MetCoOp is a Nordic collaboration on operational Numerical Weather Prediction based on a common limited-area km-scale ensemble system. The initial states are produced using a 3-dimensional ...variational data assimilation scheme utilizing a large amount of observations from conventional in-situ measurements, weather radars, global navigation satellite system, advanced scatterometer data and satellite radiances from various satellite platforms. A version of the forecasting system which is aimed for future operations has been prepared for an enhanced assimilation of microwave radiances. This enhanced data assimilation system will use radiances from the Microwave Humidity Sounder, the Advanced Microwave Sounding Unit-A and the Micro-Wave Humidity Sounder-2 instruments on-board the Metop-C and Fengyun-3 C/D polar orbiting satellites. The implementation process includes channel selection, set-up of an adaptive bias correction procedure, and careful monitoring of data usage and quality control of observations. The benefit of the additional microwave observations in terms of data coverage and impact on analyses, as derived using the degree of freedom of signal approach, is demonstrated. A positive impact on forecast quality is shown, and the effect on the precipitation for a case study is examined. Finally, the role of enhanced data assimilation techniques and adaptions towards nowcasting are discussed.
Abstract Background If patient age affects the quality of end-of-life care in cancer is unknown. Using data from a population-based register of palliative care in Sweden, we addressed this question. ...Methods This nation-wide study focused on the last week of life of adults dying from cancer in 2011–2012, based on data reported to a national quality register for end-of-life care ( N = 26,976). We specifically investigated if age-dependent differences were present with respect to thirteen indicators of palliative care quality. Patients were categorised in one out of five pre-defined age groups. Odds ratios (OR) with 95% confidence intervals (CIs), adjusted for type of end-of-life care unit, were calculated using logistic regression, with the oldest group as reference. Findings Age-dependent differences in implementation rate were detected for ten out of thirteen end-of-life care quality indicators, most of which were progressively less well met with each increment in age group. Compared to elderly cancer patients, young patients were more often informed about imminent death, (OR, 3.9; 95% CI 2.5–5.9, p < 0.001), were more often systematically assessed for the presence and severity of pain (OR, 1.6; 95% CI 1.2–2.1, p < 0.001) or other symptoms (OR, 1.4; 95% CI 1.0–1.9, p = 0.044), were more likely to be assessed by palliative care consultation services (OR, 4.3; 95% CI 3.3–5.7, p < 0.001) and to have injections prescribed as needed against pain (OR, 3.4; 95% CI 1.3–9.4, p = 0.016), anxiety (OR, 3.8; 95% CI 2.0–7.1, p < 0.001) or nausea (OR, 3.6; 95% CI 2.3–5.7, p < 0.001). The families of young patients were more likely to be informed about imminent death (OR, 2.6; 95% CI 1.5–4.3, p = 0.001) and to be offered bereavement support (OR, 4.6; 95% CI 2.7–7.8, p < 0.001). Interpretation Old age is a risk indicator for poor end-of-life care quality among cancer patients in Sweden. Funding The executive committee of the National Quality Registries in Sweden.
Abstract
Background
Patients with progressive primary brain tumors commonly develop a spectrum of physical as well as cognitive symptoms. This places a large burden on family members and the ...condition’s complexity often requires frequent health care contacts. We investigated potential associations between sociodemographic or socioeconomic factors, comorbidity or receipt of specialized palliative care (SPC) and acute healthcare utilization in the end-of-life (EOL) phase.
Methods
A population-based retrospective study of all adult patients dying with a primary malignant brain tumor as main diagnosis in 2015–2019 in the Stockholm area, the most densely populated region in Sweden (
N
= 780). Registry data was collected from the Stockholm Region´s central data warehouse (VAL). Outcome variables included emergency room (ER) visits or hospitalizations in the last month of life, or death in acute hospitals. Possible explanatory variables included age, sex, living arrangements (residents in nursing homes versus all others), Charlson Comorbidity Index, socio-economic status (SES) measured by Mosaic groups, and receipt of SPC in the last three months of life. T-tests or Wilcoxon Rank Sum tests were used for comparisons of means of independent groups and Chi-square test for comparison of proportions. Associations were tested by univariable and multivariable logistic regressions calculating odds ratios (OR).
