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To understand more fully the effects of global changes on ambient concentrations of ozone and particulate matter with aerodynamic diameter smaller than 2.5 µm (PM2.5) in the US, we conducted a comprehensive modeling effort to evaluate explicitly the effects of changes in climate, biogenic emissions, land use, and global/regional anthropogenic emissions on ozone and PM2.5 concentrations and composition. Results from the ECHAM5 global climate model driven with the A1B emission scenario from the Intergovernmental Panel on Climate Change (IPCC) were downscaled using the Weather Research and Forecasting (WRF) model to provide regional meteorological fields. We developed air quality simulations using the Community Multiscale Air Quality Model (CMAQ) chemical transport model for two nested domains with 220 and 36 km horizontal grid cell resolution for a semi-hemispheric domain and a continental United States (US) domain, respectively. The semi-hemispheric domain was used to evaluate the impact of projected Asian emissions changes on US air quality. WRF meteorological fields were used to calculate current (2000s) and future (2050s) biogenic emissions using the Model of Emissions of Gases and Aerosols from Nature (MEGAN). For the semi-hemispheric domain CMAQ simulations, present-day global emissions inventories were used and projected to the 2050s based on the IPCC A1B scenario. Regional anthropogenic emissions were obtained from the US Environmental Protection Agency National Emission Inventory 2002 (EPA NEI2002) and projected to the future using the MARKet ALlocation (MARKAL) energy system model assuming a business as usual scenario that extends current decade emission regulations through 2050. Our results suggest that daily maximum 8h average ozone (DM8O) concentrations will increase in a range between 2 to 12ppb across most of the continental US, with the highest increase in the South, Central, and Midwest regions of the US, due to increases in temperature, enhanced biogenic emissions, and changes in land use. The effects of these factors are only partially offset by reductions in DM8O associated with decreasing US anthropogenic emissions. Increases in PM2.5 levels between 2 and 4 µg m-3 in the Northeast, Southeast, and South regions are mostly a result of enhanced biogenic emissions and land use changes. Little change in PM2.5 in the Central, Northwest, and Southwest regions was found, even when PM precursors are reduced with regulatory curtailment. Changes in temperature, relative humidity, and boundary conditions shift the composition but do not alter overall PM2.5 mass concentrations. [ABSTRACT FROM AUTHOR]

The article discusses a research study which introduces the Market Allocation (MARKAL) method for anthropogenic emission scenarios. The said approach focuses on energy use and production because these factors are the main sources of air pollution and uses two emission scenarios. Findings reveal that both scenarios demonstrate significant reductions in air pollutant emissions.

Presents a case of leucocythæmia cutis in a 37-year-old male farm laborer. Medical history of the patient; Description of tumors on various parts of his body; Results of a post-mortem examination of the patient.

Competing Interests: Competing interests: None declared.

China is challenged with the simultaneous goals of improving air quality and mitigating climate change. The "Beautiful China" strategy, launched by the Chinese government in 2020, requires that all cities in China attain 35 μg/m 3 or below for annual mean concentration of PM 2.5 (particulate matter with aerodynamic diameter less than 2.5 μm) by 2035. Meanwhile, China adopts a portfolio of low-carbon policies to meet its Nationally Determined Contribution (NDC) pledged in the Paris Agreement. Previous studies demonstrated the cobenefits to air pollution reduction from implementing low-carbon energy policies. Pathways for China to achieve dual targets of both air quality and CO 2 mitigation, however, have not been comprehensively explored. Here, we couple an integrated assessment model and an air quality model to evaluate air quality in China through 2035 under the NDC scenario and an alternative scenario (Co-Benefit Energy [CBE]) with enhanced low-carbon policies. Results indicate that some Chinese cities cannot meet the PM 2.5 target under the NDC scenario by 2035, even with the strictest end-of-pipe controls. Achieving the air quality target would require further reduction in emissions of multiple air pollutants by 6 to 32%, driving additional 22% reduction in CO 2 emissions relative to the NDC scenario. Results show that the incremental health benefit from improved air quality of CBE exceeds 8 times the additional costs of CO 2 mitigation, attributed particularly to the cost-effective reduction in household PM 2.5 exposure. The additional low-carbon energy polices required for China's air quality targets would lay an important foundation for its deep decarbonization aligned with the 2 °C global temperature target., Competing Interests: The authors declare no competing interest.

