Temporal and geochemical signatures in granitoids of northwestern Nevada: Evidence for the continuity of the Mesozoic magmatic arc through the western Great Basin

Granitoid magmatism in the Basin and Range Province of northwestern Nevada remains an important gap in our understanding of the along-strike variability of Mesozoic Cordilleran arc systems. We present a comprehensive investigation on a suite of intrusions within the Santa Rosa Range (SRR) and Bloody Run Hills (BRH) of northwestern Nevada. Petrography, whole-rock geochemistry, and zircon U-Pb geochronology indicate two distinct magmatic systems in the SRR: an older, mafic, and metaluminous pulse (Santa Rosa/Andorno [SRA] group—ca. 102–100 Ma) and a younger, felsic, and peraluminous pulse (Granite Peak/Sawtooth [GPS] group—ca. 94–92 Ma). Within the BRH to the south, the Flynn (ca. 105 Ma) and Bloody Run stocks (ca. 96 Ma) are compositionally similar to the SRA group. New Al-in-hornblende thermobarometry reveals emplacement paleodepths of ~5–10 km for the SRA group. Slightly deeper emplacement levels (~10.5–12 km) are inferred for the GPS group from structural relationships and metamorphic contact aureole assemblages. Elemental characteristics are correlated with whole-rock Sr and Nd isotope ratios, revealing higher εNd(t) (+0.8 to +2.5) and lower initial 87Sr/86Sr (0.7040–0.7054) in the older SRA group than the younger GPS group (εNd(t) = −3.2 to −1.5; 87Sr/86Sr(i) 0.7056–0.7061). New zircon εHf isotope analyses reveal that with the exception of the Bloody Run stock (−0.4 ± 2.1), the SRA group has more primitive zircon εHf(t) values (+2.9 to +5.3) than the GPS group (+0.4 to −3.7). The systematic shift in whole-rock Sr and Nd isotope and zircon εHf(t) values with time suggests fundamental changes in the relative contributions of mantle and crustal sources. A comparison of published geochronology and geochemistry from regional intrusive suites confirms that SRR-BRH magmatism was coeval and geochemically similar to the larger Cordilleran batholiths, providing evidence for the continuity of the Mesozoic magmatic arc through northwestern Nevada

Is the NEI-VFQ-25 a useful tool in identifying visual impairment in an elderly population?

BACKGROUND: The use of self-report questionnaires to substitute for visual acuity measurement has been limited. We examined the association between visual impairment and self reported visual function in a population sample of older people in the UK. METHODS: Cross sectional study of people aged more than 75 years who initially participated in a trial of health screening. The association between 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ) scores and visual impairment (defined as an acuity of less than 6/18 in the better eye) was examined using logistic regression. RESULTS: Visual acuity and NEI-VFQ scores were obtained from 1807 participants (aged 77 to 101 years, 36% male), from 20 general practices throughout the UK. After adjustment for age, gender, practice and NEI-VFQ sub-scale scores, those complaining of poor vision in general were 4.77 times (95% CI 3.03 to 7.53) more likely to be visually impaired compared to those who did not report difficulty. Self-reported limitations with social functioning and dependency on others due to poor vision were also associated with visual impairment (odds ratios, 2.52, 95% CI 1.55 to 4.11; 1.73, 95% CI 1.05 to 2.86 respectively). Those reporting difficulties with near vision and colour vision were more likely to be visually impaired (odds ratios, 2.32, 95% CI 1.30 to 4.15; 2.25, 95% CI 1.35 to 3.73 respectively). Other NEI-VFQ sub-scale scores were unrelated to measures of acuity. Similar but weaker odds ratios were found with reduced visual acuity (defined as less than 6/12 in the better eye). Although differences in NEI-VFQ scores were small, scores were strongly associated with visual acuity, binocular status, and difference in acuity between eyes. CONCLUSION: NEI-VFQ questions regarding the quality of general vision, social functioning, visual dependency, near vision and colour vision are strongly and independently associated with an objective measure of visual impairment in an elderly population

Dominant inhibition of Fas ligand-mediated apoptosis due to a heterozygous mutation associated with autoimmune lymphoproliferative syndrome (ALPS) Type Ib

