sensitivity of the mediterranean sea level to atmospheric pressure and free surface elevation numerical formulation in nemo

Abstract. The sensitivity of the dynamics of the Mediterranean Sea to atmospheric pressure and free surface elevation formulation using NEMO (Nucleus for European Modelling of the Ocean) was evaluated. Four different experiments were carried out in the Mediterranean Sea using filtered or explicit free surface numerical schemes and accounting for the effect of atmospheric pressure in addition to wind and buoyancy fluxes. Model results were evaluated by coherency and power spectrum analysis with tide gauge data. We found that atmospheric pressure plays an important role for periods shorter than 100 days. The free surface formulation is important to obtain the correct ocean response for periods shorter than 30 days. At frequencies higher than 15 days−1 the Mediterranean basin's response to atmospheric pressure was not coherent and the performance of the model strongly depended on the specific area considered. A large-amplitude seasonal oscillation observed in the experiments using a filtered free surface was not evident in the corresponding explicit free surface formulation case, which was due to a phase shift between mass fluxes in the Gibraltar Strait and at the surface. The configuration with time splitting and atmospheric pressure always performed best; the differences were enhanced at very high frequencies

Clinical neurophysiological assessment of sepsis-associated brain dysfunction: a systematic review.

IntroductionSeveral studies have reported the presence of electroencephalography (EEG) abnormalities or altered evoked potentials (EPs) during sepsis. However, the role of these tests in the diagnosis and prognostic assessment of sepsis-associated encephalopathy remains unclear.MethodsWe performed a systematic search for studies evaluating EEG and/or EPs in adult (¿18 years) patients with sepsis-associated encephalopathy. The following outcomes were extracted: a) incidence of EEG/EP abnormalities; b) diagnosis of sepsis-associated delirium or encephalopathy with EEG/EP; c) outcome.ResultsAmong 1976 citations, 17 articles met the inclusion criteria. The incidence of EEG abnormalities during sepsis ranged from 12% to 100% for background abnormality and 6% to 12% for presence of triphasic waves. Two studies found that epileptiform discharges and electrographic seizures were more common in critically ill patients with than without sepsis. In one study, EEG background abnormalities were related to the presence and the severity of encephalopathy. Background slowing or suppression and the presence of triphasic waves were also associated with higher mortality. A few studies demonstrated that quantitative EEG analysis and EP could show significant differences in patients with sepsis compared to controls but their association with encephalopathy and outcome was not evaluated.ConclusionsAbnormalities in EEG and EPs are present in the majority of septic patients. There is some evidence to support EEG use in the detection and prognostication of sepsis-associated encephalopathy, but further clinical investigation is needed to confirm this suggestion

The Adriatic Basin Forecasting System: new model and system development

The Adriatic Basin Forecasting System implemented within the framework of the ADRICOSM Partnership (ADRIatic sea integrated COstal areaS and river basin Management system), nested to the operational general circulation model of the Mediterranean Sea, has recently been upgraded both in terms of system design and model parameterizations. The operational forecast is now daily, producing 9 days forecast, and a new near real time quality control has been introduced. From the modeling point of view the system has been upgraded in resolution (vertically from 21 to 31 sigma levels, and horizontally from approximately 1/22° to approximately 1/45°). Realistic fresh water fluxes have been introduced through the surface boundary condition taking into account evaporation, precipitation and river runoff, and the Smolarckiwicz advection scheme has been changed to the MUSCL scheme. The details of these developments will be presented, together with the model validation in delayed and real time mod

A nested Atlantic-Mediterranean Sea general circulation model for operational forecasting

A new numerical general circulation ocean model for the Mediterranean Sea has been implemented nested within an Atlantic general circulation model within the framework of the Marine Environment and Security for the European Area project (MERSEA, Desaubies, 2006). A 4- year twin experiment was carried out from January 2004 to December 2007 with two different models to evaluate the impact on the Mediterranean Sea circulation of open lateral boundary conditions in the Atlantic Ocean. One model considers a closed lateral boundary in a large Atlantic box and the other is nested in the same box in a global ocean circulation model. Impact was observed comparing the two simulations with independent observations: ARGO for temperature and salinity profiles and tide gauges and along-track satellite observations for the sea surface height. The improvement in the nested Atlantic-Mediterranean model with respect to the closed one is particularly evident in the salinity characteristics of the Modified Atlantic Water and in the Mediterranean sea level seasonal variability

Assimilation of SLA along track observations in the Mediterranean with an oceanographic model forced by atmospheric pressure

