Mixing Rules for Left-Handed Disordered Metamaterials: Effective-Medium and Dispersion Properties.

Left-handed materials are known to exhibit exotic properties in controlling electromagnetic fields, with direct applications in negative reflection and refraction, conformal optical mapping, and electromagnetic cloaking. While typical left-handed materials are constructed periodic metal-dielectric structures, the same effect can be obtained in composite guest-host systems with no periodicity or structural order. Such systems are typically described by the effective-medium approach, in which the components of the electric permittivity tensor are determined as a function of individual material properties and doping concentration. In this paper, we extend the discussion on the mixing rules to include left-handed composite systems and highlight the exotic properties arising from the effective-medium approach in this framework in terms of effective values and dispersion properties.

Towards Highly Efficient Nitrogen Dioxide Gas Sensors in Humid and Wet Environments Using Triggerable-Polymer Metasurfaces.

We report simulations on a highly-sensitive class of metasurface-based nitrogen dioxide (NO2) gas sensors, operating in the telecom C band around the 1550 nm line and exhibiting strong variations in terms of the reflection coefficient after assimilation of NO2 molecules. The unit architecture employs a polymer-based (polyvinylidene fluoride-PVDF or polyimide-PI) motif of either half-rings, rods, or disks having selected sizes and orientations, deposited on a gold substrate. On top of this, we add a layer of hydrophyllic polymer (POEGMA) functionalized with a NO2-responsive monomer (PAPUEMA), which is able to adsorb water molecules only in the presence of NO2 molecules. In this process, the POEGMA raises its hidrophyllicity, while not triggering a phase change in the bulk material, which, in turn, modifies its electrical properties. Contrary to absorption-based gas detection and electrical signal-based sensors, which experience considerable limitations in humid or wet environments, our method stands out by simple exploitation of the basic material properties of the functionalized polymer. The results show that NO2-triggered water molecule adsorption from humid and wet environments can be used in conjunction with our metasurface architecture in order to provide a highly-sensitive response in the desired spectral window. Additionally, instead of measuring the absorption spectrum of the NO2 gas, in which humidity counts as a parasitic effect due to spectral overlap, this method allows tuning to a desired wavelength at which the water molecules are transparent, by scaling the geometry and thicknesses of the layers to respond to a desired wavelength. All these advantages make our proposed sensor architecture an extremely-viable candidate for both biological and atmospheric NO2 gas-sensing applications.

Synergistic aircraft and ground observations of transported wildfire smoke and its impact on air quality in New York City during the 2018 LISTOS campaign.

Air pollution associated with wildfire smoke transport during the summer can significantly affect ozone (O3) and particulate matter (PM) concentrations, even in heavily populated areas like New York City (NYC). Here, we use observations from aircraft, ground-based lidar, in-situ analyzers and satellite to study and assess wildfire smoke transport, vertical distribution, optical properties, and potential impact on air quality in the NYC urban and coastal areas during the summer 2018 Long Island Sound Tropospheric Ozone Study (LISTOS). We investigate an episode of dense smoke transported and mixed into the planetary boundary layer (PBL) on August 15-17, 2018. The horizontal advection of the smoke is shown to be characterized with the prevailing northwest winds in the PBL (velocity > 10 m/s) based on Doppler wind lidar measurements. The wildfire sources and smoke transport paths from the northwest US/Canada to northeast US are identified from the NOAA hazard mapping system (HMS) fires and smoke product and NOAA-HYbrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) backward trajectory analysis. The smoke particles are distinguished from the urban aerosols by showing larger lidar-ratio (70-sr at 532-nm) and smaller depolarization ratio (0.02) at 1064-nm using the NASA High Altitude Lidar Observatory (HALO) airborne high-spectral resolution lidar (HSRL) measurements. The extinction-related angstrom exponents in the near-infrared (IR at 1020-1640 nm) and Ultraviolet (UV at 340-440 nm) from NASA-Aerosol Robotic Network (AERONET) product show a reverse variation trend along the smoke loadings, and their absolute differences indicate strong correlation with the smoke-Aerosol Optical Depth (AOD) (R > 0.94). We show that the aloft smoke plumes can contribute as much as 60-70% to the column AOD and that concurrent high-loadings of O3, carbon monoxide (CO), and black carbon (BC) were found in the elevated smoke layers from the University of Maryland (UMD) aircraft in-situ observations. Meanwhile, the surface PM2.5 (PM with diameter ≤ 2.5 µm), organic carbon (OC) and CO measurements show coincident and sharp increase (e.g., PM2.5 from 5 µg/m3 before the plume intrusion to ~30 µg/m3) with the onset of the plume intrusions into the PBL along with hourly O3 exceedances in the NYC region. We further evaluate the NOAA-National Air Quality Forecasting Capability (NAQFC) model PBL-height, PM2.5, and O3 with the observations and demonstrate good consistency near the ground during the convective PBL period, but significant bias at other times. The aloft smoke layers are sometimes missed by the model.