Results
The proportion of patients receiving SPC increased gradually during the last year of life and was 77% in the last 3 months of life. Multivariable analyses showed SPC to be equal in relation to sex and SES, and inversely associated with age (
p
≤ 0.01), comorbidity (
p
= 0.001), and nursing home residency (
p
< 0.0001). Unplanned ER visits (OR 0.41) and hospitalizations (OR 0.45) during the last month of life were significantly less common among patients receiving SPC, in multivariable analysis (
p
< 0.001). In accordance, hospital deaths were infrequent in patients receiving SPC (2%) as compared to one in every four patients without SPC (
p
< 0.0001). Patients with less comorbidity had lower acute healthcare utilization in the last month of life (OR 0.35 to 0.65), whereas age or SES was not significantly associated with acute care utilization. Female sex was associated with a lower likelihood of EOL hospitalization (OR 0.72). Nursing home residency was independently associated with a decreased likelihood of EOL acute healthcare utilization including fewer hospital deaths (OR 0.08–0.54).
Conclusions
Receipt of SPC or nursing home residency was associated with lower acute health care utilization among brain tumor patients. Patients with more severe comorbidities were less likely to receive SPC and required excess acute healthcare in end-of-life and therefore constitute a particularly vulnerable group.
Abstract Background Parenteral fluid (PF) therapy of patients in end-of-life (EOL) is controversial. The purpose of this study was to assess associations between PF, quality of the EOL care process ...and symptom burden in dying cancer patients, using a population-based approach. Methods This was a nationwide retrospective register study of all adult cancer deaths with documented information on PF in the last 24 h of life as reported to the Swedish Register of Palliative Care during a three-year period ( n = 41,709). Prevalence and relief of symptoms during the last week of life as well as EOL care process quality indicators were assessed in relation to PF in those patients who had a documented decision to focus on EOL care (immediately dying, n = 23,112). Odds ratios were calculated, adjusting for place of death (hospital vs. non-hospital). Results PF was administered to 30.9% of immediately dying patients in hospitals compared to 6.5% outside of hospitals. PF was associated with a higher likelihood for breathlessness and nausea. In patients screened for EOL symptoms with a validated instrument, PF was inversely associated with the likelihood of complete relief of breathlessness, respiratory secretions, anxiety, nausea and pain. Several palliative care quality indicators were inversely associated with PF, including EOL conversations and prescriptions of injectable drugs as needed. These associations were more pronounced in hospitals. Conclusions Parenteral fluid therapy in the last 24 h of life was associated with inferior quality of the EOL care process and with increased symptom burden in imminently dying cancer patients.
Winds measured by lidar from the Aeolus satellite are
compared with winds measured by two ground-based radars – MARA in Antarctica
(70.77∘ S, 11.73∘ E) and ESRAD (67.88∘ N,
21.10∘ E) in Arctic Sweden ...– for the period 1 July–31 December
2019. Aeolus is a demonstrator mission to test whether winds measured by
Doppler lidar from space can have sufficient accuracy to contribute to
improved weather forecasting. A comprehensive programme of calibration and
validation has been undertaken following the satellite launch in 2018, but,
so far, direct comparison with independent measurements from the Arctic or
Antarctic regions have not been made. The comparison covers heights from the
low troposphere to just above the tropopause. Results for each radar site
are presented separately for Rayleigh (clear) winds, Mie (cloudy) winds,
sunlit (“summer”) and non-sunlit (“winter”) seasons, and ascending and descending satellite tracks. Horizontally projected line-of-sight (HLOS) winds from
Aeolus, reprocessed using baseline 2B10, for passes within 100 km of the
radar sites, are compared with HLOS winds calculated from 1 h averaged
radar horizontal wind components. The agreement in most data subsets is very
good, with no evidence of significant biases (<1 m s−1).
