ABSTRACT
Particle size distribution is a major factor in the health and climate effects of ambient aerosols, and it shows a large variation depending on the prevailing atmospheric emission sources. In this work, the particle number size distributions of ambient air were investigated at a suburban detached housing area in northern Helsinki, Finland, during a half-year period from winter to summer of 2020. The measurements were conducted with a scanning mobility particle sizer (SMPS) with a particle size range of 16–698 nm (mobility diameter), and the events with a dominant particle source were identified systematically from the data based on the time of the day and different particle physical and chemical properties. During the measurement period, four different types of events with a dominant contribution from either wood-burning (WB), traffic (TRA), secondary biogenic (BIO), or long-range transported (LRT) aerosol were observed. The particle size was the largest for the LRT events followed by BIO, WB, and TRA events with the geometric mean diameters of 72, 62, 57, and 41 nm, respectively. BIO and LRT produced the largest particle mode sizes followed by WB, and TRA with the modes of 69, 69, 46, and 25 nm, respectively. Each event type had also a noticeably different shape of the average number size distribution (NSD). In addition to the evaluation of NSDs representing different particle sources, also the effects of COVID-19 lockdown on specific aerosol properties were studied as during the measurement period the COVID-19 restrictions took place greatly reducing the traffic volumes in the Helsinki area in the spring of 2020. These restrictions had a significant contribution to reducing the concentrations of NOx and black carbon originating from fossil fuel combustion concentration, but insignificant effects on other studied variables such as number concentration and size distribution or particle mass concentrations (PM1, PM2.5, or PM10). © 2022 The Authors
ABSTRACT
Background: The closure of childcare organizations (e.g. schools, childcare centers, afterschool programs, summer camps) during the Covid-19 pandemic impacted the health and wellbeing of families. Despite their reopening, parents may be reluctant to enroll their children in summer programming. Knowledge of the beliefs that underlie parental concerns will inform best practices for organizations that serve children.Methods: Parents (n = 17) participated in qualitative interviews (October 2020) to discuss Covid-19 risk per-ceptions and summer program enrollment intentions. Based on interview responses to perceived Covid-19 risk, two groups emerged for analysis-"Elevated Risk (ER)" and "Conditional Risk (CR)". Themes were identified utilizing independent coding and constant-comparison analysis. Follow-up interviews (n = 12) in the Spring of 2021 evaluated the impact of vaccine availability on parent risk perceptions. Additionally, parents (n = 17) completed the Covid-19 Impact survey to assess perceived exposure (Range: 0-25) and household impact (Range: 2-60) of the pandemic. Scores were summed and averaged for the sample and by risk classification group.Results: Parents overwhelmingly supported the operation of summer programming during the pandemic due to perceived child benefits. Parent willingness to enroll their children in summer programming evolved with time and was contingent upon the successful implementation of safety precautions (e.g. outdoor activities, increased handwashing/sanitizing of surfaces). Interestingly, parents indicated low exposure (ER: Avg. 6.3 +/- 3.1 Range [2-12], CR: Avg. 7.5 +/- 3.6 Range [1-14]) and moderate family impact (ER: Avg. 27.1 +/- 6.9 Range [20-36], CR: Avg. 33.7 +/- 11.4 Range [9-48]) on the impact survey.Conclusion: Childcare organizations should mandate and evaluate the implementation of desired Covid-19 safety precautions for their patrons.
ABSTRACT
Rivers are undoubtedly the main pathway of waste dispersed in the environment that from land reaches oceans and seas increasing the amount of marine litter. Major cities are a great source of riverine litter as large urbanization can originate pressure on the integrated waste management resulting in litter entering the rivers. Within this study, we aim to investigate the dynamic of floating riverine macrolitter (items >2.5 cm) in the city of Rome before it reaches the sea by assessing the composition, amount, and seasonal trends of litter transported from the urban centre to the main river mouth of Tiber River. Visual surveys for a whole year (March 2021–February 2022) were conducted from two bridges, Scienza Bridge (in the city) and Scafa Bridge (at the main river mouth) and followed JRC/RIMMEL protocol for riverine litter monitoring. Overall, similar litter composition was observed from the city centre to the mouth with a prevalence of plastic material, mainly related to fragmentation process (i.e. plastic pieces) and single use items, mainly in food and beverage sectors. An extrapolated annual loading of 4 × 105 items/year was estimated at the main mouth of Tiber River. The litter flux seems to be influenced by the seasonal variability and hydrometeorological parameters. The frequency of size classes decreases with increasing size in both sites, and more than half of the recorded items were below 10 cm. Specific categories belonging to "other plastics” have been reported related to anti-Covid-19 behaviour such as face masks and beverage sector, e.g. bottle lids and rings. The main colour of plastics was white, suggesting weathering process of floating riverine litter. This study contributes to increasing knowledge of the origin, composition and spatiotemporal dynamics of riverine floating litter from the city and entering the sea. © 2022 Elsevier B.V.
