Monocyte distribution width enhances early sepsis detection in the emergency department beyond SIRS and qSOFA

BACKGROUND: The initial presentation of sepsis in the emergency department (ED) is difficult to distinguish from other acute illnesses based upon similar clinical presentations. A new blood parameter, a measurement of increased monocyte volume distribution width (MDW), may be used in combination with other clinical parameters to improve early sepsis detection. We sought to determine if MDW, when combined with other available clinical parameters at the time of ED presentation, improves the early detection of sepsis. METHODS: A retrospective analysis of prospectively collected clinical data available during the initial ED encounter of 2158 adult patients who were enrolled from emergency departments of three major academic centers, of which 385 fulfilled Sepsis-2 criteria, and 243 fulfilled Sepsis-3 criteria within 12 h of admission. Sepsis probabilities were determined based on MDW values, alone or in combination with components of systemic inflammatory response syndrome (SIRS) or quick sepsis-related organ failure assessment (qSOFA) score obtained during the initial patient presentation (i.e., within 2 h of ED admission). RESULTS: Abnormal MDW (\u3e 20.0) consistently increased sepsis probability, and normal MDW consistently reduced sepsis probability when used in combination with SIRS criteria (tachycardia, tachypnea, abnormal white blood count, or body temperature) or qSOFA criteria (tachypnea, altered mental status, but not hypotension). Overall, and regardless of other SIRS or qSOFA variables, MDW \u3e 20.0 (vs. MDW ≤ 20.0) at the time of the initial ED encounter was associated with an approximately 6-fold increase in the odds of Sepsis-2, and an approximately 4-fold increase in the odds of Sepsis-3. CONCLUSIONS: MDW improves the early detection of sepsis during the initial ED encounter and is complementary to SIRS and qSOFA parameters that are currently used for this purpose. This study supports the incorporation of MDW with other readily available clinical parameters during the initial ED encounter for the early detection of sepsis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03145428. First posted May 9, 2017. The first subjects were enrolled June 19, 2017, and the study completion date was January 26, 2018

EARLINET instrument intercomparison campaigns: Overview on strategy and results

This paper introduces the recent European Aerosol Research Lidar Network (EARLINET) quality-assurance efforts at instrument level. Within two dedicated campaigns and five single-site intercomparison activities, 21 EARLINET systems from 18 EARLINET stations were intercompared between 2009 and 2013. A comprehensive strategy for campaign setup and data evaluation has been established. Eleven systems from nine EARLINET stations participated in the EARLINET Lidar Intercomparison 2009 (EARLI09). In this campaign, three reference systems were qualified which served as traveling standards thereafter. EARLINET systems from nine other stations have been compared against these reference systems since 2009. We present and discuss comparisons at signal and at product level from all campaigns for more than 100 individual measurement channels at the wavelengths of 355, 387, 532, and 607 nm. It is shown that in most cases, a very good agreement of the compared systems with the respective reference is obtained. Mean signal deviations in predefined height ranges are typically below ±2 %. Particle backscatter and extinction coefficients agree within ±2  ×  10−4 km−1 sr−1 and ± 0.01 km−1, respectively, in most cases. For systems or channels that showed larger discrepancies, an in-depth analysis of deficiencies was performed and technical solutions and upgrades were proposed and realized. The intercomparisons have reinforced confidence in the EARLINET data quality and allowed us to draw conclusions on necessary system improvements for some instruments and to identify major challenges that need to be tackled in the future

First-in-Human Experience With Ultra-Low Temperature Cryoablation for Monomorphic Ventricular Tachycardia

Ultra-low temperature cryoablation (ULTC) using near-critical nitrogen (−196ºC) has been shown to produce durable, contiguous, transmural lesions in ventricles of animal models. This report summarizes acute experience with ULTC in the first-ever 13 patients with recurrent monomorphic ventricular tachycardias (VTs) of both ischemic cardiomyopathy and nonischemic etiologies enrolled in the CryoCure-VT (Cryoablation for Monomorphic Ventricular Tachycardia; NCT04893317) clinical trial. After an average of 9.6 ± 4.6 endocardial ULTC lesions per patient, no clinical ventricular tachycardias were inducible in 91% of patients. Two procedure-related serious adverse events recorded in 2 patients resolved post-procedurally without clinical sequelae. Further investigation of both acute and chronic outcomes is warranted and ongoing

