Jurassic stratigraphy of the southern two-thirds of North Dakota

Jurassic rocks in the southern two-thirds of North Dakota consist mainly of limestone, shale, anhydrite, and salt of the Piper Formation; shaly limestone, calcareous and non-calcareous shales of the Rierden Formation; shale and sandstone of the Swift Formation; and, at the top, non-marine shale and local sandstones of the Morrison Formation. The units generally are conformable in the deep part of the Williston Basin, and are unconformable near the edge of the basin in eastern North Dakota. The Poe Member of the Piper Formation, however, unconformably overlies the Spearfish Formation in the western part of North Dakota where Dunham salt is absent; where the Dunham is present, the sequence is conformable. Also, the Morrison Formation is unconformably overlain by the Cretaceous Dakota Group except in local areas where the boundary may be gradational. Mechanical-log characteristics or the Jurassic formations, upon which the study was based, are such that units may be correlated with assurance in the subsurface in the western half of the study area. Facies changes and the progressive thinning of the units make correlation more difficult toward the edge of the basin to the east. Piper limestones and Swift sandstones appear to be the most promising for petroleum potential, although to date no oil has been discovered in the Jurassic rocks within the study area. The Poe Member may contain gypsum at the eastern edge of the basin. The Dunham beds are a potential source of salt in western North Dakota

Computed tomography measures of nutrition in patients with end-stage liver disease provide a novel approach to characterize deficits

Aim Patients with cirrhosis and end-stage liver disease (ESLD) develop severe nutrition deficits that impact on morbidity and mortality. Laboratory measures of nutrition fail to fully assess clinical deficits in muscle mass and fat stores. This study employs computed tomography imaging to assess muscle mass and subcutaneous and visceral fat stores in patients with ESLD. Methods This 1:1 case-control study design compares ESLD patients with healthy controls. Study patients were selected from a database of ESLD patients using a stratified method to assure a representative sample based on age, body mass index (BMI), gender, and model for end-stage liver disease score (MELD). Control patients were trauma patients with a low injury severity score (<10) who had a CT scan during evaluation. Cases and controls were matched for age +/- 5 years, gender, and BMI +/- 2. Results There were 90 subjects and 90 controls. ESLD patients had lower albumin levels (p<0.001), but similar total protein levels (p=0.72). ESLD patients had a deficit in muscle mass (-19%, p<0.001) and visceral fat (-13%, p<0.001), but similar subcutaneous fat (-1%, p=0.35). ESLD patients at highest risk for sarcopenia included those over age 60, BMI< 25.0, and female gender. We found degree of sarcopenia to be independent of MELD score. Conclusions These results support previous research demonstrating substantial nutrition deficits in ESLD patients that are not adequately measured by laboratory testing. Patients with ESLD have significant deficits of muscle and visceral fat stores, but a similar amount of subcutaneous fat

The origins of marketing practice in Britain: from the ancient to the early twentieth century

Purpose The purpose of this paper is to explore the development of marketing practice in Britain from the ancient to the early twentieth century. It builds upon the author’s chapter in the 2016 Routledge Companion to the History of Marketing. Design/methodology/approach This paper is based on a review of secondary history and archaeology literature supplemented by digitised historic newspaper and magazine advertising. The literature is frameworked using a modified version of Fullerton’s 1988 periodization which has been extended to include the medieval and Roman eras. Findings One of the significant findings of this paper is the key role the state has played in the development of marketing practice in Britain, the construction of pavements being a good example. Originality/value Apart from Nevett’s 1982 history of British advertising and the author’s Routledge Companion to the History of Marketing chapter, this is the first survey of the historical development of British marketing practice. It assembles and presents in a useful way important information. This paper will be of interest to marketing historians, especially students and researchers new to the subject

Mortality on Mount Everest, 1921-2006: descriptive study

Objective To examine patterns of mortality among climbers on Mount Everest over an 86 year period

Measuring the complexity of general practice consultations:development and validation of a complexity measure

Background: The complexity of general practice consultations may be increasing and varies in different settings. A measure of complexity is required to test these hypotheses. Aim: To develop a valid measure of general practice consultation complexity applicable to routine medical records. Design and setting: Delphi study to select potential indicators of complexity followed by a cross-sectional study in English general practices to develop and validate a complexity measure. Method: The online Delphi study over two rounds identified potential indicators of consultation complexity. The cross-sectional study used an age–sex stratified random sample of patients and general practice face-to-face consultations from 2013/2014 in the Clinical Practice Research Datalink. The authors explored independent relationships between each indicator and consultation duration using mixed-effects regression models, and revalidated findings using data from 2017/2018. The proportion of complex consultations in different age–sex groups was assessed. Results: A total of 32 GPs participated in the Delphi study. The Delphi panel endorsed 34 of 45 possible complexity indicators after two rounds. After excluding factors because of low prevalence or confounding, 17 indicators were retained in the cross-sectional study. The study used data from 173 130 patients and 725 616 face-to-face GP consultations. On defining complexity as the presence of any of these 17 factors, 308 370 consultations (42.5%) were found to be complex. Mean duration of complex consultations was 10.49 minutes, compared to 9.64 minutes for non-complex consultations. The proportion of complex consultations was similar in males and females but increased with age. Conclusion: The present consultation complexity measure has face and construct validity. It may be useful for research, management and policy, and for informing decisions about the range of resources needed in different practices

Radiologic Assessment of Muscle and Fat Stores in Long-Term Type I Diabetics Referred for Pancreas Transplant Compared to Healthy Controls

Type 1 diabetes (DM1) is associated with loss of skeletal muscle and bone mass and may affect body fat stores. This study employs computed tomography (CT) scans to assess the body composition of DM1 patients referred for pancreas transplant compared to healthy controls. A 1:1 case–control design matched study patients with otherwise healthy patients from the trauma database. Matching criteria included age ± 5 years, gender, and body mass index (BMI) ± 2kg/m2. Nutrition variables included serum albumin and protein levels, BMI, and CT measures of muscle mass and fat stores. There were 22 subjects and 22 controls (median DM1 duration 24 years). DM1 patients had less muscle mass and less subcutaneous fat but no difference in visceral fat. Patients with the greatest muscle deficit were those with DM1 greater than 20 years and those younger than age 40. DM1 patients maintain similar BMI and protein levels compared to healthy controls but have marked deficits of muscle and subcutaneous fat. These results inform the nutritional management of DM1 patients and quantify the muscle and fat deficits present in these patients. At highest risk are young patients and those with duration of DM1 over 20 years

Using present-day observations to detect when anthropogenic change forces surface ocean carbonate chemistry outside preindustrial bounds

© The Author(s), 2016. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Biogeosciences 13 (2016): 5065-5083, doi:10.5194/bg-13-5065-2016.One of the major challenges to assessing the impact of ocean acidification on marine life is detecting and interpreting long-term change in the context of natural variability. This study addresses this need through a global synthesis of monthly pH and aragonite saturation state (Ωarag) climatologies for 12 open ocean, coastal, and coral reef locations using 3-hourly moored observations of surface seawater partial pressure of CO2 and pH collected together since as early as 2010. Mooring observations suggest open ocean subtropical and subarctic sites experience present-day surface pH and Ωarag conditions outside the bounds of preindustrial variability throughout most, if not all, of the year. In general, coastal mooring sites experience more natural variability and thus, more overlap with preindustrial conditions; however, present-day Ωarag conditions surpass biologically relevant thresholds associated with ocean acidification impacts on Mytilus californianus (Ωarag < 1.8) and Crassostrea gigas (Ωarag < 2.0) larvae in the California Current Ecosystem (CCE) and Mya arenaria larvae in the Gulf of Maine (Ωarag < 1.6). At the most variable mooring locations in coastal systems of the CCE, subseasonal conditions approached Ωarag =  1. Global and regional models and data syntheses of ship-based observations tended to underestimate seasonal variability compared to mooring observations. Efforts such as this to characterize all patterns of pH and Ωarag variability and change at key locations are fundamental to assessing present-day biological impacts of ocean acidification, further improving experimental design to interrogate organism response under real-world conditions, and improving predictive models and vulnerability assessments seeking to quantify the broader impacts of ocean acidification.The CO2 and ocean acidification observations were funded by NOAA’s Climate Observation Division (COD) in the Climate Program Office and NOAA’s Ocean Acidification Program. The maintenance of the Stratus and WHOTS Ocean Reference Stations were also supported by NOAA COD (NA09OAR4320129). Additional support for buoy equipment, maintenance, and/or ancillary measurements was provided by NOAA through the US Integrated Ocean Observing System office: for the La Parguera buoy under a Cooperative Agreement (NA11NOS0120035) with the Caribbean Coastal Ocean Observing System, for the Chá b˘a buoy under a Cooperative Agreement (NA11NOS0120036) with the Northwest Association of Networked Ocean Observing System, for the Gray’s Reef buoy under a Cooperative Agreement (NA11NOS0120033) with the Southeast Coastal Ocean Observing Regional Association, and for the Gulf of Main buoy under a Cooperative Agreement (NA11NOS0120034) with the Northeastern Regional Association of Coastal and Ocean Observing Systems

