Governor Forrest Anderson’s Leadership & Political Acumen -- Alec Hansen “In the Crucible of Change”

Montana Governor Forrest Anderson was perhaps the most experienced and qualified person ever to be elected as Governor of Montana. Having previously served as a county attorney, a member of the legislature, a Supreme Court Justice, and twelve years as Attorney General, Anderson roared to a large victory in 1968 over the Incumbent GOP Governor Tim Babcock. Though the progressive change period in Montana began a few years earlier, Anderson’s 1968 win catapulted progressive policy-making into the mainstream of Montana political and governmental affairs. He used his unique skills and leadership to craftily architect the reorganization of the executive branch which had been kept weak since statehood so that the peoples’ government would not be able to challenge corporations who so dominated Montana. Anderson, whose “Pay More, What For?” campaign slogan strongly separated him from Tim Babcock and the GOP on the sales tax issue, not only beat back the regressive sales tax in the 1968 election, but oversaw its demise at the polls in 1971, shaping politics in Montana for decades to come. Anderson also was a strong proponent of the concept of a new Montana Constitution and contributed strategically to its calling and passage. Anderson served only one term as Governor for health reasons, but made those four years a launch pad for progressive politics and government in Montana. In this film, Alec Hansen, Special Assistant to Governor Anderson, provides an insider’s perspective as he reflects on the unique way in which Governor Anderson got things done at this critical period “In the Crucible of Change.” Alec Hansen is best known in Montana political and governmental circles as the long-time chief of the Montana League of Cities and Towns, but he cut his teeth in public service with Governor Forrest Anderson. Alec was born in Butte in 1941, attended local schools graduating from Butte High in 1959. After several years working as a miner and warehouseman for the Anaconda Company in Butte, he attended UM and graduated in History and Political Science in 1966. He joined the U.S. Navy and served with amphibious forces in Vietnam. After discharge from the Navy in 1968, he worked as a news and sports reporter for The Montana Standard in Butte until in September of 1969 he joined Governor Anderson as a Special Assistant focused on press, communications and speech-writing. Alec has noted that drafts were turned into pure Forrest Anderson remarks by the man himself. He learned at the knee of “The Fox” for the rest of Anderson’s term and continued with Governor Tom Judge for two years before returning to Butte to work for the Anaconda Company as the Director of Communications for Montana operations. In 1978, after Anaconda was acquired by the Atlantic Richfield Company, Alec went to work in February for U.S. Senator Paul Hatfield in Washington D.C., leaving after Hatfield’s primary election loss in June 1978. He went back to work for Gov. Judge, remaining until the end of 1980. In 1981 Alec worked as a contract lobbyist and news and sports reporter for the Associated Press in Helena. In 1982, the Montana League of Cities and Towns hired him as Executive Director, a position he held until retirement in 2014. Alec and his wife Colleen, are the parents of two grown children, with one grandson.

The Other Side of the Doors: Butte & Beyond -- Congressman Pat Williams “In the Crucible of Change”

