Assessment of depth of sedation using Bispectral Index™ monitoring in patients with severe traumatic brain injury in UK intensive care units.

Introduction: Severe traumatic brain injury affects ∼4500 per year across the UK. Most patients undergo a period of sedation to prevent secondary brain injury, however the optimal sedation target is unclear. This study aimed to assess the relationship between the electroencephalogram (EEG)-based Bispectral Index™ (BIS™) value and the clinical sedation score, along with other clinical outcomes. Methods: Patients with severe traumatic brain injury in four UK ICUs were recruited to have blinded BIS data collected for a 24-h period while sedated on the ICU. Drug, physiological, and outcome data were recorded from the ICU record. Sedation management was at the discretion of the ICU clinical team. Results: Twenty-six participants were recruited to the study. The mean BIS was 38 (inter-quartile range 29-44) and there was poor correlation between BIS and sedation score as a group (correlation coefficient 0.17, 95% confidence interval 0.08-0.26), however the spread in BIS values increased with decreasing sedation score. There was no statistically significant relationship between BIS and intracranial pressure, vasopressor use, osmotherapy use, or need for an additional sedative. Conclusion: This study supports previous work showing that BIS decreases with decreasing sedation score. However, the variation in BIS values increased with deeper levels of clinical sedation. Patients may not be benefiting from the full potential of sedation in traumatic brain injury and further studies of sedation titrated to an EEG-based parameter are needed. Clinical trial registration: NCT03575169.

Modeling Spatiotemporal Patterns of Ecosystem Metabolism and Organic Carbon Dynamics Affecting Hypoxia on the Louisiana Continental Shelf.

The hypoxic zone on the Louisiana Continental Shelf (LCS) forms each summer due to nutrient enhanced primary production and seasonal stratification associated with freshwater discharges from the Mississippi/Atchafalaya River Basin (MARB). Recent field studies have identified highly productive shallow nearshore waters as an important component of shelf-wide carbon production contributing to hypoxia formation. In this study we present results from a three-dimensional hydrodynamic-biogeochemical model named CGEM (Coastal Generalized Ecosystem Model) applied to quantify the spatial and temporal patterns of hypoxia, carbon production, respiration, and transport between nearshore and middle shelf regions where hypoxia is most prevalent. We first demonstrate that our simulations successfully reproduced spatial and temporal patterns of carbon production, respiration, and bottom-water oxygen gradients compared to field observations. We then used interannual simulations to identify transport of particulate organic carbon (POC) from nearshore areas where riverine organic matter and phytoplankton carbon production are greatest. The spatial disconnect between carbon production and respiration in our simulations was driven by westward and offshore POC flux, a pattern that supported heterotrophic respiration on the middle shelf where hypoxia is frequently observed. These results validate the importance of offshore carbon flux to hypoxia formation, particularly on the west shelf where hypoxic conditions are more variable.

An Ocean-Colour Time Series for Use in Climate Studies: The Experience of the Ocean-Colour Climate Change Initiative (OC-CCI).

