Rapid accelerations of Antarctic Peninsula outlet glaciers driven by surface melt

Atmospheric warming is increasing surface melting across the Antarctic Peninsula, with unknown impacts upon glacier dynamics at the ice-bed interface. Using high-resolution satellite-derived ice velocity data, optical satellite imagery and regional climate modelling, we show that drainage of surface meltwater to the bed of outlet glaciers on the Antarctic Peninsula occurs and triggers rapid ice flow accelerations (up to 100% greater than the annual mean). This provides a mechanism for this sector of the Antarctic Ice Sheet to respond rapidly to atmospheric warming. We infer that delivery of water to the bed transiently increases basal water pressure, enhancing basal motion, but efficient evacuation subsequently reduces water pressure causing ice deceleration. Currently, melt events are sporadic, so efficient subglacial drainage cannot be maintained, resulting in multiple short-lived (< 6 day) ice flow perturbations. Future increases in meltwater could induce a shift in glacier dynamic regime, characterised by seasonal-scale ice flow variations

Українська піснетворчість північно-західного Надкубання

Folk singing tradition of the Kuban especially its Ukrainian folk archive create one of the most representative spheres of the musical art of the Russian Federation. We made special expeditions in1990-1996 in order to collect Ukrainian folk songs of various genres in the historical living og Ukrainians in ex-Chornomorya lend. The collected materials can be divided into three types: epic, lyric, ritual. Among those types we figure out such genres: narratives, quazi-narratives, ritual songs of the calendar cycle, ritual songs of the family cycle, lyrical songs. All the collected texts are described in this article with the goal to show that they are functioning as a part of Ukrainian folk tradition within Russian cultural territory. The choir and individual singing are described as a sing of the state of singing performing tradition in contemporary Chornomorya. Authors give a detailed description of the particular performers, their styles and repertoire. Such deep research of the singing tradition of the Ukrainians living in Kuban gives the chance to look at these materials not only as cultural event but also like at the event social and historical meaning

Characteristics of the modelled meteoric freshwater budget of the western Antarctic Peninsula

Rapid climatic changes in the western Antarctic Peninsula (WAP) have led to considerable changes in the meteoric freshwater input into the surrounding ocean, with implications for ocean circulation, the marine ecosystem and sea-level rise. In this study, we use the high-resolution Regional Atmospheric Climate Model RACMO2.3, coupled to a firn model, to assess the various contributions to the meteoric freshwater budget of the WAP for 1979–2014: precipitation (snowfall and rainfall), meltwater runoff to the ocean, and glacial discharge. Snowfall is the largest component in the atmospheric contribution to the freshwater budget, and exhibits large spatial and temporal variability. The highest snowfall rates are orographically forced and occur over the coastal regions of the WAP (View the MathML source>2000mm water equivalent (w.e.) y−1y−1) and extend well onto the ocean up to the continental shelf break; a minimum View the MathML source(∼500mmw.e.y−1) is reached over the open ocean. Rainfall is an order of magnitude smaller, and strongly depends on latitude and season, being large in summer, when sea ice extent is at its minimum. For Antarctic standards, WAP surface meltwater production is relatively large View the MathML source(>50mmw.e.y−1), but a large fraction refreezes in the snowpack, limiting runoff. Only at a few more northerly locations is the meltwater predicted to run off into the ocean. In summer, we find a strong relationship of the freshwater fluxes with the Southern Annular Mode (SAM) index. When SAM is positive and occurs simultaneously with a La Niña event there are anomalously strong westerly winds and enhanced snowfall rates over the WAP mountains, Marguerite Bay and the Bellingshausen Sea. When SAM coincides with an El Niño event, winds are more northerly, reducing snowfall and increasing rainfall over the ocean, and enhancing orographic snowfall over the WAP mountains. Assuming balance between snow accumulation (mass gain) and glacial discharge (mass loss), the largest glacial discharge is found for the regions around Adelaide Island View the MathML source(10Gty−1), Anvers Island View the MathML source(8Gty−1) and southern Palmer Land View the MathML source(12Gty−1), while a minimum View the MathML source(<2Gty−1) is found in Marguerite Bay and the northern WAP. Glacial discharge is in the same order of magnitude as the direct freshwater input into the ocean from snowfall, but there are some local differences. The spatial patterns in the meteoric freshwater budget have consequences for local productivity and carbon drawdown in the coastal ocean

The effect of C1-esterase inhibitor on systemic inflammation in trauma patients with a femur fracture - The CAESAR study: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Systemic inflammation in response to a femur fracture and the additional fixation is associated with inflammatory complications, such as acute respiratory distress syndrome and multiple organ dysfunction syndrome. The injury itself, but also the additional procedure of femoral fixation induces a release of pro-inflammatory cytokines such as interleukin-6. This results in an aggravation of the initial systemic inflammatory response, and can cause an increased risk for the development of inflammatory complications. Recent studies have shown that administration of the serum protein C1-esterase inhibitor can significantly reduce the release of circulating pro-inflammatory cytokines in response to acute systemic inflammation.</p> <p>Objective</p> <p>Attenuation of the surgery-induced additional systemic inflammatory response by perioperative treatment with C1-esterase inhibitor of trauma patients with a femur fracture.</p> <p>Methods</p> <p>The study is designed as a double-blind randomized placebo-controlled trial. Trauma patients with a femur fracture, Injury Severity Score ≥ 18 and age 18-80 years are included after obtaining informed consent. They are randomized for administration of 200 U/kg C1-esterase inhibitor intravenously or placebo (saline 0.9%) just before the start of the procedure of femoral fixation. The primary endpoint of the study is Δ interleukin-6, measured at t = 0, just before start of the femur fixation surgery and administration of C1-esterase inhibitor, and t = 6, 6 hours after administration of C1-esterase inhibitor and the femur fixation.</p> <p>Conclusion</p> <p>This study intents to identify C1-esterase inhibitor as a safe and potent anti-inflammatory agent, that is capable of suppressing systemic inflammation in trauma patients. This might facilitate early total care procedures by lowering the risk of inflammation in response to the surgical intervention. This could result in increased functional outcomes and reduced health care related costs.</p> <p>Trial registration</p> <p>clinicaltrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01275976">NCT01275976</a> (January 12th 2011)</p

A recalibrated prediction model can identify level-1 trauma patients at risk of nosocomial pneumonia

Introduction: Nosocomial pneumonia has poor prognosis in hospitalized trauma patients. Croce et al. published a model to predict post-traumatic ventilator-associated pneumonia, which achieved high discrimination and reasonable sensitivity. We aimed to externally validate Croce’s model to predict nosocomial pneumonia in patients admitted to a Dutch level-1 trauma center. Materials and methods: This retrospective study included all trauma patients (≥ 16y) admitted for &gt; 24 h to our level-1 trauma center in 2017. Exclusion criteria were pneumonia or antibiotic treatment upon hospital admission, treatment elsewhere &gt; 24 h, or death &lt; 48 h. Croce’s model used eight clinical variables—on trauma severity and treatment, available in the emergency department—to predict nosocomial pneumonia risk. The model’s predictive performance was assessed through discrimination and calibration before and after re-estimating the model’s coefficients. In sensitivity analysis, the model was updated using Ridge regression. Results: 809 Patients were included (median age 51y, 67% male, 97% blunt trauma), of whom 86 (11%) developed nosocomial pneumonia. Pneumonia patients were older, more severely injured, and underwent more emergent interventions. Croce’s model showed good discrimination (AUC 0.83, 95% CI 0.79–0.87), yet predicted probabilities were too low (mean predicted risk 6.4%), and calibration was suboptimal (calibration slope 0.63). After full model recalibration, discrimination (AUC 0.84, 95% CI 0.80–0.88) and calibration improved. Adding age to the model increased the AUC to 0.87 (95% CI 0.84–0.91). Prediction parameters were similar after the models were updated using Ridge regression. Conclusion: The externally validated and intercept-recalibrated models show good discrimination and have the potential to predict nosocomial pneumonia. At this time, clinicians could apply these models to identify high-risk patients, increase patient monitoring, and initiate preventative measures. Recalibration of Croce’s model improved the predictive performance (discrimination and calibration). The recalibrated model provides a further basis for nosocomial pneumonia prediction in level-1 trauma patients. Several models are accessible via an online tool. Level of evidence: Level III, Prognostic/Epidemiological Study.</p

Global changes in mortality rates in polytrauma patients admitted to the ICU-a systematic review

Background Many factors of trauma care have changed in the last decades. This review investigated the effect of these changes on global all-cause and cause-specific mortality in polytrauma patients admitted to the intensive care unit (ICU). Moreover, changes in trauma mechanism over time and differences between continents were analyzed. Main body A systematic review of literature on all-cause mortality in polytrauma patients admitted to ICU was conducted. All-cause and cause-specific mortality rates were extracted as well as trauma mechanism of each patient. Poisson regression analysis was used to model time trends in all-cause and cause-specific mortality. Thirty studies, which reported mortality rates for 82,272 patients, were included and showed a decrease of 1.8% (95% CI 1.6-2.0%) in all-cause mortality per year since 1966. The relative contribution of brain injury-related death has increased over the years, whereas the relative contribution of death due to multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome, and sepsis decreased. MODS was the most common cause of death in North America, and brain-related death was the most common in Asia, South America, and Europe. Penetrating trauma was most often reported in North America and Asia. Conclusions All-cause mortality in polytrauma patients admitted to the ICU has decreased over the last decades. A shift from MODS to brain-related death was observed. Geographical differences in cause-specific mortality were present, which may provide region-specific learning possibilities resulting in improvement of global trauma care