Rhinovirus (RV) is an important virus in children with chronic respiratory conditions such as asthma; however, little is known about its role in CF. Our aim was to examine the prevalence and clinical impact of different RV species in young children with CF. We collected clinical data and nasal swabs on patients at home and in the hospital setting. Parents filled out symptom diaries and collected nasal swabs when their children were symptomatic and asymptomatic. A novel RV typing PCR assay was used to determine the RV species present. We collected 55 nasal swab samples from ten preschool CF patients over a six month period. The quality of parent collected samples at home was sufficient for PCR analysis. RV was the most common virus detected in young children with CF. There was no difference in the frequency of RV species between symptomatic and asymptomatic subjects. However, parental home-sampling is an acceptable and feasible approach to monitoring young children with CF., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The research community is responding with speed to the COVID-19 pandemic, with rapid response mechanisms to fund research, shortened application turnaround times, and expedited research ethics processes. Public and patient involvement (PPI) is under pressure in this rapid response research, where it is easy for researchers and funders to dismiss PPI as non-essential, an added extra, a "nice to have".  In this open letter, we, researchers and PPI contributors, argue that PPI is important, now more than ever. The pandemic is impacting everyone in society, with normal rules of engagement discarded. The solution to overcoming this virus will come from many different sources and many changes will emerge to healthcare delivery and to how we live our lives. It is essential that the research to find solutions is shaped by all who will be impacted: the public and the patient must be central contributors and their voice must be hear., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Murphy E et al.)

Unlabelled: The environment and its interactions with human systems, whether economic, social, or political, are complex. Relevant drivers may disrupt system dynamics in unforeseen ways, making it difficult to predict future conditions. This kind of "deep uncertainty" presents a challenge to organizations faced with making decisions about the future, including those involved in air quality management. Scenario Planning is a structured process that involves the development of narratives describing alternative future states of the world, designed to differ with respect to the most critical and uncertain drivers. The resulting scenarios are then used to understand the consequences of those futures and to prepare for them with robust management strategies. We demonstrate a novel air quality management application of Scenario Planning. Through a series of workshops, important air quality drivers were identified. The most critical and uncertain drivers were found to be "technological development" and "change in societal paradigms." These drivers were used as a basis to develop four distinct scenario storylines. The energy and emissions implications of each storyline were then modeled using the MARKAL energy system model. NOx emissions were found to decrease for all scenarios, largely a response to existing air quality regulations, whereas SO2 emissions ranged from 12% greater to 7% lower than 2015 emissions levels. Future-year emissions differed considerably from one scenario to another, however, with key differentiating factors being transition to cleaner fuels and energy demand reductions., Implications: Application of scenarios in air quality management provides a structured means of sifting through and understanding the dynamics of the many complex driving forces affecting future air quality. Further, scenarios provide a means to identify opportunities and challenges for future air quality management, as well as a platform for testing the efficacy and robustness of particular management options across wide-ranging conditions.

Surgical intervention in older people with dementia is becoming increasingly common as the population ages and the number of people with dementia continues to rise. People with dementia have unique needs that require sensitive management at all stages of hospitalisation for surgery. This article sets out a suggested pathway for the care of these patients, in the form of a flow chart. It discusses recognition and assessment of dementia and delirium, issues of capacity and consent, interventions required for optimum care of older people with dementia and peri-operative management. It explores the role of family and friends in achieving integrated care.

The management of chronic pain is complex. Services and support for people living with chronic pain are variable despite the publication of a number of reports highlighting the problem. Due to the epidemiology of pain, nurses deliver care to patients with persistent pain in a variety of settings. It is important that nurses have the knowledge, skills and correct attitude to deliver compassionate, person-centred care, in line with best practice in chronic pain management.

