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Seven rocky planets orbit the nearby dwarf star TRAPPIST-1, providing a unique opportunity to search for atmospheres on small planets outside the Solar System 1 . Thanks to the recent launch of the James Webb Space Telescope (JWST), possible atmospheric constituents such as carbon dioxide (CO 2 ) are now detectable 2 , 3 . Recent JWST observations of the innermost planet TRAPPIST-1 b showed that it is most probably a bare rock without any CO 2 in its atmosphere 4 . Here we report the detection of thermal emission from the dayside of TRAPPIST-1 c with the Mid-Infrared Instrument (MIRI) on JWST at 15 µm. We measure a planet-to-star flux ratio of f p / f ⁎  = 421 ± 94 parts per million (ppm), which corresponds to an inferred dayside brightness temperature of 380 ± 31 K. This high dayside temperature disfavours a thick, CO 2 -rich atmosphere on the planet. The data rule out cloud-free O 2 /CO 2 mixtures with surface pressures ranging from 10 bar (with 10 ppm CO 2 ) to 0.1 bar (pure CO 2 ). A Venus-analogue atmosphere with sulfuric acid clouds is also disfavoured at 2.6 σ confidence. Thinner atmospheres or bare-rock surfaces are consistent with our measured planet-to-star flux ratio. The absence of a thick, CO 2 -rich atmosphere on TRAPPIST-1 c suggests a relatively volatile-poor formation history, with less than 9.5 − 2.3 + 7.5 Earth oceans of water. If all planets in the system formed in the same way, this would indicate a limited reservoir of volatiles for the potentially habitable planets in the system. The detection of thermal emission from the rocky exoplanet TRAPPIST-1 c using the Mid-Infrared Instrument on the James Webb Space Telescope reveals a dayside brightness temperature that disfavours a thick, CO 2 -rich atmosphere.

AbstractPatients with COPD using long-term oxygen therapy (LTOT) over 15 h per day have improved outcomes. As inhalation of dry cold gas is detrimental to mucociliary clearance, humidified nasal high flow (NHF) oxygen may reduce frequency of exacerbations, while improving lung function and quality of life in this cohort. In this randomised crossover study, we assessed short-term physiological responses to NHF therapy in 30 males chronically treated with LTOT. LTOT (2–4 L/min) through nasal cannula was compared with NHF at 30 L/min from an AIRVO through an Optiflow nasal interface with entrained supplemental oxygen. Comparing NHF with LTOT: transcutaneous carbon dioxide (TcCO2) (43.3 vs 46.7 mm Hg, p<0.001), transcutaneous oxygen (TcO2) (97.1 vs 101.2 mm Hg, p=0.01), I:E ratio (0.75 vs 0.86, p=0.02) and respiratory rate (RR) (15.4 vs 19.2 bpm, p<0.001) were lower; and tidal volume (Vt) (0.50 vs 0.40, p=0.003) and end-expiratory lung volume (EELV) (174% vs 113%, p<0.001) were higher. EELV is expressed as relative change from baseline (%Δ). Subjective dyspnoea and interface comfort favoured LTOT. NHF decreased TcCO2, I:E ratio and RR, with a concurrent increase in EELV and Vt compared with LTOT. This demonstrates a potential mechanistic rationale behind the improved outcomes observed in long-term treatment with NHF in oxygen-dependent patients.Trial registration numberACTRN12613000028707.

Intubation in neonates is challenging, and repeated attempts are associated with adverse events. Among neonates undergoing urgent intubation, video laryngoscopy resulted in more successful first attempts than direct laryngoscopy.

