Continental-scale temperature variability during the past two millennia

Past global climate changes had strong regional expression. To elucidate their spatio-temporal pattern, we reconstructed past temperatures for seven continental-scale regions during the past one to two millennia. The most coherent feature in nearly all of the regional temperature reconstructions is a long-term cooling trend, which ended late in the nineteenth century. At multi-decadal to centennial scales, temperature variability shows distinctly different regional patterns, with more similarity within each hemisphere than between them. There were no globally synchronous multi-decadal warm or cold intervals that define a worldwide Medieval Warm Period or Little Ice Age, but all reconstructions show generally cold conditions between ad 1580 and 1880, punctuated in some regions by warm decades during the eighteenth century. The transition to these colder conditions occurred earlier in the Arctic, Europe and Asia than in North America or the Southern Hemisphere regions. Recent warming reversed the long-term cooling; during the period ad 1971–2000, the area-weighted average reconstructed temperature was higher than any other time in nearly 1,400 years.

Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization

OBJECTIVES The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy. BACKGROUND Since its commercialization in 2007, the number of TAVR procedures has grown exponentially. METHODS The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. Furthermore, we assessed the extent to which TAVR has penetrated its potential patient population. RESULTS Between 2007 and 2011, 34,317 patients underwent TAVR. Considerable variation in TAVR use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 89). The weighted average TAVR penetration rate was low: 17.9%. Significant correlation was found between TAVR use and healthcare spending per capita (r = 0.80; p = 0.005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698 ± 232 vs. 213 ± 112 implants/million individuals ≥ 75 years; p = 0.002). CONCLUSIONS The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.

Adjunctive corticosteroids for Pneumocystis jiroveci pneumonia in patients with HIV infection.

BACKGROUND Pneumocystis jiroveci pneumonia (PCP) remains the most common opportunistic infection in patients infected with the human immunodeficiency virus (HIV). Among patients with HIV infection and PCP the mortality rate is 10% to 20% during the initial infection and this increases substantially with the need for mechanical ventilation. It has been suggested that corticosteroids adjunctive to standard treatment for PCP could prevent the need for mechanical ventilation and decrease mortality in these patients. OBJECTIVES To assess the effects of adjunctive corticosteroids on overall mortality and the need for mechanical ventilation in HIV-infected patients with PCP and substantial hypoxaemia (arterial oxygen partial pressure < 70 mmHg or alveolar-arterial gradient > 35 mmHg on room air). SEARCH METHODS For the original review we searched The Cochrane Library (2004, Issue 4), MEDLINE (January 1980 to December 2004) and EMBASE (January 1985 to December 2004) without language restrictions. We further reviewed the reference lists from previously published overviews, searched UptoDate version 2005 and Clinical Evidence Concise (Issue 12, 2004), contacted experts in the field and searched the reference lists of identified publications for citations of additional relevant articles.In this update of our review, we searched the above-mentioned databases in September 2010 and April 2014 for trials published since our original review. We also searched for ongoing trials in ClinicalTrials.gov and the World Health Organization International Clinical Trial Registry Platform (ICTRP). We searched for conference abstracts via AEGIS. SELECTION CRITERIA Randomised controlled trials that compared corticosteroids to placebo or usual care in HIV-infected patients with PCP in addition to baseline treatment with trimethoprim-sulfamethoxazole, pentamidine or dapsone-trimethoprim, and reported mortality data. We excluded trials in patients with no or mild hypoxaemia (arterial oxygen partial pressure > 70 mmHg or an alveolar-arterial gradient < 35 mmHg on room air) and trials with a follow-up of less than 30 days. DATA COLLECTION AND ANALYSIS Two teams of review authors independently evaluated the methodology and extracted data from each primary study. We pooled treatment effects across studies and calculated a weighted average risk ratio of overall mortality in the treatment and control groups using a random-effects model.In this update of our review, we used the GRADE methodology to assess evidence quality. MAIN RESULTS Of 2029 screened records, we included seven studies in the review and six in the meta-analysis. Risk of bias varied: the randomisation and allocation process was often not clearly described, five of seven studies were double-blind and there was almost no missing data. The quality of the evidence for mortality was high. Risk ratios for overall mortality for adjunctive corticosteroids were 0.56 (95% confidence interval (CI) 0.32 to 0.98) at one month and 0.59 (95% CI 0.41 to 0.85) at three to four months of follow-up. In adults, to prevent one death, numbers needed to treat are nine patients in a setting without highly active antiretroviral therapy (HAART) available, and 23 patients with HAART available. The three largest trials provided moderate quality data on the need for mechanical ventilation, with a risk ratio of 0.38 (95% CI 0.20 to 0.73) in favour of adjunctive corticosteroids. One study was conducted in infants, suggesting a risk ratio for death in hospital of 0.81 (95% CI 0.51 to 1.29; moderate quality evidence). AUTHORS' CONCLUSIONS The number and size of trials investigating adjunctive corticosteroids for HIV-infected patients with PCP is small, but the evidence from this review suggests a beneficial effect for adult patients with substantial hypoxaemia. There is insufficient evidence on the effect of adjunctive corticosteroids on survival in infants.

