Compound events in Germany in 2018: drivers and case studies

The European continent is regularly affected by a wide range of extreme events and natural hazards including heatwaves, extreme precipitation, droughts, cold spells, windstorms, and storm surges. Many of these events do not occur as single extreme events, but rather show a multivariate character, the so-called compound events. Within the scope of the interdisciplinary project climXtreme (https://climxtreme.net/), we investigate the interplay of extreme weather events, their characteristics and changes, intensity, frequency and uncertainties in the past, present and future and associated impacts on various socio-economic sectors in Germany and Central Europe. This contribution presents several case studies with special emphasis on the calendar year of 2018, which is of particular interest given the exceptional sequence of different compound events across large parts of Europe, with devastating impacts on human lives, ecosystems and infrastructure. We provide new evidence on drivers of spatially and temporally compound events (heat and drought; heavy precipitation in combination with extreme winds) with adverse impacts on ecosystems and society using large-scale atmospheric patterns. We shed light on the interannual influence of droughts on surface water and the impact of water scarcity and heatwaves on agriculture and forests. We assessed projected changes in compound events at different current and future global surface temperature levels, demonstrating the importance of better quantifying the likelihood of future extreme events for adaptation planning. Finally, we addressed research needs and future pathways, emphasising the need to define composite events primarily in terms of their impacts prior to their statistical characterisation

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

The role of atmospheric rivers in the distribution of heavy precipitation events over North America

Atmospheric rivers (ARs) are filaments of extensive water vapor transport in the lower troposphere that play a crucial role in the distribution of freshwater but can also cause natural and economic damage by facilitating heavy precipitation. Here, we investigate the large-scale spatiotemporal synchronization patterns of heavy precipitation events (HPEs) over the western coast and the continental regions of North America (NA), during the period from 1979 to 2018. In particular, we use event synchronization and a complex network approach incorporating varying delays to examine the temporal evolution of spatial patterns of HPEs in the aftermath of land-falling ARs. For that, we employ the SIO-R1 catalog of ARs that landfall on the western coast of NA, ranked in terms of intensity and persistence on an AR-strength scale which varies from level AR1 to AR5, along with daily precipitation estimates from ERA5 with a 0.25'spatial resolution. Our analysis reveals a cascade of synchronized HPEs, triggered by ARs of level AR3 or higher. On the first 3d after an AR makes landfall, HPEs mostly occur and synchronize along the western coast of NA. In the subsequent days, moisture can be transported to central and eastern Canada and cause synchronized but delayed HPEs there. Furthermore, we confirm the robustness of our findings with an additional AR catalog based on a different AR detection method. Finally, analyzing the anomalies of integrated water vapor transport, geopotential height, upper-level meridional wind, and precipitation, we find atmospheric circulation patterns that are consistent with the spatiotemporal evolution of the synchronized HPEs. Revealing the role of ARs in the precipitation patterns over NA will lead to a better understanding of inland HPEs and the effects that changing climate dynamics will have on precipitation occurrence and consequent impacts in the context of a warming atmosphere

Effects of COVID-19 Lockdown on Tumour Burden of Melanoma and Cutaneous Squamous Cell Carcinoma.

The aim of this study was to compare tumour burden in patients who underwent surgery for melanoma and cutaneous squamous cell carcinoma during nationwide lockdown in Spain due to COVID-19 (for the period 14 March to 13 June 2020) and during the same dates in 2019 before the COVID-19 pandemic. In addition, associations between median tumour burden (Breslow thickness for melanoma and maximum clinical diameter for cutaneous squamous cell carcinoma) and demographic, clinical, and medical factors were analysed, building a multivariate linear regression model. During the 3 months of lockdown, there was a significant decrease in skin tumours operated on (41% decrease for melanoma (n = 352 vs n = 207) and 44% decrease for cutaneous squamous cell carcinoma (n = 770 vs n = 429)) compared with the previous year. The proportion of large skin tumours operated on increased. Fear of SARS-CoV-2 infection, with respect to family member/close contact, and detection of the lesion by the patient or doctor, were related to thicker melanomas; and fear of being diagnosed with cancer, and detection of the lesion by the patient or relatives, were related to larger size cutaneous squamous cell carcinoma. In conclusion, lockdown due to COVID-19 has resulted in a reduction in treatment of skin cancer

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective