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A second K/Pg boundary interval in the northern sector of the Antarctic Peninsula on Vega Island has been proposed, yet current temporal resolution of these strata prohibits direct testing of this hypothesis. To not only test for the existence of a K/Pg boundary on Vega Island but also provide increased age resolution for the associated vertebrate fauna (e.g., marine reptiles, non-avian dinosaurs, and avian dinosaurs), the Vega Island succession was intensively re-sampled. Stratigraphic investigation of the Cape Lamb Member of the Snow Hill Island Formation, and in particular, the overlying Sandwich Bluff Member of the López de Bertodano Formation, was conducted using biostratigraphy, strontium isotope stratigraphy, magnetostratigraphy, and detrital zircon geochronology. These data indicate a Late Campanian–early Maastrichtian age for the Cape Lamb Member and present three possible correlations to the global polarity time scale (GPTS) for the overlying Sandwich Bluff Member. The most plausible correlation, which is consistent with biostratigraphy, detrital zircon geochronology, sequence stratigraphy, and all but one of the Sr-isotope ages, correlates the base of the section to C31N and the top of the section with C29N, which indicates that the K/Pg boundary passes through the top of the unit. A second, less plausible option conflicts with the biostratigraphy and depends on a series of poorly defined magnetic reversals in the upper part of the stratigraphy that also correlates the section between C31N and C29R and again indicates an inclusive K/Pg boundary interval. The least likely correlation, which depends on favoring only a single Srisotope age at the top of the section over biostratigraphy, correlates the section between C31N and C30N and is inconsistent with an included K/Pg boundary interval. Although our preferred correlation is well supported, we failed to identify an Ir-anomaly, spherules/impact ejecta, or other direct evidence typically used to define the precise position of a K/Pg boundary on Vega Island. This study does, however, confirm that Vegavis, from the base of the Sandwich Bluff Member, is the oldest (69.2–68.4 Ma) phylogenetically placed representative of the avian crown clade, and that marine vertebrates and non-avian dinosaurs persisted in Antarctica up to the terminal Cretaceous.

Nutrition is essential in ensuring athletes’ optimum sports performance and good health. This study’s objective was to assess the socioeconomic (SE) standards, the nutritional knowledge, and the dietary habits of athletes across three (3) sporting regions in Ghana. Further, this study aimed to examine the relationship between the socioeconomic (SE) standards, the nutritional knowledge, and the dietary habits of athletes. The sample drew from football, hockey and basketball players. Data collection relied on an adapted Dietary Habits and Nutritional Knowledge Questionnaire by Paugh, 2005, while examination of the relationships was done using chi-square tests of association, at 0.050 level of significance. The results showed that athletes had reasonably good nutritional knowledge and dietary habits, this highlighted by mean percentage scores of 69.42% and 66.26%, respectively. Assessment of athletes’ socioeconomic standards indicated that 80% lived on GHS1000 or less, per month. There were statistically significant relationships between sex and dietary habits, p=0.001; between sex and nutritional knowledge, p

With advances in heart failure (HF) treatment, patients are living longer, putting further emphasis on quality of life (QOL) and the role of palliative care principles in their care. Spirituality is a core domain of palliative care, best defined as a dynamic, multidimensional aspect of oneself for which 1 dimension is that of finding meaning and purpose. There are substantial data describing the role of spirituality in patients with cancer but a relative paucity of studies in HF. In this review article, we explore the current knowledge of spirituality in patients with HF; describe associations among spirituality, QOL, and HF outcomes; and propose clinical applications and future directions regarding spiritual care in this population. Studies suggest that spirituality serves as a potential target for palliative care interventions to improve QOL, caregiver support, and patient outcomes including rehospitalization and mortality. We suggest the development of a spirituality-screening tool, similar to the Patient Health Questionnaire-2 used to screen for depression, to identify patients with HF at risk for spiritual distress. Novel tools are soon to be validated by members of our group. Given spirituality in HF remains less well studied compared with other patient populations, further controlled trials and uniform measures of spirituality are needed to understand its impact better.

