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Aviation has been under increasing pressure in recent years to substantially cut its impact on climate. The International Air Transport Association (IATA) committed in October 2021 to achieve net-zero carbon emissions by 2050. Other similar ambitious targets have been set for aviation, all relying strongly on alternative fuel aircraft such as hydrogen combustion or fuel cells. A significant (i.e. 60%) proportion of the current aviation contribution to global warming is caused by non-CO2 effects, with contrail cirrus the largest of these effects. Here we perform and analyse the first calculation of the contrail cirrus effective radiative forcing (ERF) for fuel cell powered aircraft and one of the first calculations for liquid hydrogen combustion aircraft, comparing them with estimates for kerosene and sustainable aviation fuel (SAF).The exhaust mix of the hydrogen combustion in an aircraft gas turbine or hydrogen fuel cell aircraft is different to that of the current hydrocarbon fuels. This leads to a potential climate penalty due to the significant increase in associated water vapour emissions. We find that for liquid hydrogen combustion and fuel cell powered planes, the area of the globe covered by contrails is set to increase substantially (~70%) due to their additional water vapour emissions leading to more regions of the atmosphere becoming susceptible to contrail formation. However, the expected cleaner exhaust and corresponding increase in average contrail particle sizes lead to changes in contrail radiative properties. These changes result in a reduction in contrail cirrus ERF for liquid hydrogen combustion (~25%) and fuel cell (~20%) powered planes, compared to kerosene planes. SAF planes are expected to lead to a slight (~5%) increase in contrail cover, but a decrease (~20%) contrail cirrus ERF, compared to kerosene planes.In general, our analysis finds that changes in contrail cirrus ERF are relatively modest between fuel types, compared to the overall uncertainty in the ERF estimate itself. Some of this uncertainty stems from our representation of physical processes in contrails and further work is needed to look at the effects of alternative fuels on contrail ice crystal sizes, contrail lifetimes and aerosol-cloud interactions.

Precipitating energetic particles can penetrate into the low-altitude ionosphere and alter the ionization rate. Enhanced ionization in the D-region caused by energetic particle precipitation (EPP) affects cosmic radio signal absorption in the ionosphere. This impact is monitored by a Canadian network of wide-beam passive radio receivers, or riometers, to study precipitation-induced variations in the D-region ionosphere remotely. In this study, we examine the relationship between the background ionospheric profiles and absorption during a precipitation event observed by one of the POES satellites in conjunction with the Gillam riometer station (56N, 95W). We use different chemistry models to model the D-region ionosphere and investigate the effect of changing the chemistry model in an absorption event. We compare modelled absorption with ground-based measurements to discuss possible reasons for any discrepancy.

Basal cell carcinoma (BCC) is the most prevalent cancer in the Western world and its incidence is increasing. The pathogenesis of BCC involves deregulated Sonic hedgehog signaling, leading to activation of the Gli transcription factors. Most BCCs have a nodular growth pattern, and are indolent, slow-growing, and considered “low-risk” lesions. In contrast, the “high-risk” morphoeic variant, which causes significant morbidity, has an infiltrative growth pattern, and is so-called because of its densely fibrous stroma. As αvβ6 is capable of promoting both carcinoma invasion and fibrosis, we examined the expression of this integrin in BCCs and found that the morphoeic type showed significantly higher αvβ6 expression than the nodular type (P = 0.0009). In order to examine the function of αvβ6, we transfected the transcription factors Gli1 or Gli2 into NTERT, human keratinocytes to generate a BCC model. These cells expressed αvβ6 and were invasive, although inhibition of αvβ6 had no direct effect on cell invasion. However, the cells showed αvβ6-dependent activation of transforming growth factor-β1, which induced transdifferentiation of human fibroblasts into myofibroblasts. Paracrine secretion of hepatocyte growth factor/scatter factor by these myofibroblasts promoted c-Met–dependent tumor invasion in both Transwell and three-dimensional organotypic assays. These experimental in vitro findings were confirmed using human clinical samples in which we showed that the stroma of morphoeic BCC is myofibroblast-rich compared with nodular BCC (P = 0.0036), that myofibroblasts express hepatocyte growth factor/scatter factor, and that morphoeic BCCs are strongly c-Met–positive. These data suggest that αvβ6-dependent transforming growth factor-β1 activation induces both the infiltrative growth pattern and fibrotic stroma so characteristic of morphoeic BCC. [Cancer Res 2008;68(9):3295–303]

Supplementary Figure Legends 1-2 from αvβ6 Integrin Promotes the Invasion of Morphoeic Basal Cell Carcinoma through Stromal Modulation

Supplementary Figure 2 from αvβ6 Integrin Promotes the Invasion of Morphoeic Basal Cell Carcinoma through Stromal Modulation

Supplementary Figure 1 from αvβ6 Integrin Promotes the Invasion of Morphoeic Basal Cell Carcinoma through Stromal Modulation

