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We utilize a variety of climate datasets to examine impacts of two mechanisms on precipitation in the Greater Horn of Africa (GHA) during northern-hemisphere summer. First, surface-pressure gradients draw moist air toward the GHA from the tropical Atlantic Ocean and Congo Basin. Variability of the strength of these gradients strongly influences GHA precipitation totals and accounts for important phenomena such as the 1960s–1980s rainfall decline and devastating 1984 drought. Following the 1980s, precipitation variability became increasingly influenced by the southern tropical Indian Ocean (STIO) region. Within this region, increases in sea-surface temperature, evaporation, and precipitation are linked with increased exports of dry mid-tropospheric air from the STIO region toward the GHA. Convergence of dry air above the GHA reduces local convection and precipitation. It also produces a clockwise circulation response near the ground that reduces moisture transports from the Congo Basin. Because precipitation originating in the Congo Basin has a unique isotopic signature, records of moisture transports from the Congo Basin may be preserved in the isotopic composition of annual tree rings in the Ethiopian Highlands. A negative trend in tree-ring oxygen-18 during the past half century suggests a decline in the proportion of precipitation originating from the Congo Basin. This trend may not be part of a natural cycle that will soon rebound because climate models characterize Indian Ocean warming as a principal signature of greenhouse-gas induced climate change. We therefore expect surface warming in the STIO region to continue to negatively impact GHA precipitation during northern-hemisphere summer.

Although psychological sequelae after intensive care unit (ICU) treatment are considered quite intrusive, robustly effective interventions to treat or prevent these long-term sequelae are lacking. Recently, it was demonstrated that ICU-specific virtual reality (ICU-VR) is a feasible and acceptable intervention with potential mental health benefits. However, its effect on mental health and ICU aftercare in COVID-19 ICU survivors is unknown. This study aimed to explore the effects of ICU-VR on mental health and on patients' perceived quality of, satisfaction with, and rating of ICU aftercare among COVID-19 ICU survivors. This was a multicenter randomized controlled trial. Patients were randomized to either the ICU-VR (intervention) or the control group. All patients were invited to an COVID-19 post-ICU follow-up clinic 3 months after hospital discharge, during which patients in the intervention group received ICU-VR. One month and 3 months later (4 and 6 months after hospital discharge), mental health, quality of life, perceived quality, satisfaction with, and rating of ICU aftercare were scored using questionnaires. Eighty-nine patients (median age 58 years; 63 males, 70%) were included. The prevalence and severity of psychological distress were limited throughout follow-up, and no differences in psychological distress or quality of life were observed between the groups. ICU-VR improved satisfaction with (mean score 8.7, SD 1.6 vs 7.6, SD 1.6 [ICU-VR vs control]; t =-2.82, P=.006) and overall rating of ICU aftercare (mean overall rating of aftercare 8.9, SD 0.9 vs 7.8, SD 1.7 [ICU-VR vs control]; t =-3.25; P=.002) compared to controls. ICU-VR added to the quality of ICU aftercare according to 81% of the patients, and all patients would recommend ICU-VR to other ICU survivors. ICU-VR is a feasible and acceptable innovative method to improve satisfaction with and rating of ICU aftercare and adds to its perceived quality. We observed a low prevalence of psychological distress after ICU treatment for COVID-19, and ICU-VR did not improve psychological recovery or quality of life. Future research is needed to confirm our results in other critical illness survivors to potentially facilitate ICU-VR's widespread availability and application during follow-up. Netherlands Trial Register NL8835; https://www.trialregister.nl/trial/8835. RR2-10.1186/s13063-021-05271-z.

Background Short-term controlled exposure to diesel exhaust (DE) in chamber studies have shown mixed results on lung and systemic effects. There is a paucity of studies on well-characterized real-life DE exposure in humans. In the present study, 29 healthy volunteers were exposed to DE while sitting as passengers in diesel-powered trains. Exposure in electric trains was used as control scenario. Each train scenario consisted of three consecutive days (6 h/day) ending with biomarker samplings. Results Combustion-derived air pollutants were considerably higher in the passenger carriages of diesel trains compared with electric trains. The concentrations of black carbon and ultrafine particles were 8.5 μg/m 3 and 1.2–1.8 × 10 5 particles/cm 3 higher, respectively, in diesel as compared to electric trains. Net increases of NOx and NO 2 concentrations were 317 μg/m 3 and 36 μg/m 3 . Exposure to DE was associated with reduced lung function and increased levels of DNA strand breaks in peripheral blood mononuclear cells (PBMCs), whereas there were unaltered levels of oxidatively damaged DNA, soluble cell adhesion molecules, acute phase proteins in blood and urinary excretion of metabolites of polycyclic aromatic hydrocarbons. Also the microvascular function was unaltered. An increase in the low frequency of heart rate variability measures was observed, whereas time-domain measures were unaltered. Conclusion Exposure to DE inside diesel-powered trains for 3 days was associated with reduced lung function and systemic effects in terms of altered heart rate variability and increased levels of DNA strand breaks in PBMCs compared with electric trains. Trial registration ClinicalTrials.Gov ( NCT03104387 ). Registered on March 23rd 2017

