Τετάρτη 30 Νοεμβρίου 2016

Automated Classification of Pain Perception using High Density Electroencephalography Data

Translating brief millisecond-long pain-eliciting stimuli to the subjective perception of pain is associated with changes in theta, alpha, beta, and gamma oscillations over sensorimotor cortex. However, when a pain-eliciting stimulus continues for minutes, regions beyond the sensorimotor cortex such as the prefrontal cortex are also engaged. Abnormalities in prefrontal cortex have been associated with chronic pain states, but conventional millisecond-long EEG paradigms do not engage prefrontal regions. In the current study we collected high-density EEG data during an experimental paradigm in which subjects experienced a 4 second low or high intensity pain-eliciting stimulus. EEG data were analyzed using independent component analyses, EEG source localization analyses, and measure projection analyses. We report three novel findings. First, an increase in pain perception was associated with an increase in gamma and theta power in a cortical region that included medial prefrontal cortex. Second, a decrease in lower beta power was associated with an increase in pain perception in a cortical region that included the contralateral sensorimotor cortex. Third, we employed machine learning for automated classification of EEG data into low and high pain classes. Theta and gamma power in the medial prefrontal region and lower beta power in the contralateral sensorimotor region served as features for classification. We found a leave-one-out cross-validation accuracy of 89.58%. Developing biological markers for pain states continues to gain traction in the literature, and our findings provide new information that advances this body of work.



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Body sway adaptation to addition, but not withdrawal of stabilizing visual information is delayed by a concurrent cognitive task

Aim of this study was to test the effects of a concurrent cognitive task on the promptness of the sensorimotor integration and reweighting processes following addition and withdrawal of vision. Fourteen subjects stood in tandem while vision was passively added and removed. Subjects performed a cognitive task, consisting of counting backwards in steps of three, or were 'mentally idle'. We estimated the time interval, following addition and following withdrawal of vision, at which body sway began to change. We also estimated the time constant of the exponential change in body oscillation until the new level of sway was reached, consistent with the current visual state. Under the mentally-idle condition, mean latency was 0.67 s and 0.46 s, and mean time constant was 1.27 s and 0.59 s, for vision addition and withdrawal, respectively. Following addition of vision, counting backward delayed the latency by about 300 ms, without affecting the time constant. Following withdrawal, counting-backward had no significant effect on either latency or time-constant. The extension by counting backwards of the time-interval to stabilization onset on addition of vision suggests a competition for cortical resources allocation. Conversely, the absence of cognitive-task effect on the rapid onset of destabilization on vision withdrawal, and on the relevant reweighting time-course, advocates the intervention of a subcortical process. Diverting attention from a challenging standing task discloses a cortical supervision on the process of sensorimotor integration of new balance-stabilizing information. A subcortical process would instead organize the response to removal of the stabilizing sensory input.



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Differential effect of visual motion adaption upon visual cortical excitability

Objective: 1) To probe the effects of visual motion adaptation upon, early visual and V5/MT cortical excitability and 2) To investigate whether or not changes in cortical excitability following visual motion adaptation are related to the degree of visual dependency, i.e. an overreliance on visual cues compared to vestibular or proprioceptive cues. Methods: Participants were exposed to a roll-motion visual stimulus pre, during and post visual motion adaptation. At these stages 20 TMS pulses at phosphene-threshold values were applied over early visual and V5/MT cortical areas from which the probability of eliciting a phosphene was calculated. Pre and post adaptation, participants aligned the subjective visual vertical in front of the roll-motion stimulus as a marker of visual dependency. Results: During adaptation, early visual cortex excitability decreased while V5/MT excitability increased. After adaptation, both early visual and V5/MT excitability were increased. The roll-motion induced tilt of the subjective visual vertical (visual dependence) was not influenced by visual motion adaptation and did not correlate with phosphene threshold or visual cortex excitability. Conclusions: Early visual and V5/MT cortical excitability is differentially affected by visual motion adaptation. Furthermore, excitability in the early or late visual cortex is not associated with an increase in visual reliance during spatial orientation. Significance: Our findings complement earlier studies that have probed visual cortical excitability following motion adaptation and highlight the differential role of the early visual cortex and V5/MT in visual motion processing.



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Spatiotopic maps during dynamic head tilt

Humans maintain a stable representation of the visual world effortlessly, despite constant movements of the eyes, head and body, across multiple planes. Whereas visual stability in the face of saccadic eye-movements has been intensely researched, fewer studies have investigated retinal image transformations induced by head movements, especially in the frontal plane. Unlike head rotations in the horizontal and sagittal planes, tilting the head in the frontal plane is only partially counteracted by torsional eye-movements, and consequently induces a distortion of the retinal image to which we seem to be completely oblivious. One possible mechanism aiding perceptual stability is an active reconstruction of a spatiotopic map of the visual world, anchored in allocentric coordinates. To explore this possibility, we measured the positional Motion Aftereffect (PMAE: the apparent change in position after adaptation to motion) with head-tilts of ~42 degrees between adaptation and test (to dissociate retinal from allocentric coordinates). The aftereffect was shown to have both a retinotopic and spatiotopic component. When tested with unpatterned Gaussian blobs rather than sinusoidal grating stimuli, the retinotopic component was greatly reduced, while the spatiotopic component remained. The results suggest that perceptual stability may be maintained at least partially through mechanisms involving spatiotopic coding.



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Spatial scale and distribution of neurovascular signals underlying decoding of orientation and eye-of-origin from fMRI data

Multivariate pattern analysis of functional MRI (fMRI) data is widely used, yet the spatial scales and origin of neurovascular signals underlying such analyses remain unclear. We compared decoding performance for stimulus orientation and eye-of-origin from fMRI measurements in human visual cortex with predictions based on the columnar organisation of each feature, and estimated the spatial scales of patterns driving decoding. Both orientation and eye-of-origin could be decoded significantly above chance in early visual areas (V1-V3). Contrary to predictions based on a columnar origin of response biases, decoding performance for eye-of-origin in V2 and V3 was not significantly lower than that in V1, nor did decoding performance for orientation and eye of origin differ significantly. Instead, response biases for both features showed large-scale organization, evident as a radial bias for orientation, and a nasotemporal bias for eye preference. To determine whether these patterns could drive classification, we quantified the effect on classification performance of binning voxels according to visual field position. Consistent with large-scale biases driving classification, binning by polar angle yielded significantly better decoding performance for orientation than random binning in V1-V3. Similarly, binning by hemifield significantly improved decoding performance for eye-of-origin. Patterns of orientation and eye preference bias in V2 and V3 showed a substantial degree of spatial correlation with the corresponding patterns in V1, suggesting that response biases in these areas originate in V1. Together, these findings indicate that multivariate classification results need not reflect the underlying columnar organization of neuronal response selectivities in early visual areas.



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Techniques to identify and temporally correlate calcium transients between multiple regions of interest in vertebrate neural circuits

Calcium imaging is commonly used to record dynamic changes in excitability from axons or cell bodies in the nervous system of vertebrates. These recordings often reveal discrete calcium transients which have variable amplitudes, durations, and rates-of-rise and decay, all of which can arise from an unstable, or "noisy" baseline. This often leads to considerable ambiguity about how to discriminate and quantify calcium transients. We describe an analytical methodology that objectively identifies multiple calcium transients from multiple recording sites and quantifies the degree of temporal synchrony between each event. The methodology consists of multiple steps; involving baselining, to either preserve the underlying shape of calcium transients, or to remove unwanted frequency components; and transform the peaks of calcium transients into more easily detectable patterns. The second step is the application of at least one of two different spike detection algorithms, one based on a gradient estimate; the other on template matching. The third step is the quantification of synchrony between pairs of recordings using at least one of two time lag correlation measures. The fourth step is the identification of statistically significant coincident firing patterns. This allows discrimination of neuronal firing patterns between different sites that appear to occur simultaneously; and which statistically could not be attributed to chance. The analytical methods we have demonstrated can be applied not only to calcium imaging, but many other physiological recordings, where discrimination and temporal correlation of biological signals from multiple sites is required, particularly when arising from unstable baselines, with variable signal-to-noise ratios.



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Genomic Prediction with Pedigree and Genotype x Environment Interaction in Spring Wheat Grown in South and West Asia, North Africa, and Mexico

Developing genomic selection (GS) models is an important step in applying GS to accelerate the rate of genetic gain in grain yield in plant breeding. In this study, seven genomic prediction models under two cross-validation scenarios were tested on 287 advanced elite spring wheat lines phenotyped for grain yield (GY), thousand-grain weight (GW), grain number (GN), and thermal time for flowering (TTF) in 18 international environments (year-location combinations) in major wheat producing countries in 2010 and 2011. Prediction models with genomic and pedigree information included main effects and interaction with environments. Two random cross-validation (CV) schemes were applied to predict a subset of lines that were not observed in any of the 18 environments (CV1) and a subset of lines that were not observed in a set of the environments but were observed in other environments (CV2). Genomic prediction models including genotype x environment (GxE) interaction had the highest average prediction ability under the CV1 scenario for GY (0.31), GN (0.32), GW (0.45) and TTF (0.27). For CV2, the average prediction ability of the model including the interaction terms was generally high for GY (0.38), GN (0.43), GW (0.63), and TTF (0.53). Wheat lines in site-year combinations in Mexico and India had relatively high prediction ability for grain yield and grain weight. Results indicated that prediction accuracy of lines not observed in certain environments could be relatively high for genomic selection when predicting GxE interaction in multi-environment trials.



