For reflected sunlight observed from space at visible and near-infrared wavelengths, particles suspended in Earth’s atmosphere provide contrast with vegetation or dark water at the surface. This is ...the physical motivation for the Dark Target (DT) aerosol retrieval algorithm developed for the Moderate Resolution Imaging Spectrometer (MODIS). To extend the data record of aerosol optical depth (AOD) beyond the expected 20-year lifespan of the MODIS sensors, DT must be adapted for other sensors. A version of the DT AOD retrieval for the Visible Infrared Imaging Radiometer Suite (VIIRS) on the Suomi-National Polar-Orbiting Partnership (SNPP) is now mature enough to be released as a standard data product, and includes some upgraded features from the MODIS version. Differences between MODIS Aqua and VIIRS SNPP lead to some inevitable disagreement between their respective AOD measurements, but the offset between the VIIRS SNPP and MODIS Aqua records is smaller than the offset between those of MODIS Aqua and MODIS Terra. The VIIRS SNPP retrieval shows good agreement with ground-based measurements. For most purposes, DT for VIIRS SNPP is consistent enough and in close enough agreement with MODIS to continue the record of satellite AOD. The reasons for the offset from MODIS Aqua, and its spatial and temporal variability, are investigated in this study.
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The new 3.6 version of the Louvain-la-Neuve sea ice model (LIM) is presented, as integrated in the most recent stable release of Nucleus for European Modelling of the Ocean (NEMO) (3.6). The release ...will be used for the next Climate Model Inter-comparison Project (CMIP6). Developments focussed around three axes: improvements of robustness, versatility and sophistication of the code, which involved numerous changes. Robustness was improved by enforcing exact conservation through the inspection of the different processes driving the air–ice–ocean exchanges of heat, mass and salt. Versatility was enhanced by implementing lateral boundary conditions for sea ice and more flexible ice thickness categories. The latter includes a more practical computation of category boundaries, parameterizations to use LIM3.6 with a single ice category and a flux redistributor for coupling with atmospheric models that cannot handle multiple sub-grid fluxes. Sophistication was upgraded by including the effect of ice and snow weight on the sea surface. We illustrate some of the new capabilities of the code in two standard simulations. One is an ORCA2-LIM3 global simulation at a nominal 2° resolution, forced by reference atmospheric climatologies. The other one is a regional simulation at 2 km resolution around the Svalbard Archipelago in the Arctic Ocean, with open boundaries and tides. We show that the LIM3.6 forms a solid and flexible base for future scientific studies and model developments.
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Patients with heart failure are at increased risk of both sudden death and pump failure death. Strategies to better identify those who have greatest net benefit from implantable ...cardioverter-defibrillator (ICD) implantation could reduce morbidity and maximize cost-effectiveness of ICDs.
We aimed to identify baseline variables in patients with cardiomyopathy that are independently associated with a disproportionate fraction of mortality risk attributable to sudden death vs nonsudden death.
We used data from 9885 patients with heart failure without ICDs, of whom 2552 died during an average follow-up of 2.3 years. Using commonly available baseline clinical and demographic variables, we developed a multivariate regression model to identify variables associated with a disproportionate risk of sudden death.
We confirmed that lower ejection fraction and better functional class were associated with a greater proportion of mortality due to sudden death. Younger age, male sex, and higher body mass index were independently associated with a greater proportional risk of sudden death, while diabetes mellitus, hyper/hypotension, higher creatinine level, and hyponatremia were associated with a disproportionately lower risk of sudden death. The use of several heart failure medications, left ventricular end-diastolic dimension, or NT-pro brain natriuretic peptide concentrations were not associated with a disproportionate risk of sudden death.
Several easily obtained baseline demographic and clinical variables, beyond ejection fraction and New York Heart Association functional class, are independently associated with a disproportionately increased risk of sudden death. Further investigation is needed to assess whether this novel predictive method can be used to target the use of lifesaving therapies to populations who will derive greatest mortality benefit .