ABSTRACT
OBJECTIVES: to analyse both direct and indirect impacts on surgical admissions, surgical rates, and clinical picture severity of the two COVID-19 pandemic waves in a hospital network covering an entire province (Trento, located in Trentino-Alto Adige Region, Northern Italy). DESIGN: retrospective epidemiological study. SETTING AND PARTICIPANTS: data regarding the patient load of the Surgical Urgencies/Emergencies flows (SUEs) of the Local Health Authority of the Autonomous Province of Trento derived from the Hospital Discharge Record (HDR) information flow. The population in study was that of patients hospitalized in the entire Province of Trento. This study com-pares the volume and characteristics of urgent/emergency surgery during the 2020 COVID-19 pandemic with the homolog-ous period in 2019, subdividing the analysed pandemic period in 3 separated groups: • phase I (March-May 2020);• phase II (June-August 2020);• phase III (October-December 2020). The 3 groups represent, respectively: the 1st pandemic wave proclamation of national lockdown from 9 March to 18 May;the summer pandemic remission;the 2nd pandemic wave with partial restrictions on circulation and commercial activ-ities. Clinical and surgical records of SUE population among these 3 periods (March-May;June-August;October-Decem-ber) of both 2020 and 2019 were analyzed and compared. MAIN OUTCOME MEASURES: the overall number of admissions and surgical rates for SUEs in the study periods were chosen as primary outcomes. The same outcomes were analysed for the most represented diagnoses in the SUEs pop-ulation: diverticulitis, intestinal obstruction, appendicitis, cholecystitis, gastrointestinal (GI) perforations, pancreat-itis, traumas. To assess the degree of clinical picture sever-ity, variables coming from the hospital discharging charts, commonly associated to worst outcomes in term of mortality and morbidity, such as age, length of hospital stay, DRG weight, and patients not discharged at home were extrapol-ated from the electronic database. A numerical weight was then assigned to each variable, obtaining a scoring system from 0 to 15 (severity index). RESULTS: the number of admissions for SUEs in the studied period showed a sinusoidal trend, with a dramatic decrea- se in phase I and III (-46.6% and-31.6%, respectively). This trend was also observed even by stratifying admissions for the most frequent pathologies, except for gastrointestinal perforations and pancreatitis. The surgical rate among ho-spitalised patients for SUEs was 35.2% in phase, significantly higher than that of 2019 (25.6%). Considering the most frequent diagnoses individually, some had a progressive increase in the surgical rate in phases I and II (diverticulitis, bowel obstructions, cholecystitis), others showed an initial decrease and then settled on values not far from those of 2019 (GI perforations and appendicitis), others again had an initial significant increase and then gradually returned to values si-milar to those of 2019 in phase III (traumas). The mean patients age was significantly higher in phase I than in 2019 (p-value <0.001) and in phase II (p-value <0.05). Consisten-tly with the trend of the number of urgent admissions, even the severity index calculated on the SUEs population showed a sinusoidal trend with and evident increase during the two pandemic waves. CONCLUSIONS: the effect of the COVID-19 pandemic on SUEs was mainly indirect, manifesting itself with a significant reduction in surgical admissions, particularly in phases I and III. Conversely, in the same phases, the surgical rate showed a significant increase compared to 2019. The stratified analysis confirmed these findings for the most frequent diagnoses except for GI perforations and pancrea-titis. The clinical pictures were more severe in the two pandemic waves than in the reference period of 2019. Although with a slight numerical attenuation, in general, the second pandemic wave confirmed the first one findings.
