Land use and management effects on soil carbon in U.S. Lake States, with emphasis on forestry, fire, and reforestation.

There is growing need to quantify and communicate how land use and management activities influence soil organic carbon (SOC) at scales relevant to, and in the tangible control of landowners and forest managers. The continued proliferation of publications and growth of data sets, data synthesis and meta-analysis approaches allows the application of powerful tools to such questions at ever finer scales. In this analysis, we combined a literature review and effect-size meta-analysis with two large, independent, observational databases to assess how land use and management impact SOC stocks, primarily with regards to forest land uses. We performed this work for the (Great Lakes) U.S. Lake States, which comprise 6% of the land area, but 7% of the forest and 9% of the forest SOC in the United States, as the second in a series of ecoregional SOC assessments. Most importantly, our analysis indicates that natural factors, such as soil texture and parent material, exert more control over SOC stocks than land use or management. With that for context, our analysis also indicates which natural factors most influence management impacts on SOC storage. We report an overall trend of significantly diminished topsoil SOC stocks with harvesting, consistent across all three data sets, while also demonstrating how certain sites and soils diverge from this pattern, including some that show opposite trends. Impacts of fire grossly mirror those of harvesting, with declines near the top of the profile, but potential gains at depth and no net change when considering the whole profile. Land use changes showing significant SOC impacts are limited to reforestation on barren mining substrates (large and variable gains) and conversion of native forest to cultivation (losses). We describe patterns within the observational data that reveal the physical basis for preferential land use, e.g., cultivation of soils with the most favorable physical properties, and forest plantation establishment on the most marginal soils, and use these patterns to identify management opportunities and considerations. We also qualify our results with ratings of confidence, based on their degree of support across approaches, and offer concise, defensible tactics for adapting management operations to site-specific criteria and SOC vulnerability.

One Health and antimicrobial resistance, a United States perspective.

Antimicrobial drugs are a precious resource, responsible for saving millions of lives since their discovery. Unfortunately, some antimicrobials are rapidly losing their effectiveness due to the development and spread of antimicrobial resistance (AMR), a multi-faceted and complex problem affecting humans, animals, plants and the environment. While AMR is a global problem, in this paper, the authors briefly highlight some ongoing efforts in the United States of America aimed at integrating a One Health approach into policies and programmes that address this important health threat.

Les antibiotiques sont des ressources de grande valeur qui ont sauvé des millions de vies depuis leur découverte. Malheureusement, certains agents antimicrobiens perdent rapidement leur efficacité en raison de l'apparition et propagation des résistances à ces agents, phénomène complexe et multidimensionnel qui affecte l'homme, les animaux, les plantes et l'environnement. La résistance aux agents antimicrobiens est un problème mondial ; dans cet article, les auteurs décrivent certaines initiatives actuellement mises en oeuvre aux États-Unis d'Amérique pour intégrer l'approche Une seule santé dans les politiques et les programmes conçus pour lutter contre cette menace sanitaire majeure.

Los fármacos antimicrobianos son un recurso valiosísimo, cuyo uso ha salvado millones de vidas desde que fueron descubiertos. Lamentablemente, algunos de ellos están perdiendo rápidamente eficacia debido a la aparición y propagación de resistencias, lo que plantea un problema tan complejo como poliédrico, que afecta a personas, animales, plantas y ecosistemas. Aunque la dimensión del problema es planetaria, los autores destacan aquí brevemente algunas de las iniciativas en curso en los Estados Unidos de América que tienen por objetivo integrar los planteamientos de Una sola salud en el conjunto de políticas y programas desde los cuales se aborda esta importante amenaza sanitaria.

Toward inventory-based estimates of soil organic carbon in forests of the United States.

