Medicine. Medical students completed self-guided content reviews with resources provided prior to the session. During the session, each medical student conducted a normal vaginal delivery and one of the emergent cases (umbilical cord prolapse, pre-eclampsia/eclampsia, shoulder dystocia, and postpartum hemorrhage). During each case the Resident facilitator followed a script which included asking questions using gamification strategies to promote a low-stress learning environment. Critical action checklists were used to ensure students gained a strong understanding of topics. Simulation sessions were conducted both remotely and in-person. The simulation experience was evaluated using surveys and quizzes completed prior to and after participating in the simulation session. Results: Students reported that the simulation experience increased their comfort with emergent obstetric situations, increased their medical knowledge, and was beneficial to their education. Discussion: Simulation is an untapped learning method in obstetrics. We developed simulations for obstetric events to provide medical students with hands-on exposure to important obstetric experiences. This simulation session provides the framework for other medical schools to incorporate these obstetric simulations into their clerkship curriculum

Massive Deliberation

Agents are proliferating on the Web, making it conceivable that their collective reasoning ability might someday be harnessed for robust decision-making. The hope is that massive deliberation power can soon help solve problems that require knowledge, reasoning, and intelligence. Until recently, working individually or in small groups, agents across the Web could barely communicate and could only reason under conditions of severely bounded rationality. Projects such as Agentcities showed that widespread heterogeneous agents could collaborate on specific predefined tasks and provide diverse agent-based services. When the tasks are dynamic, of long duration, and ill defined, however, success requires planning that is continual, distributed, and accounts for the social fabric into which the plans and their execution must fit. The authors discusses distributed planning and societal agents

Comparison of TOMS and AVHRR volcanic ash retrievals from the August 1992 eruption of Mt. Spurr

On August 19, 1992, the Advanced Very High Resolution Radiometer (AVHRR) onboard NOAA-12 and NASA\u27s Total Ozone Mapping Spectrometer (TOMS) onboard the Nimbus-7 satellite simultaneously detected and mapped the ash cloud from the eruption of Mt. Spurr, Alaska. The spatial extent and geometry of the cloud derived from the two datasets are in good agreement and both AVHRR split window IR (11–12µm brightness temperature difference) and the TOMS UV Aerosol Index (0.34–0.38µm ultraviolet backscattering and absorption) methods give the same range of total cloud ash mass. Redundant methods for determination of ash masses in drifting volcanic clouds offer many advantages for potential application to the mitigation of aircraft hazards

Dogslife: A web-based longitudinal study of Labrador Retriever health in the UK

<p>Abstract</p> <p>Background</p> <p>Dogslife is the first large-scale internet-based longitudinal study of canine health. The study has been designed to examine how environmental and genetic factors influence the health and development of a birth cohort of UK-based pedigree Labrador Retrievers.</p> <p>Results</p> <p>In the first 12 months of the study 1,407 Kennel Club (KC) registered eligible dogs were recruited, at a mean age of 119 days of age (SD 69 days, range 3 days – 504 days). Recruitment rates varied depending upon the study team’s ability to contact owners. Where owners authorised the provision of contact details 8.4% of dogs were recruited compared to 1.3% where no direct contact was possible. The proportion of dogs recruited was higher for owners who transferred the registration of their puppy from the breeder to themselves with the KC, and for owners who were sent an e-mail or postcard requesting participation in the project. Compliance with monthly updates was highly variable. For the 280 dogs that were aged 400 days or more on the 30^th June 2011, we estimated between 39% and 45% of owners were still actively involved in the project. Initial evaluation suggests that the cohort is representative of the general population of the KC registered Labrador Retrievers eligible to enrol with the project. Clinical signs of illnesses were reported in 44.3% of Labrador Retrievers registered with Dogslife (median age of first illness 138 days), although only 44.1% of these resulted in a veterinary presentation (median age 316 days).</p> <p>Conclusions</p> <p>The web-based platform has enabled the recruitment of a representative population of KC registered Labrador Retrievers, providing the first large-scale longitudinal population-based study of dog health. The use of multiple different methods (e-mail, post and telephone) of contact with dog owners was essential to maximise recruitment and retention of the cohort.</p

