In this randomized trial involving patients with traumatic brain injury and elevated intracranial pressure, therapeutic hypothermia plus standard care to reduce intracranial pressure did not result ...in outcomes better than those with standard care alone.
In Europe, traumatic brain injury is the most common cause of permanent disability in people younger than 40 years of age, with the annual cost exceeding €33 billion (approximately $37.5 billion in U.S. dollars).
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Recent statistics show a 21% increase in the incidence of traumatic brain injury during the past 5 years — three times greater than the increase in population. Despite this, management of traumatic brain injury has been underrepresented in medical research as compared with other health problems.
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Consequently, there are few data to support the commonly used stage 2 interventions (Figure 1) for the management of . . .
Accurately accounting for new particle formation (NPF) is crucial to our ability to predict aerosol number concentrations in many environments and thus cloud properties, which is in turn vital in ...simulating radiative transfer and climate. Here we present an analysis of NPF events observed in the Greenland Sea during the summertime as part of the Aerosol-Cloud Coupling And Climate Interactions in the Arctic (ACCACIA) project. While NPF events have been reported in the Arctic before, we were able, for the first time, to detect iodine in the growing particles using an Aerosol Mass Spectrometer (AMS) during a persistent event in the region of the coastal sea-ice near Greenland. Given the potency of iodine as a nucleation precursor, the results imply that iodine was responsible for the initial NPF, a phenomenon that has been reported at lower latitudes and associated with molecular iodine emissions from coastal macroalgae. The initial source of iodine in this instance is not clear, but it was associated with air originating approximately 1 day previously over melting coastal sea-ice. These results show that atmospheric models must consider iodine as a source of new particles in addition to established precursors such as sulfur compounds.
We investigate the evolution of the properties of planetary period magnetic field oscillations observed by the Cassini spacecraft in Saturn's magnetosphere over the interval from late 2004 to early ...2011, spanning equinox in mid‐2009. Oscillations within the inner quasi‐dipolar region (L ≤ 12) consist of two components of close but distinct periods, corresponding essentially to the periods of the northern and southern Saturn kilometric radiation (SKR) modulations. These give rise to modulations of the combined amplitude and phase at the beat period of the two oscillations, from which the individual oscillation amplitudes and phases (and hence periods) can be determined. Phases are also determined from northern and southern polar oscillation data when available. Results indicate that the southern‐period amplitude declines modestly over this interval, while the northern‐period amplitude approximately doubles to become comparable with the southern‐period oscillations during the equinox interval, producing clear effects in pass‐to‐pass oscillation properties. It is also shown that the periods of the two oscillations strongly converge over the equinox interval, such that the beat period increases significantly from ∼20 to more than 100 days, but that they do not coalesce or cross during the interval investigated, contrary to recent reports of the behavior of the SKR periods. Examination of polar oscillation data for similar beat phase effects yields a null result within a ∼10% upper limit on the relative amplitude of northern‐period oscillations in the south and vice versa. This result strongly suggests a polar origin for the two oscillation periods.
Key Points
Near rotation period phenomena at Saturn are studied using magnetic field data
We study seasonal changes in both period and amplitude of the oscillations
The result strongly suggests a polar origin for the two oscillation periods
We use 2009-2011 space-borne methane observations from the Greenhouse Gases Observing SATellite (GOSAT) to estimate global and North American methane emissions with 4 degree 5 degree and up to 50 km ...50 km spatial resolution, respectively. GEOS-Chem and GOSAT data are first evaluated with atmospheric methane observations from surface and tower networks (NOAA/ESRL, TCCON) and aircraft (NOAA/ESRL, HIPPO), using the GEOS-Chem chemical transport model as a platform to facilitate comparison of GOSAT with in situ data. This identifies a high-latitude bias between the GOSAT data and GEOS-Chem that we correct via quadratic regression. Our global adjoint-based inversion yields a total methane source of 539 Tg a-1 with some important regional corrections to the EDGARv4.2 inventory used as a prior. Results serve as dynamic boundary conditions for an analytical inversion of North American methane emissions using radial basis functions to achieve high resolution of large sources and provide error characterization. We infer a US anthropogenic methane source of 40.2-42.7 Tg a-1, as compared to 24.9-27.0 Tg a-1 in the EDGAR and EPA bottom-up inventories, and 30.0-44.5 Tg a-1 in recent inverse studies. Our estimate is supported by independent surface and aircraft data and by previous inverse studies for California. We find that the emissions are highest in the southern-central US, the Central Valley of California, and Florida wetlands; large isolated point sources such as the US Four Corners also contribute. Using prior information on source locations, we attribute 29-44 % of US anthropogenic methane emissions to livestock, 22-31 % to oil/gas, 20 % to landfills/wastewater, and 11-15 % to coal. Wetlands contribute an additional 9.0-10.1 Tg a-1.
