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Precipitation simulated by regional climate models (RCMs) is generally biased with respect to observations, especially at the local scale of a few tens of kilometers. This study investigates how well two different RCMs are able to reproduce the spatial correlation patterns of observed summer precipitation for the central United States. On local scales, gridded precipitation observations and simulated precipitation are compared for the period of the 1987 First International Satellite Land Surface Climatological Project Field Experiment (FIFE) campaign. The results show that spatial correlation length scales on the order of 130 km are found in both observed data and RCM simulations. When simulations and observations are aggregated to different grid sizes, the pattern correlation significantly decreases when the aggregation length is less than roughly 100 km. Furthermore, the intermodel standard deviation between simulations with different domains or resolutions increases for aggregation lengths below ~130 km. Below this length scale there is a high level of randomness in the precise location of precipitation events. Conversely, spatial correlation values increase above this length scale, reflecting larger predictive certainty of the RCMs at larger scales. The findings on aggregated grid scales are shown to be largely independent of the underlying RCMs grid resolutions but not of the overall size of RCM domain. With regard to hydrological modeling applications, these findings indicate that precipitation extracted from the present RCM simulations at a catchment scale below the intermodel standard deviation length cannot be expected to accurately match observations. [ABSTRACT FROM AUTHOR]

Hurricane Katrina made landfall on August 29, 2005 and caused widespread devastation along the central Gulf Coast states. Less than a month later Hurricane Rita followed a similar track slightly west of Katrina’s. A coordinated multi-agency response followed to collect water, sediment and tissue samples for a variety of chemical, biological and toxicological indicators. The National Oceanic and Atmospheric Administration’s National Status and Trends Program (NS&T) participated in this effort by measuring chemical contamination in sediment and oyster tissue as part of the Mussel Watch Program, a long-term monitoring program to assess spatial and temporal trends in a wide range of coastal pollutants. This paper describes results for contaminants measured in oyster tissue collected between September 29 and October 10, 2005 and discusses the results in the context of Mussel Watch and its 20-year record of chemical contamination in the region and the nation. In general, levels of metals in oyster tissue were higher then pre- hurricane levels while organic contaminants were at or near record lows. No contaminant reported here exceeded the FDA action level for food safety. [ABSTRACT FROM AUTHOR]

Background: Ethics consultation is used regularly by some doctors, whereas others are reluctant to use these services. Aim: To determine factors that may influence doctors to request or not request ethics consultation. Methods: A survey questionnaire was distributed to doctors on staff at the University Community Hospital in Tampa, Florida, USA. The responses to the questions on the survey were arranged in a Likert Scale, from strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree to strongly agree. Data were analysed with the Wilcoxon test for group comparisons, the 72 test to compare proportions and a logistic regression analysis. Results: Of the 186 surveys distributed, 121 were returned, giving a 65% response rate. Demographic data were similar between the groups saying yes (I do/would use ethics consultation when indicated) and no (I do not/would not use ethics consultation when indicated). No statistically significant differences were observed between the user and non-user groups in terms of opinions about ethics consultants having extensive training in ethics or participating in ethics educational opportunities. On the issue "Ethics committee members or consultants cannot grasp the full picture from the outside", the non-users were neutral, whereas the users somewhat disagreed (p=0.012). Even more significant was the difference between surgeons and non-surgeons, where, by logistic regression analysis, surgeons who believed that ethics consultants could not grasp the full picture from the outside were highly likely to not use (p = 0.0004). Non-users of ethics consultations thought that it was their responsibility to resolve issues with the patient or family (72.2% agree, p<0.05). Users of ethics consultation believed in shared decision making or the importance of alternate points of view (90.8% agree, p<0.05). Implications: Ethics consultations are used by doctors who believe in shared decision making. Doctors who did not use ethics consultation tended to think that it was their responsibility to resolve issues with patients and families and that they were already proficient in ethics. [ABSTRACT FROM AUTHOR]

Edge-of-field management practices that reduce nutrient pollution from tile drainage while contributing habitat and other ecosystem services are needed to enhance agricultural systems in the US Corn Belt Region. In this review, we identified edge-of-field and catchment scale agricultural conservation practices for intercepting and treating tile drainage. The reviewed conservation practices were (1) controlled drainage, also known as drainage water management (USDA-NRCS Code 554); (2) drainage water recycling (USDA-NRCS Code 447); (3) denitrifying bioreactors (USDA-NRCS Code 605); (4) saturated buffers (USDA-NRCS Code 604); and (5) constructed or restored wetlands designed for water quality improvement (USDA-NRCS Code 656) herein referred to as water quality wetlands. We examined 119 studies that had information on one or more of the following ecosystem services: water retention, water quality improvement (e.g., nitrate, phosphate, sediment, or pesticide retention), wetland habitat (for birds, aquatic organisms, and pollinators), crop yield improvement, and other benefits (e.g., recreation, education, aesthetic appreciation, greenhouse gas retention). We found the five edge-of-field practices were all effective at removing nitrate with varying degrees of other potential benefits and disservices (e.g., greenhouse gas production). Drainage water recycling and water quality wetlands have the potential to provide the most co-benefits as they provide surface water systems for capturing surface flows in addition to tile drainage while also potentially providing habitat and recreation opportunities. However, the following research needs are identified: 1) the disservices and benefits associated with drainage water recycling have not been adequately evaluated; 2) surface flow dynamics are understudied across all reviewed management practices; 3) a complete accounting of phosphorus species and flow pathways for all management practices is needed; 4) field evaluations of the habitat benefit of all management practices are needed; and 5) greenhouse gas dynamics are understudied across all management practices. While all management practices are expected to reduce nitrate loads, addressing these knowledge gaps will help inform holistic management decisions for diverse stakeholders across the US Corn Belt., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

