Until recently, long‐range forecast systems showed only modest levels of skill in predicting surface winter climate around the Atlantic Basin and associated fluctuations in the North Atlantic ...Oscillation at seasonal lead times. Here we use a new forecast system to assess seasonal predictability of winter North Atlantic climate. We demonstrate that key aspects of European and North American winter climate and the surface North Atlantic Oscillation are highly predictable months ahead. We demonstrate high levels of prediction skill in retrospective forecasts of the surface North Atlantic Oscillation, winter storminess, near‐surface temperature, and wind speed, all of which have high value for planning and adaptation to extreme winter conditions. Analysis of forecast ensembles suggests that while useful levels of seasonal forecast skill have now been achieved, key sources of predictability are still only partially represented and there is further untapped predictability.
Key Points
The winter NAO can be skilfully predicted months ahead
The signal‐to‐noise ratio of the predictable signal is anomalously low
Predictions of the risk of regional winter extremes are possible
Background and objectives
Extracorporeal membrane oxygenation (ECMO) is a method of life support for either isolated cardiac failure or respiratory failure, with or without cardiac failure. When used ...for hemodynamic support, the ECMO circuit presents a non‐endothelialized, artificial surface to blood inciting an inflammatory response which activates haemostatic pathways. Anticoagulation may complicate a pre‐existing coagulopathy and/or inadequate surgical hemostasis of varying severity. There is no standardized method to achieve and monitor anticoagulation or guide transfusion therapy during ECMO. We tested the hypothesis that institutions across the world conduct similar management of anticoagulation and transfusion during adult ECMO support.
Methods
This is a descriptive, self‐reporting cross‐sectional survey of anticoagulation and transfusion practice for patients age 18 or older on ECMO. This 38 multiple‐choice question survey was sent to 166 institutions, internationally, utilizing adult ECMO. About 32·4% (54) of institutions responded. Responses were anonymously collected. Descriptive analyses were calculated.
Results
Our findings indicate there appears to be a significant practice variation among institutions regarding anticoagulation and transfusion during adult ECMO support.
Discussion
The lack of standard practices among institutions may reflect a paucity of data regarding optimal anticoagulation and transfusion for patients requiring ECMO. Standardized protocols for anticoagulation and transfusion may help increase quality of care for and reduce morbidity, mortality and cost to patients and healthcare centres. Further study is required for standardized, high quality care.
Abstract
The European FP7 project DIANA has performed a coherent analysis of a large set of observational data of protoplanetary disks by means of thermo-chemical disk models. The collected data ...include extinction-corrected stellar UV and X-ray input spectra (as seen by the disk), photometric fluxes, low and high resolution spectra, interferometric data, emission line fluxes, line velocity profiles and line maps, which probe the dust, polycyclic aromatic hydrocarbons (PAHs) and the gas in these objects. We define and apply a standardized modeling procedure to fit these data by state-of-the-art modeling codes (
ProDiMo
,
MCFOST
,
MCMax
), solving continuum and line radiative transfer (RT), disk chemistry, and the heating and cooling balance for both the gas and the dust. 3D diagnostic RT tools (e.g., FLiTs) are eventually used to predict all available observations from the same disk model, the DIANA-standard model. Our aim is to determine the physical parameters of the disks, such as total gas and dust masses, the dust properties, the disk shape, and the chemical structure in these disks. We allow for up to two radial disk zones to obtain our best-fitting models that have about 20 free parameters. This approach is novel and unique in its completeness and level of consistency. It allows us to break some of the degeneracies arising from pure Spectral Energy Distribution (SED) modeling. In this paper, we present the results from pure SED fitting for 27 objects and from the all inclusive DIANA-standard models for 14 objects. Our analysis shows a number of Herbig Ae and T Tauri stars with very cold and massive outer disks which are situated at least partly in the shadow of a tall and gas-rich inner disk. The disk masses derived are often in excess to previously published values, since these disks are partially optically thick even at millimeter wavelength and so cold that they emit less than in the Rayleigh–Jeans limit. We fit most infrared to millimeter emission line fluxes within a factor better than 3, simultaneously with SED, PAH features and radial brightness profiles extracted from images at various wavelengths. However, some line fluxes may deviate by a larger factor, and sometimes we find puzzling data which the models cannot reproduce. Some of these issues are probably caused by foreground cloud absorption or object variability. Our data collection, the fitted physical disk parameters as well as the full model output are available to the community through an online database (
http://www.univie.ac.at/diana
).