Evaluation of the Uncertainty in Satellite-Based Crop State Variable Retrievals Due to Site and Growth Stage Specific Factors and Their Potential in Coupling with Crop Growth Models.

Coupling crop growth models and remote sensing provides the potential to improve our understanding of the genotype x environment x management (G × E × M) variability of crop growth on a global scale. Unfortunately, the uncertainty in the relationship between the satellite measurements and the crop state variables across different sites and growth stages makes it difficult to perform the coupling. In this study, we evaluate the effects of this uncertainty with MODIS data at the Mead, Nebraska Ameriflux sites (US-Ne1, US-Ne2, and US-Ne3) and accurate, collocated Hybrid-Maize (HM) simulations of leaf area index (LAI) and canopy light use efficiency (LUECanopy). The simulations are used to both explore the sensitivity of the satellite-estimated genotype × management (G × M) parameters to the satellite retrieval regression coefficients and to quantify the amount of uncertainty attributable to site and growth stage specific factors. Additional ground-truth datasets of LAI and LUECanopy are used to validate the analysis. The results show that uncertainty in the LAI/satellite measurement regression coefficients lead to large uncertainty in the G × M parameters retrievable from satellites. In addition to traditional leave-one-site-out regression analysis, the regression coefficient uncertainty is assessed by evaluating the retrieval performance of the temporal change in LAI and LUECanopy. The weekly change in LAI is shown to be retrievable with a correlation coefficient absolute value (|r|) of 0.70 and root-mean square error (RMSE) value of 0.4, which is significantly better than the performance expected if the uncertainty was caused by random error rather than secondary effects caused by site and growth stage specific factors (an expected |r| value of 0.36 and RMSE value of 1.46 assuming random error). As a result, this study highlights the importance of accounting for site and growth stage specific factors in remote sensing retrievals for future work developing methods coupling remote sensing with crop growth models.

Hypersensitivity Pneumonitis: Radiologic Phenotypes Are Associated With Distinct Survival Time and Pulmonary Function Trajectory.

BACKGROUND: Hypersensitivity pneumonitis (HP) is an interstitial lung disease with a better prognosis, on average, than idiopathic pulmonary fibrosis (IPF). We compare survival time and pulmonary function trajectory in patients with HP and IPF by radiologic phenotype. METHODS: HP (n = 117) was diagnosed if surgical/transbronchial lung biopsy, BAL, and exposure history results suggested this diagnosis. IPF (n = 152) was clinically and histopathologically diagnosed. All participants had a baseline high-resolution CT (HRCT) scan and FVC % predicted. Three thoracic radiologists documented radiologic features. Survival time is from HRCT scan to death or lung transplant. Cox proportional hazards models identify variables associated with survival time. Linear mixed models compare post-HRCT scan FVC % predicted trajectories. RESULTS: Subjects were grouped by clinical diagnosis and three mutually exclusive radiologic phenotypes: honeycomb present, non-honeycomb fibrosis (traction bronchiectasis and reticulation) present, and nonfibrotic. Nonfibrotic HP had the longest event-free median survival (> 14.73 years) and improving FVC % predicted (1.92%; 95% CI, 0.49-3.35; P = .009). HP with non-honeycomb fibrosis had longer survival than IPF (> 7.95 vs 5.20 years), and both groups experienced a significant decline in FVC % predicted. Subjects with HP and IPF with honeycombing had poor survival (2.76 and 2.81 years, respectively) and significant decline in FVC % predicted. CONCLUSIONS: Three prognostically distinct, radiologically defined phenotypes are identified among patients with HP. The importance of pursuing a specific diagnosis (eg, HP vs IPF) among patients with non-honeycomb fibrosis is highlighted. When radiologic honeycombing is present, invasive diagnostic testing directed at determining the diagnosis may be of limited value given a uniformly poor prognosis.

Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis.

High-resolution computed tomography (HRCT) may be useful for diagnosing hypersensitivity pneumonitis. Here, we develop and validate a radiological diagnosis model and model-based points score.Patients with interstitial lung disease seen at the University of Michigan Health System (derivation cohort) or enrolling in the Lung Tissue Research Consortium (validation cohort) were included. A thin-section, inspiratory HRCT scan was required. Thoracic radiologists documented radiological features.The derivation cohort comprised 356 subjects (33.9% hypersensitivity pneumonitis) and the validation cohort comprised 424 subjects (15.5% hypersensitivity pneumonitis). An age-, sex- and smoking status-adjusted logistic regression model identified extent of mosaic attenuation or air trapping greater than that of reticulation ("MA-AT>Reticulation"; OR 6.20, 95% CI 3.53-10.90; p<0.0001) and diffuse axial disease distribution (OR 2.33, 95% CI 1.31-4.16; p=0.004) as hypersensitivity pneumonitis predictors (area under the receiver operating characteristic curve 0.814). A model-based score >2 (1 point for axial distribution, 2 points for "MA-AT>Reticulation") has specificity 90% and positive predictive value (PPV) 74% in the derivation cohort and specificity 96% and PPV 44% in the validation cohort. Similar model performance is seen with population restriction to those reporting no exposure (score >2: specificity 91%).When radiological mosaic attenuation or air trapping are more extensive than reticulation and disease has diffuse axial distribution, hypersensitivity pneumonitis specificity is high and false diagnosis risk low (<10%), but PPV is diminished in a low-prevalence setting.

Utilizing Collocated Crop Growth Model Simulations to Train Agronomic Satellite Retrieval Algorithms.

Due to its worldwide coverage and high revisit time, satellite-based remote sensing provides the ability to monitor in-season crop state variables and yields globally. In this study, we presented a novel approach to training agronomic satellite retrieval algorithms by utilizing collocated crop growth model simulations and solar-reflective satellite measurements. Specifically, we showed that bidirectional long short-term memory networks (BLSTMs) can be trained to predict the in-season state variables and yields of Agricultural Production Systems sIMulator (APSIM) maize crop growth model simulations from collocated Moderate Resolution Imaging Spectroradiometer (MODIS) 500-m satellite measurements over the United States Corn Belt at a regional scale. We evaluated the performance of the BLSTMs through both k-fold cross validation and comparison to regional scale ground-truth yields and phenology. Using k-fold cross validation, we showed that three distinct in-season maize state variables (leaf area index, aboveground biomass, and specific leaf area) can be retrieved with cross-validated R2 values ranging from 0.4 to 0.8 for significant portions of the season. Several other plant, soil, and phenological in-season state variables were also evaluated in the study for their retrievability via k-fold cross validation. In addition, by comparing to survey-based United State Department of Agriculture (USDA) ground truth data, we showed that the BLSTMs are able to predict actual county-level yields with R2 values between 0.45 and 0.6 and actual state-level phenological dates (emergence, silking, and maturity) with R2 values between 0.75 and 0.85. We believe that a potential application of this methodology is to develop satellite products to monitor in-season field-scale crop growth on a global scale by reproducing the methodology with field-scale crop growth model simulations (utilizing farmer-recorded field-scale agromanagement data) and collocated high-resolution satellite data (fused with moderate-resolution satellite data).

