Synthesis and Assessment Product

This document, part of the Synthesis and Assessment Products described in the U.S. Climate Change Science Program (CCSP) Strategic Plan. Climate affects the design, construction, safety, operations, and maintenance of transportation infrastructure and systems. The prospect of a changing climate raises critical questions regarding how alterations in temperature, precipitation, storm events, and other aspects of the climate could affect the nation's roads, airports, rail, transit systems, pipelines, ports, and waterways. Phase I of this regional assessment of climate change and its potential impacts on transportation systems addresses these questions for the region of the U.S. central Gulf Coast between Galveston, Texas and Mobile, Alabama. This region contains multimodal transportation infrastructure that is critical to regional and national transportation services. Historical trends and future climate scenarios were used to establish a context for examining the potential effects of climate change on all major transportation modes within the region. Climate changes anticipated during the next 50 to 100 years for the central Gulf Coast include warming temperatures, changes in precipitation patterns, and increased storm intensity. The warming of the oceans and decline of polar ice sheets is expected to accelerate the rate of sea level rise globally. The effects of sea level rise in most central Gulf Coast counties will be exacerbated by the sinking of the land surface, which is accounted for in this assessment. The significance of these climate factors for transportation systems was assessed

Display-Rack

Patent for a display rack

Dysuria in the Emergency Department: Missed Diagnosis of Chlamydia trachomatis

Introduction: The clinical presentation of genital Chlamydia trachomatis infection (chlamydia) in women is often indistinguishable from a urinary tract infection. While merited in the setting of dysuria, emergency department (ED) clinicians do not routinely test for chlamydia in women. The primary aim of our study was to evaluate the frequency of chlamydia testing among women presenting to the ED with dysuria.Methods: We conducted a retrospective chart review of women 19-25 years of age presenting with dysuria to an urban ED and who had been coded with urinary tract infection (UTI) as their primary diagnosis (ICD-9 599.0) from October 2005 to March 2011. We excluded women who were pregnant, had underlying anatomical or neurological urinary system pathology, had continuation of symptoms from UTI or a sexually transmitted infection (STI) diagnosed elsewhere, or were already on antibiotics for a UTI or STI. We identified the rates of sexual history screening, pelvic examination and chlamydia assay testing and evaluated predictors using univariate and multivariate analyses.  Results: Of 280 women with dysuria and a UTI diagnosis, 17% were asked about their sexual history, with 94% reporting recent sexual activity. Pelvic examination was performed in 23%. We were unable to determine the overall chlamydia prevalence as only 20% of women in the cohort were tested. Among the 20% of women tested for chlamydia infection, 21% tested positive. Only 42% of chlamydia-positive women were prescribed treatment effective for chlamydia (azithromycin or doxycycline) at their visit; the remaining were prescribed UTI treatment not effective against chlamydia. Predictors of sexual history screening included vaginal bleeding (OR 5.4, 95% CI=1.5 to 19.6) and discharge (OR 2.8, 95% CI=1.1 to 6.9). Predictors of a pelvic examination being performed included having a complaint of vaginal discharge (OR 11.8, 95% CI=4.2 to 32.9), a sexual history performed (OR 2.5, 95% CI=1.1 to 5.8), abdominal pain (OR 2.2, 95% CI=1.1 to 4.4), or pelvic pain (OR 15.3, 95% CI=2.5 to 92.2); a complaint of urinary frequency was associated with a pelvic examination not being performed (OR 0.34, 95% CI=0.13 to 0.86). Conclusion: Sexual histories, pelvic examinations, and chlamydia testing were not performed in the majority of women presenting with dysuria and diagnosed with UTI in the ED. The performance of a sexual history along with the availability of self-administered vaginal swab and first-void urine-based chlamydia tests may increase identification of chlamydia infection in women with dysuria. [West J Emerg Med. 2014;15(2):227–230.

