Microbial production of high octane and high sensitivity olefinic ester biofuels.

BACKGROUND: Advanced spark ignition engines require high performance fuels with improved resistance to autoignition. Biologically derived olefinic alcohols have arisen as promising blendstock candidates due to favorable octane numbers and synergistic blending characteristics. However, production and downstream separation of these alcohols are limited by their intrinsic toxicity and high aqueous solubility, respectively. Bioproduction of carboxylate esters of alcohols can improve partitioning and reduce toxicity, but in practice has been limited to saturated esters with characteristically low octane sensitivity. If olefinic esters retain the synergistic blending characteristics of their alcohol counterparts, they could improve the bioblendstock combustion performance while also retaining the production advantages of the ester moiety. RESULTS: Optimization of Escherichia coli isoprenoid pathways has led to high titers of isoprenol and prenol, which are not only excellent standalone biofuel and blend candidates, but also novel targets for esterification. Here, a selection of olefinic esters enhanced blendstock performance according to their degree of unsaturation and branching. E. coli strains harboring optimized mevalonate pathways, thioester pathways, and heterologous alcohol acyltransferases (ATF1, ATF2, and SAAT) were engineered for the bioproduction of four novel olefinic esters. Although prenyl and isoprenyl lactate titers were limited to 1.48 ± 0.41 mg/L and 5.57 ± 1.36 mg/L, strains engineered for prenyl and isoprenyl acetate attained titers of 176.3 ± 16.0 mg/L and 3.08 ± 0.27 g/L, respectively. Furthermore, prenyl acetate (20% bRON = 125.8) and isoprenyl acetate (20% bRON = 108.4) exhibited blend properties comparable to ethanol and significantly better than any saturated ester. By further scaling cultures to a 2-L bioreactor under fed-batch conditions, 15.0 ± 0.9 g/L isoprenyl acetate was achieved on minimal medium. Metabolic engineering of acetate pathway flux further improved titer to attain an unprecedented 28.0 ± 1.0 g/L isoprenyl acetate, accounting for 75.7% theoretical yield from glucose. CONCLUSION: Our study demonstrated novel bioproduction of four isoprenoid oxygenates for fuel blending. Our optimized E. coli production strain generated an unprecedented titer of isoprenyl acetate and when paired with its favorable blend properties, may enable rapid scale-up of olefinic alcohol esters for use as a fuel blend additive or as a precursor for longer-chain biofuels and biochemicals.

Translating advances in microbial bioproduction to sustainable biotechnology.

Advances in synthetic biology have radically changed our ability to rewire microorganisms and significantly improved the scalable production of a vast array of drop-in biopolymers and biofuels. The success of a drop-in bioproduct is contingent on market competition with petrochemical analogues and weighted upon relative economic and environmental metrics. While the quantification of comparative trade-offs is critical for accurate process-level decision making, the translation of industrial ecology to synthetic biology is often ambiguous and assessment accuracy has proven challenging. In this review, we explore strategies for evaluating industrial biotechnology through life cycle and techno-economic assessment, then contextualize how recent developments in synthetic biology have improved process viability by expanding feedstock availability and the productivity of microbes. By juxtaposing biological and industrial constraints, we highlight major obstacles between the disparate disciplines that hinder accurate process evaluation. The convergence of these disciplines is crucial in shifting towards carbon neutrality and a circular bioeconomy.

Implications of Mitigating Ozone and Fine Particulate Matter Pollution in the Guangdong-Hong Kong-Macau Greater Bay Area of China Using a Regional-To-Local Coupling Model.

