Changes in snow cover dynamics over the Indus Basin: evidences from 2008 to 2018 MODIS NDSI trends analysis

The frozen water reserves on the Earth are not only very dynamic in their nature, but also have significant effects on hydrological response of complex and dynamic river basins. The Indus basin is one of the most complex river basins in the world and receives most of its share from the Asian Water Tower (Himalayas). In such a huge river basin with high-altitude mountains, the regular quantification of snow cover is a great challenge to researchers for the management of downstream ecosystems. In this study, Moderate Resolution Imaging Spectroradiometer (MODIS) daily (MOD09GA) and 8-day (MOD09A1) products were used for the spatiotemporal quantification of snow cover over the Indus basin and the western rivers’ catchments from 2008 to 2018. The high-resolution Landsat Enhanced Thematic Mapper Plus (ETM+) was used as a standard product with a minimum Normalized Difference Snow Index (NDSI) threshold (0.4) to delineate the snow cover for 120 scenes over the Indus basin on different days. All types of errors of commission/omission were masked out using water, sand, cloud, and forest masks at different spatiotemporal resolutions. The snow cover comparison of MODIS products with Landsat ETM+, in situ snow data and Google Earth imagery indicated that the minimum NDSI threshold of 0.34 fits well compared to the globally accepted threshold of 0.4 due to the coarser resolution of MODIS products. The intercomparison of the time series snow cover area of MODIS products indicated R2 values of 0.96, 0.95, 0.97, 0.96 and 0.98, for the Chenab, Jhelum, Indus and eastern rivers’ catchments and Indus basin, respectively. A linear least squares regression analysis of the snow cover area of the Indus basin indicated a declining trend of about 3358 and 2459 km2 per year for MOD09A1 and MOD09GA products, respectively. The results also revealed a decrease in snow cover area over all the parts of the Indus basin and its sub-catchments. Our results suggest that MODIS time series NDSI analysis is a useful technique to estimate snow cover over the mountainous areas of complex river basins

GHz sample excitation at the ALBA-PEEM

We describe a setup that is used for high-frequency electrical sample excitation in a cathode lens electron microscope with the sample stage at high voltage as used in many synchrotron light sources. Electrical signals are transmitted by dedicated high-frequency components to the printed circuit board supporting the sample. Sub-miniature push-on connectors (SMP) are used to realize the connection in the ultra-high vacuum chamber, bypassing the standard feedthrough. A bandwidth up to 4 GHz with -6 dB attenuation was measured at the sample position, which allows to apply sub-nanosecond pulses. We describe different electronic sample excitation schemes and demonstrate a spatial resolution of 56 nm employing the new setup

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807)