ABSTRACT
Rationale: To reduce transmission of SARS-CoV-2, non-pharmaceutical interventions (NPIs), including school closures, hand hygiene, mask mandates, and social distancing, were enforced in Arkansas from 3/2020-2/2021. We hypothesized that the presence of NPIs would correlate with a decrease in asthma exacerbations and viral infections. Methods: Demographic information was collected on subjects with asthma exacerbations or viral infections from 3/2018-5/2022, including age, race, ethnicity, and sex. To evaluate the effects of NPIs, three periods were considered: pre- (03/2018-02/2020), during (03/2020-02/2021), and post- (03/2021-05/2022) NPIs. ANOVA analysis and generalized linear models were performed to determine statistical significance. The stringency of NPIs was evaluated using publicly available data (Oxford Covid-19 Government Response Tracker), which allows for direct comparison of Arkansas NPI status to exacerbation data during the same time periods. Results: 5055 asthma exacerbations (3322 unique subjects) occurred between 3/2018-5/2022. Asthma exacerbations decreased from 3/2020-3/2021 and returned to pre-pandemic numbers by summer 2021 (p<0.0001). Similar downward trends occurred for respiratory syncytial virus (RSV) with out-of-season return in summer 2021 (p<0.0001). Rhinovirus was present throughout NPIs. The mean age of exacerbations decreased by 0.9 years when comparing the during NPIs and after NPIs periods (p = 0.0002). An increase in the proportion of exacerbations was noted for non-black and other/unknown ethnicity subjects during and after NPIs. Conclusions: Fewer asthma exacerbations occurred during the most significant NPI employment period (03/2020-02/2021), and an increase in exacerbations was seen as mitigation strategies were relaxed, which correlated with timing of increasing RSV infections.
ABSTRACT
In this brief review I shall try to discuss several topics related to hypertension which maybe associated with occupational and environmental effects. Effects of dietary sodium will not be discussed as these are extensively discussed elsewhere. Occupational stress is difficult to define but there seems to be a relationship between high demands and relatively low control, and blood pressure in both men and women despite different professional distribution. Noise, a relatively less recognized stressor that may be associated with hypertension Both industrial noise and urban noise. Recently due to the Covid19 lockdown and reduction of aircraft noise in relevant areas a reduction of bloodpressure was noted. Seasonal variation with rise of blood pressure during cold and perhaps shorter daytime light seasons, and subsequent reduction in the summer with its higher temperatures and longer light hours is one environmental factor. Air pollution, especially that associated with high level small particulate matter equal to, or smaller than 0.25 μm, was associated with hypertension in several studies, with quite and ethnic and geographic variability. High altitude exposure (higher than 2500 m), involves hypoxemia (in addition to radiation, cold temperatures, and dehydration because of dryness of inhaled air), resulting in renin angiotensin system activation and sympathetically induced vascular contraction, and elevation of pulse rate and blood-pressure at rest and an exaggerated increase during exercise. Immigration seems to be associated with hypertension through different mechanisms in different populations. Mechanisms of these effects are not well understood though some must be mediated through sympathetic activation, others through the renin angiotensin system though, hypoxemia, altered redox state and inflammation all might participate along with other mechanisms.