Ultrahigh-resolution air quality models that resolve sharp gradients of pollutant concentrations benefit the assessment of human health impacts. Mitigating fine particulate matter (PM2.5) concentrations over the past decade has triggered ozone (O3) deterioration in China. Effective control of both pollutants remains poorly understood from an ultrahigh-resolution perspective. We propose a regional-to-local model suitable for quantitatively mitigating pollution pathways at various resolutions. Sensitivity scenarios for controlling nitrogen oxide (NOx) and volatile organic compound (VOC) emissions are explored, focusing on traffic and industrial sectors. The results show that concurrent controls on both sectors lead to reductions of 17%, 5%, and 47% in NOx, PM2.5, and VOC emissions, respectively. The reduced traffic scenario leads to reduced NO2 and PM2.5 but increased O3 concentrations in urban areas. Guangzhou is located in a VOC-limited O3 formation regime, and traffic is a key factor in controlling NOx and O3. The reduced industrial VOC scenario leads to reduced O3 concentrations throughout the mitigation domain. The maximum decrease in median hourly NO2 is >11 µg/m³, and the maximum increase in the median daily maximum 8-hr rolling O3 is >10 µg/m³ for the reduced traffic scenario. When controls on both sectors are applied, the O3 increase reduces to <7 µg/m³. The daily averaged PM2.5 decreases by <2 µg/m³ for the reduced traffic scenario and varies little for the reduced industrial VOC scenario. An O3 episode analysis of the dual-control scenario leads to O3 decreases of up to 15 µg/m³ (8-hr metric) and 25 µg/m³ (1-hr metric) in rural areas.

Source terms for benchmarking models of SARS-CoV-2 transmission via aerosols and droplets.

There is ongoing and rapid advancement in approaches to modelling the fate of exhaled particles in different environments relevant to disease transmission. It is important that models are verified by comparison with each other using a common set of input parameters to ensure that model differences can be interpreted in terms of model physics rather than unspecified differences in model input parameters. In this paper, we define parameters necessary for such benchmarking of models of airborne particles exhaled by humans and transported in the environment during breathing and speaking.

Diversifying Isoprenoid Platforms via Atypical Carbon Substrates and Non-model Microorganisms.

Isoprenoid compounds are biologically ubiquitous, and their characteristic modularity has afforded products ranging from pharmaceuticals to biofuels. Isoprenoid production has been largely successful in Escherichia coli and Saccharomyces cerevisiae with metabolic engineering of the mevalonate (MVA) and methylerythritol phosphate (MEP) pathways coupled with the expression of heterologous terpene synthases. Yet conventional microbial chassis pose several major obstacles to successful commercialization including the affordability of sugar substrates at scale, precursor flux limitations, and intermediate feedback-inhibition. Now, recent studies have challenged typical isoprenoid paradigms by expanding the boundaries of terpene biosynthesis and using non-model organisms including those capable of metabolizing atypical C1 substrates. Conversely, investigations of non-model organisms have historically informed optimization in conventional microbes by tuning heterologous gene expression. Here, we review advances in isoprenoid biosynthesis with specific focus on the synergy between model and non-model organisms that may elevate the commercial viability of isoprenoid platforms by addressing the dichotomy between high titer production and inexpensive substrates.

Optimized gene expression from bacterial chromosome by high-throughput integration and screening.

Chromosomal integration of recombinant genes is desirable compared with expression from plasmids due to increased stability, reduced cell-to-cell variability, and elimination of the need for antibiotics for plasmid maintenance. Here, we present a new approach for tuning pathway gene expression levels via random integration and high-throughput screening. We demonstrate multiplexed gene integration and expression-level optimization for isobutanol production in Escherichia coli The integrated strains could, with far lower expression levels than plasmid-based expression, produce high titers (10.0 ± 0.9 g/liter isobutanol in 48 hours) and yields (69% of the theoretical maximum). Close examination of pathway expression in the top-performing, as well as other isolates, reveals the complexity of cellular metabolism and regulation, underscoring the need for precise optimization while integrating pathway genes into the chromosome. We expect this method for pathway integration and optimization can be readily extended to a wide range of pathways and chassis to create robust and efficient production strains.

Comprehensive evaluation of an advanced street canyon air pollution model.