A large number of SLA observations at a high along track horizontal resolution are an important ingredient of the data assimilation in the Mediterranean Forecasting System (MFS). Recently, new higher-frequency SLA products have become available, and the atmospheric pressure forcing has been implemented in the numerical model used in the MFS data assimilation system. In a set of numerical experiments, we show that, in order to obtain the most accurate analyses, the ocean model should include the atmospheric pressure forcing and the observations should contain the atmospheric pressure signal. When the model is not forced by the atmospheric pressure, the high-frequency filtering of SLA observations, however, improves the quality of the SLA analyses. It is further shown by comparing the power density spectra of the model fields and observations that the model is able to extract the correct information from noisy observations even without their filtering during the pre-processing

Cytokine hemoadsorption with CytoSorb^® in post-cardiac arrest syndrome, a pilot randomized controlled trial.

Hemoadsorption (HA) might mitigate the systemic inflammatory response associated with post-cardiac arrest syndrome (PCAS) and improve outcomes. Here, we investigated the feasibility, safety and efficacy of HA with CytoSorb <sup>®</sup> in cardiac arrest (CA) survivors at risk of PCAS. In this pilot randomized controlled trial, we included patients admitted to our intensive care unit following CA and likely to develop PCAS: required norepinephrine (> 0.2 µg/kg/min), and/or had serum lactate > 6 mmol/l and/or a time-to-return of spontaneous circulation (ROSC) > 25 min. Those requiring ECMO or renal replacement therapy were excluded. Eligible patients were randomly allocated to either receive standard of care (SOC) or SOC plus HA. Hemoadsorption was performed as stand-alone therapy for 24 h, using CytoSorb <sup>®</sup> and regional heparin-protamine anticoagulation. We collected feasibility, safety and clinical data as well as serial plasma cytokines levels within 72 h of randomization. We enrolled 21 patients, of whom 16 (76%) had out-of-hospital CA. Median (IQR) time-to-ROSC was 30 (20, 45) minutes. Ten were assigned to the HA group and 11 to the SOC group. Hemoadsorption was initiated in all patients allocated to the HA group within 18 (11, 23) h of ICU admission and conducted for a median duration of 21 (14, 24) h. The intervention was well tolerated except for a trend for a higher rate of aPTT elevation (5 (50%) vs 2 (18%) p = 0.18) and mild (100-150 G/L) thrombocytopenia at day 1 (5 (50%) vs 2 (18%) p = 0.18). Interleukin (IL)-6 plasma levels at randomization were low (< 100 pg/mL) in 10 (48%) patients and elevated (> 1000 pg/mL) in 6 (29%). The median relative reduction in IL-6 at 48 h was 75% (60, 94) in the HA group versus 5% (- 47, 70) in the SOC group (p = 0.06). In CA survivors at risk of PCAS, HA was feasible, safe and was associated with a nonsignificant reduction in cytokine plasma levels. Future trials are needed to further define the role of HA after CA. Those studies should include cytokine assessment to enrich the study population. NCT03523039, registered 14 May 2018

Sensitivity of the Mediterranean sea level to atmospheric pressure and free surface elevation numerical formulation in NEMO

The sensitivity of the dynamics of the Mediterranean Sea to atmospheric pressure and free surface elevation formulation using NEMO (Nucleus for European Modelling of the Ocean) was evaluated. Four different experiments were carried out in the Mediterranean Sea using filtered or explicit free surface numerical schemes and accounting for the effect of atmospheric pressure in addition to wind and buoyancy fluxes. Model results were evaluated by coherency and power spectrum analysis with tide gauge data. We found that atmospheric pressure plays an important role for periods shorter than 100 days. The free surface formulation is important to obtain the correct ocean response for periods shorter than 30 days. At frequencies higher than 15 days−1 the Mediterranean basin's response to atmospheric pressure was not coherent and the performance of the model strongly depended on the specific area considered. A large-amplitude seasonal oscillation observed in the experiments using a filtered free surface was not evident in the corresponding explicit free surface formulation case, which was due to a phase shift between mass fluxes in the Gibraltar Strait and at the surface. The configuration with time splitting and atmospheric pressure always performed best; the differences were enhanced at very high frequencies

Perception of Time-Discrete Haptic Feedback on the Waist is Invariant with Gait Events

