Invited review: A position on the Global Livestock Environmental Assessment Model (GLEAM).

The livestock sector is one of the fastest growing subsectors of the agricultural economy and, while it makes a major contribution to global food supply and economic development, it also consumes significant amounts of natural resources and alters the environment. In order to improve our understanding of the global environmental impact of livestock supply chains, the Food and Agriculture Organization of the United Nations has developed the Global Livestock Environmental Assessment Model (GLEAM). The purpose of this paper is to provide a review of GLEAM. Specifically, it explains the model architecture, methods and functionality, that is the types of analysis that the model can perform. The model focuses primarily on the quantification of greenhouse gases emissions arising from the production of the 11 main livestock commodities. The model inputs and outputs are managed and produced as raster data sets, with spatial resolution of 0.05 decimal degrees. The Global Livestock Environmental Assessment Model v1.0 consists of five distinct modules: (a) the Herd Module; (b) the Manure Module; (c) the Feed Module; (d) the System Module; (e) the Allocation Module. In terms of the modelling approach, GLEAM has several advantages. For example spatial information on livestock distributions and crops yields enables rations to be derived that reflect the local availability of feed resources in developing countries. The Global Livestock Environmental Assessment Model also contains a herd model that enables livestock statistics to be disaggregated and variation in livestock performance and management to be captured. Priorities for future development of GLEAM include: improving data quality and the methods used to perform emissions calculations; extending the scope of the model to include selected additional environmental impacts and to enable predictive modelling; and improving the utility of GLEAM output.

[Diving accident-induced arterial gas embolism]. / Arteriële gasembolieën na een duikongeval.

BACKGROUND: During scuba diving, nitrogen dissolves into the body tissues due to elevated pressure under water. During a sudden drop in pressure due to a rapid return to the water surface, arterial gas embolism can arise from pulmonary barotrauma. In a later phase, nitrogen bubbles can also arise in the venous circulation (decompression sickness). Arterial bubbles can incur vascular damage, obstruction, hypoxia and infarction. CASE DESCRIPTION: A 53-year-old healthy sport diver presented at the emergency department in a hypovolemic shock with progressive paresis of all the extremities. He had made an emergency ascent from a depth of 47 meter. During recompression therapy his condition deteriorated. It transpired that he had an patent foramen ovale. As a consequence of this, nitrogen bubbles due to decompression sickness entered the arterial circulation. Despite maximum therapeutic intervention the patient remained paretic. CONCLUSION: After an ill-fated dive, this patient with patent foramen ovale contracted arterial gas embolism due to pulmonary barotrauma and, at a later stage, decompression sickness. There was increasing damage to the spinal cord resulting in severe physiological disruption.

Collagen-rich stroma in aggressive colon tumors induces mesenchymal gene expression and tumor cell invasion.

Gene expression-based classification systems have identified an aggressive colon cancer subtype with mesenchymal features, possibly reflecting epithelial-to-mesenchymal transition (EMT) of tumor cells. However, stromal fibroblasts contribute extensively to the mesenchymal phenotype of aggressive colon tumors, challenging the notion of tumor EMT. To separately study the neoplastic and stromal compartments of colon tumors, we have generated a stroma gene filter (SGF). Comparative analysis of stromahigh and stromalow tumors shows that the neoplastic cells in stromahigh tumors express specific EMT drivers (ZEB2, TWIST1, TWIST2) and that 98% of differentially expressed genes are strongly correlated with them. Analysis of differential gene expression between mesenchymal and epithelial cancer cell lines revealed that hepatocyte nuclear factor 4α (HNF4α), a transcriptional activator of intestinal (epithelial) differentiation, and its target genes are highly expressed in epithelial cancer cell lines. However, mesenchymal-type cancer cell lines expressed only part of the mesenchymal genes expressed by tumor-derived neoplastic cells, suggesting that external cues were lacking. We found that collagen-I dominates the extracellular matrix in aggressive colon cancer. Mimicking the tumor microenvironment by replacing laminin-rich Matrigel with collagen-I was sufficient to induce tumor-specific mesenchymal gene expression, suppression of HNF4α and its target genes, and collective tumor cell invasion of patient-derived colon tumor organoids. The data connect collagen-rich stroma to mesenchymal gene expression in neoplastic cells and to collective tumor cell invasion. Targeting the tumor-collagen interface may therefore be explored as a novel strategy in the treatment of aggressive colon cancer.

