Westlake Health Center

Abstract: Cellulite is an alteration in skin topography most often found on the buttocks and posterolateral thighs of the majority of postpubertal females. This article aims to review the background, potential pathophysiology, and potential treatment options for cellulite, highlighting subcision as an ideal therapeutic option for this cosmetically distressing condition. Keywords: gynoid lipodystrophy, fibrous septae, radiofrequency, vacuum-assisted subscision

OBJECTIVES: In a Pilot Study, the clinical and biochemical effects of thiamine tetrahydrofurfuryl disulfide (TTFD) on autistic spectrum children were investigated. SUBJECTS AND METHODS: Ten children were studied. Diagnosis was confirmed through the use of form E2, a computer assessed symptom score. For practical reasons, TTFD was administered twice daily for two months in the form of rectal suppositories, each containing 50 mg of TTFD. Symptomatic responses were determined through the use of the computer assessed Autism Treatment Evaluation Checklist (ATEC) forms. The erythrocyte transketolase (TKA) and thiamine pyrophosphate effect (TPPE), were measured at outset and on completion of the study to document intracellular thiamine deficiency. Urines from patients were examined at outset, after 30 days and after 60 days of treatment and the concentrations of SH-reactive metals, total protein, sulfate, sulfite, thiosulfate and thiocyanate were determined. The concentrations of metals in hair were also determined. RESULTS: At the beginning of the study thiamine deficiency was observed in 3 out of the 10 patients. Out of 10 patients, 6 had initial urine samples containing arsenic in greater concentration than healthy controls. Traces of mercury were seen in urines from all of these autistic children. Following administration of TTFD an increase in cadmium was seen in 2 children and in lead in one child. Nickel was increased in the urine of one patient during treatment. Sulfur metabolites in urine did not differ from those measured in healthy children. CONCLUSIONS: Thiamine tetrahydrofurfuryl disulfide appears to have a beneficial clinical effect on some autistic children, since 8 of the 10 children improved clinically. We obtained evidence of an association of this increasingly occurring disease with presence of urinary SH-reactive metals, arsenic in particular.

BACKGROUND: Mobile Health (mHealth) is becoming an important tool to improve health outcomes in maternal, newborn and child health (MNCH). Studies of mHealth interventions, have demonstrated their effectiveness in improving uptake of recommended maternal services such as antenatal visits. However, evidence of impact on maternal health outcomes is still limited. METHODS: A pseudo-randomized controlled trial (single blind) was conducted to assess the impact of a voice-message based maternal intervention on maternal health knowledge, attitudes, practices and outcomes over time: Pregnancy (baseline/Time 1); Post-partum (Time 2) and when the infant turned one year old (Time 3). Women assigned to the mMitra intervention arm received gestational age- and stage-based educational voice messages via mobile phone in Hindi and Marathi, while those assigned to the control group did not. Both groups received standard care. RESULTS: Two thousand sixteen women were enrolled. Interviews were conducted with 1516 women in the intervention group and 500 women in the control group at baseline and post-partum. The intervention group performed significantly better than controls on four maternal health practice indicators: receiving the tetanus toxoid injection (OR: 1.6, 95% Confidence Interval (CI): 1.05-2.4, p = 0.028), consulting a doctor if spotting or bleeding (OR: 1.72, 95%CI: 1.07-2.75, p = 0.025), saving money for delivery expenses (OR: 1.79, 95%CI: 1.38-2.33, p = 0.0001), and delivering in hospital (OR: 2.5, 95%CI: 1.49-4.35, p = 0.001). The control group performed significantly better than the intervention group on two practice indicators: resting regularly during pregnancy (OR: 0.7, 95%CI: 0.54-0.88, p = 0.002) and having at-home deliveries attended by a skilled birth attendant (OR: 0.46, 95%CI: 0.23-0.91, p = 0.027). Both groups' knowledge improved from Time 1 to Time 2. Only one knowledge indicator, on seeking medical care during pregnancy, was statistically increased in the intervention group compared to controls. Anemia status at or near the time of delivery was unable to be assessed due to missing data from maternal health cards. CONCLUSIONS: This study provides evidence that in low-resource settings, mobile voice messages providing tailored and timed information about pregnancy can positively impact maternal health care practices proven to improve maternal health outcomes. Additional research is needed to assess whether voice messaging can motivate behavior change better than text messaging, particularly in low literacy settings. TRIAL REGISTRATION: The mMitra impact evaluation is registered with ISRCTN under Registration # 88968111, assigned on 6 September 2018 (See https://www.isrctn.com/ISRCTN88968111).

