Association of COVID-19 Vaccinations With Intensive Care Unit Admissions and Outcome of Critically Ill Patients With COVID-19 Pneumonia in Lombardy, Italy

IMPORTANCE Data on the association of COVID-19 vaccination with intensive care unit (ICU) admission and outcomes of patients with SARS-CoV-2-related pneumonia are scarce. OBJECTIVE To evaluate whether COVID-19 vaccination is associated with preventing ICU admission for COVID-19 pneumonia and to compare baseline characteristics and outcomes of vaccinated and unvaccinated patients admitted to an ICU. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study on regional data sets reports: (1) daily number of administered vaccines and (2) data of all consecutive patients admitted to an ICU in Lombardy, Italy, from August 1 to December 15, 2021 (Delta variant predominant). Vaccinated patients received either mRNA vaccines (BNT162b2 or mRNA-1273) or adenoviral vector vaccines (ChAdOx1-S or Ad26.COV2). Incident rate ratios (IRRs) were computed from August 1, 2021, to January 31, 2022; ICU and baseline characteristics and outcomes of vaccinated and unvaccinated patients admitted to an ICU were analyzed from August 1 to December 15, 2021. EXPOSURES COVID-19 vaccination status (no vaccination, mRNA vaccine, adenoviral vector vaccine). MAIN OUTCOMES AND MEASURES The incidence IRR of ICU admission was evaluated, comparing vaccinated people with unvaccinated, adjusted for age and sex. The baseline characteristics at ICU admission of vaccinated and unvaccinated patients were investigated. The association between vaccination status at ICU admission and mortality at ICU and hospital discharge were also studied, adjusting for possible confounders. RESULTS Among the 10 107 674 inhabitants of Lombardy, Italy, at the time of this study, the median [IQR] agewas 48 [28-64] years and 5 154 914 (51.0%) were female. Of the 7 863 417 individuals who were vaccinated (median [IQR] age: 53 [33-68] years; 4 010 343 [51.4%] female), 6 251 417 (79.5%) received an mRNA vaccine, 550 439 (7.0%) received an adenoviral vector vaccine, and 1 061 561 (13.5%) received a mix of vaccines and 4 497 875 (57.2%) were boosted. Compared with unvaccinated people, IRR of individuals who received an mRNA vaccine within 120 days from the last dosewas 0.03 (95% CI, 0.03-0.04; P <.001), whereas IRR of individuals who received an adenoviral vector vaccine after 120 days was 0.21 (95% CI, 0.19-0.24; P <.001). There were 553 patients admitted to an ICU for COVID-19 pneumonia during the study period: 139 patients (25.1%) were vaccinated and 414 (74.9%) were unvaccinated. Compared with unvaccinated patients, vaccinated patients were older (median [IQR]: 72 [66-76] vs 60 [51-69] years; P <.001), primarily male individuals (110 patients [ 79.1%] vs 252 patients [60.9%]; P <.001), with more comorbidities (median [IQR]: 2 [1-3] vs 0 [0-1] comorbidities; P <.001) and had higher ratio of arterial partial pressure of oxygen (PaO2) and fraction of inspiratory oxygen (FiO(2)) at ICU admission (median [IQR]: 138 [100-180] vs 120 [90-158] mm Hg; P =.007). Factors associated with ICU and hospital mortality were higher age, premorbid heart disease, lower PaO2/FiO(2) at ICU admission, and female sex (this factor only for ICU mortality). ICU and hospital mortality were similar between vaccinated and unvaccinated patients. CONCLUSIONS AND RELEVANCE In this cohort study, mRNA and adenoviral vector vaccines were associated with significantly lower risk of ICU admission for COVID-19 pneumonia. ICU and hospital mortality were not associated with vaccinated status.These findings suggest a substantial reduction of the risk of developing COVID-19-related severe acute respiratory failure requiring ICU admission among vaccinated people

