Data substantiating the optimal patient body temperature during cooling procedures in cardiac operations are currently unavailable. To explore the optimal temperature strategy, we examined the ...association between temperature management and survival among patients during cardiopulmonary bypass assisted coronary artery bypass grafting (CABG) procedures on 30-days and 5-year postoperative survival. Adult patients (n = 5,672, 23.6% female and mean (SD) age of 66 (10) years) operated between 1997 and 2015 were included, with continuous measured intraoperative nasopharyngeal temperatures. The association between mortality and patient characteristics, laboratory parameters, the lowest intraoperative plateau temperature and intraoperative cooling/rewarming rates were examined by multivariate Cox regression analysis. Machine learning-based cluster analysis was used to identify patient subgroups based on pre-cooling parameters and explore whether specific subgroups benefitted from a particular temperature management. Mild hypothermia (32–35°C) was independently associated with improved 30-days and 5-year survival compared to patients in other temperature categories regardless of operation year. 30 days and 5-year survival were 98% and 88% in the mild hypothermia group, whereas it amounted 93% and 80% in the severe hypothermia (<30°C). Normothermia (35–37°C) showed the lowest survival after 30 days and 5 years amounting 93% and 72%, respectively. Cluster analysis identified 8 distinct patient subgroups principally defined by gender, age, kidney function and weight. The full cohort and all patient subgroups displayed the highest survival at a temperature of 32°C. Given these associations, further prospective randomized controlled trials are needed to ascertain optimal patient temperatures during CPB.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
2.
Global Air Pollution Crossroads over the Mediterranean Lelieveld, J.; Berresheim, H.; Borrmann, S. ...
Science (American Association for the Advancement of Science),
10/2002, Letnik:
298, Številka:
5594
Journal Article
Recenzirano
The Mediterranean Intensive Oxidant Study, performed in the summer of 2001, uncovered air pollution layers from the surface to an altitude of 15 kilometers. In the boundary layer, air pollution ...standards are exceeded throughout the region, caused by West and East European pollution from the north. Aerosol particles also reduce solar radiation penetration to the surface, which can suppress precipitation. In the middle troposphere, Asian and to a lesser extent North American pollution is transported from the west. Additional Asian pollution from the east, transported from the monsoon in the upper troposphere, crosses the Mediterranean tropopause, which pollutes the lower stratosphere at middle latitudes.
Background. Ceftobiprole, the active moiety of ceftobiprole medocaril, is a novel broad-spectrum cephalosporin, with bactericidal activity against a wide range of gram-positive bacteria, including ...Staphylococcus aureus (including methicillin-resistant strains) and penicillin- and ceftriaxone-resistant pneumococci, and gram-negative bacteria, including Enterobacteriaceae and Pseudomonas aeruginosa. Methods. This was a double-blind, randomized, multicenter study of 781 patients with hospital-acquired pneumonia (HAP), including 210 with ventilator-associated pneumonia (VAP). Treatment was intravenous ceftobiprole 500 mg every 8 hours, or ceftazidime 2 g every 8 hours plus linezolid 600 mg every 12 hours; primary outcome was clinical cure at the test-of-cure visit. Results. Overall cure rates for ceftobiprole vs ceftazidime/linezolid were 49.9% vs 52.8% (intent-to-treat ITT, 95% confidence interval CI for the difference, -10.0 to 4.1) and 69.3% vs 71.3% (clinically evaluable CE, 95% CI, -10.0 to 6.1). Cure rates in HAP (excluding VAP) patients were 59.6% vs 58.8% (ITT, 95% CI, -7.3 to 8.8), and 77.8% vs 76.2% (CE, 95% CI, -6.9 to 10.0). Cure rates in VAP patients were 23.1% vs 36.8% (ITT, 95% CI, -26.0 to -1.5) and 37.7% vs 55.9% (CE, 95% CI, -36.4 to 0). Microbiological eradication rates in HAP (excluding VAP) patients were, respectively, 62.9% vs 67.5% (microbiologically evaluable ME, 95% CI, -16.7 to 7.6), and in VAP patients 30.4% vs 50.0% (ME, 95% CI, -38.8 to -0.4). Treatment-related adverse events were comparable for ceftobiprole (24.9%) and ceftazidime/linezolid (25.4%). Conclusions. Ceftobiprole is a safe and effective bactericidal antibiotic for the empiric treatment of HAP (excluding VAP). Further investigations are needed before recommending the use of ceftobiprole in VAP patients. Clinical Trials Registration. NCT00210964, NCT00229008.
The Indian Ocean Experiment (INDOEX) was an international, multiplatform field campaign to measure long-range transport of air pollution from South and Southeast Asia toward the Indian Ocean during ...the dry monsoon season in January to March 1999. Surprisingly high pollution levels were observed over the entire northern Indian Ocean toward the Intertropical Convergence Zone at about 6°S. We show that agricultural burning and especially biofuel use enhance carbon monoxide concentrations. Fossil fuel combustion and biomass burning cause a high aerosol loading. The growing pollution in this region gives rise to extensive air quality degradation with local, regional, and global implications, including a reduction of the oxidizing power of the atmosphere.