Ocean colour is recognised as an Essential Climate Variable (ECV) by the Global Climate Observing System (GCOS); and spectrally-resolved water-leaving radiances (or remote-sensing reflectances) in the visible domain, and chlorophyll-a concentration are identified as required ECV products. Time series of the products at the global scale and at high spatial resolution, derived from ocean-colour data, are key to studying the dynamics of phytoplankton at seasonal and inter-annual scales; their role in marine biogeochemistry; the global carbon cycle; the modulation of how phytoplankton distribute solar-induced heat in the upper layers of the ocean; and the response of the marine ecosystem to climate variability and change. However, generating a long time series of these products from ocean-colour data is not a trivial task: algorithms that are best suited for climate studies have to be selected from a number that are available for atmospheric correction of the satellite signal and for retrieval of chlorophyll-a concentration; since satellites have a finite life span, data from multiple sensors have to be merged to create a single time series, and any uncorrected inter-sensor biases could introduce artefacts in the series, e.g., different sensors monitor radiances at different wavebands such that producing a consistent time series of reflectances is not straightforward. Another requirement is that the products have to be validated against in situ observations. Furthermore, the uncertainties in the products have to be quantified, ideally on a pixel-by-pixel basis, to facilitate applications and interpretations that are consistent with the quality of the data. This paper outlines an approach that was adopted for generating an ocean-colour time series for climate studies, using data from the MERIS (MEdium spectral Resolution Imaging Spectrometer) sensor of the European Space Agency; the SeaWiFS (Sea-viewing Wide-Field-of-view Sensor) and MODIS-Aqua (Moderate-resolution Imaging Spectroradiometer-Aqua) sensors from the National Aeronautics and Space Administration (USA); and VIIRS (Visible and Infrared Imaging Radiometer Suite) from the National Oceanic and Atmospheric Administration (USA). The time series now covers the period from late 1997 to end of 2018. To ensure that the products meet, as well as possible, the requirements of the user community, marine-ecosystem modellers, and remote-sensing scientists were consulted at the outset on their immediate and longer-term requirements as well as on their expectations of ocean-colour data for use in climate research. Taking the user requirements into account, a series of objective criteria were established, against which available algorithms for processing ocean-colour data were evaluated and ranked. The algorithms that performed best with respect to the climate user requirements were selected to process data from the satellite sensors. Remote-sensing reflectance data from MODIS-Aqua, MERIS, and VIIRS were band-shifted to match the wavebands of SeaWiFS. Overlapping data were used to correct for mean biases between sensors at every pixel. The remote-sensing reflectance data derived from the sensors were merged, and the selected in-water algorithm was applied to the merged data to generate maps of chlorophyll concentration, inherent optical properties at SeaWiFS wavelengths, and the diffuse attenuation coefficient at 490 nm. The merged products were validated against in situ observations. The uncertainties established on the basis of comparisons with in situ data were combined with an optical classification of the remote-sensing reflectance data using a fuzzy-logic approach, and were used to generate uncertainties (root mean square difference and bias) for each product at each pixel.

Removal of scatter radiation in paediatric cardiac catheterisation: a randomised controlled clinical trial.

OBJECTIVE: This study sought to determine if DNA integrity was compromised by ionising radiation from paediatric cardiac catheterisations and if dose optimisation techniques allowed DNA integrity to be maintained. MATERIALS AND METHODS: Children were imaged using either: (i) an anti-scatter grid (current departmental protocol), (ii) no anti-scatter grid or, (iii) no anti-scatter grid and a 15 cm air-gap between the child and the x-ray detector. Dose area product and image quality were assessed, lifetime attributable cancer risk estimates were calculated and DNA double-strand breakages quantified using the γH2AX assay. RESULTS: Consent was obtained from 70 parents/guardians/children. Image quality was sufficient for each procedure performed. Removal of the anti-scatter grid resulted in dose reductions of 20% (no anti-scatter grid) and 30% (15 cm air-gap), DNA double-strand break reductions of 30% (no anti-scatter grid) and 20% (15 cm air-gap) and a reduction of radiation-induced cancer mortality risk of up to 45%. CONCLUSION: Radiation doses received during paediatric cardiac catheterisation procedures resulted in a significant increase in DNA damage while maintaining acceptable image quality and diagnostic efficacy. It is feasible to remove the anti-scatter grid resulting in a reduction in DNA damage to the patient. The γH2AX assay may be used for assessment of dose optimisation strategies in children.

Assessment of DNA double-strand breaks induced by intravascular iodinated contrast media following in vitro irradiation and in vivo, during paediatric cardiac catheterization.

