Variability in Global Top-of-Atmosphere Shortwave Radiation Between 2000 and 2005

Measurements from various instruments and analysis techniques are used to directly compare changes in Earth-atmosphere shortwave (SW) top-of-atmosphere (TOA) radiation between 2000 and 2005. Included in the comparison are estimates of TOA reflectance variability from published ground-based Earthshine observations and from new satellite-based CERES, MODIS and ISCCP results. The ground-based Earthshine data show an order-of-magnitude more variability in annual mean SW TOA flux than either CERES or ISCCP, while ISCCP and CERES SW TOA flux variability is consistent to 40%. Most of the variability in CERES TOA flux is shown to be dominated by variations global cloud fraction, as observed using coincident CERES and MODIS data. Idealized Earthshine simulations of TOA SW radiation variability for a lunar-based observer show far less variability than the ground-based Earthshine observations, but are still a factor of 4-5 times more variable than global CERES SW TOA flux results. Furthermore, while CERES global albedos exhibit a well-defined seasonal cycle each year, the seasonal cycle in the lunar Earthshine reflectance simulations is highly variable and out-of-phase from one year to the next. Radiative transfer model (RTM) approaches that use imager cloud and aerosol retrievals reproduce most of the change in SW TOA radiation observed in broadband CERES data. However, assumptions used to represent the spectral properties of the atmosphere, clouds, aerosols and surface in the RTM calculations can introduce significant uncertainties in annual mean changes in regional and global SW TOA flux

Unintended consequences of existential quantifications in biomedical ontologies

<p>Abstract</p> <p>Background</p> <p>The Open Biomedical Ontologies (OBO) Foundry is a collection of freely available ontologically structured controlled vocabularies in the biomedical domain. Most of them are disseminated via both the OBO Flatfile Format and the semantic web format Web Ontology Language (OWL), which draws upon formal logic. Based on the interpretations underlying OWL description logics (OWL-DL) semantics, we scrutinize the OWL-DL releases of OBO ontologies to assess whether their logical axioms correspond to the meaning intended by their authors.</p> <p>Results</p> <p>We analyzed ontologies and ontology cross products available via the OBO Foundry site <url>http://www.obofoundry.org</url> for existential restrictions (<it>someValuesFrom</it>), from which we examined a random sample of 2,836 clauses.</p> <p>According to a rating done by four experts, 23% of all existential restrictions in OBO Foundry candidate ontologies are suspicious (Cohens' <it>κ </it>= 0.78). We found a smaller proportion of existential restrictions in OBO Foundry cross products are suspicious, but in this case an accurate quantitative judgment is not possible due to a low inter-rater agreement (<it>κ </it>= 0.07). We identified several typical modeling problems, for which satisfactory ontology design patterns based on OWL-DL were proposed. We further describe several usability issues with OBO ontologies, including the lack of ontological commitment for several common terms, and the proliferation of domain-specific relations.</p> <p>Conclusions</p> <p>The current OWL releases of OBO Foundry (and Foundry candidate) ontologies contain numerous assertions which do not properly describe the underlying biological reality, or are ambiguous and difficult to interpret. The solution is a better anchoring in upper ontologies and a restriction to relatively few, well defined relation types with given domain and range constraints.</p

Microporous polysaccharide hemosphere absorbable hemostat use in cardiothoracic surgical procedures

BACKGROUND: Topical hemostatic agents are used to reduce bleeding and transfusion need during cardiothoracic surgery. We report our experience with Arista® AH Absorbable Hemostatic Particles (Arista® AH), a novel plant-based microporous polysaccharide hemostatic powder. METHODS: Data were retrospectively collected for patients (n = 240) that received cardiothoracic surgery at our institution from January 2009 to January 2013 with (n = 103) or without (n = 137) the use of Arista® AH. Endpoints included protamine to skin closure time (hemostasis time), cardiopulmonary bypass time, quantity of Arista® AH applied, intraoperative blood product usage, intraoperative blood loss, chest tube output 48 hours postoperatively, blood products required 48 hours postoperatively, length of stay in the intensive care unit, 30-day morbidity, and 30-day mortality. RESULTS: 240 patients (176 M: 64 F) underwent 240 cardiothoracic procedures including heart transplantation (n = 53), cardiac assist devices (n = 113), coronary artery bypass grafts (n = 20), valve procedures (n = 19), lung transplantation (n = 17), aortic dissection (n = 8), and other (n = 10). Application of Arista® AH led to significant reduction in hemostasis time versus the untreated control group (Arista® AH: 93.4 ± 41 min. vs. Control: 107.6 ± 56 min., p = 0.02). Postoperative chest tube output in the first 48 hours was also significantly reduced (Arista® AH: 1594 ± 949 mL vs. Control: 2112 ± 1437 mL, p < 0.001), as well as transfusion of packed red blood cells (Arista® AH: 2.4 ± 2.5 units vs. Control: 4.0 ± 5.1 units, p < 0.001). There was no significant difference in 30-day mortality or postoperative complications. CONCLUSION: Use of Arista® AH in complex cardiothoracic surgery resulted in a significant reduction in hemostasis time, postoperative chest tube output, and need for postoperative blood transfusion

