Form and function in hillslope hydrology : Characterization of subsurface flow based on response observations

The phrase form and function was established in architecture and biology and refers to the idea that form and functionality are closely correlated, influence each other, and co-evolve. We suggest transferring this idea to hydrological systems to separate and analyze their two main characteristics: their form, which is equivalent to the spatial structure and static properties, and their function, equivalent to internal responses and hydrological behavior. While this approach is not particularly new to hydrological field research, we want to employ this concept to explicitly pursue the question of what information is most advantageous to understand a hydrological system. We applied this concept to subsurface flow within a hillslope, with a methodological focus on function: we conducted observations during a natural storm event and followed this with a hillslope-scale irrigation experiment. The results are used to infer hydrological processes of the monitored system. Based on these findings, the explanatory power and conclusiveness of the data are discussed. The measurements included basic hydrological monitoring methods, like piezometers, soil moisture, and discharge measurements. These were accompanied by isotope sampling and a novel application of 2-D time-lapse GPR (ground-penetrating radar). The main finding regarding the processes in the hillslope was that preferential flow paths were established quickly, despite unsaturated conditions. These flow paths also caused a detectable signal in the catchment response following a natural rainfall event, showing that these processes are relevant also at the catchment scale. Thus, we conclude that response observations (dynamics and patterns, i.e., indicators of function) were well suited to describing processes at the observational scale. Especially the use of 2-D time-lapse GPR measurements, providing detailed subsurface response patterns, as well as the combination of stream-centered and hillslope-centered approaches, allowed us to link processes and put them in a larger context. Transfer to other scales beyond observational scale and generalizations, however, rely on the knowledge of structures (form) and remain speculative. The complementary approach with a methodological focus on form (i.e., structure exploration) is presented and discussed in the companion paper by Jackisch et al.(2017)

A novel citrate-based protocol versus heparin anticoagulation for sustained low-efficiency dialysis in the ICU: safety, efficacy, and cost

Abstract Background The high cost, complexity of the available protocols, and metabolic complications are the major barriers that impede the clinical utilization of regional citrate anticoagulation (RCA) for sustained low efficiency dialysis (SLED) in critically ill patients. By comparing a novel protocol for SLED using 30% citrate solution with common protocol using unfractionated heparin, this study aimed to provide new insights for clinical applications of RCA. Methods In this retrospective study, a total of 282 critically ill patients who underwent SLED with citrate and/or heparin anticoagulation in six adult ICUs were enrolled. These patients were divided into three groups based on the anticoagulation regimens they had received during the treatment in ICU: Group 1 (Citrate) had only received treatment with citrate anticoagulation (n=75); Group 2 (Heparin) only with heparin anticoagulation (n=79); and Group 3 (Both) with both citrate and heparin anticoagulation (n=128). We compared the mortality, metabolic complications as well as cost among these groups using different anticoagulation regimens. Results The in-hospital mortality did not significantly differ among groups (p> 0.1). However, three patients in heparin group suffered from severe bleeding which led to death, while none in citrate group. Overall, 976 SLED sessions with heparin anticoagulation and 808 with citrate were analyzed. The incidence of extracorporeal circuit clotting was significantly less in citrate (5%), as compared to that in heparin (10%) (p< 0.001). Metabolic complications and hypotension which led to interruption of SLED occurred more frequently, though not significantly, in citrate (p= 0.06, p= 0.23). Furthermore, with 30% citrate solution, the cost of anticoagulant was reduced by 70% in comparison to previously reported protocol using Acid Citrate Dextrose solution A (ACD-A). Conclusions Our results indicated that anticoagulation regimens for SLED did not significantly affect the mortality of patients. Citrate anticoagulation was superior to heparin in preventing severe bleeding and circuit clotting. The protocol adopted in this study using 30% citrate solution was safe as well as efficacious. In the meantime, it was much more cost-efficient than other citrate-based protocol