Soil organic carbon (SOC) is the largest terrestrial carbon (C) sink on Earth; this pool plays a critical role in ecosystem processes and climate change. Given the cost and time required to measure SOC, and particularly changes in SOC, many signatory nations to the United Nations Framework Convention on Climate Change report estimates of SOC stocks and stock changes using default values from the Intergovernmental Panel on Climate Change or country-specific models. In the United States, SOC in forests is monitored by the national forest inventory (NFI) conducted by the Forest Inventory and Analysis (FIA) program within the U.S. Department of Agriculture, Forest Service. The FIA program has been consistently measuring soil attributes as part of the NFI since 2001 and has amassed an extensive inventory of SOC in forest land in the conterminous United States and southeast and southcentral coastal Alaska. That said, the FIA program has been using country-specific predictions of SOC based, in part, upon a model using SOC estimates from the State Soil Geographic (STATSGO) database compiled by the Natural Resources Conservation Service. Estimates obtained from the STATSGO database are averages over large map units and are not expected to provide accurate estimates for specific locations, e.g., NFI plots. To improve the accuracy of SOC estimates in U.S. forests, NFI SOC observations were used for the first time to predict SOC density to a depth of 100 cm for all forested NFI plots. Incorporating soil-forming factors along with observations of SOC into a new estimation framework resulted in a 75% (48 ± 0.78 Mg/ha) increase in SOC densities nationally. This substantially increases the contribution of the SOC pool, from approximately 44% (17 Pg) of the total forest ecosystem C stocks to 56% (28 Pg), in the forest C budget of the United States.

Net carbon flux of dead wood in forests of the Eastern US.

Downed dead wood (DDW) in forest ecosystems is a C pool whose net flux is governed by a complex of natural and anthropogenic processes and is critical to the management of the entire forest C pool. As empirical examination of DDW C net flux has rarely been conducted across large scales, the goal of this study was to use a remeasured inventory of DDW C and ancillary forest attributes to assess C net flux across forests of the Eastern US. Stocks associated with large fine woody debris (diameter 2.6-7.6 cm) decreased over time (-0.11 Mg ha(-1) year(-1)), while stocks of larger-sized coarse DDW increased (0.02 Mg ha(-1) year(-1)). Stocks of total DDW C decreased (-0.14 Mg ha(-1) year(-1)), while standing dead and live tree stocks both increased, 0.01 and 0.44 Mg ha(-1) year(-1), respectively. The spatial distribution of DDW C stock change was highly heterogeneous with random forests model results indicating that management history, live tree stocking, natural disturbance, and growing degree days only partially explain stock change. Natural disturbances drove substantial C transfers from the live tree pool (≈-4 Mg ha(-1) year(-1)) to the standing dead tree pool (≈3 Mg ha(-1) year(-1)) with only a minimal increase in DDW C stocks (≈1 Mg ha(-1) year(-1)) in lower decay classes, suggesting a delayed transfer of C to the DDW pool. The assessment and management of DDW C flux is complicated by the diversity of natural and anthropogenic forces that drive their dynamics with the scale and timing of flux among forest C pools remaining a large knowledge gap.

Dental survey of the Falkland Islands' child population.

In November 2013 the first dental epidemiological survey of 5, 12 and 15 year old children was undertaken on The Falkland Islands. The census survey used the ICDAS II system and achieved an overall response rate of 87.4%. To allow international comparisons obvious decay experience is reported. The mean dmft of 5-year-olds was 1.2 teeth, the prevalence of decay experience was 34.6%. The mean DMFT of 12-year-old children was 0.9 teeth, the prevalence of decay experience was 36.7%. The mean DMFT of 15-year-olds was 1.78 teeth, and the prevalence of decay experience was 66.7%. This first dental survey showed that levels of child dental decay in the Falkland Islands are similar to western European countries. The results can now be used as a baseline and benchmark to follow future trends in dental health in this British Overseas Territory.

Visual outcomes and predictors in optic pathway glioma: a single centre study.

BACKGROUND/AIMS: Optic pathway gliomas (OPGs) may cause progressive visual loss despite chemotherapy. Newer, less toxic treatments might be given earlier, depending on visual prognosis. We aimed to investigate the prognostic value of visual evoked potentials (VEP) and optical coherence tomography (OCT). METHODS: A retrospective study of OPG patients (treated 2003-2017) was conducted. Primary outcome was PEDIG category visual acuity in better and worse eyes (good < = 0.2, moderate 0.3-0.6 and poor > = 0.7 logMAR). Binary logistic regression analysis was used to identify predictors of these outcomes. RESULTS: 60 patients (32 Neurofibromatosis type 1 [NF1] and 28 sporadic) had median presentation age 49 months (range 17-183) (NF1) and 27 months (range 4-92) (sporadic). Median follow up was 82 months (range 12-189 months). At follow up 24/32 (75%) of NF1 children and 14/28 (50%) of sporadic children had good better eye visual acuity and 11/32 (34%) of NF1 children and 15/28 (54%) of sporadics had poor worse eye acuity. Mean peripapillary retinal nerve fibre layer (RNFL) thickness predicted good better eye final acuity (OR 0.799, 95%CI 0.646-0.987, p = 0.038). Presenting with visual symptoms (OR 0.22 95% CI 0.001-0.508, p = 0.017) and poorer VEP scores (OR 2.35 95% CI 1.1-5.03, p = 0.027) predicted poor worse eye final acuity. 16 children had homonymous hemianopias at follow up, predicted by poor presenting binocular VEP score (OR 1.449 95%CI 1.052-1.995, p = 0.02). CONCLUSIONS: We found that both RNFL thickness on OCT and VEP were useful in predicting future visual acuity and vision and potentially in planning treatment. We had a high prevalence of homonymous hemianopia.

