Effect modification of the association between fine particulate air pollution during a wildfire event and respiratory health by area-level measures of socio-economic status, race/ethnicity, and smoking prevalence.

Fine particulate air pollution (PM2.5) is decreasing in most areas of the United States, except for areas most affected by wildfires, where increasing trends in PM2.5 can be attributed to wildfire smoke. The frequency and duration of large wildfires and the length of the wildfire season have all increased in recent decades, partially due to climate change, and wildfire risk is projected to increase further in many regions including the western United States. Increasingly, empirical evidence suggests differential health effects from air pollution by class and race; however, few studies have investigated such differential health impacts from air pollution during a wildfire event. We investigated differential risk of respiratory health impacts during the 2008 northern California wildfires by a comprehensive list of socio-economic status (SES), race/ethnicity, and smoking prevalence variables. Regardless of SES level across nine measures of SES, we found significant associations between PM2.5 and asthma hospitalizations and emergency department (ED) visits during these wildfires. Differential respiratory health risk was found by SES for ED visits for chronic obstructive pulmonary disease where the highest risks were in ZIP codes with the lowest SES levels. Findings for differential effects by race/ethnicity were less consistent across health outcomes. We found that ZIP codes with higher prevalence of smokers had greater risk of ED visits for asthma and pneumonia. Our study suggests that public health efforts to decrease exposures to high levels of air pollution during wildfires should focus on lower SES communities.

Wartime upper-extremity injuries in the Sahelian strip: Experience from a French Forward Surgical Team deployed in Mali.

This study aimed to analyze upper-extremity combat-related injuries (CRIs) and non-combat-related injuries (NCRIs) treated in the French Forward Surgical Team currently deployed in Gao, Mali. A retrospective study was conducted using the French Military Health Service OpEX surgical database from February 2013 to March 2020. All patients operated on for upper-extremity injury were included: 224 patients, with a mean age of 28.15 years, for 249 upper-extremity injuries. Seventy-six (33.9%) sustained CRIs and 148 (66.1%) NCRIs. Multiple upper-extremity injuries and associated injuries were significantly more common in the CRI group. The majority of NCRIs involved the hand. Debridement and wound care was the most common procedure in both groups. External fixation and fasciotomy were significantly more frequent in the CRI group, and internal fracture fixation in the NCRI group. The overall number of procedures was significantly higher in the CRI group. Due to the high frequency of upper-extremity injury in current theaters of operations, deployed orthopedic surgeons should be trained in basic hand surgery so as to optimally manage both CRIs and NCRIs.

Metacarpal bone reconstruction by a cementless induced membrane technique.

Gunshot wounds to the hand often produce complex injuries and large segmental bone defects. Bone reconstruction remains a challenge in this context. The induced membrane technique is a simple and effective procedure for reconstruction of segmental bone defects. The technique is straightforward but must be performed rigorously. Usually polymethylmethacrylate (PMMA) cement is required for the first stage of the surgery. We describe four cases of metacarpal bone reconstruction after gunshot wounds in a limited-resource setting. Two patients were treated using the induced membrane technique with a polypropylene syringe body instead of PMMA cement, which was unavailable in this situation. A thick membrane was observed 6 weeks after spacer implantation. Bone union was achieved in all cases.

Effect of pembrolizumab on CD4+ CD25+ , CD4+ LAP+ and CD4+ TIM-3+ T cell subsets.

Tumor immune evasion involves the expansion of avidly proliferating immunosuppressive cells and inhibition of effector T cell proliferation. Immune checkpoints (IC) block the activation pathways of tumor-reactive T cells. IC pathways are often exploited by tumor cells to evade immune destruction, and blocking these pathways through IC inhibitors (ICI) has shown promising results in multiple malignancies. In this study, we investigated the effects of an ICI, pembrolizumab, on various T cell subsets in vitro. We compared the suppressive activity of CD4+ CD25+ regulatory T cells (conventional Treg ) with T cells expressing T cell immunoglobulin-3+ (TIM-3+ ) and latency-associated peptide (LAP)+ T cells. We found that LAP-expressing T cells were more suppressive than conventional Treg , but TIM-3-expressing T cells were not suppressive. Our results show that pembrolizumab does not modulate functions of Treg and mediates its immunostimulatory effects via the release of effector T cells from suppression. These findings may assist in the development of agents designed to intervene in IC pathways to overcome Treg resistance to ICI.

"Snapping triceps": A rare and misleading condition - a clinical case report.

Snapping triceps corresponds to subluxation of the medial head of the triceps brachii over the medial epicondyle during active elbow flexion. It is a rare and misleading condition that is often associated with ulnar nerve instability. The latter can result in the snapping triceps being missed. Diagnosis requires a detailed clinical examination. Surgical treatment consists of anterior translocation of the nerve with an adipose flap to stabilize it and transfer of the distal attachment of the medial head of triceps brachii.

Effect of team sports and resistance training on physical function, quality of life, and motivation in older adults.

The aim of this study was to investigate the effect of team sports and resistance training on physical function, psychological health, quality of life, and motivation in older untrained adults. Twenty-five untrained men and forty-seven untrained women aged 80 (range: 67-93) years were recruited. Fifty-one were assigned to a training group (TRG) of which twenty-five performed team training (TG) and twenty-six resistance training (RG). The remaining twenty-one were allocated to a control group (CG). TRG trained for 1 hour twice a week for 12 weeks. Compared with CG, TRG improved the number of arm curls within 30 seconds (P<.05) and 30-seconds chair stand (P<.05) during the intervention. In TRG, participation in training led to higher (P<.05) scores in the subscales psychological well-being, general quality of life, and health-related quality of life, as well as decreased anxiety and depression levels. No differences between changes in TG and RG were found over the intervention period, neither in physical function tests nor psychological questionnaires. Both TG and RG were highly motivated for training, but TG expressed a higher degree of enjoyment and intrinsic motivation mainly due to social interaction during the activity, whereas RG was more motivated by extrinsic factors like health and fitness benefits. In conclusion, both team training and resistance training improved physical function, psychological well-being, and quality of life. However, team sport training motivated the participants more by intrinsic factors than resistance training.

Using observations and source specific model tracers to characterize pollutant transport during FRAPPÉ and DISCOVER-AQ.

Transport is a key parameter in air quality research and plays a dominant role in the Colorado Northern Front Range Metropolitan Area (NFRMA), where terrain induced flows and recirculation patterns can lead to vigorous mixing of different emission sources. To assess different transport processes and their connection to air quality in the NFRMA during the FRAPPÉ and DISCOVER-AQ campaigns in summer 2014, we use the Weather Research and Forecasting Model with inert tracers. Overall, the model represents well the measured winds and the inert tracers are in good agreement with observations of comparable trace gas concentrations. The model tracers support the analysis of surface wind and ozone measurements and allow for the analysis of transport patterns and interactions of emissions. A main focus of this study is on characterizing pollution transport from the NFRMA to the mountains by mountain-valley flows and the potential for recirculating pollution back into the NFRMA. One such event on 12 August 2014 was well captured by the aircraft and is studied in more detail. The model represents the flow conditions and demonstrates that during upslope events, frequently there is a separation of air masses that are heavily influenced by oil and gas emissions to the North and dominated by urban emissions to the South. This case study provides evidence that NFRMA pollution not only can impact the nearby Foothills and mountain areas to the East of the Continental Divide, but that pollution can "spill over" into the valleys to the West of the Continental Divide.

Use of passive samplers in pollution monitoring: a numerical approach for marinas.