Background Repeat imaging for trauma patients is common in rural health care systems after transfer to a tertiary trauma center which subjects patients to increased radiation, excess costs, and delays to definitive care. A previous retrospective review at our regional trauma center found that pre-transfer CT scans were frequently performed with little change in management. To improve this rate, additional emphasis was placed on (1) best imaging practices during Rural Trauma Team Development Courses (RTTDC), (2) management feedback during regional trauma case reviews, and (3) implementation of practice management guidelines for an inter-provider telehealth system. Methods Two hundred consecutive adult trauma patients transferred to a regional trauma center were retrospectively evaluated after trauma system improvements were implemented and compared to the previous cohort in the same system as identified by the regional trauma database. Results 140 (70%) had a pre-transfer CT scan compared to 152 (77.2%) in the prior study ( P = .0112). Additionally, 52 (37.1%) of those with pre-transfer CT scans had at least one repeat scan on arrival which decreased from (55.3%) in the prior study ( P < .0001). The most common reason for repeat CT scans was incomplete initial imaging. Those with a repeat scan were more likely to have a head injury (51.9% vs 35.8%, P = .0413). Discussion With regional trauma system maturation and implementation of internal telemedicine guidelines, there was a statistically significant decrease in both pre-transfer as well as repeat CT scans in a rural trauma system. Additional research exploring patient outcomes and cost savings is recommended.

Main text In 2017, comparisons of activity measurements of 18F, 64Cu, 99mTc and 11C using the Transfer Instrument of the International Reference System (SIRTI) took place at the Australian Nuclear Science and Technology Organisation (ANSTO, Australia). Ampoules containing 18F, 64Cu and 99mTc solutions were measured in the SIRTI for about 1.7 to 4 half-lives. The ANSTO carried out the primary standardization of the activity in the ampoules by 4π(LS)β—γ coincidence measurements. The comparisons, identifiers BIPM.RI(II)-K4.F-18, BIPM.RI(II)-K4.Cu-64 and BIPM.RI(II)-K4.Tc-99m are linked to the corresponding BIPM.RI(II)-K1.F-18, BIPM.RI(II)-K1.Cu-64 and BIPM.RI(II)-K1.Tc-99m comparisons. The BIPM.RI(II)-K1 18F and 99mTc key comparison reference values have been updated to include the latest BIPM.RI(II)-K4 linked results and degrees of equivalence for those three comparisons have been evaluated. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database https://www.bipm.org/kcdb/. The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Therapeutic cancer vaccines are designed to increase tumor-specific T cell immunity. However, suppressive mechanisms within the tumor microenvironment (TME) may limit T cell function. Here, we assessed how the route of vaccination alters intratumoral myeloid cells. Using a self-assembling nanoparticle vaccine that links tumor antigen peptides to a Toll-like receptor 7/8 agonist (SNP-7/8a), we treated tumor-bearing mice subcutaneously (SNP-SC) or intravenously (SNP-IV). Both routes generated antigen-specific CD8

Background: The study investigated the knowledge and attitude of proprietary and patent medicine vendors (PPMVs) towards Lassa fever (LF) and related practices to ascertain their risk of infection and potential role in community-based control. Methods: This cross-sectional study was conducted in Esan West and Esan Central local government areas of Edo State, Nigeria. Data were collected using self-administered questionnaires, and Statistical Package for Social Science (SPSS) was used for analysis. Result: 182 out of 200 administered questionnaires were retrieved and analysed. All respondents had heard of LF. About 35.2% (64/182) of respondents had inadequate knowledge with predictors as tertiary education (AOR = 0.11, P = 0.024), and age > 35 years (AOR = 0.07, P = 0.001). About 74.2% (135/182) expressed their willingness to educate clients on Lassa fever. About 66.5% had used a sharp device in the past 6 months, with 33.9% being an injection device. In the preceding 3 months, one-fifth encountered at least a client who did not recover after a first course of treatment for malaria. Of this, two-fifth were referred to a health facility for further care. Injection practices, hand glove use and hand hygiene were sub-optimal for 26.8% (11/41), 42.1% (51/121) and 67.6% (123/182) of respondents, respectively. Waste segregation was improper for 80.8% (147/182) of respondents. Conclusions: PPMVs, though knowledgeable about LF, held unsafe work practices. Interventions to address gaps in knowledge and infection control practices will protect them against contracting LF and position them to actively participate in LF control.

