Explaining the Statistical Properties of Salt Intrusion in Estuaries Using a Stochastic Dynamical Modeling Approach

Determining the statistical properties of salt intrusion in estuaries on sub-tidal time scales is a substantial challenge in environmental modeling. To study these properties, we here extend an idealized deterministic salt intrusion model to a stochastic one by including a stochastic model of the river discharge. In the river discharge model, two types of stochastic forcing are used: one independent (additive noise) and one dependent (multiplicative noise) on the river discharge state. Each type of forcing results in a non-Gaussian response in the salt intrusion length, which we consider here as the distance of the 2 psu isohaline contour to the estuary mouth. The salt intrusion model including both types of stochastic forcing in the river discharge provides a satisfactory explanation of the multi-year statistics of observed salt intrusion lengths in the San Francisco Bay estuary, in particular for the skewness of its probability density function

Estuarine Salinity Response to Freshwater Pulses

Freshwater pulses (during which river discharge is much higher than average) occur in many estuaries and strongly impact estuarine functioning. To gain insight into the estuarine salinity response to freshwater pulses, an idealized model is presented. With respect to earlier models on the spatiotemporal behavior of salinity in estuaries, it includes additional processes that provide a more detailed vertical structure of salinity. Simulation of an observed salinity response to a freshwater pulse in the Guadalquivir Estuary (Spain) shows that this is important to adequately simulate the salinity structure. The model is used to determine the dependency of the estuarine salinity response to freshwater pulses for different background discharge, tides, and different intensities and durations of the pulses. Results indicate that the change in salt intrusion length due to a freshwater pulse is proportional to the ratio between peak and background river discharge and depends linearly on the duration of the pulse if there is no equilibration during the pulse. The adjustment time, which is the time it takes for the estuary to reach equilibrium after an increase in river discharge, scales with the ratio of the change in salt intrusion length and the peak river discharge. The recovery time, that is, the time it takes for the estuary to reach equilibrium after a decrease in river discharge, does not depend on the amount of decrease in salt intrusion length caused by the pulse. The strength of the tides is of minor importance to the salt dynamics during and after the pulse

Quantification of cerebral perfusion and cerebrovascular reserve using Turbo‐QUASAR arterial spin labeling MRI

PurposeTo compare cerebral blood flow (CBF) and cerebrovascular reserve (CVR) quantification from Turbo‐QUASAR (quantitative signal targeting with alternating radiofrequency labeling of arterial regions) arterial spin labeling (ASL) and single post‐labeling delay pseudo‐continuous ASL (PCASL).MethodsA model‐based method was developed to quantify CBF and arterial transit time (ATT) from Turbo‐QUASAR, including a correction for magnetization transfer effects caused by the repeated labeling pulses. Simulations were performed to assess the accuracy of the model‐based method. Data from an in vivo experiment conducted on a healthy cohort were retrospectively analyzed to compare the CBF and CVR (induced by acetazolamide) measurement from Turbo‐QUASAR and PCASL on the basis of global and regional differences. The quality of the two ASL data sets was examined using the coefficient of variation (CoV).ResultsThe model‐based method for Turbo‐QUASAR was accurate for CBF estimation (relative error was 8% for signal‐to‐noise ratio = 5) in simulations if the bolus duration was known. In the in vivo experiment, the mean global CVR estimated by Turbo‐QUASAR and PCASL was between 63% and 64% and not significantly different. Although global CBF values of the two ASL techniques were not significantly different, regional CBF differences were found in deep gray matter in both pre‐ and postacetazolamide conditions. The CoV of Turbo‐QUASAR data was significantly higher than PCASL.ConclusionBoth ASL techniques were effective for quantifying CBF and CVR, despite the regional differences observed. Although CBF estimated from Turbo‐QUASAR demonstrated a higher variability than PCASL, Turbo‐QUASAR offers the advantage of being able to measure and control for variation in ATT

The predictive value of the modified early warning score for admission to the intensive care unit in patients with a hematologic malignancy – A multicenter observational study