<p>Abstract</p> <p>Background:</p> <p>Autoimmune lymphoproliferative syndrome (ALPS) is a disorder of lymphocyte homeostasis and immunological tolerance due primarily to genetic defects in Fas (CD95/APO-1; <it>TNFRSF6</it>), a cell surface receptor that regulates apoptosis and its signaling apparatus.</p> <p>Methods:</p> <p>Fas ligand gene mutations from ALPS patients were identified through cDNA and genomic DNA sequencing. Molecular and biochemical assessment of these mutant Fas ligand proteins were carried out by expressing the mutant FasL cDNA in mammalian cells and analysis its effects on Fas-mediated programmed cell death.</p> <p>Results:</p> <p>We found an ALPS patient that harbored a heterozygous A530G mutation in the FasL gene that replaced Arg with Gly at position 156 in the protein's extracellular Fas-binding region. This produced a dominant-interfering FasL protein that bound to the wild-type FasL protein and prevented it from effectively inducing apoptosis.</p> <p>Conclusion:</p> <p>Our data explain how a naturally occurring heterozygous human FasL mutation can dominantly interfere with normal FasL apoptotic function and lead to an ALPS phenotype, designated Type Ib.</p

Development of quality indicators for monitoring outcomes of frail elderly hospitalised in acute care health settings: Study Protocol

Background: Frail older people admitted to acute care hospitals are at risk of a range of adverse outcomes, including geriatric syndromes, although targeted care strategies can improve health outcomes for these patients. It is therefore important to assess inter-hospital variation in performance in order to plan and resource improvement programs. Clinical quality outcome indicators provide a mechanism for identifying variation in performance over time and between hospitals, however to date there has been no routine use of such indicators in acute care settings. A barrier to using quality indicators is lack of access to routinely collected clinical data. The interRAI Acute Care (AC) assessment system supports comprehensive geriatric assessment of older people within routine daily practice in hospital and includes process and outcome data pertaining to geriatric syndromes. This paper reports the study protocol for the development of aged care quality indicators for acute care hospitals. Methods/Design. The study will be conducted in three phases:. 1. Development of a preliminary inclusive set of quality indicators set based on a literature review and expert panel consultation,. 2. A prospective field study including recruitment of 480 patients aged 70 years or older across 9 Australian hospitals. Each patient will be assessed on admission and discharge using the interRAI AC, and will undergo daily monitoring to observe outcomes. Medical records will be independently audited, and. 3. Analysis and compilation of a definitive quality indicator set, including two anonymous voting rounds for quality indicator inclusion by the expert panel. Discussion. The approach to quality indicators proposed in this protocol has four distinct advantages over previous efforts: the quality indicators focus on outcomes; they can be collected as part of a routinely applied clinical information and decision support system; the clinical data will be robust and will contribute to better understanding variations in hospital care of older patients; The quality indicators will have international relevance as they will be built on the interRAI assessment instrument, an internationally recognised clinical system

Sleep position, patient comfort, and technical performance with two established procedures for home sleep testing

Purpose!#!In patients with a high pre-test probability of suffering from obstructive sleep apnea (OSA), (cardio)-respiratory polygraphy (RP; level 3) is commonly used for home sleep testing (HST); however, testing based on peripheral arterial tonometry (PAT) is increasingly recognized as an alternative method. The aim of the study was to compare sleep position, patients' comfort, and technical failure rates of HST with RP and PAT in patients with suspected OSA.!##!Methods!#!Sleep position, patients' comfort, and technical failure rates of RP and PAT were compared in 56 patients receiving two nights of HST with either RP or PAT in a randomized fashion.!##!Results!#!Time in supine position with PAT was significantly lower (173.7±88 min) compared to RP (181.7±103.7 min; p &amp;lt; 0.001), although the absolute mean difference was not clinically significant. Patients reported to sleep better, feeling less disturbed when falling asleep, losing less sensors, and fewer nightly awakenings with PAT, but experienced more pain at the side of the finger probe. Forty-five out of 56 patients (80%) rated PAT as being the superior sleep test and 49 out of 56 (88%) would prefer PAT for further investigations (p&amp;lt;0.001). PAT testing was associated with less technical failures.!##!Conclusion!#!The results demonstrate that HST with PAT leads to less time in supine sleep positioning, which may be clinically relevant in selected patients. Moreover, PAT is associated with less technical failures and is perceived with less discomfort during testing and a reduced number of nocturnal awakenings in patient self-reports

Prognostic value of an abnormal response to acetylcholine in patients with angina and non-obstructive coronary artery disease: Long-term follow-up of the Heart Quest cohort.