Possible biases are identified for two subsets (about −2 m s−1 for
the Rayleigh winds for the descending passes at MARA and about 2 m s−1 for the Mie winds for the ascending passes at ESRAD, both in winter), but these are only marginally significant. A robust
significant bias of about 7 m s−1 is found for the Mie winds for the ascending tracks at MARA in summer. There is also some evidence for increased
random error (by about 1 m s−1) for the Aeolus Mie winds at MARA in
summer compared to winter. This might be related to the presence of sunlight
scatter over the whole of Antarctica as Aeolus transits across it during
summer.
A limited-area kilometre scale numerical weather prediction system is applied to evaluate the effect of refined surface data assimilation on short-range heavy precipitation forecasts. The refinements ...include a spatially dependent background error representation, use of a flow-dependent data assimilation technique, and use of data from a satellite-based scatterometer instrument. The effect of the enhancements on short-term prediction of intense precipitation events is confirmed through a number of case studies. Verification scores and subjective evaluation of one particular case points at a clear impact of the enhanced surface data assimilation on short-range heavy precipitation forecasts and suggest that it also tends to slightly improve them. Although this is not strictly statistically demonstrated, it is consistent with the expectation that a better surface state should improve rainfall forecasts.
Distant spreading of tumor cells to the central nervous system in non-small cell lung cancer (NSCLC) occurs frequently and poses major clinical issues due to limited treatment options. RNAs ...displaying differential expression in brain metastasis versus primary NSCLC may explain distant tumor growth and may potentially be used as therapeutic targets. In this study, we conducted systematic microRNA expression profiling from tissue biopsies of primary NSCLC and brain metastases from 25 patients. RNA analysis was performed using the nCounter Human v3 miRNA Expression Assay, NanoString technologies, followed by differential expression analysis and in silico target gene pathway analysis. We uncovered a panel of 11 microRNAs with differential expression and excellent diagnostic performance in brain metastasis versus primary NSCLC. Five microRNAs were upregulated in brain metastasis (miR-129-2-3p, miR-124-3p, miR-219a-2-3p, miR-219a-5p, and miR-9-5p) and six microRNAs were downregulated in brain metastasis (miR-142-3p, miR-150-5p, miR-199b-5p, miR-199a-3p, miR-199b-5p, and miR-199a-5p). The differentially expressed microRNAs were predicted to converge on distinct target gene networks originating from five to twelve core target genes. In conclusion, we uncovered a unique microRNA profile linked to two target gene networks. Our results highlight the potential of specific microRNAs as biomarkers for brain metastasis in NSCLC and indicate plausible mechanistic connections.
To fill the gap in the observation system for humidity, the HIRLAM–ALADIN Research on Mesoscale Operational NWP in Euromed (HARMONIE) limited-area high-resolution kilometer-scale model has been ...prepared for assimilation of Global Navigation Satellite System (GNSS) zenith total delay (ZTD) observations. The observation-processing system includes data selection, bias correction, quality control, and a GNSS observation operator for data assimilation. A large part of the bias between observations and model equivalents comes from the relatively low model top used in the HARMONIE experiments. The functionality of the different observation-processing components was investigated in detail as was the overall performance of the GNSS ZTD data assimilation. This paper contains an extensive description of the GNSS ZTD observation-processing system and a comparison of a newly introduced variational bias correction for GNSS ZTD data with an alternative static bias correction, as well as a detailed analysis of the impact of GNSS ZTD data, both in terms of statistical evaluations over a longer period and in terms of individual case studies. Assimilation of the GNSS ZTD observations with a variational bias correction has improved the quality of short-range weather forecasts for the moisture-related parameters in particular, both in a statistical sense and in individual case studies. The paper also discusses further improvements in the HARMONIE variational data-assimilation systemthat are needed to fully utilize the potential of high-resolution GNSS ZTD observations.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Docosahexaenoic acid (DHA) protects neural cells from stress-induced apoptosis. On the contrary, DHA exerts anticancer effects, and we have shown that DHA induces apoptosis in neuroblastoma, an ...embryonal tumor of the sympathetic nervous system. We now investigate the DHA metabolome in neuroblastoma using a targeted lipidomic approach in order to elucidate the mechanisms behind the DHA-induced cytotoxicity. LC-MS/MS analysis was used to identify DHA-derived lipid mediators in neuroblastoma cells. Presence of the 15-lipoxygenase enzyme was investigated using immunoblotting, and cytotoxic potency of DHA and DHA-derived compounds was compared using the MTT cell viability assay. Neuroblastoma cells metabolized DHA to 17-hydroxydocosahexaenoic acid (17-HDHA) via 17-hydroperoxydocosahexaenoic acid (17-HpDHA) through 15-lipoxygenase and autoxidation. In contrast to normal neural cells, neuroblastoma cells did not produce the anti-inflammatory and protective lipid mediators, resolvins and protectins. 17-HpDHA had significant cytotoxic potency, with an IC₅₀ of 3-6 μM at 72 h, compared to 12-15 μM for DHA. α-Tocopherol protected cells from 17-HpDHA-induced cytotoxicity. DHA inhibited secretion of prostaglandin-E₂ and augmented the cytotoxic potency of the cyclooxygenase-2-inhibitor celecoxib. The cytotoxic effect of DHA in neuroblastoma is mediated through production of hydroperoxy fatty acids that accumulate to toxic intracellular levels with restricted production of its products, resolvins and protectins.--Gleissman, H., Yang, R., Martinod, K., Lindskog, M., Serhan, C. N., Johnsen, J. I., Kogner, P. Docosahexaenoic acid metabolome in neural tumors: identification of cytotoxic intermediates.
Upstaging and disease recurrence were non-negligible in cT1a nonmetastatic renal cell carcinoma (RCC) patients in the real world. Tumor size, upstaging, and ablation were associated with recurrence ...risk, while tumor size and recurrence were associated with decreased overall survival (OS). Patients with chromophobe RCC and partial nephrectomy achieved prolonged OS.
T1a renal cell carcinoma (RCC) is typically considered a curable disease, irrespective of the choice of local treatment modality.
To identify factors associated with the risk of local and distant recurrence, and overall survival (OS) in patients with primary nonmetastatic clinical T1a RCC.
A population-based nationwide register study of all 1935 patients with cT1a RCC, diagnosed during 2005–2012, identified through The National Swedish Kidney Cancer Register, was conducted.
Outcome variables were recurrence (local or distant) and OS. Possible explanatory variables included tumor size, RCC type, T stage, surgical technique, age, and gender. Associations with disease recurrence and OS were evaluated by multivariable regression and Cox multivariate analyses, respectively.
Among 1935 patients, 938 were treated with radical nephrectomy, 738 with partial nephrectomy, and 169 with ablative treatments, while 90 patients had no surgery. Seventy-eight (4%) patients were upstaged to pT3. Local or metastatic recurrences occurred in 145 (7.5%) patients, significantly more often after ablation (17.8%). The risk of recurrence was associated with tumor size, upstaging, and ablation. Larger tumor size, disease recurrence, and older age adversely affected OS, whereas partial nephrectomy and chromophobe RCC (chRCC) were associated with improved survival. Limitations include register design and a lack of comorbidity or performance status data.
Upstaging and recurrence occurred, respectively, in 4.0% and 7.5% of patients with nonmetastatic RCCs ≤4 cm. Tumor size upstaging and ablation were associated with the risk for recurrence, while tumor size and recurrence were associated with decreased OS. Patients with chRCC and partial nephrectomy had prolonged OS in a real-world setting.
We studied factors that may influence the risk of disease recurrence and overall survival, in a large nationwide patient cohort having nonmetastatic renal cell carcinoma ≤4 cm. Tumor size, tumor type, and treatment were associated with the risk of recurrence and overall death. Partial nephrectomy prolonged overall survival.
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