Modelled glacier dynamics over the last quarter of a century at Jakobshavn Isbræ

Observations over the past 2 decades show substantial ice loss associated with the speed-up of marine-terminating glaciers in Greenland. Here we use a regional three-dimensional outlet glacier model to simulate the behaviour of Jakobshavn Isbræ (JI) located in western Greenland. Our approach is to model and understand the recent behaviour of JI with a physical process-based model. Using atmospheric forcing and an ocean parametrization we tune our model to reproduce observed frontal changes of JI during 1990–2014. In our simulations, most of the JI retreat during 1990–2014 is driven by the ocean parametrization used and the glacier's subsequent response, which is largely governed by bed geometry. In general, the study shows significant progress in modelling the temporal variability of the flow at JI. Our results suggest that the overall variability in modelled horizontal velocities is a response to variations in terminus position. The model simulates two major accelerations that are consistent with observations of changes in glacier terminus. The first event occurred in 1998 and was triggered by a retreat of the front and moderate thinning of JI prior to 1998. The second event, which started in 2003 and peaked in the summer 2004, was triggered by the final break-up of the floating tongue. This break-up reduced the buttressing at the JI terminus that resulted in further thinning. As the terminus retreated over a reverse bed slope into deeper water, sustained high velocities over the last decade have been observed at JI. Our model provides evidence that the 1998 and 2003 flow accelerations are most likely initiated by the ocean parametrization used but JI's subsequent dynamic response was governed by its own bed geometry. We are unable to reproduce the observed 2010–2012 terminus retreat in our simulations. We attribute this limitation to either inaccuracies in basal topography or to misrepresentations of the climatic forcings that were applied. Nevertheless, the model is able to simulate the previously observed increase in mass loss through 2014

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)