This paper presents the results of modeling the distribution of eight critical heavy metals (arsenic, cadmium, chromium, copper, mercury, nickel, lead and zinc) in topsoils using 1588 georeferenced ...samples from the Forum of European Geological Surveys Geochemical database (26 European countries). The concentrations were mapped using regression-kriging (RK) and accuracy of predictions evaluated using the leave-one-out cross validation method. A large number of auxiliary raster maps (topographic indexes, land cover, geology, vegetation indexes, night lights images and earth quake magnitudes) were used to improve the predictions. These were first converted to 36 principal components and then used to explain spatial distribution of heavy metals. The study revealed that this database is suitable for geostatistical analyses: the predictors explained from 21% (Cr) to 35% (Pb) of variability; the residuals showed spatial autocorrelation. The Principal Component Analysis of the mapped heavy metals revealed that the administrative units (NUTS level3) with highest overall concentrations are: (1) Liege (Arrondissement) (BE), Attiki (GR), Darlington (UK), Coventry (UK), Sunderland (UK), Kozani (GR), Grevena (GR), Hartlepool & Stockton (UK), Huy (BE), Aachen (DE) (As, Cd, Hg and Pb) and (2) central Greece and Liguria region in Italy (Cr, Cu and Ni). The evaluation of the mapping accuracy showed that the RK models for As, Ni and Pb can be considered satisfactory (prediction accuracy 45–52% of total variance), marginally satisfactory for Cr, Cu, Hg and Zn (36–41%), while the model for Cd is unsatisfactorily accurate (30%). The critical elements limiting the mapping accuracy are: (a) the problem of sporadic high values (hot-spots); and (b) relatively coarse resolution of the input maps. Automation of the geostatistical mapping and use of auxiliary spatial layers opens a possibility to develop mapping systems that can automatically update outputs by including new field observations and higher quality auxiliary maps. This approach also demonstrates the benefits of organizing standardized joint European monitoring projects, in comparison to the merging of several national monitoring projects.
Digital elevation models (DEMs) provide fundamental depictions of the three-dimensionalshape of the Earth’s surface and are useful to a wide range of disciplines. Ideally, DEMs record theinterface ...between the atmosphere and the lithosphere using a discrete two-dimensional grid, withcomplexities introduced by the intervening hydrosphere, cryosphere, biosphere, and anthroposphere.The treatment of DEM surfaces, affected by these intervening spheres, depends on their intendeduse, and the characteristics of the sensors that were used to create them. DEM is a general term,and more specific terms such as digital surface model (DSM) or digital terrain model (DTM) recordthe treatment of the intermediate surfaces. Several global DEMs generated with optical (visible andnear-infrared) sensors and synthetic aperture radar (SAR), as well as single/multi-beam sonars andproducts of satellite altimetry, share the common characteristic of a georectified, gridded storagestructure. Nevertheless, not all DEMs share the same vertical datum, not all use the same conventionfor the area on the ground represented by each pixel in the DEM, and some of them have variable dataspacings depending on the latitude. This paper highlights the importance of knowing, understandingand reflecting on the sensor and DEM characteristics and consolidates terminology and definitions ofkey concepts to facilitate a common understanding among the growing community of DEM users,who do not necessarily share the same background
Carotid baroreflex activation lowers blood pressure and might have potential application for the treatment of resistant hypertension. We did a proof-of-principle trial with a novel endovascular ...baroreceptor amplification device, MobiusHD (Vascular Dynamics, Mountain View, CA, USA), in patients with resistant hypertension.
CALM-FIM_EUR was a prospective, first-in-human, open-label study done at six European centres. Eligible patients were adults with resistant hypertension (office systolic blood pressure ≥160 mm Hg despite taking at least three antihypertensive agents, including a diuretic). MobiusHD devices were implanted unilaterally in the internal carotid artery. The primary endpoint was the incidence of serious adverse events at 6 months. Secondary endpoints included changes in office and 24 h ambulatory blood pressure. This trial is registered with ClinicalTrials.gov, number NCT01911897.