Summary Background Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus, but no large trials have compared interventions. We investigated the ...effects of diet and physical activity on blood pressure and glucose concentrations. Methods We did a randomised, controlled trial in southwest England in adults aged 30–80 years in whom type 2 diabetes had been diagnosed 5–8 months previously. Participants were assigned usual care (initial dietary consultation and follow-up every 6 months; control group), an intensive diet intervention (dietary consultation every 3 months with monthly nurse support), or the latter plus a pedometer-based activity programme, in a 2:5:5 ratio. The primary endpoint was improvement in glycated haemoglobin A1c (HbA1c ) concentration and blood pressure at 6 months. Analysis was done by intention to treat. This study is registered, number ISRCTN92162869. Findings Of 593 eligible individuals, 99 were assigned usual care, 248 the diet regimen, and 246 diet plus activity. Outcome data were available for 587 (99%) and 579 (98%) participants at 6 and 12 months, respectively. At 6 months, glycaemic control had worsened in the control group (mean baseline HbA1c percentage 6·72, SD 1·02, and at 6 months 6·86, 1·02) but improved in the diet group (baseline-adjusted difference in percentage of HbA1c −0·28%, 95% CI −0·46 to −0·10; p=0·005) and diet plus activity group (−0·33%, −0·51 to −0·14; p<0·001). These differences persisted to 12 months, despite less use of diabetes drugs. Improvements were also seen in bodyweight and insulin resistance between the intervention and control groups. Blood pressure was similar in all groups. Interpretation An intensive diet intervention soon after diagnosis can improve glycaemic control. The addition of an activity intervention conferred no additional benefit. Funding Diabetes UK and the UK Department of Health.
APOGEE-2 is a high-resolution, near-infrared spectroscopic survey observing ∼3 × 105 stars across the entire sky. It is the successor to APOGEE and is part of the Sloan Digital Sky Survey IV ...(SDSS-IV). APOGEE-2 is expanding on APOGEE's goals of addressing critical questions of stellar astrophysics, stellar populations, and Galactic chemodynamical evolution using (1) an enhanced set of target types and (2) a second spectrograph at Las Campanas Observatory in Chile. APOGEE-2 is targeting red giant branch and red clump stars, RR Lyrae, low-mass dwarf stars, young stellar objects, and numerous other Milky Way and Local Group sources across the entire sky from both hemispheres. In this paper, we describe the APOGEE-2 observational design, target selection catalogs and algorithms, and the targeting-related documentation included in the SDSS data releases.
The synapse in traumatic brain injury Jamjoom, Aimun A B; Rhodes, Jonathan; Andrews, Peter J D ...
Brain (London, England : 1878),
02/2021, Letnik:
144, Številka:
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Journal Article
Recenzirano
Odprti dostop
Traumatic brain injury (TBI) is a leading cause of death and disability worldwide and is a risk factor for dementia later in life. Research into the pathophysiology of TBI has focused on the impact ...of injury on the neuron. However, recent advances have shown that TBI has a major impact on synapse structure and function through a combination of the immediate mechanical insult and the ensuing secondary injury processes, leading to synapse loss. In this review, we highlight the role of the synapse in TBI pathophysiology with a focus on the confluence of multiple secondary injury processes including excitotoxicity, inflammation and oxidative stress. The primary insult triggers a cascade of events in each of these secondary processes and we discuss the complex interplay that occurs at the synapse. We also examine how the synapse is impacted by traumatic axonal injury and the role it may play in the spread of tau after TBI. We propose that astrocytes play a crucial role by mediating both synapse loss and recovery. Finally, we highlight recent developments in the field including synapse molecular imaging, fluid biomarkers and therapeutics. In particular, we discuss advances in our understanding of synapse diversity and suggest that the new technology of synaptome mapping may prove useful in identifying synapses that are vulnerable or resistant to TBI.