Emissions and long-range transport of mineral dust and combustion-related aerosol from burning fossil fuels and biomass vary from year to year, driven by the evolution of the economy and changes in ...meteorological conditions and environmental regulations. This study offers both satellite and model perspectives of interannual variability and possible trend of combustion aerosol and dust in major continental outflow regions over the past 15 years (2003-2017). The decade-long record of aerosol optical depth (AOD, denoted as t), separately for combustion aerosol (τ(sub c)) and dust (τ(sub d)), over global oceans is derived from the Collection 6 aerosol products of the Moderate Resolution Imaging Spectroradiometer (MODIS) onboard both Terra and Aqua. These MODIS/Aqua datasets, complemented by aerosol source-tagged simulations using the Community Atmospheric Model Version 5 (CAM5), are then analyzed to understand the interannual variability and potential trend of τ(sub c) and τ(sub d) in the major continental outflows. Both MODIS and CAM5 consistently yield a similar decreasing trend of -0.017 to - 0.020 decade(exp -1) for τ(sub c) over the North Atlantic Ocean and the Mediterranean Sea that is attributable to reduced emissions from North America and Europe, respectively. On the contrary, both MODIS and CAM5 display an increasing trend of +0.017 to +0.036 decade(exp -1) for τ(sub c) over the tropical Indian Ocean, the Bay of Bengal, and the Arabian Sea, which reflects the influence of increased anthropogenic emissions from South Asia and Middle East in the last two decades. Over the northwestern Pacific Ocean that is often affected by East Asian emissions of pollution and dust, the MODIS retrievals show a decreasing trend of - 0.021 decade(exp -1) for τ(sub c) and -0.012 decade(exp -1) for τ(sub d), which is however not reproduced by the CAM5 model. In other outflow regions strongly influenced by biomass burning smoke or dust, both MODIS retrievals and CAM5 simulations show no statistically significant trends; and the MODIS observed interannual variability is usually larger than that of the CAM5 simulation.
Persistent high aerosol loadings together with extremely high population densities have raised serious air quality and public health concerns in many urban centers in East Asia. However, ground-based ...air quality monitoring is relatively limited in this area. Recently, satellite-retrieved Aerosol Optical Depth (AOD) at high resolution has become a powerful tool to characterize aerosol patterns in space and time. Using ground AOD observations from the Aerosol Robotic Network (AERONET) and the Distributed Regional Aerosol Gridded Observation Networks (DRAGON)-Asia Campaign, as well as from handheld sunphotometers, we evaluated emerging aerosol products from the Visible Infrared Imaging Radiometer Suite (VIIRS) aboard the Suomi National Polar-orbiting Partnership (S-NPP), the Geostationary Ocean Color Imager (GOCI) aboard the Communication, Ocean, and Meteorology Satellite (COMS), and Terra and Aqua Moderate Resolution Imaging Spectroradiometer (MODIS) (Collection 6) in East Asia in 2012 and 2013. In the case study in Beijing, when compared with AOD observations from handheld sunphotometers, 51% of VIIRS Environmental Data Record (EDR) AOD, 37% of GOCI AOD, 33% of VIIRS Intermediate Product (IP) AOD, 26% of Terra MODIS C6 3km AOD, and 16% of Aqua MODIS C6 3km AOD fell within the reference expected error (EE) envelope (+/-0.05/+/- 0.15 AOD). Comparing against AERONET AOD over the JapanSouth Korea region, 64% of EDR, 37% of IP, 61% of GOCI, 39% of Terra MODIS, and 56% of Aqua MODIS C6 3km AOD fell within the EE. In general, satellite aerosol products performed better in tracking the day-to-day variability than tracking the spatial variability at high resolutions. The VIIRS EDR and GOCI products provided the most accurate AOD retrievals, while VIIRS IP and MODIS C6 3km products had positive biases.
BACKGROUND:Acromial fractures following reverse shoulder arthroplasty are difficult to identify and have variable effects on outcomes. A reproducible classification system is needed to categorize ...these fractures before it is possible to evaluate optimal treatment. The purposes of this study were to investigate the ability of radiographs to detect acromial fractures and establish fracture union, and to assess the reliability of a new classification system of postoperative acromial fractures based on the involvement of the deltoid origin.
METHODS:Eighteen patients presenting with pain along the acromion or scapular spine following reverse shoulder arthroplasty were evaluated for acromial fractures over a period of fifty-six months. If radiographic findings were negative, computed tomography (CT) scans were performed. Sixteen acromial fractures were identified and classified into subtypes on the basis of the deltoid muscle origintype I indicated involvement of a portion of the anterior and middle deltoid origin; type II, at least the entire middle deltoid origin with a portion but not all of the posterior deltoid origin; and type III, the entire middle and posterior deltoid origin. The average age of the patients at the time of surgery was seventy-seven years (range, fifty-seven to eighty-seven years); the average duration of follow-up after surgery was twenty-five months (range, seven to forty-eight months). All fractures were treated nonoperatively. Blinded, fellowship-trained shoulder surgeons reviewed images that best illustrated the fracture, and the interobserver reliability of the classification system was evaluated. The reliability of radiographs to detect the fracture at the time of the initial presentation of pain and to observe ultimate fracture union was evaluated.
