A three-tier risk assessment process for climate change adaptation at a local scale

Abstract

Formal structures for evaluating climate change risk are important components of adaptation decision-making. In this paper, we present an accessible, cost-effective and user-tested climate change risk assessment framework which allows organisations to systematically apply a risk management process aligned with international standards to identify and manage their climate change risks. It is delivered through 'CoastAdapt', a resource supporting climate change adaptation in Australia. This three-tier framework offers four benefits to the adaptation process. First, it allows organisations to identify climate change risks and integrate them with their mainstream risk management process. Second, it makes optimal use of an organisation's limited adaptation resources by taking a tiered approach, so allowing an organisation to start from a low knowledge base using minimal resources and, only if required, then move to more complex and resource-intensive risk assessment processes. Third, it introduces a time-dependent vulnerability rating which recognises the particular characteristics of climate change risks—that they are long term and associated with a considerable degree of uncertainty. Finally, it takes into account business inter-dependencies that can exacerbate impacts but be overlooked in a sector-based impacts evaluation. In this paper, we highlight the appropriate context in which to use each risk assessment tier, explore key technical differences among the three tiers, describe performance testing and present one case study of application. We discuss the benefits of this tiered risk assessment approach in the context of broader adaptation planning.

http://bit.ly/2MNVgLZ

Modified interpretation criteria significantly improve performance of commercially available confirmatory assays for the serodiagnosis of Lyme borreliosis: a case-control study with clinically defined serum samples

Abstract

Case-control study for the evaluation of innovative test formats for second-tier testing for the serodiagnosis of Lyme borreliosis (LB). A head-to-head comparison was performed with the test systems ViraStripe, SeraSpot, ViraChip, and recomBead. Serum samples from 62 patients (21 erythema migrans, 33 Lyme neuroborreliosis, 8 late LB) and 91 controls (including 29 potentially cross-reacting sera) were tested. For ViraChip and recomBead, optimised interpretation criteria were developed for both IgG and IgM. The most important modification for the proposed interpretation criteria for ViraChip is the interpretation of strong (> 2.5-fold above cutoff) singular IgG reactions against VlsE as positive. This significantly improves sensitivity (32 to 85%, p < 0.0001) without significant changes in specificity (borderline reactions interpreted as negative). By application of our modified rules, specificity of ViraChip IgM is significantly increased (89 to 97%, p < 0.05; borderline results included to negatives), and sensitivities of recomBead IgG and IgM are also significantly improved (69 to 87%, p < 0.01, and 57 to 74%, p < 0.01, respectively; borderline results included to positives). Further improvement of sensitivity by the rating of strong singular IgG reactions against VlsE as positive can also be shown for recomBead. IgG/IgM result combinations must be interpreted as a function of the assumed disease stage, and the best combinations differ for the various assays. Application of our proposed interpretation criteria significantly improve the discriminatory abilities of two assays; however, this must be confirmed with other data sets. Recommendations from Scientific Societies should be updated as may be necessary.

http://bit.ly/2DTkshh

Multi-step optimization of the filtration method for the isolation of Campylobacter species from stool samples

Abstract

The filtration method (FM) is the most effective isolation technique for Epsilobacteriaceae from stool samples. FM's different adaptations make it difficult to compare data between studies. This study was performed in three phases to optimize FM from a routine laboratory perspective. In July–September 2014 (part I), FM was performed on Mueller–Hinton agar containing 5% sheep blood and Columbia agar containing 5% sheep blood. In July 2016 (part II), FM was performed using 0.60-μm pore size polycarbonate filters (0.6-PC filter) and 0.45-μm pore size cellulose acetate filters (0.45-AC filter); in January 2018 (part III), the addition of hydrogen to incubators was studied. On 1146 stools analyzed in part I, the positive samples that showed no growth on the Butzler medium (n = 22/72, 30.6%) had improved growth of Epsilobacteriaceae when using the Columbia instead of the Mueller–Hinton medium (21/22 strains vs. 11/22, p < 0.05). In part II, on 718 stools, 91 strains grew with FM (12.7%), more with 0.6-PC filter (90/91) than with 0.45-AC filter (44/91) (p < 0.05). In part III, 578 stools were cultured, 98 Epsilobacteriaceae strains grew with FM, and 7% hydrogen finding significantly more Epsilobacteriaceae than without hydrogen (90/98, 91.8%, vs. 72/98, 73.5%; p < 0.05). The use of a Columbia medium containing 5% sheep blood with 0.6-PC filters incubated at 37 °C in a 7% hydrogen-enriched atmosphere led to an almost fourfold increase in the isolation rate of Epsilobacteriaceae among the studied combinations. Reference centers for Campylobacter should use standardized protocols to enable the comparison of prevalence in space and time.

http://bit.ly/2MNx6kG

Compartment pressures in children with normal and fractured lower extremities

Abstract

Purpose

Needle manometry is a tool to confirm suspected acute compartment syndrome (ACS). There is scarce evidence of normal pressure values of the lower extremities in children. The aim of this study is to assess the normal compartment pressures in non-injured lower extremities of children.

