A 2000 year long seasonal record of floods in the southern European Alps

Knowledge of past natural flood variability and controlling climate factors is of high value since it can be useful to refine projections of the future flood behavior under climate warming. In this context, we present a seasonally resolved 2000 year long flood frequency and intensity reconstruction from the southern Alpine slope (North Italy) using annually laminated (varved) lake sediments. Floods occurred predominantly during summer and autumn, whereas winter and spring events were rare. The all-season flood frequency and, particularly, the occurrence of summer events increased during solar minima, suggesting solar-induced circulation changes resembling negative conditions of the North Atlantic Oscillation as controlling atmospheric mechanism. Furthermore, the most extreme autumn events occurred during a period of warm Mediterranean sea surface temperature. Interpreting these results in regard to present climate change, our data set proposes for a warming scenario, a decrease in summer floods, but an increase in the intensity of autumn floods at the South-Alpine slope.

Recent trends in Inner Asian forest dynamics to temperature and precipitation indicate high sensitivity to climate change

Semi-arid ecosystems play an important role in regulating global climate with the fate of these ecosystems in the Anthropocene depending upon interactions among temperature, precipitation, and CO2. However, in cool-arid environments, precipitation is not the only limitation to forest productivity. Interactions between changes in precipitation and air temperature may enhance soil moisture stress while simultaneously extending growing season length, with unclear consequences for net carbon uptake. This study evaluates recent trends in productivity and phenology of Inner Asian forests (in Mongolia and Northern China) using satellite remote sensing, dendrochronology, and dynamic global vegetation model (DGVM) simulations to quantify the sensitivity of forest dynamics to decadal climate variability and trends. Trends in photosynthetically active radiation fraction (FPAR) between 1982 and 2010 show a greening of about 7% of the region in spring (March, April, May), and 3% of the area ‘browning’ during summertime (June, July, August). These satellite observations of FPAR are corroborated by trends in NPP simulated by the LPJ DGVM. Spring greening trends in FPAR are mainly explained by long-term trends in precipitation whereas summer browning trends are correlated with decreasing precipitation. Tree ring data from 25 sites confirm annual growth increments are mainly limited by summer precipitation (June, July, August) in Mongolia, and spring precipitation in northern China (March, April, May), with relatively weak prior-year lag effects. An ensemble of climate projections from the IPCC CMIP3 models indicates that warming temperatures (spring, summer) are expected to be associated with higher summer precipitation, which combined with CO2 causes large increases in NPP and possibly even greater forest cover in the Mongolian steppe. In the absence of a strong direct CO2 fertilization effect on plant growth (e.g., due to nutrient limitation), water stress or decreased carbon gain from higher autotrophic respiration results in decreased productivity and loss of forest cover. The fate of these semi-arid ecosystems thus appears to hinge upon the magnitude and subtleties of CO2 fertilization effects, for which experimental observations in arid systems are needed to test and refine vegetation models.

A physical approach on flood risk vulnerability of buildings

The design of efficient hydrological risk mitigation strategies and their subsequent implementation relies on a careful vulnerability analysis of the elements exposed. Recently, extensive research efforts were undertaken to develop and refine empirical relationships linking the structural vulnerability of buildings to the impact forces of the hazard processes. These empirical vulnerability functions allow estimating the expected direct losses as a result of the hazard scenario based on spatially explicit representation of the process patterns and the elements at risk classified into defined typological categories. However, due to the underlying empiricism of such vulnerability functions, the physics of the damage-generating mechanisms for a well-defined element at risk with its peculiar geometry and structural characteristics remain unveiled, and, as such, the applicability of the empirical approach for planning hazard-proof residential buildings is limited. Therefore, we propose a conceptual assessment scheme to close this gap. This assessment scheme encompasses distinct analytical steps: modelling (a) the process intensity, (b) the impact on the element at risk exposed and (c) the physical response of the building envelope. Furthermore, these results provide the input data for the subsequent damage evaluation and economic damage valuation. This dynamic assessment supports all relevant planning activities with respect to a minimisation of losses, and can be implemented in the operational risk assessment procedure.

