Historical variations in climate and landscape configuration are the main aspects known to generate and maintain diversity. Taxa associated with open habitats within broader forest contexts are often ...overlooked in studies of Neotropical biogeography. We investigated the evolutionary and demographic history of lizards in the Cnemidophorus lemniscatus species group, which encompasses three described species - one unisexual and two bisexuals - restricted to open environments in Amazonia. We also explored the geographic ecology of the group using critical ecophysiological traits as proxies for sensitivity or resilience to environmental change. To that end, we delimited the main lineages within the group, estimated their divergence times, and asked if these lineages have experienced changes in effective population size. We recovered six lineages, three of which correspond to C. cryptus, C. lemniscatus, and C. gramivagus, and three yet unnamed species. We recovered divergence events during the Late Miocene and signs of recent population expansion for at least one of the species (the parthenogenetic C. cryptus). This pattern corroborates the ancient emergence of the Amazonian open areas, followed by a high and recent dynamism during the Pleistocene. Conserved traits related to high thermal tolerance and broad thermal tolerance ranges likely facilitated niche tracking and establishment in open ecosystems during Pleistocene climatic fluctuations. Our results bring insights regarding how these species might be influenced, and even favoured, by human-induced environmental changes in the contemporary timescale.
Cortical spreading depression (CSD) and depolarization waves are associated with dramatic failure of brain ion homeostasis, efflux of excitatory amino acids from nerve cells, increased energy ...metabolism and changes in cerebral blood flow (CBF). There is strong clinical and experimental evidence to suggest that CSD is involved in the mechanism of migraine, stroke, subarachnoid hemorrhage and traumatic brain injury. The implications of these findings are widespread and suggest that intrinsic brain mechanisms have the potential to worsen the outcome of cerebrovascular episodes or brain trauma. The consequences of these intrinsic mechanisms are intimately linked to the composition of the brain extracellular microenvironment and to the level of brain perfusion and in consequence brain energy supply. This paper summarizes the evidence provided by novel invasive techniques, which implicates CSD as a pathophysiological mechanism for this group of acute neurological disorders. The findings have implications for monitoring and treatment of patients with acute brain disorders in the intensive care unit. Drawing on the large body of experimental findings from animal studies of CSD obtained during decades we suggest treatment strategies, which may be used to prevent or attenuate secondary neuronal damage in acutely injured human brain cortex caused by depolarization waves.
Aim To determine the long‐term outcomes of patients in whom no initial cause for their anaemia is established.
Method Six hundred and thirty‐nine patients presenting to an iron deficiency anaemia ...pathway were prospectively entered onto a database. Initial assessment included haematological review, coeliac screen, oesophagogastroduodenoscopy and colonic imaging as per British Society of Gastroenterology guidelines. A 5‐year audit of outcomes was undertaken using patient medical records and hospital laboratory databases.
Results A diagnosis was found initially in 266 (42%) patients, with 124 (19%) having a gastrointestinal (GI) luminal neoplasm, 54 (8%) of which were malignant. Twelve patients had a nonluminal or non‐GI malignancy. Eighty‐eight (14%) had benign upper GI bleeding and 23 (4%) had coeliac disease. One hundred and forty‐three (22%) did not have confirmed iron deficiency anaemia on review of haematinics. Complete records were available for 595 (93%) patients at 5 years. Of the 373 patients in whom a cause was not initially diagnosed, 6 (2%) were ultimately diagnosed with a GI luminal malignancy and 18 (5%) with a nonluminal or non‐GI malignancy. There was no difference in the incidence of malignancies between those with or without confirmed iron deficiency.
Conclusions Most patients in whom no cause was found at initial investigation resolve on oral iron supplements. Patients with normal ferritin values had as high an incidence of GI malignancies as those with low values and should be investigated. In the over 50s if the anaemia remains after a course of iron further investigation is recommended as there is a significant incidence of both GI and non‐GI pathology.
