The Climatic Impact-Driver Framework for Assessment of Risk-Relevant Climate Information

The climate science and applications communities need a broad and demand-driven concept to assess physical climate conditions that are relevant for impacts on human and natural systems. Here, we augment the description of the "climatic impact-driver" (CID) approach adopted in the Working Group I (WGI) contribution to the Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report. CIDs are broadly defined as "physical climate system conditions (e.g., means, events, and extremes) that affect an element of society or ecosystems. Depending on system tolerance, CIDs and their changes can be detrimental, beneficial, neutral, or a mixture of each across interacting system elements and regions." We give background information on the IPCC Report process that led to the development of the 7 CID types (heat and cold, wet and dry, wind, snow and ice, coastal, open ocean, and other) and 33 distinct CID categories, each of which may be evaluated using a variety of CID indices. This inventory of CIDs was co-developed with WGII to provide a useful collaboration point between physical climate scientists and impacts/risk experts to assess the specific climatic phenomena driving sectoral responses and identify relevant CID indices within each sector. The CID Framework ensures that a comprehensive set of climatic conditions informs adaptation planning and risk management and may also help prioritize improvements in modeling sectoral dynamics that depend on climatic conditions. CIDs contribute to climate services by increasing coherence and neutrality when identifying and communicating relevant findings from physical climate research to risk assessment and planning activities.

Determination of Naringin and Neohesperidin in Orange Juice by Liquid Chromatography with UV Detection to Detect the Presence of Grapefruit Juice: Collaborative Study

Fifteen collaborating laboratories were sent 9 samples of citrus juice mixtures as blind duplicates for determination of naringin and neohesperidin by liquid chromatography. Two sample pairs were 100% orange juice and did not contain any naringin or neohesperidin. The remaining 7 sample pairs contained naringin at levels ranging from 3.9 to 46.5 ppm and neohesperidin at levels ranging from 0.14 to 35.6 ppm. Five sample pairs consisted of orange juice mixtures containing 1, 3, and 5% grapefruit juice; 5% sour orange; and 5% K-Early citrus variety. Two sample pairs were orange juice spiked with naringin, neohesperidin, sodium benzoate, and potassium sorbate. Data were received from 13 laboratories. Data from 1 collaborator were eliminated because the method protocol was not followed. Neohesperidin values from another laboratory were also not used because of problems with a coeluting component. Repeatability relative standard deviations ranged from 2.95 to 15.23% for naringin and from 3.00 to 11.74% for neohesperidin. Reproducibility relative standard deviations ranged from 11.34 to 31.94% for naringin and from 10.45 to 26.17% for neohesperidin. The method is reliable for detecting the presence of grapefruit juice in orange juice as indicated by a finding of ≥10 ppm naringin and ≤2 ppm neohesperidin. The method was adopted First Action by AOAC INTERNATIONAL.

A multi-disciplinary approach to evaluate pluvial floods risk under changing climate: The case study of the municipality of Venice (Italy)

Global climate change is likely to pose increasing threats in nearly all sectors and across all sub-regions worldwide (IPCC, 2014). Particularly, extreme weather events (e.g. heavy precipitations), together with changing exposure and vulnerability patterns, are expected to increase the damaging effect of storms, pluvial floods and coastal flooding. Developing climate and adaptation services for local planners and decision makers is becoming essential to transfer and communicate sound scientific knowledge about climate related risks and foster the development of national, regional and local adaptation strategies. In order to analyze the effect of climate change on pluvial flood risk and advice adaptation planning, a Regional Risk Assessment (RRA) methodology was developed and applied to the urban territory of the municipality of Venice. Based on the integrated analysis of hazard, exposure, vulnerability and risk, RRA allows identifying and prioritizing targets and sub-areas that are more likely to be affected by pluvial flood risk due to heavy precipitation events in the future scenario 2041-2050. From the early stages of its development and application, the RRA followed a bottom-up approach taking into account the requests, knowledge and perspectives of local stakeholders of the North Adriatic region by means of interactive workshops, surveys and discussions. Results of the analysis showed that all targets (i.e. residential, commercial-industrial areas and infrastructures) are vulnerable to pluvial floods due to the high impermeability and low slope of the topography. The spatial pattern of risk mostly reflects the distribution of the hazard and the districts with the higher percentage of receptors' surface in the higher risk classes (i.e. very high, high and medium) are Lido-Pellestrina and Marghera. The paper discusses how risk-based maps and statistics integrate scientific and local knowledge with the final aim to mainstream climate adaptation in the development of risk mitigation and urban plans.