Correlated cosmogenic W and Os isotopic variations in Carbo and implications for Hf-W chronology

An obstacle for establishing the chronology of iron meteorite formation using 182Hf-182W systematics (t1/2 = 8.9 Myr) is to find proper neutron fluence monitors to correct for cosmic ray modification of W isotopic composition. Recent studies showed that siderophile elements such as Pt and Os could serve such a purpose. To test and calibrate these neutron dosimeters, the isotopic compositions of W and Os were measured in a slab of the IID iron meteorite Carbo. This slab has a well-characterized noble gas depth profile reflecting different degrees of shielding to cosmic rays. The results show that W and Os isotopic ratios correlate with distance from the pre-atmospheric center. Negative correlations, barely resolved within error, were found between epsilo190Os-epsilo189Os and epsilo186Os-epsilo189Os with slopes of -0.64 ± 0.45 and -1.8(+1.9/-2.1), respectively. These Os isotope correlations broadly agree with model predictions for capture of secondary neutrons produced by cosmic ray irradiation and results reported previously for other groups of iron meteorites. Correlations were also found between epsilo182W-epsilo189Os (slope = 1.02 ± 0.37) and epsilo182W-epsilo190Os (slope = -1.38 ± 0.58). Intercepts of these two correlations yield pre-exposure epsilo182W values of -3.32 ± 0.51 and -3.62 ± 0.23, respectively (weighted average epsilo182W = -3.57 ± 0.21). This value relies on a large extrapolation leading to a large uncertainty but gives a metal-silicate segregation age of -0.5 ± 2.4 Myr after formation of the solar system. Combining the iron meteorite measurements with simulations of cosmogenic effects in iron meteorites, equations are presented to calculate and correct for cosmogenic effects on 182W using Os isotopes.

A study of oxygen isotopic fractionation during bio-induced calcite precipitation in eutrophic Baldeggersee, Switzerland

In order to better understand environmental factors controlling oxygen isotope shifts in autochthonous lacustrine carbonate sequences, we undertook an extensive one-year study (March, 1995 to February, 1996) of water-column chemistry and daily sediment trap material from a small lake in Central Switzerland. Comparisons between calculated equilibrium isotope values, using the fractionation equation of Friedman and O’Neil, (1977) and measured oxygen isotope ratios of calcite in the sediment-traps reveal that oxygen isotopic values of autochthonous calcite (δ18O) are in isotopic equilibrium with ambient water during most of the spring and summer, when the majority of the calcite precipitates. In contrast, small amounts of calcite precipitated in early-spring and again in late-autumn are isotopically depleted in 18O relative to the calculated equilibrium values, by as much as 0.8‰. This seasonally occurring apparent isotopic nonequilibrium is associated with times of high phosphorous concentrations, elevated pH (∼8.6) and increased [CO32−] (∼50 μmol/l) in the surface waters. The resulting weighted average δ18O value for the studied period is −9.6‰, compared with a calculated equilibrium δ18O value of −9.4‰. These data convincingly demonstrate that δ18O of calcite are, for the most part, a very reliable proxy for temperature and δ18O of the water.

