Natural and anthropogenic rapid changes in the Kara-Bogaz Gol over the last two centuries reconstructed from palynological analyses and a comparison to instrumental records

Palynological analyses (pollen and dinocysts) of a sediment core taken in the Kara-Bogaz Gol have been used to reconstruct rapid and catastrophic environmental changes over the last two centuries (chronology based on 210Pb). A natural cyclicity (65 years) of water level changes in the Caspian Sea and in the Kara-Bogaz Gol and anthropogenic factors (building of a dam separating the CS and the KBG waters) combine to induce rapid changes in water levels of the KBG, in the salinity of its waters and in vegetation cover of its surroundings. The impact of low water levels on the dinocysts is marked by a lower diversity and the survival of two species that are typical of the KBG, the Caspian Sea species present in the KBG having disappeared. During periods of higher water levels (AD 1871 to 1878), the lake is surrounded by a steppe-like vegetation dominated by Artemisia; whereas during periods of low water levels (AD 1878 to 1913 and AD 1955-1998), the emerged shore are colonised by Chenopodiaceae. The period of AD 1913 to 1955 corresponding to decreasing water levels has an extremely low pollen concentration and a maximum of reworking of arboreal taxa. During the last low-level period, humans responded by abandoning the shores of the bay. What happened to the KBG can be used as an example of what may happen in the future for the Aral Sea. A problem of reworking of Tertiary dinocysts into modern deposits has been detected owing to the knowledge of the modern dinoflagellate assemblages recently made available through a water survey. A comparison to modern surface pollen samples from Central Asia (Anzali, Caspian Sea south and central basins, Aral Sea, Lake Balkhash, Lake Issyk-Kul and the Chinese Tien-Shan range) allows us to establish the potential reworking of at least five arboreal pollen taxa possibly by run-off and dust storms

Prediction of the Caspian Sea level using ECMWF seasonal forecasts and reanalysis

This article is made available through the Brunel Open Access Publishing Fund. This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.The hydrological budget of the Caspian Sea (CS) is investigated using the European Centre for Medium-Range Weather Forecasts interim reanalysis (ERAi) and seasonal forecast (FCST) data with the aim of predicting the Caspian Sea Level (CSL) some months ahead. Precipitation and evaporation are used. After precipitation events over the Volga River, the discharge (Volga River discharge (VRD)) follows with delays, which are parameterized. The components of the water budget from ERAi and FCSTs are integrated to obtain time series of the CSL. Observations of the CSL and the VRD are used for comparison and tuning. The quality of ERAi data is sufficiently good to calculate the time variability of the CSL with a satisfactory accuracy. Already the storage of water within the Volga Basin allows forecasts of the CSL a few months ahead, and using the FCSTs of precipitation improves the CSL forecasts. The evaporation in the seasonal forecasts is deficient due to unrealistic sea surface temperatures over the CS. Impacts of different water budget terms on the CSL variability are shown by a variety of validation tools. The importance of precipitation anomalies over the catchment of the Volga River is confirmed, but also impacts from the two southern rivers (Sefidrud and Kura River) and the evaporation over the CS become obvious for some periods. When pushing the FCSTs beyond the limits of the seasonal FCSTs to 1 year, considerable forecast skill can still be found. Validating only FCSTs by the present approach, which show the same trend as one based on a statistical method, significantly enhances the skill scores

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

The effect of snacking and eating frequency on dietary quality in British adolescents

Purpose: To describe the effects of number of eating occasions and snacks on dietary quality (DQ), defined as adherence to dietary recommendations. Methods: A sample of 884 adolescents (11-18y) in the UK National Diet and Nutrition Survey (NDNS) were included. The Diet Quality Index for Adolescents (DQI-A) was implemented. The total number of eating occasions and snacks was frequency of food or beverages consumed over 24h and frequency of foods or beverages consumed outside of the three mealtimes respectively. Results were generated with and without low energy food under 210KJ (50kcal). Regression models were generated with DQ score as the outcome variable and number of eating occasions and snacks as predictors. Results: The mean(95%CI) DQ score was 31.1%(30.2, 32.0). The mean number of eating occasions and snacks was 7.5(7.3, 7.7) and 2.6(2.6, 2.7) times/day respectively. When low energy events were excluded, mean number of eating occasions and snacks reduced to 6.2(6.1, 6.4) and 2.0(2.0, 2.1) times/day respectively. DQ score increased by 0.74 points (0.42, 1.05; p<0.01) and 0.55 points (-0.08, 0.69; p=0.17) for total eating occasions and snacks respectively. When low energy events were excluded, DQ score increased by 0.30 points (-0.84, 0.69; p=0.13) for each eating occasion and decreased by 1.20 points (-2.1,-0.3; p<0.01) for each snack. Conclusion: Eating more frequently improves dietary quality especially if some eating occasions, are low in energy. A focus on replacing high-energy snacks with low-energy alternatives rather than reducing the number of eating occasions may result in improved dietary quality in adolescents

Prevention, recognition, and management of adverse events associated with gemtuzumab ozogamicin use in acute myeloid leukemia

Gemtuzumab ozogamicin (GO), a humanized anti-CD33 monoclonal antibody conjugated to the cytotoxic antibiotic agent calicheamicin, is approved for the treatment of newly-diagnosed CD33 + AML in adults and children ≥ 1&nbsp;month old, and relapsed or refractory CD33 + AML in adults and children ≥ 2&nbsp;years old. GO treatment has been associated with an increased risk of hepatotoxicity and hepatic veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS), especially following hematopoietic stem cell transplantation. Other non-specific serious adverse events (SAEs) associated with GO treatment are myelosuppression, bleeding/thrombocytopenia, infusion-related reaction, and tumor lysis syndrome. This report summarizes an expert panel of physicians' recommendations for the evaluation and management of SAEs following GO, emphasizing the prevention and management of VOD/SOS