A street canyon pollution dispersion model is described which accounts for a wide range of canyon geometries including deep and/or asymmetric canyons. The model uses up to six component sources to represent different effects of street canyons on the dispersion of road traffic emissions. The final concentration is a weighted sum of the component concentrations dependent on output point location; canyon geometry; and wind direction relative to canyon orientation. Conventional approaches to modeling pollution in street canyons, such as the "Operational Street Pollution Model" (OSPM), do not account for canyons with high aspect ratios, pavements, and building porosity, so are not applicable for all urban morphologies. The new model has been implemented within the widely used, street-level resolution ADMS-Urban air quality model, which is used for air quality assessment and forecasting in cities such as Hong Kong where high-rise buildings form deep and complex street canyons. The new model is evaluated in relation to measured pollutant concentration data from the "Optimisation of modelling methods for traffic pollution in streets" (TRAPOS) project and routine measurements from 42 monitoring sites in London. Comparisons have been made between modeling using the new canyon model; a simpler approach to canyon modeling based on the OSPM formulation; and without any inclusion of canyon effects. The TRAPOS dataset has been used to highlight the model's ability to replicate the dependence of concentration on wind speed and direction, and also to show improved model performance for the prediction of high concentration values, which is particularly important for model applications such as planning and assessment. The London dataset, in which the street canyons are less well defined, has also been used to demonstrate improved model performance for this advanced approach compared to the simpler methods, by categorizing the measurement locations according to site type (background, near-road, and strong canyon). Implications: Currently available air dispersion models do not allow for a number of geometric features that influence air dispersion within street canyon environments. The new advanced street canyon model described in this paper accounts for: emissions from each road carriageway separately; canyon asymmetry; canyon porosity; and pavements. The extensive model evaluation presented shows that the new model demonstrates good performance, better than more basic approaches in which the complex geometries that define "canyons" are neglected.

Random Chromosomal Integration and Screening Yields E. coli K-12 Derivatives Capable of Efficient Sucrose Utilization.

Chromosomal expression of heterologous genes offers stability and maintenance advantages over episomal expression, yet remains difficult to optimize through site-specific integration. The challenge has in large part been due to the variability of chromosomal gene expression, which has only recently been shown to be affected by multiple factors, including the local genomic context. In this work we utilize Tn5 transposase to randomly integrate a three-gene csc operon encoding nonphosphotransferase sucrose catabolism into the E. coli K-12 chromosome. Isolates from the transposon library yielded a range of growth rates on sucrose as the sole carbon source, including some that were comparable to that of E. coli K-12 on glucose (µmax = 0.70 ± 0.03 h-1). Narrowness of the growth rate distributions and faster growth compared to plasmids indicate that efficient csc expression is attainable. Furthermore, enhanced growth rate upon transduction into strains that underwent adaptive laboratory evolution indicate that sucrose catabolism is not limiting to cellular growth. We also show that transduction of a csc fast-growth locus into an isobutanol production strain yields high titer (7.56 ± 0.25 g/L) on sucrose as the sole carbon source. Our results demonstrate that random integration is an effective strategy for optimizing heterologous expression within the context of cellular metabolism for both fast growth and biochemical production phenotypes.

Potential and limitation of air pollution mitigation by vegetation and uncertainties of deposition-based evaluations.

The potential to capture additional air pollutants by introducing more vegetation or changing existing short vegetation to woodland on first sight provides an attractive route for lowering urban pollution. Here, an atmospheric chemistry and transport model was run with a range of landcover scenarios to quantify pollutant removal by the existing total UK vegetation as well as the UK urban vegetation and to quantify the effect of large-scale urban tree planting on urban air pollution. UK vegetation as a whole reduces area (population)-weighted concentrations significantly, by 10% (9%) for PM2.5, 30% (22%) for SO2, 24% (19%) for NH3 and 15% (13%) for O3, compared with a desert scenario. By contrast, urban vegetation reduces average urban PM2.5 by only approximately 1%. Even large-scale conversion of half of existing open urban greenspace to forest would lower urban PM2.5 by only another 1%, suggesting that the effect on air quality needs to be considered in the context of the wider benefits of urban tree planting, e.g. on physical and mental health. The net benefits of UK vegetation for NO2 are small, and urban tree planting is even forecast to increase urban NO2 and NOx concentrations, due to the chemical interaction with changes in BVOC emissions and O3, but the details depend on tree species selection. By extrapolation, green infrastructure projects focusing on non-greenspace (roadside trees, green walls, roof-top gardens) would have to be implemented at very large scales to match this effect. Downscaling of the results to micro-interventions solely aimed at pollutant removal suggests that their impact is too limited for their cost-benefit analysis to compare favourably with emission abatement measures. Urban vegetation planting is less effective for lowering pollution than measures to reduce emissions at source. The results highlight interactions that cannot be captured if benefits are quantified via deposition models using prescribed concentrations, and emission damage costs. This article is part of a discussion meeting issue 'Air quality, past present and future'.