Excavations at the site of Vasino, Lautem District, Timor-Leste

This chapter explores the archaeology and ethnohistory of one of the distinctive fortified settlements in the eastern part of Timor-Leste. In 2009, a team from The Australian National University (ANU), together with local people, partially excavated the site of Vasino, located close to the north coast of Timor-Leste, above the modern village of Moro-Parlamento (Figure 4.1). The site had been fortified with large stone walls and the aim was to provide more data on when, how and why these fortifications were used in the region. Two related questions guided the research. First, when was the main period of fort construction initiated? Secondly, what were the prevailing environmental and social conditions of those times

TESS Discovery of an ultra-short-period planet around the nearby M dwarf LHS 3844

Data from the newly-commissioned \textit{Transiting Exoplanet Survey Satellite} (TESS) has revealed a "hot Earth" around LHS 3844, an M dwarf located 15 pc away. The planet has a radius of $1.32\pm 0.02$ $R_\oplus$ and orbits the star every 11 hours. Although the existence of an atmosphere around such a strongly irradiated planet is questionable, the star is bright enough ($I=11.9$, $K=9.1$) for this possibility to be investigated with transit and occultation spectroscopy. The star's brightness and the planet's short period will also facilitate the measurement of the planet's mass through Doppler spectroscopy.Comment: 10 pages, 4 figures. Submitted to ApJ Letters. This letter makes use of the TESS Alert data, which is currently in a beta test phase, using data from the pipelines at the TESS Science Office and at the TESS Science Processing Operations Cente

Reviews and syntheses: Effects of permafrost thaw on Arctic aquatic ecosystems

The Arctic is a water-rich region, with freshwater systems covering about 16 % of the northern permafrost landscape. Permafrost thaw creates new freshwater ecosystems, while at the same time modifying the existing lakes, streams, and rivers that are impacted by thaw. Here, we describe the current state of knowledge regarding how permafrost thaw affects lentic (still) and lotic (moving) systems, exploring the effects of both thermokarst (thawing and collapse of ice-rich permafrost) and deepening of the active layer (the surface soil layer that thaws and refreezes each year). Within thermokarst, we further differentiate between the effects of thermokarst in lowland areas vs. that on hillslopes. For almost all of the processes that we explore, the effects of thaw vary regionally, and between lake and stream systems. Much of this regional variation is caused by differences in ground ice content, topography, soil type, and permafrost coverage. Together, these modifying factors determine (i) the degree to which permafrost thaw manifests as thermokarst, (ii) whether thermokarst leads to slumping or the formation of thermokarst lakes, and (iii) the manner in which constituent delivery to freshwater systems is altered by thaw. Differences in thaw-enabled constituent delivery can be considerable, with these modifying factors determining, for example, the balance between delivery of particulate vs. dissolved constituents, and inorganic vs. organic materials. Changes in the composition of thaw-impacted waters, coupled with changes in lake morphology, can strongly affect the physical and optical properties of thermokarst lakes. The ecology of thaw-impacted lakes and streams is also likely to change; these systems have unique microbiological communities, and show differences in respiration, primary production, and food web structure that are largely driven by differences in sediment, dissolved organic matter, and nutrient delivery. The degree to which thaw enables the delivery of dissolved vs. particulate organic matter, coupled with the composition of that organic matter and the morphology and stratification characteristics of recipient systems will play an important role in determining the balance between the release of organic matter as greenhouse gases (CO2and CH4), its burial in sediments, and its loss downstream. The magnitude of thaw impacts on northern aquatic ecosystems is increasing, as is the prevalence of thaw-impacted lakes and streams. There is therefore an urgent need to quantify how permafrost thaw is affecting aquatic ecosystems across diverse Arctic landscapes, and the implications of this change for further climate warming.Additional co-authors: G. MacMillan, M. Rautio, K. M. Walter Anthony, and K. P. Wicklan