We present the discovery of PS18kh, a tidal disruption event discovered at the center of SDSS J075654.53+341543.6 (d 322 Mpc) by the Pan-STARRS Survey for Transients. Our data set includes ...pre-discovery survey data from Pan-STARRS, the All-sky Automated Survey for Supernovae, and the Asteroid Terrestrial-impact Last Alert System as well as high-cadence, multiwavelength follow-up data from ground-based telescopes and Swift, spanning from 56 days before peak light until 75 days after. The optical/UV emission from PS18kh is well-fit as a blackbody with temperatures ranging from T 12,000 K to T 25,000 K and it peaked at a luminosity of L 8.8 × 1043 erg s−1. PS18kh radiated E = (3.45 0.22) × 1050 erg over the period of observation, with (1.42 0.20) × 1050 erg being released during the rise to peak. Spectra of PS18kh show a changing, boxy/double-peaked H emission feature, which becomes more prominent over time. We use models of non-axisymmetric accretion disks to describe the profile of the H line and its evolution. We find that at early times the high accretion rate leads the disk to emit a wind which modifies the shape of the line profile and makes it bell-shaped. At late times, the wind becomes optically thin, allowing the non-axisymmetric perturbations to show up in the line profile. The line-emitting portion of the disk extends from rin ∼ 60rg to an outer radius of rout ∼ 1400rg and the perturbations can be represented either as an eccentricity in the outer rings of the disk or as a spiral arm in the inner disk.
The Mogok metamorphic belt (MMB) extends for over 1,000 km along central Burma from the Andaman Sea to the East Himalayan syntaxis and represents exhumed lower and middle crustal metamorphic rocks of ...the Sibumasu plate. In the Mogok valley region, the MMB consists of regional high‐grade marbles containing calcite + phlogopite + spinel + apatite ± diopside ± olivine and hosts world class ruby and sapphire gemstones. The coarse‐grained marbles have been intruded by orthopyroxene‐ and clinopyroxene‐bearing charnockite‐syenite sheet‐like intrusions that have skarns around the margins. Syenites range from hornblende‐ to quartz‐bearing and frequently show layering that could be a primary igneous texture or a later metamorphic overprint. Calc‐silicate skarns contain both rubies and blue sapphires with large biotites. Rubies occur in marbles with scapolite, phlogopite, graphite, occasional diopside, and blue apatite. Both marbles and syenites have been intruded by the Miocene Kabaing garnet‐muscovite‐biotite peraluminous leucogranite. New mapping and structural observations combined with U‐Th‐Pb zircon, monazite, and titanite geochronology from syenites, charnockites, leucogranites, meta‐rhyolite‐tuffs, and skarns have revealed a complex multiphase igneous and metamorphic history for the MMB. U‐Pb zircon ages of the charnockite‐syenites fall into three categories, Jurassic (170–168 Ma), latest Cretaceous to early Paleocene (~68‐63 Ma), and late Eocene–Oligocene (44–21 Ma). New ages from five samples suggest that metamorphism in the presence of garnet and melt occurred between ~45 and 24 Ma. U‐Pb titanite ages from the ruby marbles and meta‐skarns at Le Oo mine in the Mogok valley are 21 Ma, similar to titanite ages from an adjacent syenite (22 Ma). U‐Th‐Pb dating shows that all the metamorphic ages are Late Cretaceous–early Miocene and related to the India‐Sibumasu collision.
