Effects of point source emission heights in WRF–STILT: a step towards exploiting nocturnal observations in models

An appropriate representation of point source emissions in atmospheric transport models is very challenging. In the Stochastic Time-Inverted Lagrangian Transport model (STILT), all point source emissions are typically released from the surface, meaning that the actual emission stack height plus subsequent plume rise is not considered. This can lead to erroneous predictions of trace gas concentrations, especially during nighttime when vertical atmospheric mixing is minimal. In this study we use two Weather Research and Forecasting (WRF)–STILT model approaches to simulate fossil fuel CO2 (ffCO2) concentrations: (1) the standard “surface source influence (SSI)” approach and (2) an alternative “volume source influence (VSI)” approach where nearby point sources release CO2 according to their effective emission height profiles. The comparison with 14C-based measured ffCO2 data from 2-week integrated afternoon and nighttime samples collected at Heidelberg, 30 m above ground level shows that the root-mean-square deviation (RMSD) between modelled and measured ffCO2 is indeed almost twice as high during the night (RMSD =6.3 ppm) compared to the afternoon (RMSD =3.7 ppm) when using the standard SSI approach. In contrast, the VSI approach leads to a much better performance at nighttime (RMSD =3.4 ppm), which is similar to its performance during afternoon (RMSD =3.7 ppm). Representing nearby point source emissions with the VSI approach could thus be a first step towards exploiting nocturnal observations in STILT. The ability to use nighttime observations in atmospheric inversions would dramatically increase the observational data and allow for the investigation of different source mixtures or diurnal cycles. To further investigate the differences between these two approaches, we conducted a model experiment in which we simulated the ffCO2 contributions from 12 artificial power plants with typical annual emissions of 1 million tonnes of CO2 and with distances between 5 and 200 km from the Heidelberg observation site. We find that such a power plant must be more than 50 km away from the observation site in order for the mean modelled ffCO2 concentration difference between the SSI and VSI approach to fall below 0.1 ppm during situations with low mixing heights smaller than 500 m

Evaluation of sleep, puberty and mental health in children with long-term melatonin treatment for chronic idiopathic childhood sleep onset insomnia

OBJECTIVES: To establish whether long-term use of melatonin influences pubertal development, sleep quality and mental health development in children as compared with the normal Dutch population of the same age. METHODS: This follow-up research study was conducted in children included in a previous melatonin dose-finding trial. Outcomes were measured using questionnaires (Strength and Difficulties Questionnaire (SDQ), Children's Sleep Habits Questionnaire (CSHQ) and Tanner Stages) adopted for Dutch children. Mean duration of therapy, persistence of effect, adverse events and (other) reasons leading to cessation of therapy were additional objectives of this study. RESULTS: Mean years of usage (n = 51) was 3.1 years (min 1.0 year, max 4.6 years), mean dose 2.69 mg (min 0.3 mg, max 10 mg). Mean SDQ score, mean CSHQ score and Tanner Stages standard deviation scores did not differ in a statistically significant way from published scores of the general Dutch population of the same age and sex. CONCLUSIONS: This follow-up study demonstrates that melatonin treatment in children can be sustained over a long period of time without substantial deviation of the development of children with respect to sleep quality, puberty development and mental health scores, as compared with the general Dutch population

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

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

Disease as a Factor in the Demise of the Beothuck Indians

After 330 years of European exploration and settlement on the island of Newfoundland, the Beothuck Indian population became extinct. In order to establish how far the demise of these Indians was due to diseases introduced by the Europeans, bubonic plague, smallpox, measles and tuberculosis, these are considered in relation to the changing circumstances of the Beothucks and their patterns of contact with each other and with the European settlers. The effect of these diseases on Beothuck demography is discussed using documentary evidence of disease incidence in the Newfoundland population as well as comparative data from other North American Indian groups.Après 330 ans d’exploration européenne et d’occupation de l’île de Terre-Neuve, la population indienne Béothuck est disparue. Afin d’établir jusqu’à quel point le décès de ces Indiens est dû à l’introduction de maladies par les Européens, telles la peste bubonique, la petite vérole, la rougeole et la tuberculose, nous considérons ces maladies en rapport aux circumstances changeantes chez les Béothuck et les types de contact établis entre eux et les settlers européens. Nous utilisons des informations documentaires sur l’incidence de la maladie chez la population terre-neuvienne ainsi que des données comparatives sur d’autres groupes d’indiens nord-américains afin d’analyser l’effet de ces maladies sur la démographie Béothuck