Acute Pancreatitis (AP) is a common disease with systemic complications, specifically pulmonary complications that are well-documented [1]. Here we present, to the best of our knowledge, the first reported case of tracheobronchomalacia as a respiratory complication of AP. A 54-year-old white male with multiple chronic comorbidities developed necrotizing acute pancreatitis (NAP) following a surgical procedure. Internal Medicine evaluated and managed his NAP according to protocol. Within one week of NAP onset, the patient developed rapid respiratory distress. Chest radiography and ABGs were unable to diagnose ARDS. A CT scan with IV contrast was completed to investigate a pulmonary embolus and found the tracheal diameter variations during inspiration and expiration of the respiratory cycle consistent with tracheobronchomalacia (TBM). The patient’s respiratory status continued to deteriorate requiring endotracheal intubation and mechanical ventilation with weaning trials proving to be futile. The patient eventually developed fungemia and expired after his family opted for palliative extubation. Airway collapse related to TBM is an under-recognized diagnosis which should be suspected in patients with NAP who develop acute respiratory distress in whom no specific etiology has been determined.

Very little research has occurred about students with severe disabilities and verbal difficulties and their ability to learn phonics, decoding, and other early literacy skills(Ainsworth et al., 2016 and Johnston et al., 2009b). Ainsworth et al. (2016) used the Accessible Literacy Learning curriculum to teach phonics and decoding. Johnston et al. (2009b) used a three-step instructional strategy, step one - increased opportunities for adult-directed teaching and active teacher child interaction, step two- use of time delay to teach, step three-consequences, to teach phonics and decoding. While both studies utilized time delay in some fashion, they were not entirely based upon the evidence-based practice. Therefore, the purpose of this study is to determine whether constant time delay is effective in teaching phonics and decoding to students with severe disabilities and verbal difficulties and if students can generalize the skill to words that have not been explicitly taught. Results indicated a functional relation between the use of constant time delay and decoding of CVC words. Additionally, students were able to maintain and generalize learning. Students with severe disabilities and verbal difficulties can effectively learn decoding of CVC words through constant time delay and can maintain and generalize the skill. Results were similar to other studies which implemented constant time delay to promote emergent literacy skills (e.g., Browder et al., 2012; Dessemont et al., 2019; Spooner et al., 2015; Tucker Cohen et al., 2008). Practitioners can use constant time delay to teach decoding to students with severe disabilities and verbal difficulties and to promote early reading skills. Future research should replicate the study with students from different age groups as well as examining the effects of this strategy on the acquisition of CCVC and CVCC words.

The goal of the present study is to investigate the effect of different scenarios of core degradation in a Nordic-type BWR (boiling water reactor) on the reactor pressure vessel failure mode and timing. Specifically we consider the effects of (i) in-vessel pressure, (ii) melt properties. Control rod guide tube (CRGT) cooling and cooling of the debris from the top are considered as severe accident management (SAM) measures in this study. We also consider the question about minimal amount of debris that can be retained inside the reactor pressure vessel (RPV). Analysis is carried out with coupled (i) Phase-change Effective Convectivity (PECM) model implemented in Fluent for prediction of the debris and melt pool heat transfer, and (ii) structural model of the RPV lower head implemented in ANSYS for simulation of thermo-mechanical creep. The coupling is done through transient thermal load predicted by PECM and applied as a boundary condition in ANSYS analysis. Results of the analysis suggest that applying only CRGT and top cooling is insufficient for maintaining vessel integrity with 0.4 m deep (~12 tons) corium melt pool. The failure of the vessel by thermally induced creep can be expected starting from 5.3 h after the dryout of the debris bed in the lower plenum. However, earlier failure of the instrumentation guide tubes (IGTs) is possible due to melting of the nozzle welding. The internal pressure in the vessel in the range between 3 to 60 bars has no significant influence on the mode and location of the global RPV wall failure. However, depressurization of the vessel can delay RPV wall failure by 46 min for 0.7 m (~ 30 tons) and by 24 min for 1.9 m (~ 200 tons) debris bed. For 0.7 m pool case, changes in vessel pressure from 3 to 60 bars caused changes in liquid melt mass and superheat from ~18 tons at 180 K to ~13 tons at 100 K superheat, respectively. The same changes in pressure for 1.9 m case caused changes in liquid melt mass and superheat from ~40 tons at 42 K to ~10 tons at about 8 K superheat, respectively. Investigation of the influence of melt pool properties on the mode and timing of the vessel failure suggest that the thermo-mechanical creep behavior is most sensitive to the thermal conductivity of solid debris. Both vessel wall and IGT failure timing is strongly dependent on this parameter. For given thermal conductivity of solid debris, an increase in Tsolidus or Tliquidus generally leads to a decrease in liquid melt mass and superheat at the moment of vessel wall failure. Applying models for effective thermal conductivity of porous debris helps to further reduce uncertainty in assessment of the vessel failure and melt ejection mode and timing. Only in an extreme case with Tsolidus, Tliquidus range larger than 600 K, with thermal conductivity of solid 0.5 W∙m‑1∙K‑1 and thermal conductivity of liquid melt 20 W∙m‑1∙K‑1, a noticeable vessel wall ablation and melting of the crust on the wall surface was observed. However, the failure was still caused by creep strain and the location of the failure remained similar to other considered cases. / APRI-8

