Characterization of quaternary tufas in the Serra do Andre Lopes karst, southeastern Brazil

Active tufas in the form of waterfalls and dams occur along drainage channels in the Serra do Andre Lopes region (State of Sao Paulo, southeastern Brazil) and are associated with the karst system that developed on a dolomitic plateau with a superhumid subtropical climate. The predominance of autogenic waters enables the groundwater to become enriched in calcium carbonate, with low terrigenous sediment content. The tufas that were studied are composed of calcite and have high calcium contents and low magnesium contents. Eroded tufa beds that originate from changes in the position of fluvial channels or river flow rates also occur in this region. In the Sapatu deposit, phytohermal tufas with complex morphologies are arranged in levels constituting various temporally repeated sequences that were deposited between 10,570 and 4,972 cal years BP. In the Frias deposit, distal fluvial deposits of tufa are massive with a relatively greater quantity of terrigenous material and show evidence of dissolution and reprecipitation. The base of this deposit is composed of a cemented breccia dated at 25,390 years BP, which is younger than the overlying tufas ([42,000 years BP). In the two deposits, the levels of terrigenous sediments (quartz sand and lithic pebbles) and terrestrial gastropod shells are interpreted as phases of increased flow rate of rivers during intervals of higher rainfall.

Guidelines for the Development of Comprehensive Care Centers for Congenital Adrenal Hyperplasia: Guidance from the CARES Foundation Initiative

Patients with rare and complex diseases such as congenital adrenal hyperplasia (CAH) often receive fragmented and inadequate care unless efforts are coordinated among providers. Translating the concepts of the medical home and comprehensive health care for individuals with CAH offers many benefits for the affected individuals and their families. This manuscript represents the recommendations of a 1.5 day meeting held in September 2009 to discuss the ideal goals for comprehensive care centers for newborns, infants, children, adolescents, and adults with CAH. Participants included pediatric endocrinologists, internal medicine and reproductive endocrinologists, pediatric urologists, pediatric surgeons, psychologists, and pediatric endocrine nurse educators. One unique aspect of this meeting was the active participation of individuals personally affected by CAH as patients or parents of patients. Representatives of Health Research and Services Administration (HRSA), New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services (NYMAC), and National Newborn Screening and Genetics Resource Center (NNSGRC) also participated. Thus, this document should serve as a "roadmap" for the development phases of comprehensive care centers (CCC) for individuals and families affected by CAH.