EARLINET observations of the Eyjafjallajokull ash plume over Europe

EARLINET, the European Aerosol Research Lidar NETwork, established in 2000, is the first coordinated lidar network for tropospheric aerosol study on the continental scale. The network activity is based on scheduled measurements, a rigorous quality assurance program addressing both instruments and evaluation algorithms, and a standardised data exchange format. At present, the network includes 27 lidar stations distributed over Europe. EARLINET performed almost continuous measurements since 15 April 2010 in order to follow the evolution of the volcanic plume generated from the eruption of the Eyjafjallajokull volcano, providing the 4-dimensional distribution of the volcanic ash plume over Europe. During the 15-30 April period, volcanic particles were detected over Central Europe over a wide range of altitudes, from 10 km down to the local planetary boundary layer (PBL). Until 19 April, the volcanic plume transport toward South Europe was nearly completely blocked by the Alps. After 19 April volcanic particles were transported to the south and the southeast of Europe. Descending aerosol layers were typically observed all over Europe and intrusion of particles into the PBL was observed at almost each lidar site that was affected by the volcanic plume. A second event was observed over Portugal and Spain (6 May) and then over Italy on 9 May 2010. The volcanic plume was then observed again over Southern Germany on 11 May 2010

Earlinet instrument intercomparison campaigns: overview on strategy and results

This paper introduces the recent European Aerosol Research Lidar Network (EARLINET) quality-assurance efforts at instrument level. Within two dedicated campaigns and five single-site intercomparison activities, 21 EARLINET systems from 18 EARLINET stations were intercompared between 2009 and 2013. A comprehensive strategy for campaign setup and data evaluation has been established. Eleven systems from nine EARLINET stations participated in the EARLINET Lidar Intercomparison 2009 (EARLI09). In this campaign, three reference systems were qualified which served as traveling standards thereafter. EARLINET systems from nine other stations have been compared against these reference systems since 2009. We present and discuss comparisons at signal and at product level from all campaigns for more than 100 individual measurement channels at the wavelengths of 355, 387, 532, and 607 nm. It is shown that in most cases, a very good agreement of the compared systems with the respective reference is obtained. Mean signal deviations in predefined height ranges are typically below +/- 2 %. Particle backscatter and extinction coefficients agree within +/- 2 x 10(-4) km(-1) sr(-1) and +/- 0.01 km(-1), respectively, in most cases. For systems or channels that showed larger discrepancies, an in-depth analysis of deficiencies was performed and technical solutions and upgrades were proposed and realized. The intercomparisons have reinforced confidence in the EARLINET data quality and allowed us to draw conclusions on necessary system improvements for some instruments and to identify major challenges that need to be tackled in the future

EARLINET all observations (2000-2010)

This collection contains all measurements that have been performed in the frame of the EARLINET project during the period April 2000 - December 2010. Some of these measurements are also part of the collections 'Calipso', 'Climatology', 'SaharanDust' or 'VolcanicEruption'. In addition this collection also contains measurements from the categories 'Cirrus', 'DiurnalCycles', 'ForrestFires', 'Photosmog', 'RuralUrban', and 'Stratosphere'. This collection also contains measurements not devoted to any of the above categories. More information about these categories and the contributing stations can be found in the file 'EARLINET_general_introduction.pdf' accompanying this dataset

EARLINET observations related to volcanic eruptions (2000-2010)