The purpose of this study was to examine the effects of constant time delay on decoding letter sounds within consonant-vowel-consonant words and to read constant-vowel-constant words skills for students with severe disabilities and verbal difficulties. This study used a multiple probe across participants design with four students with severe intellectual and/or development disabilities. Results indicated a functional relation between the use of constant time delay and decoding of CVC words. Additionally, students were able to maintain and generalize learning. Results were similar to other studies which implemented constant time delay to promote emergent literacy skills. Practitioners can use constant time delay to teach decoding to students with severe disabilities and verbal difficulties and to promote early reading skills. Future research should replicate the study with students from different age groups as well as examine the effects of this strategy on the acquisition of CCVC and CVCC words.

No description available.

Weather forecasting relies on the availability of observational data as input parameters. However,such data are not readily available, because of difficulties to collect weather data due toinaccessibility to many places in the world, such as oceans or mountain regions. For this reason,satellite surveillance is a suitable tool to observe the atmosphere in regions where it is notpossible by other means. This master thesis is a study of convective cloud cluster formation over Thailand, conductedthrough satellite image analysis. Characteristics of cloud cluster formations are investigatedthrough an implementation of the Maximum Spatial Correlation Technique (MASCOTTE),described by Carvalho and Jones (2001). This method allows tracking of convective cloud systemsthrough region based analysis of satellite images. The aim of this study is to investigate whether satellite image analysis, through the implementationof the MASCOTTE methodology, can provide characteristics of convective cloud systems,in order to discern convective systems by intensity, accurately enough to be able to discernsevere thunderstorms from ordinary thunderstorms. The annual distribution of the occurrenceof life cycles detected through the analysis is studied, as well as their monthly distribution ofmean and maximum life times. Moreover, the yearly distribution of life cycle mean and minimumbrightness temperatures are analysed, as well as the number of detected split and mergeevents. This is followed by a comparison of life cycle structural properties to investigate thepossibility to use individual parameters, alone or in combination with each other, as indicatorsof the degree of convective activity within life cycles. Yearly distributions were studied in order to verify if this method could reveal seasonal variations,such as the onset period of the wet season, in terms of the occurrence of life cycles andtheir life time. The findings of this study verified that the most convectively intense life cycles exist under theinfluence of the Inter Tropical Convergence Zone (ITCZ), during the onset and beginning ofthe monsoon season. Analysis of life cycle structural properties, showed that properties likemean and minimum brightness temperature as well as fractional convective area, could be usedas indicators to discern between life cycles with different level of convective activity. However,it is concluded that studies, including ground-based remote sensing technologies such asRADAR/LIDAR, as well as data from rawinsondes, needs to be conducted in order