Right coronary artery fistula to the coronary sinus and right atrium associated with giant right coronary enlargement detected by transthoracic echocardiography

We present the case of a 54-year-old female with a previous history of lung fibrosis secondary to methotrexate used for rheumatoid arthritis who was referred to cardiology evaluation due to precordial pain. Echocardiography showed biatrial enlargement with an enlarged coronary sinus and tubular image posterior to the heart. On the coronary angiogram, the right coronary artery was enlarged, and a distal fistula was identified. The patient underwent a contrast enhanced cardiac computed tomography which demonstrated an aneurysmatic right coronary artery with a distal fistula to the right atrium and coronary sinus. As the chest pain did not recur and there was a high risk of the intervention to correct coronary fistula, the patient remained on conservative treatment.

Non-stationary frequency analysis of extreme daily rainfall in Sao Paulo, Brazil

This work is an assessment of frequency of extreme values (EVs) of daily rainfall in the city of Sao Paulo. Brazil, over the period 1933-2005, based on the peaks-over-threshold (POT) and Generalized Pareto Distribution (GPD) approach. Usually. a GPD model is fitted to a sample of POT Values Selected With a constant threshold. However. in this work we use time-dependent thresholds, composed of relatively large p quantities (for example p of 0.97) of daily rainfall amounts computed from all available data. Samples of POT values were extracted with several Values of p. Four different GPD models (GPD-1, GPD-2, GPD-3. and GDP-4) were fitted to each one of these samples by the maximum likelihood (ML) method. The shape parameter was assumed constant for the four models, but time-varying covariates were incorporated into scale parameter of GPD-2. GPD-3, and GPD-4, describing annual cycle in GPD-2. linear trend in GPD-3, and both annual cycle and linear trend in GPD-4. The GPD-1 with constant scale and shape parameters is the simplest model. For identification of the best model among the four models WC used rescaled Akaike Information Criterion (AIC) with second-order bias correction. This criterion isolates GPD-3 as the best model, i.e. the one with positive linear trend in the scale parameter. The slope of this trend is significant compared to the null hypothesis of no trend, for about 98% confidence level. The non-parametric Mann-Kendall test also showed presence of positive trend in the annual frequency of excess over high thresholds. with p-value being virtually zero. Therefore. there is strong evidence that high quantiles of daily rainfall in the city of Sao Paulo have been increasing in magnitude and frequency over time. For example. 0.99 quantiles of daily rainfall amount have increased by about 40 mm between 1933 and 2005. Copyright (C) 2008 Royal Meteorological Society

Intraseasonal and Interannual Variability of Extreme Dry and Wet Events over Southeastern South America and the Subtropical Atlantic during Austral Summer

Intraseasonal and interannual variability of extreme wet and dry anomalies over southeastern Brazil and the western subtropical South Atlantic Ocean are investigated. Precipitation data are obtained from the Global Precipitation Climatology Project (GPCP) in pentads during 23 austral summers (December-February 1979/80-2001/02). Extreme wet (dry) events are defined according to 75th (25th) percentiles of precipitation anomaly distributions observed in two time scales: intraseasonal and interannual. The agreement between the 25th and 75th percentiles of the GPCP precipitation and gridded precipitation obtained from stations in Brazil is also examined. Variations of extreme wet and dry anomalies on interannual time scales are investigated along with variations of sea surface temperature (SST) and circulation anomalies. The South Atlantic SST dipole seems related to interannual variations of extreme precipitation events over southeastern Brazil. It is shown that extreme wet and dry events in the continental portion of the South Atlantic convergence zone (SACZ) are decoupled from extremes over the oceanic portion of the SACZ and there is no coherent dipole of extreme precipitation regimes between tropics and subtropics on interannual time scales. On intraseasonal time scales, the occurrence of extreme dry and wet events depends on the propagation phase of extratropical wave trains and consequent intensification (weakening) of 200-hPa zonal winds. Extreme wet and dry events over southeastern Brazil and subtropical Atlantic are in phase on intraseasonal time scales. Extreme wet events over southeastern Brazil and subtropical Atlantic are observed in association with low-level northerly winds above the 75th percentile of the seasonal climatology over central-eastern South America. Extreme wet events on intraseasonal time scales over southeastern Brazil are more frequent during seasons not classified as extreme wet or dry on interannual time scales.

