Cloud-radiative impacts on the tropical Indian Ocean associated with the evolution of 'monsoon breaks'

A detailed diagnostic analysis of a suite of observed datasets was carried out with a view to understand the importance of cloud-radiative effects on the evolution of prolonged 'monsoon breaks' over the Indian region. The study particularly focuses on the role of clouds in affecting the sub-seasonal/intra-seasonal variability of sea surface temperature (SST) and atmospheric convection in the equatorial and south-eastern tropical Indian Ocean (SETIO) during monsoon-break transitions. A characteristic feature of the monsoon-break evolution is the appearance of suppressed convection over the SETIO region nearly 7-10 days prior to the commencement of a break spell over India. It is seen from the present analysis that the lack of cloud cover over the SETIO during the 'pre-break' phase leads to significant warming of the tropical Indian Ocean due to strong solar insolation at the surface. During the 'pre-break' phase, the net cloud-radiative forcing (NETCRF) at the surface is found to be typically around -30 Wm-2 and the mean SST in the SETIO is about 29.3°C. Following the transition to a monsoon-break phase, the cloud amount increases by about 25 over the SETIO region in association with intensified convection. The NETCRF at the surface over the SETIO averaged during the 'break' phase is found to be about -60 Wm-2 (i.e. a change of about -30 Wm-2 from the 'pre-break' phase). Consistent with the above change in the NETCRF, the SST in the SETIO shows a cooling of about 0.7°C, although the mean SSTs during the 'break' phase remain as high as 28.6°C. On the basis of the findings from this study, it is suggested that the SST warming during the 'pre-break' phase plays a key role in maintaining high SST and allows sustained convection to occur over the SETTO during prolonged monsoon breaks

Cloud-radiative impacts on the tropical Indian Ocean associated with the evolution of ‘monsoon breaks'

A detailed diagnostic analysis of a suite of observed datasets was carried out with a view to understand the importance of cloud-radiative effects on the evolution of prolonged ‘monsoon breaks’ over the Indian region. The study particularly focuses on the role of clouds in affecting the sub-seasonal/intra-seasonal variability of sea surface temperature (SST) and atmospheric convection in the equatorial and south-eastern tropical Indian Ocean (SETIO) during monsoon-break transitions. A characteristic feature of the monsoon-break evolution is the appearance of suppressed convection over the SETIO region nearly 7–10 days prior to the commencement of a break spell over India. It is seen from the present analysis that the lack of cloud cover over the SETIO during the 'pre-break' phase leads to significant warming of the tropical Indian Ocean due to strong solar insolation at the surface. During the ‘pre-break’ phase, the net cloud-radiative forcing (NETCRF) at the surface is found to be typically around − 30 Wm−2 and the mean SST in the SETIO is about 29.3 °C. Following the transition to a monsoon-break phase, the cloud amount increases by about 25% over the SETIO region in association with intensified convection. The NETCRF at the surface over the SETIO averaged during the 'break' phase is found to be about − 60 Wm−2 (i.e. a change of about − 30 Wm−2 from the ‘pre-break’ phase). Consistent with the above change in the NETCRF, the SST in the SETIO shows a cooling of about 0.7 °C, although the mean SSTs during the ‘break’ phase remain as high as 28.6 °C. On the basis of the findings from this study, it is suggested that the SST warming during the ‘pre-break’ phase plays a key role in maintaining high SST and allows sustained convection to occur over the SETIO during prolonged monsoon breaks

Desain dan Implementasi Media Pembelajaran Berbasis Mobile Learning Menggunakan Moodle Mobile App