Triolein-containing semipermeable membrane devices (SPMDs) and butyl rubber (BR) based sorbents were employed as passive samplers in 14 coastal stations of Turkey including shipyards and marinas to characterize time-integrated levels of polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) and their relationship to potential pollution sources. Passive samplers of SPMDs and BR sorbents were deployed for 30days in the spring of 2012. The maximum concentrations of total PAH and PCB compounds sequestered by SPMDs were 3338 ng g(-1) SPMD and 4247 pg g(-1) SPMD. (END)-I and DDT-related compounds were dominant OCP compounds for most of the sites in passive samplers. Total PAH concentrations in SPMDs were found 1.2 to 8 times higher than the concentrations in BRs. However, BR sorbents were able to sample some PAHs which could not be sampled by SPMDs. The concentrations of PCBs and OCPs in BRs were similar or higher than SPMDs. SPMD-data were used to estimate the average ambient water concentrations of the contaminants. Two existing theoretical approaches have been used to derive the concentrations of hydrophobic pollutants in the ambient waters. The results were found very similar and range from 7318 to 183864 pg L(-1) for PAHs, from 2 to 186 pg L(-1) for PCBs, and from 98 to 848 pg L(-1) for OCPs. Furthermore, a simple numerical model was designed to estimate the boat-related water concentrations in marinas by using the seawater data supplied by SPMDs. The model was mainly built on the water concentration and the capacities of a particular marina and then applied to two sites in the second marina. A good correlation was found between the model outputs and SPMD-water data.

Comparative evaluation of ELISA kit and HPLC DAD for the determination of chlorpyrifos ethyl residues in water and sediments.

Enzyme linked immunosorbent assay (ELISA) kit is a versatile, cheap and relatively available tool that can be used in remote areas. In this study, performance of ELISA kit was evaluated in terms of accuracy, recovery, precision, sensitivity, cross reactivity and matrix interference for pesticide residue determination in water and sediment samples. This method was compared with high performance liquid chromatography (HPLC) which is not a commonly available analytical technique for chlorpyrifos ethyl residue analysis in developing countries. The ELISA kit had limits of detection (LOD) of 0.37 µg L(-1) and 0.42 µg Kg(-1) dry weight (dw), for chlorpyrifos ethyl in water and sediment samples, respectively using deionized water and a control sediment sample. Mean percentage recoveries and coefficients of variation (CV) for ELISA kit varied from 96.0±5.8% to 108.0±3.4% for water and sediment samples. Comparison between ELISA and HPLC analysis results using water and sediment samples from Lake Naivasha showed no significant difference in results (p≤0.05). Strong correlations (r2=0.9878 water samples and r1=0.9670, p<0.0001 for sediment samples, n=48) were reported between the methods for the two samples analyzed. Bland-Altman bias plot analysis showed that the two methods were in agreement within 95% confidence interval of limits -2.9 to 3.8 and -2.2 to 3.6 for water and sediment, respectively. Given the high sensitivity reported and the obtained acceptable limits of coefficient of variation and percentage recovery, ELISA appears to be a suitable rapid analytical tool in analysis of chlorpyrifos ethyl in water and sediment samples. Results demonstrate comparability to HPLC and could complement conventional tools in regular monitoring program particularly in developing countries. This will hasten results delivery for ecological risk assessment and timely execution of mitigation measures.

Water concentrations of PAH, PCB and OCP by using semipermeable membrane devices and sediments.

Water concentrations of polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) were estimated from semipermeable membrane devices (SPMDs) and from sediment pollutant concentrations. SPMDs were deployed in the Istanbul Strait and Marmara Sea and retrieved after 7 and 21 days. Performance reference compounds (PRCs) were used to determine the site-specific sampling rates of the compounds. Water concentrations (C(w)) of the analyzed compounds estimated by using two different calculation methods for SPMDs were found similar. C(w) of total PAHs estimated from SPMDs (C(w-spmd)) were found between 13 and 79 ng L⁻¹ and between 7.0 and 68 ng L⁻¹ for 7 and 21 days of deployments respectively. Water concentrations of PCBs using sediment data was found as between 0.001 and 11.0 ng L⁻¹. The highest value of C(w-spmd) for two deployments were 2.8 ng L⁻¹ for OCPs. C(w) estimated from sediment concentrations were generally higher than those estimated from SPMDs.

Localized modulation of rotating waves in Taylor-Couette flow.

We report the results of an experimental study on the multiplicity of states in Taylor-Couette flow as a result of axial localization of azimuthally rotating waves. Localized states have been found to appear hysteretically from time-dependent Taylor-Couette flow at Reynolds numbers significantly above the onset of wavy Taylor vortices. These localized states have the shape of a modulated rotating wave and differ significantly from global modulated wavy Taylor vortex states in their spatial characteristics. Axial localization of rotating waves is accompanied with a significant increase in size of the underlying pair of Taylor vortices. Our work reveals that localization provides a mechanism for the appearance of multiple time-dependent states in Taylor-Couette flow.