Changing trends in mortality among solid organ transplant recipients hospitalized for COVID-19 during the course of the pandemic

Mortality among patients hospitalized for COVID-19 has declined over the course of the pandemic. Mortality trends specifically in solid organ transplant recipients (SOTR) are unknown. Using data from a multicenter registry of SOTR hospitalized for COVID-19, we compared 28-day mortality between early 2020 (March 1, 2020–June 19, 2020) and late 2020 (June 20, 2020–December 31, 2020). Multivariable logistic regression was used to assess comorbidity-adjusted mortality. Time period of diagnosis was available for 1435/1616 (88.8%) SOTR and 971/1435 (67.7%) were hospitalized: 571/753 (75.8%) in early 2020 and 402/682 (58.9%) in late 2020 (p <.001). Crude 28-day mortality decreased between the early and late periods (112/571 [19.6%] vs. 55/402 [13.7%]) and remained lower in the late period even after adjusting for baseline comorbidities (aOR 0.67, 95% CI 0.46–0.98, p =.016). Between the early and late periods, the use of corticosteroids (≥6 mg dexamethasone/day) and remdesivir increased (62/571 [10.9%] vs. 243/402 [61.5%], p <.001 and 50/571 [8.8%] vs. 213/402 [52.2%], p <.001, respectively), and the use of hydroxychloroquine and IL-6/IL-6 receptor inhibitor decreased (329/571 [60.0%] vs. 4/492 [1.0%], p <.001 and 73/571 [12.8%] vs. 5/402 [1.2%], p <.001, respectively). Mortality among SOTR hospitalized for COVID-19 declined between early and late 2020, consistent with trends reported in the general population. The mechanism(s) underlying improved survival require further study

COVID-19 in hospitalized lung and non-lung solid organ transplant recipients: A comparative analysis from a multicenter study

Lung transplant recipients (LTR) with coronavirus disease 2019 (COVID-19) may have higher mortality than non-lung solid organ transplant recipients (SOTR), but direct comparisons are limited. Risk factors for mortality specifically in LTR have not been explored. We performed a multicenter cohort study of adult SOTR with COVID-19 to compare mortality by 28 days between hospitalized LTR and non-lung SOTR. Multivariable logistic regression models were used to assess comorbidity-adjusted mortality among LTR vs. non-lung SOTR and to determine risk factors for death in LTR. Of 1,616 SOTR with COVID-19, 1,081 (66%) were hospitalized including 120/159 (75%) LTR and 961/1457 (66%) non-lung SOTR (p =.02). Mortality was higher among LTR compared to non-lung SOTR (24% vs. 16%, respectively, p =.032), and lung transplant was independently associated with death after adjusting for age and comorbidities (aOR 1.7, 95% CI 1.0–2.6, p =.04). Among LTR, chronic lung allograft dysfunction (aOR 3.3, 95% CI 1.0–11.3, p =.05) was the only independent risk factor for mortality and age >65 years, heart failure and obesity were not independently associated with death. Among SOTR hospitalized for COVID-19, LTR had higher mortality than non-lung SOTR. In LTR, chronic allograft dysfunction was independently associated with mortality

The role of surgery in the treatment of acute myocardial infarct

The surgeon's role in the treatment of acute myocardial infarcts is limited to selected cases in which emergency revascularization can be performed with reasonable expectation for salvage of an ischemic, however, still viable myocardium. This goal can be achieved under optimal logistic conditions. At present the result of emergency revascularization can not be predicted with certainty due to the lack of diagnostic methods which would allow for instantaneous differentiation between ischemic and necrotic myocardium. Surgical techniques are established for infarct sequelae such as ventricular rupture, papillary muscle necrosis, and ventricular septal defect, however, the outcome of emergency operations in these instances is primarily determined by the duration and intensity of preoperative circulatory failure. Cardiac transplantation with or without temporary mechanical support or replacement appears to be the future treatment of choice in acute irreversible congestive heart failure and global ventricular impairment following myocardial infarction

Mechanical Circulatory Support: In Children Towards Myocardial Recovery Permanent

After decades of laboratory investigations mechanical circulatory support for the failing heart has entered the clinical arena. Today, a growing number of patients with progressive myocardial failure awaiting cardiac transplantation is successfully bridged to transplantation with ventricular assist devices. The proceedings of the "Mechanical Circulatory Support"-meeting, held in Berlin, October 21-22, 1995, present new aspects of mechanical circulatory support, recent experience with MCS in newborns and children using specially developed small devices, and the results of long-term mechanical assistance. The ability of the myocardium to recover under pressure de-loading and reduced workload is discussed. All these topics open up new perspectives for the use of mechanical circulatory support, not only as a bridge to transplantation, but also as a definitive approach for treating patients with end-stage heart failure. Some of these concepts may even provide real alternatives to heart transplantation, these being sorely needed in light of the severe donor organ shortage. Regulatory as well as ethical aspects of the extended use of mechanical circulatory support systems and new technical developments in the field are discussed by internationally distinguished experts