Climate significance of stable isotope records from Alpine ice cores

Tiefenprofile der stabilen Wasserisotopomere (d18O und dD) dreier tiefer Eisbohrkerne vom Monte Rosa Massiv (Schweizer Alpen) wurden im Hinblick auf möglicherweise aufgezeichnete Temperatursignale ausgewertet. Durch eine neuartige Methode der Wasserreduktion sind On-line dD Messungen mit einer Genauigkeit von 0.7 ‰ möglich. Upstream-Effekte in den d18O Profilen, abgeschätzt aus der gegenwärtigen Zusammensetzung der Gletscheroberfläche und modellierten Rückwärtstrajektorien, können die Trends des 20. Jahrhunderts um einen Faktor drei vermindern. Der Vergleich von d18O Profilen mit instrumentellen Sommertemperaturen über 240 Jahre zeigt, daß Temperaturtrends über eine Zeitskala von Jahrzehnten bis Jahrhunderten übereinstimmend aufgezeichnet sind, wobei die Empfindlichkeit Dd18O/DT etwa bei 1.7 ‰/°C liegt. Die derzeitigen mehrjährigen Mittel der Isotopentemperatur sind mit die wärmsten innerhalb des vergangenen Jahrtausends. Das beispiellose Temperaturminimum um 1340 A.D. weist um mehr als 1°C niedrigere mehrjährige Mittel der Isotopentemperatur auf. Alle drei Kerne zeigen eine isotopisch leichte basale Schicht. Im Gegensatz zu der bisherigen Annahme ihres eiszeitlichen Ursprungs wird eine neue Theorie aufgestellt, welche diese Signale als Folge der schnelleren Eisdeformation in Felsbettnähe erklärt

Effect of Hospital and Surgeon Case Volume on Perioperative Quality of Care and Short-term Outcomes After Radical Cystectomy for Muscle-invasive Bladder Cancer: Results From a European Tertiary Care Center Cohort

This prospective multicenter study analyzed the effect of hospital and surgeon case volume on perioperative quality of care and short-term complications and mortality in 479 patients undergoing radical cystectomy for bladder cancer. We found that hospital volume might represent an at least equally important factor regarding postoperative complications as the surgeon case volume itself at European tertiary care centers. Background Case volume has been suggested to affect surgical outcomes in different arrays of procedures. We aimed to delineate the relationship between case volume and surgical outcomes and quality of care criteria of radical cystectomy (RC) in a prospectively collected multicenter cohort. Patients and Methods This was a retrospective analysis of a prospectively collected European cohort of patients with bladder cancer treated with RC in 2011. We relied on 479 and 459 eligible patients with available information on hospital case volume and surgeon case volume, respectively. Hospital case volume was divided into tertiles, and surgeon volume was dichotomized according to the median annual number of surgeries performed. Binomial generalized estimating equations controlling for potential known confounders and inter-hospital clustering assessed the independent association of case volume with short-term complications and mortality, as well as the fulfillment of quality of care criteria. Results The high-volume threshold for hospitals was 45 RCs and, for high-volume surgeons, was > 15 cases annually. In adjusted analyses, high hospital volume remained an independent predictor of fewer 30-day (odds ratio, 0.34; P = .002) and 60- to 90-day (odds ratio, 0.41; P = .03) major complications but not of fulfilling quality of care criteria or mortality. No difference between surgeon volume groups was noted for complications, quality of care criteria, or mortality after adjustments. Conclusion The coordination of care at high-volume hospitals might confer a similar important factor in postoperative outcomes as surgeon case volume in RC. This points to organizational elements in high-volume hospitals that enable them to react more appropriately to adverse events after surgery. (C) 2017 Elsevier Inc. All rights reserved