Changing hydrological conditions in the Po basin under global warming

The Po River is a crucial resource for the Italian economy, since 40% of the gross domestic product comes from this area. It is thus crucial to quantify the impact of climate change on this water resource in order to plan for future water use. In this paper a mini ensemble of 8 hydrological simulations is completed from 1960 to 2050 under the A1B emission scenario, by using the output of two regional climate models as input (REMO and RegCM) at two different resolutions (25 km-10 km and 25 km-3 km). The river discharge at the outlet point of the basin shows a change in the spring peak of the annual cycle, with a one month shift from May to April. This shift is entirely due to the change in snowmelt timing which drives most of the discharge during this period. Two other important changes are an increase of discharge in the wintertime and a decrease in the fall from September to November. The uncertainty associated with the winter change is larger compared to that in the fall. The spring shift and the fall decrease of discharge imply an extension of the hydrological dry season and thus an increase in water stress over the basin. The spatial distributions of the discharge changes are in agreement with what is observed at the outlet point and the uncertainty associated with these changes is proportional to the amplitude of the signal. The analysis of the changes in the anomaly distribution of discharge shows that both the increases and decreases in seasonal discharge are tied to the changes in the tails of the distribution, i.e. to the increase or decrease of extreme events.

Neurodevelopment. Parasympathetic ganglia derive from Schwann cell precursors

Neural crest cells migrate extensively and give rise to most of the peripheral nervous system, including sympathetic, parasympathetic, enteric, and dorsal root ganglia. We studied how parasympathetic ganglia form close to visceral organs and what their precursors are. We find that many cranial nerve-associated crest cells coexpress the pan-autonomic determinant Paired-like homeodomain 2b (Phox2b) together with markers of Schwann cell precursors. Some give rise to Schwann cells after down-regulation of PHOX2b. Others form parasympathetic ganglia after being guided to the site of ganglion formation by the nerves that carry preganglionic fibers, a parsimonious way of wiring the pathway. Thus, cranial Schwann cell precursors are the source of parasympathetic neurons during normal development.

Removal of humic substances from water by means of calcium-ion-enriched natural zeolites

The ability of the natural zeolited Neapolitan Yellow Tuff (NYT) enriched with calcium ions to remove humic acids from water was evaluated by batch adsorption equilibrium tests and dynamic experiments carried out by percolating humic acid solutions through a small NYT column (breakthrough curves). Under the experimental condition explored, the sorption capacity increases with the ionic strength and has the highest value at pH 7.4. The partition coefficient for a low concentration of humic acid ([humic acid] --> 0), at pH 7.4 in 0.01 M sodium chloride, was approximately 1000 L/kg, versus the value of approximately 100 L/kg in the absence of the alkaline metal salt. Therefore, after humic acids have been adsorbed in a column filled with the calcium-ion-enriched tuff, a reduction of the salt concentration in the ongoing solution enhances the release of the adsorbed material. These findings show that NYT can be used for the removal of humic acids from water.

Importance of reperfusion on thromboxane A2 metabolite excretion after thrombolysis

Fibrinolytic therapy is a major advance in the treatment of coronary artery disease. A marked elevation in plasma and urinary metabolites of thromboxane A2 (TXA2) after administration of thrombolytic therapy has been observed and has been related to a direct effect of thrombolytic drugs on platelets. To test this hypothesis we evaluated the 11-dehydro-thromboxane B2 (11-d-TXB2) level, as an index of platelet activation, in 20 healthy subjects and in 30 patients with acute myocardial infarction (AMI). Patients with infarction received streptokinase (n = 8), recombinant tissue-type plasminogen activator (rt-PA) (n = 8), or thrombolytic therapy preceded by acetylsalicylic acid (n = 7) or were treated without thrombolytic therapy (n = 7). The urinary 11-d-TXB2 level in healthy control subjects was 327 +/- 126 pg/mg creatinine. A significant increase was observed in patients with AMI with no difference between those who received no thrombolytic therapy (673 +/- 283 pg/mg creatinine in the first 12 hours) and those who received streptokinase (833 +/- 613 pg/mg creatinine) or rt-PA (836 +/- 653 pg/mg creatinine). Patients pretreated with acetylsalicylic acid had urinary 11-d-TXB2 values ranging between 361 and 155 pg/mg creatinine. A significant difference in 11-d-TXB2 values was observed only when patients who were reperfused were separated from those who remained occluded according to angiographic criteria (1085 +/- 498 vs 391 +/- 227 pg/mg creatinine in the first 12 hours, p less than 0.001). We conclude that reperfusion and not thrombolytic agents per se appears to be the factor that induces platelet activation and consequently facilitates reocclusion.