Pat Williams emerged from the Mining City of Butte, Montana with a sense of grassroots, people-oriented politics. His inherent belief in the power of ordinary citizens carried him through the Montana Legislature and into Congress for a record-setting period. The accomplishments of his long career partially obscured his innate progressive and populist instinct that is reflective of the period of “in the Crucible of Change.” This film addresses Pat’s early years when his progressive instincts and activities resulted in pushback from the giant Anaconda Company which had held Montana hostage for 75 years. Pat is joined for part of the film by former campaign staffer, and now prominent media consultant, Michael Fenenbock for reflections on Pat’s 1978 “Door-to-Door to Congress” campaign, which demonstrated the power of his belief in the people on the other side of the doors. Pat Williams (b. 1937) rose from teaching grade school in his hometown of Butte, MT, to serving for the longest number of consecutive terms (9 terms, 18 years) in the US House of Representatives of anyone in Montana history. Pat was a member of the National Guard and attended UM in Missoula and William Jewel College, graduating from the University of Denver. Pat also served in the Montana legislature for 2 terms (1966 & 1968 elections). In 1969. Pat helped his legislative seat-mate John Melcher get elected as Montana’s Eastern District Congressman in the Special Election that June. Pat went to Washington DC as Melcher’s Executive Assistant. Upon returning to Montana, Pat headed up the Montana offices of the innovative Mountain Plains Family Education Program. In 1974, Pat ran unsuccessfully for Montana’s Western District Congressional seat in a three-way race with former Congressman Arnold Olsen and state Legislator Max Baucus. After the drafting and passage of the 1972 Montana Constitution, Pat was named a member of Montana’s first-ever Reapportionment Commission. In 1978 he successfully ran for Congress, conducting a massive grass-roots door-to-door campaign of 1½ years, reaching 50,000 doors. In a hotly contested 6-way Democratic primary, Pat won going away and also handily won the general election. Pat served in Congress from January, 1979 until January of 1997, 14 years representing the Western District and 4 years representing the entire state. Upon his retirement from Congress, in 1997 Williams returned to Montana where has been an instructor at the University of Montana and Senior Fellow and Regional Policy Associate at the Center for the Rocky Mountain West. He is a former member of the Montana Board of Regents and serves on a number of national education-related boards. In Congress Pat was a Deputy Whip of the U.S. House of Representatives and sat on committees on: Budget, Natural Resources, Education and Labor, and Agriculture. Pat’s leadership helped pass trailblazing legislation to assist hard-working middle-class families and ensure opportunities for every child. Pat’s fingerprints are on many pieces of important legislation, including the College Middle Income Assistance Act, the Family and Medical Leave Act, the Toddlers and Childhood Disability Act, the Library Services and Construction Act, and the Museum Services Act. Pat successfully sponsored the Lee Metcalf Wilderness Area and the Rattlesnake Wilderness area, helped save the Bob Marshall Wilderness from oil and gas exploration, and helped ban geothermal energy drilling near the borders of Yellowstone National Park. As Chairman of The Post-Secondary Education Committee, he protected the National Endowment for the Arts from elimination, a remarkable undertaking during a very trying time for the Agency. Pat worked tirelessly with Tribal College Leaders to build Montana’s seven Tribal Colleges. He was also responsible for the legislation that created The American Conservation Corps, which became the Corporation for National Service, giving thousands of America’s young people a chance to serve their country and pursue higher education. Pat lives in Missoula with his wife Carol Griffith Williams, former Montana Senate Majority Leader. They have three children and five grandchildren.

Radiation metabolomics. 2. Dose- and time-dependent urinary excretion of deaminated purines and pyrimidines after sublethal gamma-radiation exposure in mice

Gamma-radiation exposure of humans is a major public health concern as the threat of terrorism and potential hostile use of radiological devices increases worldwide. We report here the effects of sublethal gamma-radiation exposure on the mouse urinary metabolome determined using ultra-performance liquid chromatography-coupled time-of-flight mass spectrometry-based metabolomics. Five urinary biomarkers of sublethal radiation exposure that were statistically significantly elevated during the first 24 h after exposure to doses ranging from 1 to 3 Gy were unequivocally identified by tandem mass spectrometry. These are deaminated purine and pyrimidine derivatives, namely, thymidine, 2'-deoxyuridine, 2'-deoxyxanthosine, xanthine and xanthosine. Furthermore, the aminopyrimidine 2'-deoxycytidine appeared to display reduced urinary excretion at 2 and 3 Gy. The elevated biomarkers displayed a time-dependent excretion, peaking in urine at 8-12 h but returning to baseline by 36 h after exposure. It is proposed that 2'-deoxyuridine and 2'-deoxyxanthosine arise as a result of gamma irradiation by nitrosative deamination of 2'-deoxycytidine and 2'-deoxyguanosine, respectively, and that this further leads to increased synthesis of thymidine, xanthine and xanthosine. The urinary excretion of deaminated purines and pyrimidines, at the expense of aminopurines and aminopyrimidines, appears to form the core of the urinary radiation metabolomic signature of mice exposed to sublethal doses of ionizing radiation.