Dysregulation of COVID-19 related gene expression in the COPD lung

Background: chronic obstructive pulmonary disease (COPD) patients are at increased risk of poor outcome from COVID-19. Early data suggest increased expression of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) receptor angiotensin converting enzyme 2 (ACE2), but relationships to disease phenotype and downstream regulators of inflammation in the Renin-Angiotensin system (RAS) are unknown. To determine the relationship between RAS gene expression relevant to SARS-CoV-2 infection in the lung and relationship to disease characteristics in COPD.Methods: we quantified gene expression using RNA sequencing of epithelial brushings and bronchial biopsies from 31 COPD and 37 control subjects.Results: ACE2 gene expression (log2-fold change (FC)) was increased in COPD compared to ex-smoking (HV-ES) controls in epithelial brushings (0.25, p=0.042) and biopsies (0.23, p=0.050), and correlated with worse lung function (r=-0.28, p=0.0090). Angiotensin converting enzyme 2 (ACE2) was further increased in frequent exacerbators compared to infrequent exacerbators (0.51, p=0.00045). Increased ACE2 expression also associated with use of ACE inhibitors (ACEi) (0.50, p=0.0034) and having cardiovascular disease (0.23, p=0.048) or hypertension (0.34, p=0.0089) and inhaled corticosteroid use in COPD subjects in biopsies (0.33, p=0.049). Angiotensin II receptor type (AGTR)1 and 2 expression was decreased in COPD biopsies compared to HV-ES controls with log2FC of –0.26 (p=0.033) and -0.40, (p=0.0010), respectively. However, the AGTR1:2 ratio was increased in COPD subjects compared with HV-ES controls, log2FC of 0.57 (p=0.0051).Conclusion: this analysis reveals the potential mechanisms driving susceptibility to SARS-CoV-2 infection and inflammation associated with severe COVID-19 seen in COPD. Extension of this approach to other viruses may lead to opportunities for therapeutic development to improve outcomes in the pandemic and beyond

Multiomics links global surfactant dysregulation with airflow obstruction and emphysema in COPD

RationalePulmonary surfactant is vital for lung homeostasis as it reduces surface tension to prevent alveolar collapse and provides essential immune-regulatory and anti-pathogenic functions. Previous studies demonstrated dysregulation of some individual surfactant components in COPD.ObjectivesWe investigated relationships between COPD disease measures and dysregulation of surfactant components to gain new insights about potential disease mechanisms.MethodsBronchoalveolar lavage proteome and lipidome were characterised in ex-smoking mild/moderate COPD subjects (n=26) and healthy ex-smoking (n=20) and never-smoking (n=16) controls using mass spectrometry. Serum surfactant protein analysis was performed.ResultsTotal phosphatidylcholine, phosphatidylglycerol, phosphatidylinositol and surfactant protein (SP)-B, SP-A and SP-D concentrations were lower, COPD vs. controls, log2 fold change (log2FC)=-2.0, -2.2, -1.5, -0.5, -0.7, -0.5 (adj. p-value&lt;0.02), respectively, and correlated with lung function. Total phosphatidylcholine, phosphatidylglycerol, phosphatidylinositol and SP-A, SP-B, SP-D, NAPSA and CD44 inversely correlated with CT small airways disease measures (E/I MLD), r=-0.56, r=-0.58, r=-0.45, r=-0.36, r=-0.44, r=-0.37, r=-0.40, r=-0.39 (adj. p- value&lt;0.05). Total phosphatidylcholine, phosphatidylglycerol, phosphatidylinositol and SP-A, SP-B, SP-D and NAPSA inversely correlated with emphysema (%LAA): r=-0.55, r=-0.61, r=-0.48,135 r=-0.51, r=-0.41, r=-0.31, r=-0.34, respectively (adj. p-value&lt;0.05). Neutrophil elastase, known to degrade SP-A and SP-D, was elevated, COPD vs. controls, log2FC of 0.40 (adj. p-value=0.0390) and inversely correlated with SP-A and SP-D. Serum SP-D was increased in COPD vs. HV-ES, and predicted COPD status, AUC=0.85.ConclusionsUsing a multiomics approach we, for the first time, demonstrate global surfactant dysregulation in COPD which was associated with emphysema giving new insights about potential mechanisms underlying the cause or consequence of disease

Philips Oy Healthcaren asiakaspalveluprosessin kehittäminen

Tämän insinöörityön aiheena on parantaa Philips Oy Healthcaren asiakaspalveluprosessia. Työn aiheeseen kuuluu vain pelkästään Suomessa palvelevaa Healthcaren osastoa. Työn tavoitteena oli parantaa Philips Oy Healthcaren asiakaspalveluprosessia työntekijöiden näkökulmasta, koska Philipsin johto näki siinä eniten parannettavaa. Tämän insinöörityön tutkimusmenetelmä oli laadullinen tutkimus, jolloin kaikkia Philips Oy Healthcaren asiakaspalvelijoita haastateltiin sekä myynnin että huollon puolelta. Haastateltavia oli yhteensä kuusi kappaletta ja heitä haastateltiin henkilökohtaisesti. Haastatteluista tehtyjen johtopäätöksien mukaan työtehtävät olivat erittäin epäselkeät. Tämän lisäksi puhelinrinkiin ei saatu sitovuutta ja sähköpostien hoitamisessa oli myös suuria vaikeuksia. Tutkimuksen tulokseksi saatiin uusi prosessikuvaus asiakaspalveluprosessiin, jossa on selitetty eri vaiheet ja tapahtumajärjestykset mahdollisimman selkeästi sekä ratkaisut sähköpostiin ja puhelinrinkiin. Tutkimustulosta eli prosessikuvaus annetaan työntekijöille työtehtävien selkeyttämiseksi, jolloin suurin hyöty aiheutuu työntekijöille työskennellessä