Carbon dioxide release during Deccan Traps volcanism and the Chicxulub impact likely contributed to the Cretaceous-Paleogene (K-Pg) mass extinction; however, the intensity and duration of CO2 input differed between the two events. Large and rapid addition of CO2 to seawater causes transient decreases in pH, [CO32–], and carbonate mineral saturation states. Compensating mechanisms, such as dissolution of seafloor sediment, reduced biomineralization, and silicate weathering, mitigate these effects by increasing the same parameters. The calcium isotope ratios (δ44/40Ca) of seawater and marine carbonates are hypothesized to respond to these perturbations through weathering/carbonate deposition flux imbalances and/or changes in fractionation between carbonate minerals and seawater. We used a high-precision thermal ionization mass spectrometry method to measure δ44/40Ca values of aragonitic bivalve and gastropod mollusk shells from the K-Pg interval of the López de Bertodano Formation on Seymour Island, Antarctica. Well-preserved shells spanning the late Maastrichtian (ca. 67 Ma) to early Danian (ca. 65.5 Ma) have δ44/40Ca values ranging from −1.89‰ to −1.57‰ (seawater [sw]). Shifts in δ44/40Ca inversely correlate with sedimentological indicators of saturation state. A negative excursion begins before and continues across the K-Pg boundary. According to a simple mass-balance model, neither input/output flux imbalances nor change in the globally integrated bulk carbonate fractionation factor can produce variations in seawater δ44/40Ca sufficient to explain the measured trends. The data are consistent with a dynamic molluscan Ca isotope fractionation factor sensitive to the carbonate geochemistry of seawater. The K-Pg extinction appears to have occurred during a period of carbonate saturation state variability caused by Deccan volcanism.

Background Rural surgeons face unique challenges when managing patients with high-grade (III-V) blunt splenic injury (BSI) given limited access to interventional radiology and blood products. Patients therefore may require transfer for splenic artery embolization (SAE) when resuscitation may still be ongoing. This study aims to evaluate current resource utilization in a rural trauma population with limited access to SAE and blood products. Methods Retrospective analysis of adult patients with high-grade BSI at one Level 1 trauma center and two Level 2 trauma centers was performed. Patients were evaluated for resources used after transfer to the regional trauma center. Primary outcomes measured were SAE, operative management (OM), and blood product utilization. Secondary outcomes measured included injury severity score (ISS) and mortality. Results Final analysis included 134 transferred patients. 16% underwent SAE, 16% underwent OM, and 69% were treated successfully with nonoperative and non-procedural management (NOM). 52% of the SAE patients had sustained a grade III splenic injury, 38% grade IV, and 10% grade V. 84% of patients required Discussion The majority of patients with BSI transferred to a tertiary trauma center from a rural facility were successfully managed without SAE and required minimal transfusion of blood products. In the absence of other injuries necessitating transfer to a tertiary trauma center, rural surgeons should consider management of high grade splenic injuries at their home institution.

