On March 8 and 9, 1992, a thermal‐infrared‐multispectral scanner (TIMS) was flown over two military ordnance disposal facilities at the Edgewood Area of Aberdeen Proving Ground, Maryland. The data, collected by the National Aeronautics and Space Administration, in cooperation with the U.S. Army and the U.S. Geological Survey, were used to locate ground‐water discharge zones in surface water. The images from the flight show areas where ground‐water discharge is concentrated, as well as areas of diffuse discharge. Concentrated discharge is predominant in isolated or nearly isolated ponds and creeks in the study area. Diffuse discharge is found near parts of the shoreline where the study area meets the surrounding estuaries of the Chesapeake Bay and the Gunpowder River. The average temperature for surface water, measured directly in the field, and the average temperature, calculated from atmospherically corrected TIMS images, was 10.6° C (Celsius) at the first of two sites. Potentiometric surface maps of both field sites show discharge toward the nontidal marshes, the estuaries which surround the field sites, and creeks which drain into the estuaries. The average measured temperature of ground water at both sites was 10.7° C. The calculated temperature from the TIMS imagery at both sites where ground‐water discharge is concentrated within a surface‐water body is 10.4° C. In the estuaries which surround the field sites, field measurements of temperature were made resulting in an average temperature of 9.0° C. The average calculated TIMS temperature from the estuaries was 9.3° C. Along the shoreline at the first site and within 40 to 80 meters of the western and southern shores of the second site, water was 1° to 2° C warmer than water more than 80 meters away. This pattern of warmer water grading to cooler water in an offshore direction could result from diffuse ground‐water discharge. Tonal differences in the TIMS imagery could indicate changes in surface‐water temperatures. These tonal differences can be interpreted to delineate the location and extent of ground‐water discharge to bodies of surface water.

In this cohort of patients with refractory gastroparesis, GES improved symptoms in 75 % of patients with 43 % being at least moderately improved. Response in diabetics was better than in nondiabetic patients. Nausea, loss of appetite, and early satiety responded the best.

Efforts to conserve stream and river biota could benefit from tools that allow managers to evaluate landscape-scale changes in species distributions in response to water management decisions. We present a framework and methods for integrating hydrology, geographic context and metapopulation processes to simulate effects of changes in streamflow on fish occupancy dynamics across a landscape of interconnected stream segments. We illustrate this approach using a 482 km 2 catchment in the southeastern US supporting 50 or more stream fish species. A spatially distributed, deterministic and physically based hydrologic model is used to simulate daily streamflow for sub-basins composing the catchment. We use geographic data to characterize stream segments with respect to channel size, confinement, position and connectedness within the stream network. Simulated streamflow dynamics are then applied to model fish metapopulation dynamics in stream segments, using hypothesized effects of streamflow magnitude and variability on population processes, conditioned by channel characteristics. The resulting time series simulate spatially explicit, annual changes in species occurrences or assemblage metrics (e.g. species richness) across the catchment as outcomes of management scenarios. Sensitivity analyses using alternative, plausible links between streamflow components and metapopulation processes, or allowing for alternative modes of fish dispersal, demonstrate large effects of ecological uncertainty on model outcomes and highlight needed research and monitoring. Nonetheless, with uncertainties explicitly acknowledged, dynamic, landscape-scale simulations may prove useful for quantitatively comparing river management alternatives with respect to species conservation. Published 2012. This article is a U.S. Government work and is in the public domain in the USA.

This observational study aimed to assess trends in type 2 diabetes mellitus (T2DM) disease burden in European Union countries for the years 1990–2019. Sex specific T2DM age-standardised prevalence (ASPRs), mortality (ASMRs) and disability-adjusted life-year rates (DALYs) per 100,000 population were extracted from the Global Burden of Disease (GBD) Study online results tool for each EU country (inclusive of the United Kingdom), for the years 1990–2019. Trends were analysed using Joinpoint regression analysis. Between 1990 and 2019, increases in T2DM ASPRs were observed for all EU countries. The highest relative increases in ASPRs were observed in Luxembourg (males + 269.1%, females + 219.2%), Ireland (males + 191.9%, females + 165.7%) and the UK (males + 128.6%, females + 114.6%). Mortality trends were less uniform across EU countries, however a general trend towards reducing T2DM mortality was observed, with ASMRs decreasing over the 30-year period studied in 16/28 countries for males and in 24/28 countries for females. The UK observed the highest relative decrease in ASMRs for males (− 46.9%). For females, the largest relative decrease in ASMRs was in Cyprus (− 67.6%). DALYs increased in 25/28 countries for males and in 17/28 countries for females between 1990 and 2019. DALYs were higher in males than females in all EU countries in 2019. T2DM prevalence rates have increased across EU countries over the last 30 years. Mortality from T2DM has generally decreased in EU countries, however trends were more variable than those observed for prevalence. Primary prevention strategies should continue to be a focus for preventing T2DM in at risk groups in EU countries.