to clarifyif it is possible to use this methodology to successfully discern severe thunderstorms fromordinary thunderstorms. / Tillgängligheten av meteorologiska mätdata är väsentlig för att kunna prognostisera väder. Idag är tillgängligheten på dessa data relativt gles, bland annat på grund av svårigheter att mäta på många platser runt om i världen, t.ex över världshaven eller vid otillgängliga bergsområden. Därför är satellitövervakning ett bra alternativ till andra typer av väderobservationer, eftersom denna teknik kan tillhandahålla mätdata över stora områden som annars inte är möljiga att samla data från. Denna magisteruppsats är en studie om egenskaper hos konvektiv molnbildning över Thailand. Studien är genomförd med hjälp av satellitbildsanalys. Egenskaper hos olika konvektiva molnceller har studerats genom att använda en metod baserad på ”the Maximum Spatial Correlation Technique” (MASCOTTE), beskriven av Carvalho and Jones (2001). Tanken bakom denna metod är att hitta och följa utvecklingen av olika konvektiva molnceller baserat på deras storlek och temperatur. Målet med studien är att undersöka hurvida denna metoden kan ge kunskap som leder till att man kan skilja på konvektiva celler, genom intensitetsskillnader, med tillräcklig noggrannhet för att kunna urskilja vanliga konvektiva celler från intensiva celler. För att få en uppfattning om förekomsten av intensiva konvektiva system, har antalet detekterade livscykler per månad studerats. För sedan att få en bild av hurvida deras livscykler skiljer sig åt över året, har även egenskaper som medellivslängd och maximal livslängd studerats. Dessutom studerades den årliga fördelningen av livscyklernas medel och minimum temperaturer, samt förekomsten av delningar och sammanslagningar av konvektiva celler. För att finna kunskap om skillnader i intensitet mellan individuella livscykler, har egenskaper som medel och minimum temperatur analyserats. Dessutom har andelen moln med extremt låg temperatur studerats i syfte att kunna använda dessa parametrar som intensitetsindikatorer vid satellitbildsanalys. Resultaten i denna studie visar att de mest intensiva konvektiva molnsystemen (kraftigaste åskvädren), förekommer under påverkan av ITCZ (Inter Tropical Convergence Zone), under antågandet och början av regnperioden. Studier av de konvektiva systemens egenskaper visade att parametrar, som andelen extremt kallt område i molnceller (fractional convective area), och livscyklernas medel och minimum temperaturer, skulle kunna användas som intensitetsindikatorer för att skilja på olika livscykler med avseende på deras styrka i intensitet. Slutsatsen av studien är att det behövs fler studier där andra typer av meteorologiska mätdata, såsom RADAR/LIDAR och sonderingsdata är involverade, för att skaffa ytterligare kunskap om hur man genom satellitbildsanalys kan urskilja kraftiga åskväder.

Severe acute respiratory syndrome (SARS) is a severe pulmonary infection that has been identified in multiple outbreaks around the world after emerging from mainland China in early 2003, The syndrome is caused by SARS-associated coronavirus, a novel human infection. SARS-associated coronavirus is spread by multiple mechanisms, including direct contact and large-droplet aerosolization, and may be spread by droplet nuclei as well. Clinical disease is characterized by fever, dry cough, interstitial infiltrates, and variable progression to respiratory failure, No treatment has clearly been shown to be effective. Aggressive infection control measures to prevent viral spread are key to outbreak management.

