The Role of Birds of Prey in West Nile Virus Epidemiology

Reported human cases of West Nile virus (WNV) in Europe increased dramatically in 2018. Lineage 1 strains had been circulating in Euro-Mediterranean countries since the early 1990s. The subsequent introduction of WNV lineage 2 has been responsible for the remarkable upsurge of European WNV outbreaks since 2004, including the dramatic increase in human cases observed since 2018. The virus exists in a natural cycle between mosquitoes and wild birds, with humans and horses acting as dead-end hosts. As the key vertebrate hosts in the transmission cycle of WNV, avian species have been the focus of surveillance across many countries. Raptors appear particularly susceptible to WNV infection, resulting in higher prevalence, and in some cases exhibiting neurological signs that lead to the death of the animal. In addition, birds of prey are known to play an important role as WNV reservoir and potentially amplifying hosts of infection. Importantly, raptor higher susceptibility/prevalence may indicate infection through predation of infected prey. Consequently, they are considered important target species when designing cost-effective surveillance for monitoring both seasonal WNV circulation in endemic countries and its emergence into new areas, where migrating raptors may play a critical role in virus introduction. This review summarizes the different aspects of the current knowledge of WNV infection in birds of prey and evaluates their role in the evolution of the epizootic that is spreading throughout Europe

Digital Transformation

The amount of literature on Digital Transformation is staggering—and it keeps growing. Why, then, come out with yet another such document? Moreover, any text aiming at explaining the Digital Transformation by presenting a snapshot is going to become obsolete in a blink of an eye, most likely to be already obsolete at the time it is first published. The FDC Initiative on Digital Reality felt there is a need to look at the Digital Transformation from the point of view of a profound change that is pervading the entire society—a change made possible by technology and that keeps changing due to technology evolution opening new possibilities but is also a change happening because it has strong economic reasons. The direction of this change is not easy to predict because it is steered by a cultural evolution of society, an evolution that is happening in niches and that may expand rapidly to larger constituencies and as rapidly may fade away. This creation, selection by experimentation, adoption, and sudden disappearance, is what makes the whole scenario so unpredictable and continuously changing.The amount of literature on Digital Transformation is staggering—and it keeps growing. Why, then, come out with yet another such document? Moreover, any text aiming at explaining the Digital Transformation by presenting a snapshot is going to become obsolete in a blink of an eye, most likely to be already obsolete at the time it is first published. The FDC Initiative on Digital Reality felt there is a need to look at the Digital Transformation from the point of view of a profound change that is pervading the entire society—a change made possible by technology and that keeps changing due to technology evolution opening new possibilities but is also a change happening because it has strong economic reasons. The direction of this change is not easy to predict because it is steered by a cultural evolution of society, an evolution that is happening in niches and that may expand rapidly to larger constituencies and as rapidly may fade away. This creation, selection by experimentation, adoption, and sudden disappearance, is what makes the whole scenario so unpredictable and continuously changing

Digital Reality Technology, Challenges, and Human Factors

This chapter explores the concept of Digital Reality by reviewing its fundamentals including its history, technological components, and current trends. It discusses the broader components of a Digital Reality project and goes beyond the technological components by including business factors and related considerations. The chapter also identifies and discusses common challenges, examples of practical solutions and presents a generalized framework for how to approach Digital Reality projects. This includes how to manage the project, a summary of good practices, and key recommendations. Multiple examples are presented with use cases drawn from different disciplines. The chapter concludes with a summary of IEEE’s Digital Reality Exchange and the role it can play in Digital Reality projects

Liver resection surgery versus thermal ablation for colorectal LiVer MetAstases (LAVA):study protocol for a randomised controlled trial

Background: Although surgical resection has been considered the only curative option for colorectal liver metastases (CLM), thermal ablation has recently been suggested as an alternative curative treatment. A prospective randomised trial is required to define the efficacy of resection vs ablation for the treatment of colorectal liver metastases. Methods: Design and setting: This is a multicentre, open, randomised controlled non-inferiority trial design with internal pilot and will be performed in tertiary liver centres in UK and The Netherlands. Participants: Eligible patients will be those with colorectal liver metastases at high surgical risk because of their age, co-morbidities or tumour burden and who would be suitable for liver resection or thermal ablation. Intervention: Thermal ablation as per local policy. Control: Surgical liver resection performed as per centre protocol. Co-interventions: Further chemotherapy will be offered to patients as per current practice. Outcomes: Pilot study: Same as main study and in addition patients and clinicians’ acceptability of the trial to assist in optimisation of recruitment. Primary outcome: Disease-free survival (DFS) at two years post randomisation. Secondary outcomes: Overall survival, timing and site of recurrence, additional therapy after treatment failure, quality of life, complications, length of hospital stay, costs, trial acceptability, DFS measured from end of intervention. Follow-up: 24 months from randomisation; five-year follow-up for overall survival. Sample size: 330 patients to demonstrate non-inferiority of thermal ablation. Discussion: This trial will determine the effectiveness and cost-effectiveness of thermal ablation vs surgical resection for high-risk people with colorectal liver metastases, and guide the optimal treatment for these patients

