Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The potential for geostationary remote sensing of NO2 to improve weather prediction

Observations of winds in the planetary boundary layer remain sparse making it challenging to simulate and predict atmospheric conditions that are most important for describing and predicting urban air quality. Short-lived chemicals are observed as plumes whose location is affected by boundary layer winds and whose lifetime is affected by boundary layer height and mixing. Here we investigate the application of data assimilation of NO2 columns as will be observed from geostationary orbit to improve predictions and retrospective analysis of wind fields in the boundary layer

Assimilation of satellite NO2 observations at high spatial resolution using OSSEs

Observations of trace gases from space-based instruments offer the opportunity to constrain chemical and weather forecast and reanalysis models using the tools of data assimilation. In this study, observing system simulation experiments (OSSEs) are performed to investigate the potential of high space- and time-resolution column measurements as constraints on urban NOx emissions. The regional chemistry-meteorology assimilation system where meteorology and chemical variables are simultaneously assimilated is comprised of a chemical transport model, WRF-Chem, the Data Assimilation Research Testbed, and a geostationary observation simulator. We design OSSEs to investigate the sensitivity of emission inversions to the accuracy and uncertainty of the wind analyses and the emission updating scheme. We describe the overall model framework and some initial experiments that point out the first steps toward an optimal configuration for improving our understanding of NOx emissions by combining space-based measurements and data assimilation. Among the findings we describe is the dependence of errors in the estimated NOx emissions on the wind forecast errors, showing that wind vectors with a RMSE below 1 m s-1 allow inference of NOx emissions with a RMSE of less than 30 mol/(km2 × h) at the 3 km scale of the model we use. We demonstrate that our inference of emissions is more accurate when we simultaneously update both NOx emissions and NOx concentrations instead of solely updating emissions. Furthermore, based on our analyses, we recommend carrying out meteorology assimilations to stabilize NO2 transport from the initial wind errors before starting the emission assimilation. We show that wind uncertainties (calculated as a spread around a mean wind) are not important for estimating NOx emissions when the wind uncertainties are reduced below 1.5 m s-1. Finally, we present results assessing the role of separate vs. simultaneous chemical and meteorological assimilation in a model framework without covariance between the meteorology and chemistry

The impact of the absence of aliphatic glucosinolates on insect herbivory in Arabidopsis

Aliphatic glucosinolates are compounds which occur in high concentrations in Arabidopsis thaliana and other Brassicaceae species. They are important for the resistance of the plant to pest insects. Previously, the biosynthesis of these compounds was shown to be regulated by transcription factors MYB28 and MYB29. We now show that MYB28 and MYB29 are partially redundant, but in the absence of both, the synthesis of all aliphatic glucosinolates is blocked. Untargeted and targeted biochemical analyses of leaf metabolites showed that differences between single and double knock-out mutants and wild type plants were restricted to glucosinolates. Biosynthesis of long-chain aliphatic glucosinolates was blocked by the myb28 mutation, while short-chain aliphatic glucosinolates were reduced by about 50% in both the myb28 and the myb29 single mutants. Most remarkably, all aliphatic glucosinolates were completely absent in the double mutant. Expression of glucosinolate biosynthetic genes was slightly but significantly reduced by the single myb mutations, while the double mutation resulted in a drastic decrease in expression of these genes. Since the myb28myb29 double mutant is the first Arabidopsis genotype without any aliphatic glucosinolates, we used it to establish the relevance of aliphatic glucosinolate biosynthesis to herbivory by larvae of the lepidopteran insect Mamestra brassicae. Plant damage correlated inversely to the levels of aliphatic glucosinolates observed in those plants: Larval weight gain was 2.6 fold higher on the double myb28myb29 mutant completely lacking aliphatic glucosinolates and 1.8 higher on the single mutants with intermediate levels of aliphatic glucosinolates compared to wild type plants