Further evidence for CCN aerosol concentrations determining the height of warm rain and ice initiation in convective clouds over the Amazon basin

We have investigated how aerosols affect the height above cloud base of rain and ice hydrometeor Initiation and the subsequent vertical evolution of cloud droplet size and number concentrations in growing convective cumulus. For this purpose we used in situ data of hydrometeor size distributions measured with instruments mounted on HALO aircraft during the ACRIDICON CHUVA campaign over the Amazon during September 2014. The results show that the height of rain initiation by collision and coalescence processes is linearly correlated with the number concentration of droplets nucleated at cloud base

Further evidence for CCN aerosol concentrations determining the height of warm rain and ice initiation in convective clouds over the Amazon basin

We have investigated how aerosols affect the height above cloud base of rain and ice hydrometeor Initiation and the subsequent vertical evolution of cloud droplet size and number concentrations in growing convective cumulus. For this purpose we used in situ data of hydrometeor size distributions measured with instruments mounted on HALO aircraft during the ACRIDICON CHUVA campaign over the Amazon during September 2014. The results show that the height of rain initiation by collision and coalescence processes is linearly correlated with the number concentration of droplets nucleated at cloud base

Cloud droplet number closure for tropical convective clouds during the ACRIDICON CHUVA campaign

The main objective of the ACRIDICON-CHUVA campaign in September 2014 was the investigation of aerosol-cloud-interactions in the Amazon Basin. Cloud properties near cloud base of growing convective cumuli were characterized by cloud droplet size distribution measurements using a cloud combination probe and a cloud and aerosol spectrometer. In the current study, an adiabatic parcel model was used to perform cloud droplet number closure studies for several flights in differently polluted air masses

Síndrome de Seckel: relato de caso de uma rara condição genética / Seckel's Syndrome: case report of a rare genetic condition

O presente artigo objetivou relatar o caso clínico de uma paciente, sabidamente portadora de Síndrome de Seckel, em acompanhamento no ambulatório de endocrinologia e metabologia para avaliação de seu desenvolvimento. Trata-se de um estudo descritivo, do tipo relato de caso, que visou analisar as principais características clínicas apresentadas pela criança em questão e estabelecer comparativos com a literatura disponível até o momento. A paciente apresentou baixa estatura, baixo peso e dismorfismos clássicos desta alteração genética como nanismo, fronte curta, nariz proeminente com ponte e dorso elevados, face plana, orelhas pequenas e normoimplantadas e clinodactilia de 5 dedos. As manifestações evidenciadas neste relato de caso se assemelham àquelas retratadas na maioria dos estudos publicados. Ressalta-se o papel fundamental empenhado pelo conhecimento da doença, sobretudo no que tange à realização precoce do diagnóstico e ao estabelecimento do manejo multidisciplinar aos pacientes portadores da síndrome

Tetralogia de Fallot no Brasil: compreendendo a existência

Introduction: Tetralogy of Fallot involves four specific heart problems. Firstly, there is pulmonary stenosis, characterized by the narrowing of the pathway that carries blood from the heart to the lungs, hindering blood flow. Right ventricular hypertrophy is another characteristic, where the muscle of the right ventricle of the heart becomes thicker due to increased workload caused by pulmonary stenosis. Methodology: The present study adopted a descriptive epidemiological approach with the aim of analyzing cases of Tetralogy of Fallot among live births in Brazil from 2012 to 2021. Data collection utilized the Live Birth Information System (SINASC), made available by DATASUS. Results: In the group of individuals born with Tetralogy of Fallot, the analysis of variables reveals valuable information about demographic characteristics and perinatal conditions. Regarding the "Race/Ethnicity" variable, out of the 943 cases registered, 588 (62.35%) were classified as white, 51 (5.41%) as black, 10 (1.06%) as yellow, 267 (28.31%) as brown, and 27 (2.86%) had race/ethnicity recorded as unknown. Conclusion: A profound understanding of congenital heart diseases not only saves lives but also significantly improves the quality of life for affected individuals.Introdução: A Tetralogia de Fallot envolve quatro problemas cardíacos específicos. Em primeiro lugar, há a estenose pulmonar, caracterizada pelo estreitamento da via que conduz o sangue do coração para os pulmões, dificultando o fluxo sanguíneo. A hipertrofia ventricular direita é outra característica, onde o músculo do ventrículo direito do coração torna-se mais espesso devido ao aumento da carga de trabalho provocado pela estenose pulmonar. Metodologia: O presente estudo adotou uma abordagem epidemiológica descritiva com o objetivo de analisar os casos de Tetralogia de Fallot entre os nascidos vivos no Brasil no período de 2012 a 2021. Para a coleta de dados, utilizou-se o Sistema de Informações sobre Nascidos Vivos (SINASC), disponibilizado pelo DATASUS Resultado: No grupo de nascidos com Tetralogia de Fallot, a análise das variáveis revela informações valiosas sobre características demográficas e condições perinatais. Em relação à variável "Cor/Raça", dos 943 casos registrados, 588 (62,35%) eram classificados como brancos, 51 (5,41%) como pretos, 10 (1,06%) como amarelos, 267 (28,31%) como pardos, e 27 (2,86%) tiveram a cor/raça registrada como ignorada Conclusão: A compreensão profunda das cardiopatias congênitas não apenas salva vidas, mas também melhora significativamente a qualidade de vida dos indivíduos afetados

