This contribution explores the internal structure of very small debris-covered glacier systems located in permafrost environments and their current dynamical responses to short-term climatic ...variations. Three systems were investigated with electrical resistivity tomography and dGPS monitoring over a 3-year period. Five distinct sectors are highlighted in each system: firn and bare-ice glacier, debris-covered glacier, heavily debris-covered glacier of low activity, rock glacier and ice-free debris. Decimetric to metric movements, related to ice ablation, internal deformation and basal sliding affect the glacial zones, which are mainly active in summer. Conversely, surface lowering is close to zero (-0.04 m yr-1) in the rock glaciers. Here, a constant and slow internal deformation was observed (c. 0.2 m yr-1). Thus, these systems are affected by both direct and high magnitude responses and delayed and attenuated responses to climatic variations. This differential evolution appears mainly controlled by (1) the proportion of ice, debris and the presence of water in the ground, and (2) the thickness of the superficial debris layer.
The World Health Organization has defined mobile health (mHealth) as the "use of mobile and wireless technologies to support the achievement of health objectives." Smartphones currently represent one ...of the main media forms for mHealth democratization. Health apps can be an interesting tool for changing health behaviors. However, their use in France is still poorly documented.
The main aim of this study was to evaluate the frequency of use of health apps among patients consulting in the primary care setting in France. The secondary aims were to evaluate the use of health apps according to the sociodemographic and medical characteristics of patients and to determine their use.
A population-based cross-sectional survey was carried out between November 2017 and January 2018 in the Grenoble area of France among patients aged between 18 and 69 years who were consulting at 13 primary care physician offices. Patients were provided with anonymous paper self-questionnaires. The main criterion for participation was the use of a smartphone health app, defined for the purpose of this study as any app supporting patients in efforts to be healthy.
The participation rate was 49.27% (739/1500; 95% CI 46.7%-51.8%). The smartphone use was estimated at 82.6% (597/723; 95% CI 79.6%-85.2%). Of 597 smartphone owners, 47.7% (283/595; CI 43.6%-51.6%) used at least one smartphone health app. Health apps identified in this study were mainly related to wellness, prevention, and fitness (66.1%), as well as medication, treatments, and follow-up care (50.0%). The main factors associated with health app use were: use of social networks (odds ratio OR 3.4, 95% CI 2.1-5.3), age under 30 years (OR 2.7, CI 1.4-4.9), city size between 5001 and 10,000 inhabitants (OR 1.8, CI 1.1-2.8), and city size more than 10,000 inhabitants (OR 2.1, CI 1.4-3.2).
In this survey, nearly one out of two patients reported the use of smartphone health apps, which are currently focused on wellness, prevention, and fitness, and are largely used by the younger population.
ClinicalTrials.gov NCT03351491; https://clinicaltrials.gov/ct2/show/NCT03351491.
Since 1972, the United Nations Educational, Scientific and Cultural Organization (UNESCO) World Heritage Convention aims to identify and protect sites of Outstanding Universal Value for future ...generations. However, growing impacts of climate change are of the utmost concern for the integrity of many sites. Here, we inventory the glaciers present in natural World Heritage sites for the first time. We found 19,000 glaciers in 46 sites located all over the world. We analyze their recent evolution, current state, and project their mass change over the 21st century. Our results are based on a comprehensive review of the literature as well as a state‐of‐the‐art glaciological model for computing glacier responses up to 2100. Illustrating the strong influence of CO2 emission scenarios and human actions on future ice loss magnitude, we project the wastage of 33% to 60% of the 2017 cumulative ice volume of 12,000 km3 of World Heritage glaciers by 2100. Furthermore, we expect complete glacier extinction in 8 to 21 of the investigated World Heritage sites until the end of the century, depending on the climate scenario. We suggest that World Heritage glaciers should be considered as analogs to endangered umbrella, keystone, and flagship species, whose conservation would secure wider environmental and social benefits at global scale.
Plain Language Summary
The World Heritage convention aims at protecting the Earth's outmost assets and commits humanity to transmit them to future generations. However, many World Heritage sites are affected by anthropogenic climate change. Here, we present the first study on the glaciers located within the natural World Heritage sites. We inventoried 19,000 World Heritage glaciers and projected their mass changes over the 21st century. The results emphasize that major glacier decline will occur in these iconic sites in future decades. Nevertheless, ice loss magnitude will vary by a factor of 2 according to CO2 emission scenarios and thus human activities. This study points out how the conservation of World Heritage glaciers could serve as a leverage and a target to tackle the unprecedented issue of climate change. Glaciers are more than disappearing passive climatic indicators. They are key components of planetary ecosystems that influence global climate and sea level, as well as water fluxes, human activities, or biodiversity at the regional scale. The conservation of these iconic endangered features could thus mobilize global‐scale conservation and climate mitigation benefits. In this context, we show how drastic reduction of emissions will rapidly curb melt rates and safeguard a large glacier volume on the long term.