Diving accidents: a cohort study from the Netherlands.

BACKGROUND: Diving is, besides professional reasons, an increasingly popular leisure activity. Whilst statistically compared to other sports safe, diving accidents can result in serious complications. In order to treat this specific patient category adequately, early diagnosis is important. In this study, we explore various medical aspects of diving accidents. By sharing our experiences, we intend to create awareness and enhance urgent medical care for this specific category of patients. METHODS: We conducted a retrospective cohort study using anonymized patient records from the emergency department (ED) of the Admiraal De Ruyter Hospital (ADRZ) and affiliated Medical Centre Hyperbaric Oxygen Therapy (MCHZ1) both in Goes, Netherlands. We evaluated all patients that presented to our ED as a diving accident from 1 November 2011 to 30 August 2015. RESULTS: In the selected period, 43 patients presented to our ED with complaints after diving; 84 % were male and 49 % older than 40 years, and they came by ambulance or referred by a general practitioner or other medical centres in the area; 70 % presented the same date as their dive, 21 % 1 to 3 days and 9 % later than 3 days after having dived. Pain was the most frequently reported symptom (44 %), followed by constitutional symptoms (42 %). Numbness or paraesthesia was reported in 33 %. Respiratory symptoms, dizziness, a change in mental status (e.g. apathy, confused or restlessness) and problems with coordination were present in 10-21 % of the cases. Symptoms that were apparent in less than 10 % of the cases were cutis marmorata, visual or auditory complaints, muscle weakness, cardiovascular symptoms or a malfunction of the anal sphincter or urinary bladder. Most of our patients exhibited more than one symptom; 70 % of all patients received hyperbaric oxygen recompression therapy. CONCLUSIONS: The limited number of patients presenting with complaints after a diving incident, the difficulty of recognition and the (potential) huge impact if not recognized and treated adequately make us believe that every diving accident should be discussed with a centre of expertise.

Severe spinal cord decompression illness after an uneventful North Sea dive.

The aim of this case report is to illustrate that, even under moderate conditions, a dive can result in spinal cord decompression illness (DCI). The diver in question completed five dives with the same profile. The first four included substantial physical strain, while the final dive was for observation only, without physical strain. The spinal cord was the target organ for DCI. We discuss the roles of various diver-related risk factors and of factors related to the dive itself. Older divers have a higher risk for decompression incidents. The nature of the dive profile is a major factor in the uptake and release of inert gas. Physical exertion during pressure-exposure boosts the inert gas load, increases bubbling in tissues and raises the risk of DCI in the decompression phase of the dive. We discuss the causal involvement of such risk factors in this case, given the characteristics of the diver and the circumstances of the dive. Finally, we want to express our concern for physical fitness and smoking habits, especially for divers over the age of 40.

Use of bidirectional barbed suture in laparoscopic myomectomy: evaluation of perioperative outcomes, safety, and efficacy.

STUDY OBJECTIVE: To compare perioperative outcomes during laparoscopic myomectomy using a bidirectional barbed suture vs conventional smooth suture. DESIGN: Retrospective analysis of 138 consecutive laparoscopic myomectomies performed by a single surgeon over 3 years (Canadian Task Force classification II-2). SETTING: Major university teaching hospital. PATIENTS: One hundred thirty-eight women with symptomatic uterine myomas. INTERVENTIONS: In women undergoing laparoscopic myomectomy from February 2007 through April 2010, conventional smooth sutures were used in 31 patients, and bidirectional barbed suture in 107 patients. MEASUREMENTS AND MAIN RESULTS: The primary indications for laparoscopic myomectomy in either group were pelvic pain or pressure and abnormal uterine bleeding. Use of bidirectional barbed suture was found to significantly shorten the mean (SD) duration of surgery (118 [53] minutes vs 162 [69] minutes; p <.05) and reduce the duration of hospital stay (0.58 [0.46] days vs 0.97 [0.45] days; p <.05). No significant differences were observed between the 2 groups insofar as incidence of perioperative complications, estimated blood loss, and number or weight of myomas removed during surgery. CONCLUSION: Use of bidirectional barbed suture seems to facilitate closure of the hysterotomy site in laparoscopic myomectomy.

