Less Oxygen, Later Intubation and Reduced Respiratory Pressures for ELBW Infants from 1997 to 2011.

INTRODUCTION Evidence concerning delivery room management in extremely low birth weight infants (ELBW) has grown substantially within the last 20 years, leading to several guidelines and recommendations. However, it is unknown in which extent local treatment strategies have changed and if they reflect current recommendations. METHODS A detailed questionnaire about treatment strategies for ELBW infants was sent to all German neonatal intensive care units (NICUs) treating ELBW infants in 1997. A follow-up survey was conducted in 2011 and sent to all NICUs in Germany, Austria and Switzerland. RESULTS on delivery room management were compared to the first survey. RESULTS In 1997 and 2011, 63.6 and 66.2% of the approached hospitals responded. In 2011 similar results were observed between university and non-university hospitals as well as NICUs of different size. Differences between Germany, Austria and Switzerland were minimal. Changes over time were a lower initially applied fraction of inspired oxygen (FiO2) and peak inspiratory pressure (PiP) in 2011 compared to 1997. A longer time of apnea was tolerated before tracheal intubation is performed; the time of apnea was less frequently a sole criterion for intubation and surfactant was applied at lower FiO2 in 2011. The time of no thorax excursions and transport of the infant were considered an indication for intubation in 30.2 and 22.5%, and did not change in the observation period. CONCLUSION Treatment strategies for delivery room management in ELBW infants changed significantly between 1997 and 2011 and largely reflect current recommendations.

Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial.

BACKGROUND Giant cell arteritis is an immune-mediated disease of medium and large-sized arteries that affects mostly people older than 50 years of age. Treatment with glucocorticoids is the gold-standard and prevents severe vascular complications but is associated with substantial morbidity and mortality. Tocilizumab, a humanised monoclonal antibody against the interleukin-6 receptor, has been associated with rapid induction and maintenance of remission in patients with giant cell arteritis. We therefore aimed to study the efficacy and safety of tocilizumab in the first randomised clinical trial in patients with newly diagnosed or recurrent giant cell arteritis. METHODS In this single centre, phase 2, randomised, double-blind, placebo-controlled trial, we recruited patients aged 50 years and older from University Hospital Bern, Switzerland, who met the 1990 American College of Rheumatology criteria for giant cell arteritis. Patients with new-onset or relapsing disease were randomly assigned (2:1) to receive either tocilizumab (8 mg/kg) or placebo intravenously. 13 infusions were given in 4 week intervals until week 52. Both groups received oral prednisolone, starting at 1 mg/kg per day and tapered down to 0 mg according to a standard reduction scheme defined in the study protocol. Allocation to treatment groups was done using a central computerised randomisation procedure with a permuted block design and a block size of three, and concealed using central randomisation generated by the clinical trials unit. Patients, investigators, and study personnel were masked to treatment assignment. The primary outcome was the proportion of patients who achieved complete remission of disease at a prednisolone dose of 0·1 mg/kg per day at week 12. All analyses were intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01450137. RESULTS Between March 3, 2012, and Sept 9, 2014, 20 patients were randomly assigned to receive tocilizumab and prednisolone, and ten patients to receive placebo and glucocorticoid; 16 (80%) and seven (70%) patients, respectively, had new-onset giant cell arteritis. 17 (85%) of 20 patients given tocilizumab and four (40%) of ten patients given placebo reached complete remission by week 12 (risk difference 45%, 95% CI 11-79; p=0·0301). Relapse-free survival was achieved in 17 (85%) patients in the tocilizumab group and two (20%) in the placebo group by week 52 (risk difference 65%, 95% CI 36-94; p=0·0010). The mean survival-time difference to stop glucocorticoids was 12 weeks in favour of tocilizumab (95% CI 7-17; p<0·0001), leading to a cumulative prednisolone dose of 43 mg/kg in the tocilizumab group versus 110 mg/kg in the placebo group (p=0·0005) after 52 weeks. Seven (35%) patients in the tocilizumab group and five (50%) in the placebo group had serious adverse events. INTERPRETATION Our findings show, for the first time in a trial setting, the efficacy of tocilizumab in the induction and maintenance of remission in patients with giant cell arteritis. FUNDING Roche and the University of Bern.