Patient-level and practice-level factors associated with consultation duration:a cross-sectional analysis of over one million consultations in English primary care

Objectives: Consultation duration has previously been shown to be associated with patient, practitioner, and practice characteristics. However, previous studies were conducted outside the UK, considered only small numbers of GP consultations, or focused primarily on practitioner level characteristics. We aimed to determine the patient and practice level factors associated with duration of GP and nurse consultations in UK primary care. Design and setting: Cross sectional data were obtained from English general practices contributing to the Clinical Practice Research Datalink (CPRD) linked to data on patient deprivation and practice staffing, rurality, and Quality and Outcomes Framework (QOF) achievement. Participants: 218,304 patients, from 316 English general practices, consulting from 1st April 2013 to 31st March 2014. Analysis: Multilevel mixed effects models described the association between consultation duration and patient and practice-level factors (patient age, gender, smoking status, ethnic group, deprivation and practice rurality, number of full time equivalent GPs/nurses, list size, consultation rate, quintile of overall QOF achievement, and training status). Results: Mean duration of face-to-face GP consultations was 9.24 minutes and 5.32 minutes for telephone consultations. Nurse face-to-face and telephone consultations lasted 9.70 and 5.73 minutes on average, respectively. Longer GP consultation duration was associated with female patient gender, practice training status and older patient age. Shorter duration was associated with higher deprivation and consultation rate. Longer nurse consultation duration was associated with male patient gender, older patient age and ever smoking; and shorter duration with higher consultation rate. Observed differences in duration were small (e.g. GP consultations with female patients compared to male patients were 8 seconds longer on average). Conclusions: Small observed differences in consultation duration indicate that patients are treated similarly regardless of background. Increased consultation duration may be beneficial for older or comorbid patients, but the benefits and costs of increased consultation duration require further study.</p

Nuisance Bleeding With Prolonged Dual Antiplatelet Therapy After Acute Myocardial Infarction and its Impact on Health Status

ObjectivesThe purpose of this study was to examine the incidence of nuisance bleeding after AMI and its impact on QOL.BackgroundProlonged dual antiplatelet therapy (DAPT) is recommended after acute myocardial infarction (AMI) to reduce ischemic events, but it is associated with increased rates of major and minor bleeding. The incidence of even lesser degrees of post-discharge “nuisance” bleeding with DAPT and its impact on quality of life (QOL) are unknown.MethodsData from the 24-center TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status) study of 3,560 patients, who were interviewed at 1, 6, and 12 months after AMI, were used to investigate the incidence of nuisance bleeding (defined as Bleeding Academic Research Consortium type 1). Baseline characteristics associated with “nuisance” bleeding and its association with QOL, as measured by the EuroQol 5 Dimension visual analog scale, and subsequent re-hospitalization were examined.ResultsNuisance (Bleeding Academic Research Consortium type 1) bleeding occurred in 1,335 patients (37.5%) over the 12 months after AMI. After adjusting for baseline bleeding and mortality risk, ongoing DAPT was the strongest predictor of nuisance bleeding (rate ratio [RR]: 1.44, 95% confidence interval [CI]: 1.17 to 1.76 at 1 month; RR: 1.89, 95% CI: 1.35 to 2.65 at 6 months; and RR: 1.39, 95% CI: 1.08 to 1.79 at 12 months; p < 0.01 for all comparisons). Nuisance bleeding at 1 month was independently associated with a decrement in QOL at 1 month (−2.81 points on EuroQol 5 Dimension visual analog scale; 95% CI: 1.09 to 5.64) and nonsignificantly toward higher re-hospitalization (hazard ratio: 1.20; 95% CI: 0.95 to 1.52).ConclusionsNuisance bleeding is common in the year after AMI, associated with ongoing use of DAPT, and independently associated with worse QOL. Improved selection of patients for prolonged DAPT may help minimize the incidence and adverse consequences of nuisance bleeding