Air-sea CO₂ fluxes and the continental shelf pump of carbon in the Chukchi Sea adjacent to the Arctic Ocean

The Chukchi Sea, a shallow sea-ice covered coastal sea adjacent to the Arctic Ocean, exhibits an intense bloom of phytoplankton each year due to the exposure of nutrient-laden surface waters during the brief summertime retreat and melting of sea-ice. The impact of phytoplankton production and other factors on the seasonal dynamics of carbon and air-sea CO2 fluxes were investigated during two survey cruises (5 May–15 June 2002, and 17 July–26 August 2002), as part of the Western Arctic Shelf-Basins-Interactions (SBI) project. In springtime, most of the Chukchi Sea was sea-ice covered (>95%) and remnant winter water was present across the shelf. Surface layer seawater partial pressure of CO2 (pCO2) ranged from ~200–320 µatm, indicative of undersaturation with respect to atmospheric pCO2, although sea-ice cover kept rates of air-to-sea CO2 flux generally low (<1 mmoles CO2 m2 d-1). By summertime, after sea-ice retreat, seawater pCO2 contents had decreased to very low values (<80–220 µatm) in response to high rates of localized primary and net community production (NCP) and biological uptake of dissolved inorganic carbon (DIC). In the seasonally sea-ice free regions of the Chukchi Sea shelf, rates of air-to-sea CO2 fluxes, determined using the quadratic wind speed-transfer velocity relationships of Wanninkhof (1992), were high, ranging from ~30–90 mmoles CO2 m-2 d-1. In regions of the Chukchi Sea slope (and western Beaufort Sea shelf and Arctic Ocean basin) where sea-ice cover remained high (>80%), air-to-sea CO2 fluxes remained generally low (<2 mmoles CO2 m-2 d-1). Seasonal (i.e., May to September) and annual net air-to-sea CO2 fluxes from the Chukchi Sea shelf were estimated at ~27 ± 7 Tg C yr-1, and 38 ± 7 Tg C yr-1, respectively. The Chukchi Sea represents the largest oceanic CO2 sink in the marginal coastal seas adjacent to the Arctic Ocean. An active continental shelf pump of carbon, driven by the northward transport of nutrient-rich water of Pacific Ocean origin, high rates of primary and net community production during the sea-ice free period, and lateral export of organic carbon, maintains the Chukchi Sea shelf and slope as a perennial ocean CO2 sink

Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey

International audienceExtracorporeal life support (ECLS) is a means to support patients with acute respiratory failure. Initially, recommendations to treat severe cases of pandemic coronavirus disease 2019 (COVID-19) with ECLS have been restrained. In the meantime, ECLS has been shown to produce similar outcomes in patients with severe COVID-19 compared to existing data on ARDS mortality. We performed an international email survey to assess how ECLS providers worldwide have previously used ECLS during the treatment of critically ill patients with COVID-19. A questionnaire with 45 questions (covering, e.g., indication, technical aspects, benefit, and reasons for treatment discontinuation), mostly multiple choice, was distributed by email to ECLS centers. The survey was approved by the European branch of the Extracorporeal Life Support Organization (ELSO); 276 ECMO professionals from 98 centers in 30 different countries on four continents reported that they employed ECMO for very severe COVID-19 cases, mostly in veno-venous configuration (87%). The most common reason to establish ECLS was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno-arterial cannulation due to heart failure (3%). Time on ECLS varied between less than 2 and more than 4 weeks. The main reason to discontinue ECLS treatment prior to patient's recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators, were responsible for discontinuation of ECLS support. Most ECLS physicians (51%, IQR 30%) agreed that patients with COVID-19-induced ARDS (CARDS) benefitted from ECLS. Overall mortality of COVID-19 patients on ECLS was estimated to be about 55%. ECLS has been utilized successfully during the COVID-19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID-19 benefitted from ECLS