Conventional Ultrafiltration During Elective Cardiac Surgery and Postoperative Acute Kidney Injury

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颅脑外伤性癫痫发病的危险因素分析

目的探讨颅脑外伤性癫痫(PTE)发病的危险因素。方法选取我院神经外科2016年1月至2019年10月收治的120例颅脑外伤患者,既往均有癫痫史,分为PTE组和非PTE组各60例。分析两组的临床因素,采用Logistic回归分析PTE发病的危险因素。结果单因素分析结果显示,PTE发病与年龄、严重程度(GCS)、受伤部位、凹陷性颅骨骨折相关(P <0.05),与性别、蛛网膜下腔出血无相关性(P>0.05)。多因素Logistic回归分析结果显示,年龄(OR=0.652, 95%CI:1.246~2.419),严重程度(GCS)(OR=2.041, 95%CI:1.394~4.842)、受伤部位(OR=1.642, 95%CI:2.105~4.378)、凹陷性颅骨骨折(OR=6.548, 95%CI:1.541~3.547)为PTE发病的影响因素。结论年龄、严重程度(GCS)、受伤部位、凹陷性颅骨骨折为PTE发病的影响因素,临床中应针对PTE发病因素进行预防和及时治疗,以提高临床疗效和预后。     

Exploring Stigmatizing Attitudes Among Community Mental Health Clinicians Working with Clients Who Have a Dual Diagnosis

Illicit drug use, alcohol use and mental health problems frequently co-occur and are some of the most stigmatised health conditions. This can include stigma from those providing care, although stigmatization by mental health professionals towards dual-diagnosis clients is poorly understood. This study aimed to examine whether clinicians in community managed mental health organisations hold attitudes and beliefs that could be considered stigmatising towards clients with a dual diagnosis (ddx). Using an online survey, mental health clinicians (n = 32) were presented with three vignettes depicting a person with (1) schizophrenia, (2) schizophrenia and alcohol dependence and (3) schizophrenia and methamphetamine use, and two scales measuring stigmatising attitudes. Scores across the vignettes were compared to assess attitudes towards dual diagnosis compared to mental illness. Mental health clinicians' responses suggested greater stigma and a desire for greater social distance towards the methamphetamine case (but not the alcohol case) relative to the schizophrenia alone case. Rates of belief in full recovery were relatively low for all vignettes. It is recommended that training to address negative atttiudes and beliefs towards illicit drug users is implemented in mental health settings.

     

Airborne measurements of organic bromine compounds in the Pacific tropical tropopause layer