Methods

This prospective study included children up to the age of 16 years with lower extremity fractures that needed reduction. Between June 2009 and August 2015, 20 children were included. We used needle manometry to measure the pressures in the superficial (SPC), deep posterior (DPC) and in the anterior compartments (AC) on both the lower legs.

Results

On the healthy leg, the mean compartment pressure was 15.15 mmHg in the AC (range 7–30 mmHg), 14.32 mmHg in the SPC (range 8–24 mmHg) and 13.00 mmHg in the DPC (range 4–21 mmHg). On the injured leg, the mean compartment pressure was 24.07 mmHg in the AC (range 5–40 mmHg), 17.21 mmHg in the SPC (range 7–29 mmHg) and 17.13 mmHg in the DPC (range 6–37 mmHg). We found a perfusion gradient (diastolic blood pressure—compartment pressure) < 30 mmHg in at least one compartment of the fractured and healthy leg in 13 patients. Five patients underwent fasciotomy for suspected ACS and their data was excluded for the injured leg.

Conclusion

We could show that children have higher normal compartment pressures than adults in the lower leg. They seem to be able to tolerate higher absolute compartment pressures and lower pressure gradients before ACS occurs. More studies are needed to make a final statement on tolerable compartment pressures in children.

http://bit.ly/2Bktdz5

Die Entwicklung virtueller Realität als Expositionsverfahren

Zusammenfassung

Hintergrund

Virtuelle Realität (VR) wird seit 20 Jahren als Expositionsverfahren in der Verhaltenstherapie von Angststörungen untersucht. Inzwischen liegen mehrere Metaanalysen mit überzeugenden Wirksamkeitsbelegen vor.

Fragestellung

In den letzten Jahren hat eine enorme Weiterentwicklung der VR-Technologie und der damit verbundenen Möglichkeiten stattgefunden, die weiterhin andauert. Vor diesem Hintergrund wird der aktuelle Stand von VR als Expositionsmethode dargestellt.

Material und Methoden

Wir bieten einen narrativen Überblick über aktuelle Forschung zu VR-Expositionstherapie bei Angststörungen und die wichtigsten Entwicklungen in diesem Bereich.

Ergebnisse

Nach einem anfangs fast ausschließlichen Fokus auf spezifische Phobien nimmt die Zahl der Arbeiten zu komplexeren Angststörungen (v. a. soziale Angststörung) zu. Zudem hat sich VR inzwischen als experimentelle Methode etabliert, um psychopathologische Prozesse zu erforschen und die Wirkmechanismen von (VR-)Exposition zu erhellen.

Diskussion

Nach wie vor besteht Forschungsbedarf zur VR-Expositionstherapie, v. a. bei komplexen Angststörungen (z. B. Panikstörung und Agoraphobie, soziale Phobie) und Traumafolgestörungen. Darüber hinaus hat sich VR als Forschungsmethode inzwischen etabliert. Die rasche technische Entwicklung im VR-Bereich lässt eine weitere Zunahme der Forschungsaktivitäten zu VR erwarten – sowohl in der klinischen als auch in der Grundlagenforschung.

http://bit.ly/2MMqdjL

A histocytological and radiological overview of the natural history of intervertebral disk: from embryonic formation to age-related degeneration

Abstract

Purpose

To elucidate the natural history of intervertebral disk (IVD) and characterize its embryonic beginnings and age-related degeneration.

Methods

Coronal sections of embryonic (E13.5-neonatal) and postnatal (4–60-week-old) Sprague–Dawley rat IVD were stained by a series of histological stainings (hematoxylin and eosin, Alcian blue, Picrosirius red, Masson, Periodic acid–Schiff). Growth kinetics within embryonic IVD were evaluated by immunohistochemical staining of Ki67 and proliferating cell nuclear antigen. Postnatal maturation and degeneration of IVD were visualized on radiology by X-ray, CT, and MR imaging.

Results

During the formation of rat IVD, inner annulus fibrosus (AF) and cartilaginous endplate (CEP) shared similar cell density, extracellular matrix, and potential of growth kinetics; notochord provided increased and enlarged cytoplasmic vacuoles to generate nucleus pulposus (NP), part of which was retained within CEP. Postnatally, vacuolated notochord cells were reduced by devacuolation, while chondrocytic NP cells increased; cartilaginous layers of CEP were narrowed by vertebrae growth and secondary ossification; fibrotic portion of AF decreased as cartilaginous matrix accumulated and infiltrated outward. In aged and degenerated IVD, large longitudinal fissures were detected near the boundaries between inner and outer AF, whereas both reduced cellularity and accumulated cell clusters were evident within the dehydrated NP; only part of these histocytological changes could be reported on radiology.

Conclusions

By showing that the natural history of IVD is orchestrated by a dynamic histocytological regulation, our study may facilitate better understanding of the developmental defects, cellular heterogeneity, age-related degenerative mechanisms, and biological regeneration of IVD.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

http://bit.ly/2DTkgyx

Correction to: Measuring nanoparticles in the size range to 2000 nm

The original version of this article unfortunately contained mistakes.

http://bit.ly/2BjcbkO