[rTPA and streptokinase in acute myocardial infarct. Clinical instrumental evaluation of the 2 treatments]

Fifty-four patients with acute myocardial infarction were treated with thrombolytic therapy (27 with rTPA and 27 with streptokinase). In all the subjects CK was monitored (every 3 hours) and ergometric test, echocardiogram, and 24 hours holter ecg were performed in the pre-discharge period. In 22 of the patients, coronary angiography was also performed. No differences were shown between the two groups of patients as regards CK values and ejection fraction. Repetitive ventricular premature beats were registered without difference between the two groups (23% in patients treated with SK and 18% in the patients treated with rTPA). No bleeding events were shown in the patients treated with rTPA without calciparin. On the other hand no difference there was between patients treated with rTPA + calciparin and patients treated with SK with or without calciparin.

Circadian variation of ventricular tachycardia in acute myocardial infarction

Circadian rhythms have been described both for acute myocardial infarction (AMI) and sudden death. In this study the diurnal distribution of ventricular tachycardia (VT) in patients with AMI was analyzed. Ninety-four AMI patients with greater than or equal to 1 VT on Holter electrocardiographic monitoring who were not taking antiarrhythmic drugs were studied. Forty-seven patients had a recent AMI (group A) and 47 an old AMI (group B). Chronobiologic analysis was made by single cosinor method. There were 157 VTs (mean 1.67 VTs/patient, range 1 to 10) in the 94 patients: 70 in group A and 87 in group B. A significant circadian rhythm of VT was found in the total population with acrophase at 2:29 P.M. The hourly distribution of VT showed a tendency to bimodality, which seemed due to a different time of peak VT occurrence in group A (significant rhythm with acrophase at 4:40 P.M.) and group B (significant rhythm with acrophase at 12:39 P.M.). Thus, the hourly VT frequency in patients with AMI has a significant circadian variation with the highest occurrence in the awake hours, similar to the rhythms described for AMI and sudden death.

Assessment of left atrial dimensions by cross sectional echocardiography in patients with mitral valve disease

Left atrial dimensions were measured using cross sectional echocardiography in 37 patients with mitral valve disease and 30 normal subjects of similar ages. The anteroposterior (AP), superior-inferior (SI), and medial-lateral (ML) left atrial dimensions were determined at the end of ventricular systole using parasternal long and short axis and apical four chamber views (for SIa and MLa). To assess the reliability of these measurements cross sectional echocardiographic and angiographic left atrial volumes were compared in 19 patients with mitral valve disease, giving an excellent correlation. A moderate correlation was found between the anteroposterior dimension of the left atrium obtained using M mode echocardiography and that obtained using the parasternal short axis and long axis projections. In normal subjects a good correlation was found between SI and ML dimensions, while a lower correlation was found between SI and AP, and ML and AP dimensions. The SI dimension was the major axis of the left atrium and AP dimension the minor axis. In patients with mitral valve disease a good correlation was found between SI and ML dimensions, while SI and ML dimensions had a low correlation with AP dimensions. The AP dimension was the minor axis of the left atrium, while the SI and ML dimensions were not significantly different. All left atrial dimensions were significantly greater in patients with mitral valve disease than in normal subjects. Of 30 patients with at least one dimension increased, all three dimensions were abnormal in 16, two dimensions were increased in 10, and only one dimension was increased in four. AP, SI, and ML dimensions were abnormal in 25, 20, and 27 patients, respectively. Cross sectional echocardiography may provide a reliable estimate of left atrial dimensions. In patients with mitral valve disease a thorough examination of the left atrium using multiple cross sectional views is necessary to detect asymmetric left atrial enlargement and to measure the degree of left atrial dilatation.