The positive results of the Cash & Counseling Demonstration and Evaluation (CCDE) led to the funding of a replication project that included 12 more states in 2008. Since then, the political and economic environments have changed. The authors sought to investigate how well the three original and 12 replication CCDE programs are coping with current challenges, and how their experiences may inform the growth and sustainability of emerging participant-directed programs. Semistructured telephone interviews were conducted with the 15 Cash & Counseling state program administrators. Key topics addressed included: successful aspects of state programs, biggest challenges for each program, and information program administrators would like to learn from state colleagues. Themes related to budget issues (e.g., staff shortages and program funding cuts) and non-budget related issues (e.g., understanding of program operations) emerged from the interviews. State program administrators also discussed program successes. To promote the sustainability and growth of participant-directed programs, existing participant-directed programs should be tied to national policy trends as well as review whether or not the programs address participant-directed principles. The development of new participant-directed programs should be based on other states' experiences as discussed in this paper.

Global aerosol direct radiative forcing (DRF) is an important metric for assessing potential climate impacts of future emissions changes. However, the radiative consequences of emissions perturbations are not readily quantified nor well understood at the level of detail necessary to assess realistic policy options. To address this challenge, here we show how adjoint model sensitivities can be used to provide highly spatially resolved estimates of the DRF from emissions of black carbon (BC), primary organic carbon (OC), sulfur dioxide (SO(2)), and ammonia (NH(3)), using the example of emissions from each sector and country following multiple Representative Concentration Pathway (RCPs). The radiative forcing efficiencies of many individual emissions are found to differ considerably from regional or sectoral averages for NH(3), SO(2) from the power sector, and BC from domestic, industrial, transportation and biomass burning sources. Consequently, the amount of emissions controls required to attain a specific DRF varies at intracontinental scales by up to a factor of 4. These results thus demonstrate both a need and means for incorporating spatially refined aerosol DRF into analysis of future emissions scenario and design of air quality and climate change mitigation policies.

This paper addresses four family policy questions that policy makers often ask about consumer-directed services, examining issues such as quality, suitability, and fraud and abuse. Responses to these questions evolved from the experiences of diverse elder consumers and their caregivers who participated in IndependentChoices, the Arkansas site of the Cash and Counseling Demonstration and Evaluation (CCDE) program. Building on CCDE evaluation survey data, this analysis of in-home interviews with participants discussing their experiences of receiving, giving, and managing care demonstrates how the program allows consumers choices so they receive the services they want. At the same time, program flexibility allows policy makers to safeguard both consumers and program resources through the use of supports such as representatives, state consultants, and fiscal intermediaries. This article demonstrates how the Cash and Counseling model can address the needs of both consumers with diverse disabilities and policy makers.

Objective: To examine how the lives of consumers and their caregivers were affected by making choices and controlling their own resources with the cash option, this paper focuses on six case studies from the Cash and Counseling Demonstration Program., Data Sources: Twenty-one consumers, caregivers, and state consultants were interviewed about their experiences in the program., Study Design: The data come from a larger study of over 200 interviews conducted from June 2000 to August 2004. Interview data were analyzed for themes about caregiving and program satisfaction., Principal Findings: Cash and Counseling benefited consumers and caregivers by allowing consumers increased continuity and reliability of care, increased ability to set hours of care, more satisfaction with how caregiving is offered and more satisfaction with the quality of care., Conclusions: The cash option allowed consumers to create, schedule, and manage their own model of care. Some consumers faced challenges in the program with paperwork, accounting, worries about receiving care, and some ineffective state consultants who could have been more helpful.