Recent magnetostratigraphic works from different areas of the James Ross Basin have expanded on chronostratigraphic studies previously based on ammonite, palynomorph and nanoplankton biostratigraphy, and strontium isotope stratigraphy. Here we present a new magnetostratigraphy of Coniacian through Campanian marine sedimentary rocks from Hidden Lake, Santa Marta and Snow Hill Island Formations, on northwest James Ross Island. A total of 189 paleomagnetic directions were obtained along more than 1500 m of stratigraphic thickness from Brandy Bay to Santa Marta Cove areas, identifying three polarity chrons of the global polarity time scale. The local magnetostratigraphic column starts in the upper part of the Cretaceous Normal Superchron C34N (Coniacian) and ends in Chron C33N (middle Campanian). The correlation between the magnetostratigraphy and the age framework given by ammonite biostratigraphy allowed the assignment of precise ages to particular horizons of the Santa Marta Formation. The newly identified geomagnetic polarity reversals are the earliest identified in the James Ross Basin and include: a) C34N/C33R (84.2 Ma, late Santonian – early Campanian) in the Alpha Member of the Santa Marta Formation and b) C33R/C33N (79.9 Ma, middle Campanian) in the upper Beta Member (Santa Marta Formation). By integrating this new data with previous work, we present a complete Upper Cretaceous – lowermost Paleogene chronostratigraphical framework for the basin, spanning both proximal to distal sedimentary facies of the Marambio Group.

The aim of the current study (Clinical trial reg. no. NCT02715193, clinicaltrials.gov) was to study the efficacy and safety of REMD-477, a glucagon receptor antagonist, in type 1 diabetes. This was a randomized controlled trial in which 21 patients with type 1 diabetes were enrolled. Glycaemic control and insulin use were evaluated in outpatient and inpatient settings, before and after a single 70-mg dose of REMD-477 (half-life 7-10 days) or placebo. Inpatient insulin use was 26% (95% CI, 47%, 4%) lower 1 day after dosing with REMD-477 than with placebo (P = .02). Continuous glucose monitoring during post-treatment days 6 to 12 showed that average daily glucose was 27 mg/dL lower (P.001), percent time-in-target-range (70-180 mg/dL) was ~25% greater (~3.5 h/d) (P = .001), and percent time-in-hyperglycaemic-range (180 mg/dL) was ~40% lower (~4 h/d) (P = .001) in the REMD-477 group than in the placebo group, without a difference in percent time-in-hypoglycaemic-range (70 mg/dL). No serious adverse events were reported. Glucagon receptor antagonism decreases insulin requirements and improves glycaemic control in patients with type 1 diabetes.

Day Nunatak exposes an actively emergent stratigraphic section located on Snow Hill Island to the east of the Antarctic Peninsula. Strata exposed on Snow Hill Island were deposited in the James Ross Basin, which includes marine units of Cretaceous–Paleogene (K–Pg) age. Here we provide the first report of the sedimentology and paleontology of Day Nunatak, and place it into the broader stratigraphic context of the basin. Day Nunatak was previously unexplored due to difficulties accessing the site, and the historically poor exposure which has recently improved due to warming of the Antarctic Peninsula. Deposits exposed at Day Nunatak are assigned to the Karlsen Cliffs Member (KCM) of the Snow Hill Island Formation, and are better preserved than deposits at the type section of the KCM at Karlsen Cliffs, which has been altered by cross-cutting basaltic dikes. Correlation of lithostratigraphic and biostratigraphic data from Day Nunatak with other outcrops in the basin allows the section to be placed within a previously developed stratigraphic framework, and assigned an early Maastrichtian age. Our observations, and previous descriptions of the KCM, are consistent with a middle- to inner-shelf depositional environment below storm-wave base. Ammonites of the genus Gunnarites are very common, with other ammonite genera and benthic mollusks an order of magnitude less common. Stable carbon and oxygen isotope values obtained from bivalve shells are similar to values previously reported from Seymour Island, and suggest seawater temperatures of ∼7 °C. Measured bedding orientations suggest the presence of a structural offset between Day Nunatak and other sections exposed further north on Snow Hill Island. Day Nunatak preserves a similar depositional environment to deposits reported from the uppermost Maastrichtian on Seymour Island, and is the deeper-water equivalent of contemporaneous proximal sections reported from Vega Island.