Significance of high voltage QRS anterior forces in young asymptomatic adults. Evaluation by wide-angle two-dimensional echocardiography

Thirteen asymptomatic adults less than 40 years old who showed tall right precordial R waves on the ECG were examined by VCG, M-mode and two-dimensional echocardiography (2D Echo). Common causes of QRS anterior displacement, such as right ventricular enlargement or right bundle branch block, were excluded in each subject. Although each subject was normal at physical examination, 2D Echo revealed areas of left ventricular hypertrophy in eight of these 13 subjects. Four had a prevailing hypertrophy of the basal portion of the interventricular septum, three had an isolated apical hypertrophy, and one had a diffuse concentric left ventricular hypertrophy. Results were normal in five cases. 2D Echo classification was confirmed by heart catheterization findings, when available. The subjects with asymmetric septal hypertrophy showed low-voltage QRS leftward forces on the ECG and VCG. ECGs and VCGs were not useful in differentiating the subjects with atypically distributed left ventricular hypertrophy from the normals: high-voltage QRS leftward forces and T wave abnormalities were evident in some subjects of both groups. Tall right precordial R waves may constitute a marker of hypertrophic cardiomyopathy in asymptomatic young adults. 2D Echo is useful to exactly classify these subjects.

The evaluation of left and right ventricular hypertrophy in combined ventricular overload by electrocardiography: relationship with the echocardiographic data

The electrocardiographic and echocardiographic (M-mode) data were analyzed in 29 patients affected by mitral or combined mitral and aortic valve disease and with hemodynamically documented biventricular overload. No electrocardiographic parameter significantly correlated with the left ventricular internal dimension at end diastole (LVIDd), the left posterior wall (LVPW) thickness and the left ventricular mass (LV mass). A significant correlation was observed between the R/S ratio in V1 and V2, the rV1 and either the end-diastolic right ventricular internal dimension (RVIDs) or the pulmonary artery systolic pressure (PASP). The R/S ratio greater than or equal to 1 in V1 was the most sensitive among the conventional electrocardiographic criteria of right ventricular enlargement. Three groups of patients were selected on the basis of RVIDd and LV mass: Group A included nine patients with right ventricular dilatation and normal LV mass; Group B included ten patients without right ventricular dilatation and with increased LV mass; Group C included ten patients without right ventricular dilatation and with normal LV mass. The R/S ratio in V1 was significantly greater in patients in group A than in those in groups B or C. No electrocardiographic parameter was found to be significantly different between groups B and C. When only LV mass was considered (independently from RVId and PASP), no electrocardiographic parameter differentiated patients with LV mass greater than 203 g from those with LV mass less than 203 g. We conclude that in patients with biventricular overload secondary to acquired valvular disease: 1) the electrocardiographic diagnosis of left ventricular enlargement is unreliable; and 2) the R/S ratio in V1 is the most sensitive parameter to predict right ventricular enlargement or severe pulmonary hypertension.

Familial hypertrophic cardiomyopathy: vectorcardiographic findings in echocardiographically unaffected relative

The electrocardiographic and vectorcardiographic (Frank system) features of the first degree relatives of subjects with documented familial hypertrophic cardiomyopathy were analysed. A total of nine affected members and 29 relatives were examined in four families. THe subjects were considered to be affected when the septal to free posterior wall thickness ratio exceeded 1.3 at M-mode echocardiography. Four relatives had asymmetric septal hypertrophy. Among 25 relatives without evidence of asymmetric septal hypertrophy, two over 20 years and 10 under 20 years of age showed increased voltage of QRS anterior forces (Qz amplitude greater than 0.80 mV) on the orthogonal electrocardiogram. The vectorcardiographic data of the relatives under 20 years of age without evidence of asymmetric septal hypertrophy (18 subjects) were compared with those of 38 normal control subjects of comparable age range. The young relatives without disproportionate septal hypertrophy had significantly greater Qz amplitude and Q/Rz ratio than the normal control subjects. In contrast, the echocardiographic data were not significantly different. We suggest that the electrocardiographic finding of abnormal anterior forces in one or more first degree relatives of subjects with documented hypertrophic cardiomyopathy may constitute a valuable aid in ascertaining the genetic transmission of the disease and in recognising affected members without echocardiographic evidence of hypertrophic cardiomyopathy.

Catheter induced distal intra-Hisian right bundle branch block in a patient with persistent proximal intra-Hisian complete A-V block

We describe a patient with complete intra-Hisian A-V block and narrow QRS who developed catheter-induced right bundle branch block during an electrophysiological study. Selective His bundle pacing was performed during complete intra-Hisian A-V block and right bundle branch block pattern; the distal His bundle pacing normalized the QRS complex, while a more proximal His bundle stimulation showed a right bundle branch block configuration with the persistence of the proximal intra-Hisian lesion responsible for the complete A-V block. These electrophysiological findings suggest that the catheter-induced right bundle branch block in our patient was due to a focal lesion in the distal part of the main His bundle. To our knowledge, this is the first report of documented multilevel lesions within the His bundle in man.