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Continuum reverberation mapping of active galactic nuclei (AGNs) can provide new insight into the nature and geometry of the accretion flow. Some of the X-rays from the central corona irradiating the disc are absorbed, increasing the local disc temperature. This gives an additional reprocessed contribution to the spectral energy distribution (SED) which is lagged and smeared relative to the driving X-ray light curve. We directly calculate this reverberation from the accretion disc, creating fully time-dependent SEDs for a given X-ray light curve. We apply this to recent intensive monitoring data on Fairall 9, and find that it is not possible to produce the observed ultraviolet (UV) variability by X-ray reprocessing of the observed light curve from the disc. Instead, we find that the majority of the variability must be intrinsic to the UV emission process, adding to evidence from changing-look AGN that this region has a structure which is quite unlike a Shakura–Sunyaev disc. We filter out this long time-scale variability and find that reprocessing alone is still insufficient to explain even the fast variability in our assumed geometry of a central source illuminating a flat disc. The amplitude of reprocessing can be increased by any vertical structure such as the broad-line region and/or an inner disc wind, giving a better match. Fundamentally though the model is missing the major contributor to the variability, intrinsic to the UV/EUV emission rather than arising from reprocessing.

We perceived changes in the frequency of and reasons for admissions to Wisconsin pediatric intensive care units (PICU) during the advent of the COVID-19 pandemic, and we hypothesized that the rates of total, scheduled, and respiratory viral admissions were lower during the first calendar year of the pandemic than would have been predicted by historical admission data. Such findings would reflect important changes in PICU utilization paradigms during the pandemic. There are no descriptions of PICU admission changes in a single American state during the pandemic.We compared all Wisconsin PICU admissions during the COVID-19 pandemic in 2020 (the study epoch) to admissions in seasonally matched, growth-adjusted "no-COVID-19" projections generated by time series analysis of all Wisconsin PICU admissions in the previous 5 years (the control epoch).We identified 27,425 PICU admissions with 294,577 associated diagnoses in the study and control epochs. Total admissions were 60 ± 9 week-1 in the study epoch versus 103 ± 4 projected (RR 0.63; 95% CI, 0.59-0.68; P 0.001). Scheduled admissions were 17 ± 6 week-1 in the study epoch versus 28 ± 3 projected (RR 0.61; 95% CI, 0.55-0.67; P 0.001). Respiratory viral admissions were 8 ± 5 week-1 in the study epoch versus 19 ± 9 projected (RR 0.40; 95% CI, 0.33-0.48; P 0.001). Some admission categories experienced dramatic declines (c, respiratory/ear, nose, throat), while others experienced less decline (eg, injury/poisoning/adverse effects) or no significant change (eg, diabetic ketoacidosis). Except cases of COVID-19, no category had significantly increased weekly admissions. There were 104 admissions associated with COVID-19 diagnoses in 2020, 4.3% of the study epoch admissions.We describe PICU admission changes in the first calendar year of COVID-19, informing health care staffing and service planning, as well as decisions regarding strategies to combat the evolving pandemic.

Background We perceived profound changes in the frequency of and reasons for admissions to pediatric intensive care units (PICUs) during the advent of the COVID-19 pandemic in Wisconsin, and we hypothesized that the rates of total, scheduled, and respiratory viral admissions were lower during the first year of the pandemic than would have been predicted by historical admission data. We also hypothesized that the rates of other categories of PICU admissions were different than would have been predicted by historical data, reflecting broad changes in PICU utilization paradigms during the pandemic. Methods Using mean weekly admission rates with standard deviations and rate ratios with 95% confidence intervals, we compared all Wisconsin PICU admissions during the pandemic epoch in 2020 (COVID-2020) to admissions in seasonally-matched, growth-adjusted “no-COVID” forecasts generated by time series modeling from all Wisconsin PICU admissions in the previous 5 years. Results We studied 27,425 admissions with 294,577 associated diagnoses including 104 admissions associated with a COVID-19 diagnosis (4.3% of admissions in COVID-2020). Total admissions were 60 ± 9 week− 1 in COVID-2020 vs. 103 ± 4 forecasted, RR 0.63 (95% CI: 0.59–0.68), p − 1 in COVID-2020 vs. 28 ± 3 forecasted, RR 0.61 (95% CI: 0.55–0.67), p − 1 in COVID-2020 vs. 19 ± 9 forecasted, RR 0.40 (95% CI: 0.33–0.48), p