Remembering Lee Metcalf

Abstract Montana's Lee Metcalf was an extraordinary Montana leader with an unbelievable record of accomplishment fighting for the little people against the forces of economic and political power. The public memory is so short that this film will serve to help reacquaint Lee & Donna Metcalf to most of those who were around during their time. But it will also provide an opportunity for new generations to receive a perspective of an important leader from an important time. (Language from YouTube version of the film, written and provided by Executive Producer Evan Barrett) Lee Warren Metcalf (January 28, 1911 – January 12, 1978) was an American lawyer, judge, and politician. A member of the Democratic Party, he served as a U.S. Representative (1953–1961) and a U.S. Senator (1961–1978) from Montana. He was permanent acting President pro tempore of the Senate, the only person to hold that position, from 1963 until his death in 1978. U.S. House of Representatives During his tenure in the House, Metcalf served on the Education and Labor Committee (1953–1959), Interior and Insular Affairs Committee (1955–1959), Select Astronautics and Space Exploration Committee (1958), and Ways and Means Committee (1959–1960). He became known as one of Congress's "Young Turks" who promoted liberal domestic social legislation and reform of congressional procedures. He introduced legislation to provide health care to the elderly ten years before the creation of Medicare. He earned the nickname "Mr. Education" after sponsoring a comprehensive bill providing for federal aid to education. He also voted against legislation that would have raised grazing permits on federal lands, and led the opposition to a bill that would have swapped forested public lands for cutover private lands. He was elected chairman of the Democratic Study Group in 1959. U. S. Senate Regarded as "a pioneer of the conservation movement", Metcalf worked to protect the natural environment and regulate utilities. He helped pass the Wilderness Act of 1964, and supported the creation of the Great Bear Wilderness and the Absaroka-Beartooth Wilderness. In 1962, he introduced a "Save Our Streams" bill to preserve natural recreation facilities and protect fish and wildlife from being destroyed by highway construction. He was a longtime member of the Migratory Bird Conservation Commission. He was also active on the issue of education. He was a leading supporter of the Elementary and Secondary Education Act, the effort to extend the G.I. Bill's educational benefits to a new generation of veterans, and the development of legislation to improve federally-aided vocational education.[1] The Peace Corps was established under leadership of Metcalf and Senator Mansfield. In 1983, by act of Congress, the Lee Metcalf Wilderness area was created in southwestern Montana in honor of the late Congressman. The Great Bear Wilderness and Absaroka-Beartooth Wilderness areas were also created as a result of Metcalf's efforts in Congress, in addition to the Lee Metcalf National Wildlife Refuge in Montana. Metcalf was ranked number 15 on a list of the 100 Most Influential Montanans of the Century by the Missoulian newspaper. This text is courtesy of Wikipedia®, a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization, and is available under the Creative Commons Attribution-ShareAlike License.

The Amplifier - v.8,(a-9) no. 9

In this issue...Toonerville Trolley, Big Sky Conference, Theta Tau, Dorothy Sheets, New York Yankees, Tom Tresh, Montana Masquers, Copper League, Veterans

Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis

BACKGROUND: The retention of patients in antiretroviral therapy (ART) programmes is an important issue in resource-limited settings. Loss to follow up can be substantial, but it is unclear what the outcomes are in patients who are lost to programmes. METHODS AND FINDINGS: We searched the PubMed, EMBASE, Latin American and Caribbean Health Sciences Literature (LILACS), Indian Medlars Centre (IndMed) and African Index Medicus (AIM) databases and the abstracts of three conferences for studies that traced patients lost to follow up to ascertain their vital status. Main outcomes were the proportion of patients traced, the proportion found to be alive and the proportion that had died. Where available, we also examined the reasons why some patients could not be traced, why patients found to be alive did not return to the clinic, and the causes of death. We combined mortality data from several studies using random-effects meta-analysis. Seventeen studies were eligible. All were from sub-Saharan Africa, except one study from India, and none were conducted in children. A total of 6420 patients (range 44 to 1343 patients) were included. Patients were traced using telephone calls, home visits and through social networks. Overall the vital status of 4021 patients could be ascertained (63%, range across studies: 45% to 86%); 1602 patients had died. The combined mortality was 40% (95% confidence interval 33%-48%), with substantial heterogeneity between studies (P<0.0001). Mortality in African programmes ranged from 12% to 87% of patients lost to follow-up. Mortality was inversely associated with the rate of loss to follow up in the programme: it declined from around 60% to 20% as the percentage of patients lost to the programme increased from 5% to 50%. Among patients not found, telephone numbers and addresses were frequently incorrect or missing. Common reasons for not returning to the clinic were transfer to another programme, financial problems and improving or deteriorating health. Causes of death were available for 47 deaths: 29 (62%) died of an AIDS defining illness. CONCLUSIONS: In ART programmes in resource-limited settings a substantial minority of adults lost to follow up cannot be traced, and among those traced 20% to 60% had died. Our findings have implications both for patient care and the monitoring and evaluation of programmes.