OBJECTIVE: This preliminary study tests the effectiveness of an elementary school-based stress management technique on anxiety symptoms and heart rate variability (HRV) in children. METHODS: In this controlled prospective longitudinal study, children in third-grade classroom participated in a teacher-led daily 10-minute stress management intervention for 4 months. The control class teacher read from a children's book for 10 minutes daily. A standardized anxiety scale and HRV (using computer biofeedback program) were measured before the 4-month intervention, immediately after, and 1 year later. RESULTS: The intervention class showed significant improvement from baseline to the immediate postintervention period in total anxiety (N = 14, F = 12.95, p = .002), with 1-year follow-up scores maintaining improvement (N = 13, F = 5.88, p = .025). The intervention class had small improvement in HRV using the biofeedback program in the immediate postintervention period, with significant improvement at 1-year follow-up (N = 13, F = 10.61, p = .005). The control class showed no improvements. Qualitatively, children reported that the intervention was helpful during stressful times at school and at home, even after the study period. CONCLUSION: An elementary school-based short daily stress management intervention can decrease symptoms of anxiety, and improve HRV, a measure of relaxation. Ultimately, these children found this skill continued to help them cope better with everyday stressors.

COVID-19, an infectious respiratory illness, is caused by infection with the SARS-CoV-2 virus. Individuals with underlying medical conditions are at increased risk of developing serious illnesses such as long COVID. Recent studies have observed Epstein-Barr virus (EBV) reactivation in patients with severe illness or long COVID, which may contribute to associated symptoms. We determined the frequency of EBV reactivation in COVID-19 positive patients compared to COVID-19 negative patients. 106 blood plasma samples were collected from COVID-19 positive and negative patients and EBV reactivation was determined by detection of EBV DNA and antibodies against EBV lytic genes in individuals with previous EBV infection. 27.1% (13/48) of EBV reactivations, based on qPCR detection of EBV genomes, are from the COVID positive group while only 12.5% (6/48) of reactivations belonged to the negative group. 20/52 (42.30%) of the COVID PCR negative group had detectable antibodies against SARS-CoV-2 nucleoprotein (Np); indicative of past infection. A significantly higher SARS-CoV-2 Np protein level was found in the COVID-19 positive group. In conclusion, COVID-19 patients experienced increased reactivation of EBV in comparison to COVID negative patients.

In response to demands from industry and the profession for more graduates, first-year engineering numbers have grown considerably over the last decade, matched by an increasing diversity of academic backgrounds. In order to support first-year students effectively, and ensure the courses they take remain appropriately pitched, the academic preparedness of these students must be determined. Since 2007, the lecturers in the compulsory first-year Electrical and Digital Systems course at the University of Auckland (UoA), Auckland, New Zealand, have administered a short diagnostic test to determine the level of conceptual understanding of electricity and electromagnetics possessed by the incoming students. This paper presents and discusses student understanding of dc circuit theory as revealed by the diagnostic test and subsequent investigations. The evidence is indicative of both flawed conceptual models and context-triggered misapplication of fundamental rules. Parallels are drawn with the results of research conducted elsewhere, indicating the misconceptions are robust and pervasive, crossing institutional and national boundaries. Not only are concepts such as current and voltage poorly understood, but even more basic concepts such as series and parallel connections are confusing for a significant number of students. Understanding the incorrect models that underlie these basic misconceptions is the first step to correcting them. Only then can students proceed to the more advanced concepts that engineering graduates are required to master.

