121 research outputs found
Case report : synergetic effect of ischaemia and increased vagal tone inducing ventricular fibrillation in a patient with Brugada syndrome
Background
Brugada syndrome (BS) is a hereditary channelopathy associated with syncope, malignant ventricular arrhythmia, and sudden cardiac death. Right ventricular ischaemia and BS have similar underlying substrates precipitating ventricular tachycardia or fibrillation (VF).
Case summary
A 72-year-old woman with BS and a stenosis on the proximal right coronary artery received several subsequent implantable cardioverter-defibrillator shocks due to VF during an episode of extreme nausea with vomiting.
Discussion
This case report emphasizes on the synergetic effect of mild ischaemia and increased vagal tone on the substrate responsible for BS to create pathophysiological changes precipitating VF
Methylene Diphenyl Diisocyanate
The report provides the comprehensive risk assessment of the substance Methylenediphenyl diisocyanate (MDI). It has been prepared by Belgium in the frame of Council Regulation (EEC) No. 793/93 on the evaluation and control of the risks of existing substances, following the principles for assessment of the risks to humans and the environment, laid down in Commission Regulation (EC) No. 1488/94.
Part I - Environment
This part of the evaluation considers the emissions and the resulting exposure to the environment in all life cycle steps. Following the exposure assessment, the environmental risk characterisation for each protection goal in the aquatic, terrestrial and atmospheric compartment has been determined. The environmental risk assessment concludes that there is no concern.
Part II ¿ Human Health
This part of the evaluation considers the emissions and the resulting exposure to human populations in all life cycle steps. The scenarios for occupational exposure, consumer exposure and humans exposed via the environment have been examined and the possible risks have been identified. The human health risk assessment concludes that there is concern for workers and consumers with regard to irritation of skin, eye and respiratory tract, skin sensitisation and lung effects induced by repeated inhalation exposure. There is a need for further information and for testing (on hold) on the toxicity for fertility for workers and consumers. For humans exposed via the environment and for human health (physico-chemical properties) there is no concern. The conclusions of this report will lead to risk reduction measures to be proposed by the Commission¿s committee on risk reduction strategies set up in support of Council Regulation (EEC) N. 793/93.JRC.DDG.I.2-Chemical assessment and testin
Characterisations of Europe's integrated water vapour and assessments of atmospheric reanalyses using more than 2 decades of ground-based GPS
The ground-based Global Positioning System (GPS) has been
used extensively to retrieve integrated water vapour (IWV) and has been
adopted as a unique tool for the assessments of atmospheric reanalyses. In
this study, we investigated the multi-temporal-scale variabilities and
trends of IWV over Europe by using IWV time series from 108 GPS stations for more than 2 decades (1994–2018). We then adopted the GPS IWV as a
reference to assess six commonly used atmospheric reanalyses, namely the Climate Forecast System
Reanalysis (CFSR); ERA5; ERA-Interim; the Japanese 55-year Reanalysis
(JRA-55); the Modern-Era Retrospective
Analysis for Research and Applications, version 2 (MERRA-2); and NCEP-DOE AMIP-II Reanalysis (NCEP-2). The GPS results show that the
peaks of the diurnal harmonics are within 15:00–21:00 in local solar time at 90 % of the stations. The diurnal amplitudes are 0–1.2 kg m−2 (0 %–8 % of the daily mean IWV), and they are found to be related to seasons and locations with different mechanisms, such as solar heating, land–sea breeze, and orographic circulation. However, mismatches in the diurnal cycle of ERA5 IWV between 09:00 and 10:00 UTC as well as between 21:00 and 22:00 UTC were found and evaluated for the first time, and they can be attributed to the edge effect in each ERA5 assimilation cycle. The average ERA5 IWV shifts are −0.08 and 0.19 kg m−2 at the two epochs, and they were found
to be more significant in summer and in the Alps and in Eastern and central
Europe in some cases. Nevertheless, ERA5 outperforms the other reanalyses in
reproducing diurnal IWV anomalies at all the 1-, 3-, and 6-hourly temporal
resolutions. ERA5 is also superior to the others in modelling the annual
cycle and linear trend of IWV. For instance, the IWV trend differences
between ERA5 and GPS are quite small, with a mean value and a standard
deviation of 0.01 % per decade and 0.97 % per decade,
respectively. However, due to significant discrepancies with respect to GPS,
CFSR and NCEP-2 are not recommended for the analysis of IWV trends over
southern Europe and the whole of Europe, respectively.</p
Case report: Synergetic effect of ischaemia and increased vagal tone inducing ventricular fibrillation in a patient with Brugada syndrome
Background Brugada syndrome (BS) is a hereditary channelopathy associated with syncope, malignant ventricular arrhythmia,
and sudden cardiac death. Right ventricular ischaemia and BS have similar underlying substrates precipitating ventricular tachycardia or fibrillation (VF). ...................................................................................................................................................................................................
