Ice supersaturation and the potential for contrail formation in a changing climate

Ice supersaturation (ISS) in the upper troposphere and lower stratosphere is important for the formation of cirrus clouds and long-lived contrails. Cold ISS (CISS) regions (taken here to be ice-supersaturated regions with temperature below 233 K) are most relevant for contrail formation.We analyse projected changes to the 250 hPa distribution and frequency of CISS regions over the 21st century using data from the Representative Concentration Pathway 8.5 simulations for a selection of Coupled Model Intercomparison Project Phase 5 models. The models show a global-mean, annual-mean decrease in CISS frequency by about one-third, from 11 to 7% by the end of the 21st century, relative to the present-day period 1979–2005. Changes are analysed in further detail for three subregions where air traffic is already high and increasing (Northern Hemisphere mid-latitudes) or expected to increase (tropics and Northern Hemisphere polar regions). The largest change is seen in the tropics, where a reduction of around 9 percentage points in CISS frequency by the end of the century is driven by the strong warming of the upper troposphere. In the Northern Hemisphere mid-latitudes the multi-model-mean change is an increase in CISS frequency of 1 percentage point; however the sign of the change is dependent not only on the model but also on latitude and season. In the Northern Hemisphere polar regions there is an increase in CISS frequency of 5 percentage points in the annual mean. These results suggest that, over the 21st century, climate change may have large impacts on the potential for contrail formation; actual changes to contrail cover will also depend on changes to the volume of air traffic, aircraft technology and flight routing

The dependence of minimum-time routes over the North Atlantic on cruise altitude

North Atlantic air traffic is broadly organised into a track system; daily sets of tracks are defined by air traffic control which are vertically stacked, such that the same set of tracks is used for all flight levels, regardless of any vertical variations in wind. This work uses minimum-time routes, previously shown to be a good proxy for the location of the North Atlantic track system, to understand whether vertical variations in wind speed and direction significantly affect minimum-time routes optimised at different altitudes; this is to examine whether (all other factors assumed equal) there is potential for improvements in fuel efficiency. The optimum cruise altitude over the North Atlantic is determined, focusing on the New York – London route. It is found that eastbound routes, which take advantage of the jet stream, are on average faster at 250 hPa (flight level (FL) 340) than at 300 hPa (FL300) or 200 hPa (FL390) by approximately 2 minutes (compared to the annual-mean route time of about 330 minutes, assuming a true air speed of 250 m s-1). For westbound routes, the route time increases with height: aircraft flying at 300 hPa are on average 3 minutes faster than at higher levels (the annual-mean optimum time being about 400 minutes). These estimates are compared with the time penalty which arises from flying a route optimized at 250 hPa at the other two altitudes. The time penalty is generally less than a minute, compared to the minimum-time routes calculated at those altitudes

What are the implications of climate change for trans-Atlantic aircraft routing and flight time?

The effect of wind changes on aircraft routing has been identified as a potential impact of climate change on aviation. This is of particular interest for trans-Atlantic flights, where the pattern of upper-level winds over the north Atlantic, in particular the location and strength of the jet stream, strongly influences both the optimal flight route and the resulting flight time. Eastbound trans-Atlantic flights can often be routed to take advantage of the strong tailwinds in the jet stream, shortening the flight time and reducing fuel consumption. Here we investigate the impact of climate change on upper-level winds over the north Atlantic, using five climate model simulations from the Fifth Coupled Model Intercomparison Project, considering a high greenhouse-gas emissions scenario. The impact on aircraft routing and flight time are quantified using flight routing software. The climate models agree that the jet stream will be on average located 1 degree further north, with a small increase in mean strength, by 2100. However daily variations in both its location and speed are significantly larger than the magnitude of any changes due to climate change. The net effect of climate change on trans-Atlantic aircraft routes is small; in the annual-mean eastbound routes are 1 min shorter and located further north and westbound routes are 1 min longer and more spread out around the great circle. There are, however, seasonal variations; route time changes are larger in winter, while in summer both eastbound and westbound route times increase

