A Review of Subsidence Monitoring Techniques in Offshore Environments.

In view of the ever-increasing global energy demands and the imperative for sustainability in extraction methods, this article surveys subsidence monitoring systems applied to oil and gas fields located in offshore areas. Subsidence is an issue that can harm infrastructure, whether onshore or especially offshore, so it must be carefully monitored to ensure safety and prevent potential environmental damage. A comprehensive review of major monitoring technologies used offshore is still lacking; here, we address this gap by evaluating several techniques, including InSAR, GNSSs, hydrostatic leveling, and fiber optic cables, among others. Their accuracy, applicability, and limitations within offshore operations have also been assessed. Based on an extensive literature review of more than 60 published papers and technical reports, we have found that no single method works best for all settings; instead, a combination of different monitoring approaches is more likely to provide a reliable subsidence assessment. We also present selected case histories to document the results achieved using integrated monitoring studies. With the emerging offshore energy industry, combining GNSSs, InSAR, and other subsidence monitoring technologies offers a pathway to achieving precision in the assessment of offshore infrastructural stability, thus underpinning the sustainability and safety of offshore oil and gas operations. Reliable and comprehensive subsidence monitoring systems are essential for safety, to protect the environment, and ensure the sustainable exploitation of hydrocarbon resources.

Therapeutic and Diagnostic Potential of Folic Acid Receptors and Glycosylphosphatidylinositol (GPI) Transamidase in Prostate Cancer.

Due to the proliferation-induced high demand of cancer cells for folic acid (FA), significant overexpression of folate receptors 1 (FR1) is detected in most cancers. To our knowledge, a detailed characterization of FR1 expression and regulation regarding therapeutic and diagnostic feasibilities in prostate cancer (PCa) has not been described. In the present study, cell cultures, as well as tissue sections, were analyzed using Western blot, qRT-PCR and immunofluorescence. In addition, we utilized FA-functionalized lipoplexes to characterize the potential of FR1-targeted delivery into PCa cells. Interestingly, we detected a high level of FR1-mRNA in healthy prostate epithelial cells and healthy prostate tissue. However, we were able to show that PCa cells in vitro and PCa tissue showed a massively enhanced FR1 membrane localization where the receptor can finally gain its function. We were able to link these changes to the overexpression of GPI-transamidase (GPI-T) by image analysis. PCa cells in vitro and PCa tissue show the strongest overexpression of GPI-T and thereby induce FR1 membrane localization. Finally, we utilized FA-functionalized lipoplexes to selectively transfer pDNA into PCa cells and demonstrate the therapeutic potential of FR1. Thus, FR1 represents a very promising candidate for targeted therapeutic transfer pathways in PCa and in combination with GPI-T, may provide predictive imaging in addition to established diagnostics.

Metastatic Salivary Duct Carcinoma with ERBB2 Amplification and Sequential Response to Ado-Trastuzumab Emtansine and Neratinib: A Case Report.

Introduction: Salivary duct carcinoma (SDC) is an aggressive and rare subtype of salivary gland carcinoma. Surgical excision and radiotherapy are standard of care for early cancer. Chemotherapies with taxanes and platinum show overall response rates between 39% and 50%. SDCs are often associated with an overexpression of the androgen receptor (AR) and HER2/neu which have recently become druggable targets. Case Presentation: Here, we report on an 84-year-old male patient with metastatic SDC of the right parotid gland. In 2017, he underwent a right total parotidectomy, a right neck dissection, and an infratemporal fossa clearance followed by 6 weeks of radiotherapy. In 2018, due to metastatic spread in the lungs, bones, and pararenal gland, a pathological workup of the tumor tissue was performed and revealed both AR and HER2 overexpression, respectively. Consequently, he underwent androgen deprivation therapy and, due to asymptomatic progression, sequentially human epidermal growth factor receptor 2 (HER-2)-targeted therapy with ado-trastuzumab emtansine and neratinib, which led to stable disease during the course of about 18 months. The electronically captured patient-reported outcome had demonstrated a good tolerance of all three therapeutic lines. Conclusion: In conclusion, since effective standard therapeutic treatment options for SDC may often not be tolerable in older patients, the implementation of personalized and adaptive treatments, especially in patients with rare tumor types, might offer valuable treatment options.

A New Inert Natural Deep Eutectic Solvent (NADES) as a Reaction Medium for Food-Grade Maillard-Type Model Reactions.

Sustainability, low toxicity, and high solute potential are the fundamental reasons for focusing green chemistry on natural deep eutectic solvents (NADES). The application of NADES ranges from organic chemistry to the agricultural sector and the food industry. In the food industry, the desired food quality can be achieved by the extraction of small molecules, macromolecules, and even heavy metals. The compound yield in Maillard-type model reactions can also be increased using NADES. To extend the so-called "kitchen-type chemistry" field, an inert, food-grade NADES system based on sucrose/D-sorbitol was developed, characterized, and examined for its ability as a reaction medium by evaluating its temperature and pH stability. Reaction boundary conditions were determined at 100 °C for three hours with a pH range of 3.7-9.0. As proof of principle, two Maillard-type model reactions were implemented to generate the taste-modulating compounds N2-(1-carboxyethyl)guanosine 5'-monophosphate) (161.8 µmol/mmol) and N2-(furfuryl thiomethyl)guanosine 5'-monophosphate (95.7 µmol/g). Since the yields of both compounds are higher than their respective taste-modulating thresholds, the newly developed NADES is well-suited for these types of "kitchen-type chemistry" and, therefore, a potential solvent candidate for a wide range of applications in the food industry.

Legacy Effects in Buds and Leaves of European Beech Saplings (Fagus sylvatica) after Severe Drought.

Against the background of climate change, we studied the effects of a severe summer drought on buds of European beech (Fagus sylvatica L.) saplings and on leaves formed during the subsequent spring in trees attributed to different drought-damage classes. For the first time, we combined assessments of the vitality (assessed through histochemical staining), mass and stable carbon isotope ratios (δ13C) of buds from drought-stressed woody plants with morphological and physiological variables of leaves that have emerged from the same plants and crown parts. The number, individual mass and vitality of the buds decreased and δ13C increased with increasing drought-induced damage. Bud mass, vitality and δ13C were significantly intercorrelated. The δ13C of the buds was imprinted on the leaves formed in the subsequent spring, but individual leaf mass, leaf size and specific leaf area were not significantly different among damage classes. Vitality and δ13C of the buds are suitable indicators of the extent of preceding drought impact. Bud vitality may be used as a simple means of screening saplings for the flushing capability in the subsequent spring. European beech saplings are susceptible, but-due to interindividual differences-are resilient, to a certain extent, to a singular severe drought stress.

Microbiological and Clinical Effects of a Proanthocyanidin-enriched Extract from Rumex acetosa in Periodontally Healthy Carriers of Porphyromonas gingivalis: a Randomized Controlled Pilot Study.

Rumex acetosa significantly inhibits the adhesion of Porphyromonas gingivalis (P. g.) to eukaryotic host cells in vitro. The objective of this randomized placebo-controlled pilot-trial was to analyze effects of a mouth rinse containing 0.8% (w/w) of a quantified proanthocyanidin-enriched extract from Rumex acetosa (RA1) on microbiological, clinical, and cytological parameters in systemically healthy individuals without history of periodontitis, harboring P. g. intraorally. 35 subjects received a supragingival debridement (SD) followed by mouth rinsing (3 times daily) with either RA1 mouth rinse solution (test) or placebo (control) for 7 days as adjunct to routine oral hygiene. Supragingival biofilm samples were taken at screening visit, baseline (BL), 2, 4, 7 and 14 days after SD. P. g. and 11 other oral microorganisms were detected and quantified by rtPCR. Changes in the oral microbiota composition of one test and one control subject were assessed via high throughput 16S rRNS gene amplicon sequencing. Approximal Plaque Index (API) and the modified Sulcular Bleeding Index (SBI) were assessed at BL, 7- and 14-days following SD. Brush biopsies were taken at BL and 14 d following SD. Intergroup comparisons revealed no significant microbiological, cytological, and clinical differences at any timepoint. However, a significant reduction in SBI at day 14 (p = 0.003) and API at day 7 (p = 0.02) and day 14 (p = 0.009) was found in the test group by intragroup comparison. No severe adverse events were observed. The results indicate that RA1 mouth rinse is safe but does not seem to inhibit colonization of P. g. or improve periodontal health following SD.

