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There exists a good deal of indirect evidence, from several locations around the world, that there is a substantial eddy field over continental shelves. These eddies appear to have typical swirl velocities of a few centimeters per second and have horizontal scales of perhaps 5–10 km. These eddies are weak compared to typical, wind-driven, alongshore flows but often seem to dominate middepth cross-shelf flows. The idea that motivates the present contribution is that the alongshore wind stress ultimately energizes these eddies by means of baroclinic instabilities, even in cases where obvious intense fronts do not exist. The proposed sequence is that alongshore winds over a stratified ocean cause upwelling or downwelling, and the resulting horizontal density gradients are strong enough to fuel baroclinic instabilities of the requisite energy levels. This idea is explored here by means of a sequence of idealized primitive equation numerical model studies, each driven by a modest, nearly steady, alongshore wind stress applied for about 5–10 days. Different runs vary wind forcing, stratification, bottom slope, bottom friction, and Coriolis parameter. All runs, both upwelling and downwelling, are found to be baroclinically unstable and to have scales compatible with the underlying hypothesis. The model results, combined with physically based scalings, show that eddy kinetic energy generally increases with bottom slope, stratification, wind impulse (time integral of the wind stress), and inverse Coriolis parameter. The dominant length scale of the eddies is found to increase with increasing eddy kinetic energy and to decrease with Coriolis parameter.

Tanzania holds most of the remaining large populations of African lions (Panthera leo) and has extensive areas of leopard habitat (Panthera pardus), and both species are subjected to sizable harvests by sport hunters. As a first step toward establishing sustainable management strategies, we analyzed harvest trends for lions and leopards across Tanzania's 300,000 km 2 of hunting blocks. We summarize lion population trends in protected areas where lion abundance has been directly measured and data on the frequency of lion attacks on humans in high-conflict agricultural areas. We place these findings in context of the rapidly growing human population in rural Tanzania and the concomitant effects of habitat loss, human-wildlife conflict, and cultural practices. Lion harvests declined by 50% across Tanzania between 1996 and 2008, and hunting areas with the highest initial harvests suffered the steepest declines. Although each part of the country is subject to some form of anthropogenic impact from local people, the intensity of trophy hunting was the only significant factor in a statistical analysis of lion harvest trends. Although leopard harvests were more stable, regions outside the Selous Game Reserve with the highest initial leopard harvests again showed the steepest declines. Our quantitative analyses suggest that annual hunting quotas be limited to 0.5 lions and 1.0 leopard/1000 km 2 of hunting area, except hunting blocks in the Selous Game Reserve, where harvests should be limited to 1.0 lion and 3.0 leopards/1000 km 2 . Tanzania mantiene la mayoría de las poblaciones remanentes de leones Africanos (Panthera leo) y tiene extensas áreas de hábitat de leopardo (Panthera pardus), y ambas especies son sujetas a cosechas considerables por cazadores deportivos. Como un primer paso hacia el establecimiento de estrategias de manejo sustentable, analizamos las tendencias de cosecha de leones y leopardos en los 300,000 km 2 de bloques de cacería de Tanzania. Sintetizamos las tendencias poblacionales de leones en áreas protegidas donde la abundancia de leones ha sido medida directamente, así como datos sobre la frecuencia de ataques de leones sobre humanos en áreas agrícolas altamente conflictivas. Ubicamos estos resultados en el contexto de la población humana en rápido crecimiento en Tanzania rural y los efectos concomitantes de la pérdida de hábitat, el conflicto humanos-vida silvestre y las prácticas culturales. Las cosechas de leones han declinado 50% en Tanzania entre 1996 y 2008, y las áreas de cacería con las cosechas iniciales más altas sufrieron las declinaciones más pronunciadas. Aunque cada parte del país está sujeto a alguna forma de impacto antropogénico por habitantes locales, la intensidad de la cacería deportiva fue el único factor significativo en el análisis estadístico de las tendencias poblacionales de leones. Aunque las cosechas de leopardos fueron más estables, regiones fuera de la Reserva de Caza Selous con las cosechas iniciales de leopardos más altas también mostraron las declinaciones más pronunciadas. Nuestros análisis cuantitativos sugieren que las cuotas anuales de cacería se limiten a 0.5 leones y 1.0 leopardo/1000 km 2 de área de cacería, excepto los bloques de cacería en la Reserva de Caza Selous, donde las cosechas deben limitarse a 1.0 león y 3.0 leopardos/1000 km 2 .

