Investigating the enigma of an irregular groundwater age pattern in a confined, presumed “fossil” complex aquifer through mixing cell flow modeling

Significant fluctuations in the groundwater (GW) age along the eastern flow path of the Nubian Sandstone Aquifer's (NSA), as derived from Krypton-81 groundwater dating, have suggested that this aquifer, located in Israel's Negev Desert and previously presumed to be a fossil, is not entirely isolated but mixes with younger and even recent water. The intermittent rejuvenation and drastic increases in the GW age across short distances most likely imply hydraulic connectivity with the surrounding aquifers, which contribute both younger and more ancient water to the NSA. The current study aims at modeling the GW flow system to locate and quantify its water sources despite the aquifer's hydrogeological complexity and the scarcity of hydrological data. We implemented the Mixing Cell Modeling (MCM) approach, understanding that the alternating rejuvenations and increases in the GW age downstream of the NSA's eastern flow trajectory reflect the mixing of the NSA's groundwater with young and old GW bodies, respectively. Thus, prompted by the 81Kr water age distribution, yet independent of the Kr radioisotope data, a multi-tracer mixing cell flow model was adopted based on a set of balance equations of water, dissolved minerals, and stable environmental isotopes. The findings indicate that (1) there is a small, yet substantial, intrusion of old brackish GW from a deep-seated, highly pressurized aquifer into the NSA in the northeastern Negev; (2) the rejuvenation of GW in the NSA is due to significant mixing with water from nearby overlying carbonate and chert aquifers, and (3) the NSA is substantially replenished through the Nubian Sandstone (NS) outcrops along the Negev Desert anticlines. Most GW intrusions into the NSA occur near the intersections of the eastern flow path with some of the Negev's major faults and synclines, such as the Paran and Ramon Fault zones and the Zin Syncline. In light of the relatively young GW age at the end of the NSA's western flow path in the northern Negev, and based on the similarities in the hydrogeological structures in the Negev and northern Sinai Deserts, we propose that similar mixing processes with GW from the overlying carbonate aquifers and direct GW recharge through the NS outcrops also occur in the northern Sinai Peninsula. The approach presented in this study might apply to examining recharge processes and hydraulic connectivity in other aquifers that were formerly classified as “fossil,” such as the immense NSA found in the Arabian (Jordan & Saudi Arabia) and the Western (Egypt) Deserts

Impact of type 2 diabetes mellitus on short- and long-term mortality after coronary artery bypass surgery

Abstract Background Type 2 diabetes mellitus (DM) is a frequent co-morbidity among patients undergoing coronary artery bypass grafting (CABG) surgery. The aim of this study was to evaluate the impact of DM on the early- and long-term outcomes of patients who underwent isolated CABG. Methods We performed an observational cohort study in a large tertiary medical center over a period of 11 years. All data from patients who had undergone isolated CABG surgery between 2004 and 2014 were obtained from our departmental database. The study population included 2766 patients who were divided into two groups: Group I (1553 non-diabetic patients), and Group II (1213 patients suffering from type 2 DM). Group II patients were then divided into two subgroups: subgroup IIA (981 patients treated with oral antihyperglycemic medications) and subgroup IIB (232 insulin-treated patients with or without additional oral antihyperglycemic drugs). In-hospital, 1-, 3-, 5- and 10-year mortality outcome variables were evaluated. Mean follow-up was 97 ± 41 months. Results In-hospital mortality was similar between Group I and Group II patients (1.87% vs. 2.31%, p = 0.422) and between the subgroups IIA and IIB (2.14% vs. 3.02%, p = 0.464). Long-term mortality (1, 3, 5 and 10 years) was higher in Group II (DM type 2) compared with Group I (non-diabetic patients) (5.3% vs. 3.6%, p = 0.038; 9.3% vs. 5.6%, p < 0.001; 15.3% vs. 9.3%, p < 0.001 and 47.3% vs. 29.6% p < 0.001). Kaplan–Meier analysis demonstrated that all-cause mortality was higher in Group II compared with Group I (p < 0.001) and in subgroup IIB compared with subgroup IIA (p = 0.001). Multivariable analysis showed that DM increased the mortality hazard by twofold, and among diabetic patients, insulin treatment increased the mortality hazard by twofold. Conclusions Diabetic and non-diabetic patients have similar in-hospital mortality rates. Survival rates of diabetic patients start to deteriorate 3 year after surgery. Type 2 DM is an independent predictor for long-term mortality after isolated CABG surgery. Mortality is even higher when the diabetes treatment strategy included insulin