Inference of inhomogeneous clouds in an exoplaent atmosphere

We present new visible and infrared observations of the hot Jupiter Kepler-7b to determine its atmospheric properties. Our analysis allows us to (1) refine Kepler-7b's relatively large geometric albedo of Ag = 0.35 ± 0.02, (2) place upper limits on Kepler-7b thermal emission that remains undetected in both Spitzer bandpasses and (3) report a westward shift in the Kepler optical phase curve. We argue that Kepler-7b's visible flux cannot be due to thermal emission or Rayleigh scattering from H2 molecules. We therefore conclude that high altitude, optically reflective clouds located west from the substellar point are present in its atmosphere. We find that a silicate-based cloud composition is a possible candidate. Kepler-7b exhibits several properties that may make it particularly amenable to cloud formation in its upper atmosphere. These include a hot deep atmosphere that avoids a cloud cold trap, very low surface gravity to suppress cloud sedimentation, and a planetary equilibrium temperature in a range that allows for silicate clouds to potentially form in the visible atmosphere probed by Kepler. Our analysis does not only present evidence of optically thick clouds on Kepler-7b but also yields the first map of clouds in an exoplanet atmosphere.

Evolving biomarkers improve prediction of long-term mortality in patients with stable coronary artery disease: the BIO-VILCAD score.

OBJECTIVE Algorithms to predict the future long-term risk of patients with stable coronary artery disease (CAD) are rare. The VIenna and Ludwigshafen CAD (VILCAD) risk score was one of the first scores specifically tailored for this clinically important patient population. The aim of this study was to refine risk prediction in stable CAD creating a new prediction model encompassing various pathophysiological pathways. Therefore, we assessed the predictive power of 135 novel biomarkers for long-term mortality in patients with stable CAD. DESIGN, SETTING AND SUBJECTS We included 1275 patients with stable CAD from the LUdwigshafen RIsk and Cardiovascular health study with a median follow-up of 9.8 years to investigate whether the predictive power of the VILCAD score could be improved by the addition of novel biomarkers. Additional biomarkers were selected in a bootstrapping procedure based on Cox regression to determine the most informative predictors of mortality. RESULTS The final multivariable model encompassed nine clinical and biochemical markers: age, sex, left ventricular ejection fraction (LVEF), heart rate, N-terminal pro-brain natriuretic peptide, cystatin C, renin, 25OH-vitamin D3 and haemoglobin A1c. The extended VILCAD biomarker score achieved a significantly improved C-statistic (0.78 vs. 0.73; P = 0.035) and net reclassification index (14.9%; P < 0.001) compared to the original VILCAD score. Omitting LVEF, which might not be readily measureable in clinical practice, slightly reduced the accuracy of the new BIO-VILCAD score but still significantly improved risk classification (net reclassification improvement 12.5%; P < 0.001). CONCLUSION The VILCAD biomarker score based on routine parameters complemented by novel biomarkers outperforms previous risk algorithms and allows more accurate classification of patients with stable CAD, enabling physicians to choose more personalized treatment regimens for their patients.

Modular training in vascular and endovascular surgery exemplified by the Vascular International Foundation and School

The partial shift from patient to model is a reasonable and necessary paradigm shift in surgery in order to increase patient safety and to adapt to the reduced training time periods in hospitals and increased quality demands. Since 1991 the Vascular International Foundation and School has carried out many training courses with more than 2,500 participants. The modular build training system allows to teach many open vascular and endovascular surgical techniques on lifelike models with a pulsatile circulation. The simulation courses cannot replace training in operating rooms but are suitable for supporting the cognitive and associative stages for achieving motor skills. Scientific evaluation of the courses has continually shown that the training principle established since 1991 can lead to significant learning success. They are extremely useful not only for beginners but also for experienced vascular surgeons. They can help to shorten the learning curve, to learn new techniques or to refine previously used techniques in all stages of professional development. Keywords Advanced training · Advanced training regulations · Training model · Vascular International · Certification