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Genomics of Compensatory Adaptation in Experimental Populations of Aspergillus nidulans

Knowledge of the number and nature of genetic changes responsible for adaptation is essential for understanding and predicting evolutionary trajectories. Here, we study the genomic basis of compensatory adaptation to the fitness cost of fungicide resistance in experimentally evolved strains of the filamentous fungus Aspergillus nidulans. The original selection experiment tracked the fitness recovery of lines founded by an ancestral strain that was resistant to fludioxonil, but paid a fitness cost in the absence of the fungicide. We obtained whole-genome sequence data for the ancestral A. nidulans strain and 8 experimentally evolved strains. We find that fludioxonil resistance in the ancestor was likely conferred by a mutation in histidine kinase nikA, part of the two-component signal transduction system of the high-osmolarity glycerol (HOG) stress-response pathway. To compensate for the pleiotropic negative effects of the resistance mutation, the subsequent fitness gains observed in the evolved lines were likely caused by secondary modification of the HOG pathway activity. Candidate genes for the compensatory fitness increases were significantly over-represented by stress-response functions, and some were specifically associated with the HOG pathway itself. Parallel evolution at the gene level was rare among evolved lines. There was a positive relationship between the predicted number of adaptive steps, estimated from fitness data, and the number of genomic mutations, determined by whole-genome sequencing. However, the number of genomic mutations was, on average, 8.45 times greater than the number of adaptive steps inferred from fitness data. This research expands our understanding of the genetic basis of adaptation in multicellular eukaryotes and lays out a framework for future work on the genomics of compensatory adaptation in A. nidulans.



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Genetic Causes of Phenotypic Adaptation to the Second Fermentation of Sparkling Wines in Saccharomyces cerevisiae

Hybridization is known to improve complex traits due to heterosis and phenotypic robustness. However, these phenomena have been rarely explained at the molecular level. Here, the genetic determinism of Saccharomyces cerevisiae fermentation performance was investigated using a QTL-mapping approach on an F1-progeny population. Three main QTLs were detected, with positive alleles coming from both parental strains. The heterosis effect found in the hybrid was partially explained by three loci showing pseudo-overdominance and dominance effect. The molecular dissection of those QTLs revealed that the adaptation to second fermentation is related to pH, lipid or osmotic regulation. Our results suggest that stressful conditions of second fermentation have driven to select rare genetic variants adapted to maintain yeast cell homeostasis and, in particular, to low pH conditions.



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Visual/emotional stimuli and treatment with antidepressants alter Numerical Rating Scale score in patients with chronic pain

To examine the impact of visual stimulation (exciting red and tranquilizing green) on the score of the Numerical Rating Scale (NRS) questionnaire in patients with chronic pain.

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Chemotherapy alters cisatracurium induced neuromuscular blockade characteristics: A prospective cohort study

To compare the characteristics of NMDR induced muscle paralysis in breast cancer patients with and without a history of recent chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) regimen.

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Oblique approach for ultrasound-guided radial artery catheterization vs transverse and longitudinal approaches, a randomized trial

To investigate the value of using a new technique for ultrasound-guided radial artery catheterization; oblique approach; vs transverse and longitudinal views are the traditionally used approaches aiming to combine benefits and avoid drawbacks of aforementioned approaches.

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Use of ultrasound for spinal anesthesia in a super morbidly obese patient

We report the application of ultrasound prescans for spinal anesthesia to morbid obesity patient. A 38-year-old woman with a body mass index (BMI) of 50 (weight: 110 kg; height: 148 cm) was scheduled to undergo pilonidal cyst resection at the bottom of the tailbone. Spinal anesthesia was selected for the procedure, because the patient's position during the surgery was prone and the patient had morbid obesity. To determine the spinal needle insertion point and the distance between the skin and dura, we planned to use ultrasound.

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Magnesium sulfate accelerates the onset of low-dose rocuronium in patients undergoing laryngeal microsurgery

We evaluated the effect of magnesium sulfate—an enhancer of neuromuscular blockade—on onset and duration of low dose of rocuronium, and on operating conditions during laryngeal microsurgery.

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Monitoring of the intraoperative analgesia by pupillometry during laparoscopic splenectomy for splenic hydatid cyst

Echinococcosis causes a hydatid cyst, a worldwide disease. Human beings are intermediate hosts, but dogs complete the life cycle of the cestode. The most common presentation sites are the liver and lungs. We present an unusual case of a primary splenic hydatid cyst. Open splenectomy has traditionally been the treatment of choice for splenic hydatid cysts. In recent years, minimally invasive laparoscopic surgery has been used in appropriate cases. A healthy 48-year-old woman was scheduled for laparoscopic splenectomy.

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Effect of total intravenous vs volatile anesthetics on intraoperatively acquired electrically evoked compound action potential in children undergoing cochlear implant surgery: A randomized prospective study

The purpose of the present study was to compare the effects of inhalational anesthesia to those of total intravenous anesthesia on intraoperative electrically evoked compound action potential (e-ECAP) thresholds in children undergoing cochlear implantation.

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A new mutation in TUBB1 associated with thrombocytopenia confirms that C-terminal part of β1-tubulin plays a role in microtubule assembly

Thumbnail image of graphical abstract

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Regular Physical Activity Increases the Systolic Blood Pressure Response to Acute Caffeine Ingestion in Nonhabitual Caffeine Consumers

Journal of Caffeine Research , Vol. 0, No. 0.


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Clinical presentation, diagnosis, and survival in cholangiocarcinoma: A prospective study

Publication date: Available online 30 November 2016
Source:Arab Journal of Gastroenterology
Author(s): Larisa Vasilieva, Stefanos I. Papadhimitriou, Alexandra Alexopoulou, Ioannis Kostopoulos, Konstantinos Papiris, Dimitrios Pavlidis, Dimitrios Xinopoulos, Andreas Romanos, Spyridon P. Dourakis
Background and study aimsThe diagnosis of cholangiocarcinoma (CCA) is difficult. The present study aimed to assess the clinical features, diagnosis, and survival in CCA.Patients and methodsThis is a prospective study on 46 patients with CCA who underwent endoscopic retrograde cholangiopancreatography (ERCP) or surgical resection and 20 controls with a clinical and ERCP suspicion for CCA in whom surgical biopsy and/or 4-year follow-up showed a benign biliary stricture.ResultsThe median age at presentation was 71years (range 44–88). Thirty-four patients (73.9%) presented with painless jaundice. Median CA 19-9 value was 188IU/L (range 1–49,138), with a level of <100IU/L in 13 patients (28%). Total bilirubin was 11.9 (0.6–36.3)mg/dL. The tumour was intrahepatic in 3 (6.5%), hilar (Klatskin) in 25 (54.3%), and located in the lower third of the bile duct in 18 (39.1%) patients. The diagnosis was confirmed by positive cytology in 10 (21.7%), biopsy in 20 (43.5%), cholangioscopy in five (10.9%), and imaging and clinical grounds in 11 (23.9%) patients. Cytology was feasible in 36 patients; it was positive in 10 and "highly indicative" in two patients (33.3% sensitivity). Twenty-two patients (47.8%) were treated by surgical resection, and the rest were offered palliative biliary drainage. Mean estimated survival for the entire group of CCA patients was 21.5±3.3months. Survival was slightly longer in patients who underwent surgical resection than those who had palliative treatment; the estimated mean survival rates were 26.2±4.2 vs. 17.1±3.3months, respectively, but the difference was not statistically significant (p=0.115).ConclusionThe diagnosis of CCA is difficult and often delayed. The outcome is generally poor.



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Colonic manifestation of a haematologic disorder

Publication date: Available online 30 November 2016
Source:Arab Journal of Gastroenterology
Author(s): Melika Hosseina, Stephan Probst, Polymnia Galiatsatos
A 32year-old female presenting with right lower quadrant pain was found to have caecal varices. Extensive work-up revealed underlying protein C deficiency.



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High performance CPR demonstration

Fire department personnel practice CPR.

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High performance CPR demonstration

Fire department personnel practice CPR.

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ACKNOWLEDGMENTS

2016-11-30T16-42-26Z
Source: Rawal Medical Journal
RMJ.
The Editorial Board of Rawal Medical Journal would like to thank the following individuals who reviewed manuscripts for volume 41, 2016


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Photo: Good Samaritans buy IHOP meal for Calif. EMTs

By EMS1 Staff

RIVERSIDE COUNTY, Calif. — Two EMTs were treated to a free pancake breakfast this week after Good Samaritans paid for their meal.

Two families, noted as the Gladwells and Millers, left a napkin message for the EMTs after paying for their breakfast at IHOP.

A photo of the napkin surfaced on Reddit, posted by the user EnMT.

The note thanked them for protecting and keeping their community safe.

"You save lives and help those around you on a daily basis. There is nothing I could do that would match what you've done for others, but I hope this is at least a start to showing our deepest gratitude for you both!" read the note.

