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Summary Objectives/hypothesis This study investigated behavioral management of dysphonia and laryngeal dyspnea secondary to use of vagal nerve stimulation (VNS) in an individual with medically refractory epilepsy. Study design Retrospective chart review. Methods Medical records from a single patient were reviewed. The patient received treatment with the speech-language pathologist (SLP) and laryngologist to observe patterns of laryngeal hyperfunction using biofeedback, and treatment with the SLP to learn to perform rescue breathing techniques, relaxation techniques, and awareness of muscle tension to aid the control of symptoms during activation. Data collected included neurology and laryngology notes. Neurology notes were used to track VNS settings, tolerance, and incidence of seizures. Laryngology notes included documentation of diagnosis, treatment, and measures of patient perception of severity (ie, Voice Handicap Index, Dyspnea Index, Cough Severity Index). Results Prior to treatment, the patient was unable to receive benefits from VNS due to severe laryngeal adverse effects, such that the device remained off for eight months postimplantation. Following treatment, the patient effectively managed laryngeal side effects and was able to tolerate increases in VNS output current, signal frequency, and duration. Conclusions Voice therapy was effective in managing changes in vocal fold mobility and laryngeal tension. As the number of individuals receiving VNS for epilepsy and inflammatory conditions increases, the SLP and laryngologist may play a key role in interdisciplinary management of laryngeal side effects secondary to vagal nerve stimulation.

Towards autonomous driving, advanced driver assistance systems increasingly undertake basic driving tasks by replacing human assessment and interactions, when controlling the vehicle. The performance of these systems is directly related to knowledge of the vehicle’s state and influential parameters. In this respect, the road condition has a major influence on the tires’ traction and thus significantly affects the behavior of the vehicle. Therefore, a prediction of the upcoming road condition can improve the performance of the assistance systems which leads to an increased driving safety and comfort. The presented work aims to classify the road surface as well as its weather-related condition, based on images of the front camera view, using deep convolutional neural networks. In order to take computational limitations of vehicle control units into account, a pruning approach is investigated to reduce the network complexity.

Infantile onset Pompe disease (IOPD) is a rare devastating disease that presents in early infancy with rapidly progressive hypertrophic cardiomyopathy, severe generalized myopathy and death within the first year of life. The emergence of enzyme replacement therapy (ERT) with recombinant human acid alpha glucosidase (rhGAA) has improved the natural course of IOPD with a significant impact on cardiomyopathy but has a more limited effect on the progression of myopathy and consequently the later deterioration of the disease. Possible reasons for reduced ERT efficacy include insufficient enzyme, partial targeting of skeletal muscle and the development of IgG rhGAA antibodies especially in patients who are cross-reactive immunological material (CRIM) negative. We report a CRIM-negative IOPD female patient who started treatment upon diagnosis at 4.5 months with ERT at 20 mg/kg every other week and a course of combined immunomodulation with rituximab, methotrexate and IVIG according to the published Duke protocol and increased ERT within a month to 40 mg/kg/week. Despite initial good clinical response to ERT and immunomodulation, monthly monitoring identified a gradual increase of serum antibody titers to rhGAA necessitating a second course of immunomodulation with bortezomib and maintenance rituximab and methotrexate. A gradual reduction in frequency of immunotherapy was instituted and over a period of 14 months was discontinued. Serum anti-rhGAA antibody titers remained negative for 5 months since cessation of immunomodulation and the patient is now immune tolerant with recovery of CD19. At the age of 30 months the patient is walking independently and has normal cardiac function and anatomy. We recommend initiating ERT at 40 mg/kg/week in CRIM-negative IOPD patients, concomitant with immunomodulation and monthly monitoring of serum anti-rhGAA IgG titers upon confirmation of the diagnosis.