This paper examines short-term birth sequelae of the influenza pandemic of 1918-1920 in the United States using monthly data on births and all-cause deaths for 19 US states in conjunction with data on maternal deaths, stillbirths, and premature births. The data on births and all-cause deaths are adjusted for seasonal and trend effects, and the residual components of the 2 time series coinciding with the timing of peak influenza mortality are examined for these sequelae. Notable findings include: 1) a drop in births in the 3 months following peak mortality; 2) a reversion in births to normal levels occurring 5-7 months after peak mortality; and 3) a steep drop in births occurring 9-10 months after peak mortality. Interpreted in the context of parallel data showing elevated premature births, stillbirths, and maternal mortality during times of peak influenza mortality, these findings suggest that the main impacts of the 1918-1920 influenza on reproduction occurred through: 1) impaired conceptions, possibly due to effects on fertility and behavioral changes; 2) an increase in the preterm delivery rate during the peak of the pandemic; and 3) elevated maternal and fetal mortality, resulting in late-term losses in pregnancy.

Background: During the 2014-2015 US influenza season, 320 cases of non-mumps parotitis (NMP) among residents of 21 states were reported to the Centers for Disease Control and Prevention (CDC). We conducted an epidemiologic and laboratory investigation to determine viral etiologies and clinical features of NMP during this unusually large occurrence., Methods: NMP was defined as acute parotitis or other salivary gland swelling of >2 days duration in a person with a mumps- negative laboratory result. Using a standardized questionnaire, we collected demographic and clinical information. Buccal samples were tested at the CDC for selected viruses, including mumps, influenza, human parainfluenza viruses (HPIVs) 1-4, adenoviruses, cytomegalovirus, Epstein-Barr virus (EBV), herpes simplex viruses (HSVs) 1 and 2, and human herpes viruses (HHVs) 6A and 6B., Results: Among the 320 patients, 65% were male, median age was 14.5 years (range, 0-90), and 67% reported unilateral parotitis. Commonly reported symptoms included sore throat (55%) and fever (48%). Viruses were detected in 210 (71%) of 294 NMP patients with adequate samples for testing, ≥2 viruses were detected in 37 samples, and 248 total virus detections were made among all samples. These included 156 influenza A(H3N2), 42 HHV6B, 32 EBV, 8 HPIV2, 2 HPIV3, 3 adenovirus, 4 HSV-1, and 1 HSV-2. Influenza A(H3N2), HHV6B, and EBV were the most frequently codetected viruses., Conclusions: Our findings suggest that, in addition to mumps, clinicians should consider respiratory viral (influenza) and herpes viral etiologies for parotitis, particularly among patients without epidemiologic links to mumps cases or outbreaks.

Objective: To collect data regarding Canadian laypersons' perceptions of smile esthetics and compare these data to US data in order to evaluate cultural differences., Materials and Methods: Using Adobe Photoshop 7, a digital image of a posed smile of a sexually ambiguous lower face was prepared so that hard and soft tissue could be manipulated to alter buccal corridor (BC), gingival display (GD), occlusal cant (OC), maxillary midline to face discrepancy (MMFD), and lateral central gingival discrepancy (LCGD). Adult Canadian laypersons (n  =  103) completed an interactive computer-based survey of 29 randomized images to compare smile preferences for these variables. The custom survey was developed to display fluid, continuously appearing modifiable smile variables using MATLAB R2008 for presentation. These data were compared with previously published data for US laypersons. Statistical inference was determined using Wilcoxon rank sum tests., Results: Canadian laypersons were more sensitive in detecting deviations from ideal and had a narrower range of acceptability thresholds for BC, GD, OC, MMFD, and LCGD. Ideal esthetic values were significantly different only for BC., Conclusions: It appears that cultural differences do exist related to smile characteristics. Clinically significant differences in the preference of the smile characteristics were found between Canadian and US laypersons. Canadian laypersons, on average, were more discriminating to deviations from ideal and had a narrower range of acceptability.