Issues and options in addressing the environmental consequences of livestock sector's growth.

The growth of the livestock sector is being achieved at substantial environmental costs. Today, livestock are a major stressor of the global environmental, occupying a quarter of emerged land (including a third of arable land), contributing close to a fifth of the anthropogenic greenhouse gas emissions, using eight percent of all water resources and threatening a wide range of endangered species. At the same time, livestock are also a crucial engine of rural growth and a tool for improving food security. Policies are required to guide the sector in achieving sometimes conflicting development objectives. Potential pathways include encouraging resource use efficiency, correcting for environmental externalities and accelerating technological change.

The effectiveness of a health-surveillance program for caisson saturation divers in a tunnel-boring machine: a microbiological survey.

The purpose of this field study is to report and evaluate the implementation of a health surveillance program we developed to monitor the microbiological load for saturation divers, including preventive and therapeutic interventions. We extended the DMAC protocol for Saturation Diving Chamber Hygiene and added some components: ear inspections, swabs and environmental swabs every third day. The implementation was evaluated by analyzing the results of the activities. In a pre-saturation dive check we examined a total of 17 divers. Here we present the data from all seven saturation phases, collected over a period of 1.5 years. In every saturation phase we have found pathogenic bacteria or fungi in divers and in the environment, but more in some periods than in others. We did not observe any serious infection that required a diver to abort his stay in the living chamber. This health surveillance program has demonstrated the potential value of an early warning system to prevent problems. The bacterial load found in divers and in the environment was clearly visible. Prevention could be improved by more consistent implementation of the protocol. Fortunately, the infections had no serious consequences for the health of the workers or for the continuation of the work process.

Doppler ultrasound surveillance in deep tunneling compressed-air work with Trimix breathing: bounce dive technique compared to saturation-excursion technique.

The Western Scheldt Tunneling Project in The Netherlands provided a unique opportunity to evaluate two deep-diving techniques with Doppler ultrasound surveillance. Divers used the bounce diving techniques for repair and maintenance of the TBM. The tunnel boring machine jammed at its deepest depth. As a result the work time was not sufficient. The saturation diving technique was developed and permitted longer work time at great depth. Thirty-one divers were involved in this project. Twenty-three divers were examined using Doppler ultrasound. Data analysis addressed 52 exposures to Trimix at 4.6-4.8 bar gauge using the bounce technique and 354 exposures to Trimix at 4.0-6.9 bar gauge on saturation excursions. No decompression incidents occurred with either technique during the described phase of the project. Doppler ultrasound revealed that the bubble loads assessed in both techniques were generally low. We find out, that despite longer working hours, shorter decompression times and larger physical workloads, the saturation-excursion technique was associated with significant lower bubble grades than in the bounce technique using Doppler Ultrasound. We conclude that the saturation-excursion technique with Trimix is a good option for deep and long exposures in caisson work. The Doppler technique proved valuable, and it should be incorporated in future compressed-air work.

Health and efficiency in trimix versus air breathing in compressed air workers.

The Western Scheldt Tunneling Project in the Netherlands provided a unique opportunity to evaluate the effects of trimix usage on the health of compressed air workers and the efficiency of the project. Data analysis addressed 318 exposures to compressed air at 3.9-4.4 bar gauge and 52 exposures to trimix (25% oxygen, 25% helium, and 50% nitrogen) at 4.6-4.8 bar gauge. Results revealed three incidents of decompression sickness all of which involved the use of compressed air. During exposure to compressed air, the effects of nitrogen narcosis were manifested in operational errors and increased fatigue among the workers. When using trimix, less effort was required for breathing, and mandatory decompression times for stays of a specific duration and maximum depth were considerably shorter. We conclude that it might be rational--for both medical and operational reasons--to use breathing gases with lower nitrogen fractions (e.g., trimix) for deep-caisson work at pressures exceeding 3 bar gauge, although definitive studies are needed.

Coronary artery fistula formation secondary to permanent pacemaker placement.

We present the findings in two patients who apparently developed a coronary artery fistula as a complication of an endocardial pacing electrode. This complication may actually be occurring more frequently than recognized because the patient may be asymptomatic or minimally symptomatic and therefore not undergo a coronary angiogram. Awareness of this potentially serious complication is important and stresses the need for proper electrode placement without excess pressure on the tip.