Computer clinical decision support that automates personalized clinical care: a challenging but needed healthcare delivery strategy.

How to deliver best care in various clinical settings remains a vexing problem. All pertinent healthcare-related questions have not, cannot, and will not be addressable with costly time- and resource-consuming controlled clinical trials. At present, evidence-based guidelines can address only a small fraction of the types of care that clinicians deliver. Furthermore, underserved areas rarely can access state-of-the-art evidence-based guidelines in real-time, and often lack the wherewithal to implement advanced guidelines. Care providers in such settings frequently do not have sufficient training to undertake advanced guideline implementation. Nevertheless, in advanced modern healthcare delivery environments, use of eActions (validated clinical decision support systems) could help overcome the cognitive limitations of overburdened clinicians. Widespread use of eActions will require surmounting current healthcare technical and cultural barriers and installing clinical evidence/data curation systems. The authors expect that increased numbers of evidence-based guidelines will result from future comparative effectiveness clinical research carried out during routine healthcare delivery within learning healthcare systems.

The Inflammasome Activity of NLRP3 Is Independent of NEK7 in HEK293 Cells Co-Expressing ASC.

The cytosolic immune receptor NLRP3 (nucleotide-binding domain, leucine-rich repeat (LRR), and pyrin domain (PYD)-containing protein 3) oligomerizes into the core of a supramolecular complex termed inflammasome in response to microbes and danger signals. It is thought that NLRP3 has to bind NEK7 (NIMA (never in mitosis gene a)-related kinase 7) to form a functional inflammasome core that induces the polymerization of the adaptor protein ASC (Apoptosis-associated speck-like protein containing a CARD (caspase recruitment domain)), which is a hallmark for NLRP3 activity. We reconstituted the NLRP3 inflammasome activity in modified HEK293 (human embryonic kidney 293) cells and showed that the ASC speck polymerization is independent of NEK7 in the context of this cell system. Probing the interfaces observed in the different, existing structural models of NLRP3 oligomers, we present evidence that the NEK7-independent, constitutively active NLRP3 inflammasome core in HEK293 cells may resemble a stacked-torus-like hexamer seen for NLRP3 lacking its PYD (pyrin domain).

The Sensory-Directed Elucidation of the Key Tastants and Odorants in Sourdough Bread Crumb.

Sourdough bread is highly enjoyed for its exceptional flavor. In contrast to bread crust, which has been investigated intensively, the knowledge on bread crumb is rather fragmentary. In this study, the taste-active compounds of sourdough bread crumb were identified and quantified. By means of recombination experiments and omission tests, the authentic flavor signature of sourdough rye bread crumb was decoded and recreated with ten key tastants and eleven key odorants. Based on the final taste and aroma recombinants, a fast and sensitive ultra-high-performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) method using stable isotope dilution analysis (SIDA) was developed and validated. Due to prior derivatization using 3-nitrophenylhydrazine (3-NPH), key tastants and odorants in bread crumb could be quantified simultaneously in a single UHPLC run. The identified key flavor compounds in combination with the developed UHPLC-MS/MS method could offer the scientific basis for a knowledge-based optimization of the taste and odor of sourdough bread.

A Quality Initiative to Improve Postdischarge Care for Patients on Outpatient Parenteral Antimicrobial Therapy.