The extreme physical properties of the CoRoT-7b super-Earth

The search for rocky exoplanets plays an important role in our quest for extra-terrestrial life. Here, we discuss the extreme physical properties possible for the first characterised rocky super-Earth, CoRoT-7b (R(pl) = 1.58 +/- 0.10 R(Earth), M(pl) = 6.9 +/- 1.2 M(Earth)). It is extremely close to its star (a = 0.0171 AU = 4.48 R(st)), with its spin and orbital rotation likely synchronised. The comparison of its location in the (M(pl), R(pl)) plane with the predictions of planetary models for different compositions points to an Earth-like composition, even if the error bars of the measured quantities and the partial degeneracy of the models prevent a definitive conclusion. The proximity to its star provides an additional constraint on the model. It implies a high extreme-UV flux and particle wind, and the corresponding efficient erosion of the planetary atmosphere especially for volatile species including water. Consequently, we make the working hypothesis that the planet is rocky with no volatiles in its atmosphere, and derive the physical properties that result. As a consequence, the atmosphere is made of rocky vapours with a very low pressure (P <= 1.5 Pa), no cloud can be sustained, and no thermalisation of the planet is expected. The dayside is very hot (2474 +/- 71 K at the sub-stellar point) while the nightside is very cold (50-75 K). The sub-stellar point is as hot as the tungsten filament of an incandescent bulb, resulting in the melting and distillation of silicate rocks and the formation of a lava ocean. These possible features of CoRoT-7b could be common to many small and hot planets, including the recently discovered Kepler-10b. They define a new class of objects that we propose to name ""Lava-ocean planets"". (C) 2011 Elsevier Inc. All rights reserved.

Frequency of extreme rainfall events in Southern Brazil modulated by interannual and interdecadal variability

The frequency of extreme rainfall events in Southern Brazil is impacted by Ell Nino - Southern Oscillation (ENSO) episodes, especially in austral spring. There are two areas in which this impact is more significant: one is on the coast, where extreme events are more frequent during El Nino (EN) and the other one extends inland, where extreme events increase during EN and decrease during La Nina (LN). Atmospheric circulation patterns associated with severe rainfall in those areas are similar (opposite) to anomalous patterns characteristic of EN (LN) episodes, indicating why increase (decrease) of extreme events in EN (LN) episodes is favoured. The most recurrent precipitation patterns during extreme rainfall events in each of these areas are disclosed by Principal Component Analysis (PCA) and evidence the separation between extreme events in these areas: a severe precipitation event generally does not occur simultaneously in the coast and inland, although they may Occur inland and in the coastal region in sequence. Although EN predominantly enhances extreme rainfall, there are EN years in which fewer severe events occur than the average of neutral years, and also the enhancement of extreme rainfall is not uniform for different EN episodes, because the interdecadal non-ENSO variability also modulates significantly the frequency of extreme events in Southern Brazil. The inland region, which is more affected, shows increase (decrease) of extreme rainfall in association with the negative (positive) phase of the Atlantic Multidecadal Variability, with the negative (positive) phase of the Pacific Multidecadal Variability and with the positive (negative) phase of the Pacific Interdecadal Variability. Copyright (C) 2008 Royal Meteorological Society

High homologous gene conservation despite extreme autopolyploid redundancy in sugarcane

P>Modern sugarcane (Saccharum spp.) is the leading sugar crop and a primary energy crop. It has the highest level of `vertical` redundancy (2n = 12x = 120) of all polyploid plants studied to date. It was produced about a century ago through hybridization between two autopolyploid species, namely S. officinarum and S. spontaneum. In order to investigate the genome dynamics in this highly polyploid context, we sequenced and compared seven hom(oe)ologous haplotypes (bacterial artificial chromosome clones). Our analysis revealed a high level of gene retention and colinearity, as well as high gene structure and sequence conservation, with an average sequence divergence of 4% for exons. Remarkably, all of the hom(oe)ologous genes were predicted as being functional (except for one gene fragment) and showed signs of evolving under purifying selection, with the exception of genes within segmental duplications. By contrast, transposable elements displayed a general absence of colinearity among hom(oe)ologous haplotypes and appeared to have undergone dynamic expansion in Saccharum, compared with sorghum, its close relative in the Andropogonea tribe. These results reinforce the general trend emerging from recent studies indicating the diverse and nuanced effect of polyploidy on genome dynamics.

First molecular estimate of sex-ratio of southern right whale calves, Eubalaena australis, for Brazilian waters

The southern right whale (Eubalaena australis) was one of the most intensively hunted whales between the 17th and 20th centuries in the southern hemisphere. Recent estimates indicate that today there are around 7000 whales, representing 5 to 10% Of its original population. On the other hand, recent studies estimated that the population that migrates to the Brazilian coast grew by 14% from 1987 to 2003. However, there is no information about sex-ratio for adults or for calves in this region, which is an important parameter for understanding the biology of the species. We present here the first estimate Of calves` sex-ratio of southern right whales found along the southern Brazilian coast, one of the most important wintering grounds for the species. Sex was molecularly indentified for 21 biopsies collected from calves between 1998 and 2002, along the coast of Rio Grande do Sul and Santa Catarina States, in southern Brazil. The sex-ratio was two females for one male, however, it was not statistically different (chi(2) test, alpha = 0.05; df = 1) from the expected ratio of 1:1. This result is in accordance with the sex-ratio estimated for the species of all ages using external morphology (and behaviour in formation), (is well as for most species of baleen whales.

Search for first harmonic modulation in the right ascension distribution of cosmic rays detected at the Pierre Auger Observatory

We present the results of searches for dipolar-type anisotropies in different energy ranges above 2.5 x 10(17) eV with the surface detector array of the Pierre Auger Observatory, reporting on both the phase and the amplitude measurements of the first harmonic modulation in the right-ascension distribution. Upper limits on the amplitudes are obtained, which provide the most stringent bounds at present, being below 2% at 99% C.L. for EeV energies. We also compare our results to those of previous experiments as well as with some theoretical expectations. (C) 2011 Elsevier B.V. All rights reserved.

SEMIPERFECT IPRI-RINGS AND RIGHT BEZOUT RINGS

We present a survey of some results on ipri-rings and right Bezout rings. All these rings are generalizations of principal ideal rings. From the general point of view, decomposition theorems are proved for semiperfect ipri-rings and right Bezout rings.

Medical treatment and the good death: an ethical analysis of euthanasia, physician assisted suicide, and the right to die

Frequent advances in medical technologies have brought fonh many innovative treatments that allow medical teams to treal many patients with grave illness and serious trauma who would have died only a few years earlier. These changes have given some patients a second chance at life, but for others. these new treatments have merely prolonged their dying. Instead of dying relatively painlessly, these unfortunate patients often suffer from painful tenninal illnesses or exist in a comatose state that robs them of their dignity, since they cannot survive without advanced and often dehumanizing forms of treatment. Due to many of these concerns, euthanasia has become a central issue in medical ethics. Additionally, the debate is impacted by those who believe that patients have the right make choices about the method and timing of their deaths. Euthanasia is defined as a deliberate act by a physician to hasten the death of a patient, whether through active methods such as an injection of morphine, or through the withdrawal of advanced forms of medical care, for reasons of mercy because of a medical condition that they have. This study explores the question of whether euthanasia is an ethical practice and, as determined by ethical theories and professional codes of ethics, whether the physician is allowed to provide the means to give the patient a path to a "good death," rather than one filled with physical and mental suffering. The paper also asks if there is a relevant moral difference between the active and passive forms of euthanasia and seeks to define requirements to ensure fully voluntary decision making through an evaluation of the factors necessary to produce fully informed consent. Additionally, the proper treatments for patients who suffer from painful terminal illnesses, those who exist in persistent vegetative states and infants born with many diverse medical problems are examined. The ultimate conclusions that are reached in the paper are that euthanasia is an ethical practice in certain specific circumstances for patients who have a very low quality of life due to pain, illness or serious mental deficits as a result of irreversible coma, persistent vegetative state or end-stage clinical dementia. This is defended by the fact that the rights of the patient to determine his or her own fate and to autonomously decide the way that he or she dies are paramount to all other factors in decisions of life and death. There are also circumstances where decisions can be made by health care teams in conjunction with the family to hasten the deaths of incompetent patients when continued existence is clearly not in their best interest, as is the case of infants who are born with serious physical anomalies, who are either 'born dying' or have no prospect for a life that is of a reasonable quality. I have rejected the distinction between active and passive methods of euthanasia and have instead chosen to focus on the intentions of the treating physician and the voluntary nature of the patient's request. When applied in equivalent circumstances, active and passive methods of euthanasia produce the same effects, and if the choice to hasten the death of the patient is ethical, then the use of either method can be accepted. The use of active methods of euthanasia and active forms of withdrawal of life support, such as the removal of a respirator are both conscious decisions to end the life of the patient and both bring death within a short period of time. It is false to maintain a distinction that believes that one is active killing. whereas the other form only allows nature to take it's course. Both are conscious choices to hasten the patient's death and should be evaluated as such. Additionally, through an examination of the Hippocratic Oath, and statements made by the American Medical Association and the American College of physicians, it can be shown that the ideals that the medical profession maintains and the respect for the interests of the patient that it holds allows the physician to give aid to patients who wish to choose death as an alternative to continued suffering. The physician is also allowed to and in some circumstances, is morally required, to help dying patients whether through active or passive forms of euthanasia or through assisted suicide. Euthanasia is a difficult topic to think about, but in the end, we should support the choice that respects the patient's autonomous choice or clear best interest and the respect that we have for their dignity and personal worth.