Analysis of animal population status and change are core elements of ecological research and critical for prioritizing conservation actions for at-risk species. Traditionally, count-based data from structured surveys have been the main source of information used to estimate trends and changes in populations. In the past decade, advances in integrated population models (IPMs) have allowed these data to be combined with other data sources (e.g., observations of marked individuals). IPMs have allowed researchers to determine the direction and magnitude of population trends and to identify underlying mechanisms contributing to population change. For many species, life-history characteristics (e.g., colonial breeding, low site-fidelity), low abundance and/or low detection probability make it difficult to collect sufficient data; thus, IPMs for these species are difficult to employ. Citizen science data may be useful in such situations and enable conservation biologists to combine data from many sources into robust estimates of population trajectories. IPM's represent a possible way of combining diverse data sources, but their practicality for incorporating citizen science data has not been investigated. Here, we used count data from eBird to estimate population trends for a species of conservation concern, the tricolored blackbird (Agelaius tricolor). We combined estimates of relative abundance with banding and nesting data. Our joint estimation of demographic rates allowed us to evaluate their individual contributions to the population growth rate. Our analysis suggests that the California tricolored blackbird population suffered a mean decline of 34% from 2007 to 2016. Mean annual adult survival ranged from 0.28 to 0.93 for females and 0.17 to 0.78 for males. Mean juvenile survival across years was 0.21 (95% CI = 0.0007–0.49), fecundity (as nestlings per nest) ranged from 0.46 to 1.27. We suggest that investments in increasing reproductive success and recruitment are the most likely conservation strategies to increase the population. Here, the extensive survey efforts of citizen scientists aided the employment of IPMs to inform conservation efforts for tricolored blackbirds.

A view contributes to a person’s visual perception, comfort, and health in a building—reducing stress, improving concentration, increasing productivity, and bolstering creativity. Yet, what makes a view alluring is also what makes it ineffable and difficult to characterize. We introduce two new metrics to quantitatively assess view access in open floorplans, and using the metrics, we measure the economic impact of views on office rents in Manhattan, New York City. We evaluate spatial view access in 5,154 office spaces; and then, combining the view analysis results with rent transaction data, we model the financial performance of rents paid by tenants with varying views whilst controlling for other vital factors impacting office rents. We find that spaces with high access to views have a 6% net effective rent premium over spaces with low access to views. This financial impact is independent of other values drivers like daylight. In the case where there is both high daylight and view access, there is also a 6% effective rent premium. Office tenants value views and have historically paid for them. The metrics introduced in this work can be used in architectural design and planning to analyze the potential for views in new and existing buildings. The value of views is evident in human health data and, as shown in this paper, in tenant lease prices; the method proposed in this work provides a systematic means by which to further explore the value of views.

Background Preoperative hyponatremia adversely affects outcomes of cardiothoracic operation. However, in patients with chronic kidney disease, the association of sodium levels on postoperative events has never been evaluated. We investigated the impact of preoperative hyponatremia on outcomes after cardiac operation in patients with non–dialysis-dependent chronic kidney disease. Primary end points were operative mortality and acute kidney injury that required dialysis. Secondary end points were major infection and long-term survival. Methods The study is observational and includes all patients with stage III to IV chronic kidney disease (non-dialysis) undergoing cardiac operation between February 2000 and January 2016. Patients were stratified into two groups by preoperative sodium levels: sodium less than 135 mEq/L and sodium of 135 mEq/L or more. Results There were 1,008 patients (mean estimated glomerular filtration rate [GFR]: 43 ± 14 mL • min−1 • 1.73 m−2) with 92 patients (9%) in the low-sodium group. Patients with low sodium had higher operative mortality (p = 0.0004), need for new dialysis (p = 0.0008), and infection (p = 0.002). Predictors of operative mortality were European System for Cardiac Operative Risk Evaluation (EuroSCORE) (hazard ratio [HR] 1.03. 95% confidence interval [CI]: 1.02 to 1.05, p Conclusions Preoperative hyponatremia is a predictor of increased mortality and other adverse events in patients with non–dialysis-dependent chronic kidney disease undergoing cardiac operation. These findings are similar to those in hyponatremic patients without kidney disease.