Association of electrocardiogram abnormalities and incident heart failure events

BACKGROUND Unless effective preventive strategies are implemented, aging of the population will result in a significant worsening of the heart failure (HF) epidemic. Few data exist on whether baseline electrocardiographic (ECG) abnormalities can refine risk prediction for HF. METHODS We examined a prospective cohort of 2,915 participants aged 70 to 79 years without preexisting HF, enrolled between April 1997 and June 1998 in the Health, Aging, and Body Composition (Health ABC) study. Minnesota Code was used to define major and minor ECG abnormalities at baseline and at year 4 follow-up. Using Cox models, we assessed (1) the association between ECG abnormalities and incident HF and (2) the incremental value of adding ECG to the Health ABC HF Risk Score using the net reclassification index. RESULTS At baseline, 380 participants (13.0%) had minor, and 620 (21.3%) had major ECG abnormalities. During a median follow-up of 11.4 years, 485 participants (16.6%) developed incident HF. After adjusting for the Health ABC HF Risk Score variables, the hazard ratio (HR) was 1.27 (95% CI 0.96-1.68) for minor and 1.99 (95% CI 1.61-2.44) for major ECG abnormalities. At year 4, 263 participants developed new and 549 had persistent abnormalities; both were associated with increased subsequent HF risk (HR 1.94, 95% CI 1.38-2.72 for new and HR 2.35, 95% CI 1.82-3.02 for persistent ECG abnormalities). Baseline ECG correctly reclassified 10.5% of patients with HF events, 0.8% of those without HF events, and 1.4% of the overall population. The net reclassification index across the Health ABC HF risk categories was 0.11 (95% CI 0.03-0.19). CONCLUSIONS Among older adults, baseline and new ECG abnormalities are independently associated with increased risk of HF. The contribution of ECG screening for targeted prevention of HF should be evaluated in clinical trials.

Integrated testing strategy (ITS) for bioaccumulation assessment under REACH

REACH (registration, evaluation, authorisation and restriction of chemicals) regulation requires that all the chemicals produced or imported in Europe above 1 tonne/year are registered. To register a chemical, physicochemical, toxicological and ecotoxicological information needs to be reported in a dossier. REACH promotes the use of alternative methods to replace, refine and reduce the use of animal (eco)toxicity testing. Within the EU OSIRIS project, integrated testing strategies (ITSs) have been developed for the rational use of non-animal testing approaches in chemical hazard assessment. Here we present an ITS for evaluating the bioaccumulation potential of organic chemicals. The scheme includes the use of all available data (also the non-optimal ones), waiving schemes, analysis of physicochemical properties related to the end point and alternative methods (both in silico and in vitro). In vivo methods are used only as last resort. Using the ITS, in vivo testing could be waived for about 67% of the examined compounds, but bioaccumulation potential could be estimated on the basis of non-animal methods. The presented ITS is freely available through a web tool.

The Role of Plant Primary and Secondary Metabolites in Root-Herbivore Behaviour, Nutrition and Physiology

Many insect herbivores feed on belowground plant tissues. In this chapter, we discuss how they have adapted to deal with root primary and secondary metabolites. It is becoming evident that root herbivores can use root volatiles and exudates for host location and foraging. Their complex sensory apparatus suggests a sophisticated recognition and signal transduction system. Furthermore, endogenous metabolites trigger attractive or repellent responses in root feeders, indicating that they may specifically fine-tune food uptake to meet their dietary needs. Little evidence for direct toxic effects of root secondary metabolites has accumulated so far, indicating high prevalence of tolerance mechanisms. Root herbivores furthermore facilitate the entry of soil microbes into the roots, which may influence root nutritional quality. Investigating the role of plant metabolites in an ecologically and physiologically relevant context will be crucial to refine our current models on root-herbivore physiology and behaviour in the future.

Mineralogical and isotopic record of diagenesis from the Opalinus Clay formation at Benken, Switzerland: Implications for the modeling of pore-water chemistry in a clay formation

Argillaceous rocks are considered to be a suitable geological barrier for the long-term containment of wastes. Their efficiency at retarding contaminant migration is assessed using reactive-transport experiments and modeling, the latter requiring a sound understanding of pore-water chemistry. The building of a pore-water model, which is mandatory for laboratory experiments mimicking in situ conditions, requires a detailed knowledge of the rock mineralogy and of minerals at equilibrium with present-day pore waters. Using a combination of petrological, mineralogical, and isotopic studies, the present study focused on the reduced Opalinus Clay formation (Fm) of the Benken borehole (30 km north of Zurich) which is intended for nuclear-waste disposal in Switzerland. A diagenetic sequence is proposed, which serves as a basis for determining the minerals stable in the formation and their textural relationships. Early cementation of dominant calcite, rare dolomite, and pyrite formed by bacterial sulfate reduction, was followed by formation of iron-rich calcite, ankerite, siderite, glauconite, (Ba, Sr) sulfates, and traces of sphalerite and galena. The distribution and abundance of siderite depends heavily on the depositional environment (and consequently on the water column). Benken sediment deposition during Aalenian times corresponds to an offshore environment with the early formation of siderite concretions at the water/sediment interface at the fluctuating boundary between the suboxic iron reduction and the sulfate reduction zones. Diagenetic minerals (carbonates except dolomite, sulfates, silicates) remained stable from their formation to the present. Based on these mineralogical and geochemical data, the mineral assemblage previously used for the geochemical model of the pore waters at Mont Terri may be applied to Benken without significant changes. These further investigations demonstrate the need for detailed mineralogical and geochemical study to refine the model of pore-water chemistry in a clay formation.