Imported malaria in children in industrialized countries, 1992-2002

Children account for an appreciable proportion of total imported malaria cases, yet few studies have quantified these cases, identified trends, or suggested evidence-based prevention strategies for this group of travelers. We therefore sought to identify numbers of cases and deaths, Plasmodium species, place of malaria acquisition, preventive measures used, and national origin of malaria in children. We analyzed retrospective data from Australia, Denmark, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, the United Kingdom, and the United States and data provided by the United Nations World Tourism Organization. During 1992-2002, >17,000 cases of imported malaria in children were reported in 11 countries where malaria is not endemic; most (>70%) had been acquired in Africa. Returning to country of origin to visit friends and relatives was a risk factor. Malaria prevention for children should be a responsibility of healthcare providers and should be subsidized for low-income travelers to high-risk areas.

Citizenship Education – Between Social Inequality and the Promises of Modernity

For several reasons citizenship and democracy has moved into political and research focus. Socio-cultural tensions and inequalities created by globalisation processes boosted by neo-liberal modes of government seem to inspire a concern with “social cohesion”, and the European Community assigns a key role to education in engendering European democratic citizenship. It can be questioned whether it is within the scope of educational programmes to ensure social integration and democracy. However, to clarify the perspectives of the educational issue, the article discusses the conflicts and relationships between cultural identity and democracy within a framework of modernity before returning to the issue of education for democratic citizenship. It is shown on the basis of empirical studies that family background interacts with school factors in the reproduction of democratic inequalities. It is also indicated, however, that this must not be considered an unchangeable pedagogical fact, and the article briefly sketches a set of pedagogical and research challenges concerned with educating for democratic empowerment at different levels of school practice. Although this paper focuses on education and the educational system, the arguments and findings presented can also claim relevance for social pedagogy and social work, esp. in respect of recent developments that stress the educational dimensions of social work.

Italia: La chiusura della Casa dell’Emigrante come spunto riflessione sui rientri degli emigrati italiani

In the literature on migration, as well as in social policies regarding this phenomenon, the situation of returning emigrants receives scant attention. This essay establishes an intricate connection between attitudes and policies that prevail in a country regarding emigration and those concerning immigration. The case of Italy provides a prime example for this as it once was a classical country of emigration, only to turn, in recent decades, into a country that appears highly attractive (and relatively accessible) to immigrants. The essay traces the pervasive ambiguity that characterizes this country’s attitudes towards emigration from the beginning of mass emigration shortly after the unification of Italy in 1868 to the emigration policies of the fascist regime of Mussolini and the post-World War II waves of emigration right through to the corresponding ambiguity concerning the status of immigrants in contemporary society, including the indifferent treatment of returning Italian emigrants who constitute a considerable numerical phenomenon. These reflections take their origin from the impending closure of a reception centre in Lazio, the Casa dell’Emigrante near Sant’Elia Fiumerapido, Province of Frosinone, ostensibly for financial reasons. This centre had been the only one of its kind in the whole of Italy dealing officially with the needs of repatriated Italians. It had assisted returning emigrants both with practical matters, such as negotiating the labyrinth of Italian bureaucracy , and with psychological implications of a return, which are often considerable given the time lag of experiences with current social realities and the frequently unrealistic expectations associated with the return. Questions of identity become highly acute in those circumstances. The threatened closure of the centre illustrates the unwillingness of the state to face up to the factual prevalence of migratory experiences in the country as a whole and as a core element of national history, experiences of migration in both directions. The statistics speak for themselves: of the 4.660.427 persons who left Italy between 1880 and 1950, 2.322.451 have returned, almost exactly 50%. To those have to be added 3.628.430 returnees of the 5.109.860 emigrants who left Italy between the end of World War II and 1976 for Europe alone. Attitudes towards people leaving changed ostensibly over time. In the first two decades after Unification parliament on the one hand wanted to show some concern over the fate of its citizens, not wanting to abandon those newly created citizens entirely to their own destiny, while on the other portraying their decisions to emigrate as expressions of individual liberty and responsibility and not necessitated by want and poverty. Emigrants had to prove, paradoxically that they had the requisite means to emigrate when in fact poverty was largely driving them to emigrate. To admit that publicly would have amounted to admission of economic and political failure made evident through emigration. In contrast to that Mussolini’s emigration policies not only enforced large population movements within the territory of Italy to balance unemployment between regions and particularly between North and South, but also declared it citizen’s duty to be ready to move also to the colonies, thereby ‘turning emigration as a sign of social crisis into a sign of national strength and the success of the country’s political agenda’ (Gaspari 2001, p. 34). The duplicity continued even after World War II when secret deals were done with the USA to allow a continuous flow of Italian immigrants and EU membership obviously further facilitated the departure of unemployed, impoverished Italians. With the growing prosperity of Italy the reversal of the direction of migration became more obvious. On the basis of empirical research conducted by one of the author on returning emigrants four types of motives for returning can be distinguished: 1. Return as a result of failure – particularly the emigrants who left during the 1950-1970 period usually had no linguistic preparation, and in any case the gap between the spoken and the written language is enormous with the latter often being insurmountable. This gives rise to nostalgic sentiments which motivates a return into an environment where language is familiar 2. Return as a means of preserving an identity – the life of emigrants often takes place within ghetto-like conditions where familiarity is being reproduced but under restricted conditions and hence not entirely authentic. The necessity for saving money permits only a partial entry into the host society and at the same time any accumulating savings add to the desire to return home where life can be lived fully again – or so it seems. 3. Return of investment – the impossibility to become fully part of another society often motivates migrants to accumulate not so much material wealth but new experiences and competences which they then aim to reinvest in their home country. 4. Return to retire – for many emigrants returning home becomes acute once they leave a productive occupation and feelings of estrangement build up, in conjunction with the efforts of having invested in building a house back home. All those motives are associated with a variety of difficulties on the actual return home because, above all, time in relation to the country of origin has been suspended for the emigrant and the encounter with the reality of that country reveals constant discrepancies and requires constant readjustment. This is where the need for assistance to returning emigrants arises. The fact that such an important centre of assistance has been closed is further confirmation of the still prevailing politics of ambiguity which nominally demand integration from nationals and non-nationals alike but deny the means of achieving this. Citizenship is not a natural result of nationality but requires the means for active participation in society. Furthermore, the experiences of returning immigrants provide important cues for the double ambivalence in which immigrants to Italy live between the demands made on them to integrate, the simultaneous threats of repatriation and the alienation from the immigrants’ home country which grows inexorably during the absence. The state can only regain its credibility by putting an end to this ambiguity and provide to returning emigrants, and immigrants alike, the means of reconstructing strong communal identities.

