Tracking the hydro-climatic signal from lake to sediment: a field study from central Turkey

Palaeo-hydrological interpretations of lake sediment proxies can benefit from a robust understanding of the modern lake environment. In this study, we use Nar Gölü, a non-outlet, monomictic maar lake in central Turkey, as a field site for a natural experiment using observations and measurements over a 17-year monitoring period (1997–2014). We compare lake water and sediment trap data to isotopic, chemical and biotic proxies preserved in its varved sediments. Nar Gölü underwent a 3 m lake-level fall between 2000 and 2010. δ18Olakewater is correlated with this lake-level fall, responding to the change in water balance. Endogenic carbonate is shown to precipitate in isotopic equilibrium with lake water and there is a strong relationship between δ18Olakewater and δ18Ocarbonate, which suggests the water balance signal is accurately recorded in the sediment isotope record. Over the same period, sedimentary diatom assemblages also responded, and conductivity inferred from diatoms showed a rise. Shifts in carbonate mineralogy and elemental chemistry in the sediment record through this decade were also recorded. Intra-annual changes in δ18Olakewater and lake water chemistry are used to demonstrate the seasonal variability of the system and the influence this may have on the interpretation of δ18Ocarbonate. We use these relationships to help interpret the sedimentary record of changing lake hydrology over the last 1725 years. Nar Gölü has provided an opportunity to test critically the chain of connection from present to past, and its sedimentary record offers an archive of decadal- to centennial-scale hydro-climatic chang

A tale of two lakes: a multi-proxy comparison of Lateglacial and Holocene environmental change in Cappadocia, Turkey

Individual palaeoenvironmental records represent a combination of regional-scale (e.g. climatic) and site-specific local factors. Here we compare multiple climate proxies from two nearby maar lake records, assuming that common signals are due to regional-scale forcing. A new core sequence from Nar Lake in Turkey is dated by varves and U–Th to the last 13.8 ka. Markedly dry periods during the Lateglacial stadial, at 4.3–3.7 and at 3.2–2.6 ka BP, are associated with peaks in Mg/dolomite, positive δ18O, elevated diatom-inferred electrical conductivity, an absence of laminated sediments and low Quercus/chenopod ratios. Wet phases occurred during the early–mid Holocene and 1.5–0.6 ka BP, characterized by negative δ18O, calcite precipitation, high Ca/Sr ratios, a high percentage of planktonic diatoms, laminated sediments and high Quercus/chenopod ratios. Comparison with the record from nearby Eski Acıgöl shows good overall correspondence for many proxies, especially for δ18O. Differences are related to basin infilling and lake ontogeny at Eski Acıgöl, which consequently fails to register climatic changes during the last 2 ka, and to increased flux of lithogenic elements into Nar Lake during the last 2.6 ka, not primarily climatic in origin. In attempting to separate a regional signal from site-specific ‘noise’, two lakes may therefore be better than one

A Remote Patient Monitoring System for Congestive Heart Failure

Congestive heart failure (CHF) is a leading cause of death in the United States affecting approximately 670,000 individuals. Due to the prevalence of CHF related issues, it is prudent to seek out methodologies that would facilitate the prevention, monitoring, and treatment of heart disease on a daily basis. This paper describes WANDA (Weight and Activity with Blood Pressure Monitoring System); a study that leverages sensor technologies and wireless communications to monitor the health related measurements of patients with CHF. The WANDA system is a three-tier architecture consisting of sensors, web servers, and back-end databases. The system was developed in conjunction with the UCLA School of Nursing and the UCLA Wireless Health Institute to enable early detection of key clinical symptoms indicative of CHF-related decompensation. This study shows that CHF patients monitored by WANDA are less likely to have readings fall outside a healthy range. In addition, WANDA provides a useful feedback system for regulating readings of CHF patients

Naomi: a new modelling tool for estimating HIV epidemic indicators at the district level in sub-Saharan Africa.

