Controls on upstream-migrating bed forms in sandy submarine channels

Submarine channels parallel river channels in their ability to transport sediment. However, in contrast to rivers, sediment transport and bed-form development in submarine channels are less well understood. Many steep (>1°), sandy submarine channels are dominated by upstream-migrating bed forms. The flow conditions required to form these upstream-migrating bed forms remain debated because the interactions between turbidity currents and active bed forms are difficult to measure directly. Consequently, we used a depth-resolved numerical model to test the role of flow parameters that are hypothesized to control the formation of upstream-migrating bed forms in submarine channels. While our modeling results confirmed the importance of previously identified flow parameters (e.g., densiometric Froude number), we found that basal sediment concentration in turbidity currents is the strongest predictor of upstream-migrating bed-form formation. Our model shows how locally steep gradients enable high sediment concentrations (average >5 vol%) in the basal parts of flows, which allow the development of cyclic step instabilities and their associated bed forms. This new insight explains the previously puzzling observation that upstream-migrating bed forms are abundant in proximal, steep, sandy reaches of submarine channels, while their occurrence becomes more intermittent downslope

Genetic Testing to Inform Epilepsy Treatment Management From an International Study of Clinical Practice

IMPORTANCE: It is currently unknown how often and in which ways a genetic diagnosis given to a patient with epilepsy is associated with clinical management and outcomes. OBJECTIVE: To evaluate how genetic diagnoses in patients with epilepsy are associated with clinical management and outcomes. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cross-sectional study of patients referred for multigene panel testing between March 18, 2016, and August 3, 2020, with outcomes reported between May and November 2020. The study setting included a commercial genetic testing laboratory and multicenter clinical practices. Patients with epilepsy, regardless of sociodemographic features, who received a pathogenic/likely pathogenic (P/LP) variant were included in the study. Case report forms were completed by all health care professionals. EXPOSURES: Genetic test results. MAIN OUTCOMES AND MEASURES: Clinical management changes after a genetic diagnosis (ie, 1 P/LP variant in autosomal dominant and X-linked diseases; 2 P/LP variants in autosomal recessive diseases) and subsequent patient outcomes as reported by health care professionals on case report forms. RESULTS: Among 418 patients, median (IQR) age at the time of testing was 4 (1-10) years, with an age range of 0 to 52 years, and 53.8% (n = 225) were female individuals. The mean (SD) time from a genetic test order to case report form completion was 595 (368) days (range, 27-1673 days). A genetic diagnosis was associated with changes in clinical management for 208 patients (49.8%) and usually (81.7% of the time) within 3 months of receiving the result. The most common clinical management changes were the addition of a new medication (78 [21.7%]), the initiation of medication (51 [14.2%]), the referral of a patient to a specialist (48 [13.4%]), vigilance for subclinical or extraneurological disease features (46 [12.8%]), and the cessation of a medication (42 [11.7%]). Among 167 patients with follow-up clinical information available (mean [SD] time, 584 [365] days), 125 (74.9%) reported positive outcomes, 108 (64.7%) reported reduction or elimination of seizures, 37 (22.2%) had decreases in the severity of other clinical signs, and 11 (6.6%) had reduced medication adverse effects. A few patients reported worsening of outcomes, including a decline in their condition (20 [12.0%]), increased seizure frequency (6 [3.6%]), and adverse medication effects (3 [1.8%]). No clinical management changes were reported for 178 patients (42.6%). CONCLUSIONS AND RELEVANCE: Results of this cross-sectional study suggest that genetic testing of individuals with epilepsy may be materially associated with clinical decision-making and improved patient outcomes

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Supplemental Material: Controls on upstream-migrating bed forms in sandy submarine channels

Appendices S1–S4: Additional information on the boundary conditions, flow evolution, and flow state delineation in simulation trials. Appendix S3 is made up of 14 mp4 files. </p

Quantifying the three‐dimensional stratigraphic expression of cyclic steps by integrating seafloor and deep‐water outcrop observations