We evaluate the capability of the global atmospheric transport model TM5 to simulate the boundary layer dynamics and associated variability of trace gases close to the surface, using radon (222Rn). ...Focusing on the European scale, we compare the boundary layer height (BLH) in the TM5 model with observations from the National Oceanic and Atmospheric Admnistration (NOAA) Integrated Global Radiosonde Archive (IGRA) and also with ceilometer and lidar (light detection and ranging) BLH retrievals at two stations. Furthermore, we compare TM5 simulations of 222Rn activity concentrations, using a novel, process-based 222Rn flux map over Europe (Karstens et al., 2015), with harmonised 222Rn measurements at 10 stations. The TM5 model reproduces relatively well the daytime BLH (within 10–20 % for most of the stations), except for coastal sites, for which differences are usually larger due to model representation errors. During night, however, TM5 overestimates the shallow nocturnal BLHs, especially for the very low observed BLHs (< 100 m) during summer. The 222Rn activity concentration simulations based on the new 222Rn flux map show significant improvements especially regarding the average seasonal variability, compared to simulations using constant 222Rn fluxes. Nevertheless, the (relative) differences between simulated and observed daytime minimum 222Rn activity concentrations are larger for several stations (on the order of 50 %) than the (relative) differences between simulated and observed BLH at noon. Although the nocturnal BLH is often higher in the model than observed, simulated 222Rn nighttime maxima are actually larger at several continental stations. This counterintuitive behaviour points to potential deficiencies of TM5 to correctly simulate the vertical gradients within the nocturnal boundary layer, limitations of the 222Rn flux map, or issues related to the definition of the nocturnal BLH. At several stations the simulated decrease of 222Rn activity concentrations in the morning is faster than observed. In addition, simulated vertical 222Rn activity concentration gradients at Cabauw decrease faster than observations during the morning transition period, and are in general lower than observed gradients during daytime. Although these effects may be partially due to the slow response time of the radon detectors, they clearly point to too fast vertical mixing in the TM5 boundary layer during daytime. Furthermore, the capability of the TM5 model to simulate the diurnal BLH cycle is limited by the current coarse temporal resolution (3 h/6 h) of the TM5 input meteorology.
Representation of atmospheric transport is a major source of error in the estimation of greenhouse gas sources and sinks by inverse modelling. Here we assess the impact on trace gas mole fractions of ...the new physical parameterizations recently implemented in the atmospheric global climate model LMDz to improve vertical diffusion, mesoscale mixing by thermal plumes in the planetary boundary layer (PBL), and deep convection in the troposphere. At the same time, the horizontal and vertical resolution of the model used in the inverse system has been increased. The aim of this paper is to evaluate the impact of these developments on the representation of trace gas transport and chemistry, and to anticipate the implications for inversions of greenhouse gas emissions using such an updated model. Comparison of a one-dimensional version of LMDz with large eddy simulations shows that the thermal scheme simulates shallow convective tracer transport in the PBL over land very efficiently, and much better than previous versions of the model. This result is confirmed in three-dimensional simulations, by a much improved reproduction of the radon-222 diurnal cycle. However, the enhanced dynamics of tracer concentrations induces a stronger sensitivity of the new LMDz configuration to external meteorological forcings. At larger scales, the inter-hemispheric exchange is slightly slower when using the new version of the model, bringing them closer to observations. The increase in the vertical resolution (from 19 to 39 layers) significantly improves the representation of stratosphere/troposphere exchange. Furthermore, changes in atmospheric thermodynamic variables, such as temperature, due to changes in the PBL mixing modify chemical reaction rates, which perturb chemical equilibriums of reactive trace gases. One implication of LMDz model developments for future inversions of greenhouse gas emissions is the ability of the updated system to assimilate a larger amount of high-frequency data sampled at high-variability stations. Others implications are discussed at the end of the paper.