Cold-to-warm flow regime transition in snow avalanches

Large avalanches usually encounter different snow conditions along their track. When they release as slab avalanches comprising cold snow, they can subsequently develop into powder snow avalanches entraining snow as they move down the mountain. Typically, this entrained snow will be cold (T¯¯¯−1 ∘C) at lower elevations or deeper in the snowpack. The intake of warm snow is believed to be of major importance to increase the temperature of the snow composition in the avalanche and eventually cause a flow regime transition. Measurements of flow regime transitions are performed at the Vallée de la Sionne avalanche test site in Switzerland using two different radar systems. The data are then combined with snow temperatures calculated with the snow cover model SNOWPACK. We define transitions as complete when the deposit at runout is characterized only by warm snow or as partial if there is a warm flow regime, but the farthest deposit is characterized by cold snow. We introduce a transition index Ft, based on the runout of cold and warm flow regimes, as a measure to quantify the transition type. Finally, we parameterize the snow cover temperature along the avalanche track by the altitude Hs, which represents the point where the average temperature of the uppermost 0.5 m changes from cold to warm. We find that Ft is related to the snow cover properties, i.e. approximately proportional to Hs. Thus, the flow regime in the runout area and the type of transition can be predicted by knowing the snow cover temperature distribution. We find that, if Hs is more than 500 m above the valley floor for the path geometry of Vallée de la Sionne, entrainment of warm surface snow leads to a complete flow regime transition and the runout area is reached by only warm flow regimes. Such knowledge is of great importance since the impact pressure and the effectiveness of protection measures are greatly dependent on the flow regime

4D quantification of alpine permafrost degradation in steep rock walls using a laboratory‐calibrated electrical resistivity tomography approach

The warming of rock permafrost affects mechanical stability and hydro‐cryostatic pressures in rock walls. The coincident decrease in slope stability frequently affects infrastructure by creep and subsidence and promotes the generation of rockfalls and rockslides. The increasing hazard posed by warming permafrost rock walls and the growing exposure of infrastructure and individuals create a demand for quantitative monitoring methods. Laboratory‐calibrated electrical resistivity tomography provides a sensitive record for frozen versus unfrozen bedrock, presumably being the most accurate quantitative monitoring technique in permafrost areas where boreholes are not available. The data presented here are obtained at the permafrost‐affected and unstable Steintaelli Ridge at 3100 m a.s.l. and allow the quantification of permafrost changes in the longest electrical resistivity tomography time series in steep bedrock. Five parallel transects across the rock ridge have been measured five times each, between 2006 and 2019, with similar hardware. Field measurements were calibrated using temperature‐resistivity laboratory measurements of water‐saturated rock samples from the site. A 3D time‐lapse inversion scheme is applied in the boundless electrical resistivity tomography (BERT) software for the inversion of the data. To assess the initial data quality, we compare the effect of data filtering and the robustness of final results with three different filters and two time‐lapse models. We quantify the volumetric permafrost distribution in the bedrock and its degradation in the last decades. Our data show mean monthly air temperatures to increase from −3.4°C to −2.6°C between 2005‒2009 and 2015‒2019, respectively, while simultaneously permafrost volume degraded on average from 6790 m3 (±640 m3 rock in phase‐transition range) in 2006 to 3880 m3 (±1000 m3) in 2019. For the first time, we provide a quantitative measure of permafrost degradation in unstable bedrock by using a temperature‐calibrated 4D electrical resistivity tomography. Our approach represents a fundamental benchmark for the evaluation of climate change effects on bedrock permafrost

Initiation of an international database of geoelectrical surveys on permafrost to promote data sharing, survey repetition and standardized data reprocessing 

Geoelectrical methods are widely used for permafrost investigations by research groups, government agencies and industry. Electrical Resistivity Tomography (ERT) surveys are typically performed only once to detect the presence or absence of permafrost. Exchange of data and expertise among users is limited and usually occurs bilaterally. Neither complete information about the existence of geophysical surveys on permafrost nor the data itself is available on a global scale. Given the potential gain for identifying permafrost evidence and their spatiotemporal changes, there is a strong need for coordinated efforts regarding data, metadata, guidelines, and expertise exchange. Repetition of ERT surveys is rare, even though it could provide a quantitative spatio-temporal measure of permafrost evolution, helping to quantify the effects of climate change at local (where the ERT survey takes place) and global scales (due to the inventory).Our International Permafrost Association (IPA) action group (2021-2023) has the main objective of bringing together the international community interested in geoelectrical measurements on permafrost and laying the foundations for an operational International Database of Geoelectrical Surveys on Permafrost (IDGSP). Our contribution presents a new international database of electrical resistivity datasets on permafrost. The core members of our action group represent more than 10 research groups, who have already contributed their own metadata (currently > 200 profiles covering 15 countries). These metadata will be fully publicly accessible in the near future whereas access to the resistivity data may be either public or restricted. Thanks to this open access policy, we aim at increasing the level of transparency, encouraging further data providersand fostering survey repetitions by new users.The database is set up on a virtual machine hosted by the University of Fribourg. The advanced open-source relational database system PostgreSQL is used to program the database. Homogenization and standardization of a large number of data and metadata are among thegreatest challenges, yet are essential to a structured relational database. In this contribution, we present the structure of the database, statistics of the metadata uploaded, as well as first results of repetitions from legacy geoelectrical measurements on permafrost. Guidelines and strategiesare developed to handle repetition challenges such as changing survey configuration, changing geometry or inaccurate/missing metadata. First steps toward transparent and reproducible automated filtering and inversion of a great number of datasets will also be presented. Byarchiving geoelectrical data on permafrost, the ambition of this project is the reanalysis of the full database and its climatic interpretation

