The Snuffbox Arteriovenous Fistula for Vascular Access

AbstractObjectives to determine the applicability, patency rates and factors influencing patency of snuffbox arteriovenous fistulae for haemodialysis access. Design retrospective non-randomised study. Materials and methods patency was determined by reference to an ongoing database and dialysis records of 645 vascular access procedures between 1985 and 1997, including 210 snuffbox fistulae in 201 patients. Results snuffbox fistulae comprised 189/376 (50%) primary procedures. Records of 208 snuffbox fistulae were available for patency analysis by the life-table method. Twenty-two (11%) thrombosed within 24 hours of operation. After six weeks 80% were used for dialysis. Cumulative patency was 65% at 1 year and 45% at 5 years. After thrombosis of snuffbox fistulae, ipsilateral wrist fistulae could be constructed in 45%. Fistula patency was significantly better in men than women (p<0.001) and for left- than right-sided fistulae (p<0.001). Diabetes, age >70 years, and the prior commencement of haemodialysis did not significantly affect fistula survival. Conclusions the snuffbox AV fistula gives a long segment of arterialised vein for needling and preserves proximal vessels. It is feasible in 50% of patients requiring primary access and has good long-term patency, especially in men. A more proximal fistula may be preferable in women with smaller vessels

Generation of internal waves by eddies impinging on the western boundary of the North Atlantic

Despite the major role played by mesoscale eddies in redistributing the energy of the large-scale circulation, our understanding of their dissipation is still incomplete. This study investigates the generation of internal waves by decaying eddies in the North Atlantic western boundary. The eddy presence and decay are measured from the altimetric surface relative vorticity associated with an array of full-depth current meters extending ~100 km offshore at 26.5°N. In addition, internal waves are analysed over a topographic rise from 2-year high-frequency measurements of an Acoustic Doppler Current Profiler (ADCP), which is located 13 km offshore in 600 m deep water. Despite an apparent polarity independence of the eddy decay observed from altimetric data, the flow in the deepest 100 m is enhanced for anticyclones (25.2 cm s−1) compared with cyclones (-4.7 cm s−1). Accordingly, the internal wave field is sensitive to this polarity-dependent deep velocity. This is apparent from the eddy-modulated enhanced dissipation rate, which is obtained from a finescale parameterization and exceeds 10−9 W kg−1 for near-bottom flows greater than 8 cm s−1. The present study underlines the importance of oceanic western boundaries for removing the energy of low-mode westward-propagating eddies to higher-mode internal waves

Butterfly richness and abundance along a gradient of imperviousness and the importance of matrix quality

Heterogeneity in quantity and quality of resources provided in the urban matrix may mitigate adverse effects of urbanization intensity on the structure of biotic communities. To assess this we quantified the spatial variation in butterfly richness and abundance along an impervious surface gradient using three measures of urban matrix quality: floral resource availability and origin (native vs exotic plants), tree cover, and the occurrence of remnant habitat patches. Butterfly richness and abundance were surveyed in 100 cells (500 x 500‐m), selected using a random‐stratified sampling design, across a continuous gradient of imperviousness in Melbourne, Australia. Sampling occurred twice during the butterfly flight season. Occurrence data were analyzed using generalized linear models at local and meso‐ scales. Despite high sampling completeness we did not detect 75% of species from the regional species pool in the urban area, suggesting that urbanization has caused a large proportion of the region’s butterflies to become absent or extremely rare within Melbourne’s metro‐area. Those species that do remain are largely very generalist in their choice of larval host plants. Butterfly species richness and abundance declined with increasing impervious surface cover and, contrary to evidence for other taxa, there was no evidence that richness peaked at intermediate levels of urbanization. Declines in abundance appeared to be more noticeable when impervious surface cover exceeded 25%, while richness declined linearly with increasing impervious surface cover. We find evidence that the quality of the urban matrix (floral resources and remnant vegetation) influenced butterfly richness and abundance although the effects were small. Total butterfly abundance responded negatively to exotic floral abundance early in the sampling season and positively to total floral abundance later in the sampling season. Butterfly species richness increased with tree cover. Negative impacts of increased urbanization intensity on butterfly species richness and abundance may be mitigated to some extent by improving the quality of the urban matrix by enhancing tree cover and the provision of floral resources – with some evidence that native plants are more effective

Modelling spatial and inter-annual variations of nitrous oxide emissions from UK cropland and grasslands using DailyDayCent

This work contributes to the Defra funded projects AC0116: ‘Improving the nitrous oxide inventory’, and AC0114: ‘Data Synthesis, Management and Modelling’. Funding for this work was provided by the UK Department for Environment, Food and Rural Affairs (Defra) AC0116 and AC0114, the Department of Agriculture, Environment and Rural Affairs for Northern Ireland, the Scottish Government and the Welsh Government. Rothamsted Research receives strategic funding from the Biotechnology and Biological Sciences Research Council. This study also contributes to the projects: N-Circle (BB/N013484/1), U-GRASS (NE/M016900/1) and GREENHOUSE (NE/K002589/1).Peer reviewedPublisher PD

Biosecurity risks posed by a large sea-going passenger vessel: Challenges of terrestrial arthropod species detection and eradication

Large sea-going passenger vessels can pose a high biosecurity risk. The risk posed by marine species is well documented, but rarely the risk posed by terrestrial arthropods. We conducted the longest running, most extensive monitoring program of terrestrial arthropods undertaken on board a passenger vessel. Surveillance was conducted over a 19-month period on a large passenger (cruise) vessel that originated in the Baltic Sea (Estonia). The vessel was used as an accommodation facility to house workers at Barrow Island (Australia) for 15 months, during which 73,061 terrestrial arthropods (222 species - four non-indigenous (NIS) to Australia) were collected and identified on board. Detection of Tribolium destructor Uytt., a high-risk NIS to Australia, triggered an eradication effort on the vessel. This effort totalled more than 13,700 human hours and included strict biosecurity protocols to ensure that this and other non-indigenous species (NIS) were not spread from the vessel to Barrow Island or mainland Australia. Our data demonstrate that despite the difficulties of biosecurity on large vessels, stringent protocols can stop NIS spreading from vessels, even where vessel-wide eradication is not possible. We highlight the difficulties associated with detecting and eradicating NIS on large vessels and provide the first detailed list of species that inhabit a vessel of this kind

Rural Hospital Mergers Increased Between 2005 and 2016—What Did Those Hospitals Look Like?

The objective of this study is to determine whether key hospital-level financial and market characteristics are associated with whether rural hospitals merge. Hospital merger status was derived from proprietary Irving Levin Associates data for 2005 through 2016 and hospital-level characteristics from HCRIS, CMS Impact File Hospital Inpatient Prospective Payment System, Hospital MSA file, AHRF, and U.S. Census data for 2004 through 2016. A discrete-time hazard analysis using generalized estimating equations was used to determine whether factors were associated with merging between 2005 and 2016. Factors included measures of profitability, operational efficiency, capital structure, utilization, and market competitiveness. Between 2005 and 2016, 11% (n = 326) of rural hospitals were involved in at least one merger. Rural hospital mergers have increased in recent years, with more than two-thirds (n = 261) occurring after 2011. The types of rural hospitals that merged during the sample period differed from nonmerged rural hospitals. Rural hospitals with higher odds of merging were less profitable, for-profit, larger, and were less likely to be able to cover current debt. Additional factors associated with higher odds of merging were reporting older plant age, not providing obstetrics, being closer to the nearest large hospital, and not being in the West region. By quantifying the hazard of characteristics associated with whether rural hospitals merged between 2005 and 2016, these findings suggest it is possible to determine leading indicators of rural mergers. This work may serve as a foundation for future research to determine the impact of mergers on rural hospitals

A Comparison Of Outcomes In Osteoarthritis Patients Undergoing Total Hip And Knee Replacement Surgery

Objective The aims of this study were to assess changes in physical function and quality of life with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the instrument of the Medical Outcomes Study SF-36 Health Survey (MOS SF-36), respectively, in patients undergoing hip and knee joint replacement surgery and to compare the responsiveness of these two outcome measures 1 year after surgery. Design One hundred and ninety-four patients with osteoarthritis (OA knee 108, OA hip 86) admitted to four hospitals in Sydney were followed over a period of 1 year at 3 monthly intervals. Results WOMAC measures improved significantly after 1 year for OA hip and OA knee: there was reduction in pain of 71% and 53%, reduction in stiffness of 55% and 43% and improvement in physical function of 68% and 43%, respectively. MOS SF-36 measures in those having hip surgery improved significantly for pain (222%), physical function (247%), physical role functioning (402%), general health (110%), vitality (143%), social functioning (169%) and mental health (114%). For those in the knee surgery group, significant improvement was seen for pain (175%), physical function (197%), physical role functioning (275%), vitality (125%) and social functioning (119%). The WOMAC was a more responsive measure than the MOS SF-36. Conclusion WOMAC and MOS SF-36 detect significant and clinically meaningful changes in outcome after hip and knee replacement. WOMAC requires a smaller sample size and is more responsive in the short term. For a follow-up longer than 6 months MOS SF-36 provides additional information. The improvement in outcomes following hip joint surgery were significantly greater than those following knee surgery

Interaction of anions with the surface of a coordination cage in aqueous solution probed by their effect on a cage-catalysed Kemp elimination

An octanuclear M8L12 coordination cage catalyses the Kemp elimination reaction of 5-nitro-1,2-benzisoxazole (NBI) with hydroxide to give 2-cyano-4-nitrophenolate (CNP) as the product. In contrast to the previously-reported very efficient catalysis of the Kemp elimination reaction of unsubstituted benzisoxazole, which involves the substrate binding inside the cage cavity, the catalysed reaction of NBI with hydroxide is slower and occurs at the external surface of the cage, even though NBI can bind inside the cage cavity. The rate of the catalysed reaction is sensitive to the presence of added anions, which bind to the 16+ cage surface, displacing the hydroxide ions from around the cage which are essential reaction partners in the Kemp elimination. Thus we can observe different binding affinities of anions to the surface of the cationic cage in aqueous solution by the extent to which they displace hydroxide and thereby inhibit the catalysed Kemp elimination and slow down the appearance of CNP. For anions with a −1 charge the observed affinity order for binding to the cage surface is consistent with their ease of desolvation and their ordering in the Hofmeister series. With anions that are significantly basic (fluoride, hydrogen carbonate, carboxylates) the accumulation of the anion around the cage surface accelerates the Kemp elimination compared to the background reaction with hydroxide, which we ascribe to the ability of these anions to participate directly in the Kemp elimination. This work provides valuable mechanistic insights into the role of the cage in co-locating the substrate and the anionic reaction partners in a cage-catalysed reaction

Sub-terahertz, microwaves and high energy emissions during the December 6, 2006 flare, at 18:40 UT

The presence of a solar burst spectral component with flux density increasing with frequency in the sub-terahertz range, spectrally separated from the well-known microwave spectral component, bring new possibilities to explore the flaring physical processes, both observational and theoretical. The solar event of 6 December 2006, starting at about 18:30 UT, exhibited a particularly well-defined double spectral structure, with the sub-THz spectral component detected at 212 and 405 GHz by SST and microwaves (1-18 GHz) observed by the Owens Valley Solar Array (OVSA). Emissions obtained by instruments in satellites are discussed with emphasis to ultra-violet (UV) obtained by the Transition Region And Coronal Explorer (TRACE), soft X-rays from the Geostationary Operational Environmental Satellites (GOES) and X- and gamma-rays from the Ramaty High Energy Solar Spectroscopic Imager (RHESSI). The sub-THz impulsive component had its closer temporal counterpart only in the higher energy X- and gamma-rays ranges. The spatial positions of the centers of emission at 212 GHz for the first flux enhancement were clearly displaced by more than one arc-minute from positions at the following phases. The observed sub-THz fluxes and burst source plasma parameters were found difficult to be reconciled to a purely thermal emission component. We discuss possible mechanisms to explain the double spectral components at microwaves and in the THz ranges.Comment: Accepted version for publication in Solar Physic