Some citizens paid for our breakfast at iHop this morning. Feel appreciated in the job is rare, This made my week! from ems


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“The Apartment is for You, It’s Not for Anyone Else”: Managing Social Recovery and Risk on the Frontlines of Single-Adult Supportive Housing

Abstract

This multi-method qualitative study examines frontline provider perspectives on consumer social relationships and barriers to social recovery in supportive housing programs for adults with serious mental illness. Thematic analyses show that guest and occupancy policies that enforce the "single" nature of single-adult supportive housing challenge consumer rights to self-determination in the realm of social recovery. Findings also highlight the ways in which providers act to reinforce and subvert these policies while mitigating risk in this service setting. Recommendations for enhancing the recovery orientation of supportive housing and implications for the design of the homeless service system are discussed.



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High performance CPR demonstration

Fire department personnel practice CPR.

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High performance CPR demonstration

Fire department personnel practice CPR.

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Inside EMS Podcast: Why EMS should treat opioid exposure as a hazmat scene

Download this podcast on iTunes, SoundCloud or via RSS feed

​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson are joined by Art Hsieh, a member of the EMS1 Editorial Advisory Board and columnist, to discuss his latest article on carfentanil exposure. With the potency of this drug, does EMS have to consider exposure as well as making these hazmat scenes" Join the discussion and sound off in the comments.



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Mutations in SLC5A6 associated with brain, immune, bone, and intestinal dysfunction in a young child

Abstract

The human sodium-dependent multivitamin transporter (hSMVT) is a product of the SLC5A6 gene and mediates biotin, pantothenic acid, and lipoate uptake in a variety of cellular systems. We report here the identification of mutations R94X, a premature termination, and R123L, a dysfunctional amino acid change, both in exon 3 of the SLC5A6 gene in a child using whole genome-scanning. At 15 months of age, the child showed failure to thrive, microcephaly and brain changes on MRI, cerebral palsy and developmental delay, variable immunodeficiency, and severe gastro-esophageal reflux requiring a gastrostomy tube/fundoplication, osteoporosis, and pathologic bone fractures. After identification of the SLC5A6 mutations, he responded clinically to supplemental administration of excess biotin, pantothenic acid, and lipoate with improvement in clinical findings. Functionality of the two mutants was examined by 3H-biotin uptake assay following expression of the mutants in human-derived intestinal HuTu-80 and brain U87 cells. The results showed severe impairment in biotin uptake in cells expressing the mutants compared to those expressing wild-type hSMVT. Live cell confocal imaging of cells expressing the mutants showed the R94X mutant to be poorly tolerated and localized in the cytoplasm, while the R123L mutant was predominantly retained in the endoplasmic reticulum. This is the first reporting of mutations in the SLC5A6 gene in man, and suggests that this gene is important for brain development and a wide variety of clinical functions.



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Photo: Good Samaritans pay for Calif. EMTs IHOP meal

By EMS1 Staff

RIVERSIDE COUNTY, Calif. — Two EMTs were treated to a free pancake breakfast this week after Good Samaritans paid for their meal.

Two families, noted as the Gladwells and Millers, left a napkin message for the EMTs after paying for their breakfast at IHOP.

A photo of the napkin surfaced on Reddit, posted by the user EnMT.

The note thanked them for protecting and keeping their community safe.

"You save lives and help those around you on a daily basis. There is nothing I could do that would match what you've done for others, but I hope this is at least a start to showing our deepest gratitude for you both!" read the note.

Some citizens paid for our breakfast at iHop this morning. Feel appreciated in the job is rare, This made my week! from ems


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Community raises funds for EMT student shot while aiding victim

By EMS1 Staff

BATON ROUGE, La. — After a 17-year-old EMT student put his life on the line to save a shooting victim, his community has begun raising funds to pay for his medical bills.

Daniel Wesley was on his way home from a Sunday shopping trip with his mother when he saw a shooting victim lying on the side of the road. Wesley rushed to the victim, April Peck, and attempted to aid her. 

During the incident, the shooter, Terrell Walker, shot Wesley in the arm and leg, and ran over him twice as he fled from the scene, reported WBRZ. Peck did not survive. Walker was killed later Sunday night in a shootout with East Baton Rouge sheriff's deputies.

Wesley was transported to the hospital, where he underwent surgery on his leg and arm, which "shattered into 18 pieces," his mother, Kathy Wesley, said.

Wesley comes from an EMS family; his father was a longtime paramedic and his mother is also a first responder. 

Wesley's high school has started to sell bracelets to help raise funds for his medical expenses. The school's principal, David Prescott, said, "We're very proud of him. He's always in service to some else. He's come to me before this year with a fundraiser of his own to help someone out."

A GoFundMe page has also been created and it has raised over $6,000.

"Daniel wants to tell all of his friends out there, he's sending a shout out to them, and he's thinking of them as well during this time," Wesley's mother said. 

Heroic, selfless effort by this incredible young man. Strong work Daniel Wesley. https://t.co/SfRMYhYCzY

— MONOC EMS (@MONOCEMS) November 29, 2016


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Rapid reaction: EMT student shot, run over for caring

What happened: Emergency Medical Responder and EMT student Daniel Wesley, 17, is recovering from two gunshot wounds, a broken arm and a broken leg after he was attacked Sunday evening caring for a woman who had been shot and tossed in a road.

Wesley came to the aid of April Peck, 30. While donning gloves and preparing to apply pressure to Peck's wounds, the shooter returned to the scene. Terrell Walker, 48, drove Peck's car directly at Wesley, other bystanders and an ambulance crew. Wesley was struck and thrown against the ambulance, the impact breaking his arm. Walker got out of the vehicle, shot Wesley twice and ran him over a second time as he fled the scene. Walker, the gunman, was killed later Sunday night in a shootout with East Baton Rouge sheriff's deputies.

Kathy Wesley, Daniel's mother, reported that Wesley had surgery Sunday night and Tuesday. "He's a tough kid. He's silly and has a sense of humor you wouldn't believe," she said. "He's cracking jokes and trying his best to keep the pain in. He's been surrounded by friends and family all afternoon."

Why it's significant: Daniel Wesley is a caregiver. As a teenager, the son of an EMT is already a certified Emergency Medical Responder, capable of recognizing a person in need and providing care. Wesley is one of us. He is our brother who like the Good Samaritan saw a person injured in the road and gave care, but Wesley was attacked for taking action and doing the right thing.

Top takeaways: Since Wesley is one of us, a young man called to care, we all can learn from his experience.

1. Combined risks are exponentially more dangerous.
A routine roadway incident, if there is such a thing, is a hazardous hot zone for EMS providers and public safety personnel. Fire apparatus blocking scenes are regularly struck accidentally or intentionally, police officers are injured or killed and medical helicopters waiting for a patient to be loaded have been hit by drunk drivers twice in 2016.

Domestic violence incidents can be just as dangerous for EMS providers and law enforcement. If the assailant has fled the scene before EMS arrival, there is a constant worry that the assailant still enraged, armed and hopeless will return at any moment.

Wesley and other emergency responders were confronted by the combined danger of initiating care in the roadway as the assailant returned to the scene to attack Wesley and other caregivers. The combined risks were not twice as dangerous. This incident was 20 or 200 times more dangerous for everyone.

2. Anything is a weapon.
It's OK to know this and be reminded it is true. Anything is a weapon when it is wielded with malice and intent to main, injure or kill.

Sunday night, Wesley was attacked with a vehicle before being shot. Monday morning, an Ohio State University student drove onto a crowded sidewalk before attacking people with a knife. Body armor is partial defense for one type of weapon. Other shielding, along with distance, cover and concealment are partial defense for any type of weapon.

3. Targeted for caring.
Caregivers have been and will continue to be a target of violence for the simple act of caring. This year started with the fatal shooting of an Arkansas volunteer firefighter who responded to a medical call. In April, a Maryland firefighter-paramedic was fatally wounded and a volunteer firefighter was seriously wounded after being shot by a man they had been called to perform a welfare check. Throughout the year, paramedics, EMTs and other caregivers are violently attacked, assaulted and verbally abused by patients and bystanders. The risk of violence is unrelenting and unpredictable.

Your prayers, thoughts and even financial support for Wesley are important and appreciated. Reflecting on this incident, discussing it with your partner and squad and learning from it are also critical.

What are your top takeaways from this incident as an EMS provider, educator and advocate? 



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Rapid reaction: EMT student shot, run over for caring

What happened: Emergency Medical Responder and EMT student Daniel Wesley, 17, is recovering from two gunshot wounds, a broken arm and a broken leg after he was attacked Sunday evening caring for a woman who had been shot and tossed in a road.

Wesley came to the aid of April Peck, 30. While donning gloves and preparing to apply pressure to Peck's wounds, the shooter returned to the scene. Terrell Walker, 48, drove Peck's car directly at Wesley, other bystanders and an ambulance crew. Wesley was struck and thrown against the ambulance, the impact breaking his arm. Walker got out the vehicle, shot Wesley twice and ran him over a second time as he fled the scene. Walker, the gunman, was killed later Sunday night in a shootout with East Baton Rouge sheriff's deputies.

Kathy Wesley, Daniel's mother, reported that Wesley had surgery Sunday night and Tuesday. "He's a tough kid. He's silly and has a sense of humor you wouldn't believe," she said. "He's cracking jokes and trying his best to keep the pain in. He's been surrounded by friends and family all afternoon."

Why it's significant: Daniel Wesley is a caregiver. As a teenager, the son of an EMT is already a certified Emergency Medical Responder, capable of recognizing a person in need and providing care. Wesley is one of us. He is our brother who like the Good Samaritan saw a person injured in the road and gave care, but Wesley was attacked for taking action and doing the right thing.