SummaryAdult intussusception is rare, and its non-specific symptoms make the diagnosis particularly difficult. Imaging modalities such as X-ray, abdominal ultrasound and multidetector computed tomography (MDCT) may improve preoperative detection. In this report, we present a 53-year-old male with an ileocaecal intussusception. The patient underwent an extended right hemicolectomy and double barrel ileocolostomy. Histopathological review of the specimen identified the lead point as an intramural caecal lymph node which, as far as we are aware, is the first time this type of lead point has been reported.

BackgroundTo examine the mortality risk of current and life-time depressive as well as anxiety disorders, whether this risk is moderated by sex or age, and whether this risk can be explained by lifestyle and/or somatic health status.MethodsA cohort study (Lifelines) including 141,377 participants (18–93 years) which were followed-up regarding mortality for 8.6 years (range 3.0–13.7). Baseline depressive and anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria were assessed with the Mini International Neuropsychiatric Interview and lifetime diagnoses by self-report. All-cause mortality was retrieved from Statistics Netherlands. Cox-regression was applied to calculate proportional hazard ratios, adjusted for lifestyle (physical activity, alcohol use, smoking, and body mass index) and somatic health status (multimorbidity and frailty) in different models.ResultsThe mortality rate of depressive and anxiety disorders was conditional upon age but not on sex. Only in people below 60 years, current depressive and anxiety disorders were associated with mortality. Only depressive disorder and panic disorder independently predicted mortality when all mental disorders were included simultaneously in one overall model (hazard ratio [HR] = 2.18 [95% confidence intervals (CI): 1.56–3.05], p < 0.001 and HR = 2.39 [95% CI: 1.15–4.98], p = 0.020). Life-time depressive and anxiety disorders, however, were independent of each other associated with mortality. Associations hardly changed when adjusted for lifestyle characteristics but decreased substantially when adjusted for somatic health status (in particular physical frailty).ConclusionsIn particular, depressive disorder is associated with excess mortality in people below 60 years, independent of their lifestyle. This effect seems partly explained by multimorbidity and frailty, which suggest that chronic disease management of depression-associated somatic morbidity needs to be (further) improved.

Background The frailty index (FI) is a well-recognized measurement for risk stratification in older people. Among middle-aged and older people, we examined the prospective association between the FI and mortality as well as its course over time in relation to multimorbidity and specific disease clusters. Methods A frailty index (FI) was constructed based on either 64 (baseline only) or 35 health deficits (baseline and follow-up) among people aged ≥ 40 years who participated in LifeLines, a prospective population-based cohort living in the Northern Netherlands. Among 92,640 participants, multivariable Cox proportional hazard models were fitted to study the hazard ratio (HR) of the FI at baseline, as well as for 10 chronic disease clusters for all-cause mortality over a 10-year follow-up. Among 55,426 participants, linear regression analyses were applied to study the impact of multimorbidity and of specific chronic disease clusters (independent variables) on the change of frailty over a 5-year follow-up, adjusted for demographic and lifestyle characteristics. Results The FI predicted mortality independent of multimorbidity and specific disease clusters, with the highest impact in people with either endocrine, lung, or heart diseases. Adjusted for demographic and lifestyle characteristics, all chronic disease clusters remained independently associated with an accelerated increase of frailty over time. Conclusions Frailty may be seen as a final common pathway for premature death due to chronic diseases. Our results suggest that initiating frailty prevention at middle age, when the first chronic diseases emerge, might be relevant from a public health perspective.

