Reduced Complexity Model Intercomparison Project Phase 2: Synthesizing Earth System Knowledge for Probabilistic Climate Projections.

Over the last decades, climate science has evolved rapidly across multiple expert domains. Our best tools to capture state-of-the-art knowledge in an internally self-consistent modeling framework are the increasingly complex fully coupled Earth System Models (ESMs). However, computational limitations and the structural rigidity of ESMs mean that the full range of uncertainties across multiple domains are difficult to capture with ESMs alone. The tools of choice are instead more computationally efficient reduced complexity models (RCMs), which are structurally flexible and can span the response dynamics across a range of domain-specific models and ESM experiments. Here we present Phase 2 of the Reduced Complexity Model Intercomparison Project (RCMIP Phase 2), the first comprehensive intercomparison of RCMs that are probabilistically calibrated with key benchmark ranges from specialized research communities. Unsurprisingly, but crucially, we find that models which have been constrained to reflect the key benchmarks better reflect the key benchmarks. Under the low-emissions SSP1-1.9 scenario, across the RCMs, median peak warming projections range from 1.3 to 1.7°C (relative to 1850-1900, using an observationally based historical warming estimate of 0.8°C between 1850-1900 and 1995-2014). Further developing methodologies to constrain these projection uncertainties seems paramount given the international community's goal to contain warming to below 1.5°C above preindustrial in the long-term. Our findings suggest that users of RCMs should carefully evaluate their RCM, specifically its skill against key benchmarks and consider the need to include projections benchmarks either from ESM results or other assessments to reduce divergence in future projections.

[Model for a computer-assisted quality assurance system in burn intensive care]. / Modell eines computergestützten Qualitätssicherungssystems in der Verbrennungsintensivtherapie.

The prerequisites for an integrated quality management system for hospitals were developed as a result of considerations regarding the necessity of an appropriate quality-assurance system for the intensive care sector. The basis for a dynamic quality-assurance system on the documentational level is a comprehensive data base containing patient files unlimited in terms of time and data technology. The necessary hardware and software structure will be provided by consistent application of a client-server architecture. Permanent surveillance of existing quality objectives within the scope of an economic close-loop system requires a system with flexible query mechanisms. Informational data access from all hierarchical level within the hospital organization is facilitated by the data warehouse concept, a data base system with subject-oriented, integrated, time-variable, and persistent data.

Influence of ischaemic cardioplegic arrest on the haemodynamic efficacy of the PDE-III inhibitor, enoximone.

The haemodynamic support from an enoximone infusion (2 x bolus 0.5 mg.kg-1, infusion 0.5 micrograms.kg-1min-1) in the early postischaemic phase is modified by a transient diminution of the drug's positive inotropic and vasodilatory effect (1 to 4 h). Forty-five min after weaning off cardiopulmonary bypass (CPB) the initial increase in cardiac index (CI) induced by enoximone (+26 +/- 8%) faded and was no longer discernible in the control group. A significant increase in CI was observed again 4-6 h after cardioplegic arrest (ultimate steady state values greater than 10 h; CI +0.71.min-1 x m-2; +21%). This pharmacodynamic fading occurred in the presence of constant plasma concentrations of enoximone (442 +/- 31 ng.ml-1) and elevated high plasma norepinephrine (926 +/- 70 pg.ml-1). Two independent processes might be responsible for the ischaemia-induced complex time dependency of the pharmacodynamic effect: (1) sensitization of the adrenergic receptor pathway and/or activation of sarcolemmal Ca-influx, rapidly reversed during reperfusion, and (2) impaired sarcoplasmic reticulum responses, which are slowly repaired after weaning off CPB.

[Comparison of the hemodynamic effect of enoximone and dopamine in patients after coronary bypass operation]. / Vergleich der hämodynamischen Wirkung von Enoximon und Dopamin bei Patienten nach Koronarer Bypassoperation.

The efficacy of acute hemodynamic support with intravenous enoximone (n = 10), (2 x bolus 0.5 mg/kg, infusion 5.0 mcg/kg/min), dopamine (n = 10), (3-4.0 mcg/kg/min) over a 18-h period was investigated in patients to be weaned off cardio-pulmonary bypass (CPB) (placebo-controlled trial). Under steady-state conditions enoximone produced a substantial increase in cardiac index (20.6 +/- 1.7%), but no change in heart rate. The improvement in cardiac index with time until constant values were reached (6 h) was not directly paralleled by the plasma concentration of enoximone. Pharmacodynamically relevant concentrations were already present after 1 h of infusion (480 +/- 68 ng/ml) and were comparable with the value determined after 6 h (442 +/- 31 ng/ml). After 18 h of infusion, plasma concentration had reached 742 +/- 47 ng/ml without a further improvement in cardiac function. The augmentation of stroke volume index (23.3 +/- 2.5%) occurred concomitant with a decrease in systemic vascular resistance (-23.1 +/- 0.6%), obviously due to a decrease in diastolic arterial pressure (-12.0 +/- 3.8%). The pulmonary capillary wedge pressure remained unaffected, and there was only a slight decrease in pulmonary vascular resistance (-9.3 +/- 3.2%). During enoximone, as well as dopamine infusion, an increase (10 +/- 3.1 and 9 +/- 1.8%) in right atrial pressure was observed in contrast to the untreated control group. This is contradictory to the described drugs effect in patients suffering from congestive heart failure. In a concentration usually not causing cardioacceleration, dopamine was of minor hemodynamic support in the post-CPB period.(ABSTRACT TRUNCATED AT 250 WORDS)

Enoximone versus dopamine in patients being weaned from cardiopulmonary bypass.

The efficacy of acute haemodynamic support with intravenous enoximone (2 X bolus 0.5 mg/kg; infusion 5.0 micrograms/kg/min) versus dopamine (3.0-4.0 micrograms/kg/min), over an 18-hour period, was investigated in patients to be weaned from cardiopulmonary bypass (placebo-controlled trial). Under steady-state conditions, enoximone produced a substantial increase in cardiac index (20.6 +/- 1.7%), but no change in heart rate. The improvement in cardiac index with time until constant values were reached (6 h) was not directly paralleled by the plasma concentration of enoximone. Pharmacodynamically relevant concentrations were already present after 1 h of infusion (480 +/- 68 ng/ml) and comparable with the value determined after 6 h (442 +/- 37 ng/ml). After 18 h of infusion, plasma concentration had reached 742 +/- 47 ng/ml without a further improvement in cardiac function. The augmentation of stroke volume index (23.3 +/- 2.5%) occurred concomitantly with a decrease in systemic vascular resistance (-23.1 +/- 0.6%), obviously due to a decrease in diastolic arterial pressure (-12.0 +/- 3.8%). The pulmonary capillary wedge pressure remained unaffected. There was only a slight decrease in pulmonary vascular resistance (-9.3 +/- 3.2%). During both enoximone infusion and dopamine infusion, right atrial pressure increased (10.0 +/- 3.1 and 9.0 +/- 1.8%, respectively), in contrast to the untreated control group. This is contradictory to the drugs' described effect in patients suffering from congestive heart failure. At a concentration which would not normally cause cardiac acceleration, dopamine provided minor haemodynamic support in the period after cardiopulmonary bypass.(ABSTRACT TRUNCATED AT 250 WORDS)