Paediatric cardiac catheterizations may result in the administration of substantial amounts of iodinated contrast media and ionizing radiation. The aim of this work was to investigate the effect of iodinated contrast media in combination with in vitro and in vivo X-ray radiation on lymphocyte DNA. Six concentrations of iodine (15, 17.5, 30, 35, 45, and 52.5 mg of iodine per mL blood) represented volumes of iodinated contrast media used in the clinical setting. Blood obtained from healthy volunteers was mixed with iodinated contrast media and exposed to radiation doses commonly used in paediatric cardiac catheterizations (0 mGy, 70 mGy, 140 mGy, 250 mGy and 450 mGy). Control samples contained no iodine. For in vivo experimentation, pre and post blood samples were collected from children undergoing cardiac catheterization, receiving iodine concentrations of up to 51 mg of iodine per mL blood and radiation doses of up to 400 mGy. Fluorescence microscopy was performed to assess γH2AX-foci induction, which corresponded to the number of DNA double-strand breaks. The presence of iodine in vitro resulted in significant increases of DNA double-strand breaks beyond that induced by radiation for ≥ 17.5 mg/mL iodine to blood. The in vivo effects of contrast media on children undergoing cardiac catheterization resulted in a 19% increase in DNA double-strand breaks in children receiving an average concentration of 19 mg/mL iodine to blood. A larger investigation is required to provide further information of the potential benefit of lowering the amount of iodinated contrast media received during X-ray radiation investigations.

Comparative analysis of GOCI ocean color products.

The Geostationary Ocean Color Imager (GOCI) is the first geostationary ocean color sensor in orbit that provides bio-optical properties from coastal and open waters around the Korean Peninsula at unprecedented temporal resolution. In this study, we compare the normalized water-leaving radiance (nLw) products generated by the Naval Research Laboratory Automated Processing System (APS) with those produced by the stand-alone software package, the GOCI Data Processing System (GDPS), developed by the Korean Ocean Research & Development Institute (KORDI). Both results are then compared to the nLw measured by the above water radiometer at the Ieodo site. This above-water radiometer is part of the Aerosol Robotic NETwork (AeroNET). The results indicate that the APS and GDPS processed  correlates well within the same image slot where the coefficient of determination (r²) is higher than 0.84 for all the bands from 412 nm to 745 nm. The agreement between APS and the AeroNET data is higher when compared to the GDPS results. The Root-Mean-Squared-Error (RMSE) between AeroNET and APS data ranges from 0.24 [mW/(cm²srµm)] at 555 nm to 0.52 [mW/(cm²srµm)]  at 412 nm while RMSE between AeroNET and GDPS data ranges from 0.47 [mW/(cm²srµm)] at 443 nm to 0.69 [mW/(cm²srµm)]  at 490 nm.

Epidemiology of Lyme Disease, Nova Scotia, Canada, 2002-2013.

Ixodes scapularis ticks, which transmit Borrelia burgdorferi, the causative agent of Lyme disease (LD), are endemic to at least 6 regions of Nova Scotia, Canada. To assess the epidemiology and prevalence of LD in Nova Scotia, we analyzed data from 329 persons with LD reported in Nova Scotia during 2002-2013. Most patients reported symptoms of early localized infection with rash (89.7%), influenza-like illness (69.6%), or both; clinician-diagnosed erythema migrans was documented for 53.2%. In a separate serosurvey, of 1,855 serum samples screened for antibodies to B. burgdorferi, 2 were borderline positive (both with an indeterminate IgG on Western blot), resulting in an estimated seroprevalence of 0.14% (95% CI 0.02%-0.51%). Although LD incidence in Nova Scotia has risen sharply since 2002 and is the highest in Canada (16/100,000 population in 2013), the estimated number of residents with evidence of infection is low, and risk is localized to currently identified LD-endemic regions.

Effects of blueberry supplementation on measures of functional mobility in older adults.

Limited functional mobility in older adults has been associated with declines in tests of motor, psychomotor, and executive function. Animal studies have demonstrated reversals in indices of motor and psychomotor function via supplementation with polyphenolic-rich foods such as blueberries. The purpose of this study was to examine whether 6 weeks of daily consumption of 2 cups of frozen blueberries affects functional mobility in older adults. Pre- and post-intervention assessments of grip strength, simple reaction time, adaptive gait, and executive function were completed for older adults (age >60 years) partially randomly assigned to a blueberry (BB) supplementation or a carrot juice drink control (CAR) group. Paired t tests were used to assess within-group effects for outcome variables in each supplementation group, and a mixed-model analysis of covariance (ANCOVA) was used to determine group (CAR vs. BB) differences. Mixed-model analysis indicated that the BB group demonstrated significant improvements relative to the CAR group in performance (i.e., number of step errors) of a challenging dual-task adaptive gait test that were independent of differences in gait speed. Within only the BB group, significant improvements were also seen in 3 other measures (i.e., usual gait speed; number of step errors during single-task adaptive gait; and gait speed during dual-task adaptive gait). These preliminary findings support the hypothesis that blueberry supplementation may provide an effective countermeasure to age-related declines in functional mobility and serve as justification for an expansion to larger trials to more fully assess this nonpharmacologic approach to maintaining optimal mobility and independence.