RESULTS:Interobserver reliability of the classification system was excellent (interclass correlation coefficient of 0.96). Radiographs were unreliable at detecting acromial fractures at the time of the initial presentation of pain (κ = −0.5) and at determining fracture union (κ = 0.05).
CONCLUSIONS:Radiographs may be unreliable for detecting acromial fractures after reverse total shoulder arthroplasty, and CT scans are often needed to identify the fracture. Once identified, postoperative acromial fractures can be reliably classified into three subtypes. Nonoperative treatment of postoperative acromial fractures results in limitation of functional outcomes.
LEVEL OF EVIDENCE:Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
In an open-label trial, patients with type 2 diabetes with a suboptimal glycated hemoglobin level while receiving a maximally tolerated dose of metformin and sulfonylurea were randomly assigned to ...receive biphasic, prandial, or basal insulin. The addition of a single analogue-insulin formulation resulted in a glycated hemoglobin level of 6.5% or less in a minority of patients at 1 year. Regimens of biphasic or prandial insulin had greater efficacy than did the basal regimen but were associated with greater risks of hypoglycemia and weight gain.
The addition of a single analogue-insulin formulation resulted in a glycated hemoglobin level of 6.5% or less in a minority of patients at 1 year. Regimens of biphasic or prandial insulin had greater efficacy than did the basal regimen but were associated with greater risks of hypoglycemia and weight gain.
Type 2 diabetes mellitus is a progressive condition in which the glycated hemoglobin level rises inexorably over time and the function of beta cells declines.
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Most patients eventually require insulin,
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which usually is added when glycemic control with a regimen of oral antidiabetic agents becomes suboptimal.
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The addition of insulin can result in a clinically relevant improvement in a patient's glycated hemoglobin level. . . .
Background. Pneumococcal serotypes 1, 3, 5, 7F, and 19A were the most implicated in community-acquired pneumonia (CAP) after implementation of 7-valent pneumococcal conjugate vaccine (PCV7). In ...France, the switch from PCV7 to 13-valent pneumococcal conjugate vaccine (PCV13) occurred in June 2010. An active surveillance network was set up to analyze the impact of PCV13 on CAP. Methods. An observational prospective study performed in 8 pediatric emergency departments from June 2009 to May 2012 included all children between 1 month and 15 years of age with chest radiography–confirmed pneumonia. Three 1-year periods were defined: pre-PCV13, transitional, and post-PCV13. Results. During the 3-year study period, among the 953 274 pediatric emergency visits, 5645 children with CAP were included. CAP with pleural effusion and documented pneumococcal CAP were diagnosed in 365 and 136 patients, respectively. Despite an increase (4.5%) in number of pediatric emergency visits, cases of CAP decreased by 16% (2060 to 1725) between pre- and post-PCV13 periods. The decrease reached 32% in infants in the same periods (757 to 516; P < .001). Between pre- and post-PCV13 periods, the proportion of CAP patients with a C-reactive protein level >120 mg/dL decreased from 41.3% to 29.7% (P < .001), the number of pleural effusion cases decreased by 53% (167 to 79; P < .001) and the number of pneumococcal CAP cases decreased by 63% (64 to 24; P = .002). The number of additional PCV13 serotypes identified decreased by 74% (27 to 7). Conclusions. Our data suggest a strong impact of PCV13 on CAP, pleural effusion, and documented pneumococcal pneumonia, particularly cases due to PCV13 serotypes.
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The treatment for both leishmaniasis and trypanosomiasis, which are severe human infections caused by trypanosomatids belonging to Leishmania and Trypanosoma genera, respectively, is extremely ...limited because of concerns of toxicity and efficacy with the available anti-protozoan drugs, as well as the emergence of drug resistance. Consequently, the urgency for the discovery of new trypanosomatid targets and novel bioactive compounds is particularly necessary. In this context, the investigation of changes in parasite gene expression between drug resistant/sensitive strains and in the up-regulation of virulence-related genes in infective forms has brought to the fore the involvement of calpain-like proteins in several crucial pathophysiological processes performed by trypanosomatids. These studies were encouraged by the publication of the complete genome sequences of three human pathogenic trypanosomatids, Trypanosoma brucei, Trypanosoma cruzi and Leishmania major, which allowed in silico analyses that in turn directed the identification of numerous genes with interesting chemotherapeutic characteristics, including a large family of calpain-related proteins, in which to date 23 genes were assigned as calpains in T. brucei, 40 in T. cruzi and 33 in L. braziliensis. In the present review, we intend to add to these biochemical/biological reports the investigations performed upon the inhibitory capability of calpain inhibitors against human pathogenic trypanosomatids.
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