Two-dimensional transesophageal echocardiographic (2D TEE) assessment of the mitral valve requires mental integration of a limited number of 2D imaging planes. Structural display in three dimensions ...from any perspective may be of advantage to the surgeon for better judgment and planning.
Feasibility, accuracy, and limitations of preoperative three-dimensional transesophageal echocardiography (3D TEE) was assessed in 51 patients with mitral valve disease. The width of the anterior mitral valve was measured with either method and compared with the operative finding. Three-dimensional dynamic sequences of the reconstructed mitral valve were shown preoperatively to the surgeon and later compared with the intraoperative finding.
The quality of the 3D reconstruction was graded as good in 25 patients (49.0%), fair in 16 patients (31.4%), and poor in 10 patients (19.6%) where atrial fibrillation did not allow ECG gating. Thirty-nine patients had successful mitral valve repair and twelve patients required valve replacement. Based on intraoperative findings, sensitivity for the diagnosis of mitral valve prolapse using 2D TEE and 3D TEE was 97.7% and 92.9% (
p = ns) respectively and specificity was 100% by both methods. Sensitivity for the diagnosis of rupture of chordae tendineae using 2D TEE and 3D TEE was 92.3% and 30.8% respectively (
p < 0.05) and specificity was 100% by both methods.
Dynamic 3D echocardiography is feasible and can provide good insight into valvular motion and allows adequate preoperative planning when reconstruction is being considered. However dynamic 3D reconstruction is currently limited by the quality of the original 2D echo cross sectional images which can be adversely affected by minimal patient movements, breathing, or cardiac arrhythmia, thus limiting accuracy of the 3D TEE significantly compared with 2D TEE.
We present two cases of patients with extensive breast disease who underwent a reverse abdominoplasty for closure following resection: one of Paget’s disease extending beyond the breast borders and ...another of a locally recurrent triple-negative invasive ductal carcinoma following mastectomy in a patient who previously had an ipsilateral thoracotomy. The reverse abdominoplasty flap is a reconstructive option not readily considered for closure following mastectomy. However, we believe that the reverse abdominoplasty flap should be considered when evaluating patients for anterior chest wall reconstruction because it is a simple and versatile coverage option.
Student run free health clinics (SRFCs) provide medical care to vulnerable populations in communities throughout the United States. The COVID-19 pandemic had a significant impact on the delivery of ...healthcare services and demanded a rapid adjustment in care delivery methods in both resource-rich and resource-poor settings. The aim of this study is to evaluate the impact of the pandemic on the management of chronic disease, specifically diabetes. Patients with diabetes who received care continuously throughout the pre-pandemic (face-to-face) and pandemic (telehealth) study periods at MedZou Community Health Center, a SRFC located in central Missouri, were evaluated. This sample of patients (n = 29) was evaluated on six quality measures including annual eye exams, blood pressure, hemoglobin A1c, chronic kidney disease monitoring, flu vaccination, and statin therapy. Overall diabetes care, as measured by the number of quality measures met per patient, decreased by 0.37 after the onset of the pandemic. The median COVID-era ranks were not statistically significantly different than the pre-pandemic ranks (z = 1.65,
P
= 0.099). Fewer patients received an influenza vaccination the year following the onset of the pandemic (10.3%) compared to the year before the pandemic (37.9%; difference in proportions 0.276, 95% CI 0.079, 0.473; p = 0.005). No other individual measures of diabetes care statistically differed significantly in the year after the pandemic began. Twenty-six (90%) patients received diabetes care using telehealth after the onset of the pandemic. Diabetes care using telehealth in a SRFC may be an acceptable alternative model when face-to-face visits are not feasible. Observed decreases in diabetes-related clinical quality measure performance warrant further study.