Background: Patients discharged from the hospital on outpatient parenteral antimicrobial therapy (OPAT) require close monitoring, including weekly blood tests and an early posthospital follow-up visit. However, because patients often receive OPAT in a separate healthcare system from where they received inpatient care, the OPAT plan often fails, with less than 75% of OPAT patients receiving the recommended laboratory monitoring. We sought to determine whether changing our inpatient OPAT documentation method would improve postdischarge care. Methods: As a quality improvement initiative, we conducted 2 Plan-Do-Study-Act interventions on our OPAT documentation. Our first intervention was to create a standardized OPAT Progress Note, and our second was to turn that note into a SmartForm (Epic) with discrete fields for the key information. We examined the effects of these changes on the rate of completion of recommended laboratory monitoring, attendance at outpatient follow-up visits, and 30-day readmission rates. Results: Changing our documentation to a standardized Progress Note and then to a SmartForm with discrete fields led to an increase in the proportion of patients with a serum creatinine checked within 10 days of discharge (from 63% to 71% to 73%) and who attended an infectious disease clinic visit within 3 weeks of discharge (from 21% to 36% to 47%). However, the rate of readmissions for OPAT-related problems did not change, nor did a composite outcome of 30-day mortality/unplanned readmission. Conclusions: Changes in how and where care plans are documented in the inpatient medical record can have significant effects on patient care outcomes after discharge.

Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions.

Clinical decision-making is based on knowledge, expertise, and authority, with clinicians approving almost every intervention-the starting point for delivery of "All the right care, but only the right care," an unachieved healthcare quality improvement goal. Unaided clinicians suffer from human cognitive limitations and biases when decisions are based only on their training, expertise, and experience. Electronic health records (EHRs) could improve healthcare with robust decision-support tools that reduce unwarranted variation of clinician decisions and actions. Current EHRs, focused on results review, documentation, and accounting, are awkward, time-consuming, and contribute to clinician stress and burnout. Decision-support tools could reduce clinician burden and enable replicable clinician decisions and actions that personalize patient care. Most current clinical decision-support tools or aids lack detail and neither reduce burden nor enable replicable actions. Clinicians must provide subjective interpretation and missing logic, thus introducing personal biases and mindless, unwarranted, variation from evidence-based practice. Replicability occurs when different clinicians, with the same patient information and context, come to the same decision and action. We propose a feasible subset of therapeutic decision-support tools based on credible clinical outcome evidence: computer protocols leading to replicable clinician actions (eActions). eActions enable different clinicians to make consistent decisions and actions when faced with the same patient input data. eActions embrace good everyday decision-making informed by evidence, experience, EHR data, and individual patient status. eActions can reduce unwarranted variation, increase quality of clinical care and research, reduce EHR noise, and could enable a learning healthcare system.

Effects of soil moisture, needle age and leaf morphology on carbon and oxygen uptake, incorporation and allocation: a dual labeling approach with 13CO2 and H218O in foliage of a coniferous forest.

The carbon and oxygen isotopic composition of water and assimilates in plants reveals valuable information on plant responses to climatic conditions. Yet, the carbon and oxygen uptake, incorporation and allocation processes determining isotopic compositions are not fully understood. We carried out a dual-isotope labeling experiment at high humidity with 18O-enriched water (H218O) and 13C-enriched CO2 (13CO2) with attached Scots pine (Pinus sylvestris L.) branches and detached twigs of hemiparasitic mistletoes (Viscum album ssp. austriacum) in a naturally dry coniferous forest, where also a long-term irrigation takes place. After 4 h of label exposure, we sampled previous- and recent-year leaves, twig phloem and twig xylem over 192 h for the analysis of isotope ratios in water and assimilates. For both species, the uptake into leaf water and the incorporation of the 18O-label into leaf assimilates was not influenced by soil moisture, while the 13C-label incorporation into assimilates was significantly higher under irrigation compared with control dry conditions. Species-specific differences in leaf morphology or needle age did not affect 18O-label uptake into leaf water, but the incorporation of both tracers into assimilates was two times lower in mistletoe than in pine. The 18O-label allocation in water from pine needles to twig tissues was two times higher for phloem than for xylem under both soil moisture conditions. In contrast, the allocation of both tracers in pine assimilates were similar and not affected by soil moisture, twig tissue or needle age. Soil moisture effects on 13C-label but not on 18O-label incorporation into assimilates can be explained by the stomatal responses at high humidity, non-stomatal pathways for water and isotope exchange reactions. Our results suggest that non-photosynthetic 18O-incorporation processes may have masked prevalent photosynthetic processes. Thus, isotopic variation in leaf water could also be imprinted on assimilates when photosynthetic assimilation rates are low.

