Community Characteristics are Associated with Blood Pressure Levels in a Racially Integrated Community.

Community problems have been associated with higher, and community resources and social cohesion with lower, blood pressure. However, prior studies have not accounted for potential confounding by residential racial segregation. This study tested associations between community characteristics and blood pressure levels and prevalent hypertension in a racially integrated community. The Exploring Health Disparities in Integrated Communities Study measured blood pressure in residents of two contiguous racially integrated and low-income US Census Tracts. Community characteristics included a standardized community problem score and binary indicators for community social cohesion, having a community leader available, and having at least one community resource observed on the participant's block. In adjusted models, greater community problems and proximity to resources were associated with lower systolic (ß = -2.020, p = 0.028; ß = -4.132, p = 0.010) and diastolic (ß = -1.261, p = 0.038; ß = -2.290, 0.031) blood pressure, respectively, among whites (n = 548). Social cohesion was associated with higher systolic (ß = 4.905, p = 0.009) and diastolic blood pressure (ß = 3.379, p = 0.008) among African Americans (n = 777). In one racially integrated low-income community, community characteristics were associated with blood pressure levels, and associations differed by race. Directions of associations for two findings differed from prior studies; greater community problem was associated with lower blood pressure in whites and community social cohesion was associated with higher blood pressure in African Americans. These findings may be due to exposure to adverse environmental conditions and hypertensive risk factors in this low-income community.

Constraints on oceanic methane emissions west of Svalbard from atmospheric in situ measurements and Lagrangian transport modeling.

Methane stored in seabed reservoirs such as methane hydrates can reach the atmosphere in the form of bubbles or dissolved in water. Hydrates could destabilize with rising temperature further increasing greenhouse gas emissions in a warming climate. To assess the impact of oceanic emissions from the area west of Svalbard, where methane hydrates are abundant, we used measurements collected with a research aircraft (Facility for Airborne Atmospheric Measurements) and a ship (Helmer Hansen) during the Summer 2014 and for Zeppelin Observatory for the full year. We present a model-supported analysis of the atmospheric CH4 mixing ratios measured by the different platforms. To address uncertainty about where CH4 emissions actually occur, we explored three scenarios: areas with known seeps, a hydrate stability model, and an ocean depth criterion. We then used a budget analysis and a Lagrangian particle dispersion model to compare measurements taken upwind and downwind of the potential CH4 emission areas. We found small differences between the CH4 mixing ratios measured upwind and downwind of the potential emission areas during the campaign. By taking into account measurement and sampling uncertainties and by determining the sensitivity of the measured mixing ratios to potential oceanic emissions, we provide upper limits for the CH4 fluxes. The CH4 flux during the campaign was small, with an upper limit of 2.5 nmol m-2 s-1 in the stability model scenario. The Zeppelin Observatory data for 2014 suggest CH4 fluxes from the Svalbard continental platform below 0.2 Tg yr-1. All estimates are in the lower range of values previously reported.

Measurements of δ13C in CH4 and using particle dispersion modeling to characterize sources of Arctic methane within an air mass.

A stratified air mass enriched in methane (CH4) was sampled at ~600 m to ~2000 m altitude, between the north coast of Norway and Svalbard as part of the Methane in the Arctic: Measurements and Modelling campaign on board the UK's BAe-146-301 Atmospheric Research Aircraft. The approach used here, which combines interpretation of multiple tracers with transport modeling, enables better understanding of the emission sources that contribute to the background mixing ratios of CH4 in the Arctic. Importantly, it allows constraints to be placed on the location and isotopic bulk signature of the emission source(s). Measurements of δ13C in CH4 in whole air samples taken while traversing the air mass identified that the source(s) had a strongly depleted bulk δ13C CH4 isotopic signature of -70 (±2.1)‰. Combined Numerical Atmospheric-dispersion Modeling Environment and inventory analysis indicates that the air mass was recently in the planetary boundary layer over northwest Russia and the Barents Sea, with the likely dominant source of methane being from wetlands in that region.

Fluoroquinolones in the treatment of bacterial keratitis.

PURPOSE: We evaluated the potential role of three topical fluoroquinolones in the treatment of bacterial keratitis by means of a laboratory database. METHODS: Antibiotic susceptibilities were determined for 153 isolates from patients with bacterial keratitis. Results were analyzed for each fluoroquinolone individually and in combination with cefazolin. RESULTS: Predicted susceptibility to each cefazolin-fluoroquinolone combination (98.7%) was superior to that for single-agent therapy with ofloxacin (88.2%), ciprofloxacin (82.3%), or norfloxacin (80.4%) (P = .0002). A cefazolin-fluoroquinolone combination (98.7%) was comparable to a cefazolin-gentamicin combination (97.4%). CONCLUSIONS: Combination therapy with cefazolin and a fluoroquinolone offers a reasonable alternative for the treatment of bacterial keratitis. Single-agent therapy with fluoroquinolones for vision-threatening bacterial keratitis is not advised.