Treat-to-target in dermatology:A scoping review and International Eczema Council survey on the approach in atopic dermatitis

Treat-to-target (T2T) is a pragmatic therapeutic strategy being gradually introduced into dermatology after adoption in several other clinical areas. Atopic dermatitis (AD), one of the most common inflammatory skin diseases, may also benefit from this structured and practical therapeutic approach. We aimed to evaluate existing data regarding the T2T approach in dermatology, with a specific focus on AD, as well as the views of International Eczema Council (IEC) members on the potential application of a T2T approach to AD management. To do so, we systematically searched for peer-reviewed publications on the T2T approach for any skin disease in the PubMed and Scopus databases up to February 2022 and conducted a survey among IEC members regarding various components to potentially include in a T2T approach in AD. We identified 21 relevant T2T-related reports in dermatology, of which 14 were related to psoriasis, five to AD, one for juvenile dermatomyositis and one for urticaria. In the IEC member survey, respondents proposed treatable traits (with itch, disease severity and sleep problems getting the highest scores), relevant comorbidities (with asthma being selected most commonly, followed by anxiety and depression in adults), recommended specialists that should define the approach in AD (dermatologists, allergists and primary care physicians were most commonly selected in adults), and applicable assessment tools (both physician- and patient-reported), in both adult and paediatric patients, for potential future utilization of the T2T approach in AD. In conclusion, while the T2T approach may become a useful tool to simplify therapeutic goals and AD management, its foundation in AD is only starting to build. A multidisciplinary approach, including a wide range of stakeholders, including patients, is needed to further define the essential components needed to utilize T2T in AD.</p

Uncertainty-aware estimation of population abundance using machine learning

Machine Learning is widely used for mining collections, such as images, sounds, or texts, by classifying their elements into categories. Automatic classification based on supervised learning requires groundtruth datasets for modeling the elements to classify, and for testing the quality of the classification. Because collecting groundtruth is tedious, a method for estimating the potential errors in large datasets based on limited groundtruth is needed. We propose a method that improves classification quality by using limited groundtruth data to extrapolate the po-tential errors in larger datasets. It significantly improves the counting of elements per class. We further propose visualization designs for understanding and evaluating the classification un-certainty. They support end-users in considering the impact of potential misclassifications for interpreting the classification output. This work was developed to address the needs of ecologists studying fish population abundance using computer vision, but generalizes to a larger range of applications. Our method is largely applicable for a variety of Machine Learning technologies, and our visualizations further support their transfer to end-users

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effect of a Perioperative, Cardiac Output-Guided Hemodynamic Therapy Algorithm on Outcomes Following Major Gastrointestinal Surgery A Randomized Clinical Trial and Systematic Review