The purpose of this paper is to address the extent in which 4G LTE can be used for air traffic management of small Unmanned Air Vehicles (sUAVs) <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">1</sup> and the limitations and enhancements that may be necessary. We provide a brief overview of the communications aspects of the Unmanned Aerial System (UAS) <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> Traffic Management Project followed by the evolving trends in air traffic management including beyond visual line of sight (BVLOS) operations concepts and current BVLOS operational systems. Issues and Concerns are addressed including the rapidly evolving global regulations and the resulting communications requirements as well LTE downlink and uplink interference at altitude and how that interference affects command and control reliability as well as application data capabilities and mobility performance.

The clinical picture describing oxygen transfer deficits in literature is complicated by inconsistent terminology, and a weak perception of the influence total errors of measured and estimated values have on clinical decision-making. Clinical and analytical terminology: Terms like hypoxia, hypoxaemia and tissue hypoxia in clinical literature are often used synonymously. In present terminology, arterial hypoxia (pO2(a)) is considered to be based on measurements of oxygen tension in arterial blood. On the other hand, arterial hypoxaemia (ctO2(a)) is considered to be based on measurements of both pO2, total haemoglobin (ctHb), saturation (sO2), carboxyhaemoglobin (FCOHb), and methaemoglobin (FMetHb). Arterial hypoxia is simply a low oxygen tension in arterial blood. Arterial hypoxaemia is thus simply a low oxygen concentration in arterial blood. Pulmonary indices: The tension-based indices. At the bedside, assessment of the oxygen uptake in the lungs has been evaluated by calculating indices like pO2(a)/FO2(I),pO2(A-a),pO2(a/A) and the respiratory index (RI = pO2(A-a)/pO2(a)). The different oxygen tension-based indices all require the calculation of the alveolar oxygen tension from the alveolar equation. These calculations involve many assumptions (exact analytical measurements of the respiratory quotient (RQ), FO2(I), etc.) to be fulfilled, and might include clinically unacceptable errors. The concentration-based index (FShunt). Considering a fixed arterio-mixed venous oxygen difference (3-5 mL/dL), this index is by some researchers indicated to be superior to the oxygen tension-based (the correlation coefficient to the true measured shunt being 0.94 for the FShunt compared to 0.72 for the best tension-based (RI = pO2(A-a)/pO2(a))). However, the scatter around the line is considerable and this index seems to fail, as well as the tension-based in the many cases where the assumed difference is not equal to the assumed (3-5 mL/dL). The intrapulmonary shunt: The best available means of outlining the extent to which the pulmonary system contributes to hypoxic hypoxaemia, is to calculate the intrapulmonary shunt. It reflects the degree to which the lung deviates from ideal as an oxygenator of pulmonary blood. Exact calculation of the intrapulmonary shunt requires measurements of oxygen concentration in both arterial and mixed-venous blood samples. Calculation of the intrapulmonary shunt at 100% inspired oxygen represents the term (Qs/Qt). Venous admixture or the physiologic shunt (Qsp/Qt) represents measurements of the intrapulmonary shunt at less than 100% inspired oxygen. Interpretative guidelines for (Qsp/Qt) in critically ill patients having a pulmonary catheter are: A calculated shunt less than 10% is clinically compatible with normal. A shunt of 10-19% seldom would require significant support. A calculated shunt of 20-29% may be life threatening in a patient with limited cardiovascular function. A calculated shunt greater than 30% usually requires significant cardiopulmonary support. The necessity of sampling mixed-venous blood seems to be the most limiting factor for a widespread clinical use of shunt calculations.

In addition to the well-known signs of methotrexate toxicity, rare cutaneous side effects have been described. These cutaneous signs may provide a diagnostic clue into the diagnosis of toxicity as well as facilitate early and aggressive therapy. We describe the case of a 37-year-old male, with a diagnosis of psoriasis, who developed characteristic signs and symptoms of acute methotrexate toxicity after receiving an unknown amount of intravenous methotrexate. The patient experienced a distinct change in the morphology of his existing psoriatic plaques, which became ulcerated and necrotic in the week following the methotrexate injection. Shortly after the development of cutaneous erosions, the patient developed pancytopenia, which ultimately led to his death. Ulceration and necrosis of cutaneous psoriasis plaques may serve as a herald for the impending development of life-threatening pancytopenia in patients with acute methotrexate toxicity.