Impact of air pollution on educational attainment for respiratory health treated students: A cross sectional data linkage study.

INTRODUCTION: There is some evidence that exam results are worse when students are acutely exposed to air pollution. Studies investigating the association between air pollution and academic attainment have been constrained by small sample sizes. METHODS: Cross sectional educational attainment data (2009-2015) from students aged 15-16 years in Cardiff, Wales were linked to primary health care data, modelled air pollution and measured pollen data, and analysed using multilevel linear regression models. Annual cohort, school and individual level confounders were adjusted for in single and multi-pollutant/pollen models. We stratified by treatment of asthma and/or Seasonal Allergic Rhinitis (SAR). RESULTS: A unit (10µg/m3) increase of short-term exposure to NO2 was associated with 0.044 (95% CI: -0.079, -0.008) reduction of standardised Capped Point Score (CPS) after adjusting for individual and household risk factors for 18,241 students. This association remained statistically significant after controlling for other pollutants and pollen. There was no association of PM2.5, O3, or Pollen with standardised CPS remaining after adjustment. We found no evidence that treatment for asthma or SAR modified the observed NO2 effect on educational attainment. CONCLUSION: Our study showed that short-term exposure to traffic-related air pollution, specifically NO2, was associated with detrimental educational attainment for students aged 15-16. Longitudinal investigations in different settings are required to confirm this possible impact and further work may uncover the long-term economic implications, and degree to which impacts are cumulative and permanent.

Biodiversity Improves Life Cycle Sustainability Metrics in Algal Biofuel Production.

Algal biofuel has yet to realize its potential as a commercial and sustainable bioenergy source, largely due to the challenge of maximizing and sustaining biomass production with respect to energetic and material inputs in large-scale cultivation. Experimental studies have shown that multispecies algal polycultures can be designed to enhance biomass production, stability, and nutrient recycling compared to monocultures. Yet, it remains unclear whether these impacts of biodiversity make polycultures more sustainable than monocultures. Here, we present results of a comparative life cycle assessment (LCA) for algal biorefineries to compare the sustainability metrics of monocultures and polycultures of six fresh-water algal species. Our results showed that when algae were grown in outdoor experimental ponds, certain bicultures improved the energy return on investment (EROI) and greenhouse gas emissions (GHGs) by 20% and 16%, respectively, compared to the best monoculture. Bicultures outperformed monocultures by performing multiple functions simultaneously (e.g., improved stability, nutrient efficiency, biocrude characteristics), which outweighed the higher productivity attainable by a monoculture. Our results demonstrate that algal polycultures with optimized multifunctionality lead to enhanced life cycle metrics, highlighting the significant potential of ecological engineering for enabling future environmentally sustainable algal biorefineries.

DETERMINING INSULIN DOSE AT THE TIME OF DISCHARGE IN A HIGH-RISK POPULATION: IS THERE ROOM FOR IMPROVEMENT?

OBJECTIVE: To evaluate the adequacy of the insulin dose prescribed at hospital discharge in a high-risk population and assess patient characteristics that influence insulin dose requirement in the immediate postdischarge period. METHODS: This was a retrospective study conducted at Parkland Health System. We included all patients admitted to a medical floor who received an insulin prescription at discharge and had at least one follow-up visit within 6 months of discharge. All data were extracted by a detailed manual review of each electronic medical record. RESULTS: At the postdischarge follow-up (N = 797, median 33 days from discharge), 60% of patients required an insulin dose adjustment; 47% of the patients required a dose decrease. Significant predictors of a decrease insulin requirement postdischarge included (multiple regression beta coefficient [95% confidence interval]): newly diagnosed diabetes, -12.7 (-17.7, -7.7); ketosis-prone diabetes, -8.4 (-15, -1.8); glycated hemoglobin A1c (HbA1c), <10% (86 mmol/mol) -7.0 (-11.4, -2.6); discharge insulin total daily dose, -5.3 (-9.3, -1.3); and metformin prescription, -4.9 (-8.4, -1.3). CONCLUSION: An insulin dose adjustment (most commonly a decrease) was necessary shortly after discharge in more than half of our patients. A better model to estimate insulin dose at discharge is needed along with short-term follow-up after discharge for insulin titration. A pre-emptive insulin dose reduction at discharge should be considered for patients with newly diagnosed diabetes, ketosis-prone diabetes, metformin prescription, and those with HbA1c <10% at presentation. ABBREVIATIONS: DKA = diabetic ketoacidosis; HbA1c = glycated hemoglobin A1c; KPDM = ketosis-prone diabetes mellitus; TDD = total daily dose.