The Imaging Ultraviolet Spectrograph (IUVS) on the Mars Atmosphere and Volatile EvolutioN (MAVEN) mission has been used to observe the Mg+ in the upper atmosphere of Mars since 2015. These observations reveal significant diurnal, seasonal and latitudinal variations. For example, a factor of two change in Mg+ occurs during the day at the equator and Mg+ above 100 km decreases across the globe during the Southern Hemisphere summertime. Possible causes include the influence of photo-chemistry, atmospheric dynamics and the injection rate of meteoric material. To delineate these sources of variability, a 3-dimensional model of the Martian Mg has been developed. The model is based on the Laboratoire de Météorologie Dynamique (LMD) Mars global circulation model (GCM), which is capable of simulating the seasonal cycles in the Martian atmosphere arising from changes in heating rates from orbital geometry and the distribution of dust in the lower atmosphere. The model solves for the dynamics and primary constituents of the atmosphere from the surface to the thermosphere. For this study, the chemistry has been augmented with neutral and ion chemistry for meteoric metals within a CO2 atmosphere, incorporating 7 neutral and 8 ionized Mg-containing species and an additional 42 neutral and ion-molecule reactions. The atmospheric input of meteoric material is specified from seasonal and latitudinal fits to new estimates of the deposition of the ablated metals in the atmosphere. Here we present the first detailed intercomparison of the MAVEN IUV Mg+ observations with simulated Mg+ from the LMD Mars GCM. Model variability is consistent with observations and indicates tropical variability is caused by a combination of photochemistry and vertical transport by atmospheric tides. Comparisons of simulations performed with variable and fixed meteoric input show that the high latitude variations are caused by both seasonal variation in ablation rates and the residual circulation. Finally, we show how Mg+ varies in relation to neutral Mg and the remaining Mg-containing species to determine how Mg+ may be used as a proxy for total Mg variability.

It is evident that a variety of metals are deposited in the Earth’s mesosphere and lower thermosphere (MLT, ~70-120 km) through meteoric ablation when the cosmic dust particles enter the atmosphere at high entry velocity (11-72 km/s). However, it is still unclear how much and accuarate cosmic dust enters the atmosphere of Mars (though the estimation of global dust input would be a few tons per sol) and what is the difference comparing to Earth’s atmosphere (which has a 1-2 order global input range from different estimations). We have developed global atmospheric meteoric models of Na, Fe, K, Mg, Ni, Ca, Al, Si, P, S etc) into the Whole Atmosphere Community Climate Model (WACCM) and its vertical extensions to 600 km (WACCM-X) from US National Center for Atmospheric Research (NCAR, termed WACCM-metals), which simulate well the metal layers compared with the available lidar/rocket/satellite measurements. New observations of some metals for the Martian atmosphere (i.e., Mg+ observations from IUVS (Imaging UV Spectrometer) and Mg+, Na+ and Fe+ from NGIMS (Neutral Gas Ion Mass Spectrometer)) instruments on NASA’s Mars Atmosphere and Volatile Evolution Mission (MAVEN) spacecraft are available from 2014. Therefore, we have incorporated the chemistry of three metals (Mg, Na and Fe) in the Laboratoire de Météorologie Dynamique (LMD) Mars global circulation model (termed as LMD-Mars-Metals), following similar work we have done for the Earth’s atmosphere. The model has been developed by combining three components: the state-of-the-art LMD-Mars model covering the whole atmosphere from the surface to the upper thermosphere (up to ~ 2 x10-8 Pa or 240 km), a description of the neutral and ion-molecule chemistry of Mg, Fe and Na in the Martian atmosphere (where the high CO2 abundance produces a rather different chemistry from the terrestrial atmosphere), and a treatment of injection of the metals into the atmosphere from the ablation of cosmic dust particles. The LMD-Mars model contains a detailed treatment of atmospheric physics, dynamics and chemistry from the lower atmosphere to the ionosphere. The model also includes molecular diffusion and considers the chemistry of the C, O, H and N families and major photochemical ion species in the upper atmosphere, as well as improved treatments of the day-to-day variability of the UV solar flux and 15 mm CO2 cooling under non-local thermodynamic equilibrium conditions. We have incorporated the chemistries of Mg, Fe and Na into LMD-Mars because these metals have different chemistries which control the characteristic features of their ionized and neutral layers in the Martian atmosphere. The Mg chemistry adds 7 neutral and 8 ionized Mg-containing species, connected by 42 neutral and ion-molecule reactions. The corresponding Fe chemistry has 39 reactions with 14 Fe-containing species. Na chemistry adds 7 neutral and only 2 ionized Na-containing species, with 32 reactions. The injection rate of these metals as a function of latitude, solar longitude at different pressure levels is pre-calculated from the Leeds Chemical Ablation Model (CABMOD) combined with an astronomical model which predicts the dust from Jupiter Family and Long Period comets, as well as the asteroid belt, in the inner solar system. The model has been evaluated against by Mg+, Na+ and Fe+ observations from IUVS and NGIMS measurements. The comparison of these metal layers between Earth’s and Mar’s atmospheres will be discussed, which allows us to understand the meteor astronomy, chemistry and transport processes that control the different metal layers in the upper atmosphere on different planets.

