No such thing as a good war Zhang, Lindsey M.; Chapman Jr, William C.
The American journal of surgery,
07/2024, Volume:
233
Journal Article
Peer reviewed
In the paper “Family Perspectives on End of Life Care After Surgery: A Qualitative Analysis of the Veteran Affairs Bereaved Family Surveys,” Vitous et al. take on the lofty task of trying to ...understand what impacts the experience of family members following a patient death after surgery.1 Using a qualitative approach, the authors examined the results of the Bereaved Family Survey – a Veterans Affairs survey sent to the families of deceased Veterans – among families where a Veteran had expired within 90 days of surgery. Thorough analysis of 936 surveys revealed that patients’ families were negatively affected by a perception of unnecessary pain and suffering, poor communication, and lack of power and personal sovereignty. Vitous et al. have provided improved understanding of the experience of family members after the death of their loved one and have identified some viable solutions to these shortfalls.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Factors that lead to metabolic dysregulation are associated with increased risk of early-onset colorectal cancer (CRC diagnosed under age 50). However, the association between metabolic syndrome ...(MetS) and early-onset CRC remains unexamined.
We conducted a nested case-control study among participants aged 18-64 in the IBM MarketScan Commercial Database (2006-2015). Incident CRC was identified using pathologist-coded International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, and controls were frequency matched. MetS was defined as presence of ≥3 conditions among obesity, hypertension, hyperlipidaemia and hyperglycaemia/type 2 diabetes, based on ICD-9-CM and use of medications. Multivariable logistic regressions were used to estimate ORs and 95% CIs.
MetS was associated with increased risk of early-onset CRC (n=4673; multivariable adjusted OR 1.25; 95% CI 1.09 to 1.43), similar to CRC diagnosed at age 50-64 (n=14 928; OR 1.21; 95% CI 1.15 to 1.27). Compared with individuals without a metabolic comorbid condition, those with 1, 2 or ≥3 conditions had a 9% (1.09; 95% CI 1.00 to 1.17), 12% (1.12; 95% CI 1.01 to 1.24) and 31% (1.31; 95% CI 1.13 to 1.51) higher risk of early-onset CRC (p
<0.001). No associations were observed for one or two metabolic comorbid conditions and CRC diagnosed at age 50-64. These positive associations were driven by proximal (OR per condition 1.14; 95% CI 1.06 to 1.23) and distal colon cancer (OR 1.09; 95% CI 1.00 to 1.18), but not rectal cancer (OR 1.03; 95% CI 0.97 to 1.09).
Metabolic dysregulation was associated with increased risk of early-onset CRC, driven by proximal and distal colon cancer, thus at least in part contribute to the rising incidence of early-onset CRC.
Arctic sea ice data from a variety of historical sources have been synthesized into a database extending back to 1850 with monthly time-resolution. The synthesis procedure includes interpolation to a ...uniform grid and an analog-based estimation of ice concentrations in areas of no data. The consolidated database shows that there is no precedent as far back as 1850 for the 21
st
century's minimum ice extent of sea ice on the pan-Arctic scale. A regional-scale exception to this statement is the Bering Sea. The rate of retreat since the 1990s is also unprecedented and especially large in the Beaufort and Chukchi Seas. Decadal and multidecadal variations have occurred in some regions, but their magnitudes are smaller than that of the recent ice loss. Interannual variability is prominent in all regions and will pose a challenge to sea ice prediction efforts.
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BFBNIB, DOBA, FZAB, GIS, IJS, INZLJ, IZUM, KILJ, NLZOH, NMLJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, ZRSKP
5.
Presidential Foreword Chapman, William C
Journal of the American College of Surgeons,
April 2021, 2021-Apr, 2021-04-00, 20210401, Volume:
232, Issue:
4
Journal Article
We develop and compare model‐error representation schemes derived from data assimilation increments and nudging tendencies in multidecadal simulations of the Community Atmosphere Model, version 6. ...Each scheme applies a bias correction during simulation runtime to the zonal and meridional winds. We quantify the extent to which such online adjustment schemes improve the model climatology and variability on daily to seasonal timescales. Generally, we observe about a 30% improvement to annual upper‐level zonal winds, with largest improvements in boreal spring (around 35%) and winter (around 47%). Despite only adjusting the wind fields, we additionally observe around 20% improvement to annual precipitation over land, with the largest improvements in boreal fall (around 36%) and winter (around 25%), and around 50% improvement to annual sea‐level pressure, globally. With mean‐state adjustments alone, the dominant pattern of boreal low‐frequency variability over the Atlantic (the North Atlantic Oscillation) is significantly improved. Additional stochasticity increases the modal explained variances further, which brings the variability closer to the observed value. A streamfunction tendency decomposition reveals that the improvement is due to an adjustment to the high‐ and low‐frequency eddy–eddy interaction terms. In the Pacific, the mean‐state adjustment alone led to an erroneous deepening of the Aleutian low, but this was remedied with the addition of stochastically selected tendencies. Finally, from a practical standpoint, we discuss the performance of using data assimilation increments versus nudging tendencies for an online model‐error representation.