We determined serum paracetamol concentrations 4 hours after the eighth dose in infants treated enterally for ductal closure. Serum paracetamol concentrations correlated (P = .0026) with ductal response. No patent ductus arteriosus in a baby with paracetamol levels

The neutrophil-lymphocyte ratio (NLR) is a recognized marker of inflammation associated with poor outcomes in various clinical situations. We analyzed the prognostic significance of preoperative elevated NLR in patients undergoing cardiac surgery.We performed a retrospective review of 3,027 consecutive patients undergoing cardiac surgery. Receiver-operating-characteristic was used to determine the cutoff value for elevated NLR. Multivariate regression was used to determine the predictive value of preoperative NLR on clinical outcomes. Cox proportional hazards functions were used to determine predictors of late events. Late survival data to 16 years was obtained from the Ministry of Interior.The cutoff value for elevated NLR was 2.6. Patients with elevated NLR were older (p0.0001), had a higher incidence of cardiac comorbidity (p0.0001), and higher European System for Cardiac Operative Risk Evaluation score (p0.0001). An elevated NLR emerged as an independent predictor of operative mortality (hazard ratio [HR] 2.15, 95% confidence interval [CI]: 1.51 to 3.08, p0.0001); pleural effusion (HR 1.42, 95% CI: 1.13 to 1.80, p = 0.003); low output syndrome (HR 1.54, 95% CI: 1.23 to 1.93, p = 0.0002); prolonged ventilation (HR 1.49, 95% CI: 1.23 to 1.82, p = 0.0001); or composite outcomes (HR 1.61, 95% CI: 1.36 to 1.91, p 0.0001). The NLR emerged as an independent predictor of late mortality (HR 1.19, 95% CI: 1.11 to 1.28; p0.0001).Elevated NLR is associated with a higher incidence of adverse outcomes after cardiac surgery. It is a predictor of operative as well as late mortality. Further studies are warranted to determine whether prophylactic treatment with antiinflammatory agents can prevent such outcomes. It may be warranted to include the baseline NLR as another variable in risk stratification of patients about to undergo cardiac surgery.

Views contribute to occupants’ visual comfort and health in the workplace—reducing stress, improving concentration, and bolstering creativity. In this work, we introduce two new metrics, based on a 3D simulation in the urban context, to assess potential view access in open floorplans; and using the metrics, we measure the economic impact of views on office rents. We evaluate the view potential in 5,154 office spaces in Manhattan, New York City. Then, combining the analysis results with rent transaction data, we model the financial performance of rents paid by tenants with varying views whilst controlling for other vital factors impacting office rents. We find that spaces with high access to views have a 6% net effective rent premium over spaces with low access to views. This financial impact is independent of other value drivers like daylight. Where there is both high daylight and view access, we find, there is also a 6% effective rent premium. Tenants’ marginal willingness to pay for daylight and views is a financial incentive for developers and building owners to invest in these visual qualities. The metrics introduced in this work can be applied in design and planning to analyze view access in an existing urban context; and the financial incentive for views can motivate design and planning policies that preference and protect view access and sightlines from all buildings.

Ensuring that conservation decisions are informed by the best available data is a fundamental challenge in the face of rapid global environmental change. Too often, new science is not easily or quickly translated into conservation action. Traditional approaches to data collection and science delivery may be both inefficient and insufficient, as conservation practitioners need access to salient, credible, and legitimate data to take action. Open access data could serve as a tool to help bridge the gap between science and action, by providing conservation practitioners with access to relevant data in near real time. Broad-scale citizen-science data represent a fast-growing resource for open access databases, providing relevant and appropriately scaled data on organisms, much in the way autonomous sensors do so on the environment. Several such datasets are now broadly available, yet documentation of their application to conservation is rare. Here we use eBird, a project where individuals around the world submit data on bird distribution and abundance, as an example of how citizen-science data can be used to achieve tangible conservation science and action at local, regional, and global scales. Our examination illustrates how these data can be strategically applied to improve our understanding of spatial and temporal distributions of birds, the impacts of anthropogenic change on ecological systems, and creative conservation solutions to complex problems. We raise awareness of the types of conservation action now happening with citizen-science data, and discuss the benefits, limitations, and caveats of this approach.

The seasonal dynamics of snow cover strongly affect ecosystem processes and winter habitat, making them an important driver of terrestrial biodiversity patterns. Snow cover data from the Moderate Resolution Imaging Spectroradiometer (MODIS) Aqua and Terra satellites can capture these dynamics over large spatiotemporal scales, allowing for the development of indices with specific application in ecological research and predicting biodiversity. Here, our primary objective was to derive winter habitat indices (WHIs) from MODIS that quantify snow season length, snow cover variability, and the prevalence of frozen ground without snow as a proxy for subnivium conditions. We calculated the WHIs for the full snow year (Aug-Jul) and winter months (Dec-Feb) across the contiguous US from 2003/04 to 2017/18 and validated them with ground-based data from 797 meteorological stations. To demonstrate the potential of the WHIs for biodiversity assessments, we modeled their relationships with winter bird species richness derived from eBird observations. The WHIs had clear spatial patterns reflecting both altitudinal and latitudinal gradients in snow cover. Snow season length was generally longer at higher latitudes and elevations, while snow cover variability and frozen ground without snow were highest across low elevations of the mid latitudes. Variability in the WHIs was largely driven by elevation in the West and by latitude in the East. Snow season length and frozen ground without snow were most accurately mapped, and had correlations with station data across all years of 0.91 and 0.85, respectively. Snow cover variability was accurately mapped for winter (r = 0.79), but not for the full snow year (r = −0.21). The model containing all three WHIs used to predict winter bird species richness patterns across the contiguous US was by far the best, demonstrating the individual value of each index. Regions with longer snow seasons generally supported fewer species. Species richness increased steadily up to moderate levels of snow cover variability and frozen ground without snow, after which it steeply declined. Our results show that the MODIS WHIs accurately characterized unique gradients of snow cover dynamics and provided important information on winter habitat conditions for birds, highlighting their potential for ecological research and conservation planning.

Heterobimetallic 1,4-divinylphenylene- and 1,8-divinylanthracene-bridged ruthenium/osmium complexes 1-RuOs and 2-RuOs were prepared via stepwise hydroruthenation of the parent dialkynes with first the ruthenium and then the osmium hydride complexes HM(CO)Cl(P i Pr 3 ) 2 . They are compared with their homobimetallic diruthenium and diosmium analogs with respect to their electrochemical and spectroscopic properties. Trends in redox potentials and changes in the vibrational and electronic spectra on oxidation point to strongly delocalized electronic ground states for the radical cations of the homobinuclear complexes and for heterobinuclear 1-RuOs + but a significant charge localization at the more electron-rich {Os} site for 2-RuOs + and a generally less efficient coupling of the alkenyl metal moieties to the π-conjugated bridge for the dinuclear 1,8-anthracenediyl complexes. The latter is due to a significant torsion of the alkenyl metal entities as a consequence of steric congestion around the closely spaced alkenyl ruthenium moieties as indicated by X-ray crystallography and by quantum chemical calculations.

Ecological citizen science data are rapidly growing in availability and use in ecology and conservation. Many citizen science projects have the flexibility for participants to select where they survey, resulting in more participants, but also spatially biased data. It is important to assess the extent to which these spatially biased data can provide reliable estimates of species distributions. Here we quantify the extent of site selection bias in a citizen science project and the implications of this spatial bias in species distribution models. Using data from the BirdTrack citizen science project in Great Britain from 2007 to 2011, we modelled the spatial bias of data submissions. We next produced species occupancy models for 138 bird species, and assessed the impact of accounting for spatial bias. We compared the distributions to those produced using unbiased data from an Atlas survey from the same region and time period. Averaging across 138 species, models with spatially biased data produced accurate and precise estimates of species occupancy for most locations in Great Britain. However, these distributions were both less accurate and less precise in the Scottish Highlands, showing on average a positive bias. Accounting for the spatially biased sampling with weights led to on average greater accuracy in the Scottish Highlands, but did not increase precision. This region is both distinct in environmental characteristics and has a low density of observations, making it difficult to characterise environmental relationships with species occupancy. Accounting for the spatially biased sampling did not affect average accuracy or precision throughout most of the country. Spatially biased citizen science data can be used to estimate species occupancy in regions with stationary environmental relationships and good sampling across environmental space. The reliability of estimated species distributions from spatially biased data should be further validated and tested under a range of different scenarios.