Modelling the whole atmosphere from the surface to the ionosphere allows us to better forecast and understand our weather and climate. It is a scientific and computational challenge to model this complex system numerically with its many drivers and feedback loops. Recent efforts to improve whole atmosphere models include raising the altitude to incorporate improved representations of the ionosphere and thermosphere. The Whole Atmosphere Community Climate Model with thermosphere and ionosphere extension (WACCM-X) is one of the most comprehensive numerical models, spanning the range of altitude from the Earth’s surface to the upper thermosphere (~700 km). WACCM-X can model the global ionosphere and thermosphere, whilst providing coupling between atmosphere layers through chemical, physical and dynamical processes. Using WACCM-X, we can explore the implications of this coupling for the climate and for the near space environment. The high-latitude ionosphere-thermosphere behaves dynamically during geomagnetically active times due to time-varying solar wind driving and internal magnetospheric dynamics. We present high- and mid-latitude observations from the Super Dual Auroral Radar Network, Incoherent Scatter Radars and Fabry-Perot Interferometers which observe the ionosphere-thermosphere system. We investigate observed plasma flows, which respond directly to solar wind driving, alongside WACCM-X model simulations which are nudged to a meteorological reanalysis dataset in the troposphere and stratosphere during a variety of solar storm conditions. We discuss these in the context of time-varying dynamics due to solar wind driving and investigate the expansion of the high-latitude convection to lower latitudes during geomagnetic storms. Our results show that the latitudinal expansion is not yet fully captured in WACCM-X and we discuss how this may be mitigated. We further show that during a geomagnetic storm, the differences between the WACCM-X ionospheric data and the observations by SuperDARN at high- to mid-latitudes may vary by up to ~20 kV for the electrostatic potential during a geomagnetic storm. This translates to an electric field difference of 25 mV/m and differences in the plasma drift velocities in excess of ~800 m/s.

Here we report a global model of meteoric metals including Mg, Fe and Na in the Laboratoire de Météorologie Dynamique (LMD) Mars global circulation model (termed as LMD-Mars-Metals), following on similar work as we have done for the Earth’s atmosphere. The model has been developed by combining three components: the state-of-the-art LMD-Mars model covering the whole atmosphere from the surface to the upper thermosphere (up to ~ 2 x10-8 Pa or 240 km), a description of the neutral and ion-molecule chemistry of Mg, Fe and Na in the Martian atmosphere (where the high CO2 abundance produces a rather different chemistry from the terrestrial atmosphere), and a treatment of injection of the metals into the atmosphere as a result of the ablation of cosmic dust particles. The LMD-Mars model contains a detailed treatment of atmospheric physics, dynamics and chemistry from the lower atmosphere to the ionosphere. The model also includes molecular diffusion and considers the chemistry of the C, O, H and N families and major photochemical ion species in the upper atmosphere, as well as improved treatments of the day-to-day variability of the UV solar flux and 15 mm CO2 cooling under non-local thermodynamic equilibrium conditions. So far, we have incorporated the chemistries of Mg, Fe and Na into LMD-Mars because these metals have different chemistries which control the characteristic features of their ionized and neutral layers in the Martian atmosphere. The Mg chemistry has 4 neutral and 6 ionized Mg-containing species, connected by 25 neutral and ion-molecule reactions. The corresponding Fe chemistry has 39 reactions with 14 Fe-containing species. Na chemistry has 7 neutral and only 2 ionized Na-containing species, with 32 reactions. The injection rate of these metals as a function of height is pre-calculated from the Leeds Chemical Ablation Model (CABMOD) combined with an astronomical model which predicts the dust from Jupiter Family and Long Period comets, as well as the asteroid belt, in the inner solar system. The LMD-Mars-Metals model has been run for several full Martian years under different surface dust scenarios to investigate the impact of high atmospheric dust loadings on the modelled metal layers. The model has been evaluated against Mg+ observations from IUVS (Imaging UV Spectrometer) and NGIMS (Neutral Gas Ion Mass Spectrometer) instruments on NASA’s Mars Atmosphere and Volatile Evolution Mission (MAVEN) spacecraft. We have also carried out other sensitivity experiments with different seasonality/altitude/latitudinal varying of Meteoric Input Function (MIF) of these metals in the model. These sensitivity results will be discussed.

The seasonal variation of the daytime lower ionosphere, monitored using the propagation of Very Low Frequency (VLF) radio waves, shows an asymmetry when comparing the spring and autumn transitions. Considering the solar zenith angle variation, it can explain the spring transition but not the autumn one. The climatological variation exposes that the maximum of the VLF deviation is around the beginning of October. Thus, the deviation is called “the October effect”. This study aims to understand the possible atmospheric phenomena behind this effect. We use VLF signals transmitted from USA (NAA, f = 24 kHz), UK (GQD, f=19.6 kHz) and Iceland (NRK, f = 37.5 kHz) recorded in Northern Finland from 2011 to 2019. We compare our results with the Whole Atmosphere Community Climate Model with the thermosphere-ionosphere eXtension (WACCM-X) data. The October effect is separated into climatological earliest and latest effect according to WACCM-X climatological earliest and latest transitions from eastward to westward mean zonal winds