Dysuria in the Emergency Department: Missed Diagnosis of Chlamydia trachomatis

Introduction: The clinical presentation of genital Chlamydia trachomatis infection (chlamydia) in women is often indistinguishable from a urinary tract infection. While merited in the setting of dysuria, emergency department (ED) clinicians do not routinely test for chlamydia in women. The primary aim of our study was to evaluate the frequency of chlamydia testing among women presenting to the ED with dysuria.Methods: We conducted a retrospective chart review of women 19-25 years of age presenting with dysuria to an urban ED and who had been coded with urinary tract infection (UTI) as their primary diagnosis (ICD-9 599.0) from October 2005 to March 2011. We excluded women who were pregnant, had underlying anatomical or neurological urinary system pathology, had continuation of symptoms from UTI or a sexually transmitted infection (STI) diagnosed elsewhere, or were already on antibiotics for a UTI or STI. We identified the rates of sexual history screening, pelvic examination and chlamydia assay testing and evaluated predictors using univariate and multivariate analyses.  Results: Of 280 women with dysuria and a UTI diagnosis, 17% were asked about their sexual history, with 94% reporting recent sexual activity. Pelvic examination was performed in 23%. We were unable to determine the overall chlamydia prevalence as only 20% of women in the cohort were tested. Among the 20% of women tested for chlamydia infection, 21% tested positive. Only 42% of chlamydia-positive women were prescribed treatment effective for chlamydia (azithromycin or doxycycline) at their visit; the remaining were prescribed UTI treatment not effective against chlamydia. Predictors of sexual history screening included vaginal bleeding (OR 5.4, 95% CI=1.5 to 19.6) and discharge (OR 2.8, 95% CI=1.1 to 6.9). Predictors of a pelvic examination being performed included having a complaint of vaginal discharge (OR 11.8, 95% CI=4.2 to 32.9), a sexual history performed (OR 2.5, 95% CI=1.1 to 5.8), abdominal pain (OR 2.2, 95% CI=1.1 to 4.4), or pelvic pain (OR 15.3, 95% CI=2.5 to 92.2); a complaint of urinary frequency was associated with a pelvic examination not being performed (OR 0.34, 95% CI=0.13 to 0.86). Conclusion: Sexual histories, pelvic examinations, and chlamydia testing were not performed in the majority of women presenting with dysuria and diagnosed with UTI in the ED. The performance of a sexual history along with the availability of self-administered vaginal swab and first-void urine-based chlamydia tests may increase identification of chlamydia infection in women with dysuria. [West J Emerg Med. 2014;15(2):227–230.

Effects of Climate Change on Energy Production and Use in the United States

Climate change is expected to have noticeable effects in the United States: a rise in average temperatures in most regions, changes in precipitation amounts and seasonal patterns in many regions, changes in the intensity and pattern of extreme weather events, and sea level rise. Some of these effects have clear implications for energy production and use. For instance, average warming can be expected to increase energy requirements for cooling and reduce energy requirements for warming. Changes in precipitation could affect prospects for hydropower, positively or negatively. Increases in storm intensity could threaten further disruptions of the sorts experienced in 2005 with Hurricane Katrina. Concerns about climate change impacts could change perceptions and valuations of energy technology alternatives. Any or all of these types of effects could have very real meaning for energy policies, decisions, and institutions in the United States, affecting discussions of courses of action and appropriate strategies for risk management. This report summarizes what is currently known about effects of climate change on energy production and use in the United States. It focuses on three questions, which are listed below along with general short answers to each. Generally, it is important to be careful about answering these questions for two reasons. One reason is that the available research literatures on many of the key issues are limited, supporting a discussion of issues but not definite conclusions about answers. A second reason is that, as with many other categories of climate change effects in the U.S., the effects depend on more than climate change alone, such as patterns of economic growth and land use, patterns of population growth and distribution, technological change, and social and cultural trends that could shape policies and actions, individually and institutionally. The report concludes that, based on what we know now, there are reasons to pay close attention to possible climate change impacts on energy production and use and to consider ways to adapt to possible adverse impacts and take advantage of possible positive impacts. Although the report includes considerably more detail, here are the three questions along with a brief summary of the answers: • How might climate change affect energy consumption in the United States? The research evidence is relatively clear that climate warming will mean reductions in total U.S. heating requirements and increases in total cooling requirements for buildings. These changes will vary by region and by season, but they will affect household and business energy costs and their demands on energy supply institutions. In general, the changes imply increased demands for electricity, which supplies virtually all cooling energy services but only some heating services. Other effects on energy consumption are less clear. • How might climate change affect energy production and supply in the United States? The research evidence about effects is not as strong as for energy consumption, but climate change could affect energy production and supply (a) if extreme weather events become more intense, (b) where regions dependent on water supplies for hydropower and/or thermal power plant cooling face reductions in water supplies, (c) where temperature increases decrease overall thermoelectric power generation efficiencies, and (d) where changed conditions affect facility siting decisions. Most effects are likely to be modest except for possible regional effects of extreme weather events and water shortages

