Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome

Citizen sensors network as a tool to promote air quality

International audienc

Constraining the inertial dissipation method using the vertical velocity variance

The inertial dissipation method (IDM) is commonly used to measure turbulent fluxes over the ocean. It has the advantage over more direct methods in that it depends on the turbulent fluctuations only in the high frequencies of the so‐called inertial subrange. These frequencies are above those of typical ship motions and are considered to be relatively unaffected by flow distortion. However, a drawback in applying the method is that the problem is underdetermined: estimation of the fluxes requires knowledge of the Obukhov length L, which is itself a function of the fluxes. The problem is typically solved by iteration, using an initial L estimated from bulk formulae. This introduces a possible dependency on the initial bulk estimate along with problems of convergence. Recently, several authors have proposed improvements to the basic algorithm. For instance, Dupuis et al. [1997] proposed a parameterization of the “imbalance term” in the budget of turbulent kinetic energy (TKE). We explore an alternative approach to the problem. In order to constrain the equations resulting from the IDM we use the vertical velocity variance, σw, measured from the research vessel L'Atalante and an ASIS buoy, both deployed during the 1998 FETCH experiment. These data are compared to several parameterizations of σw on stability derived in experiments. For unstable cases, the data are found to be well described by the Panofsky and Dutton [1984] parameterization, although the scatter of the data is higher for swell conditions than for pure wind sea, indicating a likely sea state effect. Using measured values of σw along with this parameterization, the inertial dissipation problem is fully specified. The convergence of the method is satisfactory, and it offers u* estimates independent of bulk formulae

Momentum and heat fluxes via the eddy correlation method on the R/V L'Atalante and an ASIS buoy

In this paper, we present the results obtained with the eddy correlation method applied to data acquired during the Flux, Etat de mer et Télédetection en Condition de Fetch variable experiment onboard the R/V L'Atalante. We discuss the corrections made to account for platform motion and for the effects of mean airflow distortion. The data are compared to those obtained from a moored Air‐Sea Interaction Spar (ASIS) buoy and from the L'Atalante using the inertial dissipation method (IDM). The main results from eddy correlation method on L'Atalante are that the momentum flux in‐line with the mean wind, −〈u′w′〉, is overestimated by 18%, likely due to turbulent flow distortion around the ship. In contrast, the results for heat flux do not appear to be contaminated by turbulent flow distortion. Indeed, heat fluxes obtained using the sonic temperature on the L'Atalante and the ASIS buoy are very similar. The eddy correlation latent heat fluxes obtained on the L'Atalante using a refractometer are significantly higher than those obtained from the same sensor using the IDM