Deep‐water deposits are important archives of Earth’s history including the occurrence of powerful flow events and the transfer of large volumes of terrestrial detritus into the world’s oceans. However the interpretation of depositional processes and palaeoflow conditions from the deep‐water sedimentary record has been limited due to a lack of direct observations from modern depositional systems. Recent seafloor studies have resulted in novel findings, including the presence of upslope‐migrating bedforms such as cyclic steps formed by supercritical turbidity currents that produce distinct depositional signatures. This study builds on process to product relationships for cyclic steps using modern and ancient datasets by providing sedimentological and quantitative, three‐dimensional architectural analyses of their deposits, which are required for recognition and palaeoflow interpretations of sedimentary structures in the rock record. Repeat‐bathymetric surveys from two modern environments (Squamish prodelta, Canada, and Monterey Canyon, USA) were used to examine the stratigraphic evolution connected with relatively small‐scale (average 40 to 55 m wavelengths and 1.5 to 3.0 m wave heights) upslope‐migrating bedforms interpreted to be cyclic steps within submarine channels and lobes. These results are integrated to interpret a succession of Late Cretaceous Nanaimo Group deep‐water slope deposits exposed on Gabriola Island, Canada. Similar deposit dimensions, facies and architecture are observed in all datasets, which span different turbidite‐dominated settings (prodelta, upper submarine canyon and deep‐water slope) and timescales (days, years or thousands of years). Bedform deposits are typically tens of metres long/wide, &lt;1 m thick and make up successions of low‐angle, backstepping trough‐shaped lenses composed of massive sands/sandstones. These results support process‐based relationships for these deposits, associated with similar cyclic step bedforms formed by turbidity currents with dense basal layers under low‐aggradation conditions. Modern to ancient comparisons reveal the stratigraphic expression of globally prevalent, small‐scale, sandy upslope‐migrating bedforms on the seafloor, which can be applied to enhance palaeoenvironmental interpretations and understand long‐term preservation from ancient deep‐water deposits

Rykalová, Gabriela (2009): Entwicklung in der Tagespresse : dargestellt an journalistischen Textsorten der deutschsprachigen Zeitungen

Submarine channels have been important throughout geologic time for feeding globally significant volumes of sediment from land to the deep sea. Modern observations show that submarine channels can be sculpted by supercritical turbidity currents (seafloor sediment flows) that can generate upstream-migrating bedforms with a crescentic planform. In order to accurately interpret supercritical flows and depositional environments in the geologic record, it is important to be able to recognize the depositional signature of crescentic bedforms. Field geologists commonly link scour fills containing massive sands to crescentic bedforms, whereas models of turbidity currents produce deposits dominated by back-stepping beds. Here we reconcile this apparent contradiction by presenting the most detailed study yet that combines direct flow observations, time-lapse seabed mapping, and sediment cores, thus providing the link from flow process to depositional product. These data were collected within the proximal part of a submarine channel on the Squamish Delta, Canada. We demonstrate that bedform migration initially produces back-stepping beds of sand. However, these back-stepping beds are partially eroded by further bedform migration during subsequent flows, resulting in scour fills containing massive sand. As a result, our observations better match the depositional architecture of upstream-migrating bedforms produced by fluvial models, despite the fact that they formed beneath turbidity currents

Impact of physical fitness and daily energy expenditure on sleep efficiency in young and older humans

Item does not contain fulltextBACKGROUND: Physical activity is known to influence sleep efficiency. Relatively little is known about the relationship between physical activity and sleep efficiency in young and older humans and the impact of exercise training on sleep efficiency in healthy older individuals. OBJECTIVES: To determine the relationship between physical fitness and daily energy expenditure with sleep efficiency in young and older subjects, and assess the effect of 12-month exercise training on sleep efficiency in healthy older participants. METHODS: The relationship between physical fitness (maximal cycling test) and daily energy expenditure (accelerometry) with sleep efficiency (accelerometry) was examined cross-sectionally in 12 healthy young adults (27 +/- 5 years) and 21 healthy older participants (69 +/- 3 years). Subsequently, the effect of 12-month exercise training (n = 11) or control period (n = 10) on sleep efficiency in older participants was examined using a randomized controlled trial. RESULTS: Daily energy expenditure and sleep efficiency did not differ between young and older subjects. A significant correlation was found between energy expenditure and sleep efficiency (r = 0.627, p = 0.029) in young adults, but not in older participants (r = -0.158, p = 0.49). Physical fitness did not correlate with sleep efficiency in either group. Exercise training significantly improved physical fitness (15.0%, p < 0.001), but failed to alter sleep characteristics such as sleep efficiency, sleep onset latency and awakenings. CONCLUSIONS: We found that young adults with higher daily energy expenditure have greater sleep efficiency, whilst this relationship is diminished with advanced age. In contrast, we found no correlation between physical fitness and sleep characteristics in healthy young or older participants, which may explain the lack of improvement in sleep characteristics in older participants with 12-month exercise training. Exercise training may be more successful in subjects with existing sleep disturbances to improve sleep characteristics rather than in healthy older subjects