Between December, 2013, and February, 2016, 30 patients were enrolled and underwent successful implantation. Mean age was 52 years (SD 12), 15 patients (50%) were men, and mean antihypertensive use was 4·4 drugs (1·4). Mean office blood pressure was 184/109 mm Hg (18/14) at baseline and was reduced by 24/12 mm Hg (13–34/6–18) at 6 months (p=0·0003 for systolic and p=0·0001 diastolic blood pressure). Mean baseline 24 h ambulatory blood pressure was 166/100 mm Hg (17/14) at baseline and was reduced by 21/12 mm Hg (14–29/7–16) at 6 months (p<0·0001 for systolic and diastolic blood pressure). Five serious adverse events had occurred in four patients (13%) at 6 months: hypotension (n=2), worsening hypertension (n=1), intermittent claudication (n=1) and wound infection (n=1).
In patients with resistant hypertension, endovascular baroreceptor amplification with the MobiusHD device substantially lowered blood pressure with an acceptable safety profile. Randomised, double-blind, sham-controlled trials are warranted to investigate the use of this treatment further.
Vascular Dynamics.
We present a practical approach to inter-compare a range of candidate digital elevation models (DEMs) based on pre-defined criteria and statistically sound ranking approach. The presented approach ...integrates the randomized complete block design (RCBD) into a novel framework for DEMs comparison. The method presented provides a flexible, statistically sound and customizable tool for evaluating the quality of any raster - in this case a DEM - by means of a ranking approach, which takes into account a confidence level, and can use both quantitative and qualitative criteria. The users can design their own criteria for the quality evaluation in relation to their specific needs. The application of the RCBD method to rank six 1" global DEMs, considering a wide set of study sites, covering different morphological and landcover settings, highlights the potentialities of the approach. We used a suite of criteria relating to the differences in the elevation, slope, and roughness distributions compared to reference DEMs aggregated from 1-5 m lidar-derived DEMs. Results confirmed significant superiority of CopDEM 1" and its derivative FABDEM as the overall best 1" global DEMs. They are slightly better than ALOS, and clearly outperform NASADEM and SRTM, which are in turn much better than ASTER.
Nodular lymphoid hyperplasia of the lung is a rare disease of polyclonal lymphoid proliferation. The incidental finding of a solid nodular lesion with irregular margins adjacent to the visceral ...pleura in the reported case was highly suggestive of malignancy. The present report underscores the typical immunohistochemical findings and the benign course of nodular lymphoid hyperplasia. The current knowledge about disease aetiology and the value of different diagnostic tools to distinguish nodular lymphoid hyperplasia from other pulmonary lymphoid lesions are summarized by a review of the literature. Surgical resection is not only diagnostic but also curative with no evidence so far that NLH can regress without operation. The present case shows the spontaneous regression of NLH after CT-guided biopsy indicating that an alternative, less invasive diagnostic approach has curative potential.
Objective
Catecholamines have been the mainstay of pharmacological treatment of cardiogenic shock (CS). Recently, use of epinephrine has been associated with detrimental outcomes. In the present ...study we aimed to evaluate the association between epinephrine use and short-term mortality in all-cause CS patients.
Design
We performed a meta-analysis of individual data with prespecified inclusion criteria: (1) patients in non-surgical CS treated with inotropes and/or vasopressors and (2) at least 15% of patients treated with epinephrine administrated alone or in association with other inotropes/vasopressors. The primary outcome was short-term mortality.
Measurements and results
Fourteen published cohorts and two unpublished data sets were included. We studied 2583 patients. Across all cohorts of patients, the incidence of epinephrine use was 37% (17–76%) and short-term mortality rate was 49% (21–69%). A positive correlation was found between percentages of epinephrine use and short-term mortality in the CS cohort. The risk of death was higher in epinephrine-treated CS patients (OR CI = 3.3 2.8–3.9) compared to patients treated with other drug regimens. Adjusted mortality risk remained striking in epinephrine-treated patients (
n
= 1227) (adjusted OR = 4.7 3.4–6.4). After propensity score matching, two sets of 338 matched patients were identified and epinephrine use remained associated with a strong detrimental impact on short-term mortality (OR = 4.2 3.0–6.0).