Top takeaways: Since Wesley is one of us, a young man called to care, we all can learn from his experience.

1. Combined risks are exponentially more dangerous.
A routine roadway incident, if there is such a thing, is a hazardous hot zone for EMS providers and public safety personnel. Fire apparatus blocking scenes are regularly struck accidentally or intentionally, police officers are injured or killed and medical helicopters waiting for a patient to be loaded have been hit by drunk drivers twice in 2016.

Domestic violence incidents can be just as dangerous for EMS providers and law enforcement. If the assailant has fled the scene before EMS arrival, there is a constant worry that the assailant still enraged, armed and hopeless will return at any moment.

Wesley and other emergency responders were confronted by the combined danger of initiating care in the roadway as the assailant returned to the scene to attack Wesley and other caregivers. The combined risks were not twice as dangerous. This incident was 20 or 200 times more dangerous for everyone.

2. Anything is a weapon.
It's OK to know this and be reminded it is true. Anything is a weapon when it is wielded with malice and intent to main, injure or kill.

Sunday night, Wesley was attacked with a vehicle before being shot. Monday morning, an Ohio State University student drove onto a crowded sidewalk before attacking people with a knife. Body armor is partial defense for one type of weapon. Other shielding, along with distance, cover and concealment are partial defense for any type of weapon.

3. Targeted for caring.
Caregivers have been and will continue to be a target of violence for the simple act of caring. This year started with the fatal shooting of an Arkansas volunteer firefighter who responded to a medical call. In April, a Maryland firefighter-paramedic was fatally wounded and a volunteer firefighter was seriously wounded after being shot by a man they had been called to perform a welfare check. Throughout the year, paramedics, EMTs and other caregivers are violently attacked, assaulted and verbally abused by patients and bystanders. The risk of violence is unrelenting and unpredictable.

Your prayers, thoughts and even financial support for Wesley are important and appreciated. Reflecting on this incident, discussing it with your partner and squad and learning from it are also critical.

What are your top takeaways from this incident as an EMS provider, educator and advocate"



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Dynamical effects of calcium-sensitive potassium currents on voltage and calcium alternans

Abstract

Cardiac alternans is a precursor to life-threatening arrhythmias. Alternans can be caused by instability of the membrane voltage (Vm), instability of the intracellular Ca (Cai) cycling, or both. Vm dynamics and Cai dynamics are coupled via Ca-sensitive currents. In cardiac myocytes, there are several Ca-sensitive potassium (K) currents such as the slowly activating delayed rectifier current (IKs) and the small conductance Ca-activated potassium (SK) current (ISK). However, the role of these currents in the development of arrhythmias is not well understood. In this study, we investigated how these currents affect voltage and Ca alternans using a physiologically detailed computational model of the ventricular myocyte and mathematical analysis. We define the coupling between Vm and Cai cycling dynamics (Cai[RIGHTWARDS ARROW]Vm coupling) as positive (negative) when a larger Ca transient at a given beat prolongs (shortens) the action potential duration (APD) of that beat. While positive coupling predominates at baseline, increasing IKs and ISK promote negative Cai[RIGHTWARDS ARROW]Vm coupling at the cellular level. Specifically, when alternans is Ca-driven, electromechanically (APD-Ca) concordant alternans becomes electromechanically discordant alternans as IKs or ISK increase. These cellular level dynamics lead to different types of spatially discordant alternans in tissue. These findings help to shed light on the underlying mechanisms of cardiac alternans especially when relative strength of these currents becomes larger under pathological conditions or drug administrations.

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Vagal denervation inhibits the increase in pulmonary blood flow during partial lung aeration at birth

Air entry into the lungs at birth triggers major cardiovascular changes, including a large increase in pulmonary blood flow (PBF) that is not spatially related to regional lung aeration. To investigate the possible underlying role of a vagally-mediated stimulus, we used simultaneous phase-contrast X-ray imaging and angiography in near-term (30 days of gestation) vagotomised (n = 15) or sham-operated (n = 15) rabbit kittens. Rabbits were imaged before ventilation, when one lung was ventilated (unilateral) with 100% nitrogen (N2), air or 100% oxygen (O2), before all kittens were switched to unilateral ventilation in air, then ventilation of both lungs using air. Compared to control kittens, vagotomised kittens had little or no increase in PBF in both lungs following unilateral ventilation when ventilation occurred with 100% N2 or with air. However, relative PBF did increase in vagotomised animals ventilated with 100% O2, indicating the independent stimulatory effects of local oxygen concentration and autonomic innervation on the changes in PBF at birth. These findings demonstrate that vagal denervation inhibits the previously observed increase in PBF with partial lung aeration, although high inspired oxygen concentrations can partially mitigate this effect.

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Performance of functional fibrinogen thromboelastography in children undergoing congenital heart surgery

Summary

Background

Functional Fibrinogen assay of the Thromboelastography (FFTEG), a whole blood viscoelastic hemostatic assay, has been used to estimate fibrinogen levels in adult patients undergoing major surgery but its performance in pediatric patients undergoing cardiac surgery requires evaluation. In this study, we evaluate the correlation between FFTEG parameters and standard laboratory tests for fibrinogen and platelet counts before and after cardiopulmonary bypass in children undergoing repair for congenital heart disease.

Methods

In this prospective observational study, whole blood samples were obtained from children less than 5 years of age undergoing congenital heart surgery with cardiopulmonary bypass before surgical incision and immediately after administration of protamine. Blood samples were analyzed for Thromboelastography, Functional Fibrinogen level measured by FFTEG (FLEV), complete blood counts with platelet count and plasma fibrinogen assay (LFib, Clauss). The primary outcome of this study was to assess the correlation between FFTEG parameters, LFib and platelet counts in neonates, infants, and small children less than 5 years old. Additionally, we studied if postbypass FFTEG parameters could predict critical thresholds of hypofibrinogenemia LFib ≤200 mg·dl−1.

Results

One hundred and five children (22 neonates, 51 infants, and 32 small children) were included in the final analysis. FLEV estimated higher fibrinogen levels than LFib in all patients. Before bypass, FLEV was on average 133 mg·dl−1 higher than LFib (95% confidence interval, CI, 116–150, P < 0.001) for all the patients; after bypass, FLEV was 48 mg·dl−1 (95% CI: 37–59, P < 0.001) higher than LFib for all the patients. Linear correlation coefficients between FLEV and LFib in all patients were R = 0.41 (95% CI: 0.24–0.56, P < 0.001) before bypass and increased to R = 0.63 (95% CI: 0.51–0.74, P < 0.001) after bypass. Bland Altman analysis performed on postbypass values of FLEV and LFib showed a positive bias of FLEV in estimation of LFib. The magnitude and the variability of the bias for all the patients group was decreased with lower mean of the difference of FLEV and LFib when the average values of FLEV and LFib were <200 mg·dl−1. Low linear correlations were noticed between maximal amplitude of platelet contribution to FFTEG and platelet counts both before and after bypass. For predicting the clinical thresholds of postbypass hypofibrinogenemia at plasma fibrinogen levels ≤200 mg·dl−1, FLEV and maximal amplitude of the fibrinogen clot generated area under receiver operative curves at 0.90 (95% CI = 0.76–1.0) in neonates, 0.6 (95% CI- 0.42–0.78) in infants, and 0.97 (95% CI = 0.91–1.0) in small children. Based on the receiver operative curves, values of postbypass hypofibrinogenemia with LFib ≤200 g·dl−1 corresponded to cutoffs of FLEVPOST ≤245 mg·dl−1 and maximal amplitude of the fibrinogen clot ≤13.4 mm.

Conclusion

In pediatric patients undergoing cardiac surgery, FLEV derived from Functional Fibrinogen correlated linearly with plasma fibrinogen levels (Clauss) both before and after CPB. FLEV estimation of plasma fibrinogen was improved after CPB in neonates, infants, and small children. After CPB, FFTEG can be used to predict laboratory diagnosis of critical hypofibrinogenemia (≤200 mg·dl−1) during pediatric cardiac surgery. Further studies are required to assess the impact of predictability of FFTEG on component transfusion during pediatric cardiac surgery.

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Success rate of pneumatic reduction of intussusception with and without sedation

Summary

Background

Pneumatic reduction of ileocolic intussusception is often performed without sedation. The aim of this study was to evaluate the success rate of pneumatic reduction of intussusception with and without sedation.

Methods

We conducted a retrospective cohort study in Israel in two tertiary care centers using a similar protocol for pneumatic reduction of intussusception. In one center, patients had pneumatic reduction of intussusception under propofol-based sedation, while in the other, patients had pneumatic reduction of intussusception without any sedation. Children aged 3 months to 8 years who were diagnosed with ileocolic intussusception between January 1, 2008 and July 31, 2015 were included in the study. Multivariable regression was used to adjust for the possible confounders of age, gender, number of cases of intussusception prior to the study period, time period from the beginning of symptoms to emergency department admission (<12 h, >12 h), and time period from emergency department admission to the beginning of pneumatic reduction of intussusception. Secondary outcomes of the study included the proportion of bowel perforations during the procedure, and the proportion of early (within 48 h) recurrence of intussusception.