The Yangtze-Hydro Project: a Chinese-German environmental program.

Water of good quality is one of the basic needs of human life. Worldwide, great efforts are being undertaken for an assured water supply. In this respect, one of the largest water technology projects worldwide is the Yangtze Three Gorges Dam in China. There is a need for extensive scientific and technical understanding of the challenges arising from this large hydrological engineering project. German and Chinese groups from various scientific fields are collaborating to provide knowledge for the sustainable management of the reservoir. In this project description, the Yangtze Three Gorges Dam Project, its goals and challenges, are described in brief, and the contributions of the German research projects are presented.

End wall effects on the transitions between Taylor vortices and spiral vortices.

We present numerical simulations as well as experimental results concerning transitions between Taylor vortices and spiral vortices in the Taylor-Couette system with rigid, nonrotating lids at the cylinder ends. These transitions are performed by wavy structures appearing via a secondary bifurcation out of Taylor vortices and spirals, respectively. In the presence of these axial end walls, pure spiral solutions do not occur as for axially periodic boundary conditions but are substituted by primary bifurcating, stable wavy spiral structures. Similarly to the periodic system, we found a transition from Taylor vortices to wavy spirals mediated by so-called wavy Taylor vortices and, on the other hand, a transition from wavy spirals to Taylor vortices triggered by a propagating defect. We furthermore observed and investigated the primary bifurcation of wavy spirals out of the basic circular Couette flow with Ekman vortices at the cylinder ends.

Spirals vortices in Taylor-Couette flow with rotating endwalls.

A Hopf bifurcation with translational invariance has been widely considered as an appropriate model for the appearance of spiral vortices in counter-rotating Taylor-Couette flow. Our experimental work demonstrates that flow conditions close to the axial boundaries are responsible for the type of bifurcation scenario, i.e., either asymmetric pure traveling waves or more complex behavior, such as defect states or symmetric mixed states appearing from a Hopf bifurcation. The measurements were performed in the first Taylor-Couette experiment with independently rotating endwalls confining the system in axial direction. The rotation rate of the (synchronous) endwalls is found to be an essential control parameter for the spatial amplitude distribution of the traveling waves and also reflects symmetry of the corresponding flow pattern appearing from the Hopf bifurcation.

Long-term air monitoring of organochlorine pesticides using Semi Permeable Membrane Devices (SPMDs) in the Alps.

Atmospheric sampling of organochlorine pesticides (OCPs) was conducted using Semi Permeable Membrane Devices (SPMDs) deployed in the Alps at different altitudinal transects for two consecutive exposure periods of half a year and a third simultaneous year-long period. Along all the altitude profiles, the sequestered amounts of OCPs increased in general with altitude. SPMDs were still working as kinetic samplers after half a year for the majority of the OCPs. However, compounds with the lowest octanol-air partition coefficient (K(oa)), reached equilibrium within six months. This change in the SPMD uptake was determined for the temperature gradient along the altitude profile influencing K(oa), OCPs availability in the gaseous phase, and SPMD performance. In sum, it seems two effects are working in parallel along the altitude profiles: the change in SPMD performance and the different availability of OCPs along the altitudinal transects determined by their compound properties and concentrations in air.

[Retinal damage by perfluorocarbon liquids - a question of specific gravity? Intraocular pressure peaks and shearing forces]. / Retinale Schäden durch flüssige Perfluorkarbone - eine Frage des spezifischen Gewichts? Intraokulare Druckspitzen und Scherkräfte.