Possible consequences of shaking hands with your patients with epidemic keratoconjunctivitis.

PURPOSE: We evaluated patients' hands as a possible vector for the spread of epidemic kerato-conjunctivitis. METHODS: The hands and conjunctivitis of 26 patients with epidemic keratoconjunctivitis and the hands of 26 uninfected control patients were cultured for infectious adenovirus. RESULTS: In 12 (46%) of 26 patients with epidemic keratoconjunctivitis, cultures from the hands were positive for adenovirus, whereas cultures from the hands of all uninfected control patients were negative. CONCLUSIONS: Simultaneous coinfection of patients' hands and eyes with adenovirus may contribute to office epidemics. Ophthalmologists and coworkers should not shake the hands of patients suspected of having epidemic keratoconjunctivitis unless properly gloved.

Effective steroid-sparing treatment for peripheral ulcerative keratitis and pyoderma gangrenosum.

OBJECTIVE: To report a patient with a rare clinical presentation of marginal keratitis and pyoderma gangrenosum (PG) that responded to the steroid-sparing agent azathioprine. DESIGN: Interventional case report. METHODS: Case report and MEDLINE review of the medical literature on PG-associated peripheral ulcerative keratitis (PUK) and its treatment. RESULTS: A patient with a biopsy-proven history of PG developed an explosive episode of PUK. The ocular inflammation was minimally responsive to topical therapy and required significant long-term oral steroids for control. The patient's active skin lesions and marginal keratitis responded dramatically to systemic oral azathioprine. Since the initiation of treatment with azathioprine, there have been no subsequent recurrences of PG or marginal keratitis. CONCLUSIONS: PUK may be associated with other inflammatory conditions, such as PG and arthritis. Systemic azathioprine may successfully control ocular and extraocular conditions and should be considered in the clinical setting of topical therapy failure and/or extraocular inflammatory conditions.

Pellucid marginal degeneration with superior corneal thinning.

PURPOSE: Pellucid marginal degeneration is a noninflammatory thinning disorder typically involving the inferior cornea. We describe a patient with superior corneal thinning similar to classic pellucid marginal degeneration. METHODS: An 80-year-old man was evaluated for high astigmatism. RESULTS: The right superior cornea had a prominent band of thinning with ectasia. Both inferior corneas had characteristic zones of thinning without inflammation. CONCLUSIONS: Superior pellucid marginal corneal degeneration should be considered in the differential diagnosis of superior corneal ectatic disorders.

Epicorneal aspergilloma after penetrating keratoplasty.

PURPOSE: To report an epicorneal aspergilloma in a postkeratoplasty patient with a bandage soft contact lens. METHODS: Case report of a 77-year-old postkeratoplasty patient who presented with an epicorneal mass under a bandage soft contact lens placed for a nonhealing epithelial defect. On removal of the contact lens, a 4 x 4-mm placoid mass fell free from the corneal surface and was sent for culture and histopathology. RESULTS: Gram stain demonstrated septated branching hyphae, and cultures confirmed the diagnosis of Histopathologic sections of the epicorneal mass revealed a full-thickness aspergilloma. CONCLUSION: Contact lens removal and aggressive antimycotic treatment resulted in epithelial healing and resolution of the keratomycosis. The patient remained stable for 6 months followed by a successful repeat penetrating keratoplasty.

Street canyon aerosol pollutant transport measurements.

Current understanding of dispersion in street canyons is largely derived from relatively simple dispersion models. Such models are increasingly used in planning and regulation capacities but are based upon a limited understanding of the transport of substances within a real canyon. In recent years, some efforts have been made to numerically model localised flow in idealised canyons (e.g., J. Appl. Meteorol. 38 (1999) 1576-89) and stepped canyons (Assimakopoulos V. Numerical modelling of dispersion of atmospheric pollution in and above urban canopies. PhD thesis, Imperial College, London, 2001) but field studies in real canyons are rare. To further such an understanding, a measurement campaign has been conducted in an asymmetric street canyon with busy one-way traffic in central Manchester in northern England. The eddy correlation method was used to determine fluxes of size-segregated accumulation mode aerosol. Measurements of aerosol at a static location were made concurrently with measurements on a platform lift giving vertical profiles. Size-segregated measurements of ultrafine and coarse particle concentrations were also made simultaneously at various heights. In addition, a small mobile system was used to make measurements of turbulence at various pavement locations within the canyon. From this data, various features of turbulent transport and dispersion in the canyon will be presented. The concentration and the ventilation fluxes of vehicle-related aerosol pollutants from the canyon will be related to controlling factors. The results will also be compared with citywide ventilation data from a separate measurement campaign conducted above the urban canopy.

