Early and One-Year Stroke Case Fatality in Sao Paulo, Brazil: Applying the World Health Organization's Stroke STEPS

Case fatality rate is considered a main determinant of stroke mortality trends. We applied the World Health Organization's Stroke STEPS to identify case fatality rates in a community hospital in Brazil. We evaluated all patients with first-ever stroke seeking acute care at the hospital's emergency ward between April 2006 and December 2008 to verify early and late case fatality according to stroke subtype. We used years of formal education as a surrogate for socioeconomic status. Of 430 first-ever stroke events, 365 (84.9%) were ischemic and 65 (15.1%) were intracerebral hemorrhage. After 1 year, we adjudicated 108 deaths (86 ischemic; 22 hemorrhagic). Age-adjusted case fatality rates for ischemic stroke and intracerebral hemorrhage were 6.0% v 19.8% at 10 days, 10.6% v 22.1% at 28 days, 17.6% v 29.1% at 6 months, and 21.0% v 31.5% at 1 year. Illiteracy or no formal education was a predictor of death at 6 months (odds ratio [OR], 4.31; 95% confidence interval [CI] 1.34-13.91) and 1 year (OR, 4.21; 95% CI, 1.45-12.28) in patients with ischemic stroke, as well as at 6 months (OR, 3.19; 95% CI, 1.17-8.70) and 1 year (OR, 3.30; 95% CI, 1.30-8.45) for all stroke patients. Other variables, including previous cardiovascular risk factors and acute medical care, did not change this association to a statistically significant degree. In conclusion, case fatality, particularly up to 6 months, was higher in hemorrhagic stroke, and lack of formal education was associated with increased stroke mortality.

Risk Factor Analysis of Late Survival After Heart Transplantation According to Donor Profile: A Multi-Institutional Retrospective Study of 512 Transplants

Introduction. Patients with terminal heart failure have increased more than the available organs leading to a high mortality rate on the waiting list. Use of Marginal and expanded criteria donors has increased due to the heart shortage. Objective. We analyzed all heart transplantations (HTx) in Sao Paulo state over 8 years for donor profile and recipient risk factors. Method. This multi-institutional review collected HTx data from all institutions in the state of Sao Paulo, Brazil. From 2002 to 2008 (6 years), only 512 (28.8%) of 1777 available heart donors were accepted for transplantation. All medical records were analyzed retrospectively; none of the used donors was excluded, even those considered to be nonstandard. Results. The hospital mortality rate was 27.9% (n = 143) and the average follow-up time was 29.4 +/- 28.4 months. The survival rate was 55.5% (n = 285) at 6 years after HTx. Univariate analysis showed the following factors to impact survival: age (P = .0004), arterial hypertension (P = .4620), norepinephrine (P = .0450), cardiac arrest (P = .8500), diabetes mellitus (P = .5120), infection (P = .1470), CKMB (creatine kinase MB) (P = .8694), creatinine (P = .7225), and Na+ (P = .3273). On multivariate analysis, only age showed significance; logistic regression showed a significant cut-off at 40 years: organs from donors older than 40 years showed a lower late survival rates (P = .0032). Conclusions. Donor age older than 40 years represents an important risk factor for survival after HTx. Neither donor gender nor norepinephrine use negatively affected early survival.

Repression of osteocyte Wnt/beta-catenin signaling is an early event in the progression of renal osteodystrophy

Chronic kidney diseasemineral bone disorder (CKD-MBD) is defined by abnormalities in mineral and hormone metabolism, bone histomorphometric changes, and/or the presence of soft-tissue calcification. Emerging evidence suggests that features of CKD-MBD may occur early in disease progression and are associated with changes in osteocyte function. To identify early changes in bone, we utilized the jck mouse, a genetic model of polycystic kidney disease that exhibits progressive renal disease. At 6 weeks of age, jck mice have normal renal function and no evidence of bone disease but exhibit continual decline in renal function and death by 20 weeks of age, when approximately 40% to 60% of them have vascular calcification. Temporal changes in serum parameters were identified in jck relative to wild-type mice from 6 through 18 weeks of age and were subsequently shown to largely mirror serum changes commonly associated with clinical CKD-MBD. Bone histomorphometry revealed progressive changes associated with increased osteoclast activity and elevated bone formation relative to wild-type mice. To capture the early molecular and cellular events in the progression of CKD-MBD we examined cell-specific pathways associated with bone remodeling at the protein and/or gene expression level. Importantly, a steady increase in the number of cells expressing phosphor-Ser33/37-beta-catenin was observed both in mouse and human bones. Overall repression of Wnt/beta-catenin signaling within osteocytes occurred in conjunction with increased expression of Wnt antagonists (SOST and sFRP4) and genes associated with osteoclast activity, including receptor activator of NF-?B ligand (RANKL). The resulting increase in the RANKL/osteoprotegerin (OPG) ratio correlated with increased osteoclast activity. In late-stage disease, an apparent repression of genes associated with osteoblast function was observed. These data confirm that jck mice develop progressive biochemical changes in CKD-MBD and suggest that repression of the Wnt/beta-catenin pathway is involved in the pathogenesis of renal osteodystrophy. (C) 2012 American Society for Bone and Mineral Research.

A clinical experience of the supraclavicular flap used to reconstruct head and neck defects in late-stage cancer patients

The supraclavicular island flap has been widely used in head and neck reconstruction, providing an alternative to the traditional techniques like regional or free flaps, mainly because of its thin skin island tissue and reliable vascularity. Head and neck patients who require large reconstructions usually present poor clinical and healing conditions. An early experience using this flap for late-stage head and neck tumour treatment is reported. Forty-seven supraclavicular artery flaps were used to treat head and neck oncologic defects after cutaneous, intraoral and pharyngeal tumour resections. Dissection time, complications, donor and reconstructed area outcomes were assessed. The mean time for harvesting the flaps was 50 min by the senior author. All donor sites were closed primarily. Three cases of laryngopharyngectomy reconstruction developed a small controlled (salivary) leak that was resolved with conservative measures. Small or no strictures were detected on radiologic swallowing examinations and all patients regained normal swallowing function. Five patients developed donor site dehiscence. These wounds were treated with regular dressing until healing was complete. There were four distal flap necroses in this series. These necroses were debrided and closed primarily. The supraclavicular flap is pliable for head and neck oncologic reconstruction in late-stage patients. High-risk patients and modified radical neck dissection are not contraindications for its use. The absence of the need to isolate the pedicle offers quick and reliable harvesting. The arc of rotation on the base of the neck provides adequate length for pharyngeal, oral lining and to reconstruct the middle and superior third of the face. (C) 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Tectonics and kinematics of curved mountain belts: examples from the Andes and the Alps

Curved mountain belts have always fascinated geologists and geophysicists because of their peculiar structural setting and geodynamic mechanisms of formation. The need of studying orogenic bends arises from the numerous questions to which geologists and geophysicists have tried to answer to during the last two decades, such as: what are the mechanisms governing orogenic bends formation? Why do they form? Do they develop in particular geological conditions? And if so, what are the most favorable conditions? What are their relationships with the deformational history of the belt? Why is the shape of arcuate orogens in many parts of the Earth so different? What are the factors controlling the shape of orogenic bends? Paleomagnetism demonstrated to be one of the most effective techniques in order to document the deformation of a curved belt through the determination of vertical axis rotations. In fact, the pattern of rotations within a curved belt can reveal the occurrence of a bending, and its timing. Nevertheless, paleomagnetic data alone are not sufficient to constrain the tectonic evolution of a curved belt. Usually, structural analysis integrates paleomagnetic data, in defining the kinematics of a belt through kinematic indicators on brittle fault planes (i.e., slickensides, mineral fibers growth, SC-structures). My research program has been focused on the study of curved mountain belts through paleomagnetism, in order to define their kinematics, timing, and mechanisms of formation. Structural analysis, performed only in some regions, supported and integrated paleomagnetic data. In particular, three arcuate orogenic systems have been investigated: the Western Alpine Arc (NW Italy), the Bolivian Orocline (Central Andes, NW Argentina), and the Patagonian Orocline (Tierra del Fuego, southern Argentina). The bending of the Western Alpine Arc has been investigated so far using different approaches, though few based on reliable paleomagnetic data. Results from our paleomagnetic study carried out in the Tertiary Piedmont Basin, located on top of Alpine nappes, indicate that the Western Alpine Arc is a primary bend that has been subsequently tightened by further ~50° during Aquitanian-Serravallian times (23-12 Ma). This mid-Miocene oroclinal bending, superimposing onto a pre-existing Eocene nonrotational arc, is the result of a composite geodynamic mechanism, where slab rollback, mantle flows, and rotating thrust emplacement are intimately linked. Relying on our paleomagnetic and structural evidence, the Bolivian Orocline can be considered as a progressive bend, whose formation has been driven by the along-strike gradient of crustal shortening. The documented clockwise rotations up to 45° are compatible with a secondary-bending type mechanism occurring after Eocene-Oligocene times (30-40 Ma), and their nature is probably related to the widespread shearing taking place between zones of differential shortening. Since ~15 Ma ago, the activity of N-S left-lateral strike-slip faults in the Eastern Cordillera at the border with the Altiplano-Puna plateau induced up to ~40° counterclockwise rotations along the fault zone, locally annulling the regional clockwise rotation. We proposed that mid-Miocene strike-slip activity developed in response of a compressive stress (related to body forces) at the plateau margins, caused by the progressive lateral (southward) growth of the Altiplano-Puna plateau, laterally spreading from the overthickened crustal region of the salient apex. The growth of plateaux by lateral spreading seems to be a mechanism common to other major plateaux in the Earth (i.e., Tibetan plateau). Results from the Patagonian Orocline represent the first reliable constraint to the timing of bending in the southern tip of South America. They indicate that the Patagonian Orocline did not undergo any significant rotation since early Eocene times (~50 Ma), implying that it may be considered either a primary bend, or an orocline formed during the late Cretaceous-early Eocene deformation phase. This result has important implications on the opening of the Drake Passage at ~32 Ma, since it is definitely not related to the formation of the Patagonian orocline, but the sole consequence of the Scotia plate spreading. Finally, relying on the results and implications from the study of the Western Alpine Arc, the Bolivian Orocline, and the Patagonian Orocline, general conclusions on curved mountain belt formation have been inferred.

Thermochronologic and geodynamic evolution of the Pontides: Sakarya terrane (Karakaya Complex) and Istanbul terrane, Turkey.

An integrated array of analytical methods -including clay mineralogy, vitrinite reflectance, Raman spectroscopy on carbonaceous material, and apatite fission-track analysis- was employed to constrain the thermal and thermochronological evolution of selected portions of the Pontides of northern Turkey. (1) A multimethod investigation was applied for the first time to characterise the thermal history of the Karakaya Complex, a Permo-Triassic subduction-accretion complex cropping out throughout the Sakarya Zone. The results indicate two different thermal regimes: the Lower Karakaya Complex (Nilüfer Unit) -mostly made of metabasite and marble- suffered peak temperatures of 300-500°C (greenschist facies); the Upper Karakaya Complex (Hodul and the Orhanlar Units) –mostly made of greywacke and arkose- yielded heterogeneous peak temperatures (125-376°C), possibly the result of different degree of involvement of the units in the complex dynamic processes of the accretionary wedge. Contrary to common belief, the results of this study indicate that the entire Karakaya Complex suffered metamorphic conditions. Moreover, a good degree of correlation among the results of these methods demonstrate that Raman spectroscopy on carbonaceous material can be applied successfully to temperature ranges of 200-330°C, thus extending the application of this method from higher grade metamorphic contexts to lower grade metamorphic conditions. (2) Apatite fission-track analysis was applied to the Sakarya and the İstanbul Zones in order to constrain the exhumation history and timing of amalgamation of these two exotic terranes. AFT ages from the İstanbul and Sakarya terranes recorded three distinct episodes of exhumation related to the complex tectonic evolution of the Pontides. (i) Paleocene - early Eocene ages (62.3-50.3 Ma) reflect the closure of the İzmir-Ankara ocean and the ensuing collision between the Sakarya terrane and the Anatolide-Tauride Block. (ii) Late Eocene - earliest Oligocene (43.5-32.3 Ma) ages reflect renewed tectonic activity along the İzmir-Ankara. (iii) Late Oligocene- Early Miocene ages reflect the onset and development of the northern Aegean extension. The consistency of AFT ages, both north and south of the tectonic contact between the İstanbul and Sakarya terranes, suggest that such terranes were amalgamated in pre-Cenozoic times. (3) Fission-track analysis was also applied to rock samples from the Marmara region, in an attempt to constrain the inception and development of the North Anatolian Fault system in the region. The results agree with those from the central Pontides. The youngest AFT ages (Late Oligocene - early Miocene) were recorded in the western portion of the Marmara Sea region and reflect the onset and development of northern Aegean extension. Fission-track data from the eastern Marmara Sea region indicate rapid Early Eocene exhumation induced by the development of the İzmir-Ankara orogenic wedge. Thermochronological data along the trace of the Ganos Fault –a segment of the North Anatolian Fault system- indicate the presence of a tectonic discontinuity active by Late Oligocene time, i.e. well before the arrival of the North Anatolian Fault system in the area. The integration of thermochronologic data with preexisting structural data point to the existence of a system of major E-W-trending structural discontinuities active at least from the Late Oligocene. In the Early Pliocene, inception of the present-day North Anatolian Fault system in the Marmara region occurred by reactivation of these older tectonic structures. 


Sedimentary environments and climate change: a case study (late Miocene, central Crete)

In this study, conditions of deposition and stratigraphical architecture of Neogene (Tortonian, 11-6,7Ma) sediments of southern central Crete were analysed. In order to improve resolution of paleoclimatic data, new methods were applied to quantify environmental parameters and to increase the chronostratigraphic resolution in shallow water sediments. A relationship between paleoenvironmental change observed on Crete and global processes was established and a depositional model was developed. Based on a detailed analysis of the distribution of non geniculate coralline red algae, index values for water temperature and water depth were established and tested with the distribution patterns of benthic foraminifera and symbiont-bearing corals. Calcite shelled bivalves were sampled from the Algarve coast (southern Portugal) and central Crete and then 87Sr/86Sr was measured. A high resolution chronostratigraphy was developed based on the correlation between fluctuations in Sr ratios in the measured sections and in a late Miocene global seawater Sr isotope reference curve. Applying this method, a time frame was established to compare paleoenvironmental data from southern central Crete with global information on climate change reflected in oxygen isotope data. The comparison between paleotemperature data based on red algae and global oxygen isotope data showed that the employed index values reflect global change in temperature. Data indicate a warm interval during earliest Tortonian, a second short warm interval between 10 and 9,5Ma, a longer climatic optimum between 9 and 8Ma and an interval of increasing temperatures in the latest Tortonian. The distribution of coral reefs and carpets shows that during the warm intervals, the depositional environment became tropical while temperate climates prevailed during the cold interval. Since relative tectonic movements after initial half-graben formation in the early Tortonian were low in southern central Crete, sedimentary successions strongly respond to global sea-level fluctuation. A characteristic sedimentary succession formed during a 3rd order sea-level cycle: It comprises mixed siliciclastic-limestone deposited during sea-level fall and lowstand, homogenous red algal deposits formed during sea-level rise and coral carpets formed during late rise and highstand. Individual beds in the succession reflect glacioeustatic fluctuations that are most prominent in the mixed siliciclastic-limestone interval. These results confirm the fact that sedimentary successions deposited at the critical threshold between temperate and tropical environments develop characteristic changes in depositional systems and biotic associations that can be used to assemble paleoclimatic datasets.

Climate signatures in corals of the tropical-temperate transition zone (Late Miocene, Crete/Greece)

The present study describes a Late Miocene (early Tortonian - early Messinian) transitional carbonate system that combines elements of tropical and cool-water carbonate systems (Irakleion Basin, island of Crete, Greece). As documented by stratal geometries, the submarine topography of the basin was controlled by tilting blocks. Coral reefs formed by Porites and Tarbellastrea occurred in a narrow clastic coastal belt along a „central Cretan landmass“, and steep escarpments formed by faulting. Extensive covers of level-bottom communities existed in a low-energy environment on the gentle dip-slope ramps of the blocks that show the widest geographical distribution within the basin. Consistent patterns of landward and basinward shift of coastal onlap in all outcrop studies reveal an overriding control of 3rd and 4th order sea level changes on sediment dynamics and facies distributions over block movements. An increasingly dry climate and the complex submarine topography of the fault block mosaic kept sediment and nutrient discharge at a minimum. The skeletal limestone facies therefore reflects oligotrophic conditions and a sea surface temperature (SST) near the lower threshold temperature of coral reefs in a climatic position transitional between the tropical coral reef belt and the temperate zone. Stable isotope records (δ18O, δ13C) from massiv, exceptionally preserved Late Miocene aragonite coral skeletons reflect seasonal changes in sea surface temperature and symbiont autotrophy. Spectral analysis of a 69 years coral δ18O record reveals significant variance at interannual time scales (5-6 years) that matches the present-day eastern Mediterranean climate variability controlled by the Arctic Oscillation/North Atlantic Oscillation (AO/NAO), the Northern Hemisphere’s dominant mode of atmospheric variability. Supported by simulations with a complex atmospheric general circulation model coupled to a mixed-layer ocean model, it is suggested, that climate dynamics in the eastern Mediterranean and central Europe reflect atmospheric variability related to the Icelandic Low 10 million years ago. Usually, Miocene corals are transformed in calcite spar in geological time and isotope values are reset by diagenetic alteration. It is demonstrated that the relicts of growth bands represent an intriguing source of information for the growth conditions of fossil corals. Recrystallized growth bands were measured systematically in massive Porites from Crete. The Late Miocene corals were growing slowly with 2-4 mm/yr, compatible with present-day Porites from high latitude reefs, a relationship that fits the position of Crete at the margin of the Miocene tropical reef belt. Over Late Miocene time (Tortonian - early Messinian) growth rates remained remarkably constant, and if the modern growth temperature relationship for massive Porites applies to the Neogene, minimum (winter) SST did not exceed 19-21°C.

Mediterranean-type climate in the South Aegean (Eastern Mediterranean) during the Late Miocene: Evidence from isotope and element proxies

The present-day climate in the Mediterranean region is characterized by mild, wet winters and hot, dry summers. There is contradictory evidence as to whether the present-day conditions (“Mediterranean climate”) already existed in the Late Miocene. This thesis presents seasonally-resolved isotope and element proxy data obtained from Late Miocene reef corals from Crete (Southern Aegean, Eastern Mediterranean) in order to illustrate climate conditions in the Mediterranean region during this time. There was a transition from greenhouse to icehouse conditions without a Greenland ice sheet during the Late Miocene. Since the Greenland ice sheet is predicted to melt fully within the next millennia, Late Miocene climate mechanisms can be considered as useful analogues in evaluating models of Northern Hemispheric climate conditions in the future. So far, high resolution chemical proxy data on Late Miocene environments are limited. In order to enlarge the proxy database for this time span, coral genus Tarbellastraea was evaluated as a new proxy archive, and proved reliable based on consistent oxygen isotope records of Tarbellastraea and the established paleoenvironmental archive of coral genus Porites. In combination with lithostratigraphic data, global 87Sr/86Sr seawater chronostratigraphy was used to constrain the numerical age of the coral sites, assuming the Mediterranean Sea to be equilibrated with global open ocean water. 87Sr/86Sr ratios of Tarbellastraea and Porites from eight stratigraphically different sampling sites were measured by thermal ionization mass spectrometry. The ratios range from 0.708900 to 0.708958 corresponding to ages of 10 to 7 Ma (Tortonian to Early Messinian). Spectral analyses of multi-decadal time-series yield interannual δ18O variability with periods of ~2 and ~5 years, similar to that of modern records, indicating that pressure field systems comparable to those controlling the seasonality of present-day Mediterranean climate existed, at least intermittently, already during the Late Miocene. In addition to sea surface temperature (SST), δ18O composition of coral aragonite is controlled by other parameters such as local seawater composition which as a result of precipitation and evaporation, influences sea surface salinity (SSS). The Sr/Ca ratio is considered to be independent of salinity, and was used, therefore, as an additional proxy to estimate seasonality in SST. Major and trace element concentrations in coral aragonite determined by laser ablation inductively coupled plasma mass spectrometry yield significant variations along a transect perpendicular to coral growth increments, and record varying environmental conditions. The comparison between the average SST seasonality of 7°C and 9°C, derived from average annual δ18O (1.1‰) and Sr/Ca (0.579 mmol/mol) amplitudes, respectively, indicates that the δ18O-derived SST seasonality is biased by seawater composition, reducing the δ18O amplitude by 0.3‰. This value is equivalent to a seasonal SSS variation of 1‰, as observed under present-day Aegean Sea conditions. Concentration patterns of non-lattice bound major and trace elements, related to trapped particles within the coral skeleton, reflect seasonal input of suspended load into the reef environment. δ18O, Sr/Ca and non-lattice bound element proxy records, as well as geochemical compositions of the trapped particles, provide evidence for intense precipitation in the Eastern Mediterranean during winters. Winter rain caused freshwater discharge and transport of weathering products from the hinterland into the reef environment. There is a trend in coral δ18O data to more positive mean δ18O values (–2.7‰ to –1.7‰) coupled with decreased seasonal δ18O amplitudes (1.1‰ to 0.7‰) from 10 to 7 Ma. This relationship is most easily explained in terms of more positive summer δ18O. Since coral diversity and annual growth rates indicate more or less constant average SST for the Mediterranean from the Tortonian to the Early Messinian, more positive mean and summer δ18O indicate increasing aridity during the Late Miocene, and more pronounced during summers. The analytical results implicate that winter rainfall and summer drought, the main characteristics of the present-day Mediterranean climate, were already present in the Mediterranean region during the Late Miocene. Some models have argued that the Mediterranean climate did not exist in this region prior to the Pliocene. However, the data presented here show that conditions comparable to those of the present-day existed either intermittently or permanently since at least about 10 Ma.