INTRODUCTION: HIV planning requires granular estimates for the number of people living with HIV (PLHIV), antiretroviral treatment (ART) coverage and unmet need, and new HIV infections by district, or equivalent subnational administrative level. We developed a Bayesian small-area estimation model, called Naomi, to estimate these quantities stratified by subnational administrative units, sex, and five-year age groups. METHODS: Small-area regressions for HIV prevalence, ART coverage and HIV incidence were jointly calibrated using subnational household survey data on all three indicators, routine antenatal service delivery data on HIV prevalence and ART coverage among pregnant women, and service delivery data on the number of PLHIV receiving ART. Incidence was modelled by district-level HIV prevalence and ART coverage. Model outputs of counts and rates for each indicator were aggregated to multiple geographic and demographic stratifications of interest. The model was estimated in an empirical Bayes framework, furnishing probabilistic uncertainty ranges for all output indicators. Example results were presented using data from Malawi during 2016-2018. RESULTS: Adult HIV prevalence in September 2018 ranged from 3.2% to 17.1% across Malawi's districts and was higher in southern districts and in metropolitan areas. ART coverage was more homogenous, ranging from 75% to 82%. The largest number of PLHIV was among ages 35 to 39 for both women and men, while the most untreated PLHIV were among ages 25 to 29 for women and 30 to 34 for men. Relative uncertainty was larger for the untreated PLHIV than the number on ART or total PLHIV. Among clients receiving ART at facilities in Lilongwe city, an estimated 71% (95% CI, 61% to 79%) resided in Lilongwe city, 20% (14% to 27%) in Lilongwe district outside the metropolis, and 9% (6% to 12%) in neighbouring Dowa district. Thirty-eight percent (26% to 50%) of Lilongwe rural residents and 39% (27% to 50%) of Dowa residents received treatment at facilities in Lilongwe city. CONCLUSIONS: The Naomi model synthesizes multiple subnational data sources to furnish estimates of key indicators for HIV programme planning, resource allocation, and target setting. Further model development to meet evolving HIV policy priorities and programme need should be accompanied by continued strengthening and understanding of routine health system data

Eastern Mediterranean hydroclimate over the late glacial and Holocene, reconstructed from the sediments of Nar lake, central Turkey, using stable isotopes and carbonate mineralogy

There is a lack of high-resolution records of hydroclimate variability in the Eastern Mediterranean from the late glacial and early Holocene. More knowledge of the speed of climate shifts and the degree to which they were synchronous with changes in the North Atlantic or elsewhere is required to understand better the controls on Eastern Mediterranean climate. Using endogenic carbonate from a sediment sequence from Nar Gölü, a maar lake in central Turkey, dated by varve counting and uranium-thorium methods, we present high-resolution (∼25 years) oxygen (δ18O) and carbon isotope records, supported by carbonate mineralogy data, spanning the late glacial and Holocene. δ18Ocarbonate at Nar Gölü has been shown previously to be a strong proxy for regional water balance. After a dry period (i.e. evaporation far exceeding precipitation) in the Younger Dryas, the data show a transition into the relatively wetter early Holocene. In the early Holocene there are two drier periods that appear to peak at ∼9.3 ka and ∼8.2 ka, coincident with cooling ‘events’ seen in North Atlantic records. After this, and as seen in other records from the Eastern Mediterranean, there is a millennial-scale drying trend through the Mid Holocene Transition. The relatively dry late Holocene is punctuated by centennial-scale drought intervals, at the times of 4.2 ka ‘event’ and Late Bronze Age societal ‘collapse’. Overall, we show that central Turkey is drier when the North Atlantic is cooler, throughout this record and at multiple timescales, thought to be due to a weakening of the westerly storm track resulting from reduced cyclogenesis in the North Atlantic. However, some features, such as the Mid Holocene Transition and the fact the early Holocene dry episodes at Nar Gölü are of a longer duration than the more discrete ‘events’ seen in North Atlantic records, imply there are additional controls on Eastern Mediterranean hydroclimate

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Medical Signal Searching

This dissertation presents work in medical signal searching. Signal searching (or subsequence matching) is the process of finding similar segments within a database of time series signals. Medical signal searching is extremely challenging given the large, high entropy, multidimensional datasets. However, medical time series signals tend to be cyclical and repetitive and contain a large amount of redundancy. In addition, similar segments in a medical time series signals tend to form tight clusters where the Euclidean distance between segments within the same cluster follow a Gaussian distribution. These properties can be leveraged in many ways to significantly improve search performance in terms of computation, memory, precision, and recall.This dissertation addresses three main aspects of medical signal searching: extraction of query segments; improvement in the quality of search results; and optimization of indexing structures through the removal of redundancy. These contributions heavily leverage the properties of medical time series signals. Each contribution of this dissertation has been thoroughly tested on a wide variety of medical time series signals including data collected through a clinical study. In addition, a complete system for searching electrocardiogram (ECG) is presented

Medical Signal Searching

This dissertation presents work in medical signal searching. Signal searching (or subsequence matching) is the process of finding similar segments within a database of time series signals. Medical signal searching is extremely challenging given the large, high entropy, multidimensional datasets. However, medical time series signals tend to be cyclical and repetitive and contain a large amount of redundancy. In addition, similar segments in a medical time series signals tend to form tight clusters where the Euclidean distance between segments within the same cluster follow a Gaussian distribution. These properties can be leveraged in many ways to significantly improve search performance in terms of computation, memory, precision, and recall.This dissertation addresses three main aspects of medical signal searching: extraction of query segments; improvement in the quality of search results; and optimization of indexing structures through the removal of redundancy. These contributions heavily leverage the properties of medical time series signals. Each contribution of this dissertation has been thoroughly tested on a wide variety of medical time series signals including data collected through a clinical study. In addition, a complete system for searching electrocardiogram (ECG) is presented