Results

The sedation and nonsedation cohorts included 124 and 90 patients, respectively. The cohorts were comparable with regard to demographic characteristics, hemodynamic vital signs on admission to the emergency department, blood gases tests during emergency department stay, and time variables prior to reduction of intussusception. Multivariable regression revealed reduction of intussusception success rates of 89.5% and 83.3% for the sedation group and nonsedation group, respectively, with an adjusted odds ratio of 1.2, 95% CI 1.1–5.3. Three sedated patients and 0 nonsedated patients developed bowel perforations during the procedure. Rates of early recurrence of intussusception of sedated patients and nonsedated patients were 5.1% (6/117) and 1.3% (1/79), respectively (P = 0.15, RR = 3.9, 95% CI: 0.47 to 31.81).

Conclusion

The findings suggest that the pneumatic reduction of intussusception under propofol-based sedation had a slightly higher success rate than the pneumatic reduction of intussusception without sedation; however, the safety of this practice is yet to be determined.

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Clinico mycological study of dermatophytosis

2016-11-30T04-28-41Z
Source: International Journal of Research in Medical Sciences
B. Janardhan, G. Vani.
Background: Dermatophytoses is common, more prevalent in tropical and subtropical countries including India. Though not life threatening as it can cause great discomfort particularly in immunosuppressive conditions. It remains a general public health problem, which is prevalent in all age groups and both sexes. Aims: To study clinicomycological profile of patients. Methods: The Cross Sectional study was done on clinically diagnosed cases of Dermatophytosis with sample size of 200 cases for one and half year period. Results: The males to female ratio are 1.86:1. The common age group affected was 31-40years. Dermatophytosis was common in active workers, more common in urban than rural population particularly in low socioeconomic group of people and in summer season. Tinea corporis was the common clinical variant. 133 cases were both KOH and culture positive. The KOH mount was positive in 90% cases. In the present study 144 patients (72%) had positive culture results and 47 cases were KOH positive but culture negative, 11 cases were culture positive but KOH negative and 9 cases were both KOH and culture negative. Microsporum audoinii was isolated in 2%, Trichophyton mentagrophytes in 14%, Trichophyton rubrum in 52% and Trichophyton violaceum in 4%. Conclusions: Tinea corporis and Tinea cruris were the most common clinical types. Tinea corporis was predominantly a disease of adult males whereas Tinea capitis was seen mainly in pre- pubertal age group. Potassium hydroxide (KOH) wet mount and cultures were done for all the cases. T. rubrum was the commonest species isolated from most clinical types followed by T. mentagrophytes except T. capitis where T. violaceum was isolated.


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Costs and Length of Stay for the Acute Care of Patients with Motor-Complete Spinal Cord Injury Following Cervical Trauma: The Impact of Early Transfer to Specialized Acute SCI Center.

Objective: Acute spinal cord injury (SCI) centers aim to optimize outcome following SCI. However, there is no timeframe to transfer patients from regional to SCI centers in order to promote cost-efficiency of acute care. Our objective was to compare costs and length of stay (LOS) following early and late transfer to the SCI center. Design: A retrospective cohort study involving 116 individuals was conducted. Group 1 (n = 87) was managed in an SCI center promptly after the trauma, whereas group 2 (n = 29) was transferred to the SCI center only after surgery. Direct comparison and multivariate linear regression analyses were used to assess the relationship between costs, LOS, and timing to transfer to the SCI center. Results: Length of stay was significantly longer for group 2 (median, 93.0 days) as compared with group 1 (median, 40.0 days; P

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Inflammatory Mediators and Pain in the First Year After Acute Episode of Low-Back Pain in Elderly Women: Longitudinal Data from Back Complaints in the Elders-Brazil.

Objective: The aims of this study were to determine the course of plasma levels of inflammatory mediators (interleukin 6 [IL-6], tumor necrosis factor [alpha] [TNF-[alpha]], soluble TNF receptor 1 [sTNF-R1]) and the severity of low-back pain (LBP) over 6 to 12 months after an acute episode of LBP in elderly women and to establish an association between inflammatory mediators and LBP recovery. Design: This was a longitudinal study of a subsample (155 elderly women with acute LBP, aged >=65 years) of the international Back Complaints in the Elders cohort study. Plasma levels of IL-6, TNF-[alpha], and sTNF-R1 were measured using enzyme-linked immunosorbent assays and pain severity using the numerical pain scale. Results: There was a decrease in the severity of LBP (P = 0.033) and in the levels of IL-6 and TNF-[alpha] (P

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The Effect of Skin Pressure on Needle Entry Point Accuracy During Fluoroscopically Guided Lumbar Transforaminal Epidural Injections: A Randomized Clinical Trial.

Objective: The aim of this study was to investigate the effect of skin pressure on needle entry point accuracy during fluoroscopically guided lumbar transforaminal epidural injection. Design: This study is a prospective randomized clinical trial; 64 patients with a body mass index of 25 kg/m2 or greater were enrolled. For patients in the pressing group, the operator marked the needle entry point on the patient's back while pressing the patient's skin with the tip of an indicator. For patients in the nonpressing group, the tip of the indicator was gently positioned on the patient's skin. The data related to technical performance and radiation exposure during the procedure were compared. Results: Sixty patients (nonpressing group, n = 30; pressing group, n = 30) were analyzed. There were more attempts to reposition the needle (n) and increased procedure time (in seconds) in the pressing group (median, 5 vs. 4 [P = 0.019]; 400.0 vs. 358.5 [P = 0.033]). The fluoroscopy time (in seconds) and the kerma-area product (in cGy cm2) were also significantly longer and greater in the pressing group, respectively (median, 63.5 vs. 50.5 [P = 0.038]; 416.3 vs. 318.6 [P = 0.014]). Conclusions: This study shows that practitioners should not press the skin with a radiopaque indicator when determining the needle entry point by fluoroscopy during lumbar transforaminal epidural injection. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Bilateral Rectus Femoris Muscle Rupture Following Statin Medication.

No abstract available

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Copy number variants in a population-based investigation of Klippel–Trenaunay syndrome

Klippel–Trenaunay syndrome (KTS) is a rare congenital vascular disorder that is thought to occur sporadically; however, reports of familial occurrence suggest a genetic component. We examined KTS cases to identify novel, potentially causal copy number variants (CNVs). We identified 17 KTS cases from all live-births occurring in New York (1998–2010). Extracted DNA was genotyped using Illumina microarrays and CNVs were called using PennCNV software. CNVs selected for follow-up had ≥10 single nucleotide polymorphisms (SNPs) and minimal overlap with in-house controls or controls from the Database of Genomic Variants. We identified 15 candidate CNVs in seven cases; among them a deletion in two cases within transcripts of HDAC9, a histone deacetylase essential for angiogenic sprouting of endothelial cells. One of them also had a duplication upstream of SALL3, a transcription factor essential for embryonic development that inhibits DNMT3A, a DNA methyltransferase responsible for embryonic de novo DNA methylation. Another case had a duplication spanning ING5, a histone acetylation regulator active during embryogenesis. We identified rare genetic variants related to chromatin modification which may have a key role in regulating vascular development during embryogenesis. Further investigation of their implications in the pathogenesis of KTS is warranted. © 2016 Wiley Periodicals, Inc.



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CRTAP variants in early-onset osteoporosis and recurrent fractures



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First steps in validating the pediatric anesthesia parent satisfaction (PAPS) survey

Summary

Background

In the last few decades, patient satisfaction has become a critical component of quality assessment and is being incorporated into payment for performance plans. However, assessment of satisfaction with anesthesia services is problematic and few validated satisfaction tools have been published. Assessing parent satisfaction with pediatric anesthesia services is even more challenging.

Objective

Our aim was to develop, implement, and start validating a set of survey questions that evaluate parental satisfaction with the pediatric anesthesia services in order to identify strengths and potential areas for improvement.

Methods

The Pediatric Anesthesia Parent Satisfaction (PAPS) survey contained 17 questions adapted from the American Society of Anesthesiologists Committee on Outcomes and Performance Measures. With consent of the hospital quality improvement committee, the PAPS survey was randomly administered on iPads to 250 English-speaking parents in the main operating room and procedure center postanesthesia care units prior to discharge. Statistical analyses including descriptive statistics, exploratory factor analysis, Cronbach's alpha and Raykov's rho coefficients, composite scale creation, correlations between items, composite scores, and overall satisfaction measures were used to provide evidence for a subset of validity and reliability types.

Results and Conclusions

The PAPS survey is a short and simple tool for evaluation of parent satisfaction with pediatric anesthesia services and provides some evidence for validity and reliability. The majority (greater than 95%) of parents reported were satisfied or very satisfied with the care provided by the pediatric anesthesia department.

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Community-based participatory research: an innovative approach for improving perioperative care of underserved children

Summary

Pediatric disparities disproportionately affect Latino youth undergoing surgery and their families. As such, there is a critical need for culturally relevant frameworks that can advance perioperative intervention approaches in this population and reduce these disparities. In the following article, we first describe the methodological process of community-based participatory research (CBPR) and next report the results of the CBPR process that was conducted in this population. An interdisciplinary group of investigators, Latina mothers, and various other stakeholders met for a series of CBPR-based structured meetings. Qualitative data collection and analyses of the CBPR process were guided by principles of grounded theory that employs inductive techniques and constant comparison analyses until reaching saturation of data. Barriers identified in the process can be grouped within the following domains: child-related factors, family-related factors, health care provider factors, and hospital system factors. Family system factors category (coded references = 136) had the highest number of coded references; this category was found to be best described by the value of familismo or familism, including a duty to help family members when in need. The health care provider category (coded references = 42) was ranked second by frequency. Within this category, two major themes surfaced: health care provider cultural competence and overestimating health literacy. All barriers identified will be next incorporated in an innovative behavioral intervention that is currently being developed. We conclude that the model of CBPR can be used within the context of perioperative care of children and their families.