Genetic dynamics across early life stages in the tropical tree Prunus africana (Rosaceae)

In many plant species, the genetic template of early life-stages is formed by animal-mediated pollination and seed dispersal and has profound impact on further recruitment and population dynamics. Understanding the impact of pollination and seed dispersal on genetic patterns is a central issue in plant population biology. In my thesis, I investigated (i) contemporary dispersal and gene flow distances as well as (ii) genetic diversity and spatial genetic structure (SGS) across subsequent recruitment stages in a population of the animal-pollinated and dispersed tree Prunus africana in Kakamega Forest, West Kenya. Using microsatellite markers and parentage analyses, I inferred distances of pollen dispersal (father-to-mother), seed dispersal/maternal gene flow (mother-to-offspring) as well as paternal gene flow (father-to-offspring) for four early life stages of the species (seeds and fruits, current year seedlings, seedlings ≤ 3yr, seedlings > 3yr). Distances of pollen and seed dispersal as well as paternal gene flow were significantly shorter than expected from the spatial arrangement of trees and sampling plots. They were not affected by the density of conspecific trees in the surrounding. At the propagule stage, mean pollen dispersal distances were considerably (23-fold) longer than seed dispersal distances, and paternal gene flow distances exceeded maternal gene flow by a factor of 25. Seed dispersal distances were remarkably restricted, potentially leading to a strong initial SGS. The initial genetic template created by pollination and seed dispersal was extensively altered during later recruitment stages. Potential Janzen-Connell effects led to markedly increasing distances between offspring and both parental trees in older life stages. This showed that distance and density-dependent mortality factors are not exclusively related to the mother tree, but also to the father. Across subsequent recruitment stages, the pollen to seed dispersal ratio and the paternal to maternal gene flow ratio dropped to 2.1 and 3.4, respectively, in seedlings > 3yr. The relative changes in effective pollen dispersal, seed dispersal, and paternal gene flow distances across recruitment stages elucidate the mechanisms affecting the contribution of the two processes pollen and seed dispersal to overall gene flow. Using the same six microsatellite loci, I analyzed genetic diversity and SGS across five life stages, from seed rain to adults. Levels of genetic diversity within the studied P. africana population were comparable to other Prunus species and did not vary across life stages. In congruence with the short seed dispersal distances, I found significant SGS in all life stages. SGS decreased from seed and early seedling stages to older juvenile stages, and it was higher in adults than in late juveniles of the next generation. A comparison of the data with direct assessments of contemporary gene flow patterns indicate that distance- or density-dependent mortality, potentially due to Janzen-Connell effects, led to the initial decrease in SGS. Intergeneration variation in SGS could have been driven by variation in demographic processes, the effect of overlapping generations, and local selection processes. Overall, my study showed that complex sequential processes during recruitment contribute to the spatial genetic structure of tree populations. It highlights the importance of a multistage perspective for a comprehensive understanding of the impact of animal-mediated pollen and seed dispersal on spatial population dynamics and genetic patterns of trees.

