Local hydroclimate alters interpretation of speleothem δO records.

Oxygen isotopes (δO) are the most commonly utilized speleothem proxy and have provided many foundational records of paleoclimate. Thus, understanding processes affecting speleothem δO is crucial. Yet, prior calcite precipitation (PCP), a process driven by local hydrology, is a widely ignored control of speleothem δO.

Uncertainties in critical slowing down indicators of observation-based fingerprints of the Atlantic Overturning Circulation.

Observations are increasingly used to detect critical slowing down (CSD) to measure stability changes in key Earth system components. However, most datasets have non-stationary missing-data distributions, biases and uncertainties. Here we show that, together with the pre-processing steps used to deal with them, these can bias the CSD analysis.

Deciphering local and regional hydroclimate resolves contradicting evidence on the Asian monsoon evolution.

The winter and summer monsoons in Southeast Asia are important but highly variable sources of rainfall. Current understanding of the winter monsoon is limited by conflicting proxy observations, resulting from the decoupling of regional atmospheric circulation patterns and local rainfall dynamics. These signals are difficult to decipher in paleoclimate reconstructions.

Decline in seasonal predictability potentially destabilized Classic Maya societies.

Classic Maya populations living in peri-urban states were highly dependent on seasonally distributed rainfall for reliable surplus crop yields. Despite intense study of the potential impact of decadal to centennial-scale climatic changes on the demise of Classic Maya sociopolitical institutions (750-950 CE), its direct importance remains debated. We provide a detailed analysis of a precisely dated speleothem record from Yok Balum cave, Belize, that reflects local hydroclimatic changes at seasonal scale over the past 1600 years.

Safe use of donated positive airway pressure devices to increase access to treatment for obstructive sleep apnea: a clinical outreach program.

Unlabelled: Coverage to provide positive airway pressure (PAP) therapy for patients with obstructive sleep apnea (OSA) by the Centers for Medicare and Medicaid Services (CMS) and most private insurers is limited to those patients who meet diagnostic criteria for OSA based on a sleep study. Despite PAP therapy being a covered benefit by most insurers, many patients have high out-of-pocket costs due to copays and deductibles. Also, a subset of patients may be diagnosed per the American Academy of Sleep Medicine (AASM) recommended rule (H3A), while not meeting the diagnosis using the acceptable rule (H4) that their insurer requires.

Images: unilateral rhinorrhea in a patient starting autotitrating positive airway pressure therapy for obstructive sleep apnea.

Unlabelled: We report a case of a 65-year-old obese female who developed a unilateral nasal cerebrospinal fluid leak after starting autotitrating positive airway pressure therapy for obstructive sleep apnea. The cerebrospinal fluid leak was confirmed by β-2 transferrin testing of the nasal fluid, as well as by identification of the leak through the anterior cribriform plate after administration of intrathecal fluorescein. The cerebrospinal fluid leak was successfully repaired endoscopically, and autotitrating positive airway pressure was reinitiated 1 month postoperatively.

Use of positive airway pressure in mild cognitive impairment to delay progression to dementia.

Study Objectives: The aim was to assess the relationship between continuous positive airway pressure (CPAP) therapy and cognitive function in patients with mild cognitive impairment (MCI) and obstructive sleep apnea (OSA).

Methods: This was a retrospective chart review of patients with MCI and OSA. CPAP therapy compliance was defined as average use of CPAP therapy for at least 4 hours per night.

When using two patient identifiers is not enough with CPAP therapy.

Begum J, Skiba V. When using two patient identifiers is not enough with CPAP therapy. .

Night-to-Night Variability in Sleep Disordered Breathing and the Utility of Esophageal Pressure Monitoring in Suspected Obstructive Sleep Apnea.

Study Objective: Esophageal manometry (Pes) is the gold standard to detect repetitive episodes of increased respiratory effort followed by arousal (RERAs). Because RERAs are not included in the apnea-hypopnea index (AHI), we often refer patients with symptoms of sleep disordered breathing (SDB) and AHI < 5 for a second polysomnogram (PSG) with Pes. Often, the second PSG will demonstrate AHI > 5, confirming a diagnosis of OSA.

Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial.

Importance: Improvement has been anecdotally observed in patients with persistent postconcussion symptoms (PCS) after mild traumatic brain injury following treatment with hyperbaric oxygen (HBO). The effectiveness of HBO as an adjunctive treatment for PCS is unknown to date.

Objectives: To compare the safety of and to estimate the efficacy for symptomatic outcomes from standard PCS care alone, care supplemented with HBO, or a sham procedure.

Development of chronic epilepsy after recurrent episodes of posterior reversible encephalopathy syndrome associated with periodic lateralized epileptiform discharges.

Posterior Reversible Encephalopathy Syndrome (PRES) is a syndrome comprising headache, altered mentation, and seizures, associated with neuroimaging findings characteristic of subcortical edema in the posterior regions. It is usually seen in patients treated with immunosuppressants, in renal failure, or with eclampsia. Recurrent episodes of PRES in the same patient are rarely observed.

Central nervous system manifestations of Q fever responsive to steroids.

We report the clinical and radiological central nervous system manifestations of a 27-year-old man with Q fever who subsequently developed acute disseminated encephalomyelitis and showed a significant response to steroids. The patient presented with headache and fever and quickly progressed to develop acute respiratory failure and hepatitis. A prompt evaluation revealed positive serology for Q fever and doxycycline was initiated.

[The pathomorphogenetic characteristics of the wall of the common bile duct in cholestasis].

Data are presented on the reversibility of pathological changes of the common bile duct, causes and criteria of reversibility. Consideration of four stages of pathomorphogenesis of the common bile duct wall may be of help in the choice of surgical tactics in surgical intervention on the common bile duct.

[Method of intraoperative hemostasis in parenchymatous hemorrhage].

The authors have developed a new method for intraoperative hemostasis in parenchymatous hemorrhage. Hemostasis is achieved by means of electrophoresis of fibrinogen and some other factors of blood coagulation into the organ parenchyma. Approbation of the method on dogs has demonstrated its atraumaticity and safety.

[A new approach to the intraoperative diagnosis of cholangitis and to the choice of surgical procedure in operations on the bile ducts].

The authors have developed a prompt and informative method for assessment of the depth and reversibility of the morphofunctional changes in the common bile duct (CBD) wall with the use of staining by hematoxylin basic, fuchsin-picric acid. Four types of the morphologic changes in CBD wall, which characterize the different degree of reversibility, were established. Depending of presence of these types, the corresponding surgical tactics is recommended.