Adherence to the American College of Cardiology/American Heart Association guidelines for pharmacotherapy in New York Heart Association Class II-IV heart failure patients and associated re-hospitalization rates.

This thesis will assess differences in the rates of re-hospitalization among New York Heart Association class II, III, and IV heart failure patients, focusing on levels of adherence to the American College of Cardiology/American Heart Association guidelines for heart failure patient pharmacotherapy. Hospitalization data on 128 HF patients will be analyzed looking at 14 day, 30 day, and 6 month time points, assessing key aspects of treatment and patient characteristics as potential risk factors in predicting re-hospitalization trends. Effectiveness of ACC/AHA adherence to pharmacotherapy upon primary hospital discharge will be itemized in an intention to treat analysis, with guidelines determined by compliance between NYHA classification and ACC/AHA recommendations. Confounding interactions by demographic characteristics including race, sex, and age will be included. This study will gauge the effectiveness of current HF patient care criteria as well as point out potential confounding effects associated with prescribed care previously unaccounted for in the current literature

Australia’s first trap-and-haul fishway: Nerang River, Queensland

Australia’s first trap-and-haul fishway was built on the Nerang River in southeast Queensland during enlargement of the Hinze Dam. In gaining government approval for the project, the constructing alliance (HDA) concluded that providing upstream fish passage would have significant environmental benefits by conserving upstream native fish communities and encouraging recruitment into the reservoir’s recreational fishery. But downstream passage, other than modifications to protect fish emigrating during spill events, could not be justified. Severely constrained outflows from the dam and the impacts of downstream urban development contrast starkly with upstream habitat conditions. North American design approaches were adapted to suit the river’s fishes and streamflows. Challenges for fish passage at the site included the marked restriction of downstream river flows and the location of the flow-release point 300m from the spillway. A barrier weir was built to prevent upstream migrants bypassing the fishway entrance during spillway flows. HDA developed a trap-and-haul system to collect migrating fish at the weir and transport them by tanker to multiple upstream release areas. This system provides flexibility to accommodate varying fish biomass; ability to operate over a range of flows up to 20-year ARI events; facilities for sorting, data collection and removal of pest species; and capacity to limit predation mortalities. Fishway performance studies led to redesign of the entrance vee-trap and other modifications. To 2017, 55,590 fish from 27 large and small-bodied species used the fishway, together with 8 turtles. Fish of three pest species were identified in the sorting facility and removed to prevent their entry to the reservoir. This paper covers the project life cycle for Australia’s first trap-and-haul fishway including the basis for selecting the fishway type, design and construction. Fishway performance studies and results from ongoing operation, including the lessons learned and the improvements made, are also discussed

Proof of concept for an innovative pump fishway design to move fish upstream over dams

Reversing worldwide declines in freshwater fish while making sustainable use of water resources will require effective and economical fishways to restore fish migrations. Mitigation of barrier effects at dams and weirs is too often impeded by poor fishway performance and high costs, so that many fish migrations continue to be obstructed. Improved and less-costly designs are urgently needed. Our innovative pump fishway concept combines fish-behaviour insights, proved fishways techniques and aquaculture’s pumping methods for safe upstream transport of living fish. We ran a series of experimental trials using several scale-model fishway designs with young, hatchery-bred fish. Our horizontal-cylinder design successfully combined volitional-passage functions of existing fishways with non-volitional transport in a conduit carrying pumped water. Several key principles of fish behaviour in fishways led to design improvements: disturbed fish often seek refuge at depth; fishes’ escape reactions strongly motivate swimming into flows; and curved structures aid passage by reducing delays. Replicated trials finally produced an average of 98% successful passage, within brief cycling periods. The pump fishway concept offers potential for effective upstream fish passage at new and existing sites \u3e~2m high, with low construction and maintenance costs and highly adaptable operation in variable flow regimes. Development beyond the concept-trial phase is now a priority

Charge Symmetry Breaking in 500 MeV Nucleon-Trinucleon Scattering

Elastic nucleon scattering from the 3He and 3H mirror nuclei is examined as a test of charge symmetry violation. The differential cross-sections are calculated at 500 MeV using a microsopic, momentum-space optical potential including the full coupling of two spin 1/2 particles and an exact treatment of the Coulomb force. The charge-symmetry-breaking effects investigated arise from a violation within the nuclear structure, from the p-nucleus Coulomb force, and from the mass-differences of the charge symmetric states. Measurements likely to reveal reliable information are noted.Comment: 5 page