Objective
Many patients admitted to the intensive care unit (ICU) have pre-existing or acquired neurological disorders which significantly affect their short-term and long-term outcomes. The ESICM ...NeuroIntensive Care Section convened an expert panel to establish a pragmatic approach to neurological examination (NE) of the critically ill patient.
Methods
The group conducted a comprehensive review of published studies on the NE of patients with coma, delirium, seizures and neuromuscular weakness in critically ill patients. Quality of data was rated as high, moderate, low, or very low, and final recommendations as strong, weak, or best practice.
Summary and Conclusions
The group made the following recommendations: (1) NE should be performed in all patients admitted to ICUs; (2) NE should include an assessment of consciousness and cognition, brainstem function, and motor function; (3) sedation should be managed to maximize the clinical detection of neurological dysfunction, except in patients with reduced intracranial compliance in whom withdrawal of sedation may be deleterious; (4) the need for additional tests, including neurophysiological and neuroradiological investigations, should be guided by the NE; (5) selected features of the NE have prognostic value which should be considered in well-defined patient populations.
A reliable and precise in situ CO2 and CO analysis system has been developed and deployed at eight sites in the NOAA Earth System Research Laboratory's (ESRL) Global Greenhouse Gas Reference Network. ...The network uses very tall (> 300 m) television and radio transmitter towers that provide a convenient platform for mid-boundary-layer trace-gas sampling. Each analyzer has three sample inlets for profile sampling, and a complete vertical profile is obtained every 15 min. The instrument suite at one site has been augmented with a cavity ring-down spectrometer for measuring CO2 and CH4 . The long-term stability of the systems in the field is typically better than 0.1 ppm for CO2 , 6 ppb for CO, and 0.5 ppb for CH4 , as determined from repeated standard gas measurements. The instrumentation is fully automated and includes sensors for measuring a variety of status parameters, such as temperatures, pressures, and flow rates, that are inputs for automated alerts and quality control algorithms. Detailed and time-dependent uncertainty estimates have been constructed for all of the gases, and the uncertainty framework could be readily adapted to other species or analysis systems. The design emphasizes use of off-the-shelf parts and modularity to facilitate network operations and ease of maintenance. The systems report high-quality data with > 93% uptime. Recurrent problems and limitations of the current system are discussed along with general recommendations for high-accuracy trace-gas monitoring. The network is a key component of the North American Carbon Program and a useful model for future research-grade operational greenhouse gas monitoring efforts.
Energy loss in a fault damage zone, outside the slip zone, contributes to the fracture energy that determines rupture velocity of an earthquake. A nonelastic two‐dimensional dynamic calculation is ...done in which the slip zone is modeled as a fault plane and material off the fault is subject to a Coulomb yield condition. In a mode 2 crack‐like solution in which an abrupt uniform drop of shear traction on the fault spreads from a point, Coulomb yielding occurs on the extensional side of the fault. Plastic strain is distributed with uniform magnitude along the fault, and it has a thickness normal to the fault proportional to propagation distance. Energy loss off the fault is also proportional to propagation distance, and it can become much larger than energy loss on the fault specified by the fault constitutive relation. The slip velocity function could be produced in an equivalent elastic problem by a slip‐weakening friction law with breakdown slip Dc increasing with distance. Fracture energy G and equivalent Dc will be different in ruptures with different initiation points and stress drops, so they are not constitutive properties; they are determined by the dynamic solution that arrives at a particular point. Peak slip velocity is, however, a property of a fault location. Nonelastic response can be mimicked by imposing a limit on slip velocity on a fault in an elastic medium.
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