The performance of a new historical reanalysis, the NOAA–CIRES–DOE Twentieth Century Reanalysis version 3 (20CRv3), is evaluated via comparisons with other reanalyses and independent observations. ...This dataset provides global, 3-hourly estimates of the atmosphere from 1806 to 2015 by assimilating only surface pressure observations and prescribing sea surface temperature, sea ice concentration, and radiative forcings. Comparisons with independent observations, other reanalyses, and satellite products suggest that 20CRv3 can reliably produce atmospheric estimates on scales ranging from weather events to long-term climatic trends. Not only does 20CRv3 recreate a ‘‘best estimate’’ of the weather, including extreme events, it also provides an estimate of its confidence through the use of an ensemble. Surface pressure statistics suggest that these confidence estimates are reliable. Comparisons with independent upper-air observations in the Northern Hemisphere demonstrate that 20CRv3 has skill throughout the twentieth century. Upper-air fields from 20CRv3 in the late twentieth century and early twenty-first century correlate well with full-input reanalyses, and the correlation is predicted by the confidence fields from 20CRv3. The skill of analyzed 500-hPa geopotential heights from 20CRv3 for 1979–2015 is comparable to that of modern operational 3–4-day forecasts. Finally, 20CRv3 performs well on climate time scales. Long time series and multidecadal averages of mass, circulation, and precipitation fields agree well with modern reanalyses and station- and satellite-based products. 20CRv3 is also able to capture trends in tropospheric-layer temperatures that correlate well with independent products in the twentieth century, placing recent trends in a longer historical context.
Purpose
To investigate whether pre-operative magnetic resonance imaging (MRI) of the lumbar multifidus muscle (LMM) would predict clinical outcomes following lumbar spinal decompression for ...symptomatic spinal stenosis.
Methods
A prospective cohort of patients with symptomatic neurogenic claudication, documented spinal stenosis on pre-operative MRI underwent spinal decompression. All subjects completed standardised outcome measures (Core Outcome Measures Index (COMI), Oswestry Disability Index (ODI v2.1) pre-operatively, 1 and 2 years post-surgery. Surgery was performed using a standardised lumbar spinous process osteotomy for access, followed by a decompression of the central canal, lateral recess and foraminal zones as indicated by the pre-operative MRI. Lumbar MRI scans were evaluated by two independent observers who assessed the axial CSA of the LMM bilaterally and the degree of muscle atrophy according to the Kader classification (2000). Changes in COMI and ODI scores at 1 and 2 years were investigated for statistically significant correlations with CSA of LMM and Kader grading. Statistical analyses utilised Student’s
t
test, kappa coefficient for inter-observer agreement and Bland–Altman Limits of Agreement (BALOA).
Results
66 patients (41 female) aged between 29 and 86 years underwent single-level decompression in 44, two-level decompression in 16 and three-level decompression in 6 cases. No significant correlation was observed between improvements in ODI and COMI relative to age, degree of stenosis, posterior fat thickness or psoas CSA. Those subjects with the greatest LMM atrophy relative to psoas CSA and L5 vertebral body area on pre-operative MRI had the least absolute improvement in both ODI and COMI scores (
p
= 0.006).
Conclusions
Reduced LMM CSA (<8.5 cm
2
) and muscle atrophy were associated with less favourable outcomes following lumbar spinal decompression. Pre-operative CSA of LMM appeared to be a more reliable predictor of post-operative clinical outcomes compared to the Kader Grading Score. This is the first study to investigate the prognostic value of pre-operative MRI appearance and CSA of LMM with respect to post-operative outcome following lumbar decompression surgery. Healthy pre-operative LMM is associated with better outcomes following lumbar spinal decompression.
Testing theories of hierarchical structure formation requires estimating the distribution of galaxy morphologies and its change with redshift. One aspect of this investigation involves identifying ...galaxies with disturbed morphologies (e.g. merging galaxies). This is often done by summarizing galaxy images using, e.g. the concentration, asymmetry and clumpiness and Gini-M
20 statistics of Conselice and Lotz et al., respectively, and associating particular statistic values with disturbance. We introduce three statistics that enhance detection of disturbed morphologies at high redshift (z ∼ 2): the multimode (M), intensity (I) and deviation (D) statistics. We show their effectiveness by training a machine-learning classifier, random forest, using 1639 galaxies observed in the H band by the Hubble Space Telescope WFC3, galaxies that had been previously classified by eye by the Cosmic Assembly Near-IR Deep Extragalactic Legacy Survey collaboration. We find that the MID statistics (and the A statistic of Conselice) are the most useful for identifying disturbed morphologies.