A Pathway for Community-Acquired Pneumonia With Rapid Conversion to Oral Therapy Improves Health Care Value.

BACKGROUND: Evidence supports streamlined approaches for inpatients with community-acquired pneumonia (CAP) including early transition to oral antibiotics and shorter therapy. Uptake of these approaches is variable, and the best approaches to local implementation of infection-specific guidelines are unknown. Our objective was to evaluate the impact of a clinical decision support (CDS) tool linked with a clinical pathway on CAP care. METHODS: This is a retrospective, observational pre-post intervention study of inpatients with pneumonia admitted to a single academic medical center. Interventions were introduced in 3 sequential 6-month phases; Phase 1: education alone; Phase 2: education and a CDS-driven CAP pathway coupled with active antimicrobial stewardship and provider feedback; and Phase 3: education and a CDS-driven CAP pathway without active stewardship. The 12 months preceding the intervention were used as a baseline. Primary outcomes were length of intravenous antibiotic therapy and total length of antibiotic therapy. Clinical, process, and cost outcomes were also measured. RESULTS: The study included 1021 visits. Phase 2 was associated with significantly lower length of intravenous and total antibiotic therapy, higher procalcitonin lab utilization, and a 20% cost reduction compared with baseline. Phase 3 was associated with significantly lower length of intravenous antibiotic therapy and higher procalcitonin lab utilization compared with baseline. CONCLUSIONS: A CDS-driven CAP pathway supplemented by active antimicrobial stewardship review led to the most robust improvements in antibiotic use and decreased costs with similar clinical outcomes.

Rhizosphere activity in an old-growth forest reacts rapidly to changes in soil moisture and shapes whole-tree carbon allocation.

Drought alters carbon (C) allocation within trees, thereby impairing tree growth. Recovery of root and leaf functioning and prioritized C supply to sink tissues after drought may compensate for drought-induced reduction of assimilation and growth. It remains unclear if C allocation to sink tissues during and following drought is controlled by altered sink metabolic activities or by the availability of new assimilates. Understanding such mechanisms is required to predict forests' resilience to a changing climate. We investigated the impact of drought and drought release on C allocation in a 100-y-old Scots pine forest. We applied 13CO2 pulse labeling to naturally dry control and long-term irrigated trees and tracked the fate of the label in above- and belowground C pools and fluxes. Allocation of new assimilates belowground was ca. 53% lower under nonirrigated conditions. A short rainfall event, which led to a temporary increase in the soil water content (SWC) in the topsoil, strongly increased the amounts of C transported belowground in the nonirrigated plots to values comparable to those in the irrigated plots. This switch in allocation patterns was congruent with a tipping point at around 15% SWC in the response of the respiratory activity of soil microbes. These results indicate that the metabolic sink activity in the rhizosphere and its modulation by soil moisture can drive C allocation within adult trees and ecosystems. Even a subtle increase in soil moisture can lead to a rapid recovery of belowground functions that in turn affects the direction of C transport in trees.

Granulomatous inflammation in lymph nodes of the head and neck-a retrospective analysis of causes in a population with very low incidence of tuberculosis.