We analyzed the clinical characteristics, complications, severity, and maternal and fetal survival of patients suffering from HELLP syndrome (Hemolysis, Elevated Liver enzymes level, Low Platelet count) requiring admission to the intensive care unit in four hospitals from Buenos Aires area, Argentina. Data was revised in the charts from March 1997 to March 2003 and 62 patients were included in the study. During the second half of pregnancy or immediate puerperal period, diagnostic criteria were defined on the basis of preeclampsia and the following laboratory abnormalities: platelet count nadir <150,000/mm3, serum hepatic aminotransferases >70 UI/l, and serum lactic dehydrogenase >600 UI/l, total bilirubin >1.2 mg/dl and/or periferical blood smear with hemolysis. The mean maternal age was 28 +/- 8 years; parity 2.7 +/- 2.3; gestational age 33 +/- 4 weeks. According to platelet count, 23 cases were identified to class 1, 29 to class 2 and the rest to Martin's class 3. There were 16 eclamptic patients. The platelet count was 67,604 +/- 31,535/mm3; alanine aminotransferase 271 +/- 297 UI/l; aspartate aminotransferase 209 +/- 178 UI/l; serum lactic dehydrogenase 1444 +/- 1295 UI/l; serum creatininine levels 1.1 +/- 0.8 mg/dl. Forty-one patients had diverse degree of renal function damage, renal dialysis and plasmapheresis was required in one female. Respiratory failure due to pulmonary edema was observed in four patients. All obstetric patients survived. There were four perinatal deaths. In our population sample, low rate of life-threatening maternal complications and low perinatal mortality were observed.

Platypnea-orthodeoxia is an uncommon syndrome of dyspnea and hypoxemia induced by upright position, which is subsequently relieved by recumbency. The case reported involved a 75-year-old man with a seven days history of dyspnea in the upright position. The chest radiograph and CT scan demonstrated an elevated right hemidiaphragm. A surface echocardiogram with saline solution showed a patent foramen ovale (PFO) and atrial septal aneurysm. A pulmonary arteriogram was performed showing no evidence of pulmonary embolism and normal pulmonary arterial pressures. Later, he also developed dyspnea in the supine position and a transesophageal echocardiogram with contrast demonstrated a large right to left shunt through a PFO. The closure by a catheter-deployed double-umbrella device caused an immediate improvement in the patient's oxygenation.

Brain computed tomography, magnetic resonance imaging and magnetic resonance angiography were performed in five eclamptic patients. Three of them had HELLP syndrome. The findings on the imaging studies showed bilateral lesions affecting regions of the brain, such as cortico-subcortical either posterior and anterior circulation territories, white matter, talamic or mesencephalic-protuberancial areas. No vasospasm in middle size arteries were observed with magnetic resonance angiography. Although visual disturbance and occipital lobe involvement were correlated, no other mentioned lesions had clinical manifestations.

The inflammatory diseases of muscle are a group of disorders characterized by proximal muscle weakness. Most cases fall into three major diagnostic categories, polymyositis (PM), dermatomyositis and inclusion body myositis. Respiratory complications are a common feature and are an important cause of morbidity and mortality. The three main types of pulmonary involvement are interstitial lung disease, aspiration pneumonia and ventilatory incapacity (VI) due to muscle weakness. There are few reported cases in which mechanical ventilation has been used in patients with PM and VI in absence of lung disease. We present a patient with PM and VI due to muscle weakness who underwent therapy maintenance with mechanical ventilator and was weaned 4 months later.

We describe a framework in which a genetic algorithm (GA) and a static activated sludge (AS) treatment plant design model (WRC AS model) are used to identify low cost activated sludge designs that meet specified effluent limits (e.g. for BOD, N, and P). Once the user has chosen a particular process (Bardenpho, Biodenipho, UCT or SBR), this approach allows the parameterizations for each AS unit process to be optimized systematically and simultaneously. The approach is demonstrated for a wastewater treatment plant design problem and the GA-based performance is compared to that of a classical nonlinear optimization approach. The use of GAs for multiobjective problems such as AS design is demonstrated and their application for reliability-based design and alternative generation is discussed.