Semantic Methods for Intelligent Distributed Design Environments

Continuous advancements in technology have led to increasingly comprehensive and distributed product development processes while in pursuit of improved products at reduced costs. Information associated with these products is ever changing, and structured frameworks have become integral to managing such fluid information. Ontologies and the Semantic Web have emerged as key alternatives for capturing product knowledge in both a human-readable and computable manner. The primary and conclusive focus of this research is to characterize relationships formed within methodically developed distributed design knowledge frameworks to ultimately provide a pervasive real-time awareness in distributed design processes. Utilizing formal logics in the form of the Semantic Web’s OWL and SWRL, causal relationships are expressed to guide and facilitate knowledge acquisition as well as identify contradictions between knowledge in a knowledge base. To improve the efficiency during both the development and operational phases of these “intelligent” frameworks, a semantic relatedness algorithm is designed specifically to identify and rank underlying relationships within product development processes. After reviewing several semantic relatedness measures, three techniques, including a novel meronomic technique, are combined to create AIERO, the Algorithm for Identifying Engineering Relationships in Ontologies. In determining its applicability and accuracy, AIERO was applied to three separate, independently developed ontologies. The results indicate AIERO is capable of consistently returning relatedness values one would intuitively expect. To assess the effectiveness of AIERO in exposing underlying causal relationships across product development platforms, a case study involving the development of an industry-inspired printed circuit board (PCB) is presented. After instantiating the PCB knowledge base and developing an initial set of rules, FIDOE, the Framework for Intelligent Distributed Ontologies in Engineering, was employed to identify additional causal relationships through extensional relatedness measurements. In a conclusive PCB redesign, the resulting “intelligent” framework demonstrates its ability to pass values between instances, identify inconsistencies amongst instantiated knowledge, and identify conflicting values within product development frameworks. The results highlight how the introduced semantic methods can enhance the current knowledge acquisition, knowledge management, and knowledge validation capabilities of traditional knowledge bases.

Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

Introduction: Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods: The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results: Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73-1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20-1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51-0.93). Conclusions: In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

Lactic acidosis following heart transplantation: a common phenomenon?