Analysis of the LIFO inventory valuation method during the onset of IFRS

I propose that the Last in, First out (LIFO) inventory valuation method needs to be reevaluated. I will evaluate the impact of the LIFO method on earnings of publically traded companies with a LIFO reserve over the past 10 years. I will begin my proposal with the history of how the LIFO method became an acceptable valuation method and discuss the significance of LIFO within the accounting profession Next I will provide a description of LIFO, the First in, First out (FIFO), and the weighted average inventory valuation methods and explore the differences among each. More specifically, I will explore the arguments for and against the use of the LIFO method and the potential shift towards financial standards that do not allow LIFO (a standard adopted and influenced by the International Financial Accounting Standards Board). Data will be collected from Compustat for publicly traded companies (with a LIFO Reserve) for the past 10 years. I will document which firms use LIFO, analyze trends relating to LIFO usage and LIFO reserves (the difference in the cost of inventory between using LIFO and FIFO), and evaluate the effect on earnings. The purpose of this research is to evaluate the accuracy of LIFO in portraying earnings and to see how much tax has gone uncollected over the years because of the use of LIFO. Moreover, I will provide an opinion as to whether U.S. GAAP should adopt a standard similar to IFRS and ban the LIFO method.

Financial impact of the Medicare prospective payment system on long term acute care hospitals

Objective. Long Term Acute Care Hospitals (LTACs) are subject to Medicare rules because they accept Medicare and Medicaid patients. In October 2002, Medicare changed the LTAC reimbursement formulas, from a cost basis system to a Prospective Payment System (PPS). This study examines whether the PPS has negatively affected the financial performance of the LTAC hospitals in the period following the reimbursement change (2003-2006), as compared to the period prior to the change (1999-2003), and if so, to what extent. This study will also examine whether the PPS has resulted in a decreased average patient length of stay (LOS) in the LTAC hospitals for the period of 2003-2006 as compared to the prior period of 1999-2003, and if so, to what extent. ^ Methods. The study group consists of two large LTAC hospital systems, Kindred Healthcare Inc. and Select Specialty Hospitals of Select Medical Corporation. Financial data and operational indicators were reviewed, tabulated and dichotomized into two groups, covering the two periods: 1999-2002 and 2003-2006. The financial data included net annual revenues, net income, revenue per patient per day and profit margins. It was hypothesized that the profit margins for the LTAC hospitals were reduced because of the new PPS. Operational indicators, such as annual admissions, annual patient days, and average LOS were analyzed. It was hypothesized that LOS for the LTAC hospitals would have decreased. Case mix index, defined as the weighted average of patients’ DRGs for each hospital system, was not available to cast more light on the direction of LOS. ^ Results. This assessment found that the negative financial impacts did not materialize; instead, financial performance improved during the PPS period (2003-2006). The income margin percentage under the PPS increased for Kindred by 24%, and for Select by 77%. Thus, the study’s working hypothesis of reduced income margins for the LTACs under the PPS was contradicted. As to the average patient length of stay, LOS decreased from 34.7 days to 29.4 days for Kindred, and from 30.5 days to 25.3 days for Select. Thus, on the issue of LTAC shorter length of stay, the study’s working hypothesis was confirmed. ^ Conclusion. Overall, there was no negative financial effect on the LTAC hospitals during the period of 2003-2006 following Medicare implementation of the PPS in October 2002. On the contrary, the income margins improved significantly. ^ During the same period, LOS decreased following the implementation of the PPS. This was consistent with the LTAC hospitals’ pursuit of financial incentives.^

Financial impact of the Medicare prospective payment system on long term acute care hospitals

Objective. Long Term Acute Care Hospitals (LTACs) are subject to Medicare rules because they accept Medicare and Medicaid patients. In October 2002, Medicare changed the LTAC reimbursement formulas, from a cost basis system to a Prospective Payment System (PPS). This study examines whether the PPS has negatively affected the financial performance of the LTAC hospitals in the period following the reimbursement change (2003–2006), as compared to the period prior to the change (1999–2003), and if so, to what extent. This study will also examine whether the PPS has resulted in a decreased average patient length of stay (LOS) in the LTAC hospitals for the period of 2003–2006 as compared to the prior period of 1999-2003, and if so, to what extent. ^ Methods. The study group consists of two large LTAC hospital systems, Kindred Healthcare Inc. and Select Specialty Hospitals of Select Medical Corporation. Financial data and operational indicators were reviewed, tabulated and dichotomized into two groups, covering the two periods: 1999–2002 and 2003–2006. The financial data included net annual revenues, net income, revenue per patient per day and profit margins. It was hypothesized that the profit margins for the LTAC hospitals were reduced because of the new PPS. Operational indicators, such as annual admissions, annual patient days, and average LOS were analyzed. It was hypothesized that LOS for the LTAC hospitals would have decreased. Case mix index, defined as the weighted average of patients’ DRGs for each hospital system, was not available to cast more light on the direction of LOS. ^ Results. This assessment found that the negative financial impacts did not materialize; instead, financial performance improved during the PPS period (2003–2006). The income margin percentage under the PPS increased for Kindred by 24%, and for Select by 77%. Thus, the study’s working hypothesis of reduced income margins for the LTACs under the PPS was contradicted. As to the average patient length of stay, LOS decreased from 34.7 days to 29.4 days for Kindred, and from 30.5 days to 25.3 days for Select. Thus, on the issue of LTAC shorter length of stay, the study’s working hypothesis was confirmed. ^ Conclusion. Overall, there was no negative financial effect on the LTAC hospitals during the period of 2003–2006 following Medicare implementation of the PPS in October 2002. On the contrary, the income margins improved significantly. ^ During the same period, LOS decreased following the implementation of the PPS. This was consistent with the LTAC hospitals’ pursuit of financial incentives. ^