The purpose of this study was to investigate the risk of the patient having: (1) TB, (2) sarcoidosis, (3) atypical mycobacteria, or (4) malignant disease, if FNAC or histology from a cervical lymph node shows granulomatous inflammation (GI). And to elucidate clinical characteristics associated with these causes of GI, patients with a pathological diagnosis of GI in head and neck lymph nodes were identified though a search of the Danish national pathology database. Charts were reviewed to identify the final clinical diagnosis and specific clinical characteristics. For the most common clinical diagnoses, association to clinical characteristics was analyzed using logistic regression (Odense University Hospital January 2006 to December 2015). We included 121 patients. Clinical diagnoses fell into the following categories: sarcoidosis (26%), tuberculosis (TB) (22%), cat scratch disease (6%), atypical mycobacteriosis (7%), malignancy (2%), and other (4%). In 33% of cases, the diagnosis was unknown. In the pediatric group, atypical mycobacteriosis was the most frequent clinical diagnosis (50%). TB and sarcoidosis were dependent variables in regression analysis. Characteristics significantly related to TB were histology showing necrotizing GI, gland localization in level 3-6, and origin other than Danish and TB being the tentative diagnosis. Characteristics significantly related to sarcoidosis were histology showing non-necrotizing GI, gland localization in level 3-6, the patient being of Danish origin, and unknown duration of symptoms. TB and sarcoidosis were the most common clinical diagnoses, and they were associated with specific clinical characteristics. In a third of cases, a specific clinical diagnosis was never given.

Differences in carbon isotope leaf-to-phloem fractionation and mixing patterns along a vertical gradient in mature European beech and Douglas fir.

While photosynthetic isotope discrimination is well understood, the postphotosynthetic and transport-related fractionation mechanisms that influence phloem and subsequently tree ring δ13 C are less investigated and may vary among species. We studied the seasonal and diel courses of leaf-to-phloem δ13 C differences of water-soluble organic matter (WSOM) in vertical crown gradients and followed the assimilate transport via the branches to the trunk phloem at breast height in European beech (Fagus sylvatica) and Douglas fir (Pseudotsuga menziesii). δ13 C of individual sugars and cyclitols from a subsample was determined by compound-specific isotope analysis. In beech, leaf-to-phloem δ13 C differences in WSOM increased with height and were partly caused by biochemical isotope fractionation between leaf compounds. 13 C-Enrichment of phloem sugars relative to leaf sucrose implies an additional isotope fractionation mechanism related to leaf assimilate export. In Douglas fir, leaf-to-phloem δ13 C differences were much smaller and isotopically invariant pinitol strongly influenced leaf and phloem WSOM. Trunk phloem WSOM at breast height reflected canopy-integrated δ13 C in beech but not in Douglas fir. Our results demonstrate that leaf-to-phloem isotope fractionation and δ13 C mixing patterns along vertical gradients can differ between tree species. These effects have to be considered for functional interpretations of trunk phloem and tree ring δ13 C.

The value of urgent care dermatology.

OBJECTIVE: To determine whether urgent care dermatology adds value (service + quality/cost) to healthcare. METHODS: A retrospective cross-sectional chart review of dermatologic patients in three service settings was compared: an urgent care dermatology clinic (same day dermatology [SDD]), the emergency department (ED), and a general dermatology clinic. Study period was July 1-September 30, 2014, for ED and SDD patients and August 2014 for general dermatology patients. ED patients had diagnoses of dermatitis (629.9) or rash (782). Final diagnoses, visit length, and no-show rates were determined. Cost and charge data for patients seen in SDD versus the ED were provided by the university, without raw data available for publication. RESULTS: For matched diagnoses, ED visits were 105 (95% CI: 68.7-152.4, P < 0.001) minutes longer than SDD visits. Compared to SDD, no-shows in the general dermatology clinic were 2.24 times more likely (95% CI: 1.0003-5.02, P = 0.045). The odds for an SDD patient to be diagnosed with a code that was also seen in the ED was 13.0 (95% CI: 8.0-21.2, P < 0.01) times higher than the odds for the same diagnosis to be given to patients seen in the general dermatology clinic. ED visits cost 25% more than SDD visits. Patient charges for an ED visit are 207% more than for an SDD visit. CONCLUSIONS: Urgent care dermatology clinic adds value to the healthcare system by providing quality care and excellent service at low cost. Dermatologists better utilize their skills by seeing acute, often-serious patients who would have otherwise been seen in the ED.