BACKGROUND Lactic acidosis (LAc) is a common form of metabolic acidosis early after heart transplantation (HTX). The mechanism remains unclear. This study analyzed 13 patients who developed severe LAc after HTX. METHODS From a series of 60 consecutive heart transplant patients, we identified 13 patients with LAc in the first hours following HTX. Nine patients with normal or mildly elevated lactate levels (<5.0 mmol/l) were investigated as controls. RESULTS Thirteen patients developed a moderate or severe LAc (up to 14.6 mmol/l) after HTX. Serum lactate levels increased immediately following surgery with a peak after 6.3+/-1.4 h, spontaneously returning to normal values within 24 h. In contrast to the control group, a significant correlation was found between the maximal serum lactate level and the maximal dosage of inotropic drugs (r=0.93, P<0.02), administered during the reperfusion phase and continued for 12-24 h postoperatively. No correlation was found between LAc and blood gas analysis during extracorporeal perfusion period. CONCLUSION LAc can occur after HTX and seems to be related to the inotropic support of the graft. In contrast to other forms, LAc after HTX has an excellent prognosis and resolves rapidly and spontaneously without treatment. The fact that inotropic support during and immediately after cardiac transplantation can enhance preexisting severe peripheral metabolic cellular dysfunction remains hypothetical.

Kinetic modeling of sodium in the lunar exosphere

Our knowledge about the lunar environment is based on a large volume of ground-based, remote, and in situ observations. These observations have been conducted at different times and sampled different pieces of such a complex system as the surface-bound exosphere of the Moon. Numerical modeling is the tool that can link results of these separate observations into a single picture. Being validated against previous measurements, models can be used for predictions and interpretation of future observations results. In this paper we present a kinetic model of the sodium exosphere of the Moon as well as results of its validation against a set of ground-based and remote observations. The unique characteristic of the model is that it takes the orbital motion of the Moon and the Earth into consideration and simulates both the exosphere as well as the sodium tail self-consistently. The extended computational domain covers the part of the Earth’s orbit at new Moon, which allows us to study the effect of Earth’s gravity on the lunar sodium tail. The model is fitted to a set of ground-based and remote observations by tuning sodium source rate as well as values of sticking, and accommodation coefficients. The best agreement of the model results with the observations is reached when all sodium atoms returning from the exosphere stick to the surface and the net sodium escape rate is about 5.3 × 1022 s−1.

Prognostic value of the Geneva prediction rule in patients with pulmonary embolism

BACKGROUND Assessment of pre-test probability of pulmonary embolism (PE) and prognostic stratification are two widely recommended steps in the management of patients with suspected PE. Some items of the Geneva prediction rule may have a prognostic value. We analyzed whether the initial probability assessed by the Geneva rule was associated with the outcome of patients with PE. METHODS In a post-hoc analysis of a multicenter trial including 1,693 patients with suspected PE, the all-cause death or readmission rates during the 3-month follow-up of patients with confirmed PE were analyzed. PE probability group was prospectively assessed by the revised Geneva score (RGS). Similar analyses were made with the a posteriori-calculated simplified Geneva score (SGS). RESULTS PE was confirmed in 357 patients and 21 (5.9%) died during the 3-month follow-up. The mortality rate differed significantly with the initial RGS group, as with the SGS group. For the RGS, the mortality increased from 0% (95% Confidence Interval: [0-5.4%]) in the low-probability group to 14.3% (95% CI: [6.3-28.2%]) in the high-probability group, and for the SGS, from 0% (95% CI: [0-5.4%] to 17.9% (95% CI: [7.4-36%]). Readmission occurred in 58 out of the 352 patients with complete information on readmission (16.5%). No significant change of readmission rate was found among the RGS or SGS groups. CONCLUSIONS Returning to the initial PE probability evaluation may help clinicians predict 3-month mortality in patients with confirmed PE. (ClinicalTrials.gov: NCT00117169).

Souvenir de vacances

We describe a case of a 67-year old woman who develops three painful subcutaneous nodules with surrounding erythema and a central hemorrhagic crust localized on the left wrist and the upper back after having spent her holidays in Mexico. Soon after the first visit at our clinic she was able to extract a larva, allowing to diagnose a cutaneous myiasis from furuncular subtype. There is a worldwide distribution of myiasis, but with more species and abundance in lower socioeconomic regions of tropical and subtropical regions. With a higher number of returning travelers from these regions we are more often confronted with tropical infections or parasites implicating knowledge about differential diagnosis, diagnostic and therapeutic approaches.