Urban vegetation and particle air pollution: Experimental campaigns in a traffic hotspot

This work presents the main results of two experimental campaigns carried out in summer and winter seasons in a complex pollution hotspot near a large park, El Retiro, in Madrid (Spain). These campaigns were aimed at understanding the microscale spatio-temporal variation of ambient concentration levels in areas with high pollution values to obtain data to validate models on the effect of urban trees on particulate matter concentrations. Two different measuring approaches have been used. The first one was static, with instruments continuously characterizing the meteorological variables and the particulate matter concentration outside and inside the park. During the summer campaign, the particulate matter concentration was clearly influenced by a Saharan dust outbreak during the period 23 June to 10 July 2016, when most of the particulate matter was in the fraction PM_2.5-10. During the winter campaign, the mass concentrations were related to the meteorological conditions and the high atmospheric stability. The second approach was a dynamic case with mobile measurements by portable instruments. During the summer campaign, a DustTrak instrument was used to measure PM₁₀ and PM_2.5 in different transects close to and inside the park at different distances from the traffic lane. It was observed a decrease in the concentrations up to 25% at 20 m and 50% at 200 m. High PM₁₀ values were linked to dust resuspension caused by recreational activities and to a Saharan dust outbreak. The highest PM values were measured at the Independencia square, an area with many bus stops and high traffic density. During the winter campaign, three microaethalometers were used for Black Carbon measurement. Both pollutants also showed a reduction in their concentrations when moving towards inside the park. For PM₁₀ and PM_2.5, reductions up to 50% were observed, while for BC this reduction was smaller, about 20%.

Assessing the direction of climate interactions by means of complex networks and information theoretic tools

An estimate of the net direction of climate interactions in different geographical regions is made by constructing a directed climate network from a regular latitude-longitude grid of nodes, using a directionality index (DI) based on conditional mutual information (CMI). Two datasets of surface air temperature anomalies-one monthly averaged and another daily averaged-are analyzed and compared. The network links are interpreted in terms of known atmospheric tropical and extra-tropical variability patterns. Specific and relevant geographical regions are selected, the net direction of propagation of the atmospheric patterns is analyzed, and the direction of the inferred links is validated by recovering some well-known climate variability structures. These patterns are found to be acting at various time-scales, such as atmospheric waves in the extratropics or longer range events in the tropics. This analysis demonstrates the capability of the DI measure to infer the net direction of climate interactions and may contribute to improve the present understanding of climate phenomena and climate predictability. The work presented here also stands out as an application of advanced tools to the analysis of empirical, real-world data.

Impact of reperfusion strategy on outcomes in very elderly patients with acute myocardial infarction

AIM

The best reperfusion strategy for patients of advanced age (either primary-angioplasty or thrombolysis) after a ST-segment elevation myocardial infarction (STEMI) remains controversial. Aim of the study was to test differences in morbidity and mortality regarding the reperfusion strategy adopted.

METHODS

From 2007-2012, 182 patients ≥85 year-old with STEMI were admitted to the coronary care unit of two tertiary centers. Data regarding baseline characteristics, clinical presentation, reperfusion strategy adopted and outcomes were retrospectively reviewed. The relation between the type of reperfusion therapy and outcomes was evaluated.

RESULTS

Median age was 86.8±6.9 years (range 85-96). Most patients (54.4%) were woman. Anterior wall STEMI was the main electrocardiographic location (45.1%). A conservative treatment was seen in 64 patients (35.2%), thrombolysis in 41 (22.5%) and primary-angioplasty in the remaining 77 patients (42.3%). A total of 56 patients died (30.8%). The mortality rate in the thrombolysis group (21.9%) was similar than that found in the primary-angioplasty group (15.6%) (P=0.45). No difference was found in a subgroup analysis of high risk patients (i.e. anterior wall STEMI, Killip class ≥2). Morbidity rates were also similar between both therapeutic groups (thrombolisys 58.5% vs. primary-angioplasty 46.7%, P=0.22). Morbidity and mortality rates were much higher among those patients treated conservatively than that found in patients who received any of the reperfusion strategies (54.6% vs. 17.8%, P<0.0001 and 79.7% vs. 50.8%, P<0.0001, respectively).

CONCLUSIONS

Mortality and morbidity among very elderly patients with STEMI are extremely high. No differences were found between primary-angioplasty and fibrinolysis with regard to outcomes. A conservative treatment was associated with a worse prognosis.

The Pliocene paradox (mechanisms for a permanent El Niño)

During the early Pliocene, 5 to 3 million years ago, globally averaged temperatures were substantially higher than they are today, even though the external factors that determine climate were essentially the same. In the tropics, El Niño was continual (or "permanent") rather than intermittent. The appearance of northern continental glaciers, and of cold surface waters in oceanic upwelling zones in low latitudes (both coastal and equatorial), signaled the termination of those warm climate conditions and the end of permanent El Niño. This led to the amplification of obliquity (but not precession) cycles in equatorial sea surface temperatures and in global ice volume, with the former leading the latter by several thousand years. A possible explanation is that the gradual shoaling of the oceanic thermocline reached a threshold around 3 million years ago, when the winds started bringing cold waters to the surface in low latitudes. This introduced feedbacks involving ocean-atmosphere interactions that, along with ice-albedo feedbacks, amplified obliquity cycles. A future melting of glaciers, changes in the hydrological cycle, and a deepening of the thermocline could restore the warm conditions of the early Pliocene.

