ABSTRACT
This study conducts a spatio-temporal analysis of tropospheric nitrogen dioxide (NO2) and total carbon monoxide (CO) concentrations in the Punjab and Haryana regions of India and Pakistan, using datasets from the Sentinel 5-Precursor (S5P) satellite. These regions, marked by diverse economic growth factors including population expansion, power generation, transportation, and agricultural practices, face similar challenges in atmospheric pollution, particularly evident in major urban centers like Delhi and Lahore, identified as pollution hotspots. The study also spotlights pollution associated with power plants. In urban areas, tropospheric NO2 levels are predominantly elevated due to vehicular emissions, whereas residential activities mainly contribute to CO pollution. However, precisely attributing urban CO sources is complex due to its longer atmospheric residence time and intricate circulation patterns. Notably, the burning of rice crop residue in November significantly exacerbates winter pollution episodes and smog, showing a more pronounced correlation with total CO than with tropospheric NO2 levels. The temporal analysis indicates that the months from October to December witness peak pollution, contrasted with the relatively cleaner period during the monsoon months of July to September. The severe pollution in the OND quarter is attributed to factors such as variations in boundary layer height and depletion of OH radicals. Furthermore, the study highlights the positive impact of the COVID-19 lockdown on air quality, with a significant decrease in NO2 concentrations during April, 2020 (Delhi: 59%, Lahore: 58%). However, the reduction in total CO columns was less significant. The study also correlates lockdown stringency with tropospheric NO2 columns (R2: 0.37 for Delhi, 0.25 for Lahore, 0.22 for Rawalpindi/Islamabad), acknowledging the influence of various meteorological and atmospheric variables. The research highlights the significant impact of crop residue burning on winter pollution levels, particularly on total CO concentrations. The study also shows the notable effect of the COVID-19 lockdown on air quality, significantly reducing NO2 levels. Additionally, it explores the correlation between lockdown stringency and tropospheric NO2 columns, considering various meteorological factors.
Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Humans , Carbon Monoxide/analysis , COVID-19/epidemiology , Nitrogen Dioxide/analysis , Air Pollutants/analysis , Environmental Monitoring , Communicable Disease Control , Air Pollution/analysis , Particulate Matter/analysisABSTRACT
Objective To evaluate the efficacy and safety of short-term deep sedation strategy in patients with spontaneous intracerebral hemorrhage (ICH) after surgery. Methods A perspective, randomized, parallel-group study was conducted. Adult patients with spontaneous ICH and undergoing craniotomy admitted to Daxing Teaching Hospital of Capital Medical University from December 2015 to November 2016 were enrolled. The patients who received surgery were randomly divided into a short-term deep sedation and a slight and middle sedation group. Sufentanil was used as an analgesic drug in all patients and midazolam was used as a sedative after the operation. The patients in the slight and middle sedation group received midazolam 0.05-0.10 mg/kg with a goal of mild sedation [Richmond agitation and sedation scale (RASS) score of -2-1]. The patients in the short-term deep sedation group received midazolam 0.1-0.2 mg/kg with a goal of deep sedation (RASS score of -4 to -3) and a duration of no more than 12 hours. Postoperative sedation, blood pressure changes, laboratory indexes, residual hematoma and clinical outcomes were recorded in two groups. Results During the study, a total of 183 patients with spontaneous ICH were collected, excluding who was older than 65 years, with shock, and with preoperative Glasgow coma score (GCS) of 3. 106 patients were enrolled in this study, and 53 patients were assigned to the short-term deep sedation group and slight and middle sedation group, respectively. In the slight and middle sedation group, 4 patients received reoperation because of repeated hemorrhage and no patient operated repeatedly in the short-term deep sedation group, and there was a significant difference between the two groups (χ2= 4.000, P = 0.045). The number of patients undergoing tracheotomy in the short-term deep sedation group was significantly lower than that in the slight and middle sedation group (9 cases vs. 21 cases,P < 0.05). RASS score within 12 hours after operation of the patients in the short-term deep sedation group was lower than that in slight and middle sedation group [-4 (-4, -2) vs. -2 (-3, -1) at 4 hours, -4 (-4, -2) vs. -1 (-2, 0) at 8 hours,-3 (-4, -2) vs. 0 (-2, 1) at 12 hours, all P < 0.01], sudden restlessness was significantly reduced [times: 1 (0, 1) vs. 3 (2, 3), P < 0.01], and postoperative sedation duration was significantly prolonged [hours: 14.0 (8.3, 20.8) vs. 8.9 (3.4, 15.3), P < 0.05]. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) within 12 hours after operation in the short-term deep sedation group were significantly lower than those of the slight and middle sedation group [SBP (mmHg, 1 mmHg = 0.133 kPa): 136.8±30.5 vs. 149.1±33.5, DBP (mmHg): 85.0 (70.8, 102.3) vs. 89.0 (69.2, 116.7), both P < 0.05]. There were no significant differences in the arterial blood gas, routine blood test or coagulation function between the two groups at 24 hours after operation. The volume of residual hematoma at 2, 7 and 14 days after operation in the short-term deep sedation group was significantly decreased as compared with slight and middle sedation group (mL: 16.4±15.6 vs. 38.2±22.2 at 2 days, 9.6±8.7 vs. 20.6±18.6 at 7 days, 1.2±1.0 vs. 4.4±3.6 at 14 days, all P < 0.05), number of deaths in 3 months were significantly less (5 cases vs. 13 cases), and the patients with favorable prognosis were increased significantly (39 cases vs. 12 cases, both P < 0.05). Conclusion The study results showed that short-term deep sedation strategy after surgery can reduce the incidence of adverse events and improve the prognosis of patients with spontaneous ICH, so it is safe and effective.
ABSTRACT
The Economists Intelligence Unit pointed out that the global ranking of Chinese people's death quality index falls behind and once again causes people's attention and discussion of death and related legal issues.Palliative Care can make people go to death as far as possible with dignity,ready and calm.So it is gradually being concerned,and the importance of legislation related to it is also becoming increasing.Palliative Care has emerged in our country,but because of the lack of legislative regulation,relatives of patients and medical staff are at risk being accounted for legal liability.Through the analysis of the legitimacy and feasibility of palliative care,this paper put forward some suggestions of relevant legislation and current corresponding countermeasures;it should clarify the legal validity of living will signed by patients,strengthen the supervision in the implementation process and exempt responsibility of relevant personal.
ABSTRACT
Objective To compare the scores from the simpliifed COMFORT scale with those from the bispectral index (BIS) and analyze the variation among different evaluators in children in an intensive care unit, and to investigate the reliability;validity of simpliifed COMFORT scale. Methods Twenty children between 3 and 16 years of ages on mechanical ventilation and sedation were simultaneously classiifed based on the BIS and the simpliifed COMFORT scale evaluated by 4 independent evalua-tors. The Kappa test was performed and the correlation between the two methods (Pearson correlation) was tested. Results In to-tal, 70 observations were performed on 20 patients. Based on the Kappa coefifcient, the agreement among evaluators ranged from 0.62 to 0.77 (P<0.001). There was a correlation between the BIS and the simpliifed COMFORT scale (r=0.53-0.61,P<0.01). Conclusions Due to the strong consistency between the independent evaluators and the correlation between the two methods, the reliability and validity of simpliifed COMFORT scale are preferable and simpliifed COMFORT scale is useful in classifying the level of sedation in children on mechanical ventilation.