Prevention of venous thromboembolism in patients admitted to Australian hospitals: summary of National Health and Medical Research Council clinical practice guideline.

Each year in Australia, about 1 in 1000 people develop a first episode of venous thromboembolism (VTE), which approximates to about 20,000 cases. More than half of these episodes occur during or soon after a hospital admission, which makes them potentially preventable. This paper summarises recommendations from the National Health and Medical Research Council's 'Clinical Practice Guideline for the Prevention of Venous Thromboembolism in Patients Admitted to Australian Hospitals' and describes the way these recommendations were developed. The guideline has two aims: to provide advice on VTE prevention to Australian clinicians and to support implementation of effective programmes for VTE prevention in Australian hospitals by offering evidence-based recommendations which local hospital guidelines can be based on. Methods for preventing VTE are pharmacological and/or mechanical, and they require appropriate timing, dosing and duration and also need to be accompanied by good clinical care, such as promoting mobility and hydration whilst in hospital. With some procedures or injuries, the risk of VTE is sufficiently high to require that all patients receive an effective form of prophylaxis unless this is contraindicated; in other clinical settings, the need for prophylaxis requires individual assessment. For optimal VTE prevention, all patients admitted to hospital should have early and formal assessments of: (i) their intrinsic VTE risk and the risks related to their medical conditions; (ii) the added VTE risks resulting from surgery or trauma; (iii) bleeding risks that would contraindicate pharmacological prophylaxis; (iv) any contraindications to mechanical prophylaxis, culminating in (v) a decision about prophylaxis (pharmacological and/or mechanical, or none). The most appropriate form of prophylaxis will depend on the type of surgery, medical condition and patient characteristics. Recommendations for various clinical circumstances are provided as summary tables with relevance to orthopaedic surgical procedures, other types of surgery and medical inpatients. In addition, the tables indicate the grades of supporting evidence for the recommendations (these range from Grade A which can be trusted to guide practice, to Grade D where there is more uncertainty; Good Practice Points are consensus-based expert opinions).

Effects of cyclooxygenase and soluble epoxide hydrolase inhibitors on apoptosis of cultured primary equine chondrocytes.

BACKGROUND: Apoptosis is an important mechanism underlying chondrocyte loss in osteoarthritis that could be affected by modulation of lipid signaling via inhibition of cyclooxygenases (COX) and soluble epoxide hydrolase (sEH). OBJECTIVE: To determine the impact of inhibiting COX and sEH alone or in combination on apoptosis of equine chondrocytes. METHODS: Cultured primary equine chondrocytes were subjected to serum deprivation or incubation with 1 µg/ml tunicamycin for 24 h to induce apoptosis via caspase activation and endoplasmic reticulum (ER) stress, respectively. Cells were treated with the non-selective COX inhibitor phenylbutazone, the COX-2 selective inhibitor firocoxib and the sEH inhibitor t-TUCB alone or in combination. The inhibitors were used at half-maximal (IC50), 80% of maximal (IC80) and 10-fold the 80% inhibitory concentration (10xIC80) for the equine enzymes. Apoptosis was quantified via ELISA technique. Data were analyzed with unpaired two-tailed t-test or one-way ANOVA followed by Bonferroni's post-hoc while correcting for multiple comparisons via statistical hypothesis testing. P < 0.05 was considered significant. RESULTS: In the caspase model, 10xIC80t-TUCB significantly decreased whereas 10xIC80 phenylbutazone significantly enhanced apoptosis. Apoptosis enhancement by phenylbutazone was significantly attenuated by concurrent 10xIC80t-TUCB. The remaining treatments and concentrations had no effect on apoptosis development. In the ER stress model, IC50 and IC80 phenylbutazone and firocoxib significantly enhanced apoptosis, which was fully prevented by concurrent 10xIC80t-TUCB. MAIN LIMITATIONS: In vitro findings that will need to be verified in vivo. CONCLUSIONS: Chondrocyte apoptosis caused by ER stress can be enhanced by COX inhibition but prevented by concurrent inhibition of sEH.

