Lupus nephritis. Part II. A clinicopathological correlation and study of outcome

CITATION: Halland, A.-M. et al. 1991. Lupus nephritis. Part II. A clinicopathological correlation and study of outcome. South African Medical Journal, 79:260-264.The original publication is available at http://www.samj.org.zaA 5-year retrospective study of lupus nephritis at Tygerberg Hospital was performed in an attempt to document the clinical and histological spectrum of the disease and to study the outcome of the illness. Activity and chronicity scores were used in addition to the World Health Organisation classification system. Of 55 biopsies from 51 patients reviewed, 6 were class II, 13 class III, 32 class IV and 4 class V. There were 19 deaths and in 15 of these the histological classification was IV. Renal failure and infections, often with uncommon pathogens, were the most important causes of death. Serum creatinine values and creatinine clearance at the time of biopsy or follow-up, and hypertension at follow-up showed a significant relationship with outcome. WHO class IV was associated with a poor outcome (P= 0,048) when compared with the other WHO classes combined. Activity scores showed a significant relationship to the outcome (P = 0,018). The anticardiolipin antibodies IgG and IgM were not associated with WHO class or outcome. The study revealed a spectrum of histological results similar to that of other studies, with a high mortality rate, particularly in class IV disease. Poor renal function, persistent hypertension, histological classification IV, and high activity scores were found to be important prognostic indicators.Publisher’s versio

Developing a patient safety incident classification system for primary care. A literature review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care

This is the final version of the article. Available from Taylor & Francis via the DOI in this record.BACKGROUND: Despite awareness that comparative analysis of patient safety data from several data sources would promote risk reduction, there has been little effort to establish an incident classification system that is generally applicable to patient safety data in European primary care. OBJECTIVE: To describe the development of a patient safety incident classification system for primary care. METHODS: A systematic review was followed by an expert group discussion and a modified Delphi survey, to provide consensus statements. RESULTS: We developed a classification system providing a mechanism for classifying patient safety incidents across Europe, taking into account the varying organizational arrangements that exist for primary care. It takes into account organizational processes and outcomes related to patient safety incidents and can supplement existing classification systems. CONCLUSION: Classification systems are key tools in the analysis of patient safety incidents. A system that has relevance for primary care is now available.The research leading to these results has received funding from the European Community’s Seventh Framework Programme FP7/2008–2012 under grant agreement no. 223424

Coastally Trapped Wind Reversals: Progress toward Understanding

Coastally trapped wind reversals along the U.S. west coast, which are often accompanied by a northward surge of fog or stratus, are an important warm-season forecast problem due to their impact on coastal maritime activities and airport operations. Previous studies identified several possible dynamic mechanisms that could be responsible for producing these events, yet observational and modeling limitations at the time left these competing interpretations open for debate. In an effort to improve our physical understanding, and ultimately the prediction, of these events, the Office of Naval Research sponsored an Accelerated Research Initiative in Coastal Meteorology during the years 1993â 98 to study these and other related coastal meteorological phenomena. This effort included two field programs to study coastally trapped disturbances as well as numerous modeling studies to explore key dynamic mechanisms. This paper describes the various efforts that occurred under this program to provide an advancement in our understanding of these disturbances. While not all issues have been solved, the synoptic and mesoscale aspects of these events are considerably better understood.Most of the authors were supported through the Office of Naval Research Coastal Meteorology Accelerated Research Initiative, one of the authors (WTT) was supported by Program Element 0601153N, Naval Research Laboratory

Interactions between downslope flows and a developing cold-air pool

A numerical model has been used to characterize the development of a region of enhanced cooling in an alpine valley with a width of order (Formula presented.) km, under decoupled stable conditions. The region of enhanced cooling develops largely as a region of relatively dry air which partitions the valley atmosphere dynamics into two volumes, with airflow partially trapped within the valley by a developing elevated inversion. Complex interactions between the region of enhanced cooling and the downslope flows are quantified. The cooling within the region of enhanced cooling and the elevated inversion is almost equally partitioned between radiative and dynamic effects. By the end of the simulation, the different valley atmospheric regions approach a state of thermal equilibrium with one another, though this cannot be said of the valley atmosphere and its external environment.Peer reviewe

Pollutant dispersion in a developing valley cold-air pool

Pollutants are trapped and accumulate within cold-air pools, thereby affecting air quality. A numerical model is used to quantify the role of cold-air-pooling processes in the dispersion of air pollution in a developing cold-air pool within an alpine valley under decoupled stable conditions. Results indicate that the negatively buoyant downslope flows transport and mix pollutants into the valley to depths that depend on the temperature deficit of the flow and the ambient temperature structure inside the valley. Along the slopes, pollutants are generally entrained above the cold-air pool and detrained within the cold-air pool, largely above the ground-based inversion layer. The ability of the cold-air pool to dilute pollutants is quantified. The analysis shows that the downslope flows fill the valley with air from above, which is then largely trapped within the cold-air pool, and that dilution depends on where the pollutants are emitted with respect to the positions of the top of the ground-based inversion layer and cold-air pool, and on the slope wind speeds. Over the lower part of the slopes, the cold-air-pool-averaged concentrations are proportional to the slope wind speeds where the pollutants are emitted, and diminish as the cold-air pool deepens. Pollutants emitted within the ground-based inversion layer are largely trapped there. Pollutants emitted farther up the slopes detrain within the cold-air pool above the ground-based inversion layer, although some fraction, increasing with distance from the top of the slopes, penetrates into the ground-based inversion layer.Peer reviewe