The purpose of this study is to produce instructional media of ICT guidance based on Mobile Learning using Moodle Mobile App that is valid, practical, and effective. This type of research is Research and Development (R & D). The development model used is the ADDIE model. The experimental method used Intact-Group Comparison. The sample was students of class X at SMA Negeri 1 Sungai Geringging. The instrument was validation questionnaire to measure validity, response questionnaires to measure the practice, and post-test questions of multiple choice to measure the effectiveness of developed media.  The results showed that media declared valid by the validator assessment, and practically use by teachers and learners. Percentage of classical completeness at experiment group reached 87,5%, and 12,5%  for classical incompleteness. While the control group reached 25% for classical completeness, and 75% for classical incompleteness. It means that ICT guidance media based on Mobile Learning using Moodle Mobile App is "valid, practically, and effective" to use in ICT guidance learning process

Hemophagocytic Lymphohistiocytosis in the Medical ICU: A Single-Institution Cohort Study on Acute Liver Failure and Mortality

Hemophagocytic lymphohistiocytosis is a life-threatening hyperinflammatory disorder that is associated with high morbidity and mortality in the ICU. It has also been associated with acute liver failure. Design: Retrospective observational study. Setting: Tertiary-care medical ICU. Patients: Thirty-one patients critically ill with hemophagocytic lymphohistiocytosis. Interventions: None. Measurements and main results: We performed a comprehensive review of critically ill hemophagocytic lymphohistiocytosis patients admitted to a tertiary-care medical ICU from January 2012 to December 2018. Most patients presented with constitutional symptoms and elevated liver enzymes and thrombocytopenia were common upon hospital admission. ICU admission laboratory and clinical variables were used to calculate Acute Physiology and Chronic Health Evaluation II, hemophagocytic syndrome diagnostic score, and model for end-stage liver disease. Mean age of the cohort was 48.1 years, and 45% were male. The mortality rate was 65% at 28 days and 77% at 1 year. About 28-day survivors were younger, had lower mean Acute Physiology and Chronic Health Evaluation II score (16.5 vs 23.0; p = 0.004), and higher mean hemophagocytic syndrome diagnostic score (249.1 vs 226.0; p = 0.032) compared with nonsurvivors. Survivors were less likely to receive mechanical ventilation, renal replacement therapy, or vasopressor support and were more likely to receive chemotherapy for hemophagocytic lymphohistiocytosis. In this ICU cohort, 29% were diagnosed with acute liver failure, of whom only 22% developed acute liver failure early during their hospital stay. Acute liver failure was associated with a higher model for end-stage liver disease score upon hospital admission. Available histology in those that developed acute liver failure showed massive hepatic necrosis, or histiocytic or lymphocytic infiltrates. Conclusions: Patients admitted to the ICU with hemophagocytic lymphohistiocytosis have a high mortality. Those who survived had lower Acute Physiology and Chronic Health Evaluation scores, had higher hemophagocytic syndrome diagnostic scores, are more likely to receive hemophagocytic lymphohistiocytosis specific chemotherapy, and are less likely to have organ failure. Hemophagocytic lymphohistiocytosis can be associated with acute liver failure especially when model for end-stage liver disease score is elevated upon admission.Supported, in part, through T32HL091816 to Indiana University (Dr. Al Nasrallah). Dr. Sears receives research support to the institution through the American Cancer Society (128511-MRSG-15-163-01-DMC), National Institutes of Health, and Veterans Affairs Health Services, and is on the Scientific and Medical Advisory Boards for Biodesix and bioAffinity Technologies. The remaining authors have disclosed that they do not have any potential conflicts of interest

Decreased Quality of Life is Significantly Associated with Body Composition in Patients with Nonalcoholic Fatty Liver Disease

Background & Aims We studied impaired quality of life (QOL) and its determinants among individuals with nonalcoholic fatty liver disease (NAFLD). Methods We collected data from 341 patients with NAFLD who completed the short form 36 (SF-36) questionnaire. Body composition and liver fibrosis were assessed in patients with NAFLD using bioelectrical impedance and transient elastography, respectively. Advanced fibrosis was defined as liver stiffness measurements (LSMs) of 12.1 kPa or greater. SF-36 scores of patients with NAFLD were compared with SF36 scores of individuals with chronic medical illnesses and the general population obtained from the published literature. Results Among patients with NAFLD, percent body fat was negatively associated with scores from all 8 SF-36 scales, whereas lean body mass was positively associated with scores from 5 of 8 SF-36 scales. On multivariable analysis, SF-36 PF scores were negatively associated with type 2 diabetes, body mass index, and LSM and positively associated with lean body mass and level of alanine aminotransferase. Patients with NAFLD, and even those without advanced fibrosis, had significantly lower mean QOL scores than the control group or the general population. Conclusions Individuals with NAFLD, even those without advanced fibrosis, have lower QOL than controls. Body composition associates with QOL in patients with NAFLD; both of the modifiable factors independently associated with QOL are related to body composition. Further studies are needed to investigate if interventions to improve body composition can increase QOL for patients with NAFLD

Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review

<p>Abstract</p> <p>Background</p> <p>Health care providers (HCPs) play an important role in public health emergency preparedness and response (PHEPR) so need to be aware of public health threats and emergencies. To inform HCPs, public health issues PHEPR messages that provide guidelines and updates, and facilitate surveillance so HCPs will recognize and control communicable diseases, prevent excess deaths and mitigate suffering. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. Public health agencies need to know that the PHEPR messages sent to HCPs reach their target audience and are effective and informative. We conducted a literature review to investigate the systems and tools used by public health to generate PHEPR communications to HCPs, and to identify specific characteristics of message delivery mechanisms and formats that may be associated with effective PHEPR communications.</p> <p>Methods</p> <p>A systematic review of peer- and non-peer-reviewed literature focused on the following questions: 1) What public health systems exist for communicating PHEPR messages from public health agencies to HCPs? 2) Have these systems been evaluated and, if yes, what criteria were used to evaluate these systems? 3) What have these evaluations discovered about characterizations of the most effective ways for public health agencies to communicate PHEPR messages to HCPs?</p> <p>Results</p> <p>We identified 25 systems or tools for communicating PHEPR messages from public health agencies to HCPs. Few articles assessed PHEPR communication systems or messaging methods or outcomes. Only one study compared the effectiveness of the delivery format, device or message itself. We also discovered that the potential is high for HCPs to experience "message overload" given redundancy of PHEPR messaging in multiple formats and/or through different delivery systems.</p> <p>Conclusions</p> <p>We found that detailed descriptions of PHEPR messaging from public health to HCPs are scarce in the literature and, even when available are rarely evaluated in any systematic fashion. To meet present-day and future information needs for emergency preparedness, more attention needs to be given to evaluating the effectiveness of these systems in a scientifically rigorous manner.</p

The Ketogenic Diet Is an Effective Adjuvant to Radiation Therapy for the Treatment of Malignant Glioma

INTRODUCTION: The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that alters metabolism by increasing the level of ketone bodies in the blood. KetoCal® (KC) is a nutritionally complete, commercially available 4:1 (fat:carbohydrate+protein) ketogenic formula that is an effective non-pharmacologic treatment for the management of refractory pediatric epilepsy. Diet-induced ketosis causes changes to brain homeostasis that have potential for the treatment of other neurological diseases such as malignant gliomas. METHODS: We used an intracranial bioluminescent mouse model of malignant glioma. Following implantation animals were maintained on standard diet (SD) or KC. The mice received 2×4 Gy of whole brain radiation and tumor growth was followed by in vivo imaging. RESULTS: Animals fed KC had elevated levels of β-hydroxybutyrate (p = 0.0173) and an increased median survival of approximately 5 days relative to animals maintained on SD. KC plus radiation treatment were more than additive, and in 9 of 11 irradiated animals maintained on KC the bioluminescent signal from the tumor cells diminished below the level of detection (p<0.0001). Animals were switched to SD 101 days after implantation and no signs of tumor recurrence were seen for over 200 days. CONCLUSIONS: KC significantly enhances the anti-tumor effect of radiation. This suggests that cellular metabolic alterations induced through KC may be useful as an adjuvant to the current standard of care for the treatment of human malignant gliomas

