Integrating plant physiology into simulation of fire behavior and effects.

Wildfires are a global crisis, but current fire models fail to capture vegetation response to changing climate. With drought and elevated temperature increasing the importance of vegetation dynamics to fire behavior, and the advent of next generation models capable of capturing increasingly complex physical processes, we provide a renewed focus on representation of woody vegetation in fire models. Currently, the most advanced representations of fire behavior and biophysical fire effects are found in distinct classes of fine-scale models and do not capture variation in live fuel (i.e. living plant) properties. We demonstrate that plant water and carbon dynamics, which influence combustion and heat transfer into the plant and often dictate plant survival, provide the mechanistic linkage between fire behavior and effects. Our conceptual framework linking remotely sensed estimates of plant water and carbon to fine-scale models of fire behavior and effects could be a critical first step toward improving the fidelity of the coarse scale models that are now relied upon for global fire forecasting. This process-based approach will be essential to capturing the influence of physiological responses to drought and warming on live fuel conditions, strengthening the science needed to guide fire managers in an uncertain future.

Conjunctival necrosis following the administration of subconjunctival corticosteroid.

This report describes an unusual reaction to injected subconjunctival corticosteroid. The authors examined a patient with large areas of conjunctival necrosis at the site of a previous subconjunctival corticosteroid injection. A Gram's strain and culture of the affected conjunctival area and the bottled corticosteroid suspension were negative. Necrosis of the conjunctiva is a heretofore unreported adverse reaction to a subconjunctival corticosteroid injection. These lesions probably represent a localized toxic reaction rather than a sequela of infection.

Development of an ostomy competency.

Staff educators and staff nurses developed an ostomy competency, with the guidance and expertise of the advanced practitioner and enterostomal nurse at a large teaching hospital. The competency improved the quality of care for surgical ostomy patients. Care was standardized and staff nurses' clinical knowledge was enhanced. Following the sessions, staff nurses verbalized increased confidence in working with patients with ostomies and demonstrated increased autonomy and problem-solving abilities. No variances in educational aspects of care were noted on clinical pathways.

The utility of culturing corneal ulcers in a tertiary referral center versus a general ophthalmology clinic.

OBJECTIVE: The purpose of the study is to compare the utility of culturing corneal ulcers in a tertiary referral clinic and a general ophthalmology clinic. DESIGN: A retrospective review of medical and microbiologic records was performed. PARTICIPANTS: One hundred fifty-seven patients with corneal ulcers were included in the study. Eighty-two ulcers were treated in the referral clinic and 75 ulcers were treated in the general ophthalmology clinic. MAIN OUTCOME MEASURES: The authors determined the percentage of corneal ulcers in each clinical setting that failed to respond to empiric therapy and required a culture-directed change in treatment. RESULTS: One hundred fifty-seven ulcers were included. Eight (10%) of the 82 patients treated in the Cornea Clinic had treatment altered based on culture and sensitivity results. All 75 patients in the general clinic responded to empiric antibiotics, such that culture data never were required for modification of therapy (0%, P = 0.007). In contrast to patients treated in the Cornea Clinic, patients treated in the general clinic had smaller, more peripheral ulcers, shorter duration of symptoms, and fewer risk factors for corneal ulceration other than contact lens wear. CONCLUSIONS: Cornea specialists, who are referred the most severe cases, should consider culturing most corneal ulcers. However, it appears reasonable for general ophthalmologists to use culturing more judiciously. Patients with significant corneal ulcers should be cultured regardless of the clinic to which they present. However, small, peripheral ulcers respond extremely well to current, broad-spectrum antibiotics. Close follow-up is mandatory to discover the rare patient who will not respond to empiric therapy.

Wilson's disease: presymptomatic patients and Kayser-Fleischer rings.

PURPOSE: We evaluated patients with Wilson's disease to determine (1) whether presymptomatic patients who have Kayser-Fleischer (K F) rings demonstrate a more significant alteration of copper metabolism than those who do not have K F rings, and (2) whether presymptomatic patients have smaller K F rings than symptomatic Wilson's disease patients. METHODS: Thirty-two patients with presymptomatic Wilson's disease were retrospectively analyzed. Sixteen of these had received no prior anti-copper therapy and underwent testing for baseline copper metabolism (24-hour urine copper, liver copper, and plasma ceruloplasmin). Quantitative measurements of K F rings were made for the group of untreated presymptomatic patients and a control group of symptomatic Wilson's disease patients. RESULTS: We hypothesized that the 24-hour urine copper, in particular, would correlate with the presence of a K F ring. However, no significant difference was found between any of the baseline copper variables for presymptomatic patients who had K F rings compared to those who did not. K F rings of presymptomatic patients were found to be significantly smaller than K F rings of patients with symptomatic Wilson's disease (p < 0.05). CONCLUSIONS: While this study does not show any relationship between urinary copper excretion and the presence of K F rings, it suggests that the larger K F ring size correlates with Wilson's disease severity.

Mucoepidermoid carcinoma of the caruncle.

PURPOSE: To report a case of mucoepidermoid carcinoma, a highly aggressive variant of conjunctival squamous cell carcinoma. METHODS: We examined and treated a 57-year-old man with mucoepidermoid carcinoma of the caruncle, a highly unusual site for this tumor. RESULTS: In the past, simple excision of this tumor has been followed by rapid recurrence. Our patient underwent wide surgical excision of the tumor and has shown no evidence of recurrence after 16 months of follow-up. CONCLUSION: Mucoepidermoid carcinoma may first manifest in the caruncle. Histologically verified, tumor-free surgical margins are necessary for complete excision.

Improved detection of hypotension by automated noninvasive blood pressure monitoring.

This study was undertaken to determine whether the use of automated noninvasive blood pressure monitoring altered the frequency of detection of intraoperative hypotension. We retrospectively reviewed 1,861 anesthetic records from a period in 1987, when blood pressure was obtained manually by auscultation. We compared the records from 1987 with 1,716 anesthetic records from 1989, when automated blood pressure monitors were used universally. The incidences of hypotension requiring vasopressor therapy were determined during the two periods and compared using Student's two-tailed t test. The data revealed that the incidence of detected hypotension increased from 2.4 to 5.2% with the use of automated blood pressure monitors (P less than 0.00002). We conclude that at our hospital the use of automated noninvasive blood pressure monitors increases the incidence of detection of intraoperative hypotension as compared with the use of manual blood pressure measurement.

Determination of N-acetylserotonin and melatonin activities in the pineal gland, retina, harderian gland, brain and serum of rats and chickens.

An N-acetylserotonin/melatonin radioimmunoassay (NAS/Mel RIA) and a Mel RIA were developed to measure NAS and Mel contents in tissues of rats and chickens. Anti-NAS and anti-Mel sera were produced by immunization of rabbits with NAS-M-bovine serum albumin (BSA) and Mel-M-BSA, respectively. Anti-NAS serum used in the NAS/Mel RIA reacts equally well with NAS and Mel, while anti-Mel serum used in the Mel/RIA reacts specifically with Mel. The NAS and Mel levels in the pineal and Harderian gland, the retina and the brain of rats and chickens and Mel levels in chicken serum were determined using these RIAs. Levels of NAS and Mel in the rat pineal demonstrated diurnal rhythms with high levels during the dark period and low levels during the light period. The indole levels determined in this study correlate well with those obtained by other methods.