Although billions of devices are embedded in the World Wide Web through the Internet of Things, there is still a lack of a common, interoperable way to connect them and make them interact seamlessly. IoT has also found its way into the spatial web. Environmental monitoring and sensing platforms connected over the web by wireless sensor networks are now a common way to monitor natural phenomena. This study compares two open Web Standards ( OGC’s Sensor Observation Service and SensorThings API ) from the geospatial point of view. An IoT platform, called SEnviro , is used to integrate and evaluate implementations for each standard and contrast their qualitative and quantitative traits. The results of the study show that the SensorThings API proves to be the adequate Web Standard for IoT applications in terms of interoperability. It outperforms the contesting Web Standard in terms of flexibility and scalability, which strongly impacts on developer and user experience.

Water vapor (H2O) is the source of reactive hydrogen radicals in the middle atmosphere, whereas carbon monoxide (CO), being formed by CO2 photolysis, is suitable as a dynamical tracer. In the mesosphere, both H2O and CO are sensitive to solar irradiance variability because of their destruction/production by solar radiation. This enables to analyze the solar signal in both, models and observed data. Here, we evaluate the mesospheric H2O and CO response to solar irradiance variability using the Chemistry-Climate Model Initiative (CCMI-1) simulations and satellite data. We analyzed the results of four CCMI models (CMAM, EMAC-L90MA, SOCOLv3, CESM1-WACCM 3.5) operated in CCMI reference simulation REF-C1SD in specified dynamics mode, covering the period from 1984 to 2017. Multiple linear regression analysis shows a pronounced and statistically robust response of H2O and CO to solar irradiance variability, and to the annual and semiannual cycles. For periods with available satellite data, we compared the simulated solar signal against satellite observations, namely during 1992–2017 for H2O and 2005–2017 for CO. The model results generally agree with observations and reproduce an expected negative and positive correlation for H2O and CO, respectively, with solar irradiance. However, the magnitude of the response and patterns of the solar signal varies among the considered models, indicating differences in the applied chemical reaction and dynamical schemes including the representation of photolyses. We suggest that there is no dominating thermospheric influence of solar irradiance in CO, as reported in previous studies because the response to solar variability is comparable with observations in both, low-top and high-top models. We stress the importance of this work for improving our understanding of the current ability and limitations of state-of-the-art models to simulate a solar signal in the chemistry and dynamic of the middle atmosphere.

Energetic electron precipitation (EEP) ionizes the Earth's atmosphere and leads to production of nitric oxide (NO) from 50 to 150 km altitude. In this study we investigate the direct and indirect NO response to EEP using the Whole Atmosphere Community Climate Model (WACCM). In comparison to observations from SOFIE / AIM (Solar Occultation For Ice Experiment / Aeronomy of Ice in the Mesosphere), we find that EEP production of NO in the D-region is well simulated when both medium energy electron precipitation and negative and cluster ion chemistry is included in the model. However, the main EEP production of NO occurs in the E-region, and there the observed and modeled production differ. This discrepancy impacts also the D-region, and is seasonally dependent with the highest underestimate of D-region NO occuring during winter. The modeled transport across the mesopause during winter is generally weak, but strengthens with increased gravity wave activity. Increased eddy diffusion, increases NO at all altitudes through the polar MLT region

Concentrations of the air pollutants (NO2 and particulate matter) were measured for several months and at multiple locations inside and outside two enclosed railway stations in the United Kingdom – Edinburgh Waverly (EDB) and London King’s Cross (KGX) – which, respectively, had at the time 59% and 18% of their train services powered by diesel engines. Average concentrations of NO2 were above the 40 μg m−3 annual limit value outside the stations and were further elevated inside, especially at EDB. Concentrations of PM2.5 inside the stations were 30–40% higher at EDB than outside and up to 20% higher at KGX. Concentrations of both NO2 and PM2.5 were highest closer to the platforms, especially those with a higher frequency of diesel services. A random-forest regression model was used to quantify the impact of numbers of different types of diesel trains on measured concentrations allowing prediction of the impact of individual diesel-powered rolling stock.

In this work, a compact, mobile phone-based ECL sensor apparatus was developed using the phone cameras, screen-printed electrodes (SPE), and mobile app for dopamine detection. Methods of DC voltage application for ECL reaction were comprehensively studied from the mobile phone itself or external power. Under optimized sensing conditions, with disposable carbon SPE and 20 mM coreactant tri-n-propylamine (TPrA), acceptable repeatability and reproducibility were achieved in terms of relative standard deviation (RSD) of intra- and interassays, which were 6.7 and 5.5%, respectively. The biochemical compound dopamine was measured due to its ECL quenching characteristics and its clinical importance. The quenching mechanism of Ru(bpy)32+/TPrA by dopamine was investigated based on the estimation of the constants of the Stern-Volmer equations. The linear range for detectable dopamine concentration was from 1.0 to 50 μM (R2 = 0.982). As the developed mobile phone-based ECL sensor is simple, small and assembled from low-cost components, it offers new opportunities for the development of inexpensive analytical methods and compact sensors.

Background/Aims: Neighborhood walkability is associated with indicators of health in the general population. We explored the association between neighborhood walkability and daily steps in hemodialysis (HD) patients. Methods: We measured daily steps over 5 weeks using Fitbit Flex (Fitbit, San Francisco, CA, USA) and retrieved Walk Score® (WS) data by patient’s home ZIP code (www.walkscore.com; 0 = poorest walkability; 100 = greatest walkability). Results: HD patients took a mean of 6,393 ± 3,550 steps/day (n = 46). Median WS of the neighborhood where they resided was 28. Patients in an above-median WS (n = 27) neighborhood took significantly more daily steps compared to those (n = 19) in a below-median WS neighborhood (7,514 ± 3,900 vs. 4,800 ± 2,228 steps/day; p < 0.001, t test). Daily steps and WS were directly correlated (R = 0.425; p = 0.0032, parametric test; R = 0.359, p = 0.0143, non-parametric test). Conclusion: This is the first study conducted among HD patients to indicate a direct relationship between neighborhood walkability and the actual steps taken. These results should be considered when designing initiatives to increase and improvise exercise routines in HD populations.

Introduction: Studies conducted in our laboratory on proteomic profiling of breast cancer serum among women by shotgun LC-MS methodology have identified several biomarkers for early detection of breast cancer. However, not all of the identified biomarkers have been validated due to costs involved with validation tests. The development of a reliable, cost-effective highly sensitive portable system, the Electrochemiluminescence (ECL) biosensor will enable us to validate identified biomarkers that have valuable diagnostic applications. The purpose of this study was to detect dopamine, which has been identified as a biomarker in advanced breast cancer. Dopamine and its receptors act as novel therapeutic agents in advanced breast cancer. Dopamine significantly enhances the efficacy of commonly used anticancer drugs through its antiangiogenic action. Methods: In this work, a compact, mobile phone-based ECL sensor apparatus was developed using the phone cameras, screen-printed electrodes (SPE), and mobile app for dopamine detection. Methods of DC voltage application for ECL reaction were comprehensively studied from the mobile phone itself or external power. Under optimized sensing conditions, with disposable carbon SPE and 20 mM coreactant tri-n-propylamine (TPrA), acceptable repeatability and reproducibility were achieved in terms of relative standard deviation (RSD) of intra- and interassays, which were 6.7 and 5.5 %, respectively. The biochemical compound dopamine was measured due to its ECL quenching characteristics and its clinical significance in breast cancer detection and therapeutic properties. The quenching mechanism of Ru(bpy)32+/TPrA by dopamine was investigated based on the estimation of the constants of the Stern-Volmer equations. Results: The linear range for detectable dopamine concentration was from 1.0 to 50 µM (R2 = 0.982). As the developed mobile phone-based ECL sensor is simple, small and assembled from low-cost components, it offers new opportunities for the development of inexpensive analytical methods and compact sensors. Conclusion: The ECL sensor demonstrated that a new instrumentation with mobile technology in the point-of-care diagnostics of breast cancer could provide reliability and sensitivity of a high-end equipment. This project is funded by the NSF CBET division. Citation Format: Hyun J. Kwon, Padma P. Tadi Uppala, Elmer C. Rivera, Mabio R. Neto, Daniel Marsh, Jonathan J. Swerdlow, Rodney L. Summerscales. Development of a smartphone-based electrochemiluminescence biosensor for dopamine detection in advanced breast cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 871.

The 2016 London atmospheric emissions inventory estimates that, the construction sector contributes 34% of the total PM 10 and 7% of the total NO X – the largest and 5 th largest sources, respectively. Recent on-road light duty diesel vehicle emission tests have shown significant differences between real-world NO X emissions compared with results from laboratory based regulatory tests. The aim of this study was therefore to quantify the ‘real-world’ tail-pipe NO X, CO 2, and particle emissions, for 30 of the most commonly used construction machines in London under normal working conditions. The highest NO X emissions (g/kWh) were from the older engines (Stage III-A ~4.88 g/kWh and III-B ~4.61 g/kWh), these were reduced significantly (~78%) in the newer (Stage IV ~1.05 g/kWh) engines due to more advanced engine management systems and exhaust after treatment. One Stage IV machine emitted NO X similar to a Stage III-B machine, the failure of this SCR was only detectable using PEMS as no warning was given by the machine. Higher NO X conformity factors were observed for Stage IV machines, due to the lower NO X emission standards, which these machines must adhere to. On average, Stage III-B machines (~525 g/kWh) emitted the lowest levels of CO 2 emissions, compared to Stage III-A (~875 g/kWh) and Stage IV (~575 g/kWh) machines. Overall, a statistically significant (~41%) decrease was observed in the CO 2 emissions (g/kWh) between Stage III-A and III-B machines, while no statistically significant difference was found between Stage III-B and IV machines. Particle mass measurements, which were only measured from generators, showed that generators of all engine sizes were within their respective Stage III-A emission standards. A 95% reduction in NO X and 2 orders of magnitude reduction in particle number was observed for a SCR-DPF retrofitted generator, compared to the same generator prior to exhaust gas after-treatment strategy.

