Retrograde gastroesophageal intussusception: Initial presenting feature of achalasia in a teenager

A 16-year-old Caucasian male presented with acute vomiting and dysphagia. Imaging studies revealed retrograde gastroesophageal intussusception (RGEI), which reduced prior to diagnostic laparoscopy. No clear etiology for RGEI was identified at that time, so further surgical intervention was deferred. He returned several months later with persistent dysphagia. Imaging, endoscopy, and endoluminal function imaging probe then diagnosed achalasia. He underwent a second laparoscopy for Heller myotomy and Dor fundoplication. This is the first report of RGEI preceding a diagnosis of achalasia

Distributed visualization of gridded geophysical data: the Carbon Data Explorer, version 0.2.3

Due to the proliferation of geophysical models, particularly climate models, the increasing resolution of their spatiotemporal estimates of Earth system processes, and the desire to easily share results with collaborators, there is a genuine need for tools to manage, aggregate, visualize, and share data sets. We present a new, web-based software tool – the Carbon Data Explorer – that provides these capabilities for gridded geophysical data sets. While originally developed for visualizing carbon flux, this tool can accommodate any time-varying, spatially explicit scientific data set, particularly NASA Earth system science level III products. In addition, the tool's open-source licensing and web presence facilitate distributed scientific visualization, comparison with other data sets and uncertainty estimates, and data publishing and distribution

Rapid response tools and datasets for post-fire modeling: linking Earth Observations and process-based hydrological models to support post-fire remediation

Preparation is key to utilizing Earth Observations and process-based models to support post-wildfire mitigation. Post-fire flooding and erosion can pose a serious threat to life, property and municipal water supplies. Increased runoff and sediment delivery due to the loss of surface cover and fire-induced changes in soil properties are of great concern. Remediation plans and treatments must be developed and implemented before the first major storms in order to be effective. One of the primary sources of information for making remediation decisions is a soil burn severity map derived from Earth Observation data (typically Landsat) that reflects fire induced changes in vegetation and soil properties. Slope, soils, land cover and climate are also important parameters that need to be considered. Spatially-explicit process-based models can account for these parameters, but they are currently under-utilized relative to simpler, lumped models because they are difficult to set up and require spatially-explicit inputs (digital elevation models, soils, and land cover). Our goal is to make process-based models more accessible by preparing spatial inputs before a fire, so that datasets can be rapidly combined with soil burn severity maps and formatted for model use. We are building an online database (http://geodjango.mtri.org/geowepp /) for the continental United States that will allow users to upload soil burn severity maps. The soil burn severity map is combined with land cover and soil datasets to generate the spatial model inputs needed for hydrological modeling of burn scars. Datasets will be created to support hydrological models, post-fire debris flow models and a dry ravel model. Our overall vision for this project is that advanced GIS surface erosion and mass failure prediction tools will be readily available for post-fire analysis using spatial information from a single online site

Enteric viruses in a mangrove lagoon, survival and shellfish incidence

Mangrove oysters (Crassostrea rhizophorae) were screened for enteric viruses. For 18 months oysters were collected from Cano Boqueron, a tropical mangrove lagoon on the southwest coast of Puerto Rico. This popular tourist resort has two primary sewage treatment plants which service 158 single family cabanas. In spite of the heavy seasonal input of sewage to Cano Boqueron and high densities of fecal coliform bacteria, enteric viruses were not detected in shellfish meat. Because no viruses were detected in the oysters, a virus survival study was performed. Poliovirus type 1 was placed in diffusion chambers in situ at two sites in Cano Boqueron. More than 95% of the poliovirus inactivation occurred within 24 h. Virus inactivation was significantly different by site, indicating different inactivation rates within the lagoon. Chamber studies done simultaneously with Escherichia coli did not reveal differences between sites. It is suggested that the sewage effluent had an antiviral effect in the absence of an antibacterial effect. This study demonstrates the importance for establishing microbial contamination standards for shellfish growing waters in the tropics based upon in situ studies with tropical species, e.g. mangrove oyster

Traumatic abdominal wall hernias in children: A case for early exploration

Purpose Traumatic abdominal wall hernia (TAWH) is a rare consequence of blunt abdominal trauma (BAT). We examined a series of patients suffering TAWH to evaluate its frequency, rate of associated concurrent intraabdominal injuries (CAI) and correlation with CT, management and outcomes. Methods A Level 1 pediatric trauma center trauma registry was queried for children less than 18 years old suffering TAWH from BAT between 2009 and 2019. Results 9370 patients were admitted after BAT. TAWH was observed in 11 children, at incidence 0.1%. Eight children (73%) were male, at mean age 10 years, and mean ISS of 16. Six cases (55%) were because of MVC, three (27%) impaled by a handlebar or pole, and two (18%) dragged under large machinery. Seven (64%) had a CAI requiring operative or interventional management. Patients with CAI were similar to those without other injury, with 20% and 50% CT scan sensitivity and specificity for detection of associated injury, respectively. Five patients had immediate hernia repair with laparotomy for repair of intraabdominal injury, three had delayed repair, two have asymptomatic unrepaired TAWH, and one resolved spontaneously. Conclusions Children with TAWH have high rates of CAI requiring operative repair. CT scans have low sensitivity and specificity for detecting associated injuries. A high suspicion of injury and low threshold for exploration must be maintained in TAWH cases

Consensus statement on abusive head trauma in infants and young children

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. A multidisciplinary team bases this diagnosis on history, physical examination, imaging and laboratory findings. Because the etiology of the injury is multifactorial (shaking, shaking and impact, impact, etc.) the current best and inclusive term is AHT. There is no controversy concerning the medical validity of the existence of AHT, with multiple components including subdural hematoma, intracranial and spinal changes, complex retinal hemorrhages, and rib and other fractures that are inconsistent with the provided mechanism of trauma. The workup must exclude medical diseases that can mimic AHT. However, the courtroom has become a forum for speculative theories that cannot be reconciled with generally accepted medical literature. There is no reliable medical evidence that the following processes are causative in the constellation of injuries of AHT: cerebral sinovenous thrombosis, hypoxic-ischemic injury, lumbar puncture or dysphagic choking/vomiting. There is no substantiation, at a time remote from birth, that an asymptomatic birth-related subdural hemorrhage can result in rebleeding and sudden collapse. Further, a diagnosis of AHT is a medical conclusion, not a legal determination of the intent of the perpetrator or a diagnosis of murder. We hope that this consensus document reduces confusion by recommending to judges and jurors the tools necessary to distinguish genuine evidence-based opinions of the relevant medical community from legal arguments or etiological speculations that are unwarranted by the clinical findings, medical evidence and evidence-based literature