PIERS proteinuria: relationship with adverse maternal and perinatal outcome.

OBJECTIVE: To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes. METHODS: We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia. Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection. Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection. We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse perinatal outcomes (at any time). Models with AUC ≥ 0.70 were considered of interest. Analyses were run for all women who had each type of proteinuria assessment and for a cohort of women ("ALL measures") who had all three proteinuria assessments. RESULTS: More women were proteinuric by urinary dipstick (≥ 2+, 61.4%) than by spot urine Pr/Cr (≥ 30 g/mol, 50.4%) or 24-hour urine collection (≥ 0.3g/d, 34.7%). Each proteinuria measure evaluated had some discriminative power, and dipstick proteinuria (categorical) performed as well as other methods. No single method was predictive of adverse perinatal outcome. CONCLUSION: The measured amount of proteinuria should not be used in isolation for decision-making in women with preeclampsia. Dipstick proteinuria performs as well as other methods of assessing proteinuria for prediction of adverse events.

What best animal science teachers do.

Great teachers have the extraordinary ability to inspire and motivate even those students who resist learning. The top educators are knowledgeable not only about the content of the course they are teaching but also of the information, literature, and practice of instructional delivery to their audience. Many exemplary educators have been profiled and studied; however, there is a paucity of information pertaining to how the top animal science teachers teach. The objective of this study was to identify and describe characteristics of award-winning animal science teachers. The inclusion criterion for selecting faculty was being bestowed an excellence in teaching award through their professional organization. Each teacher answered a series of questions about themselves, their students, and the class being taught. Lecture was captured using a digital all-inclusive camera and later analyzed for pedagogical trends and instructor-student interactions. Despite a variety of topics being taught by award-winning teachers, there were multiple trends emerging from their classrooms. Common events included reviewing highlights of previous lectures, distributing something to students, posing questions during class, and calling on students by name. Each teacher taught differently, but they all understood their audience; they grasped the subject matter and most importantly, they valued students learning. Collectively, these findings can be utilized and applied by animal science teachers in their own environments in an attempt to foster improved student learning through excellent teaching.

Skeletal dosimetry in cone beam computed tomography.

Cone beam computed tomography (CBCT) is a relatively new patient imaging technique that has proved invaluable for treatment target verification and patient positioning during image-guided radiotherapy (IGRT). It has been shown that CBCT results in additional dose to bone that may amount to 10% of the prescribed dose. In this study, voxelized human phantoms, FAX06 (adult female) and MAX06 (adult male), are used together with phase-space data collected from a realistic model of a CBCT imager to calculate dose in the red bone marrow (RBM) and bone surface cells (BSCs), the two organs at risk within the bone spongiosa, during simulated head and neck, chest and pelvis CBCT scans. The FAX06/MAX06 phantoms model spongiosa based on micro-CT images, filling the relevant phantom voxels, which are 0.12 x 0.12 x 0.12 cm3, with 17 x 17 x 17 microm3 microvoxels to form a micromatrix of trabecular bone and bone marrow. FAX06/ MAX06 have already been implemented in an EGSnrc-based Monte Carlo code to simulate radiation transport in the phantoms; however, this study required significant modifications of the code to allow use of phase-space data from a simulated CBCT imager as a source and to allow scoring of total dose, RBM dose and BSC dose on a voxel-by-voxel basis. In simulated CBCT scans, the BSC dose is significantly greater than the dose to other organs at risk. For example, in a simulated head and neck scan, the average BSC dose is 25% higher than the average dose to eye lens (approximately 8.3 cGy), and 80% greater than the average dose to brain (5.7 cGy). Average dose to RBM, on the other hand, is typically only approximately 50% of the average BSC dose and less than the dose to other organs at risk (54% of the dose to eye lens and 76% of dose to brain in a head and neck scan). Thus, elevated dose in bone due to CBCT results in elevated BSC dose. This is potentially of concern when using CBCT in conjunction with radiotherapy treatment.