Refining the vulnerability model of low self-esteem and depression: Disentangling the effects of genuine self-esteem and narcissism

A growing body of research supports the vulnerability model of low self-esteem and depression, which states that low self-esteem is a risk factor for depression. The goal of the present research was to refine the vulnerability model, by testing whether the self-esteem effect is truly due to a lack of genuine self-esteem or due to a lack of narcissistic self-enhancement. For the analyses, we used data from 6 longitudinal studies consisting of 2,717 individuals. In each study, we tested the prospective effects of self-esteem and narcissism on depression both separately for each construct and mutually controlling the constructs for each other (i.e., a strategy that informs about effects of genuine self-esteem and pure narcissism), and then meta-analytically aggregated the findings. The results indicated that the effect of low self-esteem holds when narcissism is controlled for (uncontrolled effect = -.26, controlled effect = -.27). In contrast, the effect of narcissism was close to zero when self-esteem was controlled for (uncontrolled effect = -.06, controlled effect = .01). Moreover, the analyses suggested that the self-esteem effect is linear across the continuum from low to high self-esteem (i.e., the effect was not weaker at very high levels of self-esteem). Finally, self-esteem and narcissism did not interact in their effect on depression; that is, individuals with high self-esteem have a lower risk for developing depression, regardless of whether or not they are narcissistic. The findings have significant theoretical implications because they strengthen the vulnerability model of low self-esteem and depression.

Fully Automatic Segmentation of Hip CT Images

Automatic segmentation of the hip joint with pelvis and proximal femur surfaces from CT images is essential for orthopedic diagnosis and surgery. It remains challenging due to the narrowness of hip joint space, where the adjacent surfaces of acetabulum and femoral head are hardly distinguished from each other. This chapter presents a fully automatic method to segment pelvic and proximal femoral surfaces from hip CT images. A coarse-to-fine strategy was proposed to combine multi-atlas segmentation with graph-based surface detection. The multi-atlas segmentation step seeks to coarsely extract the entire hip joint region. It uses automatically detected anatomical landmarks to initialize and select the atlas and accelerate the segmentation. The graph based surface detection is to refine the coarsely segmented hip joint region. It aims at completely and efficiently separate the adjacent surfaces of the acetabulum and the femoral head while preserving the hip joint structure. The proposed strategy was evaluated on 30 hip CT images and provided an average accuracy of 0.55, 0.54, and 0.50 mm for segmenting the pelvis, the left and right proximal femurs, respectively.

Assessment of the role of LASER-Doppler in the treatment of port-wine stains in infants

BACKGROUND Port-wine stains (PWS) are malformations of capillaries in 0.3% of newborn children. The treatment of choice is by pulsed dye LASER (PDL), and requires several sessions. The efficacy of this treatment is at present evaluated on the basis of clinical inspection and of digital photographs taken throughout the treatment. LASER-Doppler imaging (LDI) is a noninvasive method of imaging the perfusion of the tissues by the microcirculatory system (capillaries). The aim of this paper is to demonstrate that LDI allows a quantitative, numerical evaluation of the efficacy of the PDL treatment of PWS. METHOD The PDL sessions were organized according to the usual scheme, every other month, from September 1, 2012, to September 30, 2013. LDI imaging was performed at the start and at the conclusion of the PDL treatment, and simultaneously on healthy skin in order to obtain reference values. The results evidenced by LDI were analyzed according to the "Wilcoxon signed-rank" test before and after each session, and in the intervals between the three PDL treatment sessions. RESULTS Our prospective study is based on 20 new children. On average, the vascularization of the PWS was reduced by 56% after three laser sessions. Compared with healthy skin, initial vascularization of PWS was 62% higher than that of healthy skin at the start of treatment, and 6% higher after three sessions. During the 2 months between two sessions, vascularization of the capillary network increased by 27%. CONCLUSION This study shows that LDI can demonstrate and measure the efficacy of PDL treatment of PWS in children. The figures obtained when measuring the results by LDI corroborate the clinical assessments and may allow us to refine, and perhaps even modify, our present use of PDL and thus improve the efficacy of the treatment.