Variation in hospital inpatient charges by payer in Houston, Texas

An analysis of variation in hospital inpatient charges in the greater Houston area is conducted to determine if there are consistent differences among payers. Differences in charges are examined for 59 Composite Diagnosis Related Groups (CDRGs) and two regression equations estimating charges are specified. Simple comparison of mean charges by diagnostic categories are significantly different for 42 (71 percent) of the 59 categories examined. In 41 of the 42 significant categories, charges to Medicaid were less than charges to private insurers. Meta-analytic statistical techniques yielded a weighted average effect size of $-$0.7198 for the 59 diagnostic categories, indicating an overall effect that Medicaid charges were less than private insurance charges. Results of a multiple regression estimating charges showed that private insurance was a significant independent variable, along with age, length of stay, and hospital variables. Results indicated consistent differential charges in the present analysis. ^

Organic temperature proxies in the subpolat region around Iceland

Subpolar regions are key areas to study natural climate variability, due to their high sensitivity to rapid environmental changes, particularly through sea surface temperature (SST) variations. Here, we have tested three independent organic temperature proxies (UK'37, TEX86 and LDI) on their potential applicability for SST reconstruction in the subpolar region around Iceland. UK'37, TEX86 and TEXL86 temperature estimates from suspended particulate matter showed a substantial discrepancy with instrumental data, while long chain alkyl diols were below detection limit in most of the stations. In the northern Iceland Basin, sedimenting particles revealed a seasonality in lipid fluxes i.e. high fluxes of alkenones and GDGTs were measured during late spring-summer, and high fluxes of long chain alkyl diols during late summer. The flux-weighted average temperature estimates had a significant negative (ca. 2.3°C for UK'37) and positive (up to 5°C for TEX86) offset with satellite-derived SSTs and temperature estimates derived from the underlying surface sediment. UK'37 temperature estimates from surface sediments around Iceland correlate well with summer mean sea surface temperatures, while TEX86 derived temperatures correspond with both annual and winter mean 0-200 m temperatures, suggesting a subsurface temperature signal. Anomalous LDI-SST values in surface sediments, and low mass flux of 1,13- and 1,15-diols compared to 1,14-diols, suggest that Proboscia diatoms are the major sources of long chain alkyl diols in this area rather than eustigmatophyte algae, and therefore the LDI cannot be applied in this region.

Molecular dissolved organic matter composition and environmental parameters from a laboratory incubation study

Dissolved organic matter (DOM) in the oceans constitutes a major carbon pool involved in global biogeochemical cycles. More than 96% of the marine DOM resists microbial degradation for thousands of years. The composition of this refractory DOM (RDOM) exhibits a molecular signature which is ubiquitously detected in the deep oceans. Surprisingly efficient microbial transformation of labile into RDOM was shown experimentally, implying that microorganisms produce far more RDOM than needed to sustain the global pool. By assessing the microbial formation and transformation of DOM in unprecedented molecular detail for 3 years, we show that most of the newly formed RDOM is molecularly different from deep sea RDOM. Only <0.4% of the net community production was channeled into RDOM molecularly undistinguishable from deep sea DOM. Our study provides novel experimentally derived molecular evidence and data for global models on the production, turnover and accumulation of marine DOM.