The presence of natural light in indoor spaces improves human health, well-being, and productivity, particularly in workplace environments. Do the social benefits of daylight translate into economic value as measured by what office tenants are willing to pay? Using a sample of 5154 office spaces in Manhattan, we pair urban daylight simulation with a hedonic valuation model to determine the marginal value of daylight in offices. Holding all other factors constant, we find that occupied spaces with access to high amounts of daylight (as measured by 55% spatial daylight autonomy) have a 5–6% value premium over occupied spaces with low amounts of daylight (as measured by less than 55% spatial daylight autonomy). We simulate the distribution of daylight on each office floor individually, taking into account architectural and location-specific characteristics. Then, using the hedonic model, we determine the added value of daylight in the office spaces. The results show, for the first time, that an estimated 74% of office spaces throughout Manhattan have low daylight, and that in a dense urban environment with differentiation in daylight levels, tenants value high daylight. Daylight value is independent of other building, neighborhood, and contract characteristics. By revealing the added value of daylight in commercial office spaces, we suggest that daylight is a key design driver and thus, should be considered in design, policy, planning, and project financing.

Citizen-science projects engage volunteers to gather or process data to address scientific questions. But citizen-science projects vary in their ability to contribute usefully for science, conservation, or public policy. eBird has evolved from a basic citizen-science project into a collective enterprise, taking a novel approach to citizen science by developing cooperative partnerships among experts in a wide range of fields: population and distributions, conservation biologists, quantitative ecologists, statisticians, computer scientists, GIS and informatics specialists, application developers, and data administrators. The goal is to increase data quantity through participant recruitment and engagement, but also to quantify and control for data quality issues such as observer variability, imperfect detection of species, and both spatial and temporal bias in data collection. Advances at the interface among ecology, statistics, and computer science allow us to create new species distribution models that provide accurate estimates across broad spatial and temporal scales with extremely detailed resolution. eBird data are openly available and used by a broad spectrum of students, teachers, scientists, NGOs, government agencies, land managers, and policy makers. Feedback from this broad data use community helps identify development priorities. As a result, eBird has become a major source of biodiversity data, increasing our knowledge of the dynamics of species distributions, and having a direct impact on the conservation of birds and their habitats.

Aims Epithelial ovarian cancer (EOC) can be classified into four major types (serous, endometrioid, clear cell, mucinous). The prevalence of driver gene mutations in the different subtypes is controversial. High-grade serous carcinomas show frequent TP53 mutations, whereas KRAS and BRAF mutations are less common. In non-serous EOC, the relevance of these gene mutations remains to be elucidated. Methods We investigated 142 formalin-fixed, paraffin-embedded EOC, including serous (n = 63), endometrioid (n = 29), clear cell (n = 25), mucinous (n = 14), and others (n = 11) for mutations in TP53 exons 5–8, KRAS exons 2 and 3, and BRAF exon 15 by pyro-sequencing using the GS Junior 454 platform. The mutational status was correlated with clinicopathological features and patient overall survival. Results We identified mutations in the coding region of TP53 in 51.4% (73/142), and of KRAS in 9.9% (14/142) but not of BRAF . TP53 mutations occurred frequently not only in high-grade serous carcinomas (58.7%), but also in mucinous (57%) and clear cell EOC (52%). TP53 mutations were associated with high-grade carcinomas (p = 0.014), advanced FIGO stage (p = 0.001), intraoperative residual disease > 1 cm (p = 0.004), as well as poor overall survival (p = 0.002). KRAS mutations were mainly identified in mucinous EOC (57%) and were concomitantly with TP53 mutations in five mucinous carcinomas (36%). Conclusions TP53 gene driver mutations are a common feature of all advanced ovarian cancer subtypes, whereas BRAF mutations seem to be a rare event in EOC. KRAS mutations with synchronous TP53 mutations occur predominantly in low-grade mucinous carcinomas, suggesting a specific molecular background of this ovarian cancer type.