An increasing number of cases of allergic contact dermatitis secondary to formaldehyde resins used for textile finishes have been seen in our office over the last several years. Although previously reported to be more common in women, we have seen almost as many men as we have seen women with this condition, possibly because men are more likely to be occupationally sensitized to formaldehyde. We have found that patch-test reactions of only questionable strength may be clinically relevant. It has been our experience that many of these cases are of long duration before referral for patch testing. A low index of suspicion leads to a delayed diagnosis, and avoidance after diagnosis is difficult owing to the lack of labeling requirements for textile finishes. Patch testing with the textile resins Fixapret AC and Fixapret CPN most often identified patients with textile allergies. We have prepared a handout to give patients more definitive recommendations.

Ekman and O’Sullivan once asked, “Who can catch a liar?”—and they demonstrated that it was not mental health clinicians. As observed by Slovenko, “A good poker player probably knows better than a mental health professional whether or not a person is lying. A psychiatrist is a doctor, not a lie-detector” (Ref. 2, p 122). Six actors recently provided a dramatic demonstration of these concerns when they feigned the symptoms of Posttraumatic Stress Disorder (PTSD) at a clinic specializing in the assessment and treatment of that disorder; all were accepted as genuine. An extensive body of literature, heretofore ignored by mental health and medicolegal experts, further documents the inability of health professionals to identify individuals who feign disorders. These studies test physicians with “simulated patients”—normal persons trained to mimic the typical signs and symptoms of common disorders. This use of pseudopatients has its origins in the 1960s, when standardized clinical vignettes were developed to teach and test clinical skills in medical trainees. Over time, the method was extended to assess physicians in community practice and health organizations. In a search of the medical literature, we identified 12 studies in which (1) normal persons presented significant clinical complaints as simulated patients (SPs), and (2) physicians were provided with a mechanism to report patients suspected to be simulators. In all 12 studies, doctors detected simulators at low rates, ranging from 0 percent to 25 percent. Most studies simply reported the percentage of simulators whom physicians correctly identified, but Gordon et al. provided additional and important data. These authors recruited 54 interns and trained six SPs to feign one of three clinical problems (urinary frequency, cough, and headache). A total of 233 SP cases resulted, of which only 22 (9.4%) were correctly identified by physicians as “definitely” not genuine. When the standard of judgment or level of confidence was reduced from “definite” to “probable,” the number of correctly identified simulators increased to 56 (24.0%). Physicians also had 477 consultations with genuine patients and incorrectly labeled 10 (2.3%) as simulators when making “definite” judgments. When the standard of confidence was lowered to “probable,” the rate of false positives increased; 45 (9.4%) genuine patients were misidentified as simulators. It might be argued that studies using SPs overestimate the likelihood that physicians can be fooled, since clinicians are denied the additional information that may result from repeated visits and an ongoing relationship. However, no studies demonstrate that these factors improve physicians’ detection of feigned disorders. Further, malingerers can be consistent when misreporting, and lie detection is not necessarily more accurate in ongoing relationships. Findings on simulated patients and the general literature on lie detection demonstrate that clinicians are not skilled in judging the credibility of their patients. In the context of a physician-patient relationship, in which a working alliance must be developed, there are good reasons to accept subjective complaints at face value. In the context of legal proceedings, however, physicians should be more circumspect. Testimony should be based on objective findings and the awareness that we all can be fooled. Treating physicians bear special responsibility, since their testimony can create “echo attributions,” Dr. Rosen is Clinical Professor, Department of Psychology, and Dr. Phillips is Clinical Professor, Department of Family Medicine, University of Washington, Seattle, WA. Address correspondence to: Gerald M. Rosen, PhD, 2825 Eastlake Center, Suite 205, Seattle, WA 98102. E-mail: grosen@u.washington.edu

