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The otoliths (ear stones) of fishes are commonly used to describe the age and growth of marine and freshwater fishes. These non-skeletal structures are fortuitous in their utility by being composed of mostly inorganic carbonate that is inert through the life of the fish. This conserved record functions like an environmental chronometer and bomb-produced radiocarbon (14C)—a 14C signal created by atmospheric testing of thermonuclear devices—can be used as a time-specific marker in validating fish age. However, complications from the hydrogeology of nearshore marine environments can complicate 14C levels, as was the case with gray snapper (Lutjanus griseus) along the Gulf of Mexico coast of Florida. Radiocarbon of these nearshore waters is influenced by freshwater input from the karst topography of the Upper Floridan Aquifer—estuarine waters that are 14C-depleted from surface and groundwater inputs. Some gray snapper likely recruited to this kind of environment where 14C levels were depleted in the earliest otolith growth, although age was validated for individuals that were not exposed to 14C-depleted waters to an age of at least 25 years with support for a 30-year lifespan.
OBJECTIVES/SPECIFIC AIMS: Delirium, a form of acute brain dysfunction, characterized by changes in attention and alertness, is a known independent predictor of mortality in the Intensive Care Unit (ICU). We sought to understand whether catatonia, a more recently recognized form of acute brain dysfunction, is associated with increased 30-day mortality in critically ill older adults. METHODS/STUDY POPULATION: We prospectively enrolled critically ill patients at a single institution who were on a ventilator or in shock and evaluated them daily for delirium using the Confusion Assessment for the ICU and for catatonia using the Bush Francis Catatonia Rating Scale. Coma, was defined as a Richmond Agitation Scale score of −4 or −5. We used the Cox Proportional Hazards model predicting 30-day mortality after adjusting for delirium, coma and catatonia status. RESULTS/ANTICIPATED RESULTS: We enrolled 335 medical, surgical or trauma critically ill patients with 1103 matched delirium and catatonia assessments. Median age was 58 years (IQR: 48 - 67). Main indications for admission to the ICU included: airway disease or protection (32%; N=100) or sepsis and/or shock (25%; N=79. In the unadjusted analysis, regardless of the presence of catatonia, non-delirious individuals have the highest median survival times, while delirious patients have the lowest median survival time. Comparing the absence and presence of catatonia, the presence of catatonia worsens survival (Figure 1). In a time-dependent Cox model, comparing non-delirious individuals, holding catatonia status constant, delirious individuals have 1.72 times the hazards of death (IQR: 1.321, 2.231) while those with coma have 5.48 times the hazards of death (IQR: 4.298, 6.984). For DSM-5 catatonia scores, a 1-unit increase in the score is associated with 1.18 times the hazards of in-hospital mortality. Comparing two individuals with the same delirium status, an individual with a DSM-5 catatonia score of 0 (no catatonia) will have 1.178 times the hazard of death (IQR: 1.086, 1.278), while an individual with a score of 3 catatonia items (catatonia) present will have 1.63 times the hazard of death. DISCUSSION/SIGNIFICANCE OF IMPACT: Non-delirious individuals have the highest median survival times, while those who are comatose have the lowest median survival times after a critical illness, holding catatonia status constant. Comparing the absence and presence of catatonia, the presence of catatonia seems to worsen survival. Those individual who are both comatose and catatonic have the lowest median survival time.
Pre-Quaternary terrestrial climate variability is less well understood than that during the Quaternary. The continuous eolian Red Clay sequence underlying the well-known Quaternary loess-paleosol sequence on the Chinese Loess Plateau (CLP) provides an opportunity to study pre-Quaternary terrestrial climate variability in East Asia. Here, we present new mineral magnetic records for a recently found Red Clay succession from Shilou area on the eastern CLP, and demonstrate a marked East Asian climate shift across the Miocene-Pliocene boundary (MPB). Pedogenic fine-grained magnetite populations, ranging from superparamagnetic (SP)/single domain (SD) up to small pseudo-single domain (PSD) sizes (i.e., from <30 nm up to ~1000 nm), dominate the magnetic properties. Importantly, our mineral magnetic results indicate that both pedogenic formation of SP grains and transformation of SP grains to SD and small PSD grains accelerated across the MPB in the Shilou Red Clay, which are indicative of enhanced pedogenesis. We relate this enhanced pedogenesis to increased soil moisture availability on the CLP, associated with stronger Asian Summer Monsoon precipitation during an overall period of global cooling. Our study thus provides new insights into the Miocene-Pliocene climate transition in East Asia.
The pathophysiological entity of a persisting left-sided superior caval vein draining into the roof of the left atrium represents an extreme form of coronary sinus de-roofing. This is an uncommon, but well-documented condition associated with systemic desaturation due to a right-to-left shunt. Depending on the size of the coronary ostium, the defect may also present with right-sided volume loading. We describe two patients, both of whom presented with desaturation, and highlight the important anatomical features underscoring management.
Methods and Results
Both patients were managed interventionally with previous assessment of the size of the coronary sinus ostium through cross-sectional imaging. This revealed a restrictive interatrial communication at the right atrial mouth of the coronary sinus in both patients, which permitted an interventional approach, as the residual left-to-right shunt subsequent to closure of the aberrant vessel would be negligible. At intervention, test occlusion of the left superior caval vein allowed assessment of decompressing vessels before successful occlusion using an Amplatzer Vascular Plug.
Persistence of a left superior caval vein draining to the left atrium may be associated with an interatrial communication at the mouth of the unroofed coronary sinus. The ostium of the de-roofed coronary sinus can be atretic, restrictive, normally sized, or enlarged. Careful assessment of the size of this defect is required before treatment. In view of its importance, which has received little attention in the literature to date, we suggest an additional consideration to the classification of unroofed coronary sinus.
This paper presents the design and optimisation of an aerofoil with active continuous trailing-edge flap (CTEF) investigated as a potential rotorcraft active control device. Several structural cross-section models are developed: high-fidelity NASA STRucture ANalysis (NASTRAN) and University of Michigan/Variational Asymptotic Beam Section Code (UM/VABS) models and a reduced-order analysis model. The validation of the reduced-order model is established by comparing its predictions of CTEF deformations with those of NASTRAN and UM/VABS analyses, which both show good agreement. The 2D aerodynamic characteristics of the CTEF aerofoil are evaluated using XFOIL and Computational Fluid Dynamics (CFD) analyses: FUN3D and Overset Transonic Unsteady Rotor Navier-Stokes (OVERTURNS). XFOIL, coupled with the reduced-order structure model, is adopted for optimisation study. The accuracy of XFOIL in predicting the aerodynamic pressure of the CTEF aerofoil is verified using CFD simulations, which shows sufficient fidelity. The predicted variations of aerodynamic coefficients with a CTEF angle are compared among the aerodynamic analyses. The optimisation process is developed and applied to two bimorph bender configurations: a Macro-Fibre Composite (MFC) solid bender and an MFC stack bender. The solid bender is used to confirm the functioning of the optimisation procedure and to use its optimal layout as a reference to the stack design, the primary design object. A linear tapered shape is found to be the optimum for a MFC solid bender, which generates an average of 63% more CTEF angles than those of an optimal rectangular bender. An optimised MFC stack bender is shown to resemble the shape of the solid bender. A four-ply bimorph is considered the best choice among the stack layouts because of its large output of CTEF angles and relatively less plies required. The CTEF angle produced by the four-ply optimal layout ranges from 7.6° to 5.3° with speeds from 0 to 200m/s at an angle of attack (AoA) of 6°. The reduction in the CTEF angle with AoA is less steep than that with speed, ranging from 6.5° to 5.8° with AoA from 0 to 8° at speed of 166m/s. An average of 14% increase in CTEF angles is achieved through optimisation for the four-ply bimorph.
The relative contribution of demographic, lifestyle and medication factors to the association between affective disorders and cardiometabolic diseases is poorly understood.
To assess the relationship between cardiometabolic disease and features of depresion and bipolar disorder within a large population sample.
Cross-sectional study of 145 991 UK Biobank participants: multivariate analyses of associations between features of depression or bipolar disorder and five cardiometabolic outcomes, adjusting for confounding factors.
There were significant associations between mood disorder features and ‘any cardiovascular disease’ (depression odds ratio (OR) = 1.15, 95% CI 1.12–1.19; bipolar OR = 1.28, 95% CI 1.14–1.43) and with hypertension (depression OR = 1.15, 95% CI 1.13–1.18; bipolar OR = 1.26, 95% CI 1.12–1.42). Individuals with features of mood disorder taking psychotropic medication were significantly more likely than controls not on psychotropics to report myocardial infarction (depression OR = 1.47, 95% CI 1.24–1.73; bipolar OR = 2.23, 95% CI 1.53–3.57) and stroke (depression OR = 2.46, 95% CI 2.10–2.80; bipolar OR = 2.31, 95% CI 1.39–3.85).
Associations between features of depression or bipolar disorder and cardiovascular disease outcomes were statistically independent of demographic, lifestyle and medication confounders. Psychotropic medication may also be a risk factor for cardiometabolic disease in individuals without a clear history of mood disorder.
The present study is the first record of twinning in Lagenorhynchus acutus and indeed any Lagenorhynchus sp. Both foetuses were male and located in the left uterine horn, had distinct grossly normal placentas and amniotic sacs, and were therefore likely dizygotic twins. The twins were an incidental finding in an animal that died of a systemic Brucella ceti infection.
The heart failure epidemic predominantly affects older people, particularly those with concurrent co-morbid conditions and geriatric syndromes. Mortality and heath service utilization associated with heart failure are significant, and extend beyond the costs associated with acute care utilization. Over time, older people with heart failure experience a journey characterized by gradual functional decline, accelerated by unpredictable disease exacerbations, requiring greater support to remain in the community, and often ultimately leading to institutionalization. In this narrative review, we posit that the rate of functional decline and associated health care resource utilization can be attenuated by optimizing the management of heart failure and associated co-morbidities. However, to realize this objective, the manner in which care is delivered to frail older people with heart failure must be restructured, from the bedside to the level of the health care system, in order to optimally anticipate, diagnose and manage co-morbidities.