This is an observational analysis of lower limb amputation incidence in European Union (EU) 15þ countries between 1990 and 2017, using data obtained from the Global Burden of Disease (GBD) Study 2017. The hypothesis was that reducing incidence trends would be identified, given previous work from the present study group using the GBD Study, which identified reducing incidence of peripheral arterial disease over the same time period in EU15þ countries. However, the present study identifies variable trends in lower limb amputation incidence across EU15þ countries between 1990 and 2017. The potential contributors to the observed results are discussed. Objective: Lower extremity amputation (LEA) carries significant mortality, morbidity, and health economic burden. In the Western world, it most commonly results from complications of peripheral arterial occlusive disease (PAOD) or diabetic foot disease. The incidence of PAOD has declined in Europe, the United States, and parts of Australasia. The present study aimed to assess trends in LEA incidence in European Union (EU15þ) countries for the years 1990e2017. Methods: This was an observational study using data obtained from the 2017 Global Burden of Disease (GBD) Study. Age standardised incidence rates (ASIRs) for LEA (stratified into toe amputation, and LEA proximal to toes) were extracted from the GBD Results Tool (http://ghdx.healthdata.org/gbd-results-tool) for EU15þ countries for each of the years 1990e2017. Trends were analysed using Joinpoint regression analysis. Results: Between 1990 and 2017, variable trends in the incidence of LEA were observed in EU15þ countries. For LEAs proximal to toes, increasing trends were observed in six of 19 countries and decreasing trends in nine of 19 countries, with four countries showing varying trends between sexes. For toe amputation, increasing trends were observed in eight of 19 countries and decreasing trends in eight of 19 countries for both sexes, with three countries showing varying trends between sexes. Australia had the highest ASIRs for both sexes in all LEAs at all time points, with steadily increasing trends. The USA observed the greatest reduction in all LEAs in both sexes over the time period analysed (LEAs proximal to toes: female patients À22.93%, male patients À29.76%; toe amputation: female patients À29.93%, male patients À32.67%). The greatest overall increase in incidence was observed in Australia. Conclusion: Variable trends in LEA incidence were observed across EU15þ countries. These trends do not reflect previously observed reductions in incidence of PAOD over the same time period.

Acute, rapid, and unimpeded increases in intra-abdominal pressure can lead to multiple organ dysfunction defined as the abdominal compartment syndrome (ACS). If this develops in the absence of obvious intra-abdominal injury, it has been termed secondary ACS (2 degrees ACS). Massive fluid resuscitation in the presence of large burns or shock can lead to 2 degrees ACS. The importance of early recognition and the need for urgent abdominal decompression have been recognized in adults; however, this has not been appreciated in the pediatric population. Medical records of four children diagnosed with 2 degrees ACS were reviewed. Secondary ACS occurred in three children with burns and in one child with a traumatic brain injury. Three children underwent decompressive laparotomy, and one underwent successful percutaneous drainage. There were two survivors. Secondary ACS may be observed in burnt or traumatized children needing large volume resuscitation. Early recognition of 2 degrees ACS by routine bladder pressure monitoring in this high-risk group of children may result in earlier decompression and a possible decrease in morbidity and mortality.

Isolated wetlands in the Southeastern United States are dynamic habitats subject to fluctuating environmental conditions. Wetlands located near marine environments are subject to alterations in water chemistry due to storm surge during hurricanes. The objective of our study was to evaluate the effect of storm surge overwash on wetland amphibian communities. Thirty-two wetlands in northwestern Florida were sampled over a 45-month period to assess amphibian species richness and water chemistry. During this study, seven wetlands were overwashed by storm surge from Hurricane Dennis which made landfall 10 July 2005 in the Florida panhandle. This event allowed us to evaluate the effect of storm surge overwash on water chemistry and amphibian communities of the wetlands. Specific conductance across all wetlands was low pre-storm (\100 lS/cm), but increased post-storm at the overwashed wetlands (" x = 7,613 lS/cm). Increased specific conductance was strongly correlated with increases in chloride concentrations. Amphibian species richness showed no correlation with specific conductance. One month post-storm we observed slightly fewer species in overwashed compared with non-overwashed wetlands, but this trend did not continue in 2006. More species were detected across all wetlands pre-storm, but there was no difference between overwashed and non-overwashed wetlands when considering all amphibian species or adult anurans and larval anurans separately. Amphibian species richness did not appear to be correlated with pH or presence of fish although the amphibian community composition differed between wetlands with and without fish. Our results suggest that amphibian communities in wetlands in the southeastern United States adjacent to marine habitats are resistant to the effects of storm surge overwash.

There is continuing concern over potential impacts of widespread application of nutrients and pesticides on ground- and surface-water quality. Transport and fate of nitrate and pesticides were investigated in a shallow aquifer and adjacent stream, Cow Castle Creek, in Orangeburg County, South Carolina. Pesticide and pesticide degradate concentrations were detected in ground water with greatest frequency and largest concentrations directly beneath and downgradient from the corn (Zea mays L.) field where they were applied. In almost all samples in which they were detected, concentrations of pesticide degradates greatly exceeded those of parent compounds, and were still present in ground waters that were recharged during the previous 18 yr. The absence of both parent and degradate compounds in samples collected from deeper in the aquifer suggests that this persistence is limited or that the ground water had recharged before use of the pesticide. Concentrations of NO(-)(3) in ground water decreased with increasing depth and age, but denitrification was not a dominant controlling factor. Hydrologic and chemical data indicated that ground water discharges to the creek and chemical exchange takes place within the upper 0.7 m of the streambed. Ground water had its greatest influence on surface-water chemistry during low-flow periods, causing a decrease in concentrations of Cl(-), NO(-)(3), pesticides, and pesticide degradates. Conversely, shallow subsurface drainage dominates stream chemistry during high-flow periods, increasing stream concentrations of Cl(-), NO(-)(3), pesticides, and pesticide degradates. These results point out the importance of understanding the hydrogeologic setting when investigating transport and fate of contaminants in ground water and surface water.