BACKGROUND: A novel endoscopic delivery system for infrared coagulation therapy (IRC) has been designed recently. IRC is a well-established treatment for symptomatic internal hemorrhoids. Patients frequently undergo lower endoscopy before hemorrhoid treatment to eliminate other sources of bleeding. Current treatment options are difficult to perform without an anal retractor, adequate lighting, and specialized instruments. Endoscopic IRC is an attractive alternative to standard IRC, because it can be performed during the lower endoscopy. TECHNIQUE: Endoscopic IRC utilizes infrared radiation generated by a control box, which is applied to the tissue through a flexible, fiber optic light guide (Precision Endoscopic Infrared Coagulator™). The light guide is placed through the colonoscope or flexible sigmoidoscope in the same chamber as other endoscopic instruments. METHODS: A retrospective review was performed using a prospectively collected database. A standardized protocol was utilized in all patients. Patients graded their symptoms before and after therapy by using the visual analog symptom severity scoring system (range, 0-10). These results were analyzed by using the nonparametric Wilcoxon signed-rank test. Exact P values were computed by using the R function wilcox.exact. RESULTS: A total of 55 patients underwent endoscopic IRC for predominately grade II and grade III symptomatic internal hemorrhoids (71 %). There were 22 (40 %) female patients. Posttherapy results indicated a significant improvement in global symptoms (pretreatment average global score = 2.24 vs. posttreatment average global score = 0.28; P < 0.0001). There have been no adverse events reported to date. CONCLUSIONS: Endoscopic IRC provides improved visibility and efficiency, allowing simultaneous treatment of symptomatic internal hemorrhoids at the time of lower endoscopy. Patients experienced significant improvement in their symptoms after a single session of endoscopic IRC. There are a variety of additional endoscopic IRC therapeutic utilities: endoscopic management of angiodysplasia, inflammation, hemostasis, and NOTES applications.

BACKGROUND: The limited availability of maternal and child health data has limited progress in reducing mortality and morbidity among pregnant women and children. Global health agencies, leaders, and funders are prioritizing strategies that focus on acquiring high quality health data. Electronic maternal and child health registries (eRegistries) offer a systematic data collection and management approach that can serve as an entry point for preventive, curative and promotive health services. Due to the highly sensitive nature of reproductive health information, careful consideration must be accorded to privacy, access, and data security. In the third paper of the eRegistries Series, we report on the current landscape of ethical and legal governance for maternal and child health registries in developing countries. METHODS: This research utilizes findings from two web-based surveys, completed in 2015 that targeted public health officials and health care providers in 76 countries with high global maternal and child mortality burden. A sample of 298 public health officials from 64 countries and 490 health care providers from 59 countries completed the online survey. Based on formative research in the development of the eRegistries Governance Guidance Toolkit, the surveys were designed to investigate topics related to maternal and child health registries including ethical and legal issues. RESULTS: According to survey respondents, the prevailing legal landscape is characterized by inadequate data security safeguards and weak support for core privacy principles. Respondents from the majority of countries indicated that health information from medical records is typically protected by legislation although legislation dealing specifically or comprehensively with data privacy may not be in place. Health care provider trust in the privacy of health data at their own facilities is associated with the presence of security safeguards. CONCLUSION: Addressing legal requirements and ensuring that privacy and data security of women's and children's health information is protected is an ethical responsibility that must not be ignored or postponed, particularly where the need is greatest. Not only are the potential harm and unintended consequences of inaction serious for individuals, but they could impact public trust in health registries leading to decreased participation and compromised data integrity.

To identify areas that should be targeted for improvement, we surveyed residents for their knowledge and barriers regarding management of inpatient hyperglycemia. One hundred thirty-five residents from 4 teaching hospitals completed a questionnaire to assess their knowledge about the different types of insulin, the perceived barriers toward managing inpatient hyperglycemia, and the problems they face when dealing with this commonly encountered problem. The majority of participants thought that managing inpatient hyperglycemia was very important in the critically ill and perioperative patients, whereas only 65% thought that it was very important for noncritically ill patients. Most residents reported that they will target blood glucose levels that are inconsistent with the current recommendations. Half of them reported that they were very comfortable with managing inpatient hyperglycemia and hypoglycemia. Of the participants, 46% said they will use a stand-alone insulin sliding scale for patients with difficult to control blood glucose and 43% thought that physicians still use it because of their unfamiliarity with ordering prandial and basal insulin. Unpredictable changes in patient diet and mealtimes, along with the risk of causing patient hypoglycemia, were the most frequently chosen as barriers to better management of inpatient hyperglycemia. Most participants lack important inpatient hyperglycemia knowledge, specifically about insulin types and pharmacokinetics. This study demonstrated the gap in knowledge about management of inpatient hyperglycemia among residents and illustrated the need to develop certain policies and to implement educational programs directed toward residents that reflect the current guidelines.

