A New Coupled Ocean-Waves-Atmosphere Model Designed for Tropical Storm Studies: Example of Tropical Cyclone Bejisa (2013-2014) in the South-West Indian Ocean

International audienceOcean-Waves-Atmosphere (OWA) exchanges are not well represented in current Numerical Weather Prediction (NWP) systems, which can lead to large uncertainties in tropical cyclone track and intensity forecasts. In order to explore and better understand the impact of OWA interactions on tropical cyclone modeling, a fully coupled OWA system based on the atmospheric model Meso-NH, the oceanic model CROCO, and the wave model WW3 and called MSWC was designed and applied to the case of tropical cyclone Bejisa (2013–2014). The fully coupled OWA simulation shows good agreement with the literature and available observations. In particular, simulated significant wave height is within 30 cm of measurements made with buoys and altimeters. Short-term (< 2 days) sensitivity experiments used to highlight the effect of oceanic waves coupling show limited impact on the track, the intensity evolution, and the turbulent surface fluxes of the tropical cyclone. However, it is also shown that using a fully coupled OWA system is essential to obtain consistent sea salt emissions. Spatial and temporal coherence of the sea state with the 10 m wind speed are necessary to produce sea salt aerosol emissions in the right place (in the eyewall of the tropical cyclone) and with the right size distribution, which is critical for cloud microphysics

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Item does not contain fulltextOBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use