Key Points
First inventory and study of the 19,000 glaciers located in natural World Heritage sites is presented
In response to anthropogenic warming, these glaciers are expected to lose 33% to 60% of their volume by 2100
The conservation of World Heritage glaciers is paramount in a changing climate because of their key role in planetary ecosystems
BACKGROUND:The use of prothrombin complex concentrates and the role of plasma concentration of anticoagulants in the management of bleeding in patients treated with direct oral anticoagulants are ...still debated. Our aim was to describe management strategies and outcomes of severe bleeding events in patients treated with direct oral anticoagulants.
METHODS:We performed a prospective cohort study of 732 patients treated with dabigatran, rivaroxaban, or apixaban hospitalized for severe bleeding, included prospectively in the registry from June 2013 to November 2015.
RESULTS:Bleeding was gastrointestinal or intracranial in 37% (212 of 732) and 24% (141 of 732) of the cases, respectively. Creatinine clearance was lower than 60 ml/min in 61% (449 of 732) of the cases. The plasma concentration of direct oral anticoagulants was determined in 62% (452 of 732) of the cases and was lower than 50 ng/ml or higher than 400 ng/ml in 9.2% (41 of 452) and in 6.6% (30 of 452) of the cases, respectively. Activated or nonactivated prothrombin complex concentrates were administered in 38% of the cases (281 of 732). Mortality by day 30 was 14% (95% CI, 11 to 16).
CONCLUSIONS:Management of severe bleeding in patients treated with direct oral anticoagulants appears to be complex. The use of prothrombin complex concentrates differs depending on bleeding sites and direct oral anticoagulant plasma concentrations. Mortality differs according to bleeding sites and was similar to previous estimates.
We report herein synthesis, characterization and antimicrobial activity of four Shiff bases derived from hexamethylenediamine. Substitution of a nitro group on each aromatic ring in ortho, meta or ...para positions of N,N'-bis(phenylmethyl)hexane-1,6-diimineallowed to have a homogeneous series of positional isomers. These four symmetric diimine Schiff bases were characterized by conventional spectrometry methods (NMR, IR, MS), then tested against Gram-positive and Gram-negative bacterial strains. Among them, compounds 1b, 1c, 1d were found to be active against bacterial strain Staphylococcus aureus CIP with MIC value of 375μg/ ml, 187.5μg /ml and 375μg /ml respectively. Candida Albicans fungal strain showed resistance to all synthesized Schiff base compounds, butin the other hand, Candida glabrata has been sensitive to all compounds with MIC of 1500μg/ ml and one more time except 1a.
Although non-invasive ventilation (NIV) is recommended in patients with chest trauma, this procedure may expose to discomfort and even failure due to agitation or excessive pain. We tested the impact ...of dexmedetomidine on the duration of the first session of NIV.
This randomised, crossover study enrolled 19 patients with blunt chest trauma who needed NIV. During one cycle comprising two NIV sessions, patients received in a random order an intravenous infusion of dexmedetomidine (0.7mcg/kg/h) and placebo (saline solution) that was initiated 60min prior to NIV. Dexmedetomidine (or placebo) was titrated to maintain a Richmond Agitation Sedation Scale (RASS) score between 0 and −3. A 6-h washout period was observed between NIV sessions. The reproducibility of the drug-related effects was tested during a second cycle of two NIV sessions.
During the first cycle, dexmedetomidine prolonged the duration of NIV compared to placebo: 280min (118–450) (median, 25–75th quartiles) versus 120min (68–287) respectively, corresponding to a median increased duration of 96min (12–180) (P=0.03). Dexmedetomidine was associated with a lower score for RASS: −0.8 (−1.0;0.0) versus 0.0 (−0.5;0.0) (P<0.01), and reduced respiratory discomfort according to the 10cm visual similar scale: 0.6cm (0.0–3.0) versus 2.2cm (0.0–5.3) (P=0.05). Pain scores, morphine consumption, and blood gas measurements were comparable between groups. No difference in the duration of non-invasive ventilation was found during the second cycle.
In this pilot trial, dexmedetomidine could facilitate the acceptance of the first session of non-invasive ventilation for patients with chest trauma.
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