Objectives: The modified early warning score (MEWS) is used to detect clinical deterioration of hospitalized patients. We aimed to investigate the predictive value of MEWS and derived quick Sequential Organ Failure Assessment (qSOFA) scores for intensive care unit admission in patients with a hematologic malignancy admitted to the ward. Design: Retrospective, observational study in two Dutch university hospitals. Setting: Data from adult patients with a hematologic malignancy, admitted to the ward over a 2-year period, were extracted from electronic patient files. Main outcome measures: Intensive care admission. Results: We included 395 patients with 736 hospital admissions; 2% (n = 15) of admissions resulted in admission to the intensive care unit. A higher MEWS (OR 1.5; 95 %CI 1.3–1.80) and qSOFA (OR 4.4; 95 %CI 2.1–9.3) were associated with admission. Using restricted cubic splines, a rise in the probability of admission for a MEWS ≥ 6 was observed. The AUC of MEWS for predicting admission was 0.830, the AUC of qSOFA was 0.752. MEWS was indicative for intensive care unit admission two days before admission. Conclusions: MEWS was a sensitive predictor of ICU admission in patients with a hematologic malignancy, superior to qSOFA. Future studies should confirm cut-off values and identify potential additional characteristics, to further enhance identification of critically ill hemato-oncology patients. Implications for Clinical Practice: The Modified Early Warning Score (MEWS) can be used as a tool for healthcare providers to monitor clinical deterioration and predict the need for intensive care unit admission in patients with a hematologic malignancy. Yet, consistent application and potential reevaluation of current thresholds is crucial. This will enable bedside nurses to more effectively identify patients needing adjunctive care, facilitating timely interventions and improved outcome.</p

Deep-mixing and deep-cooling events in Lake Garda: Simulation and mechanisms

A calibrated three-dimensional numerical model (Delft3D) and in-situ observations are used to study the relation between deep-water temperature and deep mixing in Lake Garda (Italy). A model-observation comparison indicates that the model is able to adequately capture turbulent kinetic energy production in the surface layer and its vertical propagation during unstratified conditions. From the modeling results several processes are identified to affect the deep-water temperature in Lake Garda. The first process is thermocline tilting due to strong and persistent winds, leading to a temporary disappearance of stratification followed by vertical mixing. The second process is turbulent cooling, which acts when vertical temperature gradients are nearly absent over the whole depth and arises as a combination of buoyancy-induced turbulence production due to surface cooling and turbulence production by strong winds. A third process is differential cooling, which causes cold water to move from the shallow parts of the lake to deeper parts along the sloping bottom. Two of these processes (thermocline tilting and turbulent cooling) cause deep-mixing events, while deep-cooling events are mainly caused by turbulent cooling and differential cooling. Detailed observations of turbulence quantities and lake temperature, available at the deepest point of Lake Garda for the year 2018, indicate that differential cooling was responsible for the deep-water cooling at that location. Long-term simulations of deep-water temperature and deep mixing appear to be very sensitive to the applied wind forcing. This sensitivity is one of the main challenges in making projections of future occurrences of episodic deep mixing and deep cooling under climate change

Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care

Objectives: Historically, patients with a hematologic malignancy have one of the highest mortality rates among cancer patients admitted to the ICU. Therefore, physicians are often reluctant to admit these patients to the ICU. The aim of our study was to examine the survival of patients who have a hematologic malignancy and multiple organ failure admitted to the ICU. Design: This retrospective cohort study, part of the HEMA-ICU study group, was designed to study the survival of patients with a hematologic malignancy and organ failure after admission to the ICU. Patients were followed for at least 1 year. Setting: Five university hospitals in the Netherlands. Patients: One-thousand ninety-seven patients with a hematologic malignancy who were admitted at the ICU. Interventions: None. Measurements and Main Results: Primary outcome was 1-year survival. Organ failure was categorized as acute kidney injury, respiratory failure, hepatic failure, and hemodynamic failure; multiple organ failure was defined as failure of two or more organs. The World Health Organization performance score measured 3 months after discharge from the ICU was used as a measure of functional outcome. The 1-year survival rate among these patients was 38%. Multiple organ failure was inversely associated with long-term survival, and an absence of respiratory failure was the strongest predictor of 1-year survival. The survival rate among patients with 2, 3, and 4 failing organs was 27%, 22%, and 8%, respectively. Among all surviving patients for which World Health Organization scores were available, 39% had a World Health Organization performance score of 0-1 3 months after ICU discharge. Functional outcome was not associated with the number of failing organs. Conclusions: Our results suggest that multiple organ failure should not be used as a criterion for excluding a patient with a hematologic malignancy from admission to the ICU.</p