Fort Richardson Ordnance Detonations and the Harbor Porpoise: A Case Study in Marine Mammal Bioacoustics

Hearing is extremely important for cetaceans because it is their “principal sense” (Weilgart, 2007) thus the harbor porpoise and other marine animals are highly dependent on sound for survival. This is why we should care about the impact of noise on animals like the harbor porpoise. Since sound travels so well in water, an explosion, sonar, boat noise, etc. can affect a very large area and thus many different species of marine mammals. Although military actions such as low frequency sonar have made recent news, noise has been affecting cetaceans, especially beaked whales, since at least 1991 (Weilgart, 2007). This study is an investigation of the possible impacts of artillery detonated on land on harbor porpoise hearing and covers some of the history of Fort Richardson, the legal and historical aspects and history of this type of concern, the science and physics of sound, marine mammal hearing and general biology of the harbor porpoise. Data were collected at the Fort Richardson Army base during June of 2007 by researchers from the University of Connecticut and the University of Rhode Island and will be used to determine the possible impacts that these detonations could have on the harbor porpoise.

Association between sugar-sweetened beverages and both gestational weight gain and gestational diabetes

This cross-sectional study aimed at evaluating the association between sugar sweetened beverage (SSB) consumption and both excessive gestational weight gain (EGWG) and gestational diabetes mellitus (GDM). The study was conducted in the postpartum units of Memorial Hermann Hospital, Lyndon Baines Johnson General Hospital, the University of Texas Medical Branch at Galveston General Hospital, and the University of Texas at Brownsville Hospital. Between June 2009 and September 2010, women between the ages of 18 and 49 years with singleton pregnancies who delivered an infant born at 37 weeks of gestation or later were approached. Descriptive, univariate and multivariate analysis were employed in our study using the Statistical Analysis System (SAS) software version 9.1 (SAS Institute Inc. Cary, North Carolina). Our investigation did not find statistically significant associations between SSBs and EGWG. Our study reported no evidence of an association between SSBs and GDM except for sports drinks. However, the estimate of this association was deemed very imprecise. In conclusion, our study did not find strong provide strong support for the hypothesis that high consumption of SSBs increases the risk of EGWG or GDM. ^

Patenting genes and gene sequences: Analysis of public health implications and the law

At issue is whether or not isolated DNA is patent eligible under the U.S. Patent Law and the implications of that determination on public health. The U.S. Patent and Trademark Office has issued patents on DNA since the 1980s, and scientists and researchers have proceeded under that milieu since that time. Today, genetic research and testing related to the human breast cancer genes BRCA1 and BRCA2 is conducted within the framework of seven patents that were issued to Myriad Genetics and the University of Utah Research Foundation between 1997 and 2000. In 2009, suit was filed on behalf of multiple researchers, professional associations and others to invalidate fifteen of the claims underlying those patents. The Court of Appeals for the Federal Circuit, which hears patent cases, has invalidated claims for analyzing and comparing isolated DNA but has upheld claims to isolated DNA. The specific issue of whether isolated DNA is patent eligible is now before the Supreme Court, which is expected to decide the case by year's end. In this work, a systematic review was performed to determine the effects of DNA patents on various stakeholders and, ultimately, on public health; and to provide a legal analysis of the patent eligibility of isolated DNA and the likely outcome of the Supreme Court's decision. ^ A literature review was conducted to: first, identify principle stakeholders with an interest in patent eligibility of the isolated DNA sequences BRCA1 and BRCA2; and second, determine the effect of the case on those stakeholders. Published reports that addressed gene patents, the Myriad litigation, and implications of gene patents on stakeholders were included. Next, an in-depth legal analysis of the patent eligibility of isolated DNA and methods for analyzing it was performed pursuant to accepted methods of legal research and analysis based on legal briefs, federal law and jurisprudence, scholarly works and standard practice legal analysis. ^ Biotechnology, biomedical and clinical research, access to health care, and personalized medicine were identified as the principle stakeholders and interests herein. Many experts believe that the patent eligibility of isolated DNA will not greatly affect the biotechnology industry insofar as genetic testing is concerned; unlike for therapeutics, genetic testing does not require tremendous resources or lead time. The actual impact on biomedical researchers is uncertain, with greater impact expected for researchers whose work is intended for commercial purposes (versus basic science). The impact on access to health care has been surprisingly difficult to assess; while invalidating gene patents might be expected to decrease the cost of genetic testing and improve access to more laboratories and physicians' offices that provide the test, a 2010 study on the actual impact was inconclusive. As for personalized medicine, many experts believe that the availability of personalized medicine is ultimately a public policy issue for Congress, not the courts. ^ Based on the legal analysis performed in this work, this writer believes the Supreme Court is likely to invalidate patents on isolated DNA whose sequences are found in nature, because these gene sequences are a basic tool of scientific and technologic work and patents on isolated DNA would unduly inhibit their future use. Patents on complementary DNA (cDNA) are expected to stand, however, based on the human intervention required to craft cDNA and the product's distinction from the DNA found in nature. ^ In the end, the solution as to how to address gene patents may lie not in jurisprudence but in a fundamental change in business practices to provide expanded licenses to better address the interests of the several stakeholders. ^