IntroductionEarly identification and appropriate treatment of child and adolescent mental health disorders can often be hampered by patchwork services with poorly planned or unclear pathways. The Choice and Partnership Approach (CAPA) is an evidence-based transformational model of community (community-based or outpatient) mental health and addictions services for children and adolescents that aims to better match services to needs and to improve timely access to care. CAPA has been variably implemented across jurisdictions but has not been comprehensively evaluated for its impact on system and client outcomes. Our research question is, ‘To what degree does CAPA work, for whom and under what circumstances?’. The purpose of this review is twofold: (1) to gain an understanding of the extent and outcomes of the implementation of CAPA in community mental health and addictions services; and (2) to identify the role of context as it influences the implementation of CAPA and resulting client and system outcomes.Methods and analysisWe will conduct a realist-informed scoping review of the literature related to CAPA in either child and adolescent or adult community mental health and addictions services. Relevant studies, reports and documentation will be identified by searching the following online databases: MEDLINE, Embase, CINAHL, PsycINFO, Academic Search Premier, ERIC, Web of Science, Cochrane, Dissertations Abstracts, NCBI Bookshelf, PubMed Central and the Canadian Health Research Collection. The search strategy was developed by a health sciences library scientist and informed by a multidisciplinary team comprising methodological and content knowledge experts. The search will gather evidence from multiple online databases of peer-reviewed literature and grey literature repositories. All articles will be independently assessed for inclusion by pairs of reviewers. The key themes derived from a thematic analysis of extracted data will be presented in a narrative overview.Ethics and disseminationResearch ethics review is not required for this scoping review. The results will be disseminated through meetings with stakeholders (including clients and families, clinicians and decision-makers), conference presentations and peer-reviewed publication. The results of this review will inform an overarching programme of research, policy and quality indicator development to ultimately improve mental health and addictions care and subsequent mental health outcomes for children and adolescents.

Background Controversy persists as to whether round or anatomical form-stable breast implants provide the most aesthetically pleasing results, and there is a paucity of evidence comparing cosmetic outcomes of these two implants. A blinded study comparing aesthetic outcomes was conducted in an attempt to address this issue. Objectives The authors compare aesthetic outcomes between round and anatomical form-stable breast implants. Methods Pre- and postoperative photographs of 60 consecutive patients undergoing breast augmentation (33 round, 27 anatomical) by a single surgeon were reviewed by 22 plastic surgeons. Photographs were graded on a modified Likert scale (1, poor; 4, excellent) for overall aesthetic result, upper pole contour, and natural appearance. The panel was asked to determine implant shape. Results Anatomical implants scored higher for upper pole contour: anatomical 2.80 (±0.44 – standard deviation) vs round 2.60 (±0.38). With regard to natural appearance and overall aesthetic results, anatomical implants scored higher: 2.89 (±0.42) vs 2.56 (±0.36) and 2.86 (±0.41) vs 2.72 (±0.37), respectively. None of these differences achieved statistical significance, and 62.7% of round and 49% of anatomical implants were correctly identified. There was no significant difference in the body mass index (BMI) between the 2 groups ( P = .21). Conclusions No significant difference ( P > .05) in the general and specific cosmetic points between round and anatomical implants was demonstrated; many on the panel were unable to identify implant shape correctly. Both techniques seem to yield good cosmetic results. Clearly the decision on which implant to use must be made on an individual patient basis because many factors influence overall aesthetic outcome. Anatomical implants should not be assumed to produce a more natural result. Level of Evidence 4![Graphic][1] Therapeutic [1]: /embed/inline-graphic-1.gif

Background/Aims: Hemodialysis (HD) patients are less active than their healthy counterparts. They are often plagued with sleep disorders that affect the quality of their sleep. Our aim was to objectively quantify activity and sleep quality among HD patients in a suburban HD population. Methods: Activity and sleep parameters were measured using a commercially available activity tracker in 29 HD patients from Baton Rouge, LA, USA. Patients in the feedback group received their activity and sleep data at each dialysis treatment. In addition, questionnaires were administered at the beginning and end of the study period. Patients were stratified based on activity levels and sleep quality. Results: Patients walked an average of 5,281 steps/day and slept 370.5 min/night. Informing patients about their daily number of steps taken, did not increase activity. Only 3% of the population followed were active, defined as walking more than 10,000 steps per day. Patients walked significantly less on dialysis days compared to the other days of the week. Many of the patients experienced poor sleep quality, with patients in the first shift experiencing the greatest disturbance to their sleep/wake cycle. Conclusion: Patients in a suburban environment walked much less than those in a previously studied urban population. They rarely met the recommended goal of 10,000 steps/day, even on non-dialysis days. Interventions to increase physical activity may target any day of the week, particularly HD days. Prospective, long-term studies are needed to evaluate the use of activity trackers in dialysis patients and their impact on physical activity.