Conclusions
In this very large cohort, epinephrine use for hemodynamic management of CS patients is associated with a threefold increase of risk of death.
The paper compares semi-automated interpolation methods to produce soil-class maps from profile observations and by using multiple auxiliary predictors such as terrain parameters, remote sensing ...indices and similar. The Soil Profile Database of Iran, consisting of 4250 profiles, was used to test different soil-class interpolators. The target variables were soil texture classes and World Reference Base soil groups. The predictors were 6 terrain parameters, 11 MODIS EVI images and 17 physiographic regions (polygon map) of Iran. Four techniques were considered: (a) supervised classification using maximum likelihoods; (b) multinominal logistic regression; (c) regression-kriging on memberships; and (d) classification of taxonomic distances. The predictive capabilities were assessed using a control subset of 30% profiles and the kappa statistics as criterion. Supervised classification and multinominal logistic regression can lead to poor results if soil-classes overlap in the feature space, or if the correlation between the soil-classes and predictors is low. The two other methods have better predictive capabilities, although both are computationally more demanding. For both mapping of texture classes and soil types, the best prediction was achieved using regression-kriging of indicators/memberships (
κ
=
45%,
κ
=
54%). In all cases kappa was smaller than 60%, which can be explained by the preferential sampling plan, the poor definition of soil-classes and the high variability of soils. Steps to improve interpolation of soil-class data, by taking into account the fuzziness of classes directly on the field are further discussed.
Acute kidney injury (AKI) is a common complication after cardiopulmonary resuscitation (CPR) and predicts in-hospital mortality. To which extent post-resuscitation disease or the initial event of ...cardiac arrest and the duration of insufficient cardiac output triggers AKI is challenging to discriminate. Knowledge on molecular mediators of AKI is scarce. Early identification of patients at high risk of AKI is hampered by the low sensitivity of the established tests in clinical routine practice. The present study aimed to determine the diagnostic utility of the novel urine biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) for the early recognition of AKI in patients with non-traumatic shock.
The performance of TIMP-2·IGFBP7 was prospectively analysed in 48 patients with shock following out-of-hospital cardiac arrest (OHCA). All patients were treated with target temperature management (TTM) for 24 h. Urinary TIMP-2·IGFBP7 samples were collected at 3 and 24 h after determination of OHCA.
Patients (n = 31 (65%)) developed AKI after an average of 26 ± 12 h. Patients who developed AKI had significantly higher TIMP-2·IGFBP7 compared to individuals that did not develop AKI (1.52 ± 0.13 vs. 0.13 ± 0.14; p < 0.05) as early as 3 h after determination of OHCA,. For urine TIMP-2*IGFBP7, the area under the curve (AUC) for the development of AKI was 0.97 (CI 0.90-1.00) at 3 h after OHCA. The optimal TIMP-2·IGFBP7 cut-off value for the prediction of AKI was 0.24. The sensitivity was 96.8% and specificity was 94.1%.
Urinary TIMP-2•IGFBP7 reliably predicts AKI in high-risk patients only 3 h after determination of OHCA with a cut-off at 0.24. This novel test may help to identify patients at high risk of AKI to enrol into clinical studies to further elucidate the pathophysiology of AKI and devise targeted interventions in the future.
Data covering the whole of the surface of the Earth in a homogeneous and reliable manner has been accumulating over many years. This type of data became available from meteorological satellites from ...the 1960s and from Earth-observing satellites at a small scale from the early 1970s but has gradually accumulated at larger scales up to the present day when we now have data covering many environmental themes at large scales. These data have been used to generate information which is presented in the form of global data sets. This paper will give a brief introduction to the development of Earth observation and to the organisations and sensors which collect data and produce global geospatial data sets. Means of accessing global data sets will set out the types of data available that will be covered. Digital elevation models are discussed in a separate section because of their importance in georeferencing image data as well as their application to analysis of thematic data. The paper will also examine issues of availability, accuracy, validation and reliability and will look at future challenges.
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