Variable sequence of events during the past seven terminations in two deep-sea cores from the Southern Ocean

The relationships among internally consistent records of summer sea-surface temperature (SSST), winter sea ice (WSI), and diatomaceous stable isotopes were studied across seven terminations over the last 660 ka in sedimentary cores from ODP sites 1093 and 1094. The sequence of events at both sites indicates that SSST and WSI changes led the carbon and nitrogen isotopic changes in three Terminations (TI, TII and TVI) and followed them in the other four Terminations (TIII, TIV, TV and TVII). In both TIII and TIV, the leads and lags between the proxies were related to weak glacial mode, while in TV and TVII they were due to the influence of the mid-Pleistocene transition. We show that the sequence of events is not unique and does not follow the same pattern across terminations, implying that the processes that initiated climate change in the Southern Ocean has varied through time

Emission from Hot Dust in the Infrared Spectra of Gamma-ray Bright Blazars

A possible source of $\gamma$-ray photons observed from the jets of blazars is inverse Compton scattering by relativistic electrons of infrared seed photons from a hot, dusty torus in the nucleus. We use observations from the Spitzer Space Telescope to search for signatures of such dust in the infrared spectra of four $\gamma$-ray bright blazars, the quasars 4C 21.35, CTA102, and PKS 1510$-$089, and the BL Lacertae object ON231. The spectral energy distribution (SED) of 4C 21.35 contains a prominent infrared excess indicative of dust emission. After subtracting a non-thermal component with a power-law spectrum, we fit a dust model to the residual SED. The model consists of a blackbody with temperature $\sim1200$ K, plus a much weaker optically thin component at $\sim660$ K. The total luminosity of the thermal dust emission is $7.9\pm0.2 \times 10^{45}$ erg s$^{-1}$. If the dust lies in an equatorial torus, the density of IR photons from the torus is sufficient to explain the $\gamma$-ray flux from 4C 21.35 as long as the scattering occurs within a few parsecs of the central engine. We also report a tentative detection of dust in the quasar CTA102, in which the luminosity of the infrared excess is $7 \pm 2 \times 10^{45}$ erg s$^{-1}$. However, in CTA102 the far-IR spectra are too noisy to detect the $10 \mu$m silicate feature. Upper limits to the luminosity from thermal emission from dust in PKS 1510-089, and ON231, are, $2.3\times10^{45}$, and $6.6\times10^{43}$ erg s$^{-1}$, respectively. These upper limits do not rule out the possibility of inverse Compton up-scattering of IR photons to $\gamma$-ray energies in these two sources. The estimated covering factor of the hot dust in 4C 21.35, 22%, is similar to that of non-blazar quasars; however, 4C 21.35 is deficient in cooler dust.Comment: 23 Pages, 5 Figures, 2 Tables, 1 Machine Readable Table. Accepted to Ap

The Disability discrimination Act and Developments in Accessible Public Transport in the UK

Objective: To determine the relation between time to surgery (TTS) after neoadjuvant chemoradiotherapy (nCRT) and pathologically complete response (pCR), surgical outcome, and survival in patients with esophageal cancer. Background: Standard treatment for potentially curable esophageal cancer is nCRT plus surgery after 4 to 6 weeks. In rectal cancer patients, evidence suggests that prolonged TTS is associated with a higher pCR rate and possibly with better survival. Methods: We identified patients treated with nCRT plus surgery for esophageal cancer between 2001 and 2011. TTS (last day of radiotherapy to day of surgery) varied mainly for logistical reasons. Minimal follow-up was 24 months. The effect of TTS on pCR rate, postoperative complications, and survival was determined with (ordinal) logistic, linear, and Cox regression, respectively. Results: In total, 325 patients were included. Median TTS was 48 days (p25-p75=40-60). After 45 days, TTSwas associated with an increased probability of pCR [odds ratio (OR) = 1.35 per additional week of TSS, P = 0.0004] and a small increased risk of postoperative complications (OR = 1.20, P <0.001). Prolonged TTS had no effect on disease-free and overall survivals (HR = 1.00 and HR = 1.06 per additional week of TSS, P = 0.976 and P = 0.139, respectively). Conclusions: Prolonged TTS after nCRT increases the probability of pCR and is associated with a slightly increased probability of postoperative complications, without affecting disease-free and overall survivals. We conclude that TTS can be safely prolonged from the usual 4 to 6 weeks up to at least 12 weeks, which facilitates a more conservative wait-and-see strategy after neoadjuvant chemoradiotherapy to be teste