Key Points
Rubies and sapphires in granulite‐facies marbles from the Mogok metamorphic belt, Myanmar, are spatially associated with charnockite‐syenite sill‐like intrusions and surrounding skarns
U‐Th‐Pb LA‐ICPMS dating of zircon, monazite, and titanite shows that there were two groups of charnockite‐syenite dates, one Jurassic in age (170–168 Ma) and one latest Cretaceous to early Miocene (~68–21 Ma)
Regional granulite‐facies metamorphism along the Mogok metamorphic belt is Late Cretaceous to Oligocene or early Miocene in age (~68‐21 Ma), peaking with garnet‐present melting between 45 and 21 Ma
The Forecast Ocean Assimilation Model (FOAM) is an operational ocean analysis and forecast system run daily at the Met Office. FOAM provides modelling capability in both deep ocean and coastal shelf ...sea regimes using the NEMO (Nucleus for European Modelling of the Ocean) ocean model as its dynamical core. The FOAM Deep Ocean suite produces analyses and 7-day forecasts of ocean tracers, currents and sea ice for the global ocean at 1/4° resolution. Satellite and in situ observations of temperature, salinity, sea level anomaly and sea ice concentration are assimilated by FOAM each day over a 48 h observation window. The FOAM Deep Ocean configurations have recently undergone a major upgrade which has involved the implementation of a new variational, first guess at appropriate time (FGAT) 3D-Var, assimilation scheme (NEMOVAR); coupling to a different, multi-thickness-category, sea ice model (CICE); the use of coordinated ocean-ice reference experiment (CORE) bulk formulae to specify the surface boundary condition; and an increased vertical resolution for the global model. In this paper the new FOAM Deep Ocean system is introduced and details of the recent changes are provided. Results are presented from 2-year reanalysis integrations of the Global FOAM configuration including an assessment of short-range ocean forecast accuracy. Comparisons are made with both the previous FOAM system and a non-assimilative FOAM system. Assessments reveal considerable improvements in the new system to the near-surface ocean and sea ice fields. However there is some degradation to sub-surface tracer fields and in equatorial regions which highlights specific areas upon which to focus future improvements.
Penis cancer is rare and clinical trial evidence on which to base treatment decisions is limited. Case reports suggest that the combination of docetaxel, cisplatin and 5-flurouracil (TPF) is highly ...active in this disease.
Twenty-nine patients with locally advanced or metastatic squamous carcinoma of the penis were recruited into a single-arm phase II trial from nine UK centres. Up to three cycles of chemotherapy were received (docetaxel 75 mg m(-2) day 1, cisplatin 60 mg m(-2) day 1, 5-flurouracil 750 mg m(-2) per day days 1-5, repeated every 3 weeks). Primary outcome was objective response (assessed by RECIST). Fourteen or more responses in 26 evaluable patients were required to confirm a response rate of 60% or higher (Fleming-A'Hern design), warranting further evaluation. Secondary endpoints included toxicity and survival.
10/26 evaluable patients (38.5%, 95% CI: 20.2-59.4) achieved an objective response. Two patients with locally advanced disease achieved radiological complete remission. 65.5% of patients experienced at least one grade 3/4 adverse event.
Docetaxel, cisplatin and 5FU did not reach the pre-determined threshold for further research and caused significant toxicity. Our results do not support the routine use of TPF. The observed complete responses support further investigation of combination chemotherapy in the neoadjuvant setting.