Association of NOD2/CARD15 mutations with previous surgical procedures in Crohn's disease

OBJECTIVE

The aim of this study is to assess the importance of NOD2/CARD15 gene mutations as prognostic factors for surgical indications in Crohn's disease. PATIENTS AND EXPERIMENTAL DESIGN: A total of 165 Crohn s disease patients were studied, considering previous surgery related to Crohn's disease. We analyzed for previous surgery in global procedures as well as separately for the two main surgical indications: ileal resection and fistula treatment. The need for appendectomy was also studied. All patients were genotyped for the three CARD15 mutations, and association studies were developed using Chi-square statistics and Fisher's exact test whenever appropriate.

RESULTS

Carriers of the G908R or 1007fs mutation needed surgery more frequently, both for ileal resection and fistula repair. In contrast, appendectomy was not associated with CARD15 mutations.

CONCLUSIONS

As previously reported in this population, the R702W mutation does influence parameters of disease or need of surgery. The need for Crohn's disease-related surgery is higher in carriers of the G908R or 1007fs CARD15 mutation in the Galician population. Nevertheless, the frequency of these mutations does not allow their use to predict the course of disease.

Improvement of pollutant drift forecast system applied to the Prestige oil spills in Galicia Coast (NW of Spain): development of an operational system

An integrated system named METEOMOHID, developed by MeteoGalicia in the first stage of the Prestige accident in November 2002 was used successfully in an operational form to support decision making and assist in recovering tasks. Afterwards, METEOMOHID has been enhanced with the aim of developing an operational oceanography system to be used in the NW of the Iberian Peninsula. The METEOMOHID system includes local area hydrodynamic coastal ocean modelling (MOHID), real time atmospheric forcing from a local meteorological model (ARPS). Using the available data from the Prestige crisis, a set of simulations were designed in order to reproduce the oil spill drift. The implementation of a detailed vertical resolution in the model has allowed obtaining a detailed surface dynamic, improving our knowledge of the behaviour of tarballs into the water column. Thus, the wind-driven Eckman drift, the direct dragging of the wind were detached, and the possible existence of subsurface oil was assessed. In addition, the present work evaluates the effects of introducing climatologic large scale currents in the METEOMOHID system.

An experimental model to study implant corrosion

Corrosion phenomena would appear to play a decisive role in metallic implant long term behaviour. This study presents a method to correlate results obtained in "in vivo" and "in vitro" studies on materials used for metallic implants. Samples of titanium and copper immersed in saline solution (pH 7.4 and 5.2) were used for the "in vitro" study. Implants of these same materials were placed in rat tibiae following the method previously described by Cabrini et al. The animals were killed 14 days post-implantation, the tibiae were resected, radiographed and embedded in acrylic resin. Polarization curves revealed high corrosion in copper implants and low corrosion in titanium implants. It is important to point out that the titanium samples suffered slightly higher corrosion when immersed in a lower pH medium (pH 5.2), as in chronic inflammatory processes. A passive film was found on titanium samples as opposed to the strong corrosion observed in the copper implants. Microscopy revealed osseointegration around titanium implants and a severe inflammatory reaction with abscesses surrounding the copper implants. The method presented herein would allow to correlate "in vivo" and "in vitro" studies on corrosion in different implant materials and establish their relation with cell response.

[Acceptance of generic prescribing in general practice: effect of patient education and reference prices]

AIMS

To assess patient acceptance of the substitution of brand-name drugs for generic equivalents in the context of repeat prescriptions for chronic diseases.

METHODS

A prospective multicenter study of drug use was performed. Of the 31 centers included in the study, 8 were randomized to the intervention group and 23 to the control group. For 1 year, patients in the intervention group who visited the center to collect repeat prescriptions received verbal and written information on the advantages and disadvantages of generic and brand name drugs. Data on the number of patients taking brand-name drugs for which generic equivalents were available, as well as the reasons and variables related to refusal of generic drugs (age, gender, education, primary care centre, general practitioner, type of drug and total number of repeat prescriptions) were collected. The percentage of generic drugs among the total number of drugs prescribed was calculated at 2-monthly intervals.

RESULTS

A total of 98.9% of the 4620 patients in the intervention group agreed to change to a generic formulation. The percentage of patients accepting generic drugs was significantly associated with the primary care centre, the class of drug, doctors' influence, and patient satisfaction with the drug. Generic prescriptions represented 5.9% in the intervention practices compared with 2.8% in controls. After the intervention, and before the application of reference prices, the percentages were 6.7% and 3.9%, respectively. Immediately after application of the reference prices, the percentages were 8.6% and 6.3%, respectively.

CONCLUSIONS

Direct patient education is an effective strategy in increasing the prescription of generic equivalents. General practitioners' motivation and knowledge of generic drugs influenced their use. The application of reference prices increased the use of generic equivalents.

Functional bowel disorders. A multicenter comparison of health status and development of illness severity index

In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0-100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months x 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.