High dose prolonged treatment with nitazoxanide is not effective for cryptosporidiosis in HIV positive Zambian children: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Treatment of cryptosporidiosis in HIV infected children has proved difficult and unsatisfactory with no drugs having demonstrable efficacy in controlled trials except nitazoxanide. We hypothesised that a prolonged course of treatment with high dose nitazoxanide would be effective in treating cryptosporidiosis in HIV positive Zambian children.</p> <p>Methods</p> <p>We performed a double-blind, randomised, placebo controlled trial in paediatric patients in the UTH in Lusaka. The study included HIV positive children between one and eleven years of age if 2 out of 3 stool samples were positive for oocysts of <it>Cryptosporidium </it>spp. Children were given nitazoxanide suspension in a dose of 200 mg twice daily (bid) for 28 days (if 1-3 years old) or 400 mg bid for 28 days (if 4-11 years old), or matching placebo.</p> <p>Results</p> <p>Sixty children were randomised and 52 were fully evaluated. Only five children were 4 years of age or over and received the higher dose. In the primary efficacy analysis, 11 out of 26 (42%) in the active treatment group achieved a 'Well' clinical response compared to 8 out of 26 (35%) in the placebo group. Parasitological response was declared as 'Eradicated' in 27% in the active group and 35% in the placebo group. Mortality (16/52, 31%) did not differ by treatment allocation.</p> <p>Conclusion</p> <p>We found no significant benefit in children with cryptosporidiosis despite high dose and longer treatment duration. This is the second randomised controlled trial to suggest that in Zambian children with HIV-related immunosuppression nitazoxanide does not eradicate this infection nor provide clinical symptom reduction.</p> <p>Trial Registration</p> <p>The trial was registered as ISRCTN41089957.</p

Migration of the Antarctic Polar Front through the mid-Pleistocene transition: evidence and climatic implications

The Antarctic Polar Front is an important biogeochemical divider in the Southern Ocean. Laminated diatom mat deposits record episodes of massive flux of the diatom Thalassiothrix antarctica beneath the Antarctic Polar Front and provide a marker for tracking the migration of the Front through time. Ocean Drilling Program Sites 1091, 1093 and 1094 are the only deep piston cored record hitherto sampled from the sediments of the circumpolar biogenic opal belt. Mapping of diatom mat deposits between these sites indicates a glacial-interglacial front migration of up to 6 degrees of latitude in the early / mid Pleistocene. The mid Pleistocene transition marks a stepwise minimum 7 degree northward migration of the locus of the Polar Front sustained for about 450 kyr until an abrupt southward return to a locus similar to its modern position and further south than any mid-Pleistocene locus. This interval from a “900 ka event” that saw major cooling of the oceans and a ?13C minimum through to the 424 ka Mid-Brunhes Event at Termination V is also seemingly characterised by 1) sustained decreased carbonate in the subtropical south Atlantic, 2) reduced strength of Antarctic deep meridional circulation, 3) lower interglacial temperatures and lower interglacial atmospheric CO2 levels (by some 30 per mil) than those of the last 400 kyr, evidencing less complete deglaciation. This evidence is consistent with a prolonged period lasting 450 kyr of only partial ventilation of the deep ocean during interglacials and suggests that the mechanisms highlighted by recent hypotheses linking mid-latitude atmospheric conditions to the extent of deep ocean ventilation and carbon sequestration over glacial-interglacial cycles are likely in operation during the longer time scale characteristic of the Mid-Pleistocene Transition. The cooling that initiated the “900 ka event” may have been driven by minima in insolation amplitude related to eccentricity modulation of precession that also affected low latitude climates as marked by threshold changes in the African monsoon system. The major thresholds in earth system behaviour through the Mid-Pleistocene Transition were likely governed by an interplay of the 100 kyr and 400 kyr eccentricity modulation of precession