We present the KMOS{sup 3D} survey, a new integral field survey of over 600 galaxies at 0.7 < z < 2.7 using KMOS at the Very Large Telescope. The KMOS{sup 3D} survey utilizes synergies with ...multi-wavelength ground- and space-based surveys to trace the evolution of spatially resolved kinematics and star formation from a homogeneous sample over 5 Gyr of cosmic history. Targets, drawn from a mass-selected parent sample from the 3D-HST survey, cover the star formation-stellar mass (M {sub *}) and rest-frame (U – V) – M {sub *} planes uniformly. We describe the selection of targets, the observations, and the data reduction. In the first-year of data we detect Hα emission in 191 M {sub *} = 3 × 10{sup 9}-7 × 10{sup 11} M {sub ☉} galaxies at z = 0.7-1.1 and z = 1.9-2.7. In the current sample 83% of the resolved galaxies are rotation dominated, determined from a continuous velocity gradient and v {sub rot}/σ{sub 0} > 1, implying that the star-forming ''main sequence'' is primarily composed of rotating galaxies at both redshift regimes. When considering additional stricter criteria, the Hα kinematic maps indicate that at least ∼70% of the resolved galaxies are disk-like systems. Our high-quality KMOS data confirm the elevated velocity dispersions reported in previous integral field spectroscopy studies at z ≳ 0.7. For rotation-dominated disks, the average intrinsic velocity dispersion decreases by a factor of two from 50 km s{sup –1}at z ∼ 2.3 to 25 km s{sup –1}at z ∼ 0.9. Combined with existing results spanning z ∼ 0-3, we show that disk velocity dispersions follow an evolution that is consistent with the dependence of velocity dispersion on gas fractions predicted by marginally stable disk theory.
Student run free clinics (SRFCs) fill a void in healthcare access for many communities and have been subject to unprecedented shifts in care delivery brought about by the coronavirus disease 2019 ...(COVID-19) pandemic. Our single-center institution serving uninsured patients in central Missouri switched from in-person visits to strictly telehealth visits with the onset of the pandemic. This study investigated the impact of the pandemic and the switch to telehealth on the clinic return rates by ethnicity, race, gender, rurality, and age. The pandemic led to a 47.4% reduction in the number of monthly patient encounters. Of the established SRFC population (N = 309), only 87 patients (28.2%) returned for a telehealth visit during the COVID-19 pandemic. Older patients (≥ 45 years old) were more likely to return (OR 1.71, 95% CI 1.02–2.85) for care via telehealth after the onset of the pandemic than younger patients (< 45 years old). No differences in the likelihood of returning for a telehealth visit were identified by race, ethnicity, gender, or rurality. Telehealth offers an effective solution to the complex problems faced by SRFCs during the COVID-19 pandemic and has not added barriers to care with regards to race, ethnicity, gender, or rurality at our SRFC.
Adaptive optics assisted SINFONI observations of the central regions of 10 early-type galaxies are presented. Based primarily on the SINFONI kinematics, 10 black hole (BH) masses occupying the ...high-mass regime of the M sub(BH)-sigma relation are derived using three-integral Schwarzschild models. The effect of dark matter (DM) inclusion on the BH mass is explored. The omission of a DM halo in the model results in a higher stellar mass-to-light ratio, especially when extensive kinematic data are used in the model. However, when the diameter of the sphere of influence-computed using the BH mass derived without a dark halo-is at least 10 times the point-spread function FWHM during the observations, it is safe to exclude a DM component in the dynamical modeling, i.e., the change in BH mass is negligible. When the spatial resolution is marginal, restricting the mass-to-light ratio to the right value returns the correct M sub(BH) although a dark halo is not present in the model. Compared to the M sub(BH)-sigma and M sub(BH)-L relations of McConnell et al., the 10 BHs are all more massive than expected from the luminosities and 7 BH masses are higher than expected from the stellar velocity dispersions of the host bulges. Using new fitted relations, which include the 10 galaxies, we find that the space density of the most massive BHs (M sub(BH) gap 10 super(9)M sub(odot )) estimated from the M sub(BH)-L relation is higher than the estimate based on the M sub(BH)-sigma relation and the latter is higher than model predictions based on quasar counts, each by about an order of magnitude.
PDF