PurposeIndividualising drug dosing using model-informed precision dosing (MIPD) of beta-lactam antibiotics and ciprofloxacin has been proposed as an alternative to standard dosing to optimise antibiotic efficacy in critically ill patients. However, randomised clinical trials (RCT) on clinical outcomes have been lacking.MethodsThis multicentre RCT, including patients admitted to the intensive care unit (ICU) who were treated with antibiotics, was conducted in eight hospitals in the Netherlands. Patients were randomised to MIPD with dose and interval adjustments based on monitoring serum drug levels (therapeutic drug monitoring) combined with pharmacometric modelling of beta-lactam antibiotics and ciprofloxacin. The primary outcome was ICU length of stay (LOS). Secondary outcomes were ICU mortality, hospital mortality, 28-day mortality, 6-month mortality, delta sequential organ failure assessment (SOFA) score, adverse events and target attainment.ResultsIn total, 388 (MIPD n = 189; standard dosing n = 199) patients were analysed (median age 64 [IQR 55–71]). We found no significant differences in ICU LOS between MIPD compared to standard dosing (10 MIPD vs 8 standard dosing; IRR = 1.16; 95% CI 0.96–1.41; p = 0.13). There was no significant difference in target attainment before intervention at day 1 (T1) (55.6% MIPD vs 60.9% standard dosing; p = 0.24) or at day 3 (T3) (59.5% vs 60.4%; p = 0.84). There were no significant differences in other secondary outcomes.ConclusionsWe could not show a beneficial effect of MIPD of beta-lactam antibiotics and ciprofloxacin on ICU LOS in critically ill patients. Our data highlight the need to identify other approaches to dose optimisation.

[...]Mellado and colleagues address a clinically relevant question using an innovative methodological framework. Using big data to emulate a target trial when a randomized trial is not available. Keogh RH, Gran JM, Seaman SR, Davies G, Vansteelandt S. Causal inference in survival analysis using longitudinal observational data: sequential trials and marginal structural models.

With the growing interest in more environmentally friendly solvents and processes, the introduction of Natural Deep Eutectic Solvents (NaDES) as low cost, non-toxic and biodegradable solvents represent a new opportunity for green and sustainable chemistry. Thanks to their remarkable advantages, NaDES are now arousing growing interest in many fields of research such as food, health, cosmetics and biofuels. Around the world, NaDES are seen as a promising alternative to commonly used petrochemical solvents. The objective of this review is to draw up a panorama of the existing skills on NaDES in French laboratories and industries for the valuation of natural products. This review therefore focuses on current applications, skills and perspectives, in order to analyze the place of French research in the use of NaDES for the valorization of biomass since 2015.

Background Relatives of intensive care unit (ICU) patients often endure symptoms of post-traumatic stress, anxiety, and depression during and after treatment of a family member’s hospitalization. The aim of this study was to evaluate the effect of ICU-specific virtual reality (ICU-VR) on mental health among relatives, 6 months after patient’s ICU discharge. Methods This multicenter, randomized controlled trial included relatives of ICU patients who were assigned to receive either standard care or standard care plus ICU-VR, by randomizing the ICU patients. Relatives were assessed up to 6 months after patient discharge from the ICU for post-traumatic stress, anxiety, depression, quality of life, relatives’ understanding of ICU care, and appreciation of ICU-VR. Results One hundred relatives of 81 patients and 89 relatives of 80 patients were randomized to the intervention and control groups, respectively. Relatives’ median age was 48 years and 53% were female. Compared to the control group, relatives who received ICU-VR did not experience a decrease in post-traumatic stress (23% vs. 18%; p  = 0.99), anxiety (22% vs. 30%; p  = 0.35), or depression (17% vs. 23%; p  = 0.44). There was no significant difference between median mental quality of life (50.2 vs. 52.6; p  = 0.51), physical quality of life (56.1 vs. 54.3; p  = 0.16), or understanding of ICU care between groups. Patients in the intervention group highly endorsed ICU-VR (90%), favoring it over traditional informational brochures and the majority (82%) stated it improved their understanding of ICU treatment. Conclusion ICU-VR did not significantly improve mental health distress symptoms among relatives 6-months after a patient’s discharge. Relatives highly endorsed ICU-VR and self-reported that it improved their understanding of ICU treatment.

