The morphological boundary between the Himalayas and the foreland plain is well expressed and most often corresponds to the frontal emergence of the Main Himalayan Thrust (MHT). This boundary is ...affected by surface ruptures during very large Himalayan earthquakes (Mw > 8) that regularly induce (with a recurrence of the order of 500 to 1200 years) the uplift of the foothills relative to the plain.
However, a thrust-fold system is hidden beneath the plain and is displayed by the seismic profiles of oil companies in east/central Nepal and by H/V passive geophysical techniques in Darjeeling. Its long-term kinematic evolution is slow, with a tectonic uplift of the hanging wall that is lower than the subsidence rate of the foreland basin, that is, less than approximately half a millimetre per year. During phases of low sedimentation controlled by climatic fluctuations, the morphological surfaces of the piedmont are incised by large rivers for several tens of metres; therefore, structures hidden under the sediments emerge slightly in the plain.
The evolution of the hidden structures corresponds to an embryonic thrust belt mainly affected by a long-term shortening rate of 1.4 +2.5/−1.2 mm·yr−1, that is, 2–20% of the shortening rate of the entire Himalayan thrust system. Nonetheless, the details of the deformation associated with the embryonic thrust belt are still poorly understood. Several deformation components could affect the central Himalayan and Darjeeling piedmonts. i) Any slow steady-state deformation, such as layer parallel shortening (LPS) is not detected by Global Navigation Satellite System (GNSS) data, and such deformation would therefore absorb less than 0.5 mm·yr−1. The geodetic data that suggest the aseismic growth of some of the structures are highly controversial. ii) For the rest of the deformation of the embryonic thrust wedge, it is yet to be proven whether deformation occurs during rare great earthquakes affecting the piedmont during medium earthquakes and/or during post-seismic deformation related to great earthquakes. The amplitude of this long-term low deformation is too limited to significantly reduce the seismic hazard in the seismic gaps of the Himalayan belt. iii) In some portions of the Himalayan front, such as Darjeeling (India), the thrust deformation related to great earthquakes propagates several tens of kilometres south of the morphological front in the zone previously affected by the long-term low deformation. It induces multi-metre surface ruptures in the piedmont and a mean shortening of 8.5 ± 6.2 mm·yr−1. iiii) Pre-existing faults in the bedrock of the Indian craton, often oblique to the Himalayan structures, are locally reactivated beneath the foreland plain with low deformation rates.
In animal studies, hyperglycemia during fetal development reduces nephron numbers. We tested whether this observation translates into renal dysfunction in humans by studying renal functional reserve ...in adult offspring exposed in utero to maternal type 1 diabetes.
We compared 19 nondiabetic offspring of type 1 diabetic mothers with 18 offspring of type 1 diabetic fathers (control subjects). Glomerular filtration rate ((51)Cr-EDTA clearance), effective renal plasma flow ((123)I-hippurate clearance), mean arterial pressure, and renal vascular resistances were measured at baseline and during amino acid infusion, which mobilizes renal functional reserve.
Offspring of type 1 diabetic mothers were similar to control subjects for age (median 27, range 18-41, years), sex, BMI (23.1 ± 3.7 kg/m(2)), and birth weight (3,288 ± 550 vs. 3,440 ± 489 g). During amino acid infusion, glomerular filtration rate and effective renal plasma flow increased less in offspring of type 1 diabetic mothers than in control subjects: from 103 ± 14 to 111 ± 17 ml/min (8 ± 13%) vs. from 108 ± 17 to 128 ± 23 ml/min (19 ± 7%, P = 0.009) and from 509 ± 58 to 536 ± 80 ml/min (5 ± 9%) vs. from 536 ± 114 to 620 ± 140 ml/min (16 ± 11%, P = 0.0035). Mean arterial pressure and renal vascular resistances declined less than in control subjects: 2 ± 5 vs. -2 ± 3% (P = 0.019) and 3 ± 9 vs. -14 ± 8% (P = 0.001).
Reduced functional reserve may reflect a reduced number of nephrons undergoing individual hyperfiltration. If so, offspring of type 1 diabetic mothers may be predisposed to glomerular and vascular diseases.
Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than ...with early first-line parenteral nutrition.
In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099.
After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; 95% CI −1·9 to 5·8; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 14%) and the parenteral group (194 16%; hazard ratio HR 0·89 95% CI 0·72–1·09; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 34% vs 246 20%; HR 1·89 1·62–2·20; p<0·0001), diarrhoea (432 36% vs 393 33%; 1·20 1·05–1·37; p=0·009), bowel ischaemia (19 2% vs five <1%; 3·84 1·43–10·3; p=0·007), and acute colonic pseudo-obstruction (11 1% vs three <1%; 3·7 1·03–13·2; p=0·04).
