Volcanically Triggered Ocean Warming Near the Antarctic Peninsula.

Explosive volcanic eruptions are the largest non-anthropogenic perturbations for Earth's climate, because of the injection of sulfate aerosols into the stratosphere. This causes significant radiation imbalances, resulting in surface cooling for most of the globe. However, despite its crucial importance for Antarctic ice sheet mass balance, the response of the Southern Ocean to eruptions has yet to be understood. After the eruption of Mt. Pinatubo in 1991, much of the Southern Ocean cooled; however, off the Antarctic Peninsula a warming of up to 0.8 °C is found in the observations. To understand the physical mechanisms associated with this counter-intuitive response, we combine observational analysis from the Mt. Pinatubo eruption with the Last Millennium Ensemble (850-1850) conducted with the Community Earth System Model. These results show not only that the observed warming off the Peninsula following the Mt. Pinatubo eruption is consistent with the forced response to low-latitude eruptions but further, that this warming is a response to roughly 16% weakening of subsurface Weddell Gyre outflow. These changes are triggered by a southward shift of the Southern Hemisphere polar westerlies (∼2°latitude). Our results suggest that warming induced by future volcanic eruptions may further enhance the vulnerability of the ice shelves off the Antarctic Peninsula.

Psychosocial Factors Influencing Parental Decision to Allow or Refuse Potentially Lifesaving Enucleation in Children with Retinoblastoma.

OBJECTIVE: Retinoblastoma is the most common malignancy of the eye and ocular adnexa in the Philippines. It is curable when treated early, but delay in enucleation is common due to the parental refusal of surgery for varied reasons. The aim of this study is to identify the psychosocial barriers and facilitating factors for accepting versus refusing enucleation as treatment for retinoblastoma. METHODS: This is a cross-sectional descriptive study utilizing structured interviews and a questionnaire. It was conducted at the Retinoblastoma Clinic of the Philippine General Hospital. A questionnaire using the Likert scale was constructed after performing key informant interviews and focus group discussions. It was pretested and revised before parents of patients with retinoblastoma were invited to participate in the study. Descriptive statistics, quantitative item analyses using inter-item correlations and item-total correlations was performed. RESULTS: Factors that correlate with refusal to enucleate are the beliefs that cancer is a fatal illness, the fear of unacceptable esthetic outcome of the surgery, and the cost of treatment. Favorable factors include value of life, high regard for the opinion of medical practitioners, and appreciation of the efficacy of treatment. CONCLUSIONS: There are several favorable factors and barriers that health practitioners must consider in facilitating parental decision-making toward enucleation for retinoblastoma.

The Beit CURE Classification of Childhood Chronic Haematogenous Osteomyelitis--a guide to treatment.

BACKGROUND: The Beit CURE (BC) classification is a radiographic classification used in childhood chronic haematogenous osteomyelitis. The aim of this study is to assess correlation between this classification and the type and extent of treatment required. METHODS: We present a retrospective series of 145 cases of childhood chronic haematogenous osteomyelitis classified using the BC classification. Variables measured include age, sex, bone involved, number of admissions, length of stay, type/number of operations and microbiology. RESULTS: The most commonly affected bone was the tibia (46%), followed by femur (26%) and humerus (10%). Bone defects were most common in the tibia. Staphylococcus aureus was the most commonly isolated organism. Type B, sequestrum type, was the most common (88%), followed by type C, sclerotic type, (7%) and type A, Brodie's abscess (5%). Types A and B1 had the shortest length of hospitalisation (11 days), type B4 had the longest (87 days). Types A and B1 had the fewest infection control operations. Type B4 had the greatest total number of operations. CONCLUSIONS: This study shows that the BC classification can guide surgical strategy and help predict length of inpatient treatment and number and type of procedures required.

Use of heat and moisture exchanging (HME) filters in mechanically ventilated ICU patients: influence on airway flow-resistance.

OBJECTIVE: To investigate the flow-resistance of a new generation of Heat Moisture Exchanging Filters (HME filters) during 24 h of clinical use. DESIGN: Before-after trial. SETTING: A general Intensive Care Unit of a university hospital. PATIENTS: A consecutive series of 96 patients undergoing mechanical ventilation for respiratory insufficiency of various etiology and severity. METHODS: The characteristics of the secretions collected by tracheal suctioning and the pressure/flow relationship of the HMEs before and after 24 h of clinical use were analyzed. RESULTS: The resistance of the HMEs when dry was 2 hPa/l.s, and it increased to a maximum of 1 hPa/l.s in 83% of the patients after 24 hours; in four patients with particularly heavy secretions HME resistance was 4-5 hPa/l.s. There were no significant modifications of the secretions within the investigation period, excluding, in particular, an increase in density with consequent tracheal tube obstruction. CONCLUSION: The gas conditioning efficiency and design performance of the tested HMEs did not create a significant obstacle to airflow medium term mechanical ventilation; however, these devices should be cautiously used in patients with heavy bronchial secretions.