Identifying Outflow Regions of North American Monsoon Anticyclone-Mediated Meridional Transport of Convectively Influenced Air Masses in the Lower Stratosphere.

We analyzed the effect of the North American monsoon anticyclone (NAMA) on the meridional transport of summertime cross-tropopause convective outflow by applying a trajectory analysis to a climatology of convective overshooting tops (OTs) identified in GOES satellite images, which covers the domain from 29°S to 68°N and from 205°W to 1.25°W for the time period of May to September, 2013. From this analysis, we identify seasonal development of geographically distinct outflow regions of convectively influenced air masses (CIAMs) from the NAMA circulation to the global stratosphere and quantify the associated meridional displacement of CIAMs. We find that prior to the development of the NAMA, the majority of CIAMs exit the study area in a southeastern region between 5°N and 35°N at 45°W (75.5% in May). During July and August, when the NAMA is strongest, two additional outflow regions develop that constitute the majority of outflow: 68.1% in a northeastern region between 35°N and 60°N at 45°W and 13.4% in a southwestern region between 5°N and 35°N at 145°W. The shift in the location of most CIAM outflow from the pre-NAMA southeastern region to NAMA-dependent northeastern and southwestern regions corresponds to a change in average meridional displacement of CIAMs from 3.3° northward in May to 24.5° northward in July and August. Meridional transport of CIAMs through persistent outflow regions from the NAMA circulation to the global stratosphere has the potential to impact global stratospheric composition beyond convective source regions.

Immunopathogenesis of canine chronic ulcerative stomatitis.

Canine Chronic Ulcerative Stomatitis is a spontaneously occurring inflammatory disease of the oral mucosa. An immune-mediated pathogenesis is suspected though not yet proven. We have recently reported on the clinical and histologic features, and identification of select leukocyte cell populations within the lesion. A clinical and histologic similarity to oral lichen planus of people was proposed. In the present study, these initial observations are extended by examining lesions from 24 dogs with clinical evidence of chronic ulcerative stomatitis. Because dogs with chronic ulcerative stomatitis often have concurrent periodontal disease, we wondered if dental plaque/biofilm may be a common instigator of inflammation in both lesions. We hypothesized that dogs with chronic ulcerative stomatitis would exhibit a spectrum of pathologic changes and phenotype of infiltrating leukocytes that would inform lesion pathogenesis and that these changes would differ from inflammatory phenotypes in periodontitis. Previously we identified chronic ulcerative stomatitis lesions to be rich in FoxP3+ and IL17+ cells. As such, we suspect that these leukocytes play an important role in lesion pathogenesis. The current study confirms the presence of moderate to large numbers of FoxP3+ T cells and IL17+ cells in all ulcerative stomatitis lesions using confocal immunofluorescence. Interestingly, the majority of IL17+ cells were determined to be non-T cells and IL17+ cell frequencies were negatively correlated with severity on the clinical scoring system. Three histologic subtypes of ulcerative stomatitis were determined; lichenoid, deep stomatitis and granulomatous. Periodontitis lesions, like stomatitis lesions, were B cell and plasma cell rich, but otherwise differed from the stomatitis lesions. Direct immunofluorescence results did not support an autoantibody-mediated autoimmune disease process. This investigation contributes to the body of literature regarding leukocyte involvement in canine idiopathic inflammatory disease pathogenesis.

Modeling the Effect of Potential Nitric Acid Removal During Convective Injection of Water Vapor Over the Central United States on the Chemical Composition of the Lower Stratosphere.

Tropopause-penetrating convection is a frequent seasonal feature of the Central United States climate. This convection presents the potential for consistent transport of water vapor into the upper troposphere and lower stratosphere (UTLS) through the lofting of ice, which then sublimates. Water vapor enhancements associated with convective ice lofting have been observed in both in situ and satellite measurements. These water vapor enhancements can increase the probability of sulfate aerosol-catalyzed heterogeneous reactions that convert reservoir chlorine (HCl and ClONO2) to free radical chlorine (Cl and ClO) that leads to catalytic ozone loss. In addition to water vapor transport, lofted ice may also scavenge nitric acid and further impact the chlorine activation chemistry of the UTLS. We present a photochemical model that resolves the vertical chemical structure of the UTLS to explore the effect of water vapor enhancements and potential additional nitric acid removal. The model is used to define the response of stratospheric column ozone to the range of convective water vapor transported and the temperature variability of the lower stratosphere currently observed over the Central United States in conjunction with potential nitric acid removal and to scenarios of elevated sulfate aerosol surface area density representative of possible future volcanic eruptions or solar radiation management. We find that the effect of HNO3 removal is dependent on the magnitude of nitric acid removal and has the greatest potential to increase chlorine activation and ozone loss under UTLS conditions that weakly favor the chlorine activation heterogeneous reactions by reducing NOx sources.