Growth and wood isotopic signature of Norway spruce (Picea abies) along a small-scale gradient of soil moisture.

Among the environmental factors that have an effect on the isotopic signature of tree rings, the specific impact of soil moisture on the Δ13C and, in particular, the δ18O ratios has scarcely been investigated. We studied the effects of soil type and soil moisture (from moderately moist [Cambisol] to wet [Gleysol]) on the growth and isotopic signature of tree rings of Norway spruce (Picea abies [L.] H. Karst.), a widely distributed forest tree species in Central Europe, at a small spatial scale in a typical mature forest plantation in the low mountain ranges of Western Germany. The δ18O ratios were lower in rings of trees growing at the wettest microsite (Gleysol) than in tree rings from the microsite with moderately moist soil (Cambisol). This indicates higher uptake rates of 18O-unenriched soil water at the Gleysol microsite and corresponds to less negative soil water potentials and higher transpiration rates on the Gleysol plots. Contrary to our expectations, the basal area increments, the Δ13C ratios and the intrinsic water-use efficiency (calculated on the basis of δ13C) did not differ significantly between the Cambisol and the Gleysol microsites. For average values of each microsite and year investigated, we found a significantly positive correlation between δ13C and δ18O, which indicates a consistent stomatal control over gas exchange along the soil moisture gradient at comparable relative air humidity in the stand. As δ18O ratios of tree rings integrate responses of wood formation to soil moisture over longer periods of time, they may help to identify microsites differing in soil water availability along small-scale gradients of soil moisture under homogeneous climatic conditions and to explain the occurrence of particular tree species along those gradients in forest stands.

[Meningitis and septic sinus thrombosis in connection with otitis media].

This is a case report of a 30-year-old female, who presented to the emergency department with headache, nausea and neck pain after five days of otitis media. After lumbar puncture, CT and MRI the patient was treated for meningitis with initial improvement in the clinical state. After four days she developed contralateral neurological symptoms, and after five days she had a seizure. MR-venography showed thrombosis of the lateral dural sinus with venous cerebral infarction. The treatment of intravenously administered antibiotics, mastoidectomy and anticoagulation is discussed and compared with other cases in the literature.

Leaf water 18 O and 2 H enrichment along vertical canopy profiles in a broadleaved and a conifer forest tree.

Distinguishing meteorological and plant-mediated drivers of leaf water isotopic enrichment is prerequisite for ecological interpretations of stable hydrogen and oxygen isotopes in plant tissue. We measured input and leaf water δ2 H and δ18 O as well as micrometeorological and leaf morpho-physiological variables along a vertical gradient in a mature angiosperm (European beech) and gymnosperm (Douglas fir) tree. We used these variables and different enrichment models to quantify the influence of Péclet and non-steady state effects and of the biophysical drivers on leaf water enrichment. The two-pool model accurately described the diurnal variation of leaf water enrichment. The estimated unenriched water fraction was linked to leaf dry matter content across the canopy heights. Non-steady state effects and reduced stomatal conductance caused a higher enrichment of Douglas fir compared to beech leaf water. A dynamic effect analyses revealed that the light-induced vertical gradients of stomatal conductance and leaf temperature outbalanced each other in their effects on evaporative enrichment. We conclude that neither vertical canopy gradients nor the Péclet effect is important for estimates and interpretation of isotopic leaf water enrichment in hypostomatous trees. Contrarily, species-specific non-steady state effects and leaf temperatures as well as the water vapour isotope composition need careful consideration.