With the 2006 Food and Drug Administration approval of round silicone gel breast implants in the United States, there still remained a lack of versatility in implant options. The approval of Sientra's shaped cohesive implants in 2012 brought with it the innovations needed to address varying patient needs. Because access to shaped devices is still fairly recent in the United States, some surgeons remain uncomfortable with implementing shaped cohesive gel implants into their practice. The author outlines surgical techniques and algorithms from experience with the Sientra shaped device, covering the preoperative stage, measurements (base diameter, sternal notch to nipple, tissue pinch, and nipple to inframammary fold), ideal first candidates, operative techniques, and complication avoidance, as well as important factors for shaped-implant selection, including chest base diameter, implant height, implant volume, and implant projection for the patient's desired outcome. With experience, surgeons will find new utility with shaped implants for a variety of patients in their practices.

BACKGROUND: Optical energy-based devices, including intense pulsed light (IPL) and potassium titanyl phosphate (KTP) lasers achieve reduction of pigmented and vascular lesions in a relatively similar number of treatments. This study aimed to evaluate the efficacy and safety of an IPL with a "KTP-like" filter emitting a wavelength of 525-585 nm for the treatment of solar lentigines on the hands and face. METHODS: This was a single center, prospective, open-label clinical trial including 16 healthy Caucasian subjects (15 females, mean age, 55 years; skin types II and III) with hand and facial solar lentigines. Subjects were treated with three IPL treatment sessions with a KTP-like filter conducted at monthly intervals. Follow-up evaluations were performed 1, 3, and 6 months after the last treatment session. Overall pigmentation improvement, pigmentation clearance per lesion, adverse events, and subject tolerability to treatment were evaluated. RESULTS: Significant improvements in facial and hand pigmentation were noted at all follow-up visits (P < 0.0001). One month after the last treatment session, good to excellent outcomes were noted in 74.6% of treated facial areas and 90% of treated hand regions. Although the effect of treatment gradually declined in both treatment regions over the 6-month follow-up period, over 60% of subjects demonstrated good to excellent results at the study end. Clinical effectiveness was further confirmed by the reduction in Melanin Index (MI) following each treatment as compared to baseline. Downtime and complications were minimal. CONCLUSIONS: IPL treatment with a KTP-like filter is a well-tolerated and effective method for reducing facial and hand pigmentation. Lasers Surg. Med. 51:500-508, 2019. © 2019 Wiley Periodicals, Inc.

Attachment and sexual behavior are both integral parts of adult romantic relationships. Attachment avoidance is linked to impersonal, egocentric sexual activities, whereas the sexuality of anxiously attached individuals revolves around relationship maintenance and the needs of the partner. In this attachment context, faking orgasm might serve as a means for relational regulation. The aim of our study was to investigate the links between dimensions of adult attachment and motives for faking orgasm in women. Young women completed measures of adult attachment and motivations for faking orgasm. Both attachment avoidance and attachment anxiety were related to the use of faked orgasm as a means to avoid negative, shameful feelings. Attachment avoidance was significantly associated with the intention to quickly end sexual intercourse through faking orgasm. Attachment anxiety was associated with the use of faked orgasm to increase sexual arousal and to elevate partners' self-esteem. Results are discussed with regard to relational and sexual goals associated with adult attachment orientations.