Development and Evaluation of the R-LINE Model Algorithms to Account for Chemical Transformation in the Near-road Environment.

With increased urbanization, there is increased mobility leading to higher amount of traffic-related activity on a global scale. Most NOx from combustion sources (about 90-95%) are emitted as NO, which is then readily converted to NO2 in the ambient air, while the remainder is emitted largely as NO2. Thus, the bulk of ambient NO2 is formed due to secondary production in the atmosphere, and which R-LINE cannot predict given that it can only model the dispersion of primary air pollutants. NO2 concentrations near major roads are appreciably higher than those measured at monitors in existing networks in urban areas, motivating a need to incorporate a mechanism in R-LINE to account for NO2 formation. To address this, we implemented three different approaches in order of increasing degrees of complexity and barrier to implementation from simplest to more complex. The first is an empirical approach based upon fitting a 4th order polynomial to existing near-road observations across the continental U.S., the second involves a simplified two-reaction chemical scheme, and the third involves a more detailed set of chemical reactions based upon the Generic Reaction Set (GRS) mechanism. All models were able to estimate more than 75% of concentrations within a factor of two of the near-road monitoring data and produced comparable performance statistics. These results indicate that the performance of the new R-LINE chemistry algorithms for predicting NO2 is comparable to other models (i.e. ADMS-Roads with GRS), both showing less than ±15% fractional bias and less than 45% normalized mean square error.

Creating individual level air pollution exposures in an anonymised data safe haven: a platform for evaluating impact on educational attainment.

INTRODUCTION: There is a lack of evidence on the adverse effects of air pollution on cognition for people with air quality-related health conditions. We propose that educational attainment, as a proxy for cognition, may increase with improved air quality. This study will explore whether asthma and seasonal allergic rhinitis, when exacerbated by acute exposure to air pollution, is associated with educational attainment. OBJECTIVE: To describe the preparation of individual and household-level linked environmental and health data for analysis within an anonymised safe haven. Also to introduce our statistical analysis plan for our study: COgnition, Respiratory Tract illness and Effects of eXposure (CORTEX). METHODS: We imported daily air pollution and aeroallergen data, and individual level education data into the SAIL databank, an anonymised safe haven for person-based records. We linked individual-level education, socioeconomic and health data to air quality data for home and school locations, creating tailored exposures for individuals across a city. We developed daily exposure data for all pupils in repeated cross sectional exam cohorts (2009-2015). CONCLUSION: We have used the SAIL databank, an innovative, data safe haven to create individual-level exposures to air pollution and pollen for multiple daily home and school locations. The analysis platform will allow us to evaluate retrospectively the impact of air quality on attainment for multiple cross-sectional cohorts of pupils. Our methods will allow us to distinguish between the pollution impacts on educational attainment for pupils with and without respiratory health conditions. The results from this study will further our understanding of the effects of air quality and respiratory-related health conditions on cognition. HIGHLIGHTS: This city-wide study includes longitudinal routinely-recorded educational attainment data for all pupils taking exams over seven years;High spatial resolution air pollution data were linked within a privacy protected databank to obtain individual exposure at multiple daily locations;This study will use health data linked at the individual level to explore associations between air pollution, related morbidity, and educational attainment.

Ascending Aortic Dimensions in Former National Football League Athletes.

