NT-Pro-B-Type Natriuretic Peptide Levels in Infants with Failure to Thrive due to Caloric Deprivation

Background. Brain natriuretic peptide and its inactive fragment N-terminal pro-BNP (N-BNP) are reliable markers of ventricular dysfunction in adults and children. We analyzed the impact of nutritional state on N-BNP levels in infants with failure to thrive (FTT) and in infants with severe heart failure (HF). The purpose of this study was to compare N-BNP levels in infants with FTT with infants with severe HF and healthy controls. Methods. In a retrospective cohort study, we compared N-BNP levels from all consecutive infants with FTT and bodyweight below the tenth percentile (caloric deprivation (CD) group) to infants with severe HF. Reference values from infants between 2 and 12 month were taken from the literature and healthy infants. Results. Our results show that infants with FTT (n = 15) had significantly (P < .001) elevated N-BNP values compared with the healthy infants (n = 23), 530 (119–3150) pg/mL versus 115 (15–1121) pg/mL. N-BNP values in this CD group are comparable to the median value of infants with severe HF (n = 12) 673 (408–11310) pg/mL. There is no statistical significant difference in age. Conclusion. Nutritional state has an important impact on N-BNP levels in infants with FTT. We could show comparable levels of N-BNP in infants with FTT and infants with severe HF

Beta-Blocker Therapy and Hemophagocytic Lymphohistiocytosis: A Case Report

Objective. The aim of this paper is to describe a fatal case of hemophagocytic lymphohistiocytosis (HLH) in a patient with severe heart failure, who was treated with low-dose propranolol. Patient and Interventions. We report on a 7-month-old boy with Downs syndrome who was born with an unbalanced, left dominant atrioventricular septal defect and aortic coarctation. Despite coarctation repair and pulmonary artery banding he developed intractable heart failure and fever of unknown origin. Since he remained in heart failure he received a trial of low-dose propranolol to stabilize his cardiopulmonary status, which resulted in unexpected immunomodulatory effects. Measurements and Main Result. Immunoactivation was evidenced by high concentrations of procalcitonin, soluble CD 25, tumor necrosis factor α, and interleukin 6 and 8. Propranolol resulting in hepatic compromise as indicated by high lactate dehydrogenase and alanine aminotransferase levels. A therapeutic switch from propranolol to the β1-receptor blocker metoprolol appeared to be instrumental in hemodynamic improvement and allowed discharge from hospital. However, the infant ultimately died from secondary inflammatory reactivation and intractable pulmonary obstructive disease. The autopsy results revealed HLH. Conclusion. Our case describes HLH secondary to heart failure and Downs syndrome. In this highly activated inflammatory state the beneficial hemodynamic effects of propranolol may be accompanied by immunomodulatory effects and the risk of acute liver failure. HLH occurs with a distinct pathophysiology, and specific treatment might be mandatory to increase the chance of survival

Evaluation of ESA CCI prototype land cover map at 20m

In September 2017, the ESA CCI Land Cover Team released a prototype land cover (LC) map at 20 m resolution over Africa for the year 2016. This is the first LC map produced at such a high resolution covering an entire continent for the year 2016. To help improve the quality of this product, we have assessed its overall accuracy and identified regions where the map should be improved. We have compared the product against two independent datasets developed within the Copernicus Global Land Services (CGLS): a reference land cover dataset at a 10 m resolution, which has been used as training data to produce the LC map at 100 m over Africa for the year 2015 (http://land.copernicus.eu/global/products/lc); and an independent validation dataset at a 10 m resolution, which has been developed by CGLS for independent assessment of land cover maps at resolutions finer than 100 m. According to our estimates, overall accuracy of the African CCI LC at 20 m is approximately 65%. We have highlighted regions where the spatial distribution of such classes as shrubs, crops and trees should be improved before the map at 20 m could be used as input for research questions, e.g. conservation of biodiversity, crop monitoring and climate modelling