Low-temperature thermochronological evolution of the Menderes and Alanya massifs (Turkey)

The application of two low-temperature thermochronometers [fission-track analysis and (U-Th)/He analyses, both on apatite] to various tectonostratigraphic units of the Menderes and Alanya Massifs of Turkey has provided significant new constraints to the understanding of their structural evolution. The Menderes Massif of western Anatolia is one of the largest metamorphic core complexes on Earth. The integration of the geochronometric dataset presented in this dissertation with preexisting ones from the literature delineates three groups of samples within the Menderes Massif. In the northern and southern region the massif experienced a Late Oligocene-Early Miocene tectonic denudation and surface uplift; whereas data from the central region are younger, with most ages ranging between the Middle-Late Miocene. The results of this study are consistent with the interpretation for a symmetric exhumation of the Menderes Massif. The Alanya Massif of SW Anatolia presents a typical nappe pile consisting of thrust sheets with contrasting metamorphic histories. Petrological and geochronological data clearly indicate that the tectonometamorphic evolution Alanya started from Late Cretaceous with the northward subduction of an ‘Alanya ocean’ under the Tauride plate. As an effect of the closure of the İzmir–Ankara–Erzincan ocean, northward backthrusting during the Paleocene-Early Eocene created the present stacking order. Apatite fission-track ages from this study range from 31.8 to 26.8 Ma (Late Rupelian-Early Chattian) and point to a previously unrecognized mid-Oligocene cooling/exhumation episode. (U-Th)/He analysis on zircon crystals obtained from the island of Cyprus evidentiate that the Late Cretaceous trondhjemites of the Troodos Massif not recorded a significant cooling event. Instead results for the Late Triassic turbiditic sandstones of the Vlambouros Formation show that the Mamonia mélange was never buried enough to reach the closure temperature of the ZHe radiometric system (ca. 200°C), thus retaining the Paleozoic signature of a previous sedimentary cycle.

Understanding block rotation of strike-slip fault zones: Paleomagnetic and structural approach

This thesis is focused on the paleomagnetic rotation pattern inside the deforming zone of strike-slip faults, and the kinematics and geodynamics describing it. The paleomagnetic investigation carried out along both the LOFZ and the fore-arc sliver (38º-42ºS, southern Chile) revealed an asymmetric rotation pattern. East of the LOFZ and adjacent to it, rotations are up to 170° clockwise (CW) and fade out ~10 km east of fault. West of the LOFZ at 42ºS (Chiloé Island) and around 39°S (Villarrica domain) systematic CCW rotations have been observed, while at 40°-41°S (Ranco-Osorno domain) and adjacent to the LOFZ CW rotations reach up to 136° before evolving to CCW rotations at ~30 km from the fault. These data suggest a directed relation with subduction interface plate coupling. Zones of high coupling yield to a wide deforming zone (~30 km) west of the LOFZ characterized by CW rotations. Low coupling implies a weak LOFZ and a fore-arc dominated by CCW rotations related to NW-sinistral fault kinematics. The rotation pattern is consistent with a quasi-continuous crust kinematics. However, it seems unlikely that the lower crust flux can control block rotation in the upper crust, considering the cold and thick fore-arc crust. I suggest that rotations are consequence of forces applied directly on both the block edges and along the main fault, within the upper crust. Farther south, at the Austral Andes (54°S) I measured the anisotropy of magnetic susceptibility (AMS) of 22 Upper Cretaceous to Upper Eocene sites from the Magallanes fold-thrust belt internal domains. The data document continuous compression from the Early Cretaceous until the Late Oligocene. AMS data also show that the tectonic inversion of Jurassic extensional faults during the Late Cretaceous compressive phase may have controlled the Cenozoic kinematic evolution of the Magallanes fold-thrust belt, yielding slip partitioning.

The near babylonian speech confusion in early detection of psychosis

It is barely 15 years since, in 1996, the issue theme of Schizophrenia Bulletin (Vol 22, 2) “Early Detection, and Intervention in Schizophrenia” signified the commencement of this field of research. Since that time the field of early detection research has developed rapidly and it may be translated into clinical practice by the introduction of an Attenuated Psychosis Syndrome in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-5) (www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=412#). Attenuated psychotic symptoms (APS) had first been suggested as a clinical predictor of first-episode psychosis by the Personal Assessment and Crisis Evaluation (PACE) Clinic group as part of the ultrahigh risk (UHR) criteria.1 The term ultrahigh risk became broadly accepted for this set of criteria for imminent risk of developing psychosis in the late 1990s. The use of the term “prodrome” for a state characterized by at-risk (AR) criteria was criticized as a retrospective concept inevitably followed by the full-blown disorder.1 Although alternative terms have been suggested, prodrome is still used in prospective studies (eg, prodromally symptomatic, potentially or putatively prodromal, prodrome-like state/symptoms). Some alternative suggestions such as prepsychotic state/symptoms, subthreshold psychotic symptoms, early psychosis, subsyndromal psychosis, hypopsychosis, or subpsychosis were short-lived. Other terms still in use include UHR, at-risk mental state (ARMS), AR, high risk, clinical high risk (CHR), or early and late AR state. Further, the term psychotic-like experiences (PLEs) has recently (re-)entered early detection research. …

