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Abstract The South Asian summer monsoon strongly modulates regional temperature and humidity. While extreme dry heat peaks in the pre‐monsoon season, recent literature suggests that extreme humid heat can continue to build throughout the monsoon season. Here we explore the influence of monsoon onset and subseasonal precipitation variability on the occurrence of extreme wet bulb temperatures (Tw) across South Asia. We find that extreme Tw events often occur on rainy days during the monsoon season. However, the influence of precipitation on Tw varies with the background climatology of surface specific humidity. In climatologically drier areas, positive Tw anomalies tend to occur when precipitation increases due to either early onset or wet spells during the monsoon. In contrast, in climatologically humid areas, positive Tw anomalies occur during periods of suppressed precipitation, including both delayed onset and dry spells during the monsoon.

This paper examines the ability of coupled global climate models to predict decadal variability of Arctic and Antarctic sea ice. We analyze decadal hindcasts/predictions of 11 Coupled Model Intercomparison Project Phase 5 (CMIP5) models. Decadal hindcasts exhibit a large multi-model spread in the simulated sea ice extent, with some models deviating significantly from the observations as the predicted ice extent quickly drifts away from the initial constraint. The anomaly correlation analysis between the decadal hindcast and observed sea ice suggests that in the Arctic, for most models, the areas showing significant predictive skill become broader associated with increasing lead times. This area expansion is largely because nearly all the models are capable of predicting the observed decreasing Arctic sea ice cover. Sea ice extent in the North Pacific has better predictive skill than that in the North Atlantic (particularly at a lead time of 3–7 years), but there is a re-emerging predictive skill in the North Atlantic at a lead time of 6–8 years. In contrast to the Arctic, Antarctic sea ice decadal hindcasts do not show broad predictive skill at any timescales, and there is no obvious improvement linking the areal extent of significant predictive skill to lead time increase. This might be because nearly all the models predict a retreating Antarctic sea ice cover, opposite to the observations. For the Arctic, the predictive skill of the multi-model ensemble mean outperforms most models and the persistence prediction at longer timescales, which is not the case for the Antarctic. Overall, for the Arctic, initialized decadal hindcasts show improved predictive skill compared to uninitialized simulations, although this improvement is not present in the Antarctic.

We report on a rare case of refractory hepatic hydrothorax in an individual with Scleroderma/CREST syndrome and noncirrhotic portal hypertension. Portal pressure measurements revealed a normal transjugular hepatic venous portal pressure gradient, mild pulmonary hypertension, and an unremarkable liver biopsy except for mild sinusoidal dilation. Pulmonary hypertension, cardiac diastolic dysfunction, and chronic kidney disease were determined to be the causes of his refractory pleural effusions and ascites. Over the year, he underwent 50 thoracenteses and 20 paracenteses averaging 10–12 liters/week. Repeat pulmonary evaluation determined his pulmonary pressures to be normal and a secondary review of the “unremarkable” liver biopsy noted mild venous outflow obstruction and possibly Nodular Regenerative Hyperplasia (NRH). Repeat portal pressures indirectly and directly confirmed the existence of presinusoidal portal hypertension that has been associated with NRH. A transjugular intrahepatic portal systemic shunt (TIPS) was placed and he has not required thoracentesis or paracentesis over the past 18 months.

We report an uncommon case of deep infiltrating endometriosis of the colon presenting as iron deficiency anemia nine years after hysterectomy with bilateral salpingo-oophorectomy. The endometrial implant was found at the hepatic flexure, an exceedingly rare location for endometriosis invasion with no cases distinctly reported in the literature. Additionally, the presentation of gastrointestinal endometriosis as iron deficiency anemia is not well documented in the literature. Instead of surgery, we prescribed a novel medical therapeutic approach using conjugated estrogen-bazedoxifene to antagonize the proliferative effects of estrogen on endometrial tissue. After five months of therapy and repeat colonoscopy, no evidence of endometrial tissue remained in the hepatic flexure.

Malaria treatment of children is particulary difficult because of the absence of palatable suspensions for young children. Halofantrine hydrochloride is available as a suspension which is both palatable and simple to administer, and has been studied in a number of trials in the past 5 years. Children (331) ranging from 4 months to 17 years of age (mean 4.7 years) were treated with the 5% suspension using various dose regimens and 364 children ranging from 4 months to 14 years of age (mean 5.7 years) were treated with the 2% suspension 6 hourly for 3 doses. Using the 3-dose regimen there were only 2/462 (0.4%) who failed to clear the initial parasitaemia. Recrudescence occurred in 28/367 (7.6%) children with evaluable follow up data. The mean parasite clearance time in this group was 57.1h (n = 417) and the mean fever clearance time was 50.9 h (n = 325). Symptoms related to malaria cleared rapidly following treatment generally by 24-48 h post treatment. Side effects possibly related to treatment were uncommon but were similar to those reported in adults. The frequency of diarrhoea and abdominal pain was lower than that seen in adults and was also less frequent following multiple doses and the use of the more dilute suspension. Since was evidence that the majority of recrudescences were seen in younger children or those living in areas with low or seasonal transmission it is recommended that a further course of treatment 7 days later is given to these patients to prevent recrudescence. Halofantrine suspension appears to be effective and well tolerated in children and is a useful addition to the drugs available for the treatment of paediatric malaria.

This program is designed to help members improve their understanding of horses and horse care, advance their skills in riding and handling horses, provide goals for leading, make their 4-H horse experiences more interesting and enjoyable, and let them progress at their own speeds while challenging them to keep working to become better horsemen and 4-H members. This document is 4HHSM52 of the Florida 4-H Youth Development Program, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Published 1989. Reviewed June 2002.

This document is 4HSWG04 of the Florida 4-H Youth Development Program, Florida Cooperative Extension Service, Institute of Food and Agricultural Sciences, University of Florida. Printed Janunary1989. Reviewed June 2002. https://edis.ifas.ufl.edu/4h178

Patients undergoing catheter ablation for atrial fibrillation (AF) are routinely admitted for observation overnight in the hospital. With the rising incidence of AF among the population, increased volumes of procedures are placing increased demands on hospital resources. The purpose of this study was to evaluate the efficacy and safety of same day discharge in patients undergoing ablation for AF when compared to patients admitted for overnight observation. We performed a retrospective analysis using a multicenter cohort among patients who were discharged home after elective pulmonary vein isolation (PVI) ablation for AF. In our analysis, we found no statistically significant difference between patients discharged on the day of their procedure when compared to patients admitted for overnight observation in terms of 90-day readmission, major adverse cardiovascular events and death. This study shows that same day discharge after AF ablation is a feasible option. Future studies are needed to elicit the appropriate protocol to use.