Studies of the microbial diversity on analyzed samples from from Peru Margin, Equatorial Pacific, Hydrate Ridge, and Juan de Fuca Ridge

Marine sediments harbor an enormous quantity of microorganisms, including a multitude of novel species. The habitable zone of the marine sediment column begins at the sediment-water interface and probably extends to depths of several thousands of meters. Studies of the microbial diversity in this ecosystem have mostly relied on molecular biological techniques. We used a complementary method - analysis of intact polar membrane lipids - to characterize the in-situ microbial community in sediments covering a wide range of environmental conditions from Peru Margin, Equatorial Pacific, Hydrate Ridge, and Juan de Fuca Ridge. Bacterial and eukaryotic phospholipids were only detected in surface sediments from the Peru Margin. In contrast, deeply buried sediments, independent of their geographic location, were dominated by archaeal diether and tetraether lipids with various polar head groups and core lipids. We compared ring distributions of archaeal tetraether lipids derived from polar glycosidic precursors with those that are present as core lipids. The distributions of these related compound pools were distinct, suggestive of different archaeal sources, i.e., the polar compounds derive from sedimentary communities and the core lipids are fossil remnants from planktonic communities with possible admixtures of decayed sedimentary archaea. This in-situ production of distinct archaeal lipid populations potentially affects applications of the TEX86 paleotemperature proxy as demonstrated by offsets in reconstructed temperatures between both pools. We evaluated how varying cell and lipid stabilities will influence the sedimentary pool by using a box-model. The results are consistent with (i) a requirement of continuous inputs of freshly synthesized lipids in subsurface sediments for explaining the observed distribution of intact polar lipids, and (ii) decreasing lipid inputs with increasing burial depth.

(Table 1) Bulk and grain density, porosity, and p- and s-wave velocity characteristics of ODP Hole 163-990A sediments

Seismic velocities in rocks are influenced by the properties of the solid, the pore fluid, and the pore space. Cracks dramatically affect seismic velocities in rocks; their influence on the effective elastic moduli of rocks depends on their shape and concentration. Thin cracks (or fractures) substantially lower the moduli of a rock relative to the effect of spherical voids (or vesicles), and lower moduli are reflected by lower P- and S-wave velocities. The objective of this research is to determine the types and concentrations of cracks and their influence on the seismic properties of subaerially erupted basalts drilled from Hole 990A on the Southeast Greenland margin during Ocean Drilling Program Leg 163. Ellipsoidal cracks are used to model the voids in the rocks. The elastic moduli of the solid (grains) are also free parameters in the inverse modeling procedure. The apparent grain moduli reflect a weighted average of the moduli of the constituent minerals (e.g., plagioclase, augite, and clay minerals). The results indicate that (1) there is a strong relationship between P-wave velocity and porosity, suggesting a similarity of pore shape distributions, (2) the distribution of crack types within the massive, central region of aa flows from Hole 990A is independent of total porosity, (3) thin cracks are the first to be effectively sealed by alteration products, and (4) grain densities (an alteration index) and apparent grain moduli of the basalt samples are directly related.

40Ar/39Ar single-crystal dating of detrital muscovite and K-feldspar of ODP Holes 116-717A and 116-718C

Detrital K-feldspars and muscovites from Ocean Drilling Program Leg 116 cores that have depositional ages from 0 to 18 Ma have been dated by the 40Ar/39Ar technique. Four to thirteen individual K-feldspars have been dated from seven stratigraphic levels, each of which have a very large range, up to 1660 Ma. At each level investigated, at least one K-feldspar yielded an age minimum which is, within uncertainty, identical to the age of deposition. One to twelve single muscovite crystals from each of six levels have also been studied. The range of muscovite ages is less than that of the K-feldspars and, with one exception, reveal only a 20-Ma spread in ages. As with the K-feldspars, each level investigated contains muscovites with mineral ages essentially identical to depositional ages. These results indicate that a significant portion of the material in the Bengal Fan is first-cycle detritus derived from the Himalayas. Therefore, the significant proportion of sediment deposited in the distal fan in the early to mid Miocene can be ascribed to a significant pulse of uplift and erosion in the collision zone. Moreover, these data indicate that during the entire Neogene, some portion of the Himalayan orogen was experiencing rapid erosion (<= uplift). The lack of granulite facies rocks in the eastern Himalayas and Tibetan Plateau suggests that very rapid uplift must have been distributed in brief pulses in different places in the mountain belt. We suggest that the great majority of the crystals with young apparent ages have been derived from the southern slope of the Himalayas, predominantly from near the main central thrust zone. These data provide further evidence against tectonic models in which the Himalayas and Tibetan plateaus are uplifted either uniformly during the past 40 m.y. or mostly within the last 2 to 5 m.y.