Possible UIP pattern on high-resolution computed tomography is associated with better survival than definite UIP in IPF patients.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease of unknown etiology. Inter-society consensus guidelines on IPF diagnosis and management outline radiologic patterns including definite usual interstitial pneumonia (UIP), possible UIP, and inconsistent with UIP. We evaluate these diagnostic categories as prognostic markers among patients with IPF. METHODS: Included subjects had biopsy-proven UIP, a multidisciplinary team diagnosis of IPF, and a baseline high-resolution computed tomography (HRCT). Thoracic radiologists assigned the radiologic pattern and documented the presence and extent of specific radiologic findings. The outcome of interest was lung transplant-free survival. RESULTS: IPF patients with a possible UIP pattern on HRCT had significantly longer Kaplan-Meier event-free survival compared to those with definite UIP pattern (5.21 and 3.57 years, respectively, p = 0.002). In a multivariable Cox proportional hazards model adjusted for baseline age, gender, %-predicted FVC, and %-predicted DLCO via the GAP Stage, extent of fibrosis (via the traction bronchiectasis score) and ever-smoker status, possible UIP pattern on HRCT (versus definite UIP) was associated with reduced hazard of death or lung transplant (HR = 0.42, CI 95% 0.23-0.78, p = 0.006). CONCLUSIONS: Radiologic diagnosis categories outlined by inter-society consensus guidelines is a widely-reported and potentially useful prognostic marker in IPF patients, with possible UIP pattern on HRCT associated with a favorable prognosis compared to definite UIP pattern, after adjusting for relevant covariates.

Intrathoracic Fat Measurements Using Multidetector Computed Tomography (MDCT): Feasibility and Reproducibility.

Intrathoracic fat volume, more specifically, epicardial fat volume, is an emerging imaging biomarker of adverse cardiovascular events. The purpose of this work is to show the feasibility and reproducibility of intrathoracic fat volume measurement applied to contrast-enhanced multidetector computed tomography images. A retrospective cohort study of 62 subjects free of cardiovascular disease (55% females, age = 49 ± 11 years) conducted from 2008 to 2011 formed the study group. Intrathoracic fat volume was defined as all fat voxels measuring -50 to -250 Hounsfield Unit within the intrathoracic cavity from the level of the pulmonary artery bifurcation to the heart apex. The intrathoracic fat was separated into epicardial and extrapericardial fat by tracing the pericardium. The measurements were obtained by 2 readers and compared for interrater reproducibility. The fat volume measurements for the study group were 141 ± 72 cm3 for intrathoracic fat, 58 ± 27 cm3 for epicardial fat, and 84 ± 50 cm3 for extrapericardial fat. There was no statistically significant difference in intrathoracic fat volume measurements between the 2 readers, with correlation coefficients of 0.88 (P = .55) for intrathoracic fat volume and -0.12 (P = .33) for epicardial fat volume. Voxel-based measurement of intrathoracic fat, including the separation into epicardial and extrapericardial fat, is feasible and highly reproducible from multidetector computed tomography scans.

Sepsis as 2 problems: Identifying sepsis at admission and predicting onset in the hospital using an electronic medical record-based acuity score.

PURPOSE: Early identification and treatment improve outcomes for patients with sepsis. Current screening tools are limited. We present a new approach, recognizing that sepsis patients comprise 2 distinct and unequal populations: patients with sepsis present on admission (85%) and patients who develop sepsis in the hospital (15%) with mortality rates of 12% and 35%, respectively. METHODS: Models are developed and tested based on 258 836 adult inpatient records from 4 hospitals. A "present on admission" model identifies patients admitted to a hospital with sepsis, and a "not present on admission" model predicts postadmission onset. Inputs include common clinical measurements and the Rothman Index. Sepsis was determined using International Classification of Diseases, Ninth Revision, codes. RESULTS: For sepsis present on admission, area under the curves ranged from 0.87 to 0.91. Operating points chosen to yield 75% and 50% sensitivity achieve positive predictive values of 17% to 25% and 29% to 40%, respectively. For sepsis not present on admission, at 65% sensitivity, positive predictive values ranged from 10% to 20% across hospitals. CONCLUSIONS: This approach yields good to excellent discriminatory performance among adult inpatients for predicting sepsis present on admission or developed within the hospital and may aid in the timely delivery of care.

Application of a broadly tunable SG-DBR QCL for multi-species trace gas spectroscopy.

Feasibility of using a mid-Infrared tunable sampled-grating distributed Bragg reflectors quantum cascade laser for high resolution multicomponent trace gas spectroscopy is demonstrated. By controlling the driving currents to the front and back sections of the laser, we were able to tune a pulsed 4.55 µm laser over a frequency range a of 30 cm(-1) with high resolution, accuracy and repeatability. The laser was applied to absorption spectroscopy of ambient and reduced pressure (150 Torr) air in a 205 meters multi-pass Herriott cell, and by using standard LSQ fitting to a spectral database of these trace gases (HITRAN), the concentrations of nitrous oxide, carbon monoxide, and water vapor were retrieved.