Pernicious anemia (PA) develops from atrophic gastritis due to autoimmune destruction of parietal cells and results in achlorhydria, vitamin B12 and iron deficiencies, anemia, neurologic deficits, and premalignant and malignant stomach lesions. We report the presentation, diagnosis and gastric complications of PA in patients from an endocrinology practice.Thirty-four patients (31 female, 3 male) with PA who underwent esophagogastroduodenoscopy (EGD) or gastrectomy were identified. Pertinent clinical, laboratory, and pathology findings were reviewed and summarized.The mean age of patients was 58.6 ± 14.2 years; the onset of PA was age 50.2 ± 15.3 years. Anemia reflected vitamin B12 and/or iron deficiencies. Parietal cell antibodies (PCA) were detected in 97% of patients, and intrinsic factor blocking antibody (IFBA) was found in 52%. Fasting gastrin and chromogranin A levels were elevated (1,518.0 ± 1,588.3 pg/mL, and 504.9.1 ± 1,524.9 ng/mL respectively). Autoimmune or immunologic diseases (AIDs) were present in 32/34 patients. Stomach pathology showed premalignant or malignant lesions in 26 patients, including gastric neuroendocrine tumors (GNETs) in 6 and adenocarcinoma in 1. One patient presented with neurologic symptoms and subacute combined degeneration of the posterior column of the spinal cord.PA should be suspected in patients with unexplained anemia or neurologic symptoms. The diagnosis of PA relies on fasting gastrin and gastric auto-antibody testing, in addition to hematologic evaluation. EGD with measurement of gastric pH and biopsies of the fundus and antrum identifies patients with achlorhydria, atrophic gastritis, and premalignant and malignant stomach lesions. EGD surveillance of patients with high-risk stomach lesions is recommended.AID = autoimmune or immunologic disease; EGD = esophagogastroduodenoscopy; GNET = gastric neuroendocrine tumor; IFBA = intrinsic factor blocking antibody; PA = pernicious anemia; PCA = parietal cell antibody; T1D = type 1 diabetes.

The Cretaceous-Paleogene boundary (KPB) in the Hell Creek area of Montana is recognized in several places by an iridium anomaly, which is typically identified at or very near the lithological contact between the Hell Creek Formation and the Tullock Member of the Fort Union Formation. Previous work in the area has argued that organic carbon isotope (δ13Corg) excursions can be used for chemostratigraphic correlation within these continental depositional environments, most importantly for the identification of the KPB where impact evidence is unavailable. However, it is unclear how modern surficial weathering affects δ13Corg values, particularly in terrestrial depositional settings, and whether standard sampling methods are sufficient to obtain unaltered rock material. We tested the fidelity of the terrestrial δ13Corg record with respect to surficial alteration and contamination through investigation of different field sampling techniques, including hand trenches, a backhoe-excavated trench, and sediment coring. We find that δ13Corg values in hand and backhoe trenched sections are more positive than δ13Corg values in cored sections, implying that modern surficial alteration affects δ13Corg values but not overall trends. A negative δ13Corg excursion associated with the KPB is present in most sections we analyzed, but it does not appear to be unique within our sections. The KPB excursion occurs within a coal layer, and we observe similar excursions within other carbon-rich lithologies. Given that we cannot disentangle local lithological effects from global atmospheric changes, we conclude that a negative δ13Corg excursion is not an unequivocal indicator of the KPB in the Hell Creek area.