Continuous monitoring of aerial bioburden within intensive care isolation rooms and identification of high-risk activities.

BACKGROUND: The spread of pathogens via the airborne route is often underestimated, and little is known about the extent to which airborne microbial contamination levels vary throughout the day and night in hospital facilities. AIMS: To evaluate airborne contamination levels within intensive care unit (ICU) isolation rooms over 10-24-h periods in order to improve understanding of the variability of environmental aerial bioburden, and the extent to which ward activities may contribute. METHODS: Environmental air monitoring was conducted within occupied and vacant inpatient isolation rooms. A sieve impactor sampler was used to collect 500-L air samples every 15 min over 10-h (08:00-18:00 h) and 24-h (08:00-08:00 h) periods. Samples were collected, room activity was logged, and bacterial contamination levels were recorded as colony-forming units (cfu)/m3 air. FINDINGS: A high degree of variability in levels of airborne contamination was observed across all scenarios in the studied isolation rooms. Air bioburden increased as room occupancy increased, with air contamination levels highest in rooms occupied for the longest time during the study (10 days) (mean 104.4 cfu/m3, range 12-510 cfu/m3). Counts were lowest in unoccupied rooms (mean 20 cfu/m3) and during the night. CONCLUSION: Peaks in airborne contamination were directly associated with an increase in activity levels. This study provides the first clear evidence of the extent of variability in microbial airborne levels over 24-h periods in ICU isolation rooms, and found direct correlation between microbial load and ward activity.

Identifying Source Regions and the Distribution of Cross-Tropopause Convective Outflow Over North America During the Warm Season.

We analyzed the interaction between the North American monsoon anticyclone (NAMA) and summertime cross-tropopause convective outflow by applying a trajectory analysis to a climatology of convective overshooting tops (OTs) identified in GOES satellite images, which covers the domain from 29°S to 68°N and from 205 to 1.25°W for the time period of May through September 2013. With this analysis we identified seasonally, geographically, and altitude-dependent variability in NAMA strength and in cross-tropopause convection that control their interaction. We find that the NAMA has the strongest impact on the circulation of convectively influenced air masses in August. Over the entire time period examined the intertropical convergence zone contributes the majority of OTs with a larger fraction of total OTs at 370 K (on average 70%) than at 400 K (on average 52%). During August at 370 K, the convectively influenced air masses within the NAMA circulation, as determined by the trajectory analysis, are primarily sourced from the intertropical convergence zone (monthly average of 66.1%), while at 400 K the Sierra Madres and the Central United States combined constitute the dominant source region (monthly average of 44.1%, compared to 36.6% of the combined Intertropical Convergence Zone regions). When evaluating the impact of cross-tropopause convection on the composition and chemistry of the upper troposphere and lower stratosphere, the effects of the NAMA on both the distribution of convective outflow and the residence time of convectively influenced air masses within the NAMA region must be considered.

Coupling free radical catalysis, climate change, and human health.

We present the chain of mechanisms linking free radical catalytic loss of stratospheric ozone, specifically over the central United States in summer, to increased climate forcing by CO2 and CH4 from fossil fuel use. This case directly engages detailed knowledge, emerging from in situ aircraft observations over the polar regions in winter, defining the temperature and water vapor dependence of the kinetics of heterogeneous catalytic conversion of inorganic chlorine (HCl and ClONO2) to free radical form (ClO). Analysis is placed in the context of irreversible changes to specific subsystems of the climate, most notably coupled feedbacks that link rapid changes in the Arctic with the discovery that convective storms over the central US in summer both suppress temperatures and inject water vapor deep into the stratosphere. This places the lower stratosphere over the US in summer within the same photochemical catalytic domain as the lower stratosphere of the Arctic in winter engaging the risk of amplifying the rate limiting step in the ClO dimer catalytic mechanism by some six orders of magnitude. This transitions the catalytic loss rate of ozone in lower stratosphere over the United States in summer from HOx radical control to ClOx radical control, increasing the overall ozone loss rate by some two orders of magnitude over that of the unperturbed state. Thus we address, through a combination of observations and modeling, the mechanistic foundation defining why stratospheric ozone, vulnerable to increased climate forcing, is one of the most delicate aspects of habitability on the planet.

Universal decontamination of hospital surfaces in an occupied inpatient room with a continuous 405 nm light source.

BACKGROUND: Previous work has shown that a ceiling-mounted, 405 nm high-intensity narrow-spectrum light environmental decontamination system (HINS-light EDS) reduces bacterial contamination of environmental surfaces in a burns unit by between 27% and 75%. Examination of the efficacy of the light over extended exposure times and its probable mode of action was performed. AIM: To ascertain the correlation between bacterial kill achieved on sampled surface sites around the burns unit and both irradiance levels of the 405 nm light, and exposure time. METHODS: Seventy samples were taken using contact agar plates from surfaces within an occupied side-room in the burns unit before, during, and after a seven-day use of the HINS-light EDS. This was repeated in three separate studies. Statistical analysis determined whether there was significant decrease in environmental contamination during prolonged periods of HINS-light treatment, and whether there was an association between irradiance and bacterial kill. FINDINGS: A decrease of between 22% and 86% in the mean number of surface bacteria was shown during the use of the HINS-light EDS. When the light ceased to be used, increases of between 78% and 309% occurred. There was no correlation between bacterial kill and irradiance levels at each sampling site but strong correlation between bacterial kill and exposure time. CONCLUSION: Prolonged exposure to the HINS-light EDS causes a cumulative decontamination of the surfaces within a burns unit. The importance of exposure time and possible airborne effect over irradiance levels is emphasized.

Clinical and Histopathologic Characterization of Canine Chronic Ulcerative Stomatitis.

Canine chronic ulcerative stomatitis, also known as chronic ulcerative paradental stomatitis, is a painful condition of the oral cavity. The purpose of this study was to determine if there are commonalities in clinical and radiographic features among patients, whether the histopathologic evaluation might inform the pathogenesis, and whether the condition appears similar to human oral mucosal diseases. To do this, we prospectively collected clinical, radiographic, and histopathologic data from 20 dogs diagnosed with the disease. Clinical data were based on a clinical disease activity index, oral and periodontal examination parameters, and full-mouth dental radiographs. The histopathological and immunohistochemical data were based on oral mucosal samples obtained from erosive or ulcerated areas. Our findings revealed that canine chronic stomatitis is clinically characterized by painful oral mucosal ulcers of varying size, pattern, appearance, and distribution, most often associated with teeth with early periodontitis. Histologic examination revealed a subepithelial lichenoid band (interface mucositis) where B cells, T cells, and Forkhead-box protein 3 (FoxP3)- and interleukin-17-expressing cells were present. These cells might play a role in the underlying immune response and an immune-mediated pathogenesis is suspected. The clinical and histopathologic features of this chronic inflammatory mucosal disease in dogs resemble those of oral lichen planus in humans.

Population-based risks of mortality and preterm morbidity by gestational age and birth weight.

OBJECTIVE: The objective of this study is to examine the effect of small or large for gestational age (SGA/LGA) status on mortality and morbidity by gestational age. STUDY DESIGN: Logistic binomial regression was used to calculate relative risks (RRs) and 95% confidence intervals for infant mortality and preterm morbidities for SGA or LGA compared with appropriately grown (AGA) deliveries stratified by gestational age group. RESULTS: Compared with AGA infants of similar gestational age, SGA infants were at increased risk for infant mortality. Mortality risk was decreased for LGA infants born between 25 and 27 weeks (RR: 0.6) but increased for LGA infants born between 28 and 31 weeks (RR: 1.9). Risk of preterm morbidity was increased for SGA infants born between 28 and 38 weeks, but decreased for LGA infants born before 37 weeks. CONCLUSION: This study demonstrates the importance of considering birth weight for gestational age when evaluating morbidity and mortality risks.

Inactivation of micro-organisms isolated from infected lower limb arthroplasties using high-intensity narrow-spectrum (HINS) light.

High-intensity narrow-spectrum (HINS) light is a novel violet-blue light inactivation technology which kills bacteria through a photodynamic process, and has been shown to have bactericidal activity against a wide range of species. Specimens from patients with infected hip and knee arthroplasties were collected over a one-year period (1 May 2009 to 30 April 2010). A range of these microbial isolates were tested for sensitivity to HINS-light. During testing, suspensions of the pathogens were exposed to increasing doses of HINS-light (of 123mW/cm(2) irradiance). Non-light exposed control samples were also used. The samples were then plated onto agar plates and incubated at 37°C for 24 hours before enumeration. Complete inactivation (greater than 4-log10 reduction) was achieved for all of the isolates. The typical inactivation curve showed a slow initial reaction followed by a rapid period of inactivation. The doses of HINS-light required ranged between 118 and 2214 J/cm(2). Gram-positive bacteria were generally found to be more susceptible than Gram-negative. As HINS-light uses visible wavelengths, it can be safely used in the presence of patients and staff. This unique feature could lead to its possible use in the prevention of infection during surgery and post-operative dressing changes. Cite this article: Bone Joint J 2015;97-B:283-8.