Very short-lived brominated substances (VSLBr) are an important source of stratospheric bromine, an effective ozone destruction catalyst. However, the accurate estimation of the organic and inorganic partitioning of bromine and the input to the stratosphere remains uncertain. Here, we report near-tropopause measurements of organic brominated substances found over the tropical Pacific during the NASA Airborne Tropical Tropopause Experiment campaigns. We combine aircraft observations and a chemistry−climate model to quantify the total bromine loading injected to the stratosphere. Surprisingly, despite differences in vertical transport between the Eastern and Western Pacific, VSLBr (organic + inorganic) contribute approximately similar amounts of bromine [∼6 (4−9) parts per thousand] to the stratospheric input at the tropical tropopause. These levels of bromine cause substantial ozone depletion in the lower stratosphere, and any increases in future abundances (e.g., as a result of aquaculture) will lead to larger depletions.Until the end of the last century, it was believed that only long-lived species, like bromomethane (CH₃Br) and halons, contributed to the global burden of stratospheric bromine. However, disagreement between the observed amount of reactive stratospheric bromine and the sources of long-lived trace gases suggested the existence of an additional contributor: Very short-lived brominated substances (VSL_org) [VSL_org = bromoform (3CHBr₃) + dibromomethane (2CH₂Br₂) + minor_VSLBr, where minor_VSLBr = bromochloromethane (CH₂BrCl) + dibromochloromethane (2CHBr₂Cl) + bromodichloromethane (CHBrCl₂)] that originate mainly from ocean biogenic sources (1, 2).Several studies have described the processes involved in the transformation of biogenic bromocarbons to inorganic bromine, and their transport through the tropical tropopause layer (TTL) (1–5). These studies have led to significant progress in modeling the VSL_org contribution to the formation of stratospheric inorganic bromine (Br_y) (3, 4, 6–11). However, the scarcity of observations to constrain the emissions, the impact of deep convection, and the effect of dehydration processes limit the prediction of short-lived source gases that reach the stratosphere (3). On the other hand, atmospheric observations of VSL_org have been provided by ground measurements and cruise, balloon, and airborne campaigns (12–14), but the different instruments used between campaigns, and the low spatial and temporal coverage of each study, contribute to the uncertainties in the estimations of total bromine and its partitioning (15). In an attempt to reduce these limitations, we present unique measurements of organic bromine substances carried out with the same instrument, the Global Hawk Whole Air Sampler (GWAS), deployed during the NASA Airborne Tropical Tropopause Experiment (ATTREX), which covered the tropical Pacific region during 2013 and 2014 (see SI Text for details of the campaign).Because coastal areas of tropical waters (like the Maritime Continent) are an important source for VSL_org (16–18) and highly convective zones can transport air masses from the troposphere into the stratosphere through the TTL (19), we focus this study on observations taken over the Western Pacific (120°E−165°E) and the Eastern Pacific (187°E−268°E) (Fig. S1). We compared these regions in terms of VSL_org mixing ratios at the tropopause level (∼17 km; Fig. S2), which defines the chemical composition of air that enters the stratosphere.Open in a separate windowFig. S1.GWAS sample locations during ATTREX campaign. Dotted lines define the Western (120°E–165°E) and Eastern Pacific (187°E–268°E) limits for this study.Open in a separate windowFig. S2.Sample density of measurements of organic bromine species (A) during ATTREX-2014 (Western Pacific) and (B) during ATTREX-2013 (Eastern Pacific).Whole air samples were collected during two deployments of the ATTREX campaigns, on board the unmanned aerial vehicle Global Hawk. Measurements of VSL_org were carried out in the field using a combination of gas chromatography with mass selective, flame ionization, and electron capture detectors (Materials and Methods). Fig. 1 A and B displays the observations of CHBr₃, CH₂Br₂, and minor_VSLBr, as well as the total organic bromine mixing ratio, in the upper troposphere/lower stratosphere (UTLS) of the Western and Eastern Pacific. GWAS observations indicate that the total amount of VSL_org that enters the stratosphere over the Western and Eastern Pacific is approximately similar, 3.27 ± 0.47 parts per thousand (ppt) and 2.96 ± 0.42 ppt, respectively. These observations are compared with the state-of-the-art Community Atmosphere Model (CAM-Chem) simulations (4, 20) (see Materials and Methods). The results show good agreement with the measurements, and simulate the injection of VSL_org to the stratosphere of 3.84 ± 0.64 ppt and 3.18 ± 1.49 ppt organic Br for the Western and Eastern Pacific, respectively (Fig. 1 A and B).Open in a separate windowFig. 1.GWAS measurements and CAM-Chem simulations ±1 SD. Filled symbols are the 1 km average bins from GWAS measurements. Lines are the CAM-Chem simulation. Values from the arrows represent the mean mixing ratio (ppt) of VSL_org and Br_y at the tropopause level (∼17 km) derived from CAM-Chem simulations. (A and B) Organic brominated species multiplied by their atomicity for (A) Western Pacific and (B) Eastern Pacific. (C and D) CAM-Chem estimations of inorganic bromine (Br_y) from measured brominated VSLS with shaded ±1 SD for (C) Western Pacific and (D) Eastern Pacific.Although negligible differences of the organic fraction of VSLBr were observed between the Western and Eastern Pacific, we quantified the inorganic fraction coming from the degradation of VSL_org. Estimations of inorganic bromine (Br_y = Br + BrO + HOBr + BrONO₂ + HBr + BrCl + 2Br₂ + BrNO₂ + IBr), with a focus at ∼17 km, were calculated with the CAM-Chem model using assimilated meteorological fields for each Global Hawk flight. According to these simulations, the amount of Br_y over the Eastern Pacific is 3.02 ± 1.90 ppt, whereas, in the Western Pacific, the mixing ratio of Br_y is 1.97 ± 0.21 ppt (Fig. 1 C and D). Br_y/VSL_org ratios show that at ∼17 km, the abundance of Br_y over the Western Pacific is almost half the amount of VSL_org, in contrast to the Eastern Pacific, where the abundance of Br_y is similar to the value of VSL_org (