Construction activities are common across cities; however, the studies assessing their contribution to airborne PM10 (≤10 μm) and PM2.5 (≤2.5 μm) particles on the surrounding air quality are limited. Herein, we assessed the impact of PM10 and PM2.5 arising from construction works in and around London. Measurements were carried out at 17 different monitoring stations around three construction sites between January 2002 and December 2013. Tapered element oscillating microbalance (TEOM 1400) and OSIRIS (2315) particle monitors were used to measure the PM10 and PM2.5 fractions in the 0.1-10 μm size range along with the ambient meteorological data. The data was analysed using bivariate concentration polar plots and k-means clustering techniques. Daily mean concentrations of PM10 were found to exceed the European Union target limit value of 50 μg m-3 at 11 monitoring stations but remained within the allowable 35 exceedences per year, except at two monitoring stations. In general, construction works were found to influence the downwind concentrations of PM10 relatively more than PM2.5. Splitting of the data between working (0800-1800 h; local time) and non-working (1800-0800 h) periods showed about 2.2-fold higher concentrations of PM10 during working hours when compared with non-working hours. However, these observations did not allow to conclude that this increase was from the construction site emissions. Together, the polar concentration plots and the k-means cluster analysis applied to a pair of monitoring stations across the construction sites (i.e. one in upwind and the other in downwind) confirmed the contribution of construction sources on the measured concentrations. Furthermore, pairing the monitoring stations downwind of the construction sites showed a logarithmic decrease (with R2 about 0.9) in the PM10 and PM2.5 concentration with distance. Our findings clearly indicate an impact of construction activities on the nearby downwind areas and a need for developing mitigation measures to limit their escape from the construction sites.

Worldwide, approximately 405 000 cases of oral cancer (OSCC) are diagnosed each year, with a rising incidence in many countries. Despite advances in surgery and radiotherapy, which remain the standard treatment options, the mortality rate has remained largely unchanged for decades, with a 5-year survival rate of around 50%. OSCC is a heterogeneous disease, staged currently using the TNM classification, supplemented with pathological information from the primary tumour and loco-regional lymph nodes. Although patients with advanced disease show reduced survival, there is no single pathological or molecular feature that identifies aggressive, early-stage tumours. We retrospectively analysed 282 OSCC patients for disease mortality, related to clinical, pathological, and molecular features based on our previous functional studies [EGFR, αvβ6 integrin, smooth muscle actin (SMA), p53, p16, EP4]. We found that the strongest independent risk factor of early OSCC death was a feature of stroma rather than tumour cells. After adjusting for all factors, high stromal SMA expression, indicating myofibroblast transdifferentiation, produced the highest hazard ratio (3.06, 95% CI 1.65-5.66) and likelihood ratio (3.6; detection rate: false positive rate) of any feature examined, and was strongly associated with mortality, regardless of disease stage. Functional assays showed that OSCC cells can modulate myofibroblast transdifferentiation through αvβ6-dependent TGF-β1 activation and that myofibroblasts promote OSCC invasion. Finally, we developed a prognostic model using Cox regression with backward elimination; only SMA expression, metastasis, cohesion, and age were significant. This model was independently validated on a patient subset (detection rate 70%; false positive rate 20%; ROC analysis 77%, p < 0.001). Our study highlights the limited prognostic value of TNM staging and suggests that an SMA-positive, myofibroblastic stroma is the strongest predictor of OSCC mortality. Whether used independently or as part of a prognostic model, SMA identifies a significant group of patients with aggressive tumours, regardless of disease stage.

Oral submucous fibrosis (OSF) is a premalignant, fibrosing disorder of the mouth, pharynx, and oesophagus, with a malignant transformation rate of 7-13%. OSF is strongly associated with areca (betel) nut chewing and worldwide, over 5 million people are affected. As αvβ6 integrin is capable of promoting both tissue fibrosis and carcinoma invasion, we examined its expression in fibroepithelial hyperplasia and OSF. αvβ6 was markedly up-regulated in OSF, with high expression detected in 22 of 41 cases (p < 0.001). We investigated the functional role of αvβ6 using oral keratinocyte-derived cells genetically modified to express high αvβ6 (VB6), and also NTERT-immortalized oral keratinocytes, which express low αvβ6 (OKF6/TERT-1). VB6 cells showed significant αvβ6-dependent activation of TGF-β1, which induced transdifferentiation of oral fibroblasts into myofibroblasts and resulted in up-regulation of genes associated with tissue fibrosis. These experimental in vitro findings were confirmed using human clinical samples, where we showed that the stroma of OSF contained myofibroblasts and that TGF-β1-dependent Smad signalling was detectable both in keratinocytes and in myofibroblasts. We also found that arecoline, the major alkaloid of areca nuts, up-regulated keratinocyte αvβ6 expression. This was modulated through the M(4) muscarinic acetylcholine receptor and was suppressed by the M(4) antagonist, tropicamide. Arecoline-dependent αvβ6 up-regulation promoted keratinocyte migration and induced invasion, raising the possibility that this mechanism may support malignant transformation. Over 80% of OSF-related oral cancers examined had moderate/high αvβ6 expression. These data suggest that the pathogenesis of OSF may be epithelial-driven and involve arecoline-dependent up-regulation of αvβ6 integrin.