BACKGROUND: Ascending aortic dimensions are slightly larger in young competitive athletes compared with sedentary controls, but rarely >40 mm. Whether this finding translates to aortic enlargement in older, former athletes is unknown. METHODS AND RESULTS: This cross-sectional study involved a sample of 206 former National Football League (NFL) athletes compared with 759 male subjects from the DHS-2 (Dallas Heart Study-2; mean age of 57.1 and 53.6 years, respectively, P<0.0001; body surface area of 2.4 and 2.1 m2, respectively, P<0.0001). Midascending aortic dimensions were obtained from computed tomographic scans performed as part of a NFL screening protocol or as part of the DHS. Compared with a population-based control group, former NFL athletes had significantly larger ascending aortic diameters (38±5 versus 34±4 mm; P<0.0001). A significantly higher proportion of former NFL athletes had an aorta of >40 mm (29.6% versus 8.6%; P<0.0001). After adjusting for age, race, body surface area, systolic blood pressure, history of hypertension, current smoking, diabetes mellitus, and lipid profile, the former NFL athletes still had significantly larger ascending aortas (P<0.0001). Former NFL athletes were twice as likely to have an aorta >40 mm after adjusting for the same parameters. CONCLUSIONS: Ascending aortic dimensions were significantly larger in a sample of former NFL athletes after adjusting for their size, age, race, and cardiac risk factors. Whether this translates to an increased risk is unknown and requires further evaluation.

Demonstration of transgressive overyielding of algal mixed cultures in microdroplets.

Algae are ubiquitous in natural ecosystems and have been studied extensively for biofuel production due to their unique metabolic capabilities. Most studies to date have approached biofuel optimization through synthetic biology and process engineering with few industrial scale projects considering algal community interactions. Such interactions can potentially lead to increased productivity and reduced community invasability, both important characteristics for scalable algal biofuel production. It is estimated that over a million species of algae exist such that elucidating the interactions that might be beneficial for biofuel production remains extremely resource and time intensive. Here we describe a strategy for rapid, high-throughput screening of algal community combinations using a microfluidic platform to generate millions of parallel, nanoliter-scale algal mixed cultures for estimation of biomass accumulation. Model communities were first studied in a bench scale flask experiment and then examined using microfluidic droplets. These experiments showed consistent results for both positively interacting algal bicultures that increase biomass when together, and negatively interacting bicultures that decrease biomass. Specifically, these included enhanced performance of two bicultures, Ankistrodesmus falcatus and Chlorella sorokiniana, Chlorella sorokiniana and Selenastrum minutum, and reduced performance of a biculture consisting of Selenastrum capricornutum and Scenedesmus ecornis. While the ultimate techno-economic feasibility of algal bioproducts hinges on an amalgamation of scientific fields, rapid screening of algal communities will prove imperative for efficiently discovering community interactions.

A 3D virtual reality ophthalmoscopy trainer.

BACKGROUND: Performing eye examinations is an important clinical skill that medical students often find difficult to become proficient in. This paper describes the development and evaluation of an innovative 3D virtual reality (VR) training application to support learning these skills. METHODS: The VR ophthalmoscope was developed by a clinical team and technologist using the unity game engine, smartphone and virtual reality headset. It has a series of tasks that include performing systematic eye examinations, identifying common eye pathologies and a knowledge quiz. As part of their clinical training, 15 fourth-year medical students were surveyed for their views on this teaching approach. The Technology Acceptance Model was used to evaluate perceived usefulness and ease of use. Data were also collected on the usability of the app, together with the students' written comments about it. RESULTS: Users agreed that the teaching approach improved their understanding of ophthalmoscopy (n = 14), their ability to identify landmarks in the eye (n = 14) and their ability to recognise abnormalities (n = 15). They found the app easy to use (n = 15), the teaching approach informative (n = 13) and that it would increase students' confidence when performing these tasks in future (n = 15). Performing eye examinations is an important clinical skill DISCUSSION: The evaluation showed that a VR app can successfully simulate the processes involved in performing eye examinations. The app was highly rated for all elements of perceived usefulness, ease of use and usability. Medical students stated that they would like to be taught other medical skills in this way in future.

Birmingham Behçet's service: classification of disease and application of the 2014 International Criteria for Behçet's Disease (ICBD) to a UK cohort.