Quality of life and functional status in a low -income, multiethnic HIV -positive population

The introduction of new medical treatments in recent years, commonly referred to as highly active antiretroviral therapy, has greatly increased the survival of patients with HIV/AIDS. As patients with HIV/AIDS continue to live longer, other important health-related outcomes, such as quality of life (QOL), should be thoroughly studied. There is also evidence that racial/ethnic minorities are disproportionately affected by HIV/AIDS, but potential health disparities among individuals already infected with HIV/AIDS have not been adequately examined in ethnically diverse populations. The purpose of this dissertation was to: (1) examine the impact of both demographic and behavioral variables on functional status and overall QOL among a population of ethnically diverse and economically disadvantaged HIV/AIDS patients; (2) examine the psychometric properties of a functional status measure—the Household and Leisure Time Activities questionnaire (HLTA); and (3) assess a proximal-distal theoretical framework for QOL using a full structural equation model in a population of patients with HIV/AIDS. Analyses were performed using data collected in the fall of 2000 from the project, Health and Work-Related Quality of Life and Health Risk Behaviors in a Multiethnic HIV-positive Population . Investigators from The University of Texas M.D. Anderson Cancer Center, The University of Texas-Houston Medical School, and The University of Texas School of Public Health conducted this project. The study site was the Thomas Street Clinic (TSC), a comprehensive HIV/AIDS care facility funded by the Harris County Hospital District (HCHD). TSC provides HIV/AIDS care to a diverse population of approximately 4000 medically indigent residents of Harris County. A systematic, consecutive sampling procedure yielded a sample size of 348 patients. Findings suggested that overall QOL, work-role functioning, household functioning, and leisure time functioning were impaired in this patient population. Results from the psychometric evaluation indicated that the HLTA was a reliable and valid measure of household and leisure time functioning status in a low-income multiethnic HIV-positive population. Finally, structural equation modeling of the proximal-distal QOL model suggested that this model was not a viable representation of the relationship between the study variables in this patient population. ^

Adolescents' and young adults' physical activity related to built environment

Objetivos: este trabajo tiene como objetivo analizar los niveles de actividad fisicas en estudiantes de escuelas secundarias y estudiantes universitarios; estimar su percepción del entorno contruído en relación con la actividad física, y evaluar la relación entre la educación física y el entorno contruído. Metodología: Se aplicó un estudio sociológico trasversal con diseño no experimental. Se completaron el cuestionario internacional de actividad física y el cuestionario de caraterísticas de entorno contruído con una muestra de 1.862 alumnos de escuelas secundarias y universidad en Granada, España. Resultados: los alumnos de la escuela secundaria fueron significativamente más activos que los estudiantes universitarios, quienes alcanzaron niveles insuficientes de actividad física. Sin embargo, consideraron Granada un buen contexto para hacer ejercicio al aire libre. No se encontraron relaciones entre los niveles de actividad física y el entorno contruído. Conclusión: la discrepancia de resultados entre los niveles de actividad física y la percepción del entorno contruído sugieren la necesidad de intervenciones focalizadas en hacer que los jóvenes se den cuenta de las posibilidades que el medio les ofrece para ejercitarse. En consecuencia, el medio puede tener un impacto en la salud al mismo tiempo que los jóvenes aprenden a respetarlo