ABSTRACT
There is a considerable burden of children being hospitalized due to infectious diseases worldwide. The COVID-19 pandemic provided a unique opportunity to examine effects of worldwide efforts to control spread of infection. We aimed to investigate overall age-specific hospitalizations due to viral and bacterial infections and diseases triggered by respiratory tract infections during and after lockdown. This nationwide register–based observational study included children from 29 days to 17 years old hospitalized in all Danish pediatric emergency departments during the years 2015–2021. Main outcomes were ICD-10 diagnoses for infectious diseases and infection triggered illnesses. Fluctuations in hospitalization events were explored using figures with weekly events per 100,000. Total events followed a predictable pattern during 2015–2019. In 2020–2021, there was a drop in hospital encounters after lockdowns and surge after reopenings. In 2021, there was a surge of hospital encounters in the late summer due to respiratory syncytial virus infections and asthmatic bronchitis mostly in infants from 29 days to 2 years. For the infectious diseases, there was a dramatic decrease in events after lockdowns and immediate increase in cases that followed the same pattern of previous years after reopenings. Bacterial infections, like urinary tract infections, sepsis, and meningitis followed a steady pattern throughout all calendar-years. Conclusions: Nationwide efforts to minimize infectious disease spread like lockdowns have a preventative and period lasting effect but reopenings/reunions result in surges of infectious diseases. This might be due to children not getting immunized steadily thereby increasing the pool of possible hosts for potential viral infections. What is Known:• There is a seasonal fluctuation in viral/respiratory infections in children with higher infection rates in the winter and lower rates in the summer.• RSV infection is a major source of concern.What is New:• Major lockdowns and reopenings disrupt the seasonal fluctuations which can result in high surges in infections that increases the burden of children emergency departments and the risk of serious complications. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
ABSTRACT
Climate change is expected to increase the risk of extreme weather conditions (and the associated risk of flooding). This means that hospitals must explicitly take into account a situation in which severe weather jeopardizes continuity of care. They must therefore include a water test in their technical design and take this into account in their contingency plans, whereby an evacuation is only proposed as the very last. Coordination with other hospitals, the government, the fire service, the Red Cross, the military and other actors in the emergency services, as well as multidisciplinary exercises are crucial. In the summer of 2021, this turned out not to be a distant future, but pure reality. This article describes the impact of an imminent flood on Belgian and Dutch hospitals along the Meuse, as well as their experiences and approach to this precarious situation in the summer of 2021. Since the Covid-19 pandemic, the contingency plans and evacuation protocols used must also take into account specific hygiene measures, which makes the response to such calamities even more complex. In this article, the authors discuss the risks of flooding for the healthcare sector and make policy proposals for day-to-day practice.
ABSTRACT
Objectives: The COVID-19 pandemic is characterized by successive waves that each developed differently over time and through space. We aim to provide an in-depth analysis of the evolution of COVID-19 mortality during 2020 and 2021 in a selection of countries. Methods: We focus on five European countries and the United States. Using standardized and age-specific mortality rates, we address variations in COVID-19 mortality within and between countries, and demographic characteristics and seasonality patterns. Results: Our results highlight periods of acceleration and deceleration in the pace of COVID-19 mortality, with substantial differences across countries. Periods of stabilization were identified during summer (especially in 2020) among the European countries analyzed but not in the United States. The latter stands out as the study population with the highest COVID-19 mortality at young ages. In general, COVID-19 mortality is highest at old ages, particularly during winter. Compared with women, men have higher COVID-19 mortality rates at most ages and in most seasons. Conclusion: There is seasonality in COVID-19 mortality for both sexes at all ages, characterized by higher rates during winter. In 2021, the highest COVID-19 mortality rates continued to be observed at ages 75+, despite vaccinations having targeted those ages specifically. © 2022 The Authors
ABSTRACT
As of December 2021, all former Communist countries from Central and Eastern Europe were still lagging behind in terms of COVID-19 vaccination rates in Europe. Can institutional legacy explain, at least in part, this heterogeneity in vaccination decisions across Europe? To study this question we exploit novel data from the second wave of the SHARE (Survey of Health, Ageing and Retirement in Europe) COVID-19 Survey fielded in Summer (2021) that covers older individuals in 27 European countries. First, we document lower COVID-19 vaccine take-up amongst those who were born under Communism in Europe. Next, we turn to reunified Germany to get closer to a causal effect of having lived behind the Iron Curtain. We find that exposure to the Communist regime in East Germany decreased one's probability to get vaccinated against COVID-19 by 8 percentage points and increased that of refusing the vaccine by 4 percentage points. Both effects are large and statistically significant, and they hold when controlling for individual socio-economic and demographic characteristics. We explore several possible mechanisms. The East-West Germany gap does not seem to be explained by differences in the impact of the first wave of the pandemic or in general exposure to vaccines. We find that East Germans have lower social capital than West Germans and that social capital correlates negatively with Covid-10 vaccine uptake, but only a small fraction of the East-West Germany Covid-19 vaccination gap can be explained by our measures of social capital.