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Impact of aerosol on droplet number at cloud base and on the altitude of freezing in convective clouds

We have performed cloud and aerosol measurements in and below growing convective clouds above the Amazonian basin during die ACRIDICON-CHUVA mission in 2014. The measurements were performed during 14 flights with the German research aircraft HALO stationed in Manaus equipped with a large set of novel cloud and aerosol instruments to measure size distributions, liquid and ice water content (IWC) as well as habit of the cloud particles up to a ceiling altitude of 14 km. The measurements obtained during cloud profiling in growing convective cumulus show a clear dependence of cloud particle number concentration on cloud condensation nuclei number below cloud base. Further the depth of the cloud (altitude from cloud base until the level where the ice initiation takes place) is correlated to the number of cloud particles at cloud base. Warm rain formation was suppressed under heavily polluted conditions. Instead a larger number of small ice particles were generated at higher altitudes in the cloud than under moderately polluted conditions or convection over clean marine environment. A linear relationship of cloud depths and droplet number concentration at cloud base is found. The limited IWC measurements obtained in the anvil of the clouds show moderate values but demand further research on the dependence of IWC in continental vs marine convection. The implications of our results on IWC and mass median diameter in continental polluted convection is discussed with respect to the impact on aviation and the forecast on ice water content near Mega-Cities or regions influence by wildfires or dust events

Aitken mode particles as CCN in aerosol- and updraft-sensitive regimes of cloud droplet formation

International audienceAbstract. The high variability of aerosol particle concentrations, sizes and chemical composition makes their description challenging in atmospheric models. Aerosol–cloud interaction studies are usually focused on the activation of accumulation mode particles as cloud condensation nuclei (CCN). However, under specific conditions Aitken mode particles can also contribute to the number concentration of cloud droplets (Nd), leading to large uncertainties in predicted cloud properties on a global scale. We perform sensitivity studies with an adiabatic cloud parcel model to constrain conditions under which Aitken mode particles contribute to Nd. The simulations cover wide ranges of aerosol properties, such as total particle number concentration, hygroscopicity (κ) and mode diameters for accumulation and Aitken mode particles. Building upon the previously suggested concept of updraft (w)- and aerosol-limited regimes of cloud droplet formation, we show that activation of Aitken mode particles does not occur in w-limited regimes of accumulation mode particles. The transitional range between the regimes is broadened when Aitken mode particles contribute to Nd, as aerosol limitation requires much higher w than for aerosol size distributions with accumulation mode particles only. In the transitional regime, Nd is similarly dependent on w and κ. Therefore, we analyze the sensitivity of Nd to κ, ξ(κ), as a function of w to identify the value combinations above which Aitken mode particles can affect Nd. As ξ(κ) shows a minimum when the smallest activated particle size is in the range of the “Hoppel minimum” (0.06 µm ≤ Dmin ≤0.08 µm), the corresponding (w–κ) pairs can be considered a threshold level above which Aitken mode particles have significant impact on Nd. This threshold is largely determined by the number concentration of accumulation mode particles and by the Aitken mode diameter. Our analysis of these thresholds results in a simple parametric framework and criterion to identify aerosol and updraft conditions under which Aitken mode particles are expected to affect aerosol–cloud interactions. Our results confirm that Aitken mode particles likely do not contribute to Nd in polluted air masses (urban, biomass burning) at moderate updraft velocities (w≤3 m s−1) but may be important in deep convective clouds. Under clean conditions, such as in the Amazon, the Arctic and remote ocean regions, hygroscopic Aitken mode particles can act as CCN at updrafts of w<1 m s−1