BACKGROUND: Perfluorocarbon liquids (PFCL) cause retinal damage when used as long-term ocular endotamponades. Whether these changes are related to the mechanical or to the chemical properties of PFCL is unclear. The purpose of this study was to evaluate pressure spikes or shearing forces during endotamponade with PFCL and standardised eye movements. MATERIAL AND METHODS: Part 1: In an eye model the resulting pressure forces of 6 PFCL were measured at four different sites during standardised eye movements. Part 2: Shearing forces were determined in a plexiglass eye model and the resulting tangential forces at the PFCL-retina interface were calculated. Part 3: Rabbit eyes were vitrectomised and filled with light and heavy fluorocarbons for 6 weeks. Subsequently, the retina were examined histologically and by immunohistochemistry. RESULTS: With increasing filling of the eye model, the maximum of the pressure peaks moved from the inferior wall of the eye model to the lateral eye walls. For perfluorodecalin (PFD) the highest pressure peak was 407 Pa with a 75 % filling of the vitreous cavity. The lowest pressure peak was 314 Pa with a 50 % filling of hexafluoropropene oxide. Shearing forces for standardised accelerations were dependent on viscosity and ranged between 0.87 mN/m(2) (perfluorohexyloctane) and 8055 mN/m(2) (hexafluoropropene oxide). Part 3: Histological and immunohistochemical analyses did not reveal pressure-related damage or any difference between the effects of the different tamponades in vivo. CONCLUSION: In comparison with physiological dynamic and static pressure peaks, the measured mechanical forces induced by intraocular PFCL tamponades are low. Specific gravity and mechanical damage by intraocular PFCL as a cause of retinal damage seem unlikely. Animal studies underline these findings.

A novel pulse duplicator system: evaluation of different valve prostheses.

BACKGROUND: The hemodynamic characteristics of different heart valve prostheses have been investigated in vitro with a novel pulse duplicator. A novel valved stent for transapical or percutaneous valve implantation has been compared with a native heart valve and mechanical heart valves. METHODS: All experiments were designed to imitate both physiologic pressure ratios and flow characteristics in diastole and systole. After calibrating the system using a human aortic valve (primary orifice diameter: 22.0 mm), the following valves were studied under aortic pulsatile flow conditions: Hall-Kaster (Medtronic-Hall, 20.0 mm), St. Jude Medical (20.0 mm), a newly developed tricuspid valved stent (Tricumed TM4, 20.7 mm) and a newly developed biomechanical valve (Engage aortic valve Model 6000, 21.0 mm). All valves including the human aortic valve were assessed by videotape observation under pulsatile flow conditions. Measured flow-related parameters include in vitro mean transvalvular pressure, regurgitant volume, effective orifice area and performance index. RESULTS: The optical assessment of all five valves demonstrated a complete opening during systole and closing at the beginning of diastole. All valves were optically sufficient during diastole. Engage aortic valve Model 6000 showed the highest maximum transvalvular pressure (27.5 +/- 8.2 mmHg), whereas both Hall-Kaster (17.9 +/- 1.5 mmHg) and St. Jude Medical (16.7 +/- 0.7 mmHg) had a lower gradient than the native aortic valve (24.0 +/- 0.2 mmHg) and Tricumed TM4 (21.8 +/- 3.8 mmHg). The maximum effective orifice area of St. Jude Medical amounted to 258.7 +/- 3.4 mm(2), followed by Tricumed TM4 with an area of 222.1 +/- 1.9 mm(2) and the human aortic valve with 160.4 +/- 2.9 mm(2). Hall-Kaster and Engage aortic valve Model 6000 had an area of 198.9 +/- 1.6 mm(2) and 176.7 +/- 3.1 mm(2), respectively. CONCLUSIONS: The pulse duplicator proved to be highly accurate and yielded reproducible results. Since it has been calibrated with a human aortic valve, the hemodynamics of any heart valve prosthesis can be compared with the human valve. This system can evaluate and promote the development of new biological and mechanical heart valve prostheses.

Nonlinear defects separating spiral waves in Taylor-Couette flow.

Stable domain walls which are realized by a defect between oppositely traveling spiral waves in a pattern-forming hydrodynamic system, i.e., Taylor-Couette flow, are studied numerically as well as experimentally. A nonlinear mode coupling resulting from the nonlinearities in the underlying momentum balance is found to be essential for the stability of the defects. These nonlinearly driven defects separate spiral domains and act either as a phase generating or annihilating defect. Specific phase differences of either 0 or pi between the participating traveling waves are a characteristic feature of this defect. The influence of a symmetry breaking externally imposed flow on the spiral domains and the defects is studied. The numerical and experimental results are in excellent agreement.