We present inverse modelling (top down) estimates of European methane (CH4) emissions for 2006–2012 based on a new quality-controlled and harmonised in situ data set from 18 European atmospheric ...monitoring stations. We applied an ensemble of seven inverse models and performed four inversion experiments, investigating the impact of different sets of stations and the use of a priori information on emissions.The inverse models infer total CH4 emissions of 26.8 (20.2–29.7) Tg CH4 yr-1 (mean, 10th and 90th percentiles from all inversions) for the EU-28 for 2006–2012 from the four inversion experiments. For comparison, total anthropogenic CH4 emissions reported to UNFCCC (bottom up, based on statistical data and emissions factors) amount to only 21.3 Tg CH4 yr-1 (2006) to 18.8 Tg CH4 yr-1 (2012). A potential explanation for the higher range of top-down estimates compared to bottom-up inventories could be the contribution from natural sources, such as peatlands, wetlands, and wet soils. Based on seven different wetland inventories from the Wetland and Wetland CH4 Inter-comparison of Models Project (WETCHIMP), total wetland emissions of 4.3 (2.3–8.2) Tg CH4 yr-1 from the EU-28 are estimated. The hypothesis of significant natural emissions is supported by the finding that several inverse models yield significant seasonal cycles of derived CH4 emissions with maxima in summer, while anthropogenic CH4 emissions are assumed to have much lower seasonal variability. Taking into account the wetland emissions from the WETCHIMP ensemble, the top-down estimates are broadly consistent with the sum of anthropogenic and natural bottom-up inventories. However, the contribution of natural sources and their regional distribution remain rather uncertain.Furthermore, we investigate potential biases in the inverse models by comparison with regular aircraft profiles at four European sites and with vertical profiles obtained during the Infrastructure for Measurement of the European Carbon Cycle (IMECC) aircraft campaign. We present a novel approach to estimate the biases in the derived emissions, based on the comparison of simulated and measured enhancements of CH4 compared to the background, integrated over the entire boundary layer and over the lower troposphere. The estimated average regional biases range between -40 and 20 % at the aircraft profile sites in France, Hungary and Poland.
During the summer of 2018, a widespread drought developed over Northern and Central Europe. The increase in temperature and the reduction of soil moisture have influenced carbon dioxide (CO
2
) ...exchange between the atmosphere and terrestrial ecosystems in various ways, such as a reduction of photosynthesis, changes in ecosystem respiration, or allowing more frequent fires. In this study, we characterize the resulting perturbation of the atmospheric CO
2
seasonal cycles. 2018 has a good coverage of European regions affected by drought, allowing the investigation of how ecosystem flux anomalies impacted spatial CO
2
gradients between stations. This density of stations is unprecedented compared to previous drought events in 2003 and 2015, particularly thanks to the deployment of the Integrated Carbon Observation System (ICOS) network of atmospheric greenhouse gas monitoring stations in recent years. Seasonal CO
2
cycles from 48 European stations were available for 2017 and 2018. Earlier data were retrieved for comparison from international databases or national networks. Here, we show that the usual summer minimum in CO
2
due to the surface carbon uptake was reduced by 1.4 ppm in 2018 for the 10 stations located in the area most affected by the temperature anomaly, mostly in Northern Europe. Notwithstanding, the CO
2
transition phases before and after July were slower in 2018 compared to 2017, suggesting an extension of the growing season, with either continued CO
2
uptake by photosynthesis and/or a reduction in respiration driven by the depletion of substrate for respiration inherited from the previous months due to the drought. For stations with sufficiently long time series, the CO
2
anomaly observed in 2018 was compared to previous European droughts in 2003 and 2015. Considering the areas most affected by the temperature anomalies, we found a higher CO
2
anomaly in 2003 (+3 ppm averaged over 4 sites), and a smaller anomaly in 2015 (+1 ppm averaged over 11 sites) compared to 2018.
This article is part of the theme issue ‘Impacts of the 2018 severe drought and heatwave in Europe: from site to continental scale'.
Carbonyl sulfide (COS) is a promising tracer for the estimation of
terrestrial ecosystem gross primary production (GPP). However, understanding
its non-GPP-related sources and sinks, e.g., ...anthropogenic sources and soil
sources and sinks, is also critical to the success of the approach. Here we
infer the regional sources and sinks of COS using continuous in situ mole fraction
profile measurements of COS along the 60 m tall Lutjewad tower (1 m a.s.l.;
53∘24′ N, 6∘21′ E) in the Netherlands. To identify
potential sources that caused the observed enhancements of COS mole
fractions at Lutjewad, both discrete flask samples and in situ measurements
in the province of Groningen were made from a mobile van using a quantum
cascade laser spectrometer (QCLS). We also simulated the COS mole fractions
at Lutjewad using the Stochastic Time-Inverted Lagrangian Transport (STILT)
model combined with emission inventories and plant uptake fluxes. We
determined the nighttime COS fluxes to be -3.0±2.6 pmol m−2 s−1 using the radon-tracer correlation approach and Lutjewad
observations. Furthermore, we identified and quantified several COS sources,
including biodigesters, sugar production facilities and silicon carbide
production facilities in the province of Groningen. Moreover, the simulation
results show that the observed COS enhancements can be partially explained
by known industrial sources of COS and CS2, in particular from the Ruhr
Valley (51.5∘ N, 7.2∘ E) and Antwerp (51.2∘ N,
4.4∘ E) areas. The contribution of likely missing anthropogenic
sources of COS and CS2 in the inventory may be significant. The impact
of the identified sources in the province of Groningen is estimated to be
negligible in terms of the observed COS enhancements. However, in specific
conditions, these sources may influence the measurements in Lutjewad. These
results are valuable for improving our understanding of the sources and
sinks of COS, contributing to the use of COS as a tracer for GPP.
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