Objective The aim of the study was to describe the (a) symptom experience of women with vulvar intraepithelial neoplasia and vulvar cancer (vulvar neoplasia) during the first week after hospital discharge, and (b) associations between age, type of disease, stage of disease, the extent of surgical treatment and symptom experience. Methods This cross-sectional study was conducted in eight hospitals in Germany and Switzerland (Clinical Trial ID: NCT01300663). Symptom experience after surgical treatment in women with vulvar neoplasia was measured with our newly developed WOMAN-PRO instrument. Outpatients (n = 65) rated 31 items. We used descriptive statistics and regression analysis. Results The average number of symptoms reported per patient was 20.2 (SD 5.77) with a range of 5 to 31 symptoms. The three most prevalent wound-related symptoms were ‘swelling’ (n = 56), ‘drainage’ (n = 54) and ‘pain’ (n = 52). The three most prevalent difficulties in daily life were ‘sitting’ (n = 63), ‘wearing clothes’ (n = 56) and ‘carrying out my daily activities’ (n = 51). ‘Tiredness’ (n = 62), ‘insecurity’ (n = 54) and ‘feeling that my body has changed’ (n = 50) were the three most prevalent psychosocial symptoms/issues. The most distressing symptoms were ‘sitting’ (Mean 2.03, SD 0.88), ‘open spot (e.g. opening of skin or suture)’ (Mean 1.91, SD 0.93), and ‘carrying out my daily activities’ (Mean 1.86, SD 0.87), which were on average reported as ‘quite a bit’ distressing. Negative associations were found between psychosocial symptom experience and age. Conclusions WOMAN-PRO data showed a high symptom prevalence and distress, call for a comprehensive symptom assessment, and may allow identification of relevant areas in symptom management.

The distributions of animal populations are not static. During regular migratory movements species exploit different habitats. This spatiotemporal variation needs to be accounted for when modeling a species’ distribution and is essential for developing conservation strategies for widespread species, and especially for migratory species. Attempts to design conservation landscapes across large regions based on models of distributions in a single season or a small region may not fully reflect the limiting factors that are driving population declines. Our goal is to predict and explore patterns of species’ occurrence and local habitat usage across broad landscapes. We use data from eBird (http://www.ebird.org), an online citizen science bird-monitoring project and environmental descriptions from continent-wide covariates linked through observation location and time. These covariates include remotely sensed habitat information from the National Land Cover Database and vegetation phenology from MODIS. We model species occurrence with the SpatioTemporal Exploratory Model (STEM), an ensemble model designed to adapt to non-stationary spatiotemporal processes. This is accomplished by creating a large ensemble of local models, each restricted to a local spatial and temporal region. Within each region a user specified predictive model associates the predictors with the response. Patterns modeled locally “scale up” via ensemble averaging to larger scales. Here we analyze eBird data to study broad-scale movements of bird populations throughout the year. We use STEM built with decision trees to adapt to a wide variety avian migration patterns without requiring a detailed understanding of the underlying dynamic local processes. We demonstrate how eBird data are capable of resolving the changing distributions of birds through their migrations. Then we illustrate how seasonal variation in habitat association can be identified and explored. These tools provide valuable information for generating hypotheses and making inference about the processes driving dynamic species distributional patterns.

Objective To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW). Design Cross-sectional analysis nested in a retrospective observational study (n = 940). Setting Hospitals and associated private practices. Patient(s) Previously pregnant women (n = 268) within reproductive age in matched pairs. Intervention(s) Retrospective analysis of surgical reports and self-administered questionnaires. Main Outcome Measure(s) Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis). Result(s) The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%–42.0%]) compared with CW (22.0% [16.7%–27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41–2.75). This remained significant in subfertile WwE (50.0% [40.7%–59.4%]) vs. CW (25.8% [8.5%–41.2%]) but not in fertile WwE (24.5% [16.3%–31.6%]) vs. CW (21.5% [15.9%–26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%–51.4%] vs. rASRM III/IV 30.8% [22.6%–38.7%], compared with 22.0% [16.7%–27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%–53.9%]) compared with ovarian endometriosis (28.6% [17.7%–38.7%]) and deep infiltrating endometriosis (33.9% [21.2%–46.0%]) compared with CW (22.0% [16.7%–27.0%]). Conclusion(s) Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage. Clinical Trial Registration Number NCT02511626.