Background Current continuous kidney replacement therapy (CKRT) protocols ignore physiological renal compensation for hypercapnia. This study aimed to explore feasibility, safety, and clinical benefits of pCO2-adapted CKRT for hypercapnic acute respiratory distress syndrome (ARDS) patients with indication for CKRT. Methods We enrolled mechanically ventilated hypercapnic ARDS patients (pCO2 > 7.33 kPa) receiving regional citrate anticoagulation (RCA) based CKRT in a prospective, randomized-controlled pilot-study across five intensive care units at the Charité—Universitätsmedizin Berlin, Germany. Patients were randomly assigned 1:1 to the control group with bicarbonate targeted to 24 mmol/l or pCO 2 -adapted-CKRT with target bicarbonate corresponding to physiological renal compensation. Study duration was six days. Primary outcome was bicarbonate after 72 h. Secondary endpoints included safety and clinical endpoints. Endpoints were assessed in all patients receiving treatment. Results From September 2021 to May 2023 40 patients (80% male) were enrolled. 19 patients were randomized to the control group, 21 patients were randomized to pCO 2 -adapted-CKRT. Five patients were excluded before receiving treatment: three in the control group (consent withdrawal, lack of inclusion criteria fulfillment (n = 2)) and two in the intervention group (lack of inclusion criteria fulfillment, sudden unexpected death) and were therefore not included in the analysis. Median plasma bicarbonate 72 h after randomization was significantly higher in the intervention group (30.70 mmol/l (IQR 29.48; 31.93)) than in the control group (26.40 mmol/l (IQR 25.63; 26.88); p  < 0.0001). More patients in the intervention group received lung protective ventilation defined as tidal volume < 8 ml/kg predicted body weight. Thirty-day mortality was 10/16 (63%) in the control group vs. 8/19 (42%) in the intervention group ( p  = 0.26). Conclusion Tailoring CKRT to physiological renal compensation of respiratory acidosis appears feasible and safe with the potential to improve patient care in hypercapnic ARDS. Trial registration The trial was registered in the German Clinical Trials Register (DRKS00026177) on September 9, 2021 and is now closed.

ObjectiveThis study aims to calculate the global warming potential, in carbon dioxide (CO2) equivalent emissions, from all in-scope activities involved in a phase-1 clinical study.DesignRetrospective analysis.Data sourceInternal data held by Janssen Pharmaceuticals.Studies includedJanssen-sponsored TMC114FD1HTX1002 study conducted between 2019 and 2021.Main outcomeMeasure CO2 equivalents (CO2e) for in-scope clinical trial activities calculated according to intergovernmental panel on climate change 2021 impact assessment methodology.ResultsThe CO2e emissions generated by the trial were 17.65 tonnes. This is equivalent to the emissions generated by driving an average petrol-fueled family car 71 004 km or roughly 1.8 times around the circumference of the Earth. Commuting to the clinical site by the study participants generated the most emissions (5419 kg, 31% of overall emissions), followed by trial site utilities (2725 kg, 16% of overall emissions) and site staff travel (2560 kg, 15% of overall emissions). In total, the movement of people (participant travel, site staff travel and trial site staff travel) accounted for 8914 kg or 51% of overall trial emissions.ConclusionsDecentralised trial models which seek to bring clinical trial operations closer to the participant offer opportunities to reduce participant travel. The electrification of sponsor vehicle fleets and society’s transition towards electric vehicles may result in further reductions.Trial registration numberNCT04208061.

