We aimed to investigate the impact of comorbidity burden on mortality in patients with coronavirus disease (COVID-19). We analyzed the COVID-19 data from the nationwide health insurance claims of ...South Korea. Data on demographic characteristics, comorbidities, and mortality records of patients with COVID-19 were extracted from the database. The odds ratios of mortality according to comorbidities in these patients with and without adjustment for age and sex were calculated. The predictive value of the original Charlson comorbidity index (CCI) and the age-adjusted CCI (ACCI) for mortality in these patients were investigated using the receiver operating characteristic (ROC) curve analysis. Among 7590 patients, 227 (3.0%) had died. After age and sex adjustment, hypertension, diabetes mellitus, congestive heart failure, dementia, chronic pulmonary disease, liver disease, renal disease, and cancer were significant risk factors for mortality. The ROC curve analysis showed that an ACCI threshold > 3.5 yielded the best cut-off point for predicting mortality (area under the ROC 0.92; 95% confidence interval 0.91-0.94). Our study revealed multiple risk factors for mortality in patients with COVID-19. The high predictive power of the ACCI for mortality in our results can support the importance of old age and comorbidities in the severity of COVID-19.
The 2013–2014 California drought was initiated by an anomalous high‐amplitude ridge system. The anomalous ridge was investigated using reanalysis data and the Community Earth System Model (CESM). It ...was found that the ridge emerged from continual sources of Rossby wave energy in the western North Pacific starting in late summer and subsequently intensified into winter. The ridge generated a surge of wave energy downwind and deepened further the trough over the northeast U.S., forming a dipole. The dipole and associated circulation pattern is not linked directly with either El Niño–Southern Oscillation (ENSO) or Pacific Decadal Oscillation; instead, it is correlated with a type of ENSO precursor. The connection between the dipole and ENSO precursor has become stronger since the 1970s, and this is attributed to increased greenhouse gas loading as simulated by the CESM. Therefore, there is a traceable anthropogenic warming footprint in the enormous intensity of the anomalous ridge during winter 2013–2014 and the associated drought.
Key Points
The drought‐inducing ridge is recurrent
The ridge is linked to an ENSO precursor
The link of the ridge with ENSO precursor has grown
Hurricane Harvey made landfall in August 2017 as the first land-falling category 4 hurricane to hit the state of Texas since Hurricane Carla in September 1961. While its intensity at landfall was ...notable, most of the vast devastation in the Houston metropolitan area was due to Harvey stalling near the southeast Texas coast over the next several days. Harvey's long-duration rainfall event was reminiscent of extreme flooding that occurred in the neighboring state of Louisiana: both of which were caused by a stalled tropical low-pressure system producing four days of intense precipitation. A quantitative attribution analysis of Harvey's rainfall was conducted using a mesoscale atmospheric model forced by constrained boundary and initial conditions that had their long-term climate trends removed. The removal of the various trends of the boundary and initial conditions minimizes the effects of warming in the air and the ocean surface on Harvey. The 60 member ensemble simulations suggest that post-1980 climate warming could have contributed to the extreme precipitation that fell on southeast Texas during 26-29 August 2017 by approximately 20%, with an interquartile range of 13%-37%. While the attribution outcome could be model dependent, this downscaling approach affords the closest means possible of a case-to-case comparison for event attribution, complementing other statistics-based attribution studies on Harvey. Further analysis of a global climate model tracking Harvey-like stalling systems indicates an increase in storm frequency and intensity over southeast Texas through the mid-21st century.
The equilibrium climate response to the total effects (direct, indirect and semi‐direct effects) of aerosols arising from anthropogenic and biomass burning emissions on the South Asian summer monsoon ...system is studied using a coupled atmosphere‐slab ocean model. Our results suggest that anthropogenic and biomass burning aerosols generally induce a reduction in mean summer monsoon precipitation over most parts of the Indian subcontinent, strongest along the western coastline of the Indian peninsula and eastern Nepal region, but modest increases also occur over the north western part of the subcontinent. While most of the noted reduction in precipitation is triggered by increased emissions of aerosols from anthropogenic activities, modest increases in the north west are mostly associated with decreases in local emissions of aerosols from forest fire and grass fire sources. Anthropogenic aerosols from outside Asia also contribute to the overall reduction in precipitation but the dominant contribution comes from aerosol sources within Asia. Local emissions play a more important role in the total rainfall response to anthropogenic aerosol sources during the early monsoon period, whereas both local as well as remote emissions of aerosols play almost equally important roles during the later part of the monsoon period. While precipitation responses are primarily driven by local aerosol forcing, regional surface temperature changes over the region are strongly influenced by anthropogenic aerosols from sources further away (non‐local changes). Changes in local anthropogenic organic and black carbon emissions by as much as a factor of two (preserving their ratio) produce the same basic signatures in the model's summer monsoon temperature and precipitation responses.