Warming events observed in paleotemperature proxy records within 500 kyr of the Cretaceous–Paleogene (K–Pg) boundary have often been attributed to atmospheric CO 2 increases due to Deccan Traps flood volcanism. Currently, there is uncertainty in the size, nature, and timing of the Deccan eruptions, all of which lead to uncertainty in the likely climatic effects. Modeling the impact of Deccan Traps eruption on climate is complicated by the discrepancy between the lifetimes of emitted gasses and the length of the total eruptive sequence. Though SO 2 emissions can have important climatic effects, the short atmospheric lifetimes of SO 2 and resulting aerosols mean these effects are unlikely to be recognized in the proxy record. Here we focus on the CO 2 emissions, and attempt to match paleotemperature proxy records with plausible emissions scenarios. We also test the relevance for climate of the number, length, and arrangement (e.g., increasing or decreasing size) of individual eruptions as well as the total duration and size of the overall eruptive sequence. We find that the number and length of individual eruptions are largely unimportant to CO 2 -based based climate effects, but that the pattern and duration of eruption have measureable effects. Unsurprisingly, the total emitted CO 2 from the Deccan Traps exerts a strong control on climatic effects, and better constraints on the volume of emitted gas are necessary. At the high end of the uncertainty range, the Deccan Traps eruptions are capable of generating warming events recorded in the proxy record, but rates of silicate weathering above modern rates are necessary to draw down CO 2 in accordance with those records.

Two paleomagnetic poles of 80 and 75 Ma have been computed from 191 to 123 paleomagnetic samples, respectively, of the marine sedimentary units of the Upper Cretaceous Marambio Group exposed in the James Ross Island, Antarctic Peninsula. Paleomagnetic behaviors during stepwise thermal demagnetization and rock magnetic analyses indicate that magnetization is likely primary and carried by SD-PSD detrital titanomagnetite. Application of an inclination shallowing correction by the elongation-inclination method yielded a significant inclination shallowing affecting the older (ca. 80 Ma) succession exposed in the northwest area of the island. However, the paleomagnetic directions computed from the younger (ca. 75 Ma) succession outcropping in the southeast corner of the island yielded an indeterminate result using the same analysis. The inclination shallowing-corrected 80 Ma paleopole position plus previous ones of ca.110, 90 and 55 Ma were used to construct the Apparent Polar Wander Path (APWP) for the Antarctic Peninsula during the Late Cretaceous-Paleocene. This path confirms that oroclinal bending of the Antarctic Peninsula as well as relative displacement with respect to East Antarctica are negligible since 110 Ma. Comparison with the apparent polar wander path for South America for the 130-45 Ma period suggests that this continent and the Antarctic Peninsula kept a very similar relative paleogeographic position since 110 Ma until 55 Ma, which likely meant a physical link between both continental masses. During that period, both continents underwent a relatively fast southward displacement of around 7° and a clockwise rotation relative to the Earth spin axis that can be bracketed between around 100 and 90 Ma. Oroclinal bending of the Fuegian Andes was likely due to tectonic interactions between the Patagonian-Fuegian Andes and the Antarctic Peninsula promoted, at least partially, by such displacements. By 55 Ma the Antarctic Peninsula probably was starting or about to start its final separation from South America. Fil: Milanese, Florencia Nidia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; Argentina Fil: Rapalini, Augusto Ernesto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Geociencias Básicas, Aplicadas y Ambientales de Buenos Aires; Argentina Fil: Slotznick, Sarah P.. University of California at Berkeley; Estados Unidos Fil: Tobin, Thomas S.. University of Alabama at Birmingahm; Estados Unidos Fil: Kirschvink, Joseph. Tokyo Institute Of Technology; Japón Fil: Olivero, Eduardo Bernardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; Argentina

For this paper a standalone OEM (Original Equipment Manufactuer) GNSS wave sensor module is co-located on an existing accelerometer-based three-meter diameter disc wave buoy for statistical comparison. Additionally, a GNSS wave sensor is placed on an existing, already deployed, nearby navigational buoy 700 meters away to assess suitability as a platform for a GNSS directional wave height sensor. Both sensors were deployed in 30 meters depth of water in Herring Cove, Nova Scotia, Canada.