A European Aerosol Research Lidar Network to Establish an Aerosol ClimatologyAerosols affect life on earth in several ways. They play an important role in the climate system; the effect of aerosols on the global climate system is one of the major uncertainties of present climate predictions. They play a major role in atmospheric chemistry and hence affect the concentrations of other potentially harmful atmospheric constituents, e.g. ozone. They are an important controlling factor for the radiation budget, in particular in the UV-B part of the spectrum. At ground level, they can be harmful, even toxic, to man, animals, and plants. Because of these adverse effects that aerosols can have on human life, it is necessary to achieve an advanced understanding of the processes that generate, redistribute, and remove aerosols in the atmosphere.A quantitative dataset describing the aerosol vertical, horizontal, and temporal distribution, including its variability on a continental scale, is necessary. The dataset is used to validate and improve models that predict the future state of the atmosphere and its dependence on different scenarios describing economic development, including those actions taken to preserve the quality of the environment. The EARLINET data set is the most comprehensive compilation of data available for this purpose.This project description is taken from: http://www.earlinet.org/index.php?id=earlinet_homepageSummary: Aerosols originating from volcanic emissions have an impact on the climate: sulfate and ash particles from volcanic emissions reflect solar radiation, act as cloud condensation and ice nuclei, and modify the radiative properties and lifetime of clouds, and therefore influence the precipitation cycle. These volcanic particles can also have an impact on environmental conditions and could be very dangerous for aircraft in flight. In addition to the routine measurements, further EARLINET observations are devoted to monitor volcano eruptions. The EARLINET volcanic dataset includes extended observations related to two different volcanoes in Europe Mt. Etna (2001 and 2002 eruptions), and the Eyjafjallajokull volcano in Iceland (April - May 2010 eruption). This dataset includes also recent events of volcanic eruptions in the North Pacific region (2008-2010) that emitted sulfuric acid droplets into the upper troposphere - lower stratosphere (UTLS) height region of the northern hemisphere. The EARLINET volcanic observations in the UTLS are complemented by the long-term stratospheric aerosol observations collected in the Stratosphere category

EARLINET correlative observations for CALIPSO (2006-2010)

A European Aerosol Research Lidar Network to Establish an Aerosol ClimatologyAerosols affect life on earth in several ways. They play an important role in the climate system; the effect of aerosols on the global climate system is one of the major uncertainties of present climate predictions. They play a major role in atmospheric chemistry and hence affect the concentrations of other potentially harmful atmospheric constituents, e.g. ozone. They are an important controlling factor for the radiation budget, in particular in the UV-B part of the spectrum. At ground level, they can be harmful, even toxic, to man, animals, and plants. Because of these adverse effects that aerosols can have on human life, it is necessary to achieve an advanced understanding of the processes that generate, redistribute, and remove aerosols in the atmosphere.A quantitative dataset describing the aerosol vertical, horizontal, and temporal distribution, including its variability on a continental scale, is necessary. The dataset is used to validate and improve models that predict the future state of the atmosphere and its dependence on different scenarios describing economic development, including those actions taken to preserve the quality of the environment. The EARLINET data set is the most comprehensive compilation of data available for this purpose.This project description is taken from: http://www.earlinet.org/index.php?id=earlinet_homepageSummary: Since the beginning of CALIPSO observations in June 2006 EARLINET has performed correlative measurements during nearby overpasses of the satellite at individual stations following a dedicated observational strategy. The EARLINET-CALIPSO correlative measurement plan considers the criteria established in the CALIPSO validation plan (http://calipsovalidation.hamptonu.edu). Participating EARLINET stations perform measurements, as close in time as possible and for a period of at least 30 min up to several hours, when CALIPSO overpasses their location within a horizontal radius of 100 km. Within the 16-day observational cycle of CALIPSO each station is overpassed within this distance 1-2 times during daytime (typically between 1100 and 1400 UTC) and 1-2 times during night time (typically between 0000 and 0300 UTC). Additional measurements are performed, mainly on a non-regular basis, when CALIPSO overpasses a neighboring station in order to study the horizontal variability of the aerosol distribution. The time schedule for correlative observations is calculated starting from the high-resolution ground-track data provided by NASA, and is updated and distributed to whole network weekly. The EARLINET-CALIPSO correlative dataset represents a statistically significant data set to be used for the validation and full exploitation of the CALIPSO mission, for studying the representativeness of cross sections along an orbit against network observations on a continental scale, and for supporting the continuous, harmonized observation of aerosol and clouds with remote-sensing techniques from space over long time periods