Estimation of NO2 emission strengths over Riyadh and Madrid from space from a combination of wind-assigned anomalies and a machine learning technique

Nitrogen dioxide (NO2) air pollution provides valuable information for quantifying NOx (NOx = NO + NO2) emissions and exposures. This study presents a comprehensive method to estimate average tropospheric NO2 emission strengths derived from 4-year (May 2018–June 2022) TROPOspheric Monitoring Instrument (TROPOMI) observations by combining a wind-assigned anomaly approach and a machine learning (ML) method, the so-called gradient descent algorithm. This combined approach is firstly applied to the Saudi Arabian capital city of Riyadh, as a test site, and yields a total emission rate of 1.09×1026 molec. s-1. The ML-trained anomalies fit very well with the wind-assigned anomalies, with an R2 value of 1.0 and a slope of 0.99. Hotspots of NO2 emissions are apparent at several sites: over a cement plant and power plants as well as over areas along highways. Using the same approach, an emission rate of 1.99×1025 molec. s-1 is estimated in the Madrid metropolitan area, Spain. Both the estimate and spatial pattern are comparable with the Copernicus Atmosphere Monitoring Service (CAMS) inventory.Weekly variations in NO2 emission are highly related to anthropogenic activities, such as the transport sector. The NO2 emissions were reduced by 16 % at weekends in Riyadh, and high reductions were found near the city center and in areas along the highway. An average weekend reduction estimate of 28 % was found in Madrid. The regions with dominant sources are located in the east of Madrid, where residential areas and the Madrid-Barajas airport are located. Additionally, due to the COVID-19 lockdowns, the NO2 emissions decreased by 21 % in March–June 2020 in Riyadh compared with the same period in 2019. A much higher reduction (62 %) is estimated for Madrid, where a very strict lockdown policy was implemented. The high emission strengths during lockdown only persist in the residential areas, and they cover smaller areas on weekdays compared with weekends. The spatial patterns of NO2 emission strengths during lockdown are similar to those observed at weekends in both cities. Although our analysis is limited to two cities as test examples, the method has proven to provide reliable and consistent results. It is expected to be suitable for other trace gases and other target regions. However, it might become challenging in some areas with complicated emission sources and topography, and specific NO2 decay times in different regions and seasons should be taken into account. These impacting factors should be considered in the future model to further reduce the uncertainty budget.

AI-ENABLED TECHNOLOGY INNOVATION IN E-COMMERCE

Recently, advanced digital/internet-based technology has become more prevalent and advanced to play a dominant role in e-commerce. Among them, AI-driven technology innovation in e-commerce plays an important role for its development. There is research potential to discuss how AI-driven technology innovation can benefit the digital economy, as typified by e-commerce, and how it can contribute to the digital transformation of companies in traditional industries. This special issue expands our understanding of organizational and customer intentions and behavior toward AI, such as privacy issues, the perceived benefits and risks of AI-driven technology innovations in e-commerce and building long-term trust relationships between users and AI.

Dramatic decline of observed atmospheric CO2 and CH4 during the COVID-19 lockdown over the Yangtze River Delta of China

The temporal variation of greenhouse gas concentrations in China during the COVID-19 lockdown in China is analyzed in this work using high resolution measurements of near surface △CO2, △CH4 and △CO concentrations above the background conditions at Lin'an station (LAN), a regional background station in the Yangtze River Delta region. During the pre-lockdown observational period (IOP-1), both △CO2 and △CH4 exhibited a significant increasing trend relative to the 2011-2019 climatological mean. The reduction of △CO2, △CH4 and △CO during the lockdown observational period (IOP-2) (which also coincided with the Chinese New Year Holiday) reached up to 15.0 ppm, 14.2 ppb and 146.8 ppb, respectively, and a reduction of △CO2/△CO probably due to a dramatic reduction from industrial emissions. △CO2, △CH4 and △CO were observed to keep declining during the post-lockdown easing phase (IOP-3), which is the synthetic result of lower than normal CO2 emissions from rural regions around LAN coupled with strong uptake of the terrestrial ecosystem. Interestingly, the trend reversed to gradual increase for all species during the later easing phase (IOP-4), with △CO2/△CO constantly increasing from IOP-2 to IOP-3 and finally IOP-4, consistent with recovery in industrial emissions associated with the staged resumption of economic activity. On average, △CO2 declined sharply throughout the days during IOP-2 but increased gradually throughout the days during IOP-4. The findings showcase the significant role of emission reduction in accounting for the dramatic changes in measured atmospheric △CO2 and △CH4 associated with the COVID-19 lockdown and recovery.

Has Public Interest in Elective Spine Surgery Returned to Pre-COVID 19 Levels? A Google Trends Analysis.

Objective To utilize Google trends to examine the effects of changing rules and regulations on public interest regarding elective spine surgery.  Methods This is a retrospective review analyzing data from Google trends to quantify public interest in elective cervical and lumbar fusion as restrictions related to COVID-19 were released. Three time periods were created surrounding the release of restriction on elective surgery on March 13, 2020, by the Centers for Medicare and Medicaid Services (CMS). "Pre-COVID" was defined as the four-month period directly preceding the national ban on elective surgery (11/13/2019 to 3/13/2020). "COVID" was defined as the four-month time period directly after the national ban on elective surgery (3/13/20-7/13/20), and "Post-COVID" was defined as the time period starting four months after the restrictions on elective surgeries first took place (7/13/20-11/13/20). Relative search volume (RSV) was assessed during all three time periods and compared using an analysis of variance test.  Results Search volume for all terms pertaining to cervical and lumbar fusion declined precipitously after the release of restrictions on elective surgery. Additionally, search volume has yet to return to pre-pandemic levels. However, for many of the terms public interest has been steadily increasing and signals the return in demand for these procedures.  Conclusion Public interest in elective spine surgery has been increasing as restrictions continue to loosen and many patients that deferred care will drive increased demand for the foreseeable future.

Operational Policies and Procedures for Critical Care Transport During a Respiratory Pandemic.

The severe acute respiratory syndrome coronavirus 2 pandemic of 2020 to 2021 created unprecedented challenges for health care organizations, including those in the critical care transport sector. Critical care transport services had to rapidly adjust to changing patient demographics, distribution of diagnoses, and transport utilization stratagem. To evolve with the pandemic, organizations developed new protocols and guidelines in rapid succession. The growth bore out of a need to cater to this new patient population and their safety as well as the safety of the crewmembers from severe acute respiratory syndrome coronavirus 2. The critical changes to operations involved adaptability, efficient communication, continual reassessment, and implementation of novel approaches. Although these lessons learned were specific to coronavirus disease 2019, many processes will apply to future respiratory epidemics and pandemics. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic of 2020 to 2021 created unprecedented challenges for health care organizations, including critical care transport (CCT) organizations. The changes were numerous, including a change in the patient population, with a rapid decrease in trauma and pediatrics to a preponderance of adult patients with acute hypoxemic respiratory failure. CCT teams were called on to transport these patients at potential risk to themselves, especially early in 2020, before the effectiveness of personal protective equipment (PPE) was determined. Even seemingly simple tasks, such as defining a person under investigation (PUI) for coronavirus disease 2019 (COVID-19), varied from institution to institution, putting transport organizations in the middle of conflicts. Agility has always been an essential part of any CCT organization because clinicians and managers must adapt to an unpredictable environment. However, the frequency and speed of changes occurring during the COVID-19 pandemic were unprecedented. This report offers our best practices based on our experience and the available data. Although these procedures were developed for the COVID-19 pandemic, they will logically apply to future respiratory outbreaks and illuminate helpful changes for otherwise quotidian operations.

ASSOCIATION BETWEEN DAYS AT REFERRING HOSPITAL AND MORTALITY IN PATIENTS TRANSFERRED WITH COVID-19

B Introduction/Hypothesis: b Prior studies have shown that transporting critically ill patients, especially those with severe acute hypoxemic respiratory failure to ECMO centers, is associated with improved outcomes. While critical care transport is associated with adverse events, prior work has shown improved outcomes when patients with COVID-19 are transported to ECMO centers. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Clinical Policies and Procedures for Critical Care Transport during a Respiratory Pandemic.

The severe acute respiratory syndrome coronavirus disease-2 (SARS-CoV-2) pandemic of 2020-2021 created unprecedented challenges for clinicians in critical care transport (CCT). These CCT services had to rapidly adjust their clinical approaches to evolving patient demographics, a preponderance of respiratory failure, and transport utilization stratagem. Organizations had to develop and implement new protocols and guidelines in rapid succession, often without the education and training that would have been involved pre-coronavirus disease 2019 (COVID-19). These changes were complicated by the need to protect crew members as well as to optimize patient care. Clinical initiatives included developing an awake proning transport protocol and a protocol to transport intubated proned patients. One service developed a protocol for helmet ventilation to minimize aerosolization risks for patients on noninvasive positive pressure ventilation (NIPPV). While these clinical protocols were developed specifically for COVID-19, the growth in practice will enhance the care of patients with other causes of respiratory failure. Additionally, these processes will apply to future respiratory epidemics and pandemics.

Dramatic decline of observed atmospheric CO2 and CH4 during the COVID-19 lockdown over the Yangtze River Delta of China

The temporal variation of greenhouse gas concentrations in China during the COVID-19 lockdown in China is analyzed in this work using high resolution measurements of near surface △CO2, △CH4 and △CO concentrations above the background conditions at Lin'an (LAN), a regional background station in the Yangtze River Delta region. During the pre-lockdown observational period (IOP-1), both △CO2 and △CH4 exhibited a significant increasing trend relative to the 2011-2019 climatological mean. The reduction of △CO2, △CH4 and △CO during the lockdown observational period (IOP-2) (which also coincided with the Chinese New Year Holiday) reached up to 15.0 ppm, 14.2 ppb and 146.8 ppb, respectively, and a reduction of △CO2/△CO probably due to a dramatic reduction from industrial emissions. △CO2, △CH4 and △CO were observed to keep declining during the post-lockdown easing phase (IOP-3), which is the synthetic result of lower than normal CO2 emissions from rural regions around LAN coupled with strong uptake of the terrestrial ecosystem. Interestingly, the trend reversed to gradual increase for all species during the later easing phase (IOP-4), with △CO2/△CO constantly increasing from IOP-2 to IOP-3 and finally IOP-4, consistent with recovery in industrial emissions associated with the staged resumption of economic activity. On average, △CO2 declined sharply throughout the time of day during IOP-2 but increased gradually throughout the day during IOP-4. The findings showcase the significant role of emission reduction in accounting for the dramatic changes in measured atmospheric △CO2 and △CH4 associated with the COVID-19 lockdown and recovery.