In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition.
La Roche-sur-Yon Departmental Hospital and French Ministry of Health.
Evaluations of red light camera (RLC) traffic safety programs have produced mixed results. Some conclude RLCs were associated with significant increases in motor vehicle crashes and injury crashes, ...whereas other research reports safety benefits. To understand the difference in findings, the present analysis assessed whether standards required for internal validity in quasi-experimental public health program evaluations were adhered to in frequently cited RLC analyses. Four evaluation standards were identified and used to assess the RLC analyses: lack of bias in the selection of both (a) treated sites and (b) comparison sites, (c) integration of relevant control variables in the analysis, and (d) full disclosure of results of the statistical analysis. Six leading RLC studies were then critiqued. Only two of the six studies adhered to the four standards and both concluded RLCs were associated with significant increases in crashes and injury or possible injury crashes. A third study reported an increase in fatal/injury crashes but did not test for statistical significance. Three studies reported equivocal findings; however, each failed to adhere to most standards. Differences in findings were attributed to the evaluation methods used. If implementing an RLC program, communities should use sound public health evaluation methods to assess effectiveness.
: Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare ...resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2‐stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations.
In February 2011, the Insurance Institute for Highway Safety (IIHS) disseminated their research study that compared red light running traffic fatality rates between cities that implemented red light ...camera (RLC) programs with cities that did not. The IIHS researchers concluded cities that used RLCs had a significantly larger percentage reduction in both red light running (RLR) fatality rates and total fatality rates at signalized intersections. Because a previous IIHS study on RLCs was found to use flawed research methods, as well as to incorrectly report findings, the current IIHS RLC analysis is reviewed for adherence to scientific methods. Our review reveals the 2011 IIHS study is logically flawed and violates basic scientific research methods that are required for a study’s findings to be valid. It has neither internal nor external validity. More importantly, the IIHS did not fully explain the results of its analysis. Correctly interpreting its model’s results actually shows that cities using RLCs had an estimated higher rate of red light running fatalities, specifically 25%, than cities that did not use RLCs in the period “after” cameras were used. Further, the IIHS study was only able to make statements suggesting favorable results from the use ofRLCs due to the biased selection ofsampled cities. The red light running fatality rate as well as the total fatality rate at all signalized intersections in cities that used cameras was higher in both the “before” and “after” time periods, which affirms that superior interventions exist. Also, we explain the IIHS’ financial conflict ofinterest regarding photo enforcement.
Since publishing our critique of red light camera (RLC) studies in 2008, we have gained increased insights on the controversy over RLCs. Herein we provide additional information on RLCs, and use a ...question-and-answer format to address frequently asked questions. This update includes the rationale given for ignoring fatalities at RLC sites, the convergence in findings from the National Highway Traffic Safety Administration's compendium of best RLC studies, common violations of research methods in RLC evaluations, the RLC cost-to-benefit implications for motorists, an explanation for the increase in rear-end crashes at RLC sites, and why RLCs may be ineffective in reducing red light running crashes. We conclude with a proposed solution: restoring and improving federal standards through the Manual on Uniform Traffic Control Devices to assure proper intersection engineering prior to consideration of RLCs (even though RLCs are not recognized as an established safety device).
Running a red light can cause severe traffic crashes especially when one vehicle runs into the side of another. Red light cameras photograph violators who are sent traffic tickets by mail. ...Intuitively, cameras appear to be a good idea. However, comprehensive studies conclude cameras actually increase crashes and injuries, providing a safety argument not to install them. Presently, Florida statutes do not permit red light camera evidence to be used as the sole basis for ticketing drivers for violating the law. Legislation to permit camera citations has been proposed since the 1990s, but none has passed to date. This paper explains red light running trends in Florida; effective solutions to reduce red light running; findings from major camera evaluations; examples of flawed evaluations; the automobile insurance financial interest in cameras; and the increased likelihood of even higher crash and injury rates if cameras are used in Florida due to the high percent of elderly drivers and passengers. The theory behind red light cameras as potentially effective is that they rely on deterring red light running primarily through punishment of a specific driving behavior and secondarily by changing drivers’ experience. Because the rigorous and robust studies conclude that cameras are associated with increased crashes and costs, any economic analysis of cameras should include these newly generated costs to the public. Indirect costs to the public are usually not considered in the calculation of total revenues and profits generated from red light cameras. Florida should be cautious in using traffic safety information from the automobile insurance industry. Insurance financial goals are to increase their revenues and profits, which do not necessarily include reducing traffic crashes, injuries or fatalities. Also, public policy should avoid conflicts of interest that enhance revenues for government and private interests at the risk of public safety.
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