ABSTRACT
As the labor market has tightened, seasonal recreation employers have struggled to find and hire quality staff. Operating under tight budgetary constraints due to the COVID-19 pandemic, many seasonal employers are looking for alternatives to pay increases to attract staff. Emerging adults, defined as people between 18 and 29 years of age, are commonly seeking seasonal employment to complement their school schedules during the summer months. Therefore, adding non-monetary value to these seasonable employment experiences may encourage further interest from emerging adults.Emerging adults are generally focused on understanding who they are and what they want out of life. This type of learning is often facilitated through experiences that offer opportunities to be socially and emotionally supported (Yohalem et al., 2007), build meaningful relationships with others (Lerner & Lerner, 2013), try and experiment in new contexts and activities (Durlak et al., 2010), and contribute in significant ways (Eccles & Gootman, 2002). Collectively, such experiences are often termed developmental experiences (Nagaoka et al., 2015). Seasonal employ-ment experiences that are developmental offer emerging adults non-monetary value that they may find attractive. Therefore, the purpose of this paper was to understand developmental experiences reported by emerging adult summer camp employees as a way to inform seasonal staffing efforts.Participants were 254 individuals (Mage = 19.8 years), majority female (68.9%) and White (76%) who were recruited from a longitudinal study and were camp staff during summer 2018. A convergent design was used, including data from semi-structured interviews and quantitative surveys. Qualitative data were ana-lyzed inductively and deductively, and within-subjects designs (RMANOVAs and paired t-tests) were used to analyze quantitative data. The reported employment experiences generally aligned with the existing literature on important character-istics of developmental experiences and were categorized as experiential and en-gaging activities, positive social and emotional climate, supportive relationships, and meaningful contributions. An additional characteristic, less consistent with the extant literature, separate time and space, was also present. Implications for practice are offered, highlighting ways to facilitate developmental experiences for camp staff and reduce characteristics that may hinder developmental experiences.
ABSTRACT
Purpose of Study: In areas endemic for murine typhus, it can be difficult to distinguish from other febrile syndromes. During COVID-19 surges, we identified several cases of typhus. Presenting symptoms and quantitative lab values at and during admission were compared between patients who were diagnosed with murine typhus or multisystem-inflammatory syndrome in children (MIS-C). Methods Used: Retrospective data was collected at a tertiary care center from July 2020 to March 2022. Inclusion criteria were patients under 21 years of age diagnosed at discharge with murine typhus or MIS-C based on clinical and laboratory evidence, serologic data, and expert consultation. Patients found to have an alternate diagnosis, and those without serologic testing were excluded. Subjects were grouped as either MIS-C or typhus based final diagnosis. Categorical data included headache, fatigue, mucocutaneous changes, rash, con-junctival injection, sore throat, rhinorrhea, palpitations, shortness of breath, chest pain, abdominal pain, nausea/vomiting, diarrhea, myalgia, and appetite change at initial presentation. The categorical data were compared using chi-square test. Quantitative data included age, maximum temperature in first 24 hours of hospitalization, duration of symptoms prior to admission, C-reactive protein, erythrocyte sedimentation rate, platelet count, white blood cell count (WBC), absolute neutrophil count (ANC), absolute lymphocyte count, serum sodium, alanine aminotransferase, hemoglobin (Hgb), and albumin (Alb). Means of the quantitative data were compared with a one-tailed 2- Sample T-Test. The maximum and minimum laboratory values during admission were also compared. Additional demographic data including gender and date of initial presentation was also collected. Summary of Results: There were 7 patients in the MIS-C group and 19 in the typhus group. The average age of MIS-C patients, 6.5 years of age vs. 11.5,was significantly lower (p < 0.5) than the typhus group. Initial mean WBC (cells x 103/mm3) was higher in MIS-C than typhus (12.21, SD = 3.52, vs. 7.85, SD = 3.52, p < 0.05), as was ANC (8.9, SD = 3.7vs. 5.12, SD = 2.05, p < 0.05). During hospitalization, minimum Hgb (g/dL) was 9.3, SD = 2.07, and11.49, SD = 1.67, in MIS-C and typhus respectively (p < 0.05). Minimum albumin (g/dL) was also lower in MIS-C than typhus (2.32, SD = 0.86 vs. 2.8, SD = 0.45, p < 0.05). There were no other statistically significant differences in categorical or quantitative data. Typhus cases typically occurred in the summer and fall months. There was no clear seasonality of MIS-C, but occurred during local COVID-19 surges. Conclusion(s): The initial presenting symptoms of typhus and MIS-C were similar. WBC and ANC were higher in MIS-C, while age, Hgb and Alb were lower. These parameters may aid in distinguishing the diseases. A high clinical suspicion for both typhus and MIS-C in endemic areas for typhus is crucial. A rapid detection for typhus would aid in distinguishing these diseases and allow prompt treatment interventions. Copyright © 2023 Southern Society for Clinical Investigation.