We also explore whether human annotators are useful for identifying disturbed morphologies. We demonstrate that they show limited ability to detect disturbance at high redshift, and that increasing their number beyond 10 does not provably yield better classification performance. We propose a simulation-based model-fitting algorithm that mitigates these issues by bypassing annotation.
Summary
The effectiveness of bariatric surgery has been well‐studied. However, complications after bariatric surgery have been understudied. This review assesses <30‐d major complications associated ...with bariatric procedures, including anastomotic leak, myocardial infarction and pulmonary embolism. This review included 71 studies conducted in the USA between 2003 and 2014 and 107,874 patients undergoing either gastric bypass, adjustable gastric banding or sleeve gastrectomy, with mean age of 44 years and pre‐surgery body mass index of 46.5 kg m−2. Less than 30‐d anastomotic leak rate was 1.15%; myocardial infarction rate was 0.37%; pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction and pulmonary embolism was 0.12%, 0.37% and 0.18%, respectively. Among surgical procedures, <30‐d after surgery, sleeve gastrectomy (1.21% 95% confidence interval, 0.23–2.19%) had higher anastomotic leak rate than gastric bypass (1.14% 95% confidence interval, 0.84–1.43%); gastric bypass had higher rates of myocardial infarction and pulmonary embolism than adjustable gastric banding or sleeve gastrectomy. During the review, we found that the quality of complication reporting is lower than the reporting of other outcomes. In summary, <30‐d rates of the three major complications after either one of the procedures range from 0% to 1.55%. Mortality following these complications ranges from 0% to 0.64%. Future studies reporting complications after bariatric surgery should improve their reporting quality.
Anti-Müllerian hormone based (AMH) age at menopause predictions remain cumbersome due to predictive inaccuracy.
To perform an Individual Patient Data (IPD) meta-analysis, regarding AMH based ...menopause prediction.
A systematic literature search was performed using PubMed, Embase and Cochrane databases.
Prospective cohort studies regarding menopause prediction using serum AMH levels were selected by consensus discussion.
Individual cases were included if experiencing a regular cycle at baseline. Exclusion criteria were hormone use and gynecological surgery.
2596 women were included, 1077 experienced menopause. A multivariable Cox regression analysis assessed time to menopause (TTM) using age and AMH. AMH predicted TTM, however, added value on top of age was poor (age alone C-statistic 84%; age + AMH HR 0.66 95% CI 0.61-0.71, C-statistic 86%). Moreover, the capacity of AMH to predict early (≤45 years) and late menopause (≥55 years) was assessed. An added effect of AMH was demonstrated for early menopause (age alone C-statistic 52%; age + AMH HR 0.33, 95% CI 0.24-0.45, C-statistic 80%). A Weibull regression model calculating individual age at menopause revealed that predictive inaccuracy remained present and increased with decreasing age at menopause. Lastly, a check of non-proportionality of the predictive effect of AMH demonstrated a reduced predictive effect with increasing age.
AMH was a significant predictor of TTM and especially of time to early menopause. However, individual predictions of age at menopause demonstrated a limited precision, particularly when concerning early age at menopause, making clinical application troublesome.
The influence of polydopamine- and polydopamine-graft-poly(ethylene glycol)-coated feed spacers and membranes, copper-coated feed spacers, and commercially-available biostatic feed spacers on ...biofouling has been studied in membrane fouling simulators. Feed spacers and membranes applied in practical membrane filtration systems were used; biofouling development was monitored by feed channel pressure drop increase and biomass accumulation. Polydopamine and polydopamine-g-PEG are hydrophilic surface modification agents expected to resist protein and bacterial adhesion, while copper feed spacer coatings and biocides infused in feed spacers are expected to restrict biological growth. Our studies showed that polydopamine and polydopamine-g-PEG coatings on feed spacers and membranes, copper coatings on feed spacers, and a commercial biostatic feed spacer did not have a significant impact on feed channel pressure drop increase and biofilm accumulation as measured by ATP and TOC content. The studied spacer and membrane modifications were not effective for biofouling control; it is doubtful that feed spacer and membrane modification, in general, may be effective for biofouling control regardless of the type of applied coating.
► Effect of feed spacer modification on biofouling was studied in membrane fouling simulator. ► Polydopamine coated feed spacers and membranes. ► Poly(ethylene glycol) grafted polydopamine coated feed spacers and membranes. ► Copper coated and biostatic feed spacer. ► Spacer and membrane modifications were not effective for biofouling control.
Objective
To distinguish satisfaction with pain relief using remifentanil patient‐controlled analgesia (RPCA) compared with epidural analgesia (EA) in low‐risk labouring women.