Relationships between water attenuation coefficients derived from active and passive remote sensing: a case study from two coastal environments.

Relationships between the satellite-derived diffuse attenuation coefficient of downwelling irradiance (K(d)) and airborne-based vertical attenuation of lidar volume backscattering (α) were examined in two coastal environments. At 1.1 km resolution and a wavelength of 532 nm, we found a greater connection between α and K(d) when α was computed below 2 m depth (Spearman rank correlation coefficient up to 0.96), and a larger contribution of K(d) to α with respect to the beam attenuation coefficient as estimated from lidar measurements and K(d) models. Our results suggest that concurrent passive and active optical measurements can be used to estimate total scattering coefficient and backscattering efficiency in waters without optical vertical structure.

Quantifying the spatial and temporal variation of ground-level ozone in the rural Annapolis Valley, Nova Scotia, Canada using nitrite-impregnated passive samplers.

The spatiotemporal variability of ground-level ozone (GLO) in the rural Annapolis Valley, Nova Scotia was investigated between August 29, 2006, and September 28, 2007, using Ogawa nitrite-impregnated passive diffusion samplers (PS). A total of 353 PS measurements were made at 17 ambient and 1 indoor locations over 18 sampling periods ranging from 2 to 4 weeks. The calculated PS detection limit was 0.8 +/- 0.02 parts per billion by volume (ppbv), for a 14-day sampling period. Duplicate samplers were routinely deployed at three sites and these showed excellent agreement (R2 values of 0.88 [n = 11], 0.95 [n = 17], and 0.96 [n = 17]), giving an overall PS imprecision value of 5.4%. Comparisons between PS and automated continuous ozone analyzers at three sites also demonstrated excellent agreement with R2 values of 0.82, 0.95, and 0.95, and gradients not significantly different from unity. The minimum, maximum, and mean (+/- 1 sigma) ambient annual GLO concentrations observed were 7.7, 72.1, and 34.3 +/- 10.1 ppbv, respectively. The three highest sampling sites had significantly greater (P = 0.032) GLO concentrations than three Valley floor sites, and there was a strong correlation between concentration and elevation (R2 = 0.82). Multivariate models were used to parameterize the observed GLO concentrations in terms of prevailing meteorology at an elevated site found at Kejimkujik National Park and also at a site on the Valley floor. Validation of the multivariate models using 30 months of historical meteorological data at these sites yielded R2 values of 0.70 (elevated site) and 0.61 (Valley floor). The mean indoor ozone concentration was 5.4 +/- 3.3 ppbv and related to ambient GLO concentration by the equation: indoor = 0.34 x ambient - 5.07. This study has demonstrated the suitability of PS for long-term studies of GLO over a wide geographic area and the effect of topographical and meteorological influences on GLO in this region.

Optical scattering and backscattering by organic and inorganic particulates in U.S. coastal waters.

We present the results of a study of optical scattering and backscattering of particulates for three coastal sites that represent a wide range of optical properties that are found in U.S. near-shore waters. The 6000 scattering and backscattering spectra collected for this study can be well approximated by a power-law function of wavelength. The power-law exponent for particulate scattering changes dramatically from site to site (and within each site) compared with particulate backscattering where all the spectra, except possibly the very clearest waters, cluster around a single wavelength power-law exponent of -0.94. The particulate backscattering-to-scattering ratio (the backscattering ratio) displays a wide range in wavelength dependence. This result is not consistent with scattering models that describe the bulk composition of water as a uniform mix of homogeneous spherical particles with a Junge-like power-law distribution over all particle sizes. Simultaneous particulate organic matter (POM) and particulate inorganic matter (PIM) measurements are available for some of our optical measurements, and site-averaged POM and PIM mass-specific cross sections for scattering and backscattering can be derived. Cross sections for organic and inorganic material differ at each site, and the relative contribution of organic and inorganic material to scattering and backscattering depends differently at each site on the relative amount of material that is present.