Designing air quality management strategies is complicated by the difficulty in simultaneously considering large amounts of relevant data, sophisticated air quality models, competing design objectives, and unquantifiable issues. For many problems, mathematical optimization can be used to simplify the design process by identifying cost-effective solutions. Optimization applications for controlling nonlinearly reactive pollutants such as tropospheric ozone, however, have been lacking because of the difficulty in representing nonlinear chemistry in mathematical programming models. We discuss the use of genetic algorithms (GAs) as an alternative optimization approach for developing ozone control strategies. A GA formulation is described and demonstrated for an urban-scale ozone control problem in which controls are considered for thousands of pollutant sources simultaneously. A simple air quality model is integrated into the GA to represent ozone transport and chemistry. Variations of the GA formulation for multiobjective and chance-constrained optimization are also presented. The paper concludes with a discussion of the practically of using more sophisticated, regulatory-scale air quality models with the GA. We anticipate that such an approach will be practical in the near term for supporting regulatory decision-making.

Treating periodontitis which involves the mesial concavity of the maxillary first bicuspid can be very challenging. Fifty extracted adolescent maxillary first bicuspids were sectioned in 2-mm thick sections apical to the cementoenamel junction (CEJ). The mesial concavity depth and the cementum and dentin thickness were measured in the sections. The single-rooted bicuspids have a concavity 0.35 mm deep at the CEJ and a concavity 0.59 mm deep 4.7 mm apical to the CEJ. Two-rooted bicuspids furcate at 7.9 mm and have a concavity 0.44 mm deep at the CEJ which increases to 1.08 mm at the 4.7 mm level. Cementum thickness averages from 0.9 mm at the CEJ to 1.1 mm at the 9.4-mm level. Most bicuspids also have a distal concavity which is deepest at the 4.7-mm level. The results imply that any attachment loss around the maxillary first bicuspid involves surfaces which are most likely concave. These concave surfaces make both plaque removal and various periodontal therapeutic procedures difficult.

The definitive treatment of periodontitis for pocket elimination and the establishment of periodontal architecture that can be effectively maintained with daily personal oral hygiene techniques is sometimes an elusive goal. Performing osseous reduction, primarily from the lingual aspect of the posterior mandible, definitely helps in accomplishing such a goal. This paper should not be interpreted to mean that osseous correction of bony defects should be approached strictly from the lingual, since almost all cases require some buccal recontouring if a satisfactory soft and hard tissue architectural form is to be achieved. Clinical observation and experience have shown that the anatomical patterns, seen in relation to the mandible, have a powerful effect on normal periodontal architecture as well as the types and locations of bony defects encountered. Tooth to bone relationships deserve attention. The buccal housing of the alveolar bone is frequently thin in the premolar region and occasionally on the first molar, while the external oblique ridge causes thicknened bone over the second molar. The vestibular depth on the buccal of the molars is often quite shallow, meaning that only a very limited amount of osteoplasty-osteoectomy can be performed from the buccal. The lingual housing of the alveolar bone is normally thickened and shelf-like from the distal of the third molars to the mesial aspect of the premolar region. Because the posterior teeth are inclined lingually from the second premolar distally, the buccal marginal bone height is higher occlusally than the lingual bone margins, with the interproximal bone therefore sloping somewhat apically and lingually. Interdental craters are the most common defect seen with the onset of periodontitis. Such defects in the lower arch tend to occur beneath the contact areas of the teeth, which are much further to the lingual than in the maxilla. The highest percentage of interproximal craters are shallow and not amenable to grafting techniques in the hands of most clinicians. These shallow craters are prime candidates for osseous reduction techniques. With the progression of periodontitis, the interproximal defects frequently extend to include infrabony lingual defects. Although obtaining lingual access for osseous reduction techniques is often difficult, osteoectomy-osteoplasty techniques performed primarily from the buccal of the posterior mandible frequently result in compromise of the lingual and over treating the buccal in terms of osteoectomy procedures. The lingual embrasure spaces are usually wider than on the buccal, and with adequate reduction of the mylohyoid ridge, greater access for oral hygiene procedures is provided.