Genetic heterogeneity in infantile spasms

Infantile spasms (IS) is a developmental and epileptic encephalopathy with heterogeneous etiologies including many genetic causes. Genetic studies have identified pathogenic variants in over 30 genes as causes of IS. Many of these genetic causes are extremely rare, with only one reported incidence in an individual with IS. To better understand the genetic landscape of IS, we used targeted sequencing to screen 42 candidate IS genes and 53 established developmental and epileptic encephalopathy genes in 92 individual with IS. We identified a genetic diagnosis for 7.6% of our cohort, including pathogenic variants in KCNB1 (n = 2), GNA01 (n = 1), STXBP1 (n = 1), SLC35A2 (n = 1), TBLIXR1 (n = 1), and K1F1A (n = 1). Our data emphasize the genetic heterogeneity of IS and will inform the diagnosis and management of individuals with this devastating disorder.Peer reviewe

Anatomy of wintertime ozone associated with oil and natural gas extraction activity in Wyoming and Utah

Winter maximum daily 8-hour average (MDA8) ozone concentrations in the Upper Green River Basin, Wyoming (UGRBWY) and the Uintah Basin, Utah (UBUT) have frequently exceeded 100 ppb in January, February and March, in the past few years. Such levels are well above the U.S. air quality standard of 75 ppb. In these two remote basins in the Rockies, local ozone precursor emissions result from intense oil and gas extraction activities that release methane, volatile organic compounds (VOCs), and nitrogen oxides (NOx) to the atmosphere. These emissions become trapped beneath a stable and shallow (~50–200 m) boundary layer maintained in low wind conditions. Wintertime surface ozone formation conditions are more likely in the UBUT than in the UGRBWY as the topography of the UBUT is an enclosed basin whereas the UGRBWY is open on its southern perimeter thus allowing for more air turnover. With snow-covered ground, high ozone events regularly begin in mid-December and last into early March in the UBUT whereas they usually do not begin in earnest until about a month later in the UGRBWY and may persist until mid-March. Winters without snow cover and the accompanying cold pool meteorological conditions do not experience high ozone events in either basin. For nine years with ozone observations in the UGRBWY (2005–2013) and four in the UBUT (2010–2013), all years with adequate (≥6 inches) and persistent snow cover, experienced days with ozone values ≥75 ppb except in 2012 in the UGRBWY when persistent high wind (>5 m/s) conditions were prevalent. Year to year differences in the occurrences of high ozone episodes appear to be driven primarily by differing meteorological conditions rather than by variations in ozone precursor levels

Phenotypic Spectrum of Seizure Disorders in MBD5-Associated Neurodevelopmental Disorder

OBJECTIVE: To describe the phenotypic spectrum in patients with MBD5-associated neurodevelopmental disorder (MAND) and seizures; features of MAND include intellectual disability, epilepsy, psychiatric features of aggression and hyperactivity, and dysmorphic features including short stature and microcephaly, sleep disturbance, and ataxia. METHODS: We performed phenotyping on patients with MBD5 deletions, duplications, or point mutations and a history of seizures. RESULTS: Twenty-three patients with MAND and seizures were included. Median seizure onset age was 2.9 years (range 3 days–13 years). The most common seizure type was generalized tonic-clonic; focal, atypical absence, tonic, drop attacks, and myoclonic seizures occurred frequently. Seven children had convulsive status epilepticus and 3 nonconvulsive status epilepticus. Fever, viral illnesses, and hot weather provoked seizures. EEG studies in 17/21 patients were abnormal, typically showing slow generalized spike-wave and background slowing. Nine had drug-resistant epilepsy, although 3 eventually became seizure-free. All but one had moderate-to-severe developmental impairment. Epilepsy syndromes included Lennox-Gastaut syndrome, myoclonic-atonic epilepsy, and infantile spasms syndrome. Behavioral problems in 20/23 included aggression, self-injurious behavior, and sleep disturbance. CONCLUSION: MBD5 disruption may be associated with severe early childhood-onset developmental and epileptic encephalopathy. Because neuropsychiatric dysfunction is common and severe, it should be an important focus of clinical management