Increased epicardial fat is independently associated with the presence and chronicity of atrial fibrillation and radiofrequency ablation outcome.

OBJECTIVE: To determine whether intrathoracic fat volumes are associated with presence and chronicity of atrial fibrillation (AF) and radiofrequency ablation (RFA) treatment outcome. METHODS: IRB approval was obtained and patient consent was waived for this HIPAA-compliant retrospective study. 169 patients with AF (75 non-paroxysmal and 94 paroxysmal) and 62 control patients underwent cardiac CT examination. Extrapericardial (EPFV) and epicardial fat volumes (EFV) were measured on CT, the sum of which is the total intrathoracic fat volume. Associations between these three fat volumes and presence and chronicity of AF, and outcome after RFA, were evaluated using logistic regression analysis. RESULTS: EFV was significantly associated with presence [OR 1.01 (95 % CI 1.003-1.03), p = 0.01], chronicity of AF [1.008 (1.001-1.020), p = 0.03] and AF recurrence after RFA [1.009 (1.001-1.01), p = 0.02] after adjustment for age, gender and BMI. Patients with a larger EFV had a shorter time to AF recurrence (p = 0.017) and a higher rate of recurrence (54 % vs 46 %) (p = 0.002) after RFA. EPFV had no significant associations. CONCLUSION: Increased epicardial fat is associated with the presence and chronicity of AF, a higher probability of AF recurrence after RFA and a shorter AF-free interval. KEY POINTS: • Increased epicardial fat is associated with presence and chronicity of atrial fibrillation • Extensive epicardial fat is associated with earlier recurrences of AF after ablation • Extensive epicardial fat may reduce transmurality of ablation by affecting current dynamics.

Left atrial function and maximum volume as determined by MDCT are independently associated with atrial fibrillation.

RATIONALE AND OBJECTIVES: To assess whether left atrial (LA) volume, function, and diameter as determined by multidetector computed tomography (MDCT) are associated with the presence and chronicity of atrial fibrillation (AF). MATERIALS AND METHODS: A total of 232 subjects, 156 with AF (43 with chronic and 113 with paroxysmal) and 76 normal subjects, formed the study population. AF subjects underwent MDCT of the pulmonary veins and LA, and normal subjects underwent coronary computed tomography (CT), on which LA volume, function, and diameter were measured. Associations between each MDCT LA parameter and presence and chronicity of AF were assessed using logistic regression analysis. RESULTS: The indexed LA maximum volume (odds ratio [OR]=2.42; 95% confidence interval [CI], 1.43-4.08; P=.0009) was significantly associated with chronicity and presence of AF (OR=1.06; 95% CI, 1.03-1.10; P=.0003) after adjustment for traditional risk factors. The LA function was associated with presence of AF (OR=0.93; 95% CI, 0.89-0.97; P=.0005), but not with AF chronicity (OR=1.12; 95% CI, 0.93-1.33; P=.21). CONCLUSIONS: Decreased LA function is associated with presence of AF, and increased LA maximum volume is associated with presence and chronicity of AF, independent of traditional risk factors.

Smoking-related idiopathic interstitial pneumonia.

Cigarette smoking is a key factor in the development of numerous pulmonary diseases. An international group of clinicians, radiologists and pathologists evaluated patients with previously identified idiopathic interstitial pneumonia (IIP) to determine unique features of cigarette smoking. Phase 1 (derivation group) identified smoking-related features in patients with a history of smoking (n=41). Phase 2 (validation group) determined if these features correctly predicted the smoking status of IIP patients (n=100) to participants blinded to smoking history. Finally, the investigators sought to determine if a new smoking-related interstitial lung disease phenotype could be defined. Phase 1 suggested that preserved forced vital capacity with disproportionately reduced diffusing capacity of the lung for carbon monoxide, and various radiographic and histopathological findings were smoking-related features. In phase 2, the kappa coefficient among clinicians was 0.16 (95% CI 0.11-0.21), among the pathologists 0.36 (95% CI 0.32-0.40) and among the radiologists 0.43 (95% CI 0.35-0.52) for smoking-related features. Eight of the 100 cases were felt to represent a potential smoking-related interstitial lung disease. Smoking-related features of interstitial lung disease were identified in a minority of smokers and were not specific for smoking. This study is limited by its retrospective design, the potential for recall bias in smoking history and lack of information on second-hand smoke exposure. Further research is needed to understand the relationship between smoking and interstitial lung disease.