Medical programs are valuable tools when they properly align with operational objectives. In counterinsurgency operations, the medical program should promote the capacity of the host nation government and lead to greater self-sufficiency. The Medical Civic Action Program (MEDCAP) often fails to fully integrate host nation providers and officials which may undermine local medical infrastructure and rarely provides sustainable improvement. The Medical Seminar (MEDSEM) was developed during Operation Enduring Freedom- Philippines to address the shortcomings of the traditional MEDCAP. The MEDSEM greatly enhanced the MEDCAP by adding education to the venue, thereby promoting self reliance and improving the sustainability of medical interventions. Furthermore, the MEDSEM forged relationships and promoted interoperability through collaboration between local medical providers, governmental leaders, host nation forces, and U.S. Special Operations Forces.

Purpose: To examine the applicability of US reference data from the Pediatric Evaluation of Disability Inventory (PEDI) in a random Danish sample and to assess intrarespondent reliability., Methods: The PEDI was administered as a mailed questionnaire that was completed by the parents. Linear regression models and comparisons of item difficulty were performed in the data analysis. Intraclass correlation coefficients were used in the intrarespondent analysis., Results: US and Danish children differed on 3 of the 6 subscales of the PEDI. Danish children had significantly lower scores on the caregiver assistance subscales (self-care and mobility) and significantly higher scores on the functional skills subscale (social function). Item difficulty was found to be comparable (r = 0.82-0.97) on all 6 subscales. Intrarespondent reliability was good (intraclass correlation coefficient = 0.62-0.97)., Conclusion: The PEDI reference values seem partly applicable in a Danish population. In a Danish rehabilitation setting, interpreting PEDI scores with regard to detecting functional delays must be done cautiously.

1. The planning and implementation of an automatic external defibrillator (AED) intervention in the workplace necessitates a comprehensive approach to program development. 2. Initiation of an AED intervention program at the worksite, based on an informed decision, requires each company to conduct a detailed assessment of need. 3. Prior to initiating an AED intervention program, appropriate resources should be consulted to examine national, state, and local law provisions and legal factors governing AED use in each specific community. 4. Essential components of an AED intervention program include: the combined cardiopulmonary resuscitation and AED use training program; written policies, procedures, and medical directives; a plan for the purchase, maintenance, and location of the AED equipment and supplies; an integrated emergency response plan; and an ongoing quality improvement process.

In the development of molecular therapies, a great deal of attention has focused on tissue targets, gene delivery vectors, and expression cassettes. In order to become an approved therapy, however, a molecular therapeutic has to pass down the same product registration pathway as any other biological product. Moving from research into industrial production requires careful attention to regulatory, manufacturing and quality concerns. Early work on developing and characterizing robust and scaleable manufacturing processes will ultimately be rewarded by ease of implementation as the product is successful in clinical trials. Regulatory agencies require solid process and product characterization studies to demonstrate control and understanding of the molecular therapeutic. As the gene therapy industry matures, standards will continue to rise, creating an industry that is capable of producing safe, high-quality and effective therapies for many of the world's most difficult disease targets.

The potential clinical and financial advantages of providing neurorehabilitation directly in patients' homes and communities have recently been discussed. However, the specific characteristics and outcomes of a coordinated, interdisciplinary, home-based programme does not currently exist in the rehabilitation literature. The present paper presents patient demographics, type and intensity of services provided, satisfaction measures, and clinical outcomes for 77 brain injured individuals in an attempt to begin to define and evaluate this new level of care. Additionally, the challenges of conducting home-based rehabilitation, and needs for further research are discussed.

Change has affected physiological optics graduate programs' fulfillment of their original purpose of providing faculty for the schools and colleges of optometry. Relevant change has been divided into two categories: 1) change in optometry and optometric education, and 2) change in the characteristics of students opting for graduate study. The answer to the question posed is that these programs are still preparing faculty for academic careers, but not in the numbers they once did. A few consequences and options are considered.

The duration of a large number of representative vowels produced by 10 esophageal and nine normal speakers were measured. Overall vowel durations of esophageal speakers were consistently longer than those of normal speakers, indicating that esophageal speakers do not compensate for their striking diminution in air supply for speech by decreasing vowel duration. The differences in the vowel duration characteristics between normal and esophageal speakers were observed to vary systematically as a function of the voicing features of their consonant environments. Specifically, the durations of vowels of esophageal speakers spoken within voiceless consonant environments were consistently longer than those spoken in similar contexts by normal speakers. There were no significant differences between the average durations of vowels spoken by normal and exophageal speakers within voiced consonant speakers differed significantly as a function of the voicing features of their consonant context was interpreted to support the belief that inherent, rule-governed durational features of English are retained following laryngeal amputation.

Instances of overt, serious functional impairment of space crews caused by adverse psychologic responses have not been scientifically documented. However, transient disorientation, spatial illusions, and visual disturbances as well as anomalous myopias, sleep disturbances, and instances of substandard performance have been described. Moreover, anecdotal information describes significant psychologic aberrations in space flight. Adequate scientific data are lacking for optimal psychological and psychophysiological methods for crew selection, training, and performance evaluation, for identifying key psychosocial factors for crew compatibility, cohesiveness, and productivity, and for determining the effects of space flight on perceptual, intellectual, and motor skills. The ad hoc Working Group, convened to review psychological aspects of space flight, favored establishment of a comprehensive research and development program to address the deficiencies identified in the study.