Storm surge flooding can cause significant damage to coastal communities. In addition, coastal communities face an increased risk of coastal hazards due to sea-level rise (SLR). This research developed a dataset to communicate the socioeconomic consequences of flooding within the 1% and 0.2% Annual Exceedance Probability Floodplain (AEP) under four SLR scenarios for the Northern Gulf of Mexico region. Assessment methods primarily used HAZUS-MH software, a GIS-based modeling tool developed by the Federal Emergency Management Agency in the United States, to estimate natural disasters’ physical, economic, and social impacts. This dataset consists of 29 shapefiles containing seven different measures of storm surge inundation impacts under SLR (including building damage, displaced people and shelter needs, road exposure, essential facilities, wastewater treatment plants, bridges, and vehicle damage). The data is publicly available under the Gulf of Mexico Research Initiative Information and Data Cooperative (GRIIDC).

A special issue of Earth’s Future examines the impacts of sea level rise on coastal areas and showcases a paradigm shift in the modeling of these dynamic systems.

The authors describe a multiinstitutional collaborative project to address a gap in global health training by creating a free online platform to share a curriculum for performing procedures in resource-limited settings. This curriculum called PEARLS (Procedural Education for Adaptation to Resource-Limited Settings) consists of peer-reviewed instructional and demonstration videos describing modifications for performing common pediatric procedures in resource-limited settings. Adaptations range from the creation of a low-cost spacer for inhaled medications to a suction chamber for continued evacuation of a chest tube. By describing the collaborative process, we provide a model for educators in other fields to collate and disseminate procedural modifications adapted for their own specialty and location, ideally expanding this crowd-sourced curriculum to reach a wide audience of trainees and providers in global health.

In the world emergencies occur everywhere, and each day they consume ressources regardless of whether there are systems capable of achieving good outcomes. Low-income countries suffer the most highest rates of every category of injury--from traffic and the highest rates of acute complications of communicable diseases including tuberculosis, malaria and HIV.To describe the development of pediatrics emergency medicine at Tikur Anbesa Specialized HospitalA twinning partnership model was used in developing a pediatric emergency medicine training program helps in development of pediatrics emergency system.Strengthening the capacity of Addis Ababa University (AAU), Tikur Anbessa Hospital (TASH) to provide pediatric emergency medical services through improved organization of the pediatrics emergency department and strengthening of continuing education opportunities for faculty and staff capacity building by this improving quality of care in pediatrics patients in the country.The Addis Ababa University, University of Wiscosin and People to People partners intend to continue working together to strengthening and developing effetive systems to deliver quality pediatrics emergency medicine care troughout all regions of Ethiopia.

To compare survival of pediatric umbilical cord blood and bone marrow transplant recipients requiring admission to a pediatric intensive care unit for mechanical ventilation and to determine the effect of organ dysfunction on outcome.Retrospective chart review.Tertiary care referral center for pediatric stem cell transplants.All children 0-18 yrs old admitted to the pediatric intensive care unit for mechanical ventilation after receiving a stem cell transplant.None.Data were collected from medical records of 86 patients who received a stem cell transplant and were subsequently admitted to the pediatric intensive care unit for mechanical ventilation. Demographic data were collected at the time of intubation, and physiologic data were collected at 6 hrs and 96 hrs after intubation. The pediatric intensive care unit, hospital, and 2-yr survival rates for umbilical cord blood transplant recipients were 37%, 25%, and 19%, respectively. The survival rates for bone marrow transplant recipients were 47%, 32%, and 21% for the same time periods. Umbilical cord blood and bone marrow transplant recipients with hepatic dysfunction had a significantly worse outcome, as did patients admitted for respiratory failure or sepsis.Pediatric recipients of an umbilical cord blood transplant who subsequently required mechanical ventilation had lower pediatric intensive care unit and hospital survival rates compared with patients receiving bone marrow transplantation. Survival at 2 yrs for umbilical cord blood transplant and bone marrow transplant patients was similar. Predictors of outcome for all stem cell transplant recipients requiring mechanical ventilation included pediatric intensive care unit diagnosis requiring intubation and hepatic function. Predictors of outcome can be identified shortly after intubation in pediatric stem cell transplant recipients and may aid in therapeutic decision making and family counseling.