Abstract. We present 2019 global methane (CH4) emissions and uncertainties, by sector, at 1-degree and country-scale resolution based on a Bayesian integration of satellite data and inventories. Globally, we find that agricultural and fire emissions are 227 +/− 19 Tg CH4/yr, waste is 50 +/− 7 Tg CH4/yr , anthropogenic fossil emissions are 82 +/− 12 Tg CH4/yr, and natural wetland/aquatic emissions are 180 +/− 10 Tg CH4/yr. These estimates are intended as a pilot dataset for the Global Stock Take in support of the Paris Agreement. However, differences between the emissions reported here and widely-used bottom-up inventories should be used as a starting point for further research because of potential systematic errors of these satellite based emissions estimates. Calculation of emissions and uncertainties: We first apply a standard optimal estimation (OE) approach to quantify CH4 fluxes using Greenhouse Gases Observing Satellite (GOSAT) total column CH4 concentrations and the GEOS-Chem global chemistry transport model. Second, we use a new Bayesian algorithm that projects these posterior fluxes to emissions by sector to 1 degree and country-scale resolution. This algorithm can also quantify uncertainties from measurement as well as smoothing error, which is due to the spatial resolution of the top-down estimate combined with the assumed structure in the prior emission uncertainties. Detailed Results: We find that total emissions for approximately 58 countries can be resolved with this observing system based on the degrees-of-freedom for signal (DOFS) metric that can be calculated with our Bayesian flux estimation approach. We find the top five emitting countries (Brazil, China, India, Russia, USA) emit about half of the global anthropogenic budget, similar to our choice of prior emissions. However, posterior emissions for these countries are mostly from agriculture, waste and fires (~129 Tg CH4/yr) with ~45 Tg CH4/yr from fossil emissions, as compared to prior inventory estimates of ~88 and 60 Tg CH4/yr respectively, primarily because the satellite observed concentrations are larger than expected in regions with substantive livestock activity. Differences are outside of 1-sigma uncertainties between prior and posterior for Brazil, India, and Russia but are consistent for China and the USA. The new Bayesian algorithm to quantify emissions from fluxes also allows us to “swap priors” if better informed or alternative priors and/or their covariances are available for testing. For example, recent bottom-up literature supposes greatly increased values for wetland/aquatic as well as fossil emissions. Swapping in priors that reflect these increased emissions results in posterior wetland emissions or fossil emissions that are inconsistent (differences greater than calculated uncertainties) with these increased bottom-up estimates, primarily because constraints related to the methane sink only allow total emissions across all sectors of ~560 Tg CH4/yr and because the satellite based estimate well constrains the spatially distinct fossil and wetland emissions. Given that this observing system consisting of GOSAT data and the GEOS-Chem model can resolve much of the different sectoral and country-wide emissions, with ~402 DOFS for the whole globe, our results indicate additional research is needed to identify the causes of discrepancies between these top-down and bottom-up results for many of the emission sectors reported here. In particular, the impact of systematic errors in the methane retrievals and transport model employed should be assessed where differences exist. However, our results also suggest that significant attention must be provided to the location and magnitude of emissions used for priors in top-down inversions; for example, poorly characterized prior emissions in one region and/or sector can affect top-down estimates in another because of the limited spatial resolution of these top-down estimates. Satellites such as the Tropospheric Monitoring Instrument (TROPOMI) and those in formulation such as the Copernicus CO2M, Methane-Sat, or Carbon Mapper offer the promise of much higher resolution fluxes relative to GOSAT assuming they can provide data with comparable or better accuracy, thus potentially reducing this uncertainty from poorly characterized emissions. These higher resolution estimates can therefore greatly improve the accuracy of emissions by reducing smoothing error. Fluxes calculated from other sources can also in principal be incorporated in the Bayesian estimation framework demonstrated here for the purpose of reducing uncertainty and improving the spatial resolution and sectoral attribution of subsequent methane emissions estimates.