Importance: small trials suggest that postoperative outcomes may be improved by the use of cardiac output monitoring to guide administration of intravenous fluid and inotropic drugs as part of a hemodynamic therapy algorithm.Objective: to evaluate the clinical effectiveness of a perioperative, cardiac output–guided hemodynamic therapy algorithm.Design, setting, and participants: OPTIMISE was a pragmatic, multicenter, randomized, observer-blinded trial of 734 high-risk patients aged 50 years or older undergoing major gastrointestinal surgery at 17 acute care hospitals in the United Kingdom. An updated systematic review and meta-analysis were also conducted including randomized trials published from 1966 to February 2014.Interventions: patients were randomly assigned to a cardiac output–guided hemodynamic therapy algorithm for intravenous fluid and inotrope (dopexamine) infusion during and 6 hours following surgery (n=368) or to usual care (n=366).Main outcomes and measures: the primary outcome was a composite of predefined 30-day moderate or major complications and mortality. Secondary outcomes were morbidity on day 7; infection, critical care–free days, and all-cause mortality at 30 days; all-cause mortality at 180 days; and length of hospital stay.Results: baseline patient characteristics, clinical care, and volumes of intravenous fluid were similar between groups. Care was nonadherent to the allocated treatment for less than 10% of patients in each group. The primary outcome occurred in 36.6% of intervention and 43.4% of usual care participants (relative risk [RR], 0.84 [95% CI, 0.71-1.01]; absolute risk reduction, 6.8% [95% CI, ?0.3% to 13.9%]; P?=?.07). There was no significant difference between groups for any secondary outcomes. Five intervention patients (1.4%) experienced cardiovascular serious adverse events within 24 hours compared with none in the usual care group. Findings of the meta-analysis of 38 trials, including data from this study, suggest that the intervention is associated with fewer complications (intervention, 488/1548 [31.5%] vs control, 614/1476 [41.6%]; RR, 0.77 [95% CI, 0.71-0.83]) and a nonsignificant reduction in hospital, 28-day, or 30-day mortality (intervention, 159/3215 deaths [4.9%] vs control, 206/3160 deaths [6.5%]; RR, 0.82 [95% CI, 0.67-1.01]) and mortality at longest follow-up (intervention, 267/3215 deaths [8.3%] vs control, 327/3160 deaths [10.3%]; RR, 0.86 [95% CI, 0.74-1.00]).Conclusions and relevance: in a randomized trial of high-risk patients undergoing major gastrointestinal surgery, use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality. However, inclusion of these data in an updated meta-analysis indicates that the intervention was associated with a reduction in complication rate

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

Basic science232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function

Background: Cardiovascular disease is a major comorbidity of rheumatoid arthritis (RA) and a leading cause of death. Chronic systemic inflammation involving tumour necrosis factor alpha (TNF) could contribute to endothelial activation and atherogenesis. A number of anti-TNF therapies are in current use for the treatment of RA, including certolizumab pegol (CZP), (Cimzia ®; UCB, Belgium). Anti-TNF therapy has been associated with reduced clinical cardiovascular disease risk and ameliorated vascular function in RA patients. However, the specific effects of TNF inhibitors on endothelial cell function are largely unknown. Our aim was to investigate the mechanisms underpinning CZP effects on TNF-activated human endothelial cells. Methods: Human aortic endothelial cells (HAoECs) were cultured in vitro and exposed to a) TNF alone, b) TNF plus CZP, or c) neither agent. Microarray analysis was used to examine the transcriptional profile of cells treated for 6 hrs and quantitative polymerase chain reaction (qPCR) analysed gene expression at 1, 3, 6 and 24 hrs. NF-κB localization and IκB degradation were investigated using immunocytochemistry, high content analysis and western blotting. Flow cytometry was conducted to detect microparticle release from HAoECs. Results: Transcriptional profiling revealed that while TNF alone had strong effects on endothelial gene expression, TNF and CZP in combination produced a global gene expression pattern similar to untreated control. The two most highly up-regulated genes in response to TNF treatment were adhesion molecules E-selectin and VCAM-1 (q 0.2 compared to control; p > 0.05 compared to TNF alone). The NF-κB pathway was confirmed as a downstream target of TNF-induced HAoEC activation, via nuclear translocation of NF-κB and degradation of IκB, effects which were abolished by treatment with CZP. In addition, flow cytometry detected an increased production of endothelial microparticles in TNF-activated HAoECs, which was prevented by treatment with CZP. Conclusions: We have found at a cellular level that a clinically available TNF inhibitor, CZP reduces the expression of adhesion molecule expression, and prevents TNF-induced activation of the NF-κB pathway. Furthermore, CZP prevents the production of microparticles by activated endothelial cells. This could be central to the prevention of inflammatory environments underlying these conditions and measurement of microparticles has potential as a novel prognostic marker for future cardiovascular events in this patient group. Disclosure statement: Y.A. received a research grant from UCB. I.B. received a research grant from UCB. S.H. received a research grant from UCB. All other authors have declared no conflicts of interes