Uncertainties In Future Projections Of Extreme Rainfall: The Role Of Climate Model, Emission Scenario And Randomness

Climate change has resulted in substantial variations in annual extreme rainfall quantiles in different durations and return periods. Predicting the future changes in extreme rainfall quantiles is essential for various water resources design, assessment, and decision making purposes. Current Predictions of future rainfall extremes, however, exhibit large uncertainties. According to extreme value theory, rainfall extremes are rather random variables, with changing distributions around different return periods; therefore there are uncertainties even under current climate conditions. Regarding future condition, our large-scale knowledge is obtained using global climate models, forced with certain emission scenarios. There are widely known deficiencies with climate models, particularly with respect to precipitation projections. There is also recognition of the limitations of emission scenarios in representing the future global change. Apart from these large-scale uncertainties, the downscaling methods also add uncertainty into estimates of future extreme rainfall when they convert the larger-scale projections into local scale. The aim of this research is to address these uncertainties in future projections of extreme rainfall of different durations and return periods. We plugged 3 emission scenarios with 2 global climate models and used LARS-WG, a well-known weather generator, to stochastically downscale daily climate models’ projections for the city of Saskatoon, Canada, by 2100. The downscaled projections were further disaggregated into hourly resolution using our new stochastic and non-parametric rainfall disaggregator. The extreme rainfall quantiles can be consequently identified for different durations (1-hour, 2-hour, 4-hour, 6-hour, 12-hour, 18-hour and 24-hour) and return periods (2-year, 10-year, 25-year, 50-year, 100-year) using Generalized Extreme Value (GEV) distribution. By providing multiple realizations of future rainfall, we attempt to measure the extent of total predictive uncertainty, which is contributed by climate models, emission scenarios, and downscaling/disaggregation procedures. The results show different proportions of these contributors in different durations and return periods.

Analysis Of Semi-Distributed And Global Hydrological Models In The Central Tropical Basins Of The Gulf Of Mexico To The Effects Of Extreme Hydrometeorological Phenomena

In the last years extreme hydrometeorological phenomena have increased in number and intensity affecting the inhabitants of various regions, an example of these effects are the central basins of the Gulf of Mexico (CBGM) that they have been affected by 55.2% with floods and especially the state of Veracruz (1999-2013), leaving economic, social and environmental losses. Mexico currently lacks sufficient hydrological studies for the measurement of volumes in rivers, since is convenient to create a hydrological model (HM) suited to the quality and quantity of the geographic and climatic information that is reliable and affordable. Therefore this research compares the semi-distributed hydrological model (SHM) and the global hydrological model (GHM), with respect to the volumes of runoff and achieve to predict flood areas, furthermore, were analyzed extreme hydrometeorological phenomena in the CBGM, by modeling the Hydrologic Modeling System (HEC-HMS) which is a SHM and the Modèle Hydrologique Simplifié à I'Extrême (MOHYSE) which is a GHM, to evaluate the results and compare which model is suitable for tropical conditions to propose public policies for integrated basins management and flood prevention. Thus it was determined the temporal and spatial framework of the analyzed basins according to hurricanes and floods. It were developed the SHM and GHM models, which were calibrated, validated and compared the results to identify the sensitivity to the real model. It was concluded that both models conform to tropical conditions of the CBGM, having MOHYSE further approximation to the real model. Worth mentioning that in Mexico there is not enough information, besides there are no records of MOHYSE use in Mexico, so it can be a useful tool for determining runoff volumes. Finally, with the SHM and the GHM were generated climate change scenarios to develop risk studies creating a risk map for urban planning, agro-hydrological and territorial organization.