The effectiveness of haptic feedback devices highly depends on the perception of tactile stimuli, which differs across body parts and can be affected by movement. In this study, a novel wearable sensory feedback apparatus made of a pair of pressure-sensitive insoles and a belt equipped with vibrotactile units is presented; the device provides time-discrete vibrations around the waist, synchronized with biomechanically-relevant gait events during walking. Experiments with fifteen healthy volunteers were carried out to investigate users' tactile perception on the waist. Stimuli of different intensities were provided at twelve locations, each time synchronously with one pre-defined gait event (i.e. heel strike, flat foot or toe off), following a pseudo-random stimulation sequence. Reaction time, detection rate and localization accuracy were analyzed as functions of the stimulation level and site and the effect of gait events on perception was investigated. Results revealed that above-threshold stimuli (i.e. vibrations characterized by acceleration amplitudes of 1.92g and 2.13g and frequencies of 100 Hz and 150 Hz, respectively) can be effectively perceived in all the sites and successfully localized when the intertactor spacing is set to 10 cm. Moreover, it was found that perception of time-discrete vibrations was not affected by phase-related gating mechanisms, suggesting that the waist could be considered as a preferred body region for delivering haptic feedback during walking

Characterization, mechanism of action and optimization of activity of a novel peptide-peptoid hybrid against bacterial pathogens involved in canine skin infections

Integumentary infections like pyoderma represent the main reason for antimicrobial prescription in dogs. Staphylococcus pseudintermedius and Pseudomonas aeruginosa are frequently identified in these infections, and both bacteria are challenging to combat due to resistance. To avoid use of important human antibiotics for treatment of animal infections there is a pressing need for novel narrow-spectrum antimicrobial agents in veterinary medicine. Herein, we characterize the in vitro activity of the novel peptide-peptoid hybrid B1 against canine isolates of S. pseudintermedius and P. aeruginosa. B1 showed potent minimum inhibitory concentrations (MICs) against canine S. pseudintermedius and P. aeruginosa isolates as well rapid killing kinetics. B1 was found to disrupt the membrane integrity and affect cell-wall synthesis in methicillin-resistant S. pseudintermedius (MRSP). We generated 28 analogues of B1, showing comparable haemolysis and MICs against MRSP and P. aeruginosa. The most active analogues (23, 26) and B1 were tested against a collection of clinical isolates from canine, of which only B1 showed potent activity. Our best compound 26, displayed activity against P. aeruginosa and S. pseudintermedius, but not the closely related S. aureus. This work shows that design of target-specific veterinary antimicrobial agents is possible, even species within a genus, and deserves further exploration

Electroencephalography Predicts Poor and Good Outcomes After Cardiac Arrest: A Two-Center Study.

The prognostic role of electroencephalography during and after targeted temperature management in postcardiac arrest patients, relatively to other predictors, is incompletely known. We assessed performances of electroencephalography during and after targeted temperature management toward good and poor outcomes, along with other recognized predictors. Cohort study (April 2009 to March 2016). Two academic hospitals (Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Mayo Clinic, Rochester, MN). Consecutive comatose adults admitted after cardiac arrest, identified through prospective registries. All patients were managed with targeted temperature management, receiving prespecified standardized clinical, neurophysiologic (particularly, electroencephalography during and after targeted temperature management), and biochemical evaluations. We assessed electroencephalography variables (reactivity, continuity, epileptiform features, and prespecified "benign" or "highly malignant" patterns based on the American Clinical Neurophysiology Society nomenclature) and other clinical, neurophysiologic (somatosensory-evoked potential), and biochemical prognosticators. Good outcome (Cerebral Performance Categories 1 and 2) and mortality predictions at 3 months were calculated. Among 357 patients, early electroencephalography reactivity and continuity and flexor or better motor reaction had greater than 70% positive predictive value for good outcome; reactivity (80.4%; 95% CI, 75.9-84.4%) and motor response (80.1%; 95% CI, 75.6-84.1%) had highest accuracy. Early benign electroencephalography heralded good outcome in 86.2% (95% CI, 79.8-91.1%). False positive rates for mortality were less than 5% for epileptiform or nonreactive early electroencephalography, nonreactive late electroencephalography, absent somatosensory-evoked potential, absent pupillary or corneal reflexes, presence of myoclonus, and neuron-specific enolase greater than 75 µg/L; accuracy was highest for early electroencephalography reactivity (86.6%; 95% CI, 82.6-90.0). Early highly malignant electroencephalography had an false positive rate of 1.5% with accuracy of 85.7% (95% CI, 81.7-89.2%). This study provides class III evidence that electroencephalography reactivity predicts both poor and good outcomes, and motor reaction good outcome after cardiac arrest. Electroencephalography reactivity seems to be the best discriminator between good and poor outcomes. Standardized electroencephalography interpretation seems to predict both conditions during and after targeted temperature management