OBJECTIVE Type 1 diabetes (T1DM) is associated with other autoimmune diseases (AIDs), which may have serious health consequences. The epidemiology of AIDs in T1DM is not well defined in adults with T1DM. In this cross-sectional cohort study, we sought to characterize the incident ages and prevalence of AIDs in adults with T1DM across a wide age spectrum. RESEARCH DESIGN AND METHODS A total of 1,212 adults seen at the Washington University Diabetes Center from 2011 to 2018 provided informed consent for the collection of their age, sex, race, and disease onset data. We performed paired association analyses based on age at onset of T1DM. Multivariate logistic regression was used to evaluate the independent effects of sex, race, T1DM age of onset, and T1DM duration on the prevalence of an additional AID. RESULTS Mean ± SD age of T1DM onset was 21.2 ± 14.4 years. AID incidence and prevalence increased with age. Female sex strongly predicted AID risk. The most prevalent T1DM-associated AIDs were thyroid disease, collagen vascular diseases, and pernicious anemia. T1DM age of onset and T1DM duration predicted AID risk. Patients with late-onset T1DM after 30 years of age had higher risks of developing additional AIDs compared with patients with younger T1DM onset. CONCLUSIONS The prevalence of AIDs in patients with T1DM increases with age and female sex. Later onset of T1DM is an independent and significant risk factor for developing additional AIDs. Individuals who are diagnosed with T1DM at older ages, particularly women, should be monitored for other autoimmune conditions.

Cape Marsh, located on the eastern end of Robertson Island to the east of the Antarctic Peninsula, exposes an isolated outcrop of Upper Cretaceous sedimentary strata. The outcrop is approximately 120 km southwest of the much better-studied exposures of similar age on and around James Ross Island (JRI); as such, its remoteness has complicated logistical access to the site and hindered geologic correlations on a regional scale. Here we present the results of fieldwork conducted in 2016 that yielded a more diverse invertebrate fossil assemblage than had been previously recognized, in addition to new U–Pb detrital zircon and magnetostratigraphic data. The invertebrate fauna, particularly the ammonites and inoceramids, support a biostratigraphic correlation of the upper Cape Marsh strata to Ammonite Assemblage 7 previously established on JRI. Detrital zircon U–Pb analysis conducted on a sandstone sample from the same strata indicates a maximum depositional age of 74.2 ± 1.1 Ma, and magnetostratigraphic interpretation of the lower strata suggest a normal magnetochron. These results are all consistent with a Campanian age for the deposition of the upper strata at Cape Marsh, and deposition during magnetochron C33N for the lower layers. However, a slight age inconsistency between the biostratigraphic correlation and the detrital zircon-derived maximum depositional age may imply that the fossils are reworked. Regardless, these new data allow us to correlate the strata at Cape Marsh to the Santa Marta and Rabot formations (or possibly the lower part of the Snow Hill Island Formation) in the northern part of the James Ross Basin.

Patients and physicians in the 21st century require new tools to manage the growing burden of chronic illness. For providers responsible for the care of diabetic patients, developments in information management, real-time health education and feedback, and new approaches to self-monitoring and insulin delivery hold great promise to improve the quality and safety of diabetes care. This article will briefly highlight some of the major developments in the field, and the ways these technologies can be integrated into a typical practice.

Inpatient severe hypoglycemia (SH), blood glucose (BG) This study reflects a retrospective analysis of system-wide data from 2011 to 2017. Results show BG levels post alert are higher on average (mean 92.83) than pre-alert (mean 74.43). This magnitude of difference occurs in each year (pre-post differences range from 14.7 to 19.3), suggesting that the alert system led to a sustained beneficial effect over time. A decreasing trend in SH rate over time was observed, which differed by hospital (Figure). System-wide electronic surveillance and alerts improve safety in patients with diabetes across a range of clinical settings. This study proves ongoing efficacy of the alert process and variables. Disclosure M. Elliott: None. M.C. Blackburn: None. K.M. Heard: None. P.E. Milligan: None. P. Cruz Bravo: None. G.S. Tobin: Speaker's Bureau; Self; Novo Nordisk Inc., MannKind Corporation. Advisory Panel; Self; Novo Nordisk Inc..