A randomized controlled trial of palifermin (recombinant human keratinocyte growth factor) for the treatment of inadequate CD4+ T-lymphocyte recovery in patients with HIV-1 infection on antiretroviral therapy.

BACKGROUND: Poor CD4 lymphocyte recovery on antiretroviral therapy (ART) is associated with reduced function of the thymus. Palifermin (keratinocyte growth factor), by providing support to the thymic epithelium, promotes lymphopoiesis in animal models of bone marrow transplantation and graft-versus-host disease. METHODS: In AIDS Clinical Trials Group A5212, a randomized, double-blind, placebo-controlled study, 99 HIV-infected patients on ART with plasma HIV-1 RNA levels ≤200 copies per milliliter for ≥6 months and CD4 lymphocyte counts <200 cells per cubic milliliter were randomized 1:1:1:1 to receive once daily intravenous administration of placebo or 20, 40, or 60 µg/kg of palifermin on 3 consecutive days. RESULTS: The median change in the CD4 T-cell count from baseline to week 12 was not significantly different between the placebo arm [15 (-16, 23) cells/mm] and the 20-µg/kg dose [11 (2, 32) cells/mm], the 40-µg/kg dose [12 (-2, 25) cells/mm], or the 60-µg/kg dose arm [8 (-13, 35) cells/mm] of palifermin. No significant changes were observed in thymus size or in the number of naive T cells or recent thymic emigrants. CONCLUSIONS: Palifermin in the doses studied was not effective in improving thymic function and did not raise CD4 lymphocyte counts in HIV-infected patients with low CD4 cell counts despite virologically effective ART.

Reference absolute and indexed values for left and right ventricular volume, function and mass from cardiac computed tomography.

INTRODUCTION: Left ventricular (LV) and right ventricular (RV) volumetric and functional parameters are important biomarkers for morbidity and mortality in patients with heart failure. PURPOSE: To retrospectively determine reference mean values of LV and RV volume, function and mass normalised by age, gender and body surface area (BSA) from retrospectively electrocardiographically gated 64-slice cardiac computed tomography (CCT) by using automated analysis software in healthy adults. MATERIALS AND METHODS: The study was approved by the institutional review board with a waiver of informed consent. Seventy-four healthy subjects (49% female, mean age 49.6 ± 11) free of hypertension and hypercholesterolaemia with a normal CCT formed the study population. Analyses of LV and RV volume (end-diastolic, end-systolic and stroke volumes), function (ejection fraction), LV mass and inter-rater reproducibility were performed with commercially available analysis software capable of automated contour detection. General linear model analysis was performed to assess statistical significance by age group after adjustment for gender and BSA. Bland-Altman analysis assessed the inter-rater agreement. RESULTS: The reference range for LV and RV volume, function, and LV mass was normalised to age, gender and BSA. Statistically significant differences were noted between genders in both LV mass and RV volume (P-value < 0.0001). Age, in concert with gender, was associated with significant differences in RV end-diastolic volume and LV ejection fraction (P-values 0.027 and 0.03). Bland-Altman analysis showed acceptable limits of agreement (±1.5% for ejection fraction) without systematic error. CONCLUSION: LV and RV volume, function and mass normalised to age, gender and BSA can be reported from CCT datasets, providing additional information important for patient management.

A contemporary carbon balance for the Northeast region of the United States.

Development of regional policies to reduce net emissions of carbon dioxide (CO2) would benefit from the quantification of the major components of the region's carbon balance--fossil fuel CO2 emissions and net fluxes between land ecosystems and the atmosphere. Through spatially detailed inventories of fossil fuel CO2 emissions and a terrestrial biogeochemistry model, we produce the first estimate of regional carbon balance for the Northeast United States between 2001 and 2005. Our analysis reveals that the region was a net carbon source of 259 Tg C/yr over this period. Carbon sequestration by land ecosystems across the region, mainly forests, compensated for about 6% of the region's fossil fuel emissions. Actions that reduce fossil fuel CO2 emissions are key to improving the region's carbon balance. Careful management of forested lands will be required to protect their role as a net carbon sink and a provider of important ecosystem services such as water purification, erosion control, wildlife habitat and diversity, and scenic landscapes.

Older HIV-infected patients on antiretroviral therapy have B-cell expansion and attenuated CD4 cell increases with immune activation reduction.

BACKGROUND: The contribution of immune activation to accelerated HIV-disease progression in older individuals has not been delineated. METHODS: Prospective multicenter cohort of older (≥45 years) and younger (18-30 years) HIV-infected adults initiating 192 weeks of antiretroviral therapy (ART). Longitudinal models of CD4 cell restoration examined associations with age-group, thymic volume, immune activation, and viral load. RESULTS: Forty-five older and 45 younger adults (median age 50 and 26 years, respectively) were studied. Older patients had fewer naive CD4 cells (P<0.001) and higher HLA-DR/CD38 expression on CD4 (P=0.05) and CD8 cells (P=0.07) than younger patients at any time on ART. The rate of naive and total CD4 cell increase was similar between age groups, but older patients had a faster mean rate of B-cell increase (by +0.7 cells/week; P=0.01), to higher counts than healthy controls after 192 weeks (P=0.003). Naive CD4 increases from baseline were associated with immune activation reductions (as declines from baseline of %CD8 cells expressing HLA-DR/CD38; P<0.0001), but these increases were attenuated in older patients, or in those with small thymuses. A 15% reduction in activation was associated with naive gains of 29.9 and 6.2 cells/µl in younger, versus older patients, or with gains of 25.7, 23.4, and 2.1 cells/µl in patients with the largest, intermediate, and smallest thymuses, respectively (P<0.01 for interactions between activation reduction and age-group or thymic volume). CONCLUSION: Older patients had significant B-cell expansion, higher levels of immune activation markers, and significantly attenuated naive CD4 cell gains associated with activation reduction.

Reference normal absolute and indexed values from ECG-gated MDCT: left atrial volume, function, and diameter.

OBJECTIVE: The purpose of this study was to retrospectively determine CT-based normal reference values of left atrial volume, function, and diameter normalized by age, sex, and body surface area. MATERIALS AND METHODS: The study group consisted of 74 subjects with normal findings at ECG-gated coronary CT angiography performed with retrospective gating. Analysis of left atrial volume (end-diastolic, end-systolic, and stroke volume) and function (ejection fraction) was performed with the Simpson method. Left atrial diameter was measured in the anteroposterior dimension. General linear model analysis was performed to model the data and assess statistical significance by age group after adjustment for sex and body surface area. RESULTS: The reference range for left atrial volume, function, and diameter was normalized (indexed) to age, sex, and body surface area in healthy subjects. A statistically significant difference was noted between left atrial volume and age without adjustment for sex and body surface area, but no statistically significant difference was found after adjustment for these variables. Sex and body surface area had a significant influence on left atrial volume, function, and diameter. CONCLUSION: Left atrial volume, function, and diameter normalized to age, sex, and body surface area can be reported from CTA datasets and may provide information important for patient care.

Neural network approach to retrieve the inherent optical properties of the ocean from observations of MODIS.

Retrieving the inherent optical properties of water from remote sensing multispectral reflectance measurements is difficult due to both the complex nature of the forward modeling and the inherent nonlinearity of the inverse problem. In such cases, neural network (NN) techniques have a long history in inverting complex nonlinear systems. The process we adopt utilizes two NNs in parallel. The first NN is used to relate the remote sensing reflectance at available MODIS-visible wavelengths (except the 678 nm fluorescence channel) to the absorption and backscatter coefficients at 442 nm (peak of chlorophyll absorption). The second NN separates algal and nonalgal absorption components, outputting the ratio of algal-to-nonalgal absorption. The resulting synthetically trained algorithm is tested using both the NASA Bio-Optical Marine Algorithm Data Set (NOMAD), as well as our own field datasets from the Chesapeake Bay and Long Island Sound, New York. Very good agreement is obtained, with R² values of 93.75%, 90.67%, and 86.43% for the total, algal, and nonalgal absorption, respectively, for the NOMAD. For our field data, which cover absorbing waters up to about 6 m⁻¹, R² is 91.87% for the total measured absorption.