Early closure of ileostomy is associated with less postoperative nausea and vomiting

Background/Aims: Temporary loop ileostomy is increasingly used in colorectal surgery but necessitates secondary closure. We evaluated postoperative complications, particularly nausea and vomiting, in patients with early, intermediate, or late elective ileostomy closure. Methods: We included all patients undergoing ileostomy closure from 2001 to 2008. Time from ileostomy construction to closure was classified as early (EC, <12 weeks), intermediate (IC, 12–18 weeks), and late (LC, >18 weeks). Using multivariable logistic regression, we compared the frequency of postoperative complications between the groups. Results: We included 134 patients (87 males; median age 71 years, range 29–91). Carcinoma of the rectum (n = 67, 50%) was the main reason for ileostomy construction. The median time to ileostomy closure was 103 days (range 8–461). Among patients with EC, IC, and LC, postoperative nausea occurred in 50.0, 73.1, and 78.6%, respectively (p = 0.006), and postoperative vomiting in 22.5, 57.7, and 59.5%, respectively (p = 0.001). Adjusting for important covariates, the odds ratio for postoperative nausea was 2.0 (95% CI 0.76–5.1) for IC and 4.1 (95% CI 1.2–14.3) for LC compared to EC (p = 0.069). For postoperative vomiting, adjusted odds ratios were 3.8 (95% CI 1.4–10.4) for IC and 4.6 (95% CI 1.4–15.5) for LC (p = 0.012). Other complications did not differ between the groups. Conclusions: These findings suggest that early ileostomy closure might reduce postoperative nausea and vomiting.

Paleoenvironment and Paleoecology of a Late Paleocene High-Latitude Terrestrial Succession, Arkose Ridge Formation at Box Canyon, Southern Talkeetna Mountains, Alaska

Paleogene sedimentary rocks of the Arkose Ridge Formation (Talkeetna Mountains, Alaska) preserve a record of a fluvial-lacustrine depositional environment and its forested ecosystem in an active basin among the convergent margin tectonic processes that shaped southern Alaska. An -800 m measured succession at Box Canyon indicates braid-plain deposition with predominantly gravelly deposits low in the exposure to sandy and muddy facies associations below an overlying lava flow sequence. U-Pb geochronology on zircons from a tuff and a sandstone within the measured section, as well as an Ar/Ar date from the overlying lava constrain the age of the sedimentary succession to between similar to 59 Ma and 48 Ma Fossil plant remains occur throughout the Arkose Ridge Formation as poorly-preserved coalified woody debris and fragmentary leaf impressions. At Box Canyon, however, a thin la-custrine depositional lens of rhythmically laminated mudrocks yielded fish fossils and a well-preserved floral assemblage including foliage and reproductive organs representing conifers, sphenopsids, monocots, and dicots. Leaf physiognomic methods to estimate paleoclimate were applied to the dicot leaf collection and indicate warm temperate paleotemperatures (-11-15 +/- -4 degrees C MAT) and elevated paleoprecipitation (-120 cm/yr MAP) estimates as compared to modem conditions; results that are parallel with previously published estimates from the partly coeval Chickaloon Formation deposited in more distal depositional environments in the same basin. The low abundance of leaf herbivory in the Box Canyon dicot assemblage (-9% of leaves damaged) is also similar to the results from assemblages in the meander-plain depositional systems of the Chickaloon. This new suite of data informs models of the tectonostratigraphic evolution of southern Alaska and the developing understanding of terrestrial paleoecology and paleoclimate at high latitudes during the Late Paleocene-Early Eocene greenhouse climate phase. (c) 2014 Elsevier B.V. All rights reserved.