Key Points
While BC can warm the atmosphere, we find anthropogenic aerosols mostly cool it
Local anthropogenic aerosols reduce the mean South Asian summer monsoon rainfall
Decreased aerosol emission from local fire sources increase rainfall over S Asia
Successive cold winters of severely low temperatures in recent years have had critical social and economic impacts on the mid-latitude continents in the Northern Hemisphere. Although these cold ...winters are thought to be partly driven by dramatic losses of Arctic sea-ice, the mechanism that links sea-ice loss to cold winters remains a subject of debate. Here, by conducting observational analyses and model experiments, we show how Arctic sea-ice loss and cold winters in extra-polar regions are dynamically connected through the polar stratosphere. We find that decreased sea-ice cover during early winter months (November-December), especially over the Barents-Kara seas, enhances the upward propagation of planetary-scale waves with wavenumbers of 1 and 2, subsequently weakening the stratospheric polar vortex in mid-winter (January-February). The weakened polar vortex preferentially induces a negative phase of Arctic Oscillation at the surface, resulting in low temperatures in mid-latitudes.
Simulations from the Community Earth System Model (CESM) Large Ensemble project are analyzed to investigate the impact of global warming on atmospheric rivers (ARs) making landfall in western North ...America. The model has notable biases in simulating the subtropical jet position and the relationship between extreme precipitation and moisture transport. After accounting for these biases, the model projects an ensemble mean increase of 35% in the number of landfalling AR days between the last 20 years of the twentieth and 21st centuries under Representative concentration pathway 8.5 (RCP8.5). However, the associated extreme precipitation days increase only by 28% because the moisture transport required to produce extreme precipitation also increases with warming. Internal variability introduces an uncertainty of ±8% and ±7% in the changes in AR days and associated extreme precipitation days compared to only about 1% difference from accountings for model biases. The significantly larger mean changes compared to internal variability, and effects of model biases highlight the robust AR responses to global warming.
Key Points
ARs and related extreme precipitation days will increase with global warming
The model response is larger than the uncertainty from bias and natural variability
Increase in the frequency of AR extreme precipitation days is smaller than in AR days
Ionogels are good candidates for flexible electronics owing to their excellent mechanical and electrical properties, including stretchability, high conductivity, and stability. In this study, ...conducting ionogels comprising a double network (DN) of poly(N‐isopropylacrylamide‐co‐N,N′‐diethylacrylamide)/chitosan which are further reinforced by the ionic and covalent crosslinking of the chitosan network by tripolyphosphate and glutaraldehyde, respectively, are prepared. Based on their excellent mechanical properties and high conductivity, the developed DN ionogels are envisioned as stretchable ionic conductors for extremely stretchable alternating‐current electroluminescent (ACEL) devices. The ACEL device fabricated with the developed ionogel exhibits stable working operation under an ultrahigh elongation of over 1200% as well as severe mechanical deformations such as bending, rolling, and twisting. Furthermore, the developed ACEL devices also display stable luminescence over 1000 stretch/release cycles or at temperatures as harsh as 200 °C.
A super stretchable electroluminescent device is successfully fabricated with double‐network ionogel as a soft electrode owing to its excellent mechanical robustness and electrical conductivity. The fabricated device exhibits extremely stable light‐emitting operation even at high elongation as well as demonstrating mechanical, electrical, and thermal stability, which can be applied to new types of stretchable light display and sensors.
Data on P2Y12 inhibitor monotherapy after short-duration dual antiplatelet therapy (DAPT) in patients undergoing percutaneous coronary intervention are limited.
To determine whether P2Y12 inhibitor ...monotherapy after 3 months of DAPT is noninferior to 12 months of DAPT in patients undergoing PCI.
The SMART-CHOICE trial was an open-label, noninferiority, randomized study that was conducted in 33 hospitals in Korea and included 2993 patients undergoing PCI with drug-eluting stents. Enrollment began March 18, 2014, and follow-up was completed July 19, 2018.
Patients were randomly assigned to receive aspirin plus a P2Y12 inhibitor for 3 months and thereafter P2Y12 inhibitor alone (n = 1495) or DAPT for 12 months (n = 1498).