ABSTRACT
The consequences of the COVID-19 pandemic are extensive and far-reaching. Non COVID communicable diseases continue to spread and non-communicable diseases continue to progress. People may access healthcare facilities little bit late due to fear of contracting COVID-19 and present with severe symptoms, even with complications. Nepal has been facing dual burden of both non-communicable and communicable diseases. The number of COVID-19 patients has continuously been rising in Nepal since the start of May 2020. There is an anticipated surge of infectious disease such as malaria, dengue fever, enteric fever, scrub typhus, leptospirosis during summer and monsoon seasons in Nepal. There will be surge of cases of acute undifferentiated febrile illness (AUFI) during monsoon. As fever is one of the very common symptoms of COVID-19, so COVID-19 needs to be considered in differential diagnoses of acute undifferentiated febrile illness. Copyright © 2020, Kathmandu University. All rights reserved.
ABSTRACT
Background On March 11, 2020, the World Health Organization declared COVID-19 a worldwide pandemic. Responses to the pandemic response disrupted Canadian social connections in complex ways;because social connections are determinants of health and well-being, their disruption could adversely affect health and well-being. Moreover, understanding how pandemics and public health responses affect social connections could inform pandemic recovery strategy and public health approaches designed for future pandemics. The purpose of this study is to understand experiences of pandemic impact on social connections over the pandemic. Methods A sample of 343 Canadian adults was recruited through Athabasca University and social media. Participants were predominantly White (81%) and female (88%). After the pandemic onset, participants responded to open-ended questions about the impact of the pandemic on and any changes to social connections at three time points (baseline, and three- and 6 months from study entry). Responses were categorized into epochs by date (April-June 2020 [Spring];July-August 2020 [Summer];September 2020-January 2021 [Fall/Winter]). Qualitative thematic analysis was used to code themes for each epoch. Results Negative impact of the pandemic (37–45%), loss of social connections (32–36%), and alternative means of connection (26–32%) were prominent themes across the epochs. Restrictions to face-to-face connections were largest in spring (9%) and lowest in the Summer (4%). Conversely, participants increasingly reported limited contact or communication into the Fall and Winter (6–12%) as pandemic restrictions in Canada were reinstated. Conclusions The COVID-19 pandemic threatens social connections, with negative impacts that fluctuated with COVID-19 case rates and subsequent pandemic restrictions. These findings could be used to identify targets for social supports during the pandemic recovery, and to adjust public health strategies for future pandemics that minimize impact on social connections.