The hydrogoniometer and assessment of gleno-humeral joint motion.

Inter-observer and intra-observer reliability tests have been investigated for the passive ranges of gleno-humeral abduction, lateral rotation with arm by the side and both lateral and medial rotation with the upper arm abducted to 90°, using the Hydrogon-iometer. This device allows accurate quantification of gleno-humeral movement and is most appropriate for the Physiotherapy profession as an inexpensive, simple measuring device.

Case management and clinical paths: strategies to support the perinatal experience.

The needs of the perinatal client population and the current health care environment necessitate exceptionally well coordinated care throughout the entire episode. This is especially true of individuals who have complex problems, including pathophysiology, psychosocial, and economic issues. Case management enhances care coordination activities for individuals with complex issues. Clinical paths support the needs of the usual perinatal client. These two strategies have demonstrated effectiveness in supporting the coordination and management of care of perinatal clients.

Case management: unraveling the confusion.

I'm going to close with some of my ideas about the characteristics that case managers exhibit. I have a great deal of professional respect for case managers. I think that you are a tenacious lot. One of the major things that case managers do is help create new alternatives to problems. You open doors; no ... you first build the door and then you open it. You're creative, persistent, and resourceful. You are sometimes asked to solve all of an organization's problems. I think that is a tremendous burden, and that you can get confused because of that role conflict and confusion. What model is best for my organization? Within that is my patient population. What is it that they need? What are the current issues that you are seeing? How is my case management role different from other roles? How large a scope of practice can I handle and be reasonably successful with the patients with whom I'm dealing? How many different kinds of approaches and models are needed within my organization? Look toward the future; think about the future in terms of your crystal balls. What trends do you see building in either the demographics or the health and social environments that are going to influence health care in the future? What effect will the aging of our population have on you and your case management practice? What issues are going to be related to those trends? How many more people do we have living in fragmented families? What's going to happens in terms of resources available for patients? How can case management influence those changes? I don't think we're going to see the pace of change in the health care industry slow down. We will continue to have health care organizations address social issues in addition to pathophysiologic ones. No matter what the role and how it evolves, case management will always be at the junction of change in health care. This will be difficult at times to deal with. It will also be a source of satisfaction for those in the role because of the tremendously positive effect case managers have on the lives of patients and their families.

Efficiency of Pm-147 direct charge radioisotope battery.

A theoretical analysis is presented here of the efficiency of direct charge radioisotope batteries based on the efficiency of the radioactive source, the system geometry, electrostatic repulsion of beta particles from the collector, the secondary electron emission, and backscattered beta particles from the collector. Efficiency of various design batteries using Pm-147 sources was experimentally measured and found to be in good agreement with calculations. The present approach can be used for predicting the efficiency for different designs of direct charge radioisotope batteries.

Promethium-147 capacitor.

Beta particle surface fluxes for tritium, Ni-63, Pm-147, and Sr-90 sources were calculated in this work. High current density was experimentally achieved from Pm-147 oxide in silica-titana glass. A 96 GBq (2.6 Ci) Pm-147 4pi-source with flux efficiency greater than 50% was used for constructing a direct charge capacitor with a polyimide coated collector and vacuum as electrical insulation. The capacitor connected to high resistance (TOmega) loads produced up to 35 kV. Overall conversion efficiency was over 10% (on optimal load).

Evolution of organic aerosols in the atmosphere.

Organic aerosol (OA) particles affect climate forcing and human health, but their sources and evolution remain poorly characterized. We present a unifying model framework describing the atmospheric evolution of OA that is constrained by high-time-resolution measurements of its composition, volatility, and oxidation state. OA and OA precursor gases evolve by becoming increasingly oxidized, less volatile, and more hygroscopic, leading to the formation of oxygenated organic aerosol (OOA), with concentrations comparable to those of sulfate aerosol throughout the Northern Hemisphere. Our model framework captures the dynamic aging behavior observed in both the atmosphere and laboratory: It can serve as a basis for improving parameterizations in regional and global models.