Adolescents' and young adults' physical activity related to built environment

Objetivos: este trabajo tiene como objetivo analizar los niveles de actividad fisicas en estudiantes de escuelas secundarias y estudiantes universitarios; estimar su percepción del entorno contruído en relación con la actividad física, y evaluar la relación entre la educación física y el entorno contruído. Metodología: Se aplicó un estudio sociológico trasversal con diseño no experimental. Se completaron el cuestionario internacional de actividad física y el cuestionario de caraterísticas de entorno contruído con una muestra de 1.862 alumnos de escuelas secundarias y universidad en Granada, España. Resultados: los alumnos de la escuela secundaria fueron significativamente más activos que los estudiantes universitarios, quienes alcanzaron niveles insuficientes de actividad física. Sin embargo, consideraron Granada un buen contexto para hacer ejercicio al aire libre. No se encontraron relaciones entre los niveles de actividad física y el entorno contruído. Conclusión: la discrepancia de resultados entre los niveles de actividad física y la percepción del entorno contruído sugieren la necesidad de intervenciones focalizadas en hacer que los jóvenes se den cuenta de las posibilidades que el medio les ofrece para ejercitarse. En consecuencia, el medio puede tener un impacto en la salud al mismo tiempo que los jóvenes aprenden a respetarlo

Adolescents' and young adults' physical activity related to built environment

Objetivos: este trabajo tiene como objetivo analizar los niveles de actividad fisicas en estudiantes de escuelas secundarias y estudiantes universitarios; estimar su percepción del entorno contruído en relación con la actividad física, y evaluar la relación entre la educación física y el entorno contruído. Metodología: Se aplicó un estudio sociológico trasversal con diseño no experimental. Se completaron el cuestionario internacional de actividad física y el cuestionario de caraterísticas de entorno contruído con una muestra de 1.862 alumnos de escuelas secundarias y universidad en Granada, España. Resultados: los alumnos de la escuela secundaria fueron significativamente más activos que los estudiantes universitarios, quienes alcanzaron niveles insuficientes de actividad física. Sin embargo, consideraron Granada un buen contexto para hacer ejercicio al aire libre. No se encontraron relaciones entre los niveles de actividad física y el entorno contruído. Conclusión: la discrepancia de resultados entre los niveles de actividad física y la percepción del entorno contruído sugieren la necesidad de intervenciones focalizadas en hacer que los jóvenes se den cuenta de las posibilidades que el medio les ofrece para ejercitarse. En consecuencia, el medio puede tener un impacto en la salud al mismo tiempo que los jóvenes aprenden a respetarlo

Isotopic and chemical compositions of DSDP site 18-174 sediments

The Astoria submarine fan, located off the coast of Washington and Oregon, has grown throughout the Pleistocene from continental input delivered by the Columbia River drainage system. Enormous floods from the sudden release of glacial lake water occurred periodically during the Pleistocene, carrying vast amounts of sediment to the Pacific Ocean. DSDP site 174, located on the southern distal edge of the Astoria Fan, is composed of 879 m of terrigenous sediments. The section is divided into two major units separated by a distinct seismic discontinuity: an upper, turbidite fan unit (Unit I), and an underlying finer-grained unit (Unit II). Both units have overlapping ranges of Nd and Hf isotope compositions, with the majority of samples having e-Nd values of -7.1 to -15.2 and eHf values -6.2 to -20.0; the most notable exception is the uppermost sample in the section, which is identical to modern Columbia River sediment. Nd depleted mantle model ages for the site range from 2.0 to 1.2 Ga and are consistent with derivation from cratonic Proterozoic source regions, rather than Cenozoic and Mesozoic terranes proximal to the Washington-Oregon coast. The Astoria Fan sediments have significantly less radiogenic Nd (and Hf) isotopic compositions than present day Columbia River sediment (e-Nd=-3 to -4; [Goldstein, S.J., Jacobsen, S.B., 1987. Nd and Sr isotopic systematics of river water suspended material: implications for crustal evolution. Earth. Planet. Sci. Lett. 87, 249-265; doi:10.1016/0012-821X(88)90013-1]), and suggest that outburst flooding, tapping Proterozoic source regions, was the dominant sediment transport mechanism in the genesis and construction of the Astoria Fan. Pb isotopes form a highly linear 207Pb/204Pb - 206Pb/204Pb array, and indicate the sediments are a binary mixture of two disparate sources with isotopic compositions similar to Proterozoic Belt Supergroup metasediments and Columbia River Basalts. The combined major, trace and isotopic data argue that outburst flooding was responsible for depositing the majority (top 630 m) of the sediment in the Astoria Fan.