New technologies are rapidly changing the way we collect, archive, analyze, and share scientific data. For example, over the next several years it is estimated that more than one billion autonomous sensors will be deployed over large spatial and temporal scales, and will gather vast quantities of data. Networks of human observers play a major role in gathering scientific data, and whether in astronomy, meteorology, or observations of nature, they continue to contribute significantly. In this paper we present an innovative use of the Internet and information technologies that better enhances the opportunity for citizens to contribute their observations to science and the conservation of bird populations. eBird is building a web-enabled community of bird watchers who collect, manage, and store their observations in a globally accessible unified database. Through its development as a tool that addresses the needs of the birding community, eBird sustains and grows participation. Birders, scientists, and conservationists are using eBird data worldwide to better understand avian biological patterns and the environmental and anthropogenic factors that influence them. Developing and shaping this network over time, eBird has created a near real-time avian data resource producing millions of observations per year.

This case study examines NETmundial, the Global Multistakeholder Meeting on the Future of Internet Governance, which was held in Sao Paulo, Brazil on April 23 and 24 of 2014. The meeting was convened by 1net, a coalition of stakeholder groups involved in Internet governance discussions, in partnership with the Brazilian Internet Steering Committee (CGI.br), in response to revelations of mass surveillance of communications by the United States. It sought to develop a set of universally acceptable Internet governance principles as well as a way forward for the evolution of the Internet governance system, which together could serve as a framework for the governance and use of the Internet. It convened 930 participants from 110 different countries, representing civil society, the private sector, academia, the technical community, governments and intergovernmental organizations, as well as over 1000 remote participants from 23 countries around the globe. It also employed a content contribution platform that sought to crowd source inputs from stakeholders for the production of the outcome document. The meeting served as a demonstration of the multistakeholder process in action: in the production of the outcome document, stakeholders with a diverse range of backgrounds and interests collectively negotiated the inclusion or exclusion of highly sensitive and complex issues. While the process of achieving rough consensus involved sometimes messy debates and there were procedural imperfections, the case is informative for its structured production of bottom-up multistakeholder outcomes.

Background BioGlue (Cryolife Inc, Kennesaw GA) was introduced as an alternative tissue sealant. Its most common application has been in repairs of acute dissections of the aorta. There is no reported experience with its use in the repair of intracardiac structural defects. Methods In 5 patients BioGlue was used as an adjunct in repairs of complex intracardiac structural defects. It was used during patch repair of posterior mitral annular defects in 2 patients and aortic annular defect in 1 patient in the presence of active endocarditis. It was also used in 1 patient with a chronic atrioventricular groove pseudoaneurysm following mitral valve replacement, and in 1 patient during repair of a postinfarction posterior ventricular septal rupture. Results There were no hospital or late deaths. Immediate intraoperative transesophageal echocardiography and late follow-up echocardiography documented complete and durable repair of all defects without recurrence. At follow-up all patients are in New York Heart Association class I–II, 6 to 29 months postoperatively. No patient has suffered late complications or exhibited signs of glue embolization. Conclusions BioGlue was found to be an effective adjuvant to the standard techniques used for the repair of intracardiac structural defects of various etiologies. Long-term follow-up is recommended to determine its long-term safety in this application.