Photoactivable sphingosine as a tool to study membrane microenvironments in cultured cells[S]

Human fibroblasts from normal subjects and Niemann-Pick A (NPA) disease patients were fed with two labeled metabolic precursors of sphingomyelin (SM), [3H]choline and photoactivable sphingosine, that entered into the biosynthetic pathway allowing the synthesis of radioactive phosphatidylcholine and SM, and of radioactive and photoactivable SM ([3H]SM-N3). Detergent resistant membrane (DRM) fractions prepared from normal and NPA fibroblasts resulted as highly enriched in [3H]SM-N3. However, lipid and protein analysis showed strong differences between the two cell types. After cross-linking, different patterns of SM-protein complexes were found, mainly associated with the detergent soluble fraction of the gradient containing most cell proteins. After cell surface biotinylation, DRMs were immunoprecipitated using streptavidin. In conditions that maintain the integrity of domain, SM-protein complexes were detectable only in normal fibroblasts, whereas disrupting the membrane organization, these complexes were not recovered in the immunoprecipitate, suggesting that they involve proteins belonging to the inner membrane layer. These data suggest that differences in lipid and protein compositions of these cell lines determine specific lipid-protein interactions and different clustering within plasma membrane. In addition, our experiments show that photoactivable sphingolipids metabolically synthesized in cells can be used to study sphingolipid protein environments and sphingolipid-protein interactions

Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. The SICE CLOUD19 Study

BACKGROUND: The spread of the SARS-CoV2 virus, which causes COVID-19 disease, profoundly impacted the surgical community. Recommendations have been published to manage patients needing surgery during the COVID-19 pandemic. This survey, under the aegis of the Italian Society of Endoscopic Surgery, aims to analyze how Italian surgeons have changed their practice during the pandemic.METHODS: The authors designed an online survey that was circulated for completion to the Italian departments of general surgery registered in the Italian Ministry of Health database in December 2020. Questions were divided into three sections: hospital organization, screening policies, and safety profile of the surgical operation. The investigation periods were divided into the Italian pandemic phases I (March-May 2020), II (June-September 2020), and III (October-December 2020).RESULTS: Of 447 invited departments, 226 answered the survey. Most hospitals were treating both COVID-19-positive and -negative patients. The reduction in effective beds dedicated to surgical activity was significant, affecting 59% of the responding units. 12.4% of the respondents in phase I, 2.6% in phase II, and 7.7% in phase III reported that their surgical unit had been closed. 51.4%, 23.5%, and 47.8% of the respondents had at least one colleague reassigned to non-surgical COVID-19 activities during the three phases. There has been a reduction in elective (>200 procedures: 2.1%, 20.6% and 9.9% in the three phases, respectively) and emergency (<20 procedures: 43.3%, 27.1%, 36.5% in the three phases, respectively) surgical activity. The use of laparoscopy also had a setback in phase I (25.8% performed less than 20% of elective procedures through laparoscopy). 60.6% of the respondents used a smoke evacuation device during laparoscopy in phase I, 61.6% in phase II, and 64.2% in phase III. Almost all responders (82.8% vs. 93.2% vs. 92.7%) in each analyzed period did not modify or reduce the use of high-energy devices.CONCLUSION: This survey offers three faithful snapshots of how the surgical community has reacted to the COVID-19 pandemic during its three phases. The significant reduction in surgical activity indicates that better health policies and more evidence-based guidelines are needed to make up for lost time and surgery not performed during the pandemic