Type 2 diabetes mellitus increases long-term mortality risk after isolated surgical aortic valve replacement

Abstract Background Diabetes mellitus (DM) adversely affects morbidity and mortality for major atherosclerosis-related cardiovascular diseases and is associated with increased risk for the development of aortic stenosis. Clinical data regarding the impact of DM on outcomes of patients undergoing aortic valve replacement (AVR) have revealed inconsistent results. The aim of the current study was to investigate and compare the impact of type 2 DM on short-, intermediate- and long-term mortality between DM and non-DM patients who undergo isolated AVR. Methods We performed an observational study in a large tertiary medical center over a 14-year period (2004–2018), which included all patients who had undergone isolated AVR surgery for the first time. Of the 1053 study patients, 346 patients (33%) had type 2 DM (DM group) and were compared with non-DM (non-DM group) patients (67%). Short-term (in-hospital), intermediate (1- and 3-years), and late (5- and 10-years) mortality were evaluated. Mean follow-up of was 69 ± 43 months. Results Short-term (in-hospital) mortality was similar between the DM compared with the non-DM group: 3.5% and 2.5% (p = 0.517). Intermediate-term mortality (1- and 3-year) was higher in the DM group compared with the non-DM group, but did not reach statistical significance: 8.1% vs. 5.7% (p = 0.169) and 12.1% vs. 8.3% (p = 0.064) respectively. Long-term (5- and 10-year) mortality was significantly higher in the DM group, compared to the non-DM group: 19.4% vs. 12.9% (p = 0.007) and 30.3% vs. 23.5% (p = 0.020) respectively. Among the 346 DM patients, 55 (16%) were treated with insulin and 291 (84%) with oral antiglycemic medication only. Overall in-hospital mortality among insulin-treated DM patients was 7.3% compared with 2.7% among non insulin-treated DM patients (p = 0.201). Long-term mortality was higher in the subgroup of insulin-treated DM patients compared with the subgroup of non-insulin treated DM patients with an overall mortality rate of 36.4% vs. 29.2% (p = 0.039). Furthermore, predictors for late mortality included DM (HR 1.39 CI 1.03–1.86, p = 0.031) and insulin treatment (HR 1.76 CI 1.05–2.94, p = 0.033), as demonstrated after adjustment for confounders by multivariable analysis. Conclusions Type 2 DM is an independent predictor for long-term mortality after isolated AVR surgery

Field Degassing as a New Sampling Method for 14C Analyses in Old Groundwater

AbstractRadiocarbon (14C) activity in groundwater can be used to determine subsurface residence time up to ∼40 kyr, providing crucial information on dynamic properties of groundwater and on paleoclimate. However, commonly applied sampling methods for dissolved inorganic carbon (DIC-14C) are prone to low level of modern atmospheric contamination, resulting in underestimation of groundwater ages that cluster around 30–40 kyr. We extract CO2gas from groundwater using a device originally developed for studies of noble gas radionuclides. Carbon is collected in the gas phase, eliminating the possibility of fostering microbial activities and aqueous chemical reactions during sample storage. This method collects CO2-14C and radiokrypton (81Kr and85Kr) samples simultaneously. The presence of any shorter-lived85Kr is used to evaluate the degree of atmospheric contamination during sampling or mixing of young groundwater. Most groundwater samples showed lower CO2-14C activities than those of DIC-14C, presumably due to the absence of atmospheric contamination. Samples with81Kr age exceeding 150 kyr have no detectable CO2-14C except where mixing sources of young groundwater is suspected. These field data serve as confirmations for the reliability of the newly presented sample collection and CO2-14C method, and for the outstanding roles of radiokrypton isotopes in characterizing old groundwater.</jats:p