The primary end point was major adverse cardiac and cerebrovascular events (a composite of all-cause death, myocardial infarction, or stroke) at 12 months after the index procedure. Secondary end points included the components of the primary end point and bleeding defined as Bleeding Academic Research Consortium type 2 to 5. The noninferiority margin was 1.8%.
Among 2993 patients who were randomized (mean age, 64 years; 795 women 26.6%), 2912 (97.3%) completed the trial. Adherence to the study protocol was 79.3% of the P2Y12 inhibitor monotherapy group and 95.2% of the DAPT group. At 12 months, major adverse cardiac and cerebrovascular events occurred in 42 patients in the P2Y12 inhibitor monotherapy group and in 36 patients in the DAPT group (2.9% vs 2.5%; difference, 0.4% 1-sided 95% CI, -∞% to 1.3%; P = .007 for noninferiority). There were no significant differences in all-cause death (21 1.4% vs 18 1.2%; hazard ratio HR, 1.18; 95% CI, 0.63-2.21; P = .61), myocardial infarction (11 0.8% vs 17 1.2%; HR, 0.66; 95% CI, 0.31-1.40; P = .28), or stroke (11 0.8% vs 5 0.3%; HR, 2.23; 95% CI, 0.78-6.43; P = .14) between the 2 groups. The rate of bleeding was significantly lower in the P2Y12 inhibitor monotherapy group than in the DAPT group (2.0% vs 3.4%; HR, 0.58; 95% CI, 0.36-0.92; P = .02).
Among patients undergoing percutaneous coronary intervention, P2Y12 inhibitor monotherapy after 3 months of DAPT compared with prolonged DAPT resulted in noninferior rates of major adverse cardiac and cerebrovascular events. Because of limitations in the study population and adherence, further research is needed in other populations.
ClinicalTrials.gov Identifier: NCT02079194.
This study provides comprehensive insight into the notable differences in clouds and precipitation simulated by the Energy Exascale Earth System Model Atmosphere Model version 0 and version 1 ...(EAMv1). Several sensitivity experiments are conducted to isolate the impact of changes in model physics, resolution, and parameter choices on these differences. The overall improvement in EAMv1 clouds and precipitation is primarily attributed to the introduction of a simplified third‐order turbulence parameterization Cloud Layers Unified By Binormals (along with the companion changes) for a unified treatment of boundary layer turbulence, shallow convection, and cloud macrophysics, though it also leads to a reduction in subtropical coastal stratocumulus clouds. This lack of stratocumulus clouds is considerably improved by increasing vertical resolution from 30 to 72 layers, but the gain is unfortunately subsequently offset by other retuning to reach the top‐of‐atmosphere energy balance. Increasing vertical resolution also results in a considerable underestimation of high clouds over the tropical warm pool, primarily due to the selection for numerical stability of a higher air parcel launch level in the deep convection scheme. Increasing horizontal resolution from 1° to 0.25° without retuning leads to considerable degradation in cloud and precipitation fields, with much weaker tropical and subtropical short‐ and longwave cloud radiative forcing and much stronger precipitation in the intertropical convergence zone, indicating poor scale awareness of the cloud parameterizations. To avoid this degradation, significantly different parameter settings for the low‐resolution (1°) and high‐resolution (0.25°) were required to achieve optimal performance in EAMv1.
Plain Language Summary
The Energy Exascale Earth System Model (E3SM) is a new and ongoing U.S. Department of Energy (DOE) climate modeling effort to develop a high‐resolution Earth system model specifically targeting next‐generation DOE supercomputers to meet the science needs of the nation and the mission needs of DOE. The increase of model resolution along with improvements in representing cloud and convective processes in the E3SM atmosphere model version 1 has led to quite significant model behavior changes from its earlier version, particularly in simulated clouds and precipitation. To understand what causes the model behavior changes, this study conducts sensitivity experiments to isolate the impact of changes in model physics, resolution, and parameter choices on these changes. Results from these sensitivity tests and discussions on the underlying physical processes provide substantial insight into the model errors and guidance for future E3SM development.
Key Points
CLUBB along with the companion changes in EAMv1 primarily account for the overall improvements in clouds and precipitation simulation
Underestimate of coastal Sc in EAMv1 is due to CLUBB and model tuning; increased vertical resolution partially offsets this degradation
The poor scale awareness of EAMv1 requires retuning as resolution increases, which has a large impact on model cloud behavior
PDF