Developing and applying a multi-purpose land cover validation dataset for Africa

The production of global land cover products has accelerated significantly over the past decade thanks to the availability of higher spatial and temporal resolution satellite data and increased computation capabilities. The quality of these products should be assessed according to internationally promoted requirements e.g., by the Committee on Earth Observation Systems-Working Group on Calibration and Validation (CEOS-WGCV) and updated accuracy should be provided with new releases (Stage-4 validation). Providing updated accuracies for the yearly maps would require considerable effort for collecting validation datasets. To save time and effort on data collection, validation datasets should be designed to suit multiple map assessments and should be easily adjustable for a timely validation of new releases of land cover products. This study introduces a validation dataset aimed to facilitate multi-purpose assessments and its applicability is demonstrated in three different assessments focusing on validating discrete and fractional land cover maps, map comparison and user-oriented map assessments. The validation dataset is generated primarily to validate the newly released 100 m spatial resolution land cover product from the Copernicus Global Land Service (CGLS-LC100). The validation dataset includes 3617 sample sites in Africa based on stratified sampling. Each site corresponds to an area of 100 m × 100 m. Within site, reference land cover information was collected at 100 subpixels of 10 m × 10 m allowing the land cover information to be suitable for different resolution and legends. Firstly, using this dataset, we validated both the discrete and fractional land cover layers of the CGLS-LC100 product. The CGLS-LC100 discrete map was found to have an overall accuracy of 74.6 ± 2.1% (at 95% confidence level) for the African continent. Fraction cover products were found to have mean absolute errors of 9.3, 8.8, 16.2, and 6.5% for trees, shrubs, herbaceous vegetation and bare ground, respectively. Secondly, for user-oriented map assessment, we assessed the accuracy of the CGLS-LC100 map from four user groups' perspectives (forest monitoring, crop monitoring, biodiversity and climate modelling). Overall accuracies for these perspectives vary between 73.7% ± 2.1% and 93.5% ± 0.9%, depending on the land cover classes of interest. Thirdly, for map comparison, we assessed the accuracy of the Globeland30-2010 map at 30 m spatial resolution. Using the subpixel level validation data, we derived 15,252 sample pixels at 30 m spatial resolution. Based on these sample pixels, the overall accuracy of the Globeland30-2010 map was found to be 66.6 ± 2.4% for Africa. The three assessments exemplify the applicability of multi-purpose validation datasets which are recommended to increase map validation efficiency and consistency. Assessments of subsequent yearly maps can be conducted by augmenting or updating the dataset with sample sites in identified change areas

Towards operational validation of annual global land cover maps

Annual global land cover maps (GLC) are being provided by several operational monitoring efforts. However, map validation is lagging, in the sense that the annual land cover maps are often not validated. Concurrently, users such as the climate and land management community require information on the temporal consistency of multi-date GLC maps and stability in their accuracy. In this study, we propose a framework for operational validation of annual global land cover maps using efficient means for updating validation datasets that allow timely map validation according to recommendations in the CEOS Stage-4 validation guidelines. The framework includes a regular update of a validation dataset and continuous map validation. For the regular update of a validation dataset, a partial revision of the validation dataset based on random and targeted rechecking (areas with a high probability of change) is proposed followed by additional validation data collection. For continuous map validation, an accuracy assessment of each map release is proposed including an assessment of stability in map accuracy addressing the user needs on the temporal consistency information of GLC map and map quality. This validation approach was applied to the validation of the Copernicus Global Land Service GLC product (CGLS-LC100). The CGLS-LC100 global validation dataset was updated from 2015 to 2019. The update was done through a partial revision of the validation dataset and an additional collection of sample validation sites. From the global validation dataset, a total of 40% (10% for each update year) was revisited, supplemented by a targeted revision focusing on validation sample locations that were identified as possibly changed using the BFAST time series algorithm. Additionally, 6720 sample sites were collected to represent possible land cover change areas within 2015 and 2019. Through this updating mechanism, we increased the sampling intensity of validation sample sites in possible land cover change areas within the period. Next, the dataset was used to validate the annual GLC maps of the CGLS-LC100 product for 2015–2019. The results showed that the CGLS-LC100 annual GLC maps have about 80% overall accuracy showing high temporal consistency in general. In terms of stability in class accuracy, herbaceous wetland class showed to be the least stable over the period. As more operational land cover monitoring efforts are upcoming, we emphasize the importance of updated map validation and recommend improving the current validation practices and guidelines towards operational map validation so that long-term land cover maps and their uncertainty information are well understood and properly used