Critical Care Transport of Patients With COVID-19.

PURPOSE: Critical care transport is associated with a high rate of adverse events, and the risks and outcomes of transporting critically ill patients during the COVID-19 pandemic have not been previously described. MATERIALS AND METHODS: We performed a retrospective review of transports of subjects with suspected or confirmed COVID-19 from sending hospitals to tertiary care hospitals in Boston. Follow-up data were obtained for patients transported between March 1st and April 20th, 2020. RESULTS: Of 254 charts identified, 250 patients were transported. Nine patients (3.5%) had cardiac arrest prior to transport. Twenty-nine (11.6%) had hypotension, 22 (8.8%) had a critical desaturation, and 4 (1.6%) had both en route. Hospital follow-up data were available for 189 patients. Of those intubated during their hospitalization, 44 (25.0%) had died, 59 (33.5%) had been extubated, and 13 (17.6%) had been discharged alive. For the subgroup with prior cardiac arrest, follow-up data available for 6. Of these 6, 2 died and 4 (66.7%) have been discharged alive. CONCLUSIONS: Few patients with COVID-19 had an adverse event in transport. The in-hospital mortality rate was 25%, with a 33.5% extubation rate. Patients resuscitated from cardiac arrest prior to transport had a 66.7% discharge rate among those transported to consortium hospitals.

Feasibility and Safety of Prone Position Transport for Severe Hypoxemic Respiratory Failure Due to Coronavirus Disease 2019.

OBJECTIVES: To assess the safety and feasibility of a new protocol for interhospital critical care transport of mechanically ventilated patients in the prone position during the coronavirus disease 2019 pandemic by nurse and paramedic critical care transport teams. DESIGN: Retrospective observational study. SETTING: Single critical care transport agency serving multiple centers in the greater Boston area. PATIENTS: All transports of intubated patients in the prone position with severe hypoxemic respiratory failure secondary to coronavirus disease 2019. INTERVENTIONS: Records were reviewed for patients transported in the prone position. Major adverse events in transport, defined as severe hypoxemia (oxygen saturation < 80% or an absolute decrease in oxygen saturation > 10%), hypotension (mean arterial pressure < 65 mm Hg) not responsive to vasopressors or inotropes, endotracheal tube or vascular catheter dislodgement, and cardiac arrest, were recorded. MEASUREMENTS AND MAIN RESULTS: A total of 25 patients were transported in prone position. The mean Pao2:Fio2 ratio in the group was 101.3 mm Hg, and 76% (n = 19) were on vasopressors. Fourteen patients (56%) had hypotension with at least one episode of mean arterial pressure less than 65 mm Hg en route, and seven (28%) had an episode of oxygen desaturation less than 88%. Only one major adverse event of severe hypoxemia (oxygen saturation < 80%) was noted. CONCLUSIONS: Critical care transport of severe hypoxemic respiratory failure patients with coronavirus disease 2019 in the prone position is safe when performed by a dedicated team of critical care nurse and paramedics with an established protocol.

Telehealth for the cognitively impaired older adult and their caregivers: lessons from a coordinated approach.

The Covid-19 pandemic forced providers to alter their delivery of care to special populations, including older adults with cognitive impairment. The Montefiore-Einstein Center for the Aging Brain, a specialty multidisciplinary center for the evaluation and management of patients with neurodegenerative disorders, developed a coordinated approach (Coordinated Care At Risk/Remote Elderly program [CCARRE]) to reach our diverse population during the initial Covid-19 crisis in New York City, USA. In the tele-evaluation of the first 85 patients seen with CCARRE, we recognized unique factors that could improve patient care, lessen burden and optimize access to community resources. Lessons learned from the experience are shared.

Transport of a Nonintubated Prone Patient with Severe Hypoxemic Respiratory Failure Due to COVID-19.

With the COVID-19 pandemic, healthcare systems have been facing an unprecedented, large-scale respiratory disaster. Prone positioning improves mortality in severe hypoxemic respiratory failure, including COVID-19. While this is effective for intubated patients with moderate-to-severe ARDS, it has also been shown to be beneficial for non-intubated patients. Critical care transport (CCT) has become an essential component of combating COVID-19, frequently transporting patients to receive advanced respiratory therapies and distribute patients in concert with available resources. With increasing awake proning, CCT teams may encounter patients supported in the prone position. Historically, transporting in the prone position has not been embraced due to substantial risks of desaturation during transport. In this case report, we describe the first known report of transporting a non-intubated, critically ill COVID-19 patient in the prone position.