Design
Randomised ...controlled equivalence trial.
Setting
Eighteen midwifery practices and six hospitals in the Netherlands.
Population
A total of 408 pregnant women at low risk for obstetric complications initially under the care of primary‐care midwives.
Methods
Women randomised before active labour to receive analgesia with RPCA or EA, if requested.
Main outcome measures
Primary outcome was satisfaction with pain relief measured hourly using a visual analogue scale and summed as area under the curve (AUC). Secondary outcomes were overall satisfaction with pain relief, pain intensity scores during labour, mode of delivery, and maternal and neonatal outcomes.
Results
We randomised 418 women, of whom 409 could be followed for the primary endpoint. Analgesia was received by 46% (94/203) in the remifentanil group and 37% (76/206) in the epidural group. The AUC for satisfaction with pain relief was 32 in the remifentanil group and 31 in the epidural group (mean difference −0.50; 95% CI −6.8 to 5.9). Among women who actually received analgesia, these values were 23 and 35, respectively (mean difference −12; 95% CI −22 to −1.5). Secondary outcomes were comparable.
Conclusions
In low‐risk labouring women, we could not demonstrate equivalence between a strategy with RPCA to EA with respect to satisfaction with pain relief assessed during the total duration of labour. However, once applied satisfaction was higher in women who received epidural analgesia.
Tweetable
Satisfaction with pain relief is higher in women receiving epidural analgesia compared with Remifentanil PCA.
Tweetable
Satisfaction with pain relief is higher in women receiving epidural analgesia compared with Remifentanil PCA.
Summary
In this study, we followed the genomic, lipidomic and metabolomic changes associated with the selection of miltefosine (MIL) resistance in two clinically derived Leishmania donovani strains ...with different inherent resistance to antimonial drugs (antimony sensitive strain Sb‐S; and antimony resistant Sb‐R). MIL‐R was easily induced in both strains using the promastigote‐stage, but a significant increase in MIL‐R in the intracellular amastigote compared to the corresponding wild‐type did not occur until promastigotes had adapted to 12.2 μM MIL. A variety of common and strain‐specific genetic changes were discovered in MIL‐adapted parasites, including deletions at the LdMT transporter gene, single‐base mutations and changes in somy. The most obvious lipid changes in MIL‐R promastigotes occurred to phosphatidylcholines and lysophosphatidylcholines and results indicate that the Kennedy pathway is involved in MIL resistance. The inherent Sb resistance of the parasite had an impact on the changes that occurred in MIL‐R parasites, with more genetic changes occurring in Sb‐R compared with Sb‐S parasites. Initial interpretation of the changes identified in this study does not support synergies with Sb‐R in the mechanisms of MIL resistance, though this requires an enhanced understanding of the parasite's biochemical pathways and how they are genetically regulated to be verified fully.
This study provides an integrated analysis of genomic and metabolomic data during selection of miltefosine resistance in two Leishmania donovani strains with different inherent antimonial sensitivities.
Using gravitational microlensing, we detected a cold terrestrial planet
orbiting one member of a binary star system. The planet has low mass
(twice Earth's) and lies projected at ∼0.8 astronomical ...units (AU) from
its host star, about the distance between Earth and the Sun. However,
the planet's temperature is much lower, <60 Kelvin, because the host
star is only 0.10 to 0.15 solar masses and therefore more than 400 times
less luminous than the Sun. The host itself orbits a slightly more
massive companion with projected separation of 10 to 15 AU. This
detection is consistent with such systems being very common.
Straightforward modification of current microlensing search strategies
could increase sensitivity to planets in binary systems. With more
detections, such binary-star planetary systems could constrain models of
planet formation and evolution.
The age-metallicity relation (AMR) is a fundamental observational constraint for understanding how the Galactic disc formed and evolved chemically in time. However, there is not yet an agreement on ...the observational properties of the AMR for the solar neighbourhood, primarily due to the difficulty in obtaining accurate stellar ages for individual field stars. We have started an observational campaign for providing the much needed observational input by using wide white-dwarf-main-sequence (WDMS) binaries. White dwarfs are 'natural' clocks and can be used to derive accurate ages. Metallicities can be obtained from the main-sequence companions. Since the progenitors of white dwarfs and the main-sequence stars were born at the same time, WDMS binaries provide a unique opportunity to observationally constrain in a robust way the properties of the AMR. In this work we present the AMR derived from analysing a pilot sample of 23 WDMS binaries and provide clear observational evidence for the lack of correlation between age and metallicity at young and intermediate ages (0-7 Gyr).
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