Within hours after its initiation, the severe systemic inflammatory response of sepsis shifts to an adaptive anti-inflammatory state with coincident immunosuppression. This anti-inflammatory phenotype is characterized by diminished proinflammatory cytokine gene expression in response to toll-like receptor (TLR) stimulation with bacterial endotoxin/lipopolysaccharide (LPS), also known as endotoxin tolerance/adaptation. Our and other studies have established that gene-specific reprogramming following TLR4 responses independently represses transcription and translation of proinflammatory genes such as tumor necrosis factor alpha (TNFα). We also previously demonstrated that TNFα and interleukin (IL)-6 mRNA translation is repressed in endotoxin-adapted THP-1 human monocytes by an miRNA-based mechanism involving the argonaute family protein argonaute 2 (Ago2). Here, we further define the molecular nature of reprogramming translation by showing that TLR4-induced microRNA-146 promotes a feed-forward loop that modifies the subcellular localization of the RNA-binding protein RBM4 (RNA-binding motif protein 4) and promotes its interaction with Ago2. This interaction results in the assembly of a translation-repressor complex that disrupts TNFα and IL-6 cytokine synthesis in endotoxin-adapted THP-1 monocytes. This novel molecular path prevents the phosphorylation of RBM4 on serine-309 by p38 MAPK (mitogen-activated protein kinase), which leads to RBM4 accumulation in the cytosol and interaction with Ago2. We further find that microRNA-146a knockdown by antagomirs or protein phosphatase inhibition by okadaic acid increases p38 MAPK phosphorylation and results in RBM4 serine-309 phosphorylation and nuclear relocalization, which disrupts RBM4 and Ago2 interactions and restores TLR4-dependent synthesis of TNFα and IL-6. We conclude that miR-146a has a diverse and critical role in limiting an excessive acute inflammatory reaction.

Background: Stroke remains a major public health burden. Few studies have focused on the age differences in the associations of behavioral and psychosocial factors with stroke while no study focusing on the effect of severe psychological distress (SPD) on stroke has been conducted. The aim of this study was to examine the age differences in these risk factors for stroke as young (18-44 years), middle aged (45-64 years), and elderly (65 years or older). Methods: A total of 1,258 adults with stroke and 39,985 controls were selected from the 2005 California Health Interview Survey. Multiple logistic regression analyses were used to estimate the associations of the factors with stroke at different ages. Results: The prevalence of SPD was 10% in cases and 3.6% in controls, respectively. Overall, current smoking, lack of physical activity, alcohol consumption, SPD, type II diabetes, male, older age, and unemployment were all associated with a higher prevalence of stroke. Practically, we found that smoking and SPD were associated with the prevalence of stroke in young adults, lack of physical activity was associated with the prevalence of stroke in middle-aged adults, and lack of physical activity and SPD were associated with the prevalence of stroke in the elderly. Conclusions: Appropriate intervention for reducing stroke and eliminating its disparities may be developed separately at each age.

Within hours after its initiation, the severe systemic inflammatory response of sepsis shifts to an adaptive anti-inflammatory state with coincident immunosuppression. This anti-inflammatory phenotype is characterized by diminished proinflammatory cytokine gene expression in response to toll-like receptor (TLR) stimulation with bacterial endotoxin/lipopolysaccharide (LPS), also known as endotoxin tolerance/adaptation. Our and other studies have established that gene-specific reprogramming following TLR4 responses independently represses transcription and translation of proinflammatory genes such as tumor necrosis factor alpha (TNFα). We also previously demonstrated that TNFα and interleukin (IL)-6 mRNA translation is repressed in endotoxin-adapted THP-1 human monocytes by an miRNA-based mechanism involving the argonaute family protein argonaute 2 (Ago2). Here, we further define the molecular nature of reprogramming translation by showing that TLR4-induced microRNA-146 promotes a feed-forward loop that modifies the subcellular localization of the RNA-binding protein RBM4 (RNA-binding motif protein 4) and promotes its interaction with Ago2. This interaction results in the assembly of a translation-repressor complex that disrupts TNFα and IL-6 cytokine synthesis in endotoxin-adapted THP-1 monocytes. This novel molecular path prevents the phosphorylation of RBM4 on serine-309 by p38 MAPK (mitogen-activated protein kinase), which leads to RBM4 accumulation in the cytosol and interaction with Ago2. We further find that microRNA-146a knockdown by antagomirs or protein phosphatase inhibition by okadaic acid increases p38 MAPK phosphorylation and results in RBM4 serine-309 phosphorylation and nuclear relocalization, which disrupts RBM4 and Ago2 interactions and restores TLR4-dependent synthesis of TNFα and IL-6. We conclude that miR-146a has a diverse and critical role in limiting an excessive acute inflammatory reaction.