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Effects of partial sleep deprivation on reaction time in anesthesiologists

Abstract

Background

Fatigue in anesthesiologists may have implications that extend beyond individual well-being.

Aim

The aim of the present study was to evaluate the impact of sleep deprivation on the reaction time in anesthesiologists either after an overnight call or regular working hours. Moderation of this effect by coping strategies was observed.

Methods

Psychomotor vigilance test was used to assess reaction time in 23 anesthesiologists at two time-points: (i) on a regular non-call day and (ii) after a 17-h in-house call. Student's paired t-test was used to compare Psychomotor Vigilance Task data at these two moments. Change score regression was performed to determine the association between coping strategies, assessed using the Coping Strategy Indicator instrument, and decline in reaction time after night call.

Results

Twenty-one colleagues completed the psychomotor vigilance test measurements after two decided to end their participation for personal reasons. Post-call psychomotor vigilance test mean reaction time decreased by an average of 31.2 ms (95% CI: 0.5, 61.9; P = 0.047) when compared to regular day. Reliance on specific coping mechanisms, indicated by Coping Strategy Indicator scale scores, included problem-solving (28 ± 4), followed by seeking social support (23 ± 5) and avoidance (19 ± 4). The change score regression model (r2 = 0.48) found that greater reliance on avoidance was associated with greater increase in reaction time after night call.

Conclusion

Reaction time increased considerably in anesthesiologists after a night call duty. Greater subjective reliance on avoidance as a coping strategy was associated with greater deterioration in performance.

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Manipulation of Muscle Creatine and Glycogen Changes DXA Estimates of Body Composition.

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Standardising a dual x-ray absorptiometry (DXA) protocol is thought to provide a reliable measurement of body composition. Purpose: We investigated the effects of manipulating muscle glycogen and creatine content independently and additively on DXA estimates of lean mass. Method: Eighteen well-trained male cyclists undertook a parallel group application of creatine loading (n=9) (20 g/d for 5 d loading; 3 g/d maintenance) or placebo (n=9) with crossover application of glycogen loading (12 v 6 g/kg BM/d for 48 h) as part of a larger study involving a glycogen-depleting exercise protocol. Body composition, total body water, muscle glycogen and creatine content were assessed via DXA, bioelectrical impedance spectroscopy and standard biopsy techniques. Changes in the mean were assessed using the following effect-size scale: >0.2 small, >0.6, moderate, >1.2 large and compared with the threshold for the smallest worthwhile effect of the treatment. Results: Glycogen loading, both with and without creatine loading, resulted in substantial increases in estimates of lean body mass (mean +/- SD; 3.0 +/- 0.7 % and 2.0 +/- 0.9 %) and leg lean mass (3.1 +/- 1.8 %and 2.6 +/- 1.0 %) respectively. A substantial decrease in leg lean mass was observed following the glycogen depleting condition (-1.4 +/- 1.6 %). Total body water showed substantial increases following glycogen loading (2.3 +/- 2.3 %), creatine loading (1.4 +/- 1.9 %) and the combined treatment (2.3 +/- 1.1 %). Conclusions: Changes in muscle metabolites and water content alter DXA estimates of lean mass during periods in which minimal change in muscle protein mass is likely. This information needs to be considered in interpreting the results of DXA-derived estimates of body composition in athletes. (C) 2016 American College of Sports Medicine

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Effect of Different Osmolalities, CHO Types, and [CHO] on Gastric Emptying in Humans.

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Purpose: This study investigated the effect of beverage osmolalities, carbohydrate (CHO) type and CHO concentration on gastric emptying in euhydrated subjects at rest. Methods: The gastric emptying of water (W), four glucose beverages (2, 4, 6, and 8% glucose: 2G, 4G, 6G, and 8G) and four sucrose beverages (2, 4, 6, and 8% sucrose: 2S, 4S, 6S, and 8S) were determined in eight healthy subjects using the modified George double-sampling technique. Subjects ingested a beverage (7 ml/kg body weight) containing 25-ppm phenol red as quickly as possible (0.05). 8G resulted in a significantly greater GRBV compared with other beverages at 20, 30 and 40 min (p

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Oral Contraceptive Use Dampens Physiological Adaptations to Sprint Interval Training.

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Purpose: Oral contraceptive (OC) use reduces peak aerobic capacity (V[spacing dot above]O2peak), however, whether it also influences adaptations to training has yet to be determined. This study aimed to examine the influence of OC use on peak performance [peak power output (PPO)] and physiological adaptations [V[spacing dot above]O2peak and peak cardiac output (Q[spacing dot above]peak)] following sprint interval training (SIT) in recreationally-active women. Methods: Women taking an OC (n=25) or experiencing natural regular menstrual cycles (MC; n=16) completed an incremental exercise test to assess V[spacing dot above]O2peak, PPO, and Q[spacing dot above]peak before, immediately after, and four weeks following 12 sessions of SIT. The SIT consisted of 10, one-minute efforts at 100-120% PPO in a 1:2 work:rest ratio. Results: Though V[spacing dot above]O2peak increased in both groups following SIT (both p

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Τρίτη 29 Νοεμβρίου 2016

Influence of menstrual phase and arid vs. humid heat stress on autonomic and behavioural thermoregulation during exercise in trained but unacclimated women

Abstract

We studied thermoregulatory responses of ten well-trained (VO2max, 57 (7) mL min−1 kg−1) eumenorrheic women exercising in dry and humid heat, across their menstrual cycle. They completed four trials, each of resting and cycling at fixed intensities (125 and 150 W), to assess autonomic regulation, then self-paced intensity (30-min work trial), to assess behavioural regulation. Trials were in early-follicular (EF) and mid-luteal (ML) phases in dry (DRY) and humid (HUM) heat matched for wet bulb globe temperature (WBGT, 27°C). During rest and fixed-intensity exercise, rectal temperature was ∼0.2°C higher in ML than EF (p < 0.01) independent of environment (p = 0.66). Mean skin temperature did not differ between menstrual phases (p ≥ 0.13) but was higher in DRY than HUM (p < 0.01). Local sweat rate and/or forearm blood flow differed as a function of menstrual phase and environment (interaction: p ≤ 0.01). Exercise performance did not differ between phases (EF: 257 (37), ML: 255 (43) kJ, p = 0.62), but was 7 (9)% higher in DRY than HUM (263 (39), 248 (40) kJ; p < 0.01) in conjunction with equivalent autonomic regulation and thermal strain but higher evaporative cooling (16 (6) W m−2; p < 0.01). In well-trained women exercising in the heat: i) menstrual phase did not affect performance, ii) humidity impaired performance due to reduced evaporative cooling despite matched WBGT, and iii) behavioural responses nullified thermodynamic and autonomic differences associated with menstrual phase and dry vs. humid heat.

This article is protected by copyright. All rights reserved



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Unfolded Protein Response Promotes Doxorubicin-Induced Nonsmall-Cell Lung Cancer Cells Apoptosis via the mTOR Pathway Inhibition

Cancer Biotherapy & Radiopharmaceuticals , Vol. 0, No. 0.


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Special issue of the Journal of Environmental Radioactivity: Geogenic radiation and its potential use for developing the geogenic radon map – Foreword

Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): Tore Tollefsen, Giorgia Cinelli, Marc De Cort




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Estimation and mapping of uranium content of geological units in France

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): G. Ielsch, M. Cuney, F. Buscail, F. Rossi, A. Leon, M.E. Cushing
In France, natural radiation accounts for most of the population exposure to ionizing radiation. The Institute for Radiological Protection and Nuclear Safety (IRSN) carries out studies to evaluate the variability of natural radioactivity over the French territory. In this framework, the present study consisted in the evaluation of uranium concentrations in bedrocks. The objective was to provide estimate of uranium content of each geological unit defined in the geological map of France (1:1,000,000). The methodology was based on the interpretation of existing geochemical data (results of whole rock sample analysis) and the knowledge of petrology and lithology of the geological units, which allowed obtaining a first estimate of the uranium content of rocks. Then, this first estimate was improved thanks to some additional information. For example, some particular or regional sedimentary rocks which could present uranium contents higher than those generally observed for these lithologies, were identified. Moreover, databases on mining provided information on the location of uranium and coal/lignite mines and thus indicated the location of particular uranium-rich rocks. The geological units, defined from their boundaries extracted from the geological map of France (1:1,000,000), were finally classified into 5 categories based on their mean uranium content. The map obtained provided useful data for establishing the geogenic radon map of France, but also for mapping countrywide exposure to terrestrial radiation and for the evaluation of background levels of natural radioactivity used for impact assessment of anthropogenic activities.



