Inferring Suspended Sediment Carbon Content and Particle Size at High Frequency From the Optical Response of a Submerged Spectrometer

Real time monitoring of suspended sediment (SS) carbon content and particle size information is essential to understand SS transport mechanisms and processes. However, limited in situ methods are available, and manual and unattended sampling makes high frequency observation challenging. Based on evidence that optical measurements of SS concentration are dependent on particle size and composition, we hypothesize that SS carbon content and mean particle size (Formula presented.) can simultaneously be inferred from the absorbance data measured with a submerged spectrometer at high frequency. With the aim to predict both parameters, we investigate if global calibrations can be obtained and used instead of site-dependent local calibrations. To test this, we created a laboratory data set using a tank setup, and an in situ field data set. Sediment samples varying in composition were collected and used in a tank setup to obtain global (all sites grouped together) calibrations between absorbance, particle size and carbon content. Two sites were instrumented to collect in situ field data, to generate local (site-specific) calibrations and to validate the global calibrations obtained in the laboratory. A procedure to account for the effect of SS concentration when using the global calibration to predict (Formula presented.) is also presented. Our findings indicate that global calibrations can accurately predict (Formula presented.) from in situ absorbance readings, with a median absolute error of 17.3 μm, versus 10.5 μm for a local calibration. Local calibrations are indispensable to reliably predict carbon content, with a median absolute error of 1.3%

A Generic Relation Between Turbidity, Suspended Particulate Matter Concentration, and Sediment Characteristics

Optical turbidity sensors have become standard instrumentation to estimate suspended particulate matter concentration (SPMC). However, turbidity readings respond to factors other than SPMC, such as particle size and shape, organic fraction, sediment density and color. Therefore, local and site dependent calibrations are needed to transfer turbidity to SPMC. In this study, we propose a new relation between turbidity, suspended particulate matter (SPM) carbon content and particle size, which helps to move from local calibrations between turbidity and SPMC toward generic relations based on inherent SPM properties. Organic content is known to influence particle size, density and, as a result, turbidity, but an explicit formulation of turbidity accounting for organic content has not yet been established. We address this knowledge gap by collecting field data from four sites representing contrasting land use types, geological settings and watershed size. The sites were monitored with a turbidity meter, a LISST-200X particle size analyzer and an automatic water sampler. SPM samples were collected and analyzed for particle size, carbon content, and color. Local calibrations between turbidity and SPMC derived at each site were compared with a generic calibration, where SPMC was obtained as a function of turbidity, carbon content, particle size and color. The mean relative error associated to predicted SPMCs was equal to 3% when using the generic calibration, which is only marginally lower than the mean relative error of 5% obtained using the local calibrations

Positive bronchoalveolar lavage pepsin assay associated with viral and fungal respiratory infections in children with chronic cough.

OBJECTIVE: To assess the association between commonly obtained endoscopic and serologic data and bronchoalveolar lavage pepsin assay (BAL) results in children with chronic cough. STUDY DESIGN: We performed a retrospective chart review of seventy-two children with a BAL pepsin obtained through our Aerodigestive Center over an 18-month period. BAL outcomes include evidence of viral, bacterial, or fungal infection, presence of lipid laden macrophages, and cytology (eosinophils, neutrophils, and lymphocytes). Gastrointestinal outcomes include esophagogastroduodenoscopy (EGD) and pH impedance probe findings. Other characteristics include serum eosinophil, neutrophils, and lymphocytes; spirometry; FeNO; and IgE. RESULTS: Seventy-two patients underwent BAL pepsin testing. Median age was 4.9 years, 30.6% had severe persistent asthma, and 59.2% were on reflux medication. There was an association between positive BAL pepsin assay and positive viral panel (p=0.002) or fungal culture (p=0.027). No significant association found between positive BAL bacterial culture; BAL cytology; presence of BAL lipid laden macrophages; IgE; spirometry; FeNO; CBC neutrophil, eosinophil, or lymphocytes; pH impedance testing parameters; or EGD pathology. CONCLUSIONS: BAL pepsin is associated with a positive BAL viral PCR or fungal culture. Lack of correlation between pepsin-positivity and pH-impedance parameters or EGD pathology suggests microaspiration may be due to an acute event (such as a respiratory infection) rather than chronic GERD. This may be especially true in the presence of a positive viral panel or fungal culture when a BAL pepsin is obtained

Positive bronchoalveolar lavage pepsin assay associated with viral and fungal respiratory infections in children with chronic cough

OBJECTIVE: To assess the association between commonly obtained endoscopic and serologic data and bronchoalveolar lavage pepsin assay (BAL) results in children with chronic cough. STUDY DESIGN: We performed a retrospective chart review of seventy-two children with a BAL pepsin obtained through our Aerodigestive Center over an 18-month period. BAL outcomes include evidence of viral, bacterial, or fungal infection, presence of lipid laden macrophages, and cytology (eosinophils, neutrophils, and lymphocytes). Gastrointestinal outcomes include esophagogastroduodenoscopy (EGD) and pH impedance probe findings. Other characteristics include serum eosinophil, neutrophils, and lymphocytes; spirometry; FeNO; and IgE. RESULTS: Seventy-two patients underwent BAL pepsin testing. Median age was 4.9 years, 30.6% had severe persistent asthma, and 59.2% were on reflux medication. There was an association between positive BAL pepsin assay and positive viral panel (p=0.002) or fungal culture (p=0.027). No significant association found between positive BAL bacterial culture; BAL cytology; presence of BAL lipid laden macrophages; IgE; spirometry; FeNO; CBC neutrophil, eosinophil, or lymphocytes; pH impedance testing parameters; or EGD pathology. CONCLUSIONS: BAL pepsin is associated with a positive BAL viral PCR or fungal culture. Lack of correlation between pepsin-positivity and pH-impedance parameters or EGD pathology suggests microaspiration may be due to an acute event (such as a respiratory infection) rather than chronic GERD. This may be especially true in the presence of a positive viral panel or fungal culture when a BAL pepsin is obtained