Update on aromatase inhibitors in breast cancer.

PURPOSE OF REVIEW: Hormonal treatment is one of the cornerstones of management for breast cancer. For many years, tamoxifen represented the gold standard. The development of aromatase inhibitors has, however, challenged the primary role of tamoxifen. Randomized studies evaluating the role of aromatase inhibitors in both the metastatic and adjuvant settings, in postmenopausal women, have been conducted. This article describes the most recent available data for these trials. RECENT FINDINGS: The efficacy of aromatase inhibitors for metastatic disease is well established and has not changed recently. Multiple adjuvant aromatase inhibitor trials have been completed and published or presented. These trials vary in the timing of aromatase inhibitor administration, but all show statistically significant reductions in breast-cancer recurrence. An improvement in overall survival has not been observed to date. Tolerability is improved with aromatase inhibitors, the major concern with the use of aromatase inhibitors being the development of osteoporosis and bone fractures. SUMMARY: Aromatase inhibitors are consistently showing improved efficacy and tolerability to tamoxifen for both early and advanced breast cancer. Optimal therapy for postmenopausal women should include an aromatase inhibitor. The optimal sequence of aromatase inhibitors and tamoxifen for adjuvant therapy is still, however, under investigation.

Comparisons of optical properties of the coastal ocean derived from satellite ocean color and in situ measurements.

Satellite-derived optical properties are compared to in situ mooring and ship-based measurements at a coastal site. Comparisons include remote sensing reflectance (R(rs)), chlorophyll concentration (Chl) using two different Chl algorithms, and spectral absorption [a(pg)(lambda)] and backscattering coefficients [b(b)(555)] using three different bio-optical algorithms. For mooring/shipboard comparisons, we observed mean relative errors of 70.5%/-3.8% (SeaWiFS OC4v4), -21.4%/-49.3% (SeaWiFS Stumpf), 109.5%/13.4% (MODIS OC3m) and 0.5%/-48.9% (MODIS Stumpf) for Chl. For satellite-derived and mooring comparisons of a(pg)(412), we found mean relative errors of -69.4% (-67.1%), -52.6% (- 48.9%), and -62.7% (-65.4%) for the Arnone, GSM, and QAA algorithms for SeaWiFS (MODIS), respectively. Mean relative errors of 21.3%, 19.9%, and 16.5% were found between SeaWiFS-derived (Arnone, GSM, and QAA algorithms, respectively) and moored b(b)(555) measurements. Discrepancies in Rrs at blue wavelengths are attributed to the satellite atmospheric correction and sea surface variations of the moored radiometers. High spatial and temporal variability of bio-optical properties coupled with differences in measurement techniques (pixel versus point) contribute to inconsistencies between remotely sensed and in situ biooptical properties.

Uniqueness in remote sensing of the inherent optical properties of ocean water.

We examine the problem of uniqueness in the relationship between the remote-sensing reflectance (Rrs) and the inherent optical properties (IOPs) of ocean water. The results point to the fact that diffuse reflectance of plane irradiance from ocean water is inherently ambiguous. Furthermore, in the 400 < lambda < 750 nm region of the spectrum, Rrs(lambda) also suffers from ambiguity caused by the similarity in wavelength dependence of the coefficients of absorption by particulate matter and of absorption by colored dissolved organic matter. The absorption coefficients have overlapping exponential responses, which lead to the fact that more than one combination of IOPs can produce nearly the same Rrs spectrum. This ambiguity in absorption parameters demands that we identify the regions of the Rrs spectrum where we can isolate the effects that are due only to scattering by particulates and to absorption by pure water. The results indicate that the spectral shape of the absorption coefficient of phytoplankton, a(ph)(lambda), cannot be derived from a multiparameter fit to Rrs(lambda). However, the magnitude and the spectral dependence of the absorption coefficient can be estimated from the difference between the measured Rrs(lambda) and the best fit to Rrs(lambda) in terms of IOPs that exclude a(ph)(lambda).