At continental margins, energetic deep-ocean eddies can transport shelf water offshore in filaments that wrap around the eddy. One example is that of Gulf Stream warm-core rings interacting with the Mid-Atlantic Bight shelf. The rate at which shelf water is exported in these filaments is a major unknown in regional budgets of volume, heat, and salt. This unknown transport is constrained using a series of idealized primitive equation numerical experiments wherein a surface-intensified anticyclonic eddy interacts with idealized shelf–slope topography. There is no shelfbreak front in these experiments, and shelf water is tracked using a passive tracer. When anticyclones interact with shelf–slope topography, they suffer apparent intrusions of shelf–slope water, resulting in a subsurface maximum in offshore transport. The simulations help construct an approximate model for the filament of exported water that originates inshore of any given isobath. This model is then used to derive an expression for the total volume of shelf–slope water transported by the eddy across that isobath. The transport scales with water depth, radius, and azimuthal velocity scale of the eddy. The resulting expression can be used with satellite-derived eddy properties to estimate approximate real-world transports ignoring the presence of a shelfbreak front. The expression assumes that the eddy’s edge is at the shelf break, a condition not always satisfied by real eddies.

Sea level rise, especially combined with possible changes in storm surges and increased river discharge resulting from climate change, poses a major threat in low-lying river deltas. In this study we focus on a specific example of such a delta: the Netherlands. To evaluate whether the country’s flood protection strategy is capable of coping with future climate conditions, an assessment of low-probability/high-impact scenarios is conducted, focusing mainly on sea level rise. We develop a plausible high-end scenario of 0.55 to 1.15 m global mean sea level rise, and 0.40 to 1.05 m rise on the coast of the Netherlands by 2100 (excluding land subsidence), and more than three times these local values by 2200. Together with projections for changes in storm surge height and peak river discharge, these scenarios depict a complex, enhanced flood risk for the Dutch delta.

BackgroundThe Helen Joseph Hospital Breast Clinic has implemented a clinical triage system for patients presenting with a variety of breast concerns. The goal of this system is to expedite the process from initial presentation to radiological assessment of patients with suspected breast malignancy or breast abscess in a resource limited setting. The objective was to assess the clinical, imaging and histological diagnoses of breast disease in these patients with malignancy and sepsis.MethodsA retrospective audit of patients clinically deemed high risk for malignant breast pathology referred to the breast imaging unit (BIU) in 2018. Patients were triaged based on strict clinical criteria: presence of a breast mass with or without lymph nodes or a breast abscess. Patients that were subsequently referred for mammography/ultrasound were identified using the patient files in the BIU. Results were recorded on Microsoft Excel and analysed using SAS version 9.2.ResultsThree hundred and twenty-five patients were included in this study. Eighty-seven (26.8%) were diagnosed with breast cancer and 236 (72.6%) with benign disease. The most common presenting complaint was a palpable mass (n = 227; 69.9%). Ninety-five per cent of patients characterised as BI-RADS 5 had malignant disease. 55.8% of malignancies diagnosed on ultrasound had locally advanced disease. The most common histological diagnosis of malignancy was invasive ductal carcinoma (n = 67, 77%). The most commonly diagnosed benign disease was breast abscess (n = 42, 17.8%).ConclusionBI-RADS findings correspond to similar studies, however, a large number of benign breast disease was diagnosed. This may indicate heightened clinical awareness of breast cancer diagnosis and early detection. A significant percentage of malignancies presented as locally advanced. Except for a lower number of invasive lobular carcinoma, the histological spectrum of malignant disease is similar to comparative studies.

BackgroundMultiple meningiomas occur in <10% of meningioma patients. Their development may be caused by the presence of a predisposing germline mutation in the neurofibromatosis type 2 (NF2) gene. The predisposing gene in patients with non-NF2 associated multiple meningiomas remains to be identified. Recently, SMARCB1 was reported to be a potential predisposing gene for multiple meningiomas in a family with schwannomatosis and multiple meningiomas. However, involvement of this gene in the development of the meningiomas was not demonstrated.ResultsFive affected members of a large family with multiple meningiomas were investigated for the presence of mutations in SMARCB1 and NF2. A missense mutation was identified in exon 2 of SMARCB1 as the causative germline mutation predisposing to multiple meningiomas; furthermore, it was demonstrated that, in accordance with the two-hit hypothesis for tumourigenesis, the mutant allele was retained and the wild-type allele lost in all four investigated meningiomas. In addition, independent somatically acquired NF2 mutations were identified in two meningiomas of one patient with concomitant losses of the wild-type NF2 allele.ConclusionIt is concluded that, analogous to the genetic events in a subset of schwannomatosis associated schwannomas, a four-hit mechanism of tumour suppressor gene inactivation, involving SMARCB1 and NF2, might be operative in familial multiple meningiomas associated meningiomas.