The influence of bedrock hydrogeology on catchment-scale nitrate fate and transport in fractured aquifers

Characterising catchment scale biogeochemical processes controlling nitrate fate in groundwater constitutes a fundamental consideration when applying programmes of measures to reduce risks posed by diffuse agricultural pollutants to water quality. Combining hydrochemical analyses with nitrate isotopic data and physical hydrogeological measurements permitted characterisation of biogeochemical processes influencing nitrogen fate and transport in the groundwater in two fractured bedrock aquifers with contrasting hydrogeology but comparable nutrient loads. Hydrochemical and isotopic analyses of groundwater samples collected from moderately fractured, diffusely karstified limestone indicated nitrification controlled dissolved nitrogen fate and delivery to aquatic receptors. By contrast nitrate concentrations in groundwater were considerably lower in a low transmissivity highly lithified sandstone and pyrite-bearing shale unit with patchy subsoil cover. Geophysical and hydrochemical investigations showed shallower intervals contained hydraulically active fractures where denitrification was reflected through lower nitrogen levels and an isotopic enrichment ratio of 1.7 between δ15N and δ18O. Study findings highlight the influence of bedrock hydrogeological conditions on aqueous nitrogen mobility. Investigation results demonstrate that bedrock conditions need to be considered when implementing catchment management plans to reduce the impact of agricultural practices on the quality of groundwater and baseflow in receiving rivers.

Levosimendan for the Prevention of Acute Organ Dysfunction in Sepsis

BACKGROUND Levosimendan is a calcium-sensitizing drug with inotropic and other properties that may improve outcomes in patients with sepsis. 
METHODS We conducted a double-blind, randomized clinical trial to investigate whether levosimendan reduces the severity of organ dysfunction in adults with sepsis. Patients were randomly assigned to receive a blinded infusion of levosimendan (at a dose of 0.05 to 0.2 μg per kilogram of body weight per minute) for 24 hours or placebo in addition to standard care. The primary outcome was the mean daily Sequential Organ Failure Assessment (SOFA) score in the intensive care unit up to day 28 (scores for each of five systems range from 0 to 4, with higher scores indicating more severe dysfunction; maximum score, 20). Secondary outcomes included 28-day mortality, time to weaning from mechanical ventilation, and adverse events. 
RESULTS The trial recruited 516 patients; 259 were assigned to receive levosimendan and 257 to receive placebo. There was no significant difference in the mean (±SD) SOFA score between the levosimendan group and the placebo group (6.68±3.96 vs. 6.06±3.89; mean difference, 0.61; 95% confidence interval [CI], −0.07 to 1.29; P=0.053). Mortality at 28 days was 34.5% in the levosimendan group and 30.9% in the placebo group (absolute difference, 3.6 percentage points; 95% CI, −4.5 to 11.7; P=0.43). Among patients requiring ventilation at baseline, those in the levosimendan group were less likely than those in the placebo group to be successfully weaned from mechanical ventilation over the period of 28 days (hazard ratio, 0.77; 95% CI, 0.60 to 0.97; P=0.03). More patients in the levosimendan group than in the placebo group had supraventricular tachyarrhythmia (3.1% vs. 0.4%; absolute difference, 2.7 percentage points; 95% CI, 0.1 to 5.3; P=0.04). 
CONCLUSIONS The addition of levosimendan to standard treatment in adults with sepsis was not associated with less severe organ dysfunction or lower mortality. Levosimendan was associated with a lower likelihood of successful weaning from mechanical ventilation and a higher risk of supraventricular tachyarrhythmia. (Funded by the NIHR Efficacy and Mechanism Evaluation Programme and others; LeoPARDS Current Controlled Trials number, ISRCTN12776039.)