Endotracheal intubation is an important emergency procedure, especially in critical care settings. Capnography-guided intubation (CGI) is a technology that may enhance procedural efficiency. This study aimed to compare the effectiveness of CGI with conventional intubation (CI) using a manikin simulation. A case-crossover manikin simulation study was conducted with three clinical scenarios: normal airway, cervical immobilization, and cardiopulmonary resuscitation. A CO2-exhalation simulation manikin was developed for this purpose. Participants were randomly assigned to perform CGI or CI first, followed by the alternative method. The primary outcome was the first-attempt success rate, and the secondary outcome was the procedure time of intubation. A linear mixed-effects model with a random effect for each subject was applied. A total of 40 participants were enrolled, and 20 in each study group. The first-attempt success rate was higher with CGI than CI across all clinical situations, with statistically significant differences in the normal airway and cervical immobilization settings. Specifically, for the normal airway, the success rate was 40 (100.0 %) for CGI vs. 33 (82.5 %) for CI [abs diff: 17.5 %, 95 % CI: 5.7 %–29.3 %]; for cervical immobilization, 39 (97.5 %) vs. 32 (80.0 %) [abs diff: 17.5 %, 95 % CI: 4.2 %–30.8 %]; and for cardiopulmonary resuscitation, 40 (100.0 %) vs. 38 (95.0 %) [abs diff: 5.0 %, 95 % CI: −1.8 %-11.8 %]. The intubation time was shorter with CGI in the normal airway and cervical immobilization scenarios. The median [interquartile range (IQR)] time for normal airway was 23.5 (19.2–28.4) sec for CGI vs. 31.6 (22.2–59.7) sec for CI, and for cervical immobilization, 24.4 (20.4–30.8) sec for CGI vs. 28.6 (22.6–56.9) sec for CI. In cardiopulmonary resuscitation, the median [IQR] was 23.1 (19.6–31.4) sec for CGI vs. 25.1 (18.6–32.4) sec for CI. In the manikin-based randomized crossover simulation, CGI achieved a higher first-attempt success rate and shorter intubation time than CI in the normal airway and cervical immobilization scenarios.

Background Cerebral hypoperfusion may aggravate neurological damage after cardiac arrest. Near-infrared spectroscopy (NIRS) provides information on cerebral oxygenation but its relevance during post-resuscitation care is undefined. We investigated whether cerebral oxygen saturation (rSO 2 ) measured with NIRS correlates with the serum concentration of neuron-specific enolase (NSE), a marker of neurological injury, and with clinical outcome in out-of-hospital cardiac arrest (OHCA) patients. Methods We performed a post hoc analysis of a randomised clinical trial (COMACARE, NCT02698917) comparing two different levels of carbon dioxide, oxygen and arterial pressure after resuscitation from OHCA with ventricular fibrillation as the initial rhythm. We measured rSO 2 in 118 OHCA patients with NIRS during the first 36 h of intensive care. We determined the NSE concentrations from serum samples at 48 h after cardiac arrest and assessed neurological outcome with the Cerebral Performance Category (CPC) scale at 6 months. We evaluated the association between rSO 2 and serum NSE concentrations and the association between rSO 2 and good (CPC 1–2) and poor (CPC 3–5) neurological outcome. Results The median (inter-quartile range (IQR)) NSE concentration at 48 h was 17.5 (13.4–25.0) μg/l in patients with good neurological outcome and 35.2 (22.6–95.8) μg/l in those with poor outcome, p  < 0.001. We found no significant correlation between median rSO 2 and NSE at 48 h, r s  = − 0.08, p  = 0.392. The median (IQR) rSO 2 during the first 36 h of intensive care was 70.0% (63.5–77.0%) in patients with good outcome and 71.8% (63.3–74.0%) in patients with poor outcome, p  = 0.943. There was no significant association between rSO 2 over time and neurological outcome. In a binary logistic regression model, rSO 2 was not a statistically significant predictor of good neurological outcome (odds ratio 0.99, 95% confidence interval 0.94–1.04, p  = 0.635). Conclusions We found no association between cerebral oxygenation measured with NIRS and NSE concentrations or outcome in patients resuscitated from OHCA. Trial registration ClinicalTrials.gov, NCT02698917 . Registered on 26 January 2016.