ABSTRACT
Can summer programs, as remedial supplements to regular schooling, extend learning opportunities and other benefits to disadvantaged students? To frame this question, we compare logics from "social reproduction” and "partial compensation” perspectives, and then apply them to a large mixed method study of four kinds of summer programs in Ontario. Drawing on quantitative data on over 10,000 students and qualitative data from interviews with over 200 teachers and parents, we examined patterns of student recruitment and participation, social valuations, and academic outcomes. We found that all summer programs successfully recruited disadvantaged students without stigmatizing them, and raised their average achievement without widening pre-existing gaps. We interpret these findings as being consistent with the "partial compensation” perspective, and discuss related policy implications that include COVID-19 learning recovery strategies © 2023 Canadian Society for the Study of Education/Société canadienne pour l'étude de l'éducation
ABSTRACT
We present the CarbonTracker Europe High-Resolution (CTE-HR) system that estimates carbon dioxide (CO2) exchange over Europe at high resolution (0.1 × 0.2∘) and in near real time (about 2 months' latency). It includes a dynamic anthropogenic emission model, which uses easily available statistics on economic activity, energy use, and weather to generate anthropogenic emissions with dynamic time profiles at high spatial and temporal resolution (0.1×0.2∘, hourly). Hourly net ecosystem productivity (NEP) calculated by the Simple Biosphere model Version 4 (SiB4) is driven by meteorology from the European Centre for Medium-Range Weather Forecasts (ECMWF) Reanalysis 5th Generation (ERA5) dataset. This NEP is downscaled to 0.1×0.2∘ using the high-resolution Coordination of Information on the Environment (CORINE) land-cover map and combined with the Global Fire Assimilation System (GFAS) fire emissions to create terrestrial carbon fluxes. Ocean CO2 fluxes are included in our product, based on Jena CarboScope ocean CO2 fluxes, which are downscaled using wind speed and temperature. Jointly, these flux estimates enable modeling of atmospheric CO2 mole fractions over Europe.We assess the skill of the CTE-HR CO2 fluxes (a) to reproduce observed anomalies in biospheric fluxes and atmospheric CO2 mole fractions during the 2018 European drought, (b) to capture the reduction of anthropogenic emissions due to COVID-19 lockdowns, (c) to match mole fraction observations at Integrated Carbon Observation System (ICOS) sites across Europe after atmospheric transport with the Transport Model, version 5 (TM5) and the Stochastic Time-Inverted Lagrangian Transport (STILT), driven by ECMWF-IFS, and (d) to capture the magnitude and variability of measured CO2 fluxes in the city center of Amsterdam (the Netherlands).We show that CTE-HR fluxes reproduce large-scale flux anomalies reported in previous studies for both biospheric fluxes (drought of 2018) and anthropogenic emissions (COVID-19 pandemic in 2020). After applying transport of emitted CO2, the CTE-HR fluxes have lower median root mean square errors (RMSEs) relative to mole fraction observations than fluxes from a non-informed flux estimate, in which biosphere fluxes are scaled to match the global growth rate of CO2 (poor person's inversion). RMSEs are close to those of the reanalysis with the CTE data assimilation system. This is encouraging given that CTE-HR fluxes did not profit from the weekly assimilation of CO2 observations as in CTE.We furthermore compare CO2 concentration observations at the Dutch Lutjewad coastal tower with high-resolution STILT transport to show that the high-resolution fluxes manifest variability due to different emission sectors in summer and winter. Interestingly, in periods where synoptic-scale transport variability dominates CO2 concentration variations, the CTE-HR fluxes perform similarly to low-resolution fluxes (5–10× coarsened). The remaining 10 % of the simulated CO2 mole fraction differs by >2 ppm between the low-resolution and high-resolution flux representation and is clearly associated with coherent structures ("plumes”) originating from emission hotspots such as power plants. We therefore note that the added resolution of our product will matter most for very specific locations and times when used for atmospheric CO2 modeling. Finally, in a densely populated region like the Amsterdam city center, our modeled fluxes underestimate the magnitude of measured eddy covariance fluxes but capture their substantial diurnal variations in summertime and wintertime well.We conclude that our product is a promising tool for modeling the European carbon budget at a high resolution in near real time. The fluxes are freely available from the ICOS Carbon Portal (CC-BY-4.0) to be used for near-real-time monitoring and modeling, for example, as an a priori flux product in a CO2 data assimilation system. The data are available at 10.18160/20Z1-AYJ2 .