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Radon in the soil air of Estonia

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): Valter Petersell, Krista Täht-Kok, Mark Karimov, Heli Milvek, Siim Nirgi, Margus Raha, Krista Saarik
Several investigations in Estonia during 1996¬-1999 have shown that permissible level (200 Bq/m3) of radon (222Rn) in indoor air is exceeded in 33% of the inspected dwellings. This makes Estonia one of the five countries with highest radon risk in Europe (Fig 1). Due to correlation between the soil radon risk level and radon concentration in houses, small scale radon risk mapping of soil air was carried out (one study point per 70–100 km2). It turned out that one-third of Estonian mainland has high radon risk potential, where radon concentration in soil air exceeds safe limit of 50 kBq/m3.In order to estimate radon content in soil air, two different methods developed in Sweden were used simultaneously. Besides measuring radon content from soil air at the depth of 80 cm with an emanometer (RnM), maximum potential content of radon in soil (RnG) was estimated based on the rate of eU (226Ra) concentration in soil, which was acquired by using gamma-ray spectrometer.Mapping and following studies revealed that simultaneously measured RnG and RnM in study points may often differ. To inspect the cause, several monitoring points were set up in places with different geological conditions. It appeared that unlike the RnG content, which remains close to average level in repeated measurements, the RnM content may differ more than three times periodically. After continuous observations it turned out that concentration of directly measured radon depended on various factors being mostly controlled by mineral composition of soil, properties of topsoil as well as different factors influencing aeration of soil.The results of Rn monitoring show that reliable level of radon risk in Estonian soils can only be acquired by using calculated Rn-concentration in soil air based on eU content and directly measured radon content of soil air in combination with interpreting specific geological and geochemical situations in the study points.



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Mapping natural radioactivity of soils in the eastern Canary Islands

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): M.A. Arnedo, J.G. Rubiano, H. Alonso, A. Tejera, A. González, J. González, J.M. Gil, R. Rodríguez, P. Martel, J.P. Bolivar
The Canary Islands archipielago (Spain) comprises seven main volcanic islands and several islets that form a chain extending for around 500 km across the eastern Atlantic, between latitudes 27°N and 30°N, with its eastern edge only 100 km from the NW African coast. The administrative province of Las Palmas comprises the three eastern Canary Islands (Lanzarote, Fuerteventura and Gran Canaria). An extensive study of terrestrial gamma dose rates in surface soils has been carried out to cover the entire territory of the province (4093 km2). The average outdoor gamma dose rate in air at 1 m above ground is 73 nGyh−1 at Gran Canaria, 32 nGyh−1 at Fuerteventura, and 25 nGyh−1 at Lanzarote. To complete the radiological characterization of this volcanic area, 350 soil samples at 0–5 cm depth were collected to cover all the geologic typologies of the islands. These samples were measured using high resolution gamma spectrometry to determine the activity concentrations of 226Ra, 232Th and 40K. The average values obtained were 25.2 Bq/kg, 28.9 Bq/kg, and 384.4 Bq/kg, respectively. Maps of terrestrial gamma activity, effective dose, and activity concentrations of 226Ra, 232Th and 40K for the region have been developed through the use of geostatistical interpolation techniques. These maps are in accord with the geology of the islands.



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Editorial board

Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2





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Assessment of lithogenic radioactivity in the Euganean Hills magmatic district (NE Italy)

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): Laura Tositti, Giorgia Cinelli, Erika Brattich, Antonio Galgaro, Domiziano Mostacci, Claudio Mazzoli, Matteo Massironi, Raffaele Sassi
The Euganean Hills of North East Italy have long been recognised as an area characterized by a higher than average natural radiation background. This is due to two main reasons: a) primary lithogenic radiation due to rhyolitic and trachytic outcrops, which are "acidic alkaline" magmatic rocks potentially enriched in uranium and thorium; b) secondary sources related to a geothermal field – widely exploited for spa tourism in the area since the Roman age – producing surface release of radon-enriched fluids.Though radioactivity levels in the Euganean district have been often investigated in the past – including recent works aimed at assessing the radiation doses from radon and/or total gamma radiation – no effort has been put so far into producing a thorough assessment linking radiation protection data to geological-structural features (lithology, faults, water, organic matter content, etc.). This work represents the first part of the interdisciplinary project "Geological and geochemical control on Radon occurrence and natural radioactivity in the Euganean Hills district (North-Eastern Italy)", aimed at producing detailed results of the actual radiation levels in connection mainly with lithological parameters.A detailed sampling strategy, based on lithostratigraphy, petrology and mineralogy, has been adopted. The 151 rock samples collected were analyzed by high resolution γ-ray spectrometry with ex situ HPGe detectors. Statistical and geostatistical analyses were performed, and outlier values of U and Th – possibly associated with anomalies in the geological formation – were identified. U, Th and K concentration maps were developed using both the entire database and then again after expunging the outliers; the two were then compared. In all maps the highest values can be associated to trachyte and rhyolite lithologies, and the lowest ones to sedimentary formations. The external dose due to natural radionuclides in the soil – the so called terrestrial gamma dose rate – has been calculated using the U, Th and K distribution measured in the bedrock samples.



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Estimation of the radon production rate in granite rocks and evaluation of the implications for geogenic radon potential maps: A case study in Central Portugal

Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): A. Pereira, R. Lamas, M. Miranda, F. Domingos, L. Neves, N. Ferreira, L. Costa
AbstractThe goal of this study was to estimate radon gas production rate in granitic rocks and identify the factors responsible for the observed variability. For this purpose, 180 samples were collected from pre-Hercynian and Hercynian rocks in north and central Portugal and analysed for a) 226Ra activity, b) radon (222Rn) per unit mass activity, and c) radon gas emanation coefficient. On a subset of representative samples from the same rock types were also measured d) apparent porosity and e) apparent density. For each of these variables, the values ranged as follows: a) 15 to 587 Bq kg−1, b) 2 to 73 Bq kg−1, c) 0.01 to 0.80, d) 0.3 to 11.4 % and e) 2530 to 2850 kg m−3. Radon production rate varied between 40 to 1386 Bq m−3 h−1. The variability observed was associated with geologically late processes of low and high temperature which led to the alteration of the granitic rock with mobilization of U and increase in radon 222Rn gas emanation. It is suggested that, when developing geogenic radon potential maps, data on uranium concentration in soils/altered rock should be used, rather than data obtained from unaltered rock.



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Radon measurements in an area of tectonic zone: A case study in Central Slovakia

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): Andrej Mojzeš, František Marko, Barbara Porubčanová, Andrea Bartošová
General overviews of the spatial distribution of radon and other natural radionuclides in the geological basement as commonly presented on regional or country maps tend to offer a low density of information, insufficient for gaining relevant knowledge of the environmental impact, especially in the areas of tectonic zones often assumed to be radon prone and therefore dangerous for the human population. An additional survey, employing radon measurements in soil and indoor air, was carried out seeking to provide a more detailed characterization of the expressive fault zone of the Malá Magura in the Horná Nitra region of Central Slovakia. Eventually, the results of soil 222Rn volume activity measurements along two short profiles crossing the assumed fault line did not reveal any indication of active nature of local tectonics, but merely pointed to an existence of a zone of contact between different types of rocks. The results of indoor radon measurements in dwellings of two villages lying on the studied fault showed values that were lower than those commonly observed on the Slovak territory, ruling out any negative health impact on population. Nevertheless, in order to add new findings to an already well established study of geological structure of the region, the indoor radon data collected through a previous survey require a further analysis.



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Verification of the radiometric map of the Czech Republic

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): Milan Matolín
The radiometric map of the Czech Republic is based on uniform regional airborne radiometric total count measurements (1957–1959) which covered 100% of the country. The airborne radiometric instrument was calibrated to a 226Ra point source. The calibration facility for field gamma-ray spectrometers, established in the Czech Republic in 1975, significantly contributed to the subsequent radiometric data standardization. In the 1990's, the original analogue airborne radiometric data were digitized and using the method of back-calibration (IAEA, 2003) converted to dose rate. The map of terrestrial gamma radiation expressed in dose rate (nGy/h) was published on the scale 1:500,000 in 1995. Terrestrial radiation in the Czech Republic, formed by magmatic, sedimentary and metamorphic rocks of Proterozoic to Quaternary age, ranges mostly from 6 to 245 nGy/h, with a mean of 65.6 ± 19.0 nGy/h. The elevated terrestrial radiation in the Czech Republic, in comparison to the global dose rate average of 54 nGy/h, reflects an enhanced content of natural radioactive elements in the rocks.The 1995 published radiometric map of the Czech Republic was successively studied and verified by additional ground gamma-ray spectrometric measurements and by comparison to radiometric maps of Germany, Poland and Slovakia in border zones. A ground dose rate intercomparison measurement under participation of foreign and domestic professional institutions revealed mutual dose rate deviations about 20 nGy/h and more due to differing technical parameters of applied radiometric instruments. Studies and verification of the radiometric map of the Czech Republic illustrate the magnitude of current deviations in dose rate data. This gained experience can assist in harmonization of dose rate data on the European scale.