Resonant gravity-wave drag enhancement in linear stratified flow over mountains

High-drag states produced in stratified flow over a 2D ridge and an axisymmetric mountain are investigated using a linear, hydrostatic, analytical model. A wind profile is assumed where the background velocity is constant up to a height z1 and then decreases linearly, and the internal gravity-wave solutions are calculated exactly. In flow over a 2D ridge, the normalized surface drag is given by a closed-form analytical expression, while in flow over an axisymmetric mountain it is given by an expression involving a simple 1D integral. The drag is found to depend on two dimensionless parameters: a dimensionless height formed with z_1, and the Richardson number, Ri, in the shear layer. The drag oscillates as z_1 increases, with a period of half the hydrostatic vertical wavelength of the gravity waves. The amplitude of this modulation increases as Ri decreases. This behaviour is due to wave reflection at z_1. Drag maxima correspond to constructive interference of the upward- and downward-propagating waves in the region z < z_1, while drag minima correspond to destructive interference. The reflection coefficient at the interface z = z_1 increases as Ri decreases. The critical level, z_c, plays no role in the drag amplification. A preliminary numerical treatment of nonlinear effects is presented, where z_c appears to become more relevant, and flow over a 2D ridge qualitatively changes its character. But these effects, and their connection with linear theory, still need to be better understood

BAERLIN2014 -The influence of land surface types on and the horizontal heterogeneity of air pollutant levels in Berlin

Urban air quality and human health are among the key aspects of future urban planning. In order to address pollutants such as ozone and particulate matter, efforts need to be made to quantify and reduce their concentrations. One important aspect in understanding urban air quality is the influence of urban vegetation which may act as both emitter and sink for trace gases and aerosol particles. In this context, the "Berlin Air quality and Ecosystem Research: Local and long-range Impact of anthropogenic and Natural hydrocarbons 2014" (BAERLIN2014) campaign was conducted between 2 June and 29 August in the metropolitan area of Berlin and Brandenburg, Germany. The predominant goals of the campaign were (1) the characterization of urban gaseous and particulate pollution and its attribution to anthropogenic and natural sources in the region of interest, especially considering the connection between biogenic volatile organic compounds and particulates and ozone; (2) the quantification of the impact of urban vegetation on organic trace gas levels and the presence of oxidants such as ozone; and (3) to explain the local heterogeneity of pollutants by defining the distribution of sources and sinks relevant for the interpretation of model simulations. In order to do so, the campaign included stationary measurements at urban background station and mobile observations carried out from bicycle, van and airborne platforms. This paper provides an overview of the mobile measurements (Mobile BAERLIN2014) and general conclusions drawn from the analysis. Bicycle measurements showed micro-scale variations of temperature and particulate matter, displaying a substantial reduction of mean temperatures and particulate levels in the proximity of vegetated areas compared to typical urban residential area (background) measurements. Van measurements extended the area covered by bicycle observations and included continuous measurements of O3, NOx, CO, CO2 and point-wise measurement of volatile organic compounds (VOCs) at representative sites for traffic- and vegetation-affected sites. The quantification displayed notable horizontal heterogeneity of the short-lived gases and particle number concentrations. For example, baseline concentrations of the traffic-related chemical species CO and NO varied on average by up to ±22.2 and ±63.5 %, respectively, on the scale of 100 m around any measurement location. Airborne observations revealed the dominant source of elevated urban particulate number and mass concentrations being local, i.e., not being caused by long-range transport. Surface-based observations related these two parameters predominantly to traffic sources. Vegetated areas lowered the pollutant concentrations substantially with ozone being reduced most by coniferous forests, which is most likely caused by their reactive biogenic VOC emissions. With respect to the overall potential to reduce air pollutant levels, forests were found to result in the largest decrease, followed by parks and facilities for sports and leisure. Surface temperature was generally 0.6–2.1 °C lower in vegetated regions, which in turn will have an impact on tropospheric chemical processes. Based on our findings, effective future mitigation activities to provide a more sustainable and healthier urban environment should focus predominantly on reducing fossil-fuel emissions from traffic as well as on increasing vegetated areas

BAERLIN2014 - stationary measurements and source apportionment at an urban background station in Berlin, Germany

The Berlin Air quality and Ecosystem Research: Local and long-range Impact of anthropogenic and Natural hydrocarbons (BAERLIN2014) campaign was conducted during the 3 summer months (June–August) of 2014. During this measurement campaign, both stationary and mobile measurements were undertaken to address complementary aims. This paper provides an overview of the stationary measurements and results that were focused on characterization of gaseous and particulate pollution, including source attribution, in the Berlin–Potsdam area, and quantification of the role of natural sources in determining levels of ozone and related gaseous pollutants. Results show that biogenic contributions to ozone and particulate matter are substantial. One indicator for ozone formation, the OH reactivity, showed a 31% (0.82±0.44s−1) and 75% (3.7±0.90s−1) contribution from biogenic non-methane volatile organic compounds (NMVOCs) for urban background (2.6±0.68s−1) and urban park (4.9±1.0s−1) location, respectively, emphasizing the importance of such locations as sources of biogenic NMVOCs in urban areas. A comparison to NMVOC measurements made in Berlin approximately 20 years earlier generally show lower levels today for anthropogenic NMVOCs. A substantial contribution of secondary organic and inorganic aerosol to PM10 concentrations was quantified. In addition to secondary aerosols, source apportionment analysis of the organic carbon fraction identified the contribution of biogenic (plant-based) particulate matter, as well as primary contributions from vehicles, with a larger contribution from diesel compared to gasoline vehicles, as well as a relatively small contribution from wood burning, linked to measured levoglucosan