The authors investigated the effect of neck dimension upon cervical range of motion. Data relating to 100 healthy subjects, aged between 20 and 40 years, were recorded with respect to age, gender and range of motion in three planes. Additionally, two widely used methods of measuring neck motion, chin-sternal distance and uniplanar goniometer, were assessed against a validated measurement tool, the ‘CROM goniometer’. Using multiple linear regression analysis it was determined that sagittal flexion (P = 0.002) and lateral rotation (P

Although bioabsorbable pins have been used to successfully stabilize a wide range of osteotomies, to date there have been not published studies describing the results of their use for fixation of first metatarsal osteotomies in Mitchell's bunionectomy. The purpose of this retrospective investigation of 78 first metatarsal osteotomies was to evaluate the effectiveness of polydioxanone bioabsorbable pin fixation of the first metatarsal osteotomy in Mitchell's bunionectomy. The mean length of the first metatarsal preoperatively was 6.65 +/- 0.42 cm, and postoperatively it was 6.31 +/- 0.57 cm (P.0001). The mean first IMA preoperatively was 17.59 degrees +/- 3.51 degrees , and postoperatively it was 9.91 degrees +/- 2.58 degrees (P.0001). The mean HVA preoperatively was 29.74 degrees +/- 4.70 degrees , and postoperatively it was 12.89 degrees +/- 4.26 degrees (P.0001). The average time to bony union was 6.01 +/- 0.61 weeks. There were 5 (6.41%) superficial wound infections that resolved with oral antibiotics, 1 (1.28%) deep-seated infection requiring surgical debridement, and 2 (2.56%) patients complained of transfer metatarsalgia. Five (6.41%) patients displayed persistent localized translucency at some portion of the osteotomy site on postoperative radiographs, and there were no cases of progressive osteolysis. In this series there were no complications related to pin fracture or failure of osteotomy fixation. Based on the results observed in this study, it appears that the use of polydioxanone bioabsorbable pins provides satisfactory stabilization of the first metatarsal osteotomy in Mitchell's bunionectomy, and was not associated with any serious complications.2.

Five hundred orthopaedic surgeons and 336 anaesthetists were surveyed to assess current UK attitudes towards transfusion practice following arthroplasty surgery. Seventy-two percent of surgeons and 73% of anaesthetists responded to the survey. In an uncomplicated patient following total hip arthroplasty, 53.2% of surgeons and 63.1% of anaesthetists would transfuse at or below a haemoglobin (Hb) level of 8 g/dL. Surgeons tended to be more aggressive in their attitudes, with a mean transfusion threshold of 8.3 g/dL compared to 7.9 g/dL for anaesthetists (p

Summary Background Seroma formation remains a significant problem in abdominoplasty procedures – the cause of which remains to be elucidated. It has been suggested that one of the causative factors for seroma formation is the use of handheld electrocautery as opposed to scalpel for abdominal flap dissection. Methods Prospective trial in 102 consecutive abdominoplasty patients randomised to have abdominal flap dissection with either handheld electrocautery device on ‘coagulation setting' or sharp dissection with scalpel and monopolar electrocautery forceps for haemostasis. In all other aspects the surgical technique was identical between the two groups. All drains were removed at 48 h, irrespective of drain volume. Primary outcome measure is postoperative seroma formation on clinical examination, secondary outcome measures are drain volume, weight of tissue removed, effect of liposuction and patient BMI. Results Both study groups were similar in demographics with no significant difference in weight of tissue excised, BMI, drain output or post operative complictions. There was no significant difference in seroma formation rates between the handheld electrocautery group (17.2%) and the sharp dissection group (20.1%). Overall, the seroma rate was 18.6%. Liposuction to the flanks at the time of abdominoplasty was found to significantly increase the incidence of seroma, compared to patients having abdominoplasty alone. Conclusions Use of handheld electrocautery rather than scalpel for tissue dissection does not lead to increased seroma formation in abdominoplasty patients. Concomitant liposuction at the time of abdominoplasty increases the risk of seroma formation compared to patients having abdominoplasty alone.

A 65-year-old lady presented to the Accident and Emergency Department complaining of right hip pain and inability to weight bear following a mechanical fall at home. Her past medical history included chronic pancreatitis as a complication of acute pancreatitis 30 years ago. Due to severe chronic epigastric pain she had been self administering intramuscular pentazocine for a number of years. Examination revealed pain with limited movements of the affected hip, as well as reduced ranges of movement of the hip and knee on the contralateral side. On further examination there was found to be bilateral hard woody indurations in the anterior thigh muscles and gluteal region as well as the upper arms, although other muscle groups seemed to be spared (Figs. 1—3). Plain radiographs showed a right intracapsular fractured neck of femur with associated extensive soft tissue calcification of the muscles surrounding both femora (Figs. 1 and 2). In view of the patient’s age and poor mobility prior to the fall, the fracture was managed with a hemiarthroplasty. The patient was prepared for theatre in the normal manner