ABSTRACT Exposures of poly(ethylene‐terephthalate) (PET) films were performed under xenon‐arc (full spectrum) and fluorescent UVA‐340 (UV only) irradiation to investigate the reciprocity principle and wavelength dependence of photodegradation in weathering. When the intensity of full spectral irradiance is increased from 5× to 50×, the reciprocity principle is not obeyed in this material system. The change in optical properties for PET is attributed to the corresponding longer exposure time of the 5× exposure that allows oxidative reactions to occur at lower irradiance. Full spectrum xenon‐arc and fluorescent UVA‐340 lamps have different spectral distributions and samples exhibits different material degradation mechanisms under each source. The UVA‐340 exposure leads to more pronounced degradation relative to the full spectrum xenon‐arc. This study shows that intensification of a single stressor in lab‐based weathering experiments to accelerate degradation and the use of differing light sources are not sufficient to allow reliable determination of service lifetime of polymeric materials. © 2019 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2019 , 136 , 47589.

Letters21 April 2009Strongyloides Hyperinfection: An Unusual Cause of Respiratory FailureFaris Khasawneh, MD, Radhika Sreedhar, MD, and Vishnu Chundi, MDFaris Khasawneh, MDFrom St. Joseph Hospital, Fort Wayne, IN 46802, and Westlake Hospital, Melrose Park, IL 60160.Search for more papers by this author, Radhika Sreedhar, MDFrom St. Joseph Hospital, Fort Wayne, IN 46802, and Westlake Hospital, Melrose Park, IL 60160.Search for more papers by this author, and Vishnu Chundi, MDFrom St. Joseph Hospital, Fort Wayne, IN 46802, and Westlake Hospital, Melrose Park, IL 60160.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-8-200904210-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Infection with Strongyloides stercoralis may present with symptoms of asthma or chronic obstructive pulmonary disease (COPD) (1). However, use of steroids in a wheezing patient with chronic strongyloides may trigger disseminated strongyloides infection (1, 2). In this case, steroid-induced immunosuppression triggered strongyloides hyperinfection in a chronically infected patient.Case Report: A 71-year-old woman presented with a 3-day history of shortness of breath associated with nonproductive cough and fever (temperature, 101.2 °F).Her medical history included stroke with subsequent aphasia, dysphagia, and dementia. She had a history of recurrent small-bowel obstructions secondary to adhesions resulting from a hysterectomy. She is a ...References1. Chu E, Whitlock WL, Dietrich RA. Pulmonary hyperinfection syndrome with Strongyloides stercoralis. Chest. 1990;97:1475-7. [PMID: 2347234] CrossrefMedlineGoogle Scholar2. Newberry AM, Williams DN, Stauffer WM, Boulware DR, Hendel-Paterson BR, Walker PF. Strongyloides hyperinfection presenting as acute respiratory failure and gram-negative sepsis. Chest. 2005;128:3681-4. [PMID: 16304332] CrossrefMedlineGoogle Scholar3. Lim S, Katz K, Krajden S, Fuska M, Keyatone JS, Kain KC. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. CMAJ. 2004;171:479-84. [PMID: 15337730] CrossrefMedlineGoogle Scholar4. Brambilla G, Grassi V, Giffo B, Simeon R, Charneau C, Ba L. Malignant intestinal strongyloidiasis associated with human T-cell lymphotropic virus. Infectious Diseases in Clinical Practice. 2005;13:206-7. CrossrefGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From St. Joseph Hospital, Fort Wayne, IN 46802, and Westlake Hospital, Melrose Park, IL 60160.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByMeprednisoneStrongyloidiasis with Emphasis on Human Infections and Its Different Clinical FormsThe urgent need for clinical, diagnostic, and operational research for management of Buruli ulcer in AfricaSevere strongyloidiasis: a systematic review of case reportsImported Strongyloidiasis: Epidemiology, Presentations, and TreatmentAcute Respiratory Distress Syndrome Complicating Strongyloides stercoralis HyperinfectionRegulation and dysregulation of immunoglobulin E: a molecular and clinical perspective 21 April 2009Volume 150, Issue 8Page: 570-571KeywordsAsthmaDiagnostic radiologyLungsRespiratory failureSputumSteroidsThoraxTransplantationUpper respiratory tract infectionsVentilators ePublished: 21 April 2009 Issue Published: 21 April 2009 CopyrightCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...