UHP Metamorphism Documented in Ti-chondrodite- and Ti-clinohumite-bearing Serpentinized Ultramafic Rocks from Chinese Southwestern Tianshan

The southwestern Tianshan (China) metamorphic belt records high-pressure (HP) to ultrahigh-pressure (UHP) conditions corresponding to a cold oceanic subduction-zone setting. Serpentinites enclosing retrogressed eclogite and rodingite occur as lenses within metapelites in the UHP unit, which also hosts coesite-bearing eclogites. Based on the petrology and petrography of these serpentinites, five events are recognized: (1) formation of a wehrlite–harzburgite–dunite association in the mantle; (2) retrograde metamorphism and partial hydration during exhumation of the mantle rocks close to the seafloor; (3) oceanic metamorphism leading to the first serpentinization and rodingitization; (4) UHP metamorphism during subduction; (5) retrograde metamorphism during exhumation together with a second serpentinization. The peak metamorphic mineral assemblage of the serpentinized wehrlite comprises Ti-chondrodite + olivine + antigorite + chlorite + magnetite + brucite. A computed pseudosection for this serpentinized wehrlite shows that the Al content in antigorite is mostly sensititive to temperature but can also be used to constrain pressure. The average XAl = 0·204 ± 0·026 of antigorite (XAl = Al (a.p.f.u.)/8, where Al is in atoms per formula unit for a structural formula M48T34O85(OH)62, and M and T are octahedral and tetrahedral sites, respectively) included in Ti-chondrodite and average XAl = 0·203 ± 0·019 of antigorite in the matrix result in a well-constrained peak metamorphic temperature of 510–530°C. Peak pressures are less precisely constrained at 37 ± 7 kbar. The Tianshan serpentinites thus record UHP metamorphic conditions and represent the deepest subducted serpentinites discovered so far. The retrograde evolution occurs within the stability field of brucite + antigorite + olivine + chlorite and formation of Ti-clinohumite at the expense of Ti-chondrodite has been observed, suggesting isothermal decompression. The resulting P–T path is in excellent agreement with the metamorphic evolution of country rocks, indicating that the UHP unit in Tianshan was subducted and exhumed as a coherent block. To refine the metamorphic path of the ultramafic rocks, we have investigated the stability fields of Ti-chondrodite and Ti-clinohumite using piston-cylinder experiments. A total of 11 experiments were conducted at 25–55 kbar and 600–750°C in a F-free natural system. Combined with previous experiments and information from natural rocks we constructed a petrogenetic grid for the stability of Ti-chondrodite and Ti-clinohumite in F-free peridotite compositions. The formation of Ti-chondrodite in serpentinites requires a minimum pressure of about 26 kbar, whereas in Ti-rich systems it can form at considerably lower pressures. A key finding is that at UHP conditions, F-free Ti-chondrodite or Ti-clinohumite breaks down in the presence of orthopyroxene between 700 and 750°C, at temperatures that are significantly lower than those of the terminal breakdown reactions of these humite minerals. These breakdown reactions are an additional source of fluid during prograde subduction of serpentinites.

Management of fever and neutropenia in paediatric cancer patients: room for improvement?

PURPOSE OF REVIEW Fever and neutropenia is the most common complication in the treatment of childhood cancer. This review will summarize recent publications that focus on improving the management of this condition as well as those that seek to optimize translational research efforts. RECENT FINDINGS A number of clinical decision rules are available to assist in the identification of low-risk fever and neutropenia however few have undergone external validation and formal impact analysis. Emerging evidence suggests acute fever and neutropenia management strategies should include time to antibiotic recommendations, and quality improvement initiatives have focused on eliminating barriers to early antibiotic administration. Despite reported increases in antimicrobial resistance, few studies have focused on the prediction, prevention, and optimal treatment of these infections and the effect on risk stratification remains unknown. A consensus guideline for paediatric fever and neutropenia research is now available and may help reduce some of the heterogeneity between studies that have previously limited the translation of evidence into clinical practice. SUMMARY Risk stratification is recommended for children with cancer and fever and neutropenia. Further research is required to quantify the overall impact of this approach and to refine exactly which children will benefit from early antibiotic administration as well as modifications to empiric regimens to cover antibiotic-resistant organisms.