Comparison of diagnoses of early-onset sepsis associated with use of Sepsis Risk Calculator versus NICE CG149: a prospective, population-wide cohort study in London, UK, 2020-2021.

OBJECTIVE: We sought to compare the incidence of early-onset sepsis (EOS) in infants ≥34 weeks' gestation identified >24 hours after birth, in hospitals using the Kaiser Permanente Sepsis Risk Calculator (SRC) with hospitals using the National Institute for Health and Care Excellence (NICE) guidance. DESIGN AND SETTING: Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units colocated with maternity services across London (10 using SRC, 16 using NICE). PARTICIPANTS: All live births ≥34 weeks' gestation between September 2020 and August 2021. OUTCOME MEASURES: EOS was defined as isolation of a bacterial pathogen in the blood or cerebrospinal fluid (CSF) culture from birth to 7 days of age. We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures. RESULTS: Of 99 683 live births, 42 952 (43%) were born in SRC hospitals and 56 731 (57%) in NICE hospitals. The overall incidence of EOS (24 hours was 2.3/100 000 (n=1) for SRC vs 7.1/100 000 (n=4) for NICE (OR 0.5, 95% CI (0.1 to 2.7)). This corresponded to (1/20) 5% (SRC) vs (4/45) 8.9% (NICE) of EOS cases (χ=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4.4/1000 (n=187) for SRC vs 2.9/1000 (n=158) for NICE (OR 1.5, 95% CI (1.2 to 1.9)). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals vs 8428 (15%) in NICE hospitals. CONCLUSION: There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life

The extreme European summer 2012

The European summer of 2012 was marked by strongly contrasting rainfall anomalies, which led to flooding in northern Europe and droughts and wildfires in southern Europe. This season was not an isolated event, rather the latest in a string of summers characterized by a southward shifted Atlantic storm track as described by the negative phase of the SNAO. The degree of decadal variability in these features suggests a role for forcing from outside the dynamical atmosphere, and preliminary numerical experiments suggest that the global SST and low Arctic sea ice extent anomalies are likely to have played a role and that warm North Atlantic SSTs were a particular contributing factor. The direct effects of changes in radiative forcing from greenhouse gas and aerosol forcing are not included in these experiments, but both anthropogenic forcing and natural variability may have influenced the SST and sea ice changes

Explaining Extreme Events of 2012 from a Climate Perspective

Attribution of extreme events is a challenging science and one that is currently undergoing considerable evolution. In this paper are 19 analyses by 18 different research groups, often using quite different methodologies, of 12 extreme events that occurred in 2012. In addition to investigating the causes of these extreme events, the multiple analyses of four of the events, the high temperatures in the United States, the record low levels of Arctic sea ice, and the heavy rain in northern Europe and eastern Australia, provide an opportunity to compare and contrast the strengths and weaknesses of the various methodologies. The differences also provide insights into the structural uncertainty of event attribution, that is, the uncertainty that arises directly from the differences in analysis methodology. In these cases, there was considerable agreement between the different assessments of the same event. However, different events had very different causes. Approximately half the analyses found some evidence that anthropogenically caused climate change was a contributing factor to the extreme event examined, though the effects of natural fluctuations of weather and climate on the evolution of many of the extreme events played key roles as well.Peer Reviewe

Comparison of diagnoses of early onset sepsis associated with use of Sepsis Risk Calculator versus NICE CG149: a prospective, population-wide cohort study in London, UK, 2020-21

Objective: We sought to compare the incidence of early-onset sepsis (EOS) in infants ≥34 weeks’ gestation identified > 24 hours after birth, in hospitals using the Kaiser Permanente sepsis risk calculator (SRC) with hospitals using the NICE guidance. Design and setting: Prospective observational population-wide cohort study involving all 26 hospitals with neonatal units co-located with maternity services across London (10 using SRC, 16 using NICE). Participants: All livebirths ≥34 weeks’ gestation between September 2020 and August 2021. Outcome measures: EOS was defined as isolation of a bacterial pathogen in the blood or CSF culture from birth to 7 days of age. We evaluated the incidence of EOS identified by culture obtained >24 hours to 7 days after birth. We also evaluated the rate empiric antibiotics were commenced >24 hours to 7 days after birth, for a duration of ≥5 days, with negative blood or CSF cultures. Results: Of 99,683 livebirths, 42,952 (43%) were born in SRC hospitals and 56,731 (57%) in NICE hospitals. The overall incidence of EOS (24 hours was 2.3/100,000 (n=1) for SRC versus 7.1/100,000 (n=4) for NICE (odds ratio 0·5, 95%CI [0·1; 2·7]). This corresponded to (1/20) 5% (SRC) versus (4/45) 8.9% (NICE) of EOS cases (chi=0.3, p=0.59). Empiric antibiotics were commenced >24 hours to 7 days after birth in 4·4/1000 (n=187) for SRC versus 2·9/1000 (n=158) for NICE (odds ratio 1·5, 95%CI [1·2; 1·9]). 3111 (7%) infants received antibiotics in the first 24 hours in SRC hospitals versus 8428 (15%) in NICE hospitals. Conclusion: There was no significant difference in the incidence of EOS identified >24 hours after birth between SRC and NICE hospitals. SRC use was associated with 50% fewer infants receiving antibiotics in the first 24 hours of life

The NASA hydrological forecast system for food and water security applications

Many regions in Africa and the Middle East are vulnerable to drought and to water and food insecurity, motivating agency efforts such as the U.S. Agency for International Development’s (USAID) Famine Early Warning Systems Network (FEWS NET) to provide early warning of drought events in the region. Each year these warnings guide life-saving assistance that reaches millions of people. A new NASA multimodel, remote sensing–based hydrological forecasting and analysis system, NHyFAS, has been developed to support such efforts by improving the FEWS NET’s current early warning capabilities. NHyFAS derives its skill from two sources: (i) accurate initial conditions, as produced by an offline land modeling system through the application and/or assimilation of various satellite data (precipitation, soil moisture, and terrestrial water storage), and (ii) meteorological forcing data during the forecast period as produced by a state-of-the-art ocean–land–atmosphere forecast system. The land modeling framework used is the Land Information System (LIS), which employs a suite of land surface models, allowing multimodel ensembles and multiple data assimilation strategies to better estimate land surface conditions. An evaluation of NHyFAS shows that its 1–5-month hindcasts successfully capture known historic drought events, and it has improved skill over benchmark-type hindcasts. The system also benefits from strong collaboration with end-user partners in Africa and the Middle East, who provide insights on strategies to formulate and communicate early warning indicators to water and food security communities. The additional lead time provided by this system will increase the speed, accuracy, and efficacy of humanitarian disaster relief, helping to save lives and livelihoods