Localized opacification of hydrophilic acrylic intraocular lenses after procedures using intracameral injection of air or gas

To describe clinical and laboratory findings in a series of cases of intraocular lens (IOL) opacification after procedures involving intracameral injections of air or gas. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Experimental study. Seven hydrophilic acrylic IOLs explanted after Descemet-stripping endothelial keratoplasty (DSEK) or Descemet-stripping automated endothelial keratoplasty (DSAEK) because of a localized central optic opacification associated with decrease in visual acuity and complaints of foggy vision were analyzed. The explanted IOLs were sent to our laboratory in the dry state or in fixative by the explanting surgeons. They underwent pathological and histochemical evaluation (alizarin red and von Kossa method). Light scattering measurements were also performed on the surface of 1 explant using Scheimpflug photography. A questionnaire was sent to the surgeons to obtain information pertinent to each case. The 7 explanted IOLs were represented by 6 hydrophilic acrylic designs from 5 manufacturers. Gross and light microscopy showed that granular deposits were densely distributed in an overall round pattern within the margins of the capsulorhexis or the pupil on the anterior surface/subsurface of the IOLs. The granules stained positive for calcium (alizarin red and von Kossa method). Light scattering on the anterior optic surface was very high (228 versus 13 computer-compatible tapes on a control IOL). A localized pattern of calcification was seen on the anterior surface/subsurface of various hydrophilic acrylic IOLs. Surgeons should be aware of this phenomenon following DSEK/DSAEK procedures in pseudophakic patients with hydrophilic acrylic IOLs. No author has a financial or proprietary interest in any material or method mentione

Effects of Global Change on U.S. Urban Areas: Vulnerabilities, Impacts, and Adaptation

Human settlements, both large and small, are where the vast majority of people on the Earth live. Expansion of cities both in population and areal extent, is a relentless process that will accelerate in the 21st century. As a consequence of urban growth both in the United States and around the globe, it is important to develop an understanding of how urbanization will affect the local and regional environment. Of equal importance, however, is the assessment of how cities will be impacted by the looming prospects of global climate change and climate variability. The potential impacts of climate change and variability has recently been annunciated by the IPCC's "Climate Change 2007" report. Moreover, the U.S. Climate Change Science Program (CCSP) is preparing a series of "Synthesis and Assessment Products" (SAPs) reports to support informed discussion and decision making regarding climate change and variability by policy matters, resource managers, stakeholders, the media, and the general public. We are authors on a SAP describing the effects of global climate change on human settlements. This paper will present the elements of our SAP report that relate to what vulnerabilities and impacts will occur, what adaptation responses may take place, and what possible effects on settlement patterns and characteristics will potentially arise, on human settlements in the U.S. as a result of climate change and climate variability. We will also present some recommendations about what should be done to further research on how climate change and variability will impact human settlements in the U.S., as well as how to engage government officials, policy and decision makers, and the general public in understanding the implications of climate change and variability on the local and regional levels. Additionally, we wish to explore how technology such as remote sensing data coupled with modeling, can be employed as synthesis tools for deriving insight across a spectrum of impacts (e.g. public health, urban planning for mitigation strategies) on how cities can cope and adapt to climate change and variability. This latter point parallels the concepts and ideas presented in the U.S. National Academy of Sciences, Decadal Survey report on "Earth Science Applications from Space: National Imperatives for the Next Decade and Beyond" wherein the analysis of the impacts of climate change and variability, human health, and land use change are listed as key areas for development of future Earth observing remote sensing systems