ABSTRACT
Introduction/Background: Eosinophilic granulomatosis with polyangiitis (EGPA), previously known as Churg-Strauss Syndrome, is a rare, small to medium vessel ANCA associated vasculitis. Hallmarks of EGPA include asthma, chronic rhinosinusitis, and peripheral neuropathy. EGPA is characterized by a prodrome of asthma and allergic rhinitis, followed by peripheral blood hyper-eosinophilia and accumulation of extravascular eosinophils, and finally systemic vasculitis. Extrapulmonary involvement is common, sometimes with fatal outcomes. The onset of EPGA is typically between 25-50 years;however, EGPA also occurs during childhood and has a significant morbidity and mortality. Description/Method: Our patient presented to the emergency department with a 2-week history of lethargy, wheeze and left sided neck swelling. After testing COVID-19 positive eight months prior to this, she developed wheezy episodes and was subsequently diagnosed with asthma which was managed with bronchodilators as required. She was reviewed by an allergist who confirmed a dust mite allergy and prescribed Montelukast. She remained well during the summer months however during winter she had 3 distinctive episodes of wheeze and cough which were managed by antibiotics and prednisolone. In the emergency department, an echocardiogram was performed which showed a cardiac tamponade. She was transferred to CICU where she had a pericardial drain inserted. The fluid was abundant with inflammatory cells. Multiple investigations were performed as follows: Hb: 135g/L, wbc: 20.30 x 10 9/L, Eosinophils: 12.77 x 10 9/L, CRP: 51 mg/L, ESR: 75 mm/hr, LDH: 1188 IU/L, IgE: 8000 UI/ml, ANA, ANCA: negative. CT chest showed mediastinal lymphadenopathy and patchy bilateral infiltrate and cardiac MRI showed myopericarditis and LV fibrosis. BMA showed no malignant cells and sinusitis was confirmed by CT. On examination, she was underweight. Her nasal mucosa looked inflamed. Otherwise systemic examination was unremarkable. In the context of poor ejection fraction (20%) with LV fibrosis, urgent MDT was arranged and concluded that our working diagnosis was EGPA. The decision was made to start IV methylprednisolone 10mg/kg/day for 3 days and Ivermectin. That night our patient had a VF arrest which required a single shock conversion 4J/kg. There was 7-minute downtime. Treatment was escalated to include cyclophosphamide, rituximab and plasmapheresis. The patient made a remarkable recovery, extubated and transferred to a normal ward. Her eosinophils count and inflammatory markers improved dramatically following treatment. However, she developed severe neuropathic left leg pain and NCS confirmed peripheral neuropathy Discussion/Results: EGPA is a very rare disease and diagnosis can be challenging especially with the absence of histopathology diagnosis. Early empirical treatment especially in a very ill child in intensive care unit can save lives and divert the progress of the disease. This patient has fulfilled the American College of Rheumatology criteria to diagnose EGPA including asthma, eosinophil count > 10% of upper normal, peripheral neuropathy, pulmonary infiltrates on CT thorax and paranasal sinuses abnormalities. Cardiac biopsy of the fibrotic mass may be a useful tool for diagnosis;however, this invasive procedure may expose this patient with high risk of fatal arrhythmias. Since other causes of eosinophilia were ruled out including parasitic infections, lymphoproliferative disorders, and rare primary immunodeficiency syndromes (hyper-IgE syndrome due to STAT3 or DOCK8 deficiency and Omenn syndrome) and the patient responded well to treatment, the diagnosis of EGPA was supported. Key learning points/Conclusion: Asthma not responding to bronchodilator could be another diagnosis Eosinophilia should be interpreted with caution. Defer the need for histopathology diagnosis in critically ill children Cardiac involvement is a life-threatening marker Early diagnosis prevents life threatening complications.
ABSTRACT
Obtaining visual comfort, satisfaction and well-being in residential interiors are now becoming more important, especially in times of extreme events such as the COVID-19 pandemic. It also became important to collect users' evaluations and their own solutions for residential lighting in order to improve the current lighting conditions. For this aim, with a group of international and inter-disciplinary researchers, a comprehensive study was conducted. This study is the last part of a three-stage investigation aimed at increasing our knowledge of the current lighting conditions in residential areas during and after the COVID-19 pandemic. For the current study, an online survey and in-depth interviews were conducted between June and August 2022 in Poland, Turkey, Sweden, and the U.K., with 520 participants. As results of this study show, a correlation was found between daylight satisfaction and its sufficiency. Similar correlations were found between artificial lighting satisfaction, its sufficiency, and its uniformity. The differences between seasons were detected for being very satisfied with daylight quality. Also, the correlation between satisfaction with daylighting and the ratio of windows showed difference among seasons. Stronger correlations between satisfaction with artificial lighting, its sufficiency and uniformity were found in summerterm according to winter-term results. Correlations between artificial lighting brightness - CRI and uniformity weakened in summer-term. Results from open-ended questions and in-depth interviews showed, removing the shading device and augmenting the characteristics of artificial lighting were the mostly done adjustments during the COVID- 19 pandemic. The most prominent theme is visual comfort according to the in-depth interview responses.'