We develop and compare online model‐error representation schemes derived from data assimilation increments and nudging tendencies. Generally, we observe significant improvements to annual upper‐level zonal wind. Despite only adjusting the wind fields, we additionally observe an improvement to annual precipitation over land and annual sea‐level pressure. We additionally quantify improvements to model variability over the North Atlantic and North Pacific. Finally, we discuss the performance of using data assimilation increments versus nudging tendencies for an online model‐error representation.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Movement through space is a fundamental behavior for all animals. Cognitive maps of environments are encoded in the hippocampal formation in an allocentric reference frame, but motor movements that ...comprise physical navigation are represented within an egocentric reference frame. Allocentric navigational plans must be converted to an egocentric reference frame prior to implementation as overt behavior. Here we describe an egocentric spatial representation of environmental boundaries in the dorsomedial striatum.
Here we explore the relative contribution of the Madden‐Julian Oscillation (MJO) and El Niño Southern Oscillation (ENSO) to midlatitude subseasonal predictive skill of upper atmospheric circulation ...over the North Pacific, using an inherently interpretable neural network applied to pre‐industrial control runs of the Community Earth System Model version 2. We find that this interpretable network generally favors the state of ENSO, rather than the MJO, to make correct predictions on a range of subseasonal lead times and predictand averaging windows. Moreover, the predictability of positive circulation anomalies over the North Pacific is comparatively lower than that of their negative counterparts, especially evident when the ENSO state is important. However, when ENSO is in a neutral state, our findings indicate that the MJO provides some predictive information, particularly for positive anomalies. We identify three distinct evolutions of these MJO states, offering fresh insights into opportune forecasting windows for MJO teleconnections.
Plain Language Summary
Weather is hard to predict with longer forecast leads. Here, we use a data‐driven statistical model to dissect tropical sources of predictability of North Pacific upper‐level variability on subseasonal (2 weeks to 2 months) timescales. This model was constructed so that we can identify the relative contributions of two tropical phenomena important for predictability on these timescales. Namely, we use the Madden‐Jullian Oscillation (MJO) and the El Niño Southern Oscillation (ENSO) as predictor variables, two phenomena that provide a teleconnecting signal from the tropics to North Pacific variability. We find that the ENSO signal alone consistently provides more forecast predictability than the MJO. However, when ENSO is not active, the MJO provides distinct windows of forecast opportunity, particularly for anomalously anticyclonic events. We identify three evolutions of the MJO which offer new insights into forecasting weather at long forecast leads.
Key Points
An interpretable neural network is used to decompose contributions of MJO and ENSO to North Pacific subseasonal circulation predictability
ENSO alone is overall more useful than the MJO for subseasonal predictions across various lead times and predictand averaging windows
Unique MJO events, that provide enhanced subseasonal predictability during ENSO neutral conditions, are identified
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Organ waste is a major cause of the donor liver shortage. Roughly 67% of recovered organ donors have liver utilization annually. A new technology called normothermic machine perfusion (NMP) offers a ...way to recover marginal and declined livers for transplant. We report interim results of the RESTORE trial (FDA investigational drug exemption trial NCT04483102) that aims to transplant NMP-treated livers that would otherwise be discarded.
Declined livers were screened for NMP eligibility (eg donation after circulatory death DCD grafts with warm ischemic time <40 minutes, donation after brain death DBD grafts with cold ischemic time <8 hours). Livers meeting pre-NMP eligibility criteria received NMP using the OrganOx metra device for a minimum of 4 hours. All NMP-treated livers meeting the viability criteria were transplanted to consented recipients.
Over 22 months, 60 declined livers from three organ procurement organizations (OPOs; 40 DCD and 20 DBD donor livers) were offered, and 22 livers (10 DCD and 12 DBD livers) met the pre-NMP eligibility. After NMP, 16 of 22 livers passed viability testing and were transplanted into needy recipients (median Model for End-Stage Liver Disease MELD score of 8, range 6 to 24), resulting in a 72.7% rescue rate (50% DCD, 91.7% DBD). The rate of early allograft dysfunction was 31.3%, but there were no graft-related deaths, primary nonfunction, or instances of nonanastomotic biliary strictures.
Interim results of the RESTORE trial suggest that a sizable number of declined livers can be reclaimed. They are safe for transplantation and can enable lower MELD patients at high risk of morbidity and mortality to receive lifesaving grafts while offering OPOs a way to allocate more livers and reduce organ waste.
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