The Gepatschferner from 1850 - 2006, with links to digital elevation models and glacier margins

This theses investigates changes at Gepatschferner in length, area and volume since the last glacier maximum in 1850. Changes are discussed for the following time periods: 1850-1922, 1922-1971, 1971-1997, 1997-2006. Digital elevation models were created for 1850 from geomorphological data and for 1922 and 1971 from historical maps. Existing DEMs for 1997 and 2006 were further analysed. Since 1850 Gepatschferner has retreated by 2 km in length and has lost 32% of its area and 36% of its volume. The rate of loss of volume is increasing faster than the rate of loss of area and losses in the upper regions of the glacier are becoming increasingly more important to overall losses. The largest losses per 50 m elevation increment occur at the tongue. These losses are greatest in the most recent time step studied, 1997-2006, and exceed previous values by 40% and more. The data base includes the glacier margins, elevations models as they have been compiled within the thesis (DEMs of 1997 and 2006 are part of the glacier inventories, length changes are part of the length change data base of the Austrian Alpine Club).

Ice thickness distribution and glacier bed of Hallstätter Gletscher

Hallstätter Glacier is the northernmost glacier of Austria. Appendant to the northern Limestone Alps, the glacier is located at 47°28'50'' N, 13°36'50'' E in the Dachstein-region. At the same time with its advance linked to the Little Ice Age (LIA), research on changes in size and mass of Hallstätter glacier was started in 1842 by Friedrich Simony. He observed and documented the glacier retreat related to its last maximum extension in 1856. In addition, Hallstätter Glacier is a subject to scientific research to date. In this thesis methods and results of ongoing mass balance measurements are presented and compared to long term volume changes and meteorological observations. The current mass balance monitoring programm using the direct glaciological method was started 2006. In this context, 2009 the ice thickness was measured with ground penetrating radar. The result are used with digital elevation models reconstucted from historical maps and recent digital elevation models to calculate changes in shape and volume of Hallstätter Glacier. Based on current meteorological measurements near the glacier and longtime homogenized climate data provided by HISTALP, time series of precipitation and temperature beginning at the LIA are produced. These monthly precipitation and monthly mean temperature data are used to compare results of a simple degree day model with the volume change calculated from the difference of the digital elevation models. The two years of direct mass balance measurements are used to calibrate the degree day model. A number of possible future scenarios are produced to indicate prospective changes. Within the 150-year-period between 1856 and 2007 the Hallstätter Glacier lost 1940 meters of its length and 2.23 km**2 in area. 37% of the initial volume of 1856 remained. This retreat came along with a change in climate. The application of a running avarage of 30 years shows an increase in precipitation of 18.5% and a warming of 1.3°C near the glacier between 1866 and 1993. The mass loss was continued in the hydrological years 2006/2007 and 2007/2008 showing mean specific mass balance of -376 mm and -700 mm, respectively. Applying a temperature correction for the different minimum elevations of the glacier, the degree day approach based on the two measured mass balances can reproduce sign and order of magnitude of the volume change of Hallstätter Glacier since 1856. Nevertheless, the relative deviation is significant. Future scenarios show, that 30% of the entire glacier volume remains after subtracting the elevation changes between the digital elevation models of 2002 and 2007 ten times from the surface of 2007. The past and present mass changes of Hallstätter Glacier are showing a retreating glacier as a consequence of rising temperatures. Due to high precepitation, increased with previous warming, the Hallstätter Glacier can and will exist in lower elevation compared to inner alpine glaciers.