Differential effects of Usp14 and Uch-L1 on the ubiquitin proteasome system and synaptic activity.

The ubiquitin proteasome pathway has been implicated in the pathogenesis of many neurodegenerative diseases, and alterations in two different deubiquitinating enzymes, Uch-L1 and Usp14, result in neurological phenotypes in mice. We identified a new mutation in Uch-L1 and compared the roles of Uch-L1 and Usp14 in the ubiquitin proteasome system. Deficiencies in either Uch-L1 or Usp14 result in decreased levels of ubiquitin, suggesting that they both regulate ubiquitin stability in the nervous system. However, the effect of ubiquitin depletion on viability and onset of symptoms is more severe in the Usp14-deficient mice, and changes in hippocampal synaptic transmission were only observed in Usp14-deficient mice. In addition, while Usp14 appears to function at the proteasome, Uch-L1 deficiency resulted in up-regulation of lysosomal components, indicating that Uch-L1 and Usp14 may differentially affect the ubiquitin proteasome system and synaptic activity by regulating different pools of ubiquitin in the cell.

Technical note: overprediction of dose with default PRESTA-I boundary crossing in DOSXYZnrc and BEAMnrc.

Use of the PRESTA-I (current default) boundary crossing algorithm for charged particles in DOSXYZnrc and BEAMnrc is shown to result in dose overprediction by up to 2.5% in photon and electron beams (less in high-energy electron beams). The effect is most pronounced when charged particle equilibrium does not exist or when the phantom is not divided into uniform voxels throughout. As a result, the default boundary crossing algorithm in BEAMnrc will be changed to "exact" (single scattering).

A "HOWFARLESS" option to increase efficiency of homogeneous phantom calculations with DOSXYZnrc.

This paper describes a "HOWFARLESS" transport option, which has been added to DOSXYZnrc to increase the efficiency of beam commissioning calculations in homogeneous phantoms. The algorithm speeds up charged particle transport by only considering the distance to the extreme outer boundaries of the phantom, thus eliminating the need to stop at voxel boundaries. Dose is deposited by approximating the total curved charged particle steps by two straight-line steps joined at a hinge point. Good agreement with normal simulations is achieved at all beam energies and for all practical maximum step lengths with a 1:1 mixture of approximations based on the initial position/ direction of the particle and on its final position/direction. Use of the "HOWFARLESS" option in phantom calculations for 6 and 18 MV photon beams (10 x 10 cm2 and 40 x 40 cm2 fields) from BEAMnrc-simulated accelerators increases the efficiency at the optimum photon splitting number by a factor of 2.9-5.4 when the exact EGSnrc boundary crossing algorithm (BCA) is used and by 51%-89% when the faster PRESTA-I BCA is employed. The efficiency gain due to the "HOWFARLESS" transport option increases with increasing beam energy and decreases with increasing field/dose voxel size. Efficiency improvement is greater when the efficiency of the particle source itself is not a factor, and in such cases the "HOWFARLESS" option improves the DOSXYZnrc efficiency by up to a factor of 13.1 (exact BCA) or 3.5 (PRESTA-I BCA) for photon beams, and up to a factor of 17.2 (exact BCA) or 5.2 (PRESTA-I BCA) for electron beams.

Management of acute traumatic spinal cord injuries.

Acute traumatic spinal cord injury (SCI) is a devastating disease process affecting tens of thousands of people across the USA each year. Despite the increase in primary prevention measures, such as educational programs, motor vehicle speed limits, automobile running lights, and safety technology that includes automobile passive restraint systems and airbags, SCIs continue to carry substantial permanent morbidity and mortality. Medical measures implemented following the initial injury are designed to limit secondary insult to the spinal cord and to stabilize the spinal column in an attempt to decrease devastating sequelae. This chapter is an overview of the contemporary management of an acute traumatic SCI patient from the time of injury through the stay in the intensive care unit. We discuss initial triage, immobilization, and transportation of the patient by emergency medical services personnel to a definitive treatment facility. Upon arrival at the emergency department, we review initial trauma protocols and the evidence-based recommendations for radiographic evaluation of the patient's vertebral column. Finally, we outline closed cervical spine reduction and various aggressive medical therapies aimed at improving neurologic outcome.