Summary High-speed videoendoscopy excels in the ability to observe the vocal-fold oscillatory patterns during voice initiation and termination. The initial and most critical step in the analysis of these transient regions is to identify the locations of these transient periods, that is, determining when the vocal-fold oscillation is absent and when the oscillation has reached its steady-state behavior. The latter is more challenging as the "steady" oscillation during sustained phonation is not truly steady and is expected to vary over time. This variation may cause unreliable identification of the transient periods, possibly resulting in less accurate or less reliable parameter measurements. An oscillation feature that is relatively consistent in the steady state is the glottal length, that is, the extent of the oscillation along vocal folds. This paper proposes an autonomous algorithm to estimate the vocal-fold oscillation length and its use to detect four transient events: oscillation onset and offset, and attainment and loss of full-length oscillation. The detected event markers are intended to be used to improve the transient parameter measurements. The autonomous algorithm manipulates the set of glottal width waveforms spatiotemporally to estimate the oscillation length. Examples with in vivo high-speed videoendoscopy recordings of both normal and pathological cases are included to show the efficacy of the proposed algorithm to identify the transient markers.

Objective. To evaluate the prognostic significance of and predictive value for survival of CA 125 and TPS levels after three chemotherapy courses in ovarian cancer patients. Methods. We analyzed in a prospective multicenter study the 1- and 2-year overall survival (OS) in ovarian carcinoma patients. The prognostic significance of CA 125 and TPS levels above the discrimination value (25 kU/L and 100 Un, respectively) was examined by univariate and multivariate analyses. Results. Of the 213 cases included, 64 patients were staged as PICO I + II and 149 patients were staged as PICO III + IV. Tumor marker levels in stage I + II were not correlated with survival. However, stage UI and IV patients with elevated levels of CA 125 or TPS after three chemotherapy courses had a worse 2-year OS (69% vs 26%, P

Objective. The hypercalcemic type of the small cell carcinoma of the ovary (HTSCCO) is a rapidly fatal ovarian tumor in young women. Photodynamic therapy (PDT) induces selective necrosis to malignant tissues. The aim of this study was to determine the sensitivity of the HTSCCO to PDT in a mouse xenograft model. Methods. Tumors were obtained from a patient with a HTSCCO and were transplanted into nude mice. Following photosensitization with m -THPC, either superficial or interstitial laser light was administered to the tumors. Necroses were measured by morphometry. Serum calcium levels were determined prior to and after PDT. Results. Superficial irradiation of m -THPC sensitized tumors showed over three times more necrosis than control tumors ( P = 0.037). Interstitially irradiated tumors showed over seven times more necrosis than control tumors ( P = 0.0012). All animals showed a highly significant hypercalcemia prior to PDT ( P P = 0.0297). Conclusion. This study suggests that PDT may be of therapeutic value for the HTSCCO.

Background Surgery for acute type B aortic dissection is associated with significant mortality. We report the results for 34 consecutive patients who underwent urgent surgery because they met criteria for operation during the acute phase ( Methods The average patient age was 64 (32 to 88) years. Indications for surgery were persistent pain (12), threatened exsanguination (18), malperfusion (renal [3], limb [3]), rapid aortic enlargement (4), and uncontrolled hypertension (1). The mean interval from onset of pain to operation was 7 (1 to 14) days. Resection included the proximal descending aorta in 32, the distal aortic arch in 10, extension to the diaphragm in 10, and involved a thoracoabdominal procedure in 3. Surgical techniques included hypothermic circulatory arrest (16 [47%]), distal bypass, monitoring of somatosensory-evoked potentials, sequential intercostal sacrifice (average, 5.6 pairs), cerebrospinal fluid drainage, and steroid administration. Results There was no hospital mortality. Important complications occurred in 16 patients (47%): 10 respiratory requiring tracheostomy, six infectious, four dialysis, two myocardial infarctions, and two neurologic (one transient stroke, one paraplegia). Mean intensive care unit and hospital stays were 10 (3 to 32) and 35 (7 to 107) days. Survival at 5 and 10 years was 80% and 57%, respectively (mean follow-up, 5.8 years). Conclusions Patients meeting criteria for urgent surgery have a low perioperative risk for mortality and paraplegia, and are relatively free from long-term aorta-related complications. These findings warrant consideration of earlier surgery for appropriate patients with acute type B aortic dissection.