The power of peers in GTA development of practice: evaluation of an equal-status teaching observation project

Peer observation of teaching is a well-established professional development practice and can occur through a range of different activities (e.g., micro-teaching, lesson study, performance reviews, etc.). There is evidence that these various activities are being increasingly used to support Graduate Teaching Assistants (GTAs). This paper reports the findings of a pilot project that implemented equal-status, interdisciplinary and developmental peer observations. As a collaborative project, it was co-designed and evaluated by eight GTAs and an academic developer. Our observation framework involved GTAs’ undertaking the observee and observer roles and retaining five of six identified dimensions of control. The findings show that the observation experiences encouraged both new and experienced GTAs to take a self-reflective and critical stance to their teaching and disciplinary approaches. This confirms the value of GTAs’ experiencing the observer role and their exposure to other disciplinary environments. The post-observation ‘learning conversations’ provided significant opportunities for GTAs to discuss and reflect on their practice contexts and experiences together. This represents an effective example of peer supported learning, which also reduces the sense of isolation that GTAs often experience

Variability in Antarctic surface climatology across regional climate models and reanalysis datasets

Regional climate models (RCMs) and reanalysis datasets provide valuable information for assessing the vulnerability of ice shelves to collapse over Antarctica, which is important for future global sea level rise estimates. Within this context, this paper examines variability in snowfall, near-surface air temperature and melt across products from the Met Office Unified Model (MetUM), Regional Atmospheric Climate Model (RACMO) and Modèle Atmosphérique Régional (MAR) RCMs, as well as the ERA-Interim and ERA5 reanalysis datasets. Seasonal and trend decomposition using LOESS (STL) is applied to split the monthly time series at each model grid cell into trend, seasonal and residual components. Significant systematic differences between outputs are shown for all variables in the mean and in the seasonal and residual standard deviations, occurring at both large and fine spatial scales across Antarctica. Results imply that differences in the atmospheric dynamics, parametrisation, tuning and surface schemes between models together contribute more significantly to large-scale variability than differences in the driving data, resolution, domain specification, ice sheet mask, digital elevation model and boundary conditions. Despite significant systematic differences, high temporal correlations are found for snowfall and near-surface air temperature across all products at fine spatial scales. For melt, only moderate correlation exists at fine spatial scales between different RCMs and low correlation between RCM and reanalysis outputs. Root mean square deviations (RMSDs) between all outputs in the monthly time series for each variable are shown to be significant at fine spatial scales relative to the magnitude of annual deviations. Correcting for systematic differences results in significant reductions in RMSDs, suggesting the importance of observations and further development of bias-correction techniques

Clinical outcomes and end-of-life treatment in 596 patients with isolated traumatic brain injury:a retrospective comparison of two Dutch level-I trauma centers

Purpose: With an increasingly older population and rise in incidence of traumatic brain injury (TBI), end-of-life decisions have become frequent. This study investigated the rate of withdrawal of life sustaining treatment (WLST) and compared treatment outcomes in patients with isolated TBI in two Dutch level-I trauma centers. Methods: From 2011 to 2016, a retrospective cohort study of patients aged ≥ 18 years with isolated moderate-to-severe TBI (Abbreviated Injury Scale (AIS) head ≥ 3) was conducted at the University Medical Center Rotterdam (UMC-R) and the University Medical Center Utrecht (UMC-U). Demographics, radiologic injury characteristics, clinical outcomes, and functional outcomes at 3–6 months post-discharge were collected. Results: The study population included 596 patients (UMC-R: n = 326; UMC-U: n = 270). There were no statistical differences in age, gender, mechanism of injury, and radiologic parameters between both institutes. UMC-R patients had a higher AIShead (UMC-R: 5 [4–5] vs. UMC-U: 4 [4–5], p &lt; 0.001). There was no difference in the prehospital Glasgow Coma Scale (GCS). However, UMC-R patients had lower GCSs in the Emergency Department and used more prehospital sedation. Total in-hospital mortality was 29% (n = 170), of which 71% (n = 123) occurred after WLST. Two percent (n = 10) remained in unresponsive wakefulness syndrome (UWS) state during follow-up. Discussion: This study demonstrated a high WLST rate among deceased patients with isolated TBI. Demographics and outcomes were similar for both centers even though AIShead was significantly higher in UMC-R patients. Possibly, prehospital sedation might have influenced AIS coding. Few patients persisted in UWS. Further research is needed on WLST patients in a broader spectrum of ethics, culture, and complex medical profiles, as it is a growing practice in modern critical care. Level of evidence: Level III, retrospective cohort study.</p