Treatment of short stature and growth hormone deficiency in children with somatotropin (rDNA origin)

Somatotropin (growth hormone, GH) of recombinant DNA origin has provided a readily available and safe drug that has greatly improved management of children and adolescents with GH deficiency (GHD) and other disorders of growth. In the US and Europe, regulatory agencies have given approval for the use of GH in children and adults who meet specific criteria. However, clinical and ethical controversies remain regarding the diagnosis of GHD, dosing of GH, duration of therapy and expected outcomes. Areas which also require consensus include management of pubertal patients, transitioning pediatric patients to adulthood, management of children with idiopathic short stature and the role of recombinant IGF-1 in treatment. Additionally, studies have demonstrated anabolic benefits of GH in children who have inflammatory-based underlying disease and efficacy of GH in overcoming growth delays in people treated chronically with corticosteroids. These areas are open for possible new uses of this drug. This review summarizes current indications for GH use in children and discusses areas of clinical debate and potential anabolic uses in chronic illness

Rumble Stripes and Pavement Marking Delineation

Pavement markings serve an important role on the highway and must be visible in day, night, and wet conditions. Pavement markings placed in grooved pavement are receiving considerable interest due to their potential for greater durability by providing protection from plow blades used during winter maintenance. Raised pavement markers (RPMs) are also used for roadway delineation, and the failure rate of RPMs in and in between rumble depressions is also of interest. This study evaluated white edge lines and yellow edge lines on roads in Indiana and other northern states, as well as RPMs in and in between rumble depressions. Data for pavement markings was collected by use of a hand-operated retroreflectometer as well as a mobile retroreflectometer, while RPM data collection consisted of documenting the total number of RPMs, number of missing reflectors, and castings. Results showed that for both white and yellow edge lines, grooved preformed tape has the highest durability for greater than ten winter seasons, and grooved thermoplastic could last five winter seasons. Grooved multi-component may last three or four winter seasons while non-grooved paint will last one or perhaps two winter seasons. RPMs in rumble stripes have a higher failure rate than RPMs installed between rumble stripes. Based upon data collected during this project, grooved thermoplastic and multi-component have the lowest lifetime costs for durable markings, and additional performance data should be collected to determine if either has a distinct economic advantage. It is also recommended that RPM installation in rumble depressions be further evaluated

Why Acute Ischemic Stroke Patients in the United States Use or Do Not Use Emergency Medical Services Transport? Findings of an Inpatient Survey

Background Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS. Methods During 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed. Results Of 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01,0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS. Conclusion Systematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability

European cystic fibrosis bone mineralisation guidelines

Patients with cystic fibrosis (CF) are at risk of developing low bone mineral density (BMD) and fragility fractures. This paper presents consensus statements that summarise current knowledge of the epidemiology and pathophysiology of CF-related skeletal deficits and provides guidance on its assessment, prevention and treatment. The statements were validated using a modified Delphi methodology

Why Acute Ischemic Stroke Patients in the United States Use or Do Not Use Emergency Medical Services Transport? Findings of an Inpatient Survey

Background: Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS. Methods: During 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed. Results: Of 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01, 0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS. Conclusion: Systematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability

Gulf of Mexico Regional Collaborative Final Report

This report presents the results of the Gulf of Mexico Regional Collaborative (GoMRC), a year-long project funded by NASA. The GoMRC project was organized around end user outreach activities, a science applications team, and a team for information technology (IT) development. Key outcomes are summarized below for each of these areas. End User Outreach Successfully engaged federal and state end users in project planning and feedback With end user input, defined needs and system functional requirements Conducted demonstration to End User Advisory Committee on July 9, 2007 and presented at Gulf of Mexico Alliance (GOMA) meeting of Habitat Identification committee Conducted significant engagement of other end user groups, such as the National Estuary Programs (NEP), in the Fall of 2007 Established partnership with SERVIR and Harmful Algal Blooms Observing System (HABSOS) programs and initiated plan to extend HABs monitoring and prediction capabilities to the southern Gulf. Established a science and technology working group with Mexican institutions centered in the State of Veracruz. Key team members include the Federal Commission for the Protection Against Sanitary Risks (COFEPRIS), the Ecological Institute (INECOL) a unit of the National Council for science and technology (CONACYT), the Veracruz Aquarium (NOAA’s first international Coastal Ecology Learning Center) and the State of Veracruz. The Mexican Navy (critical to coastal studies in the Southern Gulf) and other national and regional entities have also been engaged. Training on use of SERVIR portal planned for Fall 2007 in Veracruz, Mexico Science Applications Worked with regional scientists to produce conceptual models of submerged aquatic vegetation (SAV) ecosystems Built a logical framework and tool for ontological modeling of SAV and HABs Created online guidance for SAV restoration planning Created model runs which link potential future land use trends, runoff and SAV viability Analyzed SAV cover change at five other bays in the Gulf of Mexico to demonstrate extensibility of the analytical tools Initiated development of a conceptual model for understanding the causes and effects of HABs in the Gulf of Mexico IT Tool Development Established a website with the GoMRC web-based tools at www.gomrc.org Completed development of an ArcGIS-based decision support tool for SAV restoration prioritization decisions, and demonstrated its use in Mobile Bay Developed a web-based application, called Conceptual Model Explorer (CME), that enables non-GIS users to employ the prioritization model for SAV restoration Created CME tool enabling scientists to view existing, and create new, ecosystem conceptual models which can be used to document cause-effect relationships within coastal ecosystems, and offer guidance on management solutions. Adapted the science-driven advanced web search engine, Noesis, to focus on an initial set of coastal and marine resource issues, including SAV and HABs Incorporated map visualization tools with initial data layers related to coastal wetlands and SAV

Search for Cosmic-Ray Events Using Radio Signals and CNNs in Data from the IceTop Enhancement Prototype Station

Cosmic-ray air showers emit radio waves that can be used to measure the properties of cosmic-ray primary particles. The radio detection technique presents several advantages, such as low cost and year-round duty cycle as well as the ability to provide high sensitivity to Xmax and energy estimation with minimal theoretical uncertainties, making it a promising tool for studying cosmic rays at the highest energies. However, the primary limitation of radio detection is the irreducible background from various sources that obscure the impulsive signals generated by air showers. To address this issue, we investigated the use of Convolutional Neural Networks (CNNs), trained on CoREAS simulations and radio backgrounds measured by a prototype station at the South Pole. We developed two different CNNs: a Classifier that distinguishes between cosmic ray event radio signals and pure background waveforms, and a Denoiser that mitigates background noise to recover the underlying cosmic-ray signal. After training the networks we apply them to the air-shower data to search for radio events. With two months data, we were able to identify 51 candidate events. The event’s arrival direction reconstructed using CNN denoised radio waveforms is found to bein good agreement with the IceTop reconstruction. Finally, our approach demonstrated improved directional reconstruction compared to traditional methods

Dogs Can Be Successfully Trained to Alert to Hypoglycemia Samples from Patients with Type 1 Diabetes

ABSTRACT Introduction: Hypoglycemia (Hypo) is the most common side effect of insulin therapy i