BACKGROUND This study aims to determine whether small vessel disease (SVD) or vasospastic disease (VSD) has an impact on prognosis. METHODS The prospective cohort embraced 718 patients with angina equivalent symptoms and no coronary stenosis ≥50% recruited between 1997 and 2008. At baseline, patients were classified as having SVD, VSD, other cardiac disease or non-cardiac problem based on intracoronary acetylcholine application and fast atrial pacing during coronary angiography. Patients underwent follow-up between 2007 and 2015. Prognostic significance of the diagnosis on cardiovascular events (cardiovascular death or non-fatal myocardial infarction) was evaluated using Cox proportional hazards models adjusted for age and sex. RESULTS The mean follow-up duration was 11.3±2.7years. Only 11 patients (1.5%) were lost to follow-up, resulting in an analyzed population of 707 patients. Patients with SVD (HR: 4.9, 95% CI: 1.1-22.4, P=0.040) and VSD (HR: 4.8, 95% CI: 1.0-23.4, P=0.050) had an increased risk of suffering cardiovascular events compared to patients with non-cardiac problems. Among SVD patients, those with the presence of endothelial dysfunction had a particularly high risk (HR: 7.3, 95% CI: 1.5-35.5, P=0.015). Among patients with SVD or VSD, those having persisting or worsening angina during follow-up had a higher risk than patients in whom angina improved (HR: 4.8, 95% CI: 1.9-12.3, P=0.001). CONCLUSIONS Our study shows that patients with SVD or VSD have an increased risk of cardiovascular events. This particularly applies to SVD patients with endothelial dysfunction. Symptoms should be taken seriously in SVD and VSD patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01318629

Maximum isometric tongue force in patients with obstructive sleep apnoea

Background!#!Obstructive sleep apnea (OSA) is a sleep disorder with a prevalence of 9-38%. The underlying pathology in OSA is a collapse of the upper airway. Especially in more severely affected patients, this collapse is often located at the level of the tongue base. Therefore, various implantable systems (anchors and ligament techniques) were developed to prevent or overcome this collapse. These systems are exposed to various forces. Different models have been developed to measure these forces and data comparing forces in healthy individuals with OSA patients are rare.!##!Purpose!#!Purpose of the study was to evaluate possible differences in tongue forces between healthy individuals and patients with OSA.!##!Method!#!To evaluate maximum isometric tongue forces, we conducted a matched pair design study including 20 healthy individuals and 20 patients suffering from OSA. Maximum isometric tongue forces were measured in an anterior/posterior direction with the help of self-designed new device that clamps the tongue.!##!Results!#!We could show that the maximum isometric force does not differ significantly in healthy individuals (10.7 ± 5.2N) from patients with OSA (14.4 ± 6.3N).!##!Conclusion!#!Currently there are no indications that maximum isometric tongue force does differ in healthy individuals and patients with OSA. Higher, as well as lower, tongue forces in patients with OSA seem not to differ from healthy subjects and therefore may not be needed to consider, in the development of tongue management devices, for OSA patients

Guidelines on Limits of Exposure to Incoherent Visible and Infrared Radiation.

International audienc

(International Commission on Non-Ionizing Radiation Protection). ICNIRP Guidelines for Limiting Exposure to Electric Fields Induced by Movement of the Human Body in a Static Magnetic Field and by Time-Varying Magnetic Fields below 1 Hz.

International audienc

Exploration of the relationship between sleep position and isolated tongue base or multilevel surgery in obstructive sleep apnea

This study aimed to elucidate the role of sleep position as a confounding factor on apnea hypopnea index (AHI) and surgical success in isolated tongue base or multilevel surgery. This study was conducted using retrospective analysis of patients who underwent hyoid suspension because of obstructive sleep apnea (OSA), in the St. Lucas Andreas Hospital, Amsterdam, The Netherlands, from 2004 to 2011. Concurrent surgical treatment was documented. Sleep positions and corresponding AHIs before and after surgery were compared. A total of 130 patients were included. 94 patients underwent surgery of base of tongue and palate (either uvulopalatopharyngoplasty or Z-palatoplasty), of whom 72 underwent concurrent radiofrequent thermotherapy of the base of tongue. 36 patients underwent base of tongue surgery alone, of whom 22 underwent concurrent radiofrequent thermotherapy of the base of tongue. 65 patients either had a successful reduction in AHI or in AI. Isolated tongue base or multilevel surgery was as successful on the supine AHI as it was on the AHI in other sleeping positions. Surgery was not more successful in the group with position-dependent patients as compared with the non-position-dependent patients (P = 0.615). Successful and non-successful surgical results could not be explained by variations in percentages of supine sleep position. Sleep position is not a confounding factor on surgical outcomes in tongue base surgery. The results of isolated base of tongue or multilevel surgery in position-dependent OSA patients leave room for improvement, possibly through positional therapy