Sea ice diatom contributions to Holocene nutrient utilization in East Antarctica

Combined high-resolution Holocene δ30Sidiat and δ13Cdiat paleorecords are presented from theSeasonal Ice Zone, East Antarctica. Both data sets reflect periods of increased nutrient utilization by diatomsduring the Hypsithermal period (circa 7800 to 3500 calendar years (cal years) B.P.), coincident with a higherabundance of open water diatom species (Fragilariopsis kerguelensis), increased biogenic silica productivity(%BSi), and higher regional summer temperatures. The Neoglacial period (after circa 3500 cal years B.P.) isreflected by an increase in sea ice indicative species (Fragilariopsis curta and Fragilariopsis cylindrus,upto50%) along with a decrease in %BSi and δ13Cdiat(< 18‰ to 23‰). However, over this period, δ30Sidiatdata show an increasing trend, to some of the highest values in the Holocene record (average of +0.43‰).Competing hypotheses are discussed to account for the decoupling trend in utilization proxies including ironfertilization, species-dependent fractionation effects, and diatom habitats. Based on mass balance calculations,we highlight that diatom species derived from the semi-enclosed sea ice environment may have a confoundingeffect upon δ30Sidowncorecompositions of the seasonal sea ice zone. A diatom composition, with approximately28% of biogenic silica derived from the sea ice environment (diat-SI) can account for the increased averagecompo sition of δ30Sidiatduring the Neoglacial. These data highlight the significant role sea ice diatoms can playwith relation to their export in sediment records, which has implications on productivity reconstructions fromthe seasonal ice zone

Interpretation and application of carbon isotope ratios in freshwater diatom silica

Carbon incorporated into diatom frustule walls is protected from degradation enabling analysis for carbon isotope composition (δ13Cdiatom). This presents potential for tracing carbon cycles via a single photosynthetic host with well-constrained ecophysiology. Improved understanding of environmental processes controlling carbon delivery and assimilation is essential to interpret changes in freshwater δ13Cdiatom. Here relationships between water chemistry and δ13Cdiatom from contemporary regional data sets are investigated. Modern diatom and water samples were collected from river catchments within England and lake sediments from across Europe. The data suggest dissolved, biogenically produced carbon supplied proportionately to catchment productivity was critical in the rivers and soft water lakes. However, dissolved carbon from calcareous geology overwhelmed the carbon signature in hard water catchments. Both results demonstrate carbon source characteristics were the most important control on δ13Cdiatom, with a greater impact than productivity. Application of these principles was made to a sediment record from Lake Tanganyika. δ13Cdiatom co-varied with δ13Cbulk through the last glacial and Holocene. This suggests carbon supply was again dominant and exceeded authigenic demand. This first systematic evaluation of contemporary δ13Cdiatom controls demonstrates that diatoms have the potential to supply a record of carbon cycling through lake catchments from sediment records over millennial timescales

Many quality measurements, but few quality measures assessing the quality of breast cancer care in women: A systematic review

BACKGROUND: Breast cancer in women is increasingly frequent, and care is complex, onerous and expensive, all of which lend urgency to improvements in care. Quality measurement is essential to monitor effectiveness and to guide improvements in healthcare. METHODS: Ten databases, including Medline, were searched electronically to identify measures assessing the quality of breast cancer care in women (diagnosis, treatment, followup, documentation of care). Eligible studies measured adherence to standards of breast cancer care in women diagnosed with, or in treatment for, any histological type of adenocarcinoma of the breast. Reference lists of studies, review articles, web sites, and files of experts were searched manually. Evidence appraisal entailed dual independent assessments of data (e.g., indicators used in quality measurement). The extent of each quality indicator's scientific validation as a measure was assessed. The American Society of Clinical Oncology (ASCO) was asked to contribute quality measures under development. RESULTS: Sixty relevant reports identified 58 studies with 143 indicators assessing adherence to quality breast cancer care. A paucity of validated indicators (n = 12), most of which assessed quality of life, only permitted a qualitative data synthesis. Most quality indicators evaluated processes of care. CONCLUSION: While some studies revealed patterns of under-use of care, all adherence data require confirmation using validated quality measures. ASCO's current development of a set of quality measures relating to breast cancer care may hold the key to conducting definitive studies