Surgical ablation for atrial fibrillation: impact of Diabetes Mellitus type 2

Abstract Background Diabetes mellitus (DM) type 2 is an independent risk factor for atrial fibrillation (AF). Surgical ablation or "maze procedure" is an option for patients with AF undergoing concomitant or isolated cardiac surgery. The aim of this study was to evaluate the impact of DM type 2 on early and long-term outcomes of patients following surgical AF ablation. Methods We performed an observational cohort study in Israel’s largest tertiary care center. All data of patients who underwent surgical AF ablation, between 2006 and 2021 were extracted from our departmental database. Patients were divided into Group I (non-diabetic patients) and Group II (DM type 2 patients). We compared the two groups with respect to freedom from recurrent atrial arrhythmia, and mortality rate. Results The study population included 606 patients. Group I (non-DM patients), consisting of 484 patients, and Group II (DM type 2 patients), comprised 122 patients. Patients with DM were older, had more hypertension and incidence of cerebrovascular accident (CVA)/transient ischemic attack (TIA), higher EuroSCORE (p < .05 for all), and a longer bypass time—130 ± 40 vs. 122 ± 36 min (p = 0.028). The mean follow-up duration was 39.0 ± 22.7 months. Freedom from atrial fibrillation was similar between the non-DM and DM type 2 groups after a 1-year follow-up, 414 (88.2%) vs. 101 (87.1%) (p = 0.511), after a 3-year follow-up, 360 (86.3%) vs. 84 (79.9%) (p = 0.290) and after a 5-year follow-up, 226 (74.1%) vs. 55 (71.5%) (p = 0.622) respectively. Furthermore, 1- and 3-year mortality was similar between non-DM and DM type 2 groups, 2.5% vs. 4.9%, (p = 0.226) and 5.6% vs. 10.5% (p = 0.076) respectively. 5-year mortality was higher in Group II (DM type 2 patients) compared with Group I (non-DM patients), 11.1% vs. 23.4% (p = 0.009). Conclusion Surgical ablation had a high success rate, with freedom from recurrent atrial arrhythmia at 1- 3- and 5- years follow-up in both the DM type 2 and non-DM groups. Furthermore,1- and 3-year mortality after surgical ablation was also similar in both groups. However, 5-year mortality was higher in the DM type 2 group

Identifying recharge processes into a vast "fossil" aquifer based on dynamic groundwater 81Kr age evolution

Water in deep aquifers in arid regions is often considered to be “fossil” when modern recharge rates are negligible relative to the reservoir capacity. Over the past five decades, the Nubian Sandstone Aquifer (NSA) in the arid region of the Sinai Peninsula (Egypt) and the Negev Desert (Israel) has been considered to contain fossil water based on 14C dating, which revealed 14C ages of about 30 kyr over most of the aquifer. However, this relatively homogeneous age distribution contradicts the expected increase in groundwater age in the direction of decreasing piezometric head along the flow trajectories. Here, dating results with the longer-lived 81Kr radioisotope (t1/2 = 229 ± 11 kyr) are presented, highlighting a wide age range of 40 kyr to 630 kyr in the confined sections of the aquifer, all with very low 14C activity (<1 pmC). Elevated 81Kr and 14C activities were only observed within or close to the system's recharge areas. These findings support a new perception of groundwater replenishment during different epochs from the early mid-Pleistocene to the Holocene. By tracking the downstream age evolution, rejuvenation was identified in places where the confinement had been breached. At other locations, the existence of an older groundwater body contributing to the aquifer was detected by means of strongly depleted 81Kr activity. High spatial heterogeneity in groundwater ages close to the discharge zone of the system is attributed to pronounced age stratification with depth. Calculated ages in the more isolated sections of the system were used to assess regional flow velocity, hydraulic conductivity, and their agreement with present recharge rates. We conclude that groundwater ages should be reevaluated with 81Kr in regional aquifers where low 14C activities prevail. With an effective age range beyond one million years, this may enable the reconstruction of recharge history well into the Pleistocene and provide crucial information for the management of groundwater resources

Radiokrypton unveils dual moisture sources of a deep desert aquifer

In arid regions, groundwater is a vital resource that can also provide a long-term record of the regional water cycle. However, the use of groundwater as a paleoclimate proxy has been limited by the complex hydrology and the lack of appropriate chronometers to determine the recharge time without complication. Applying 81Kr, a long-lived radioisotope tracer, we investigate the paleohydroclimate and subsurface water storage properties of the Nubian Sandstone Aquifer in the Negev Desert, Israel. Based on the spatial distributions of stable isotopes and the abundance of 81Kr, we resolve subsurface mixing and identify two distinct moisture sources of the recharge: one recent (<38 ky ago) from the Mediterranean and the other 361 ± 30 ky ago from the tropical Atlantic, both of which occurred under conditions of low orbital eccentricity comparable to that of the present. The recent recharge provided by the moisture from Mediterranean cyclones can be attributed to the southward shift of the storm track during the Last Glacial Maximum, and the earlier recharge can be attributed to moisture from the Atlantic delivered as tropical plumes under a climate colder than the present. Furthermore, the residence time of the latter reveals that tectonically active terrain can store groundwater for an unexpectedly long period, likely due to strongly attenuated groundwater flow across the fault zones. With this tracer, groundwater can now serve as a direct record of paleoprecipitation over land and of subsurface water storage from the mid-Pleistocene and onward