Efficient photon beam dose calculations using DOSXYZnrc with BEAMnrc.

This study examines the efficiencies of doses calculated using DOSXYZnrc for 18 MV (10 X 10 cm2 field size) and 6 MV (10 X 10 cm2 and 20 X 20 cm2 field sizes) photon beams simulated using BEAMnrc. Both phase-space sources and full BEAMnrc simulation sources are used in the DOSXYZnrc calculations. BEAMnrc simulation sources consist of a BEAMnrc accelerator simulation compiled as a shared library and run by the user code (DOSXYZnrc in this case) to generate source particles. Their main advantage is in eliminating the need to store intermediate phase-space files. In addition, the efficiency improvements due to photon splitting and particle recycling in the DOSXYZnrc simulation are examined. It is found that photon splitting increases dose calculation efficiency by a factor of up to 6.5, depending on beam energy, field size, voxel size, and the type of secondary collimation used in the BEAMnrc simulation (multileaf collimator vs photon jaws). The optimum efficiency with photon splitting is approximately 55% higher than that with particle recycling, indicating that, while most of the gain is due to time saved by reusing source particle data, there is significant gain due to the uniform distribution of interaction sites and faster DOSXYZnrc simulation time when photon splitting is employed. Use of optimized directional bremsstrahlung splitting in the BEAMnrc simulation sources increases the efficiency of photon beam simulations sufficiently that the peak efficiencies (i.e., with optimum setting of the photon splitting number) of DOSXYZnrc simulations using these sources are only 3-13% lower than those with phase-space file sources. This points towards eliminating the need for storing intermediate phase-space files.

The utility of non-HDL in managing dyslipidemia of stage 5 chronic kidney disease.

BACKGROUND: The Kidney Disease Outcomes Quality Initiative (K/DOQI) treatment guidelines for managing dyslipidemia in patients with chronic kidney disease (CKD) designate CKD as a high-risk category for coronary heart disease and, in Stage 5 CKD patients, recommend maintaining low-density lipoprotein (LDL) < 100 mg/dl and, for patients with hypertriglyceridemia (> or = 200 mg/ dl), non-high-density lipoprotein (non-HDL) < 130 mg/dl, the latter to achieve very low-density lipoprotein (VLDL) < 30 mg/dl. More recently, the National Cholesterol Education Program has recommended an LDL target of < 70 mg/dl for high-risk patients. AIMS: The purposes of this study were: to document the point prevalence of dyslipidemia in CKD patients at hemodialysis inception, prior to potential impact of dialysis treatments; to assess the hypothesis that non-HDL serves as a reliable surrogate marker for elevated VLDL; to examine the performance of K/DOQI guidelines in treating dyslipidemia; and to evaluate the utility of non-HDL as an alternative primary trigger/target of lipid-lowering therapy in Stage 5 CKD patients. METHODS: Consistent with K/DOQI guidelines, lipid levels drawn immediately prior to hemodialysis sessions, thus possibly non-fasting, were analyzed in 21,893 incident dialysis patients by laboratory measurements of triglycerides, total cholesterol, and HDL and from calculated values of non-HDL, LDL, VLDL and intermediate-density lipoprotein. RESULTS: Prevalence of dyslipidemia, by guideline definitions, was 82%, predominantly manifested by elevated triglycerides (52%) and VLDL (52%) and decreased HDL (51%), with less frequent elevations of LDL (40%) and total cholesterol (24%). Non-HDL > or = 130 mg/dl was neither a sensitive (61%) nor specific (75%) marker for elevated VLDL. There was a striking disparity between the high prevalence of dyslipidemia and the percentage of dyslipidemic patients qualified by K/DOQI guidelines for therapy. Non-HDL > or = 130 mg/dl was as effective in qualifying dyslipidemic patients for lipid-lowering therapy (54%) as the entire K/DOQI treatment algorithm (57%). Lowering the trigger of non-HDL to > or = 100 mg/dl would qualify 81% of dyslipidemic patients for treatment while offering the important advantage of being uninfluenced by the non-fasting state. CONCLUSIONS: In Stage 5 CKD patients at hemodialysis inception, dyslipidemia is highly prevalent with predominance of the atherogenic triad (hypertriglyceridemia, elevated VLDL and reduced HDL). Non-HDL is a poor surrogate marker for VLDL. As a valid non-fasting lipid parameter, non-HDL alone at the level of > or = 130 mg/dl qualifies dyslipidemic Stage 5 CKD patients for therapy as effectively as the K/DOQI guidelines. Setting the non-HDL trigger/target cut-off at 100 mg/dl overcomes the insensitivity of non-HDL as a marker for atherogenic lipoproteins represented by the VLDL designation while ensuring more aggressive lipid-lowering therapy for Stage 5 CKD patients at high risk for cardiovascular events. Accordingly, non-HDL of 100 mg/dl is proposed as the all-encompassing primary trigger/target of lipid-lowering therapy in high-risk Stage 5 CKD patients, particularly those patients on dialysis in whom lipid samples obtained before dialysis cannot be guaranteed to be fasting.