Total phenolic compounds (TPC) and the chlorogenic acids content of potato by-product extracts of two hydro alcoholic solvents (methanol, ethanol) and two extraction methods (maceration and heating-assisted extraction) were studied. The content of TPC in the extracts was determined spectrometrically according to the Folin–Ciocalteu procedure and calculated as chlorogenic acid equivalents. Soluble phenolic acids, especially the chlorogenic acids, were performed by HPLC. The antioxidant activity of potato by-product extracts was determined by using the total oxygen radical absorbance capacity (ORAC) method. The highest content of TPC was found in raw and lyophilized red waters when using ethanol as a solvent around 57 mg/g fresh weight. Heating-assisted extraction enhances this quantitative increasing. At the given operating conditions, unpeeled potato samples exhibit a higher TPC than peeled ones, showing that TPC are accumulated in skin tissue. The greatest amount of chlorogenic acid (Caffeoyl-Quinic Acids, 3, 4, 5 CQA), mainly the 5-CQA (870 ± 39.66 µg/g WM for wet matter versus DM dry matter), was obtained in the pellets and lyophilized fresh peels (skin vs. flesh). In addition, the greatest amounts of chlorogenic acids were found when potato peels were extracted with methanol. Heating-assisted extraction improved the chlorogenic acid concentration of the potato peel extracts. The total ORAC amounts recorded in the different potato fractions varied between 1500 and 1650 µM TE/g. They were higher than those of some fruits, vegetables, nuts, cereals, and sweet potato cultivar. The good correlation coefficient found between TPC, chlorogenic acids determination, and the ORAC capacity indicates that the TPC can be used as a good indicator of the antioxidant capacity of potato by-products.

Illnesses requiring hospitalization are known to negatively impact psychological well-being and health-related quality of life (HRQoL) after discharge. The impact of hospitalization during the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic on psychological well-being and health-related quality of life is expected to be higher due to the exceptional circumstances within and outside the hospital during the pandemic surge. The objective of this study was to quantify psychological distress up to three months after discharge in patients hospitalized during the first coronavirus disease 2019 (COVID-19) pandemic wave. We also aimed to determine HRQoL, to explore predictors for psychological distress and HRQoL, and to examine whether psychological distress was higher in COVID-19 confirmed patients, and in those treated in Intensive Care Units (ICUs). In this single-center, observational cohort study, adult patients hospitalized with symptoms suggestive of COVID-19 between March 16 and April 28, 2020, were enrolled. Patients were stratified in analyses based on SARS-CoV-2 PCR results and the necessity for ICU treatment. The primary outcome was psychological distress, expressed as symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression, up to three months post-discharge. Health-related quality of life (HRQoL) was the secondary outcome. Exploratory outcomes comprised predictors for psychological distress and HRQoL. 294 of 622 eligible patients participated in this study (median age 64 years, 36% female). 16% and 13% of these patients reported probable PTSD, 29% and 20% probable anxiety, and 32% and 24% probabledepression at one and three months after hospital discharge, respectively. ICU patients reported less frequently probable depression, but no differences were found in PTSD, anxiety, or overall HRQoL. COVID-19 patients had a worse physical quality of life one month after discharge, and ICU patients reported a better mental quality of life three months after discharge. PTSD severity was predicted by time after discharge and being Caucasian. Severity of anxiety was predicted by time after discharge and being Caucasian. Depression severity was predicted by time after discharge and educational level. COVID-19 suspected patients hospitalized during the pandemic frequently suffer from psychological distress and poor health-related quality of life after hospital discharge. Non-COVID-19 and non-ICU patients appear to be at least as affected as COVID-19 and ICU patients, underscoring that (post-)hospital pandemic care should not predominantly focus on COVID-19 infected patients.