The Viking formation in southern Saskatchewan Canada represents an active area where steep production declines in the first year of production are common and are often attributed to wellbore or near-wellbore precipitation of paraffin. Excessive decline rates within the first year on production have been observed. A producer was experiencing paraffin deposition in the wellbore and suspected it to be the reason for production declines. Conventional treatments targeted at wellbore deposition were carried out with little effect on production rates. In an effort to improve production rates horizontal treatments were attempted. These treatments resulted in brief increases in production (up to 6 weeks). Horizontal treatment success led to investigation into other treatment options. Precipitation in the formation may contribute to reduced conductivity and, therefore, lower oil production rates. Solid paraffin inhibitors delivered via hydraulic fracturing offered the best potential for success in new wells. The chemical additive treatment was designed through product selection testing using cold finger deposition tests, compatibility testing with the hydraulic fracturing fluid system, and proppant crush prediction models. A baseline of the untreated oil characteristics was determined using offset wells. Pour point, carbon number distribution and wax percentage were analyzed in offset untreated wells and each treated well. Production trends were used to track the performance of the treatments. The solid inhibitor application effectively prevented conductivity restrictions due to paraffin precipitation issues in the proppant pack. Placement of solid paraffin inhibitors into the Viking formation with the proppant during hydraulic fracturing increased cumulative production by approximately forty percent in the first 350 days on production and reduced decline rates. Comparing 150 untreated wells with the 90 wells treated with the solid paraffin inhibitor in 2012 has increased revenue by about 15.8 million USD over the 350-day period. Wells drilled in the same area, with similar frac treatments, depths, horizontal lengths and stages were compared.

Linear sweep voltammograms have been computed for reversible electron transfer at ring microelectrodes of various shapes for sweep rates spanning nine diffusion-limited current, computed using the integral equation method for a ring electrode of specified shape, and the appropriate potential scan func computer, each voltammogram typically requiring about 3 min of computation time. The dependence of the maximum current and of the potential at one-half Excellent agreement between theoretical and experimental voltammograms is demonstrated.

Background Cardiopulmonary bypass (CPB) has been implicated in the development of organ injury associated with cardiac surgery. At the molecular level, CPB is accompanied by a pronounced proinflammatory response including an increase in plasma interleukin (IL)-6. The IL-6 has been shown to be increased in rheumatoid arthritis, a chronic inflammatory disease, where it has been implicated in decreasing G protein-coupled receptor kinases (GRKs) in peripheral blood mononuclear cells. Since IL-6 is substantially increased after CPB, the study tested whether the increase of IL-6 during CPB leads to a decrease of GRKs in mononuclear cells. This is important because GRKs regulate the function of G protein-coupled receptors involved in inflammation. Methods Fifteen patients had blood withdrawn before CPB, 2 h after CPB, and on postoperative day one (POD1). Plasma IL-6 concentrations were determined by enzyme-linked immunosorbent assay. The GRK protein expression and activity were determined by Western blot and phosphorylation of rhodopsin using [gamma-(32)P] adenosine triphosphate, respectively. Results Plasma IL-6 increased over 20-fold after CPB and remained increased on POD1. Cytosolic GRK activity in mononuclear cells decreased by 39 +/- 29%; cytosolic GRK2 and membrane-bound GRK6 decreased by 90 +/- 15 and 65 +/- 43%, respectively. The GRK activity and expression of GRK2/GRK6 on POD1 returned to basal levels in many but not all patients. Conclusions The CPB causes a profound decrease in mononuclear cell GRKs, and the recovery of these kinases on POD1 is quite variable. The significance of the variable recovery of GRKs after CPB and their potential role as a marker of clinical outcome deserves further investigation.

Introduction: A sedation provider course was developed by the Society for Pediatric Sedation (SPS) to provide practitioners with the competencies that promote safe and effective sedation. We hypothesized that modification of a structured sedation course would lead to safe and effective sedation and