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Measurements of Δ14C and CO2 can cleanly separate biogenic and fossil contributions to CO2 enhancements above background. Our measurements of these tracers in air around Los Angeles in 2015 reveal high values of fossil CO2 and a significant and seasonally varying contribution of CO2 from the urban biosphere. The biogenic CO2 is composed of sources such as biofuel combustion and human metabolism and an urban biospheric component likely originating from urban vegetation, including turf and trees. The urban biospheric component is a source in winter and a sink in summer, with an estimated amplitude of 4.3 parts per million (ppm), equivalent to 33% of the observed annual mean fossil fuel contribution of 13 ppm. While the timing of the net carbon sink is out of phase with wintertime rainfall and the sink seasonality of Southern California Mediterranean ecosystems (which show maximum uptake in spring), it is in phase with the seasonal cycle of urban water usage, suggesting that irrigated urban vegetation drives the biospheric signal we observe. Although 2015 was very dry, the biospheric seasonality we observe is similar to the 2006-2015 mean derived from an independent Δ14C record in the Los Angeles area, indicating that 2015 biospheric exchange was not highly anomalous. The presence of a large and seasonally varying biospheric signal even in the relatively dry climate of Los Angeles implies that atmospheric estimates of fossil fuel-CO2 emissions in other, potentially wetter, urban areas will be biased in the absence of reliable methods to separate fossil and biogenic CO2.
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Dióxido de Carbono/análise , Isótopos de Carbono/análise , Monitoramento Ambiental/métodos , Ciclo do Carbono , Combustíveis Fósseis , Humanos , Los Angeles , Estações do Ano , Emissões de VeículosRESUMO
This study derives methane emission rates from 92 airborne observations collected over 23 facilities including 5 refineries, 10 landfills, 4 wastewater treatment plants (POTWs), 2 composting operations, and 2 dairies in the San Francisco Bay Area. Emission rates are measured using an airborne mass-balance technique from a low-flying aircraft. Annual measurement-based sectorwide methane emissions are 19,000 ± 2300 Mg for refineries, 136,700 ± 25,900 Mg for landfills, 11,900 ± 1,500 Mg for POTWs, and 11,100 ± 3,400 Mg for composting. The average of measured emissions for each refinery ranges from 4 to 23 times larger than the corresponding emissions reported to regulatory agencies, while measurement-derived landfill and POTW estimates are approximately twice the current inventory estimates. Significant methane emissions at composting facilities indicate that a California mandate to divert organics from landfills to composting may not be an effective measure for mitigating methane emissions unless best management practices are instituted at composting facilities. Complementary evidence from airborne remote sensing imagery indicates atmospheric venting from refinery hydrogen plants, landfill working surfaces, composting stockpiles, etc., to be among the specific source types responsible for the observed discrepancies. This work highlights the value of multiple measurement approaches to accurately estimate facility-scale methane emissions and perform source attribution at subfacility scales to guide and verify effective mitigation policy and action.
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Poluentes Atmosféricos , Metano , Poluentes Atmosféricos/análise , Monitoramento Ambiental , Metano/análise , São Francisco , Instalações de Eliminação de ResíduosRESUMO
BACKGROUND: The ideal target blood glucose range for intensive care patients on insulin infusions is controversial. Avoidance of hyperglycaemia and hypoglycaemia are well supported goals. METHODS: An audit of insulin infusion management was conducted following the institution of an insulin infusion guideline in a tertiary adult intensive care unit (ICU). The primary aim was to evaluate this guideline for safety and efficacy. Secondary aims were to compare outcomes such as ICU and hospital mortality