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Estimating the terrestrial gamma dose rate by decomposition of the ambient dose equivalent rate

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): P. Bossew, G. Cinelli, M. Hernández-Ceballos, N. Cernohlawek, V. Gruber, B. Dehandschutter, F. Menneson, M. Bleher, U. Stöhlker, I. Hellmann, F. Weiler, T. Tollefsen, P.V. Tognoli, M. de Cort
An extensive network of dose rate monitoring stations continuously measures ambient dose rate across Europe, as part of the EURDEP system. Its purpose is early warning in radiological emergencies and documenting its temporal and spatial evolution. In normal conditions, when there is no contribution to the dose rate signal coming from fresh anthropogenic contamination, the data represent the radiation "background", i.e. the combined natural radiation and existing anthropogenic contamination (by global and Chernobyl fallout). These data are being stored, but have so far not been evaluated in depth, or used for any purpose. In the framework of the EU project 'European Atlas of Natural Radiation' the idea has emerged to exploit these data for generating a map of natural terrestrial gamma radiation. This component contributes to the total radiation exposure and knowing its geographical distribution can help establishing local 'radiation budgets'. A further use could be found in terrestrial dose rate as a proxy of the geogenic radon potential, as both quantities are related by partly the same source, namely uranium content of the ground. In this paper, we describe in detail the composition of the ambient dose equivalent rate as measured by the EURDEP monitors with respect to its physical nature and to its sources in the environment. We propose and compare methods to recover the terrestrial component from the gross signal. This requires detailed knowledge of detector response. We consider the probes used in the Austrian, Belgian and German dose rate networks, which are the respective national networks supplying data to EURDEP. It will be shown that although considerable progress has been made in understanding the dose rate signals, there is still space for improvement in terms of modelling and model parameters. An indispensable condition for success of the endeavour to establish a Europe-wide map of terrestrial dose rate background is progress in harmonising the European dose rate monitoring network.



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Spatial analysis of ambient gamma dose equivalent rate data by means of digital image processing techniques

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): Katalin Zsuzsanna Szabó, Gyozo Jordan, Attila Petrik, Ákos Horváth, Csaba Szabó
A detailed ambient gamma dose equivalent rate mapping based on field measurements at ground level and at 1 m height was carried out at 142 sites in 80 × 90 km area in Pest County, Hungary. Detailed digital image processing analysis was carried out to identify and characterise spatial features such as outlying points, anomalous zones and linear edges in a smoothed TIN interpolated surface. The applied method proceeds from the simple shaded relief model and digital cross-sections to the more complex gradient magnitude and gradient direction maps, 2nd derivative profile curvature map, relief map and lineament density map. Each map is analysed for statistical characteristics and histogram-based image segmentation is used to delineate areas homogeneous with respect to the parameter values in these maps. Assessment of spatial anisotropy is implemented by 2D autocorrelogram and directional variogram analyses. The identified spatial features are related to underlying geological and tectonic conditions using GIS technology. Results show that detailed digital image processing is efficient in revealing the pattern present in field-measured ambient gamma dose equivalent rates and they are related to regional scale tectonic zones and surface sedimentary lithological conditions in the study area.



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The use of mapped geology as a predictor of radon potential in Norway

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): Robin J. Watson, Mark A. Smethurst, Guri V. Ganerød, Ingvild Finne, Anne Liv Rudjord
Radon exposure is considered to cause several hundred fatalities from lung-cancer each year in Norway. A national map identifying areas which are likely to be exposed to elevated radon concentrations would be a useful tool for decision-making authorities, and would be particularly important in areas where only few indoor radon measurements exist. An earlier Norwegian study (Smethurst et al. 2008) produced radon hazard maps by examining the relationship between airborne gamma-ray spectrometry, bedrock and drift geology, and indoor radon. The study was limited to the Oslo region where substantial indoor radon and airborne equivalent uranium datasets were available, and did not attempt to test the statistical significance of relationships, or to quantify the confidence of its predictions. While it can be anticipated that airborne measurements may have useful predictive power for indoor radon, airborne measurement coverage in Norway is at present sparse; to provide national coverage of radon hazard estimates, a good understanding of the relationship between geology and indoor radon is therefore important. In this work we use a new enlarged (n = 34,563) form of the indoor radon dataset with national coverage, and we use it to examine the relationship between geology and indoor radon concentrations. We use this relationship to characterise geological classes by their radon potential, and we produce a national radon hazard map which includes confidence limits on the likelihood of areas having elevated radon concentrations, and which covers the whole of mainland Norway, even areas where little or no indoor radon data are available. We find that bedrock and drift geology classes can account for around 40% of the total observed variation in radon potential. We test geology-based predictions of RP (radon potential) against locally-derived estimates of RP, and produce classification matrices with kappa values in the range 0.37–0.56. Our classifier has high predictive value but suffers from low sensitivities for radon affected areas. We investigate an alternative classification method based on a Naïve Bayes classifier which results in similar overall performance. The work forms part of an ongoing study which will eventually incorporate airborne equivalent uranium data, as and when new airborne data become available.



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Geographically weighted regression and geostatistical techniques to construct the geogenic radon potential map of the Lazio region: A methodological proposal for the European Atlas of Natural Radiation

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): G. Ciotoli, M. Voltaggio, P. Tuccimei, M. Soligo, A. Pasculli, S.E. Beaubien, S. Bigi
In many countries, assessment programmes are carried out to identify areas where people may be exposed to high radon levels. These programmes often involve detailed mapping, followed by spatial interpolation and extrapolation of the results based on the correlation of indoor radon values with other parameters (e.g., lithology, permeability and airborne total gamma radiation) to optimise the radon hazard maps at the municipal and/or regional scale. In the present work, Geographical Weighted Regression and geostatistics are used to estimate the Geogenic Radon Potential (GRP) of the Lazio Region, assuming that the radon risk only depends on the geological and environmental characteristics of the study area. A wide geodatabase has been organised including about 8000 samples of soil-gas radon, as well as other proxy variables, such as radium and uranium content of homogeneous geological units, rock permeability, and faults and topography often associated with radon production/migration in the shallow environment. All these data have been processed in a Geographic Information System (GIS) using geospatial analysis and geostatistics to produce base thematic maps in a 1000 m × 1000 m grid format. Global Ordinary Least Squared (OLS) regression and local Geographical Weighted Regression (GWR) have been applied and compared assuming that the relationships between radon activities and the environmental variables are not spatially stationary, but vary locally according to the GRP. The spatial regression model has been elaborated considering soil-gas radon concentrations as the response variable and developing proxy variables as predictors through the use of a training dataset. Then a validation procedure was used to predict soil-gas radon values using a test dataset. Finally, the predicted values were interpolated using the kriging algorithm to obtain the GRP map of the Lazio region. The map shows some high GRP areas corresponding to the volcanic terrains (central-northern sector of Lazio region) and to faulted and fractured carbonate rocks (central-southern and eastern sectors of the Lazio region). This typical local variability of autocorrelated phenomena can only be taken into account by using local methods for spatial data analysis. The constructed GRP map can be a useful tool to implement radon policies at both the national and local levels, providing critical data for land use and planning purposes.



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Modeling of geogenic radon in Switzerland based on ordered logistic regression

Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): Georg Kropat, François Bochud, Christophe Murith, Martha Palacios (Gruson), Sébastien Baechler
PurposeThe estimation of the radon hazard of a future construction site should ideally be based on the geogenic radon potential (GRP), since this estimate is free of anthropogenic influences and building characteristics. The goal of this study was to evaluate terrestrial gamma dose rate (TGD), geology, fault lines and topsoil permeability as predictors for the creation of a GRP map based on logistic regression.MethodSoil gas radon measurements (SRC) are more suited for the estimation of GRP than indoor radon measurements (IRC) since the former do not depend on ventilation and heating habits or building characteristics. However, SRC have only been measured at a few locations in Switzerland. In former studies a good correlation between spatial aggregates of IRC and SRC has been observed. That's why we used IRC measurements aggregated on a 10 km × 10 km grid to calibrate an ordered logistic regression model for geogenic radon potential (GRP). As predictors we took into account terrestrial gamma doserate, regrouped geological units, fault line density and the permeability of the soil.ResultsThe classification success rate of the model results to 56% in case of the inclusion of all 4 predictor variables. Our results suggest that terrestrial gamma doserate and regrouped geological units are more suited to model GRP than fault line density and soil permeability.ConclusionOrdered logistic regression is a promising tool for the modeling of GRP maps due to its simplicity and fast computation time. Future studies should account for additional variables to improve the modeling of high radon hazard in the Jura Mountains of Switzerland.



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Spanish experience on the design of radon surveys based on the use of geogenic information

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Publication date: January 2017
Source:Journal of Environmental Radioactivity, Volume 166, Part 2
Author(s): C. Sainz Fernández, L.S. Quindós Poncela, A. Fernández Villar, I. Fuente Merino, J.L. Gutierrez-Villanueva, S. Celaya González, L. Quindós López, J. Quindós López, E. Fernández, J. Remondo Tejerina, J.L. Martín Matarranz, M. García Talavera
One of the requirements of the recently approved EU-BSS (European Basic Safety Standards Directive, EURATOM, 2013) is the design and implementation of national radon action plans in the member states (Annex XVIII). Such plans require radon surveys. The analysis of indoor radon data is supported by the existing knowledge about geogenic radiation. With this aim, we used the terrestrial gamma dose rate data from the MARNA project. In addition, we considered other criterion regarding the surface of Spain, population, permeability of rocks, uranium and radium contain in soils because currently no data are available related to soil radon gas concentration and permeability in Spain. Given that, a Spanish radon map was produced which will be part of the European Indoor Radon Map and a component of the European Atlas of Natural Radiation. The map indicates geographical areas with high probability of finding high indoor radon concentrations. This information will support legislation regarding prevention of radon entry both in dwellings and workplaces. In addition, the map will serve as a tool for the development of strategies at all levels: individual dwellings, local, regional and national administration.



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