Soil salinity adversely limits crop and soil health, and this can be reversed by cropping systems where species exclude salts and activate microbial nutrient cycling. A randomized complete block design experiment was established in Laayoune–Morocco to evaluate the influence of irrigated grass pea and barley monocrops or combined together in 50–50% and 70–30% mixtures against soil salinity and CO2-C flux in sites with varying salinity. Site by treatment interaction significantly influenced (p < 0.05) soil salinity and CO2-C flux. Salinity reduced by 37 to 68 dS m−1 in highly saline soils across season regardless of treatment and barley monocrop retained the least salinity (15 dS m−1). Same applied to sites with low (1 to 2 dS m−1) and medium (2 to 5 dS m−1) salinity although less pronounced. The 70–30% grass pea, barley mixture maintained the greatest CO2-C flux in soils with low salinity and marginally enhancing soil active carbon (130 to 229 mg kg−1 soil) in different sites. Increasingly saline water filled pore space devastated CO2-C flux, although this process recovered under barley at extreme salinity. Overall, barley in mixture with grass pea can alleviate salinity and accelerate microbial carbon sequestration if irrigation is modulated in shallow desertic soils.

To analyse i) the association of physical fitness during early second trimester and late pregnancy with maternal and neonatal outcomes; and ii) to investigate whether physical fitness is associated with the type of birth (vaginal or caesarean section). Pregnant women from the GESTAFIT Project (n = 159) participated in this longitudinal study. Maternal physical fitness including upper- and lower-body strength, cardiorespiratory fitness (CRF) and flexibility were measured through objective physical fitness tests at the 16th and 34th gestational weeks. Maternal and neonatal outcomes were collected from obstetric medical records. Umbilical arterial and venous blood gas pH and partial pressure of carbon dioxide (PCO2) and oxygen (PO2), were assessed. At the 16th week, greater upper-body muscle strength was associated with greater neonatal birth weight (r = 0.191, p<0.05). Maternal flexibility was associated with a more alkaline arterial pH (r = 0.220, p<0.05), higher arterial PO2 (r = 0.237, p<0.05) and lower arterial PCO2 (r = -0.331, p<0.01) in umbilical cord blood. Maternal CRF at the 16th gestational week was related to higher arterial umbilical cord PO2 (r = 0.267, p<0.05). The women who had caesarean sections had lower CRF (p<0.001) at the 16th gestational week and worse clustered overall physical fitness, both at the 16th (-0.227, p = 0.003, confidence interval (CI): -0.376, -0.078) and 34th gestational week (-0.223; p = 0.018; CI: -0.432, -0.015) compared with the women who had vaginal births. Increasing physical fitness during pregnancy may promote better neonatal outcomes and is associated with a decrease in the risk of caesarean section. This trial was registered at ClinicalTrials.gov (NCT02582567) on October 20, 2015.

Repeated sprint ability (RSA) is a critical success factor for intermittent sport performance. Repeated sprint training has been shown to improve RSA, we hypothesised that hypoxia would augment these training adaptations. Thirty male well-trained academy rugby union and rugby league players (18.4±1.5 years, 1.83±0.07 m, 88.1±8.9 kg) participated in this single-blind repeated sprint training study. Participants completed 12 sessions of repeated sprint training (10×6 s, 30 s recovery) over 4 weeks in either hypoxia (13% FiO2) or normoxia (21% FiO2). Pretraining and post-training, participants completed sports specific endurance and sprint field tests and a 10×6 s RSA test on a non-motorised treadmill while measuring speed, heart rate, capillary blood lactate, muscle and cerebral deoxygenation and respiratory measures. Yo-Yo Intermittent Recovery Level 1 test performance improved after RS training in both groups, but gains were significantly greater in the hypoxic (33±12%) than the normoxic group (14±10%, p<0.05). During the 10×6 s RS test there was a tendency for greater increases in oxygen consumption in the hypoxic group (hypoxic 6.9±9%, normoxic (−0.3±8.8%, p=0.06) and reductions in cerebral deoxygenation (% changes for both groups, p=0.09) after hypoxic than normoxic training. Twelve RS training sessions in hypoxia resulted in twofold greater improvements in capacity to perform repeated aerobic high intensity workout than an equivalent normoxic training. Performance gains are evident in the short term (4 weeks), a period similar to a preseason training block.