Attribution of net carbon change by disturbance type across forest lands of the conterminous United States.

BACKGROUND: Locating terrestrial sources and sinks of carbon (C) will be critical to developing strategies that contribute to the climate change mitigation goals of the Paris Agreement. Here we present spatially resolved estimates of net C change across United States (US) forest lands between 2006 and 2010 and attribute them to natural and anthropogenic processes. RESULTS: Forests in the conterminous US sequestered -460 ± 48 Tg C year-1, while C losses from disturbance averaged 191 ± 10 Tg C year-1. Combining estimates of net C losses and gains results in net carbon change of -269 ± 49 Tg C year-1. New forests gained -8 ± 1 Tg C year-1, while deforestation resulted in losses of 6 ± 1 Tg C year-1. Forest land remaining forest land lost 185 ± 10 Tg C year-1 to various disturbances; these losses were compensated by net carbon gains of -452 ± 48 Tg C year-1. C loss in the southern US was highest (105 ± 6 Tg C year-1) with the highest fractional contributions from harvest (92%) and wind (5%). C loss in the western US (44 ± 3 Tg C year-1) was due predominantly to harvest (66%), fire (15%), and insect damage (13%). The northern US had the lowest C loss (41 ± 2 Tg C year-1) with the most significant proportional contributions from harvest (86%), insect damage (9%), and conversion (3%). Taken together, these disturbances reduced the estimated potential C sink of US forests by 42%. CONCLUSION: The framework presented here allows for the integration of ground and space observations to more fully inform US forest C policy and monitoring efforts.

Contractile response to colonic distention is influenced by oscillation frequency.

Static colonic mechanical properties are characterized by stepwise balloon distention. It is unclear whether the state of contractile activation affects frequency-dependent differences in biomechanical properties. Our aim was to investigate the frequency-dependence of colonic mechanical properties by sinusoidal oscillation. A descending colonic balloon was sinusoidally oscillated by 25 mL at 5, 10 and 20 cpm in randomized order for 20 min at each frequency in six healthy subjects before and after neostigmine. Volume oscillation was between 75-100 mL before, and 25-50 mL after neostigmine. Pressure waveforms were most variable shortly after commencing oscillation, reflecting an initial contractile response to distention. Elastance (i.e. pressure response to imposed volume) and hysteresivity were estimated; hysteresivity represents the proportion of energy added to the system during inflation, which cannot be recovered during deflation. Colonic elastance was frequency dependent, being highest and most variable at 10 cpm. In contrast, hysteresivity was not significantly different across frequencies. Neostigmine increased mean colonic elastance at all frequencies, and hysteresivity only at 5 cpm. Thus, colonic mechanical properties, particularly elastance are frequency-dependent. The frequency-dependence of colonic mechanical properties is worthy of future study because it may provide insights into reflex responses in health and disease.

Influence of ion chamber response on in-air profile measurements in megavoltage photon beams.

This article presents an investigation of the influence of the ion chamber response, including buildup caps, on the measurement of in-air off-axis ratio (OAR) profiles in megavoltage photon beams using Monte Carlo simulations with the EGSnrc system. Two new techniques for the calculation of OAR profiles are presented. Results of the Monte Carlo simulations are compared to measurements performed in 6, 10 and 25 MV photon beams produced by an Elekta Precise linac and shown to agree within the experimental and simulation uncertainties. Comparisons with calculated in-air kerma profiles demonstrate that using a plastic mini phantom gives more accurate air-kerma measurements than using high-Z material buildup caps and that the variation of chamber response with distance from the central axis must be taken into account.