Impact of the COVID-19 Pandemic on the Clinical Learning Environment: Addressing Identified Gaps and Seizing Opportunities

The clinical learning environment (CLE) encompasses the learner’s personal characteristics and experiences, social relationships, organizational culture, and the institution’s physical and virtual infrastructure. During the COVID-19 pandemic, all four of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communications have been limited to virtual interactions or shifted to unfamiliar clinical spaces because of redeployment. Rapid changes to the organizational culture required prompt adaptations from learners and educators in their complex organizational systems yet caused increased confusion and anxiety among them. A traditional reliance on a physical infrastructure for classical educational practices in the CLE was challenged when all institutions had to undergo a major transition to a virtual learning environment. However, disruptions spurred exciting innovations in the CLE. An entire cohort of physicians and learners underwent swift adjustments in their personal and professional development and identity as they rose to meet the clinical and educational challenges they faced due to COVID-19. Social networks and collaborations were expanded beyond traditional institutional walls and previously held international boundaries within multiple specialties. Specific aspects of the organizational and educational culture, including epidemiology, public health, and medical ethics, were brought to the forefront in health professions education, while the physical learning environment underwent a rapid transition to a virtual learning space. As health professions education continues in the era of COVID-19 and into a new era, educators must take advantage of these dynamic systems to identify additional gaps and implement meaningful change. In this article, health professions educators and learners from multiple institutions and specialties discuss the gaps and weaknesses exposed, opportunities revealed, and strategies developed for optimizing the CLE in the post–COVID-19 world

Valorization, comparison and characterization of coconuts waste and cactus in a biorefinery context using NaClO2-C2H4O2 and sequential NaClO2-C2H4O2/autohydrolysis pretreatment

The search for new sources of lignocellulosic raw materials for the generation of energy and new compounds encourages the search for locations not well known and with a high potential for biomass availability as is the case of the Northeast Region of Brazil. Thus, the cactus (CAC), green coconut shell (GCS), mature coconut fibre and mature coconut shell were pretreated by NaClO2C2H4O2 and sequential NaClO2C2H4O2/autohydrolysis aiming at the obtention of high added-value compounds in the liquid fraction and solid phase. The yield of the solid phase was between 61.42 and 90.97% and the reduction up to 91.63% of lignin in the materials pretreated by NaClO2C2H4O2. After NaClO2C2H4O2/autohydrolysis pretreatment the obtained solids yield was between 43.57 and 52.08%, with a solubilization of the hemicellulose content up to 81.42%. For both pretreatments the cellulosic content remained almost unchanged. The pretreated solids were characterized by SEM, X-ray and crystallinity indexes showing significant modifications when submitted to pretreatments. These results were further confirmed by the enzymatic conversion yields of 81.6890.03 and 86.9790.36% of the LCMs pretreated by NaClO2C2H4O2 and pretreated by NaClO2C2H4O2/autohydrolysis, respectively. The resulting liquors had a total phenolic compounds content between 0.20 and 3.05 g/L, lignin recovered up to 7.40 g/L (absence of sulphur) and xylooligosaccharides between 16.13 and 20.37 g/L. Thus, these pretreatments showed an efficient fractionation of LCMs, especially in the GCS, being an important requirement for the generation of products and byproducts in the context of the biorefinery.The authors gratefully acknowledge the Brazilian research funding agencies CNPq and CAPES for financial support. Financial support from the Energy Sustainability Fund 2014-05 (CONACYT-SENER), Mexican Centre for Innovation in Bioenergy (CemieBio), Cluster of Bioalcohols (Ref. 249564) is gratefully acknowledged. We also gratefully acknowledge support for this research by the Mexican Science and Technology Council (CONACYT, Mexico) for the infrastructure project - INFR201601 (Ref. 269461) and CB-2015-01 (Ref. 254808).info:eu-repo/semantics/publishedVersio