Deccan Traps continental flood basalt eruptions spanned the Cretaceous-Paleogene mass extinction, erupting over a million cubic kilometers of basalt over a total duration of approximately a million years. The environmental consequences of flood basalt eruptions depend on the timing and amount of volatile release; eruption rates are thus needed to evaluate their potential to cause climate change. Radioisotopic dates are not currently sufficient to resolve sub-ten thousand year eruptive tempos, necessary for constraining the effects of short-lifetime volatiles including sulfur dioxide. Recent studies have demonstrated that increases in mercury concentration in sedimentary records correlate with flood basalt eruptions under some circumstances. However, mercury concentrations have primarily been used to show the presence or absence of flood basalt eruptions. We show that this proxy can be used to quantitatively estimate eruptive rates using a mercury geochemical cycle framework. We illustrate this using new mercury chemostratigraphic records from terrestrial Cretaceous-Paleogene boundary sections in eastern Montana, USA, with multiple high-resolution chronologic constraints. We estimate that Deccan eruptions lasted on the order of centuries and released 500–3000 megagrams (Mg) of mercury per year, corresponding to ∼50–250 km3/a of lava. The box model framework highlights the importance of carefully accounting for differences in sedimentation rate and sampling resolution when comparing mercury records from different locations and depositional environments. While there are uncertainties in the box model estimates due to possible variation in flood basalt mercury emissions and sedimentation rates, they provide a useful framework to quantitatively evaluate the global mercury budget change indicated by changing concentration in sedimentary records. Eruptions of the estimated size would have released enough SO2, if it reached the stratosphere, to cause significant cooling for the duration of the eruption. However, given our constraints on the duration of individual eruptions, these colder periods are likely too brief to be clearly visible in most existing paleoclimate records.

Hypoglycemia and severe hypoglycemia (SH) in the inpatient setting are associated with poor outcomes. This review is designed to highlight approaches to predict and prevent inpatient hypoglycemia that has been successfully implemented focusing on developing overlapping policies and procedures that allow safe glycemic management to occur at all levels of the institution. Standardizing point-of-care (POC) testing, nursing protocols, meal delivery, and formulary restriction are useful tools to prevent hypoglycemia. Informatics and real-time alert processes are highly effective tools to reduce hypoglycemia but require a significant investment in time and infrastructure as well as clear policies on how alerts are acted upon. Computerized dosing support technology and continuous glucose monitoring (CGM) technology are an emerging area of investigation showing promising results. Inpatient hypoglycemia is often predictable and preventable and requires institutional support to deliver targeted and safe diabetes care. This requires each institution to do periodic reassessment of policies and technologies. Future research needs to focus on the cost/benefits of interventions including studies of automated dosing algorithms as well as CGM in higher-risk patient populations.

Ammonites are one of the most common fossils of the Mesozoic, but there is little consensus on their mode of life. Isotopic studies have been used to reconstruct their preferred water temperature from δ 18 O measurements, but δ 13 C values have more ambiguous interpretations. Previous studies have recorded population differences in δ 13 C values between ammonite and benthic organisms without explaining the cause in detail. Here we examine a molluscan community from Seymour Island, Antarctica and find a 4‰ carbon isotope offset between ammonites and other benthic mollusks. The most likely cause of this anomaly is an increased metabolic carbon contribution to ammonite shell material when compared with other mollusks, but we cannot rule out the possibility of a methane seep contribution. Increased respired CO 2 production could be generated by a more active lifestyle and increased energy demands, which may have increased the susceptibility of ammonites to the end Cretaceous mass extinction.