Northward subduction of the leading edge of the Indian continental margin to depths greater than 100 km during the early Eocene resulted in high‐pressure (HP) quartz‐eclogite to ultrahigh‐pressure ...(UHP) coesite–eclogite metamorphism at Tso Morari, Ladakh Himalaya, India. Integrated pressure–temperature–time determinations within petrographically well‐constrained settings for zircon‐ and/or monazite‐bearing assemblages in mafic eclogite boudins and host aluminous gneisses at Tso Morari uniquely document segments of both the prograde burial and retrograde exhumation path for HP/UHP units in this portion of the western Himalaya. Poikiloblastic cores and inclusion‐poor rims of compositionally zoned garnet in mafic eclogite were utilized with entrapped inclusions and matrix minerals for thermobarometric calculations and isochemical phase diagram construction, the latter thermodynamic modelling performed with and without the consideration of cation fractionation into garnet during prograde metamorphism. Analysis of the garnet cores document (M1) conditions of 21.5 ± 1.5 kbar and 535 ± 15 °C during early garnet growth and re‐equilibration. Sensitive high resolution ion microprobe (SHRIMP) U–Pb analysis of zircon inclusions in garnet cores yields a maximum age determination of 58.0 ± 2.2 Ma for M1. Peak HP/UHP (M2) conditions are constrained at 25.5–27.5 kbar and 630–645 °C using the assemblage garnet rim–omphacite–rutile–phengite–lawsonite–talc–quartz (coesite), with mineral compositional data and regional considerations consistent with the upper P–T bracket. A SHRIMP U–Pb age determination of 50.8 ± 1.4 Ma for HP/UHP metamorphism is given by M2 zircons analysed in the eclogitic matrix and that are encased in the garnet rim. Two garnet‐bearing assemblages from the Puga gneiss (host to the mafic eclogites) were utilized to constrain the subsequent decompression path. A non‐fractionated isochemical phase diagram for the assemblage phengite–garnet–biotite–plagioclase–quartz–melt documents a restricted (M3) P–T stability field centred on 12.5 ± 0.5 kbar and 690 ± 25 °C. A second non‐fractionated isochemical phase diagram calculated for the lower pressure assemblage garnet–cordierite–sillimanite–biotite–plagioclase–quartz–melt (M4) documents a narrow P–T stability field ranging between 7–8.4 kbar and 705–755 °C, which is consistent with independent multiequilibria P–T determinations. Th–Pb SHRIMP dating of monazite cores surrounded by allanite rims is interpreted to constrain the timing of the M4 equilibration to 45.3 ± 1.1 Ma. Coherently linking metamorphic conditions with petrographically constrained ages at Tso Morari provides an integrated context within which previously published petrological or geochronological results can be evaluated. The new composite path is similar to those published for the Kaghan UHP locality in northern Pakistan, although the calculated 12‐mm a−1 rate of post‐pressure peak decompression at Tso Morari would appear less extreme.
The Pan-STARRS1 (PS1) survey has obtained imaging in five bands (griz
y
P1) over 10 Medium Deep Survey (MDS) fields covering a total of 70 square degrees. This paper describes the search for ...apparently hostless supernovae (SNe) within the first year of PS1 MDS data with an aim of discovering superluminous supernovae (SLSNe). A total of 249 hostless transients were discovered down to a limiting magnitude of M
AB ∼ 23.5, of which 76 were classified as Type Ia supernovae (SNe Ia). There were 57 SNe with complete light curves that are likely core-collapse SNe (CCSNe) or type Ic SLSNe and 12 of these have had spectra taken. Of these 12 hostless, non-Type Ia SNe, 7 were SLSNe of type Ic at redshifts between 0.5 and 1.4. This illustrates that the discovery rate of type Ic SLSNe can be maximized by concentrating on hostless transients and removing normal SNe Ia. We present data for two possible SLSNe; PS1-10pm (z = 1.206) and PS1-10ahf (z = 1.1), and estimate the rate of type Ic SLSNe to be between
$3^{+3}_{-2}\times 10^{-5}$
and
$8^{+2}_{-1}\times 10^{-5}$
that of the CCSN rate within 0.3 ≤ z ≤ 1.4 by applying a Monte Carlo technique. The rate of slowly evolving, type Ic SLSNe (such as SN2007bi) is estimated as a factor of 10 lower than this range.
Herpes zoster is a localized skin infection caused by reactivation of latent varicella-zoster virus. Tissue-resident T cells likely control skin infections. Zoster provides a unique opportunity to ...determine if focal reinfection of human skin boosts local or disseminated antigen-specific tissue-resident T cells. Here, we show virus-specific T cells are retained over one year in serial samples of rash site and contralateral unaffected skin of individuals recovered from zoster. Consistent with zoster resolution, viral DNA is largely undetectable on skin from day 90 and virus-specific B and T cells decline in blood. In skin, there is selective infiltration and long-term persistence of varicella-zoster virus-specific T cells in the rash site relative to the contralateral site. The skin T cell infiltrates express the canonical tissue-resident T cell markers CD69 and CD103. These findings show that zoster promotes spatially-restricted long-term retention of antigen-specific tissue-resident T cells in previously infected skin.
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