Case summary A 72-year-old woman with BS and a stenosis on the proximal right coronary artery received several subsequent
implantable cardioverter-defibrillator shocks due to VF during an episode of extreme nausea with vomiting. ...................................................................................................................................................................................................
Discussion This case report emphasizes on the synergetic effect of mild ischaemia and increased vagal tone on the substrate
responsible for BS to create pathophysiological changes precipitating VF
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Review of Environmental Monitoring by Means of Radio Waves in the Polar Regions: From Atmosphere to Geospace
The Antarctic and Arctic regions are Earth's open windows to outer space. They provide unique opportunities for investigating the troposphere–thermosphere–ionosphere–plasmasphere system at high latitudes, which is not as well understood as the mid- and low-latitude regions mainly due to the paucity of experimental observations. In addition, different neutral and ionised atmospheric layers at high latitudes are much more variable compared to lower latitudes, and their variability is due to mechanisms not yet fully understood. Fortunately, in this new millennium the observing infrastructure in Antarctica and the Arctic has been growing, thus providing scientists with new opportunities to advance our knowledge on the polar atmosphere and geospace. This review shows that it is of paramount importance to perform integrated, multi-disciplinary research, making use of long-term multi-instrument observations combined with ad hoc measurement campaigns to improve our capability of investigating atmospheric dynamics in the polar regions from the troposphere up to the plasmasphere, as well as the coupling between atmospheric layers. Starting from the state of the art of understanding the polar atmosphere, our survey outlines the roadmap for enhancing scientific investigation of its physical mechanisms and dynamics through the full exploitation of the available infrastructures for radio-based environmental monitoring
Long-term photometric monitoring with the Mercator telescope. Frequencies and multicolour amplitudes of Doradus stars
Gamma Doradus stars are excellent targets for asteroseismology since the
gravity modes present in these stars probe the deep stellar interiors. Mode
identification will improve the knowledge of these stars considerably. A
selected group of Gamma Doradus stars and some candidates were observed with
the Mercator telescope to find and/or confirm the periodicities in the light
variations and to derive reliable amplitude ratios in different pass bands. A
frequency analysis was performed on all new data obtained in the Geneva
photometric system. In order to have more reliable and accurate frequencies,
the new data were combined with similar data from the literature and with
Hipparcos observations. A set of frequencies that minimized the the residuals
in a harmonic fit was searched for while allowing means and amplitudes to vary
from one observation set to another. Frequencies and amplitudes in the
photometric passbands of the Geneva system are given for 21 Gamma Doradus
stars. We report the discovery of HD 74504 as a newly found Gamma Doradus star.
Our study provides the first extensive multicolour database for the
understanding of gravity modes in F-type stars.Comment: Electronic tables (5 to 25) not included in this versio
Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study
Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60\u20131.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14\u20131.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely
Long term photometric monitoring with the Mercator telescope. Frequencies and mode identification of variable O-B stars
Aims. We selected a large sample of O-B stars that were considered as (candidate) slowly pulsating B, beta Cep, and Maia stars after the analysis of their hipparcos data. We analysed our new seven passband geneva data collected for these stars during the first three years of scientific operations of the mercator telescope. We performed a frequency analysis for 28 targets with more than 50 high-quality measurements to improve their variability classification. For the pulsating stars, we tried both to identify the modes and to search for rotationally split modes. Methods: We searched for frequencies in all the geneva passbands and colours by using two independent frequency analysis methods and we applied a 3.6 S/N-level criterion to locate the significant peaks in the periodograms. The modes were identified by applying the method of photometric amplitudes for which we calculated a large, homogeneous grid of equilibrium models to perform a pulsational stability analysis. When both the radius and the projected rotational velocity of an object are known, we determined a lower limit for the rotation frequency to estimate the expected frequency spacings in rotationally split pulsation modes. Results: We detected 61 frequencies, among which 33 are new. We classified 21 objects as pulsating variables (7 new confirmed pulsating stars, including 2 hybrid beta Cep/SPB stars), 6 as non-pulsating variables (binaries or spotted stars), and 1 as photometrically constant. All the Maia candidates were reclassified into other variability classes. We performed mode identification for the pulsating variables for the first time. The most probable l value is 0, 1, 2, and 4 for 1, 31, 9, and 5 modes, respectively, including only 4 unambiguous identifications. For 7 stars we cannot rule out that some of the observed frequencies belong to the same rotationally split mode. For 4 targets we may begin to resolve close frequency multiplets. Based on observations collected with the p7 photometer attached to the Flemish 1.2-m mercator telescope situated at the Roque de los Muchachos observatory on La Palma (Spain). Section [see full textsee full text], including Figs. is only available in electronic form at http://www.aanda.org, and Tables 2 and 3 are only available in electronic form at the CDS via anonymous ftp to cdsarc.u-strasbg.fr (130.79.128.5) or via http://cdsweb.u-strasbg.fr/cgi-bin/qcat?J/A+A/463/243Peer reviewe
Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA
Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods: In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis. Results: Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former. Conclusion: Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life
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