Multimodality Management of Two Pairs of Pyopagus Twins

Background and Aim: Conjoined twins, due to their rarity and complex anatomy, pose not only a technical, but also a physiological challenge for their separation, with each case being uniquely distinct. The aim of the present article is to describe the surgical approach and management strategy for two cases of pyopagus conjoined twins operated at our center. Case Report: Case 1: Antenatally detected conjoined twin girls presented postnatally to our centre. They were found to have a common vestibule with single anal opening facing partially away from each other. On evaluation they were found to have a single sacrum and fused conus and filum terminale. They were taken up for separation at 2years of age & the 24hour long surgery, culminated in successful separation. The children had good post-operative outcome at 10months post separation. Case 2: Conjoined pyopagus twin girls presented postnatally, and were found to have fused cords, having a terminal syrinx and partially separate sacrum. They were separated at 2.5 years of age, with a multi-departmental effort and coordination. They are doing well 2 months post-operatively. Conclusion: A multidisciplinary team support with thorough preoperative planning significantly aids in improving the outcome of surgical separation. This has been possible by using modern technology. Each reported case contributes significantly to literature

Where should hydrology go? An early-career perspective on the next IAHS Scientific Decade: 2023–2032

This paper shares an early-career perspective on potential themes for the upcoming International Association of Hydrological Sciences (IAHS) Scientific Decade (SD). This opinion paper synthesizes six discussion sessions in western Europe identifying three themes that all offer a different perspective on the hydrological threats the world faces and could serve to direct the broader hydrological community: “Tipping points and thresholds in hydrology,” “Intensification of the water cycle,” and “Water services under pressure.” Additionally, four trends were distinguished concerning the way in which hydrological research is conducted: big data, bridging science and practice, open science, and inter- and multidisciplinarity. These themes and trends will provide valuable input for future discussions on the theme for the next IAHS SD. We encourage other early-career scientists to voice their opinion by organizing their own discussion sessions and commenting on this paper to make this initiative grow from a regional initiative to a global movement

Effect of Noninvasive Respiratory Strategies on Intubation or Mortality Among Patients With Acute Hypoxemic Respiratory Failure and COVID-19: The RECOVERY-RS Randomized Clinical Trial.

Importance Continuous positive airway pressure (CPAP) and high-flow nasal oxygen (HFNO) have been recommended for acute hypoxemic respiratory failure in patients with COVID-19. Uncertainty exists regarding the effectiveness and safety of these noninvasive respiratory strategies. Objective To determine whether either CPAP or HFNO, compared with conventional oxygen therapy, improves clinical outcomes in hospitalized patients with COVID-19-related acute hypoxemic respiratory failure. Design, Setting, and Participants A parallel group, adaptive, randomized clinical trial of 1273 hospitalized adults with COVID-19-related acute hypoxemic respiratory failure. The trial was conducted between April 6, 2020, and May 3, 2021, across 48 acute care hospitals in the UK and Jersey. Final follow-up occurred on June 20, 2021. Interventions Adult patients were randomized to receive CPAP (n = 380), HFNO (n = 418), or conventional oxygen therapy (n = 475). Main Outcomes and Measures The primary outcome was a composite of tracheal intubation or mortality within 30 days. Results The trial was stopped prematurely due to declining COVID-19 case numbers in the UK and the end of the funded recruitment period. Of the 1273 randomized patients (mean age, 57.4 [95% CI, 56.7 to 58.1] years; 66% male; 65% White race), primary outcome data were available for 1260. Crossover between interventions occurred in 17.1% of participants (15.3% in the CPAP group, 11.5% in the HFNO group, and 23.6% in the conventional oxygen therapy group). The requirement for tracheal intubation or mortality within 30 days was significantly lower with CPAP (36.3%; 137 of 377 participants) vs conventional oxygen therapy (44.4%; 158 of 356 participants) (absolute difference, -8% [95% CI, -15% to -1%], P = .03), but was not significantly different with HFNO (44.3%; 184 of 415 participants) vs conventional oxygen therapy (45.1%; 166 of 368 participants) (absolute difference, -1% [95% CI, -8% to 6%], P = .83). Adverse events occurred in 34.2% (130/380) of participants in the CPAP group, 20.6% (86/418) in the HFNO group, and 13.9% (66/475) in the conventional oxygen therapy group. Conclusions and Relevance Among patients with acute hypoxemic respiratory failure due to COVID-19, an initial strategy of CPAP significantly reduced the risk of tracheal intubation or mortality compared with conventional oxygen therapy, but there was no significant difference between an initial strategy of HFNO compared with conventional oxygen therapy. The study may have been underpowered for the comparison of HFNO vs conventional oxygen therapy, and early study termination and crossover among the groups should be considered when interpreting the findings. Trial Registration isrctn.org Identifier: ISRCTN16912075

Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic

Aim This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks