Links between central west western australian rainfall variability and large-scale climate drivers

Over the past century, and especially after the 1970s, rainfall observations show an increase (decrease) of the wet summer (winter) season rainfall over northwest (southwest) Western Australia. The rainfall in central west Western Australia (CWWA), however, has exhibited comparatively much weaker coastal trends, but a more prominent inland increase during the wet summer season. Analysis of seasonally averaged rainfall data from a group of stations, representative of both the coastal and inland regions of CWWA, revealed that rainfall trends during the 1958-2010 period in the wet months of November-April were primarily associated with El Niñ o-Southern Oscillation (ENSO), and with the southern annular mode (SAM) farther inland. During the wet months of May-October, the Indian Ocean dipole (IOD) showed the most robust relationships. Those results hold when the effects of ENSOor IOD are excluded, and were confirmed using a principal component analysis of sea surface temperature (SST) anomalies, rainfall wavelet analyses, and point-by-point correlations of rainfall with global SST anomaly fields. Although speculative, given their long-term averages, reanalysis data suggest that from 1958 to 2010 the increase inCWWAinland rainfall largely is attributable to an increasing cyclonic anomaly trend over CWWA, bringing onshore moist tropical flow to the Pilbara coast. During May-October, the flow anomaly exhibits a transition from an onshore to offshore flow regime in the 2001-10 decade, which is consistent with the observed weaker drying trend during this period. © 2013 American Meteorological Society

Integrating anaerobic digestion and pyrolysis for treating digestates derived from sewage sludge and fat wastes

P. 32603-32614The coupling of biological and thermal technologies allows for the complete conversion of wastes into energy and biochar eliminating the problem of sludge disposal. The valorisation of fatty residues as co-substrate in a mesophilic digester of a wastewater treatment plant was studied considering an integrated approach of co-digestion and pyrolysis. Four digested samples obtained from co-digestion of sewage sludge and butcher’s fat waste were studied by thermogravimetric analysis. The activation energy corresponding to the sludge pyrolysis was calculated by a non-isothermal kinetic. Arrhenius activation energy was lower for the pyrolysis of a digested grease sample (92 kJ mol−1 obtained by OFW and 86 kJ mol−1 obtained by Vyazovkin) than for the pyrolysis of sewage sludge and its blends (164–190 kJ mol−1 obtained by OFW and 162–190 kJ mol−1 obtained by Vyazovkin). The analysis of the integrated approach of anaerobic co-digestion and pyrolysis of digestates demonstrated that the addition of 3% (w/v) of fat to the feeding sludge results in a 25% increase in the electricity obtained from biogas (if a combined heat and power unit is considered for biogas valorisation) and increasing the fat content to 15% allows for covering all thermal needs for drying of digestate and more than doubles (2.4 times) the electricity production when the scenario of digestion and pyrolysis is contemplated.S

A projected decrease in lightning under climate change

Lightning strongly influences atmospheric chemistry, and impacts the frequency of natural wildfires. Most previous studies project an increase in global lightning with climate change over the coming century but these typically use parameterizations of lightning that neglect cloud ice fluxes, a component generally considered to be fundamental to thunderstorm charging. As such, the response of lightning to climate change is uncertain. Here, we compare lightning projections for 2100 using two parameterizations: the widely used cloud-top height (CTH) approach, and a new upward cloud ice flux (IFLUX) approach that overcomes previous limitations. In contrast to the previously reported global increase in lightning based on CTH, we find a 15% decrease in total lightning flash rate with IFLUX in 2100 under a strong global warming scenario. Differences are largest in the tropics, where most lightning occurs, with implications for the estimation of future changes in tropospheric ozone and methane, as well as differences in their radiative forcings. These results suggest that lightning schemes more closely related to cloud ice and microphysical processes are needed to robustly estimate future changes in lightning and atmospheric composition

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Mesenchymal stem cell-based therapy for ischemic stroke

Ischemic stroke represents a major, worldwide health burden with increasing incidence. Patients affected by ischemic strokes currently have few clinically approved treatment options available. Most currently approved treatments for ischemic stroke have narrow therapeutic windows, severely limiting the number of patients able to be treated. Mesenchymal stem cells represent a promising novel treatment for ischemic stroke. Numerous studies have demonstrated that mesenchymal stem cells functionally improve outcomes in rodent models of ischemic stroke. Recent studies have also shown that exosomes secreted by mesenchymal stem cells mediate much of this effect. In the present review, we summarize the current literature on the use of mesenchymal stem cells to treat ischemic stroke. Further studies investigating the mechanisms underlying mesenchymal stem cells tissue healing effects are warranted and would be of benefit to the field

Relationships between southeast australian temperature anomalies and large-scale climate drivers

Over the past century, particularly after the 1960s, observations of mean maximum temperatures reveal an increasing trend over the southeastern quadrant of the Australian continent. Correlation analysis of seasonally averaged mean maximum temperature anomaly data for the period 1958-2012 is carried out for a representative group of 10 stations in southeast Australia (SEAUS). For the warm season (November- April) there is a positive relationship with the El Niño-Southern Oscillation (ENSO) and the Pacific decadal oscillation (PDO) and an inverse relationship with the Antarctic Oscillation (AAO) for most stations. For the cool season (May-October), most stations exhibit similar relationships with the AAO, positive correlations with the dipolemode index (DMI), andmarginal inverse relationships with the SouthernOscillation index (SOI) and the PDO. However, for both seasons, the blocking index (BI, as defined by M. Pook and T. Gibson) in the Tasman Sea (160°E) clearly is the dominant climatemode affectingmaximumtemperature variability in SEAUS with negative correlations in the range from r520.30 to 20.65. These strong negative correlations arise from the usual definition ofBI,which is positivewhen blocking high pressure systems occur over the Tasman Sea (near 45°S, 160°E), favoring the advection of modified cooler, higher-latitude maritime air over SEAUS. A point-by-point correlation with global sea surface temperatures (SSTs), principal component analysis, and wavelet power spectra support the relationships with ENSO and DMI. Notably, the analysis reveals that the maximum temperature variability of one group of stations is explained primarily by local factors (warmer near-coastal SSTs), rather than teleconnections with large-scale drivers. © 2014 American Meteorological Society