BACKGROUND: This study reports on the analysis of the application and diagnostic predictability of the revised 2014 ICBD criteria in an unselected cohort of UK patients, and the ensuing organ associations and patterns of disease. METHODS: A retrospective cohort study was conducted using a database of electronic medical records. Three categories were recognised: clinically defined BD, incomplete BD and rejected diagnoses of BD. We applied the ISG 1990 and ICBD 2014 classification criteria to these subgroups to validate diagnostic accuracy against the multidisciplinary assessment. RESULTS: Between 2012 and 2015, 281 patients underwent initial assessment at an urban tertiary care centre: 190 patients with a confirmed diagnosis of BD, 7 with an incomplete diagnosis, and 84 with a rejected diagnosis. ICBD 2014 demonstrated an estimated sensitivity of 97.89% (95% CI: 94.70 to 99.42) and positive likelihood ratio of 1.21 (1.10 to 1.28). The strongest independent predictors were: Central nervous lesions (OR = 10.57, 95% CI: 1.34 to 83.30); Genital ulceration (OR = 9.05, 95% CI: 3.35 to 24.47); Erythema nodosum (OR = 6.59, 95% CI: 2.35 to 18.51); Retinal vasculitis (OR = 6.25, 95% CI: 1.47 to 26.60); Anterior uveitis (OR = 6.16, 95% CI: 2.37 to 16.02); Posterior uveitis (OR = 4.82, 95% CI: 1.25 to 18.59). CONCLUSIONS: The ICBD 2014 criteria were more sensitive at picking up cases than ISG 1990 using the multidisciplinary assessment as the gold standard. ICBD may over-diagnose BD in a UK population. Patients who have an incomplete form of BD represent a distinct group that should not be given an early diagnostic label. Behçet's disease is a complex disease that is best diagnosed by multidisciplinary clinical assessment. Patients in the UK differ in their clinical presentation and genetic susceptibility from the original descriptions. This study also highlights an incomplete group of Behçet's patients that are less well defined by their clinical presentation.

Multiple Aneurysms and a Transplanted Kidney in Behçet Disease.

Arterial manifestation of Behçet disease represents a challenging clinical scenario with a potential for fatal complications. This case depicts the surgical management of a 4.5-cm infrarenal aortic aneurysm and a 6-cm left renal artery aneurysm in a patient with known Behçet disease. The presence of a contralateral living donor kidney transplant added to the complexity of the case. Open surgical repair was performed on both aneurysms with the use of axillofemoral bypass to protect the transplanted kidney. This case highlights the challenges of treating an aortic aneurysm in a patient with Behçet disease and a kidney transplant.

Evaluation of an explicit NOx chemistry method in AERMOD.

An explicit NOx chemistry method has been implemented in AERMOD version 15181, ADMSM. The scheme has been evaluated by comparison with the methodologies currently recommended by the U.S. EPA for Tier 3 NO2 calculations, that is, OLM and PVMRM2. Four data sets have been used for NO2 chemistry method evaluation. Overall, ADMSM-modeled NO2 concentrations show the most consistency with the AERMOD calculations of NOx and the highest Index of Agreement; they are also on average lower than those of both OLM and PVMRM2. OLM shows little consistency with modeled NOx concentrations and markedly overpredicts NO2. PVMRM2 shows performance closer to that of ADMSM than OLM; however, its behavior is inconsistent with modeled NOx in some cases and it has less good statistics for NO2. The trend in model performance can be explained by examining the features particular to each chemistry method: OLM can be considered as a screening model as it calculates the upper bound of conversion from NO to NO2 possible with the background O3 concentration; PVMRM2 includes a much-improved estimate of in-plume O3 but is otherwise similar to OLM, assuming instantaneous reaction of NO with O3; and ADMSM allows for the rate of this reaction and also the photolysis of NO2. Evaluation with additional data sets is needed to further clarify the relative performance of ADMSM and PVMRM2. IMPLICATIONS: Extensive evaluation of the current AERMOD Tier 3 chemistry methods OLM and PVMRM2, alongside a new scheme that explicitly calculates the oxidation of NO by O3 and the reverse photolytic reaction, shows that OLM consistently overpredicts NO2 concentrations. PVMRM2 performs well in general, but there are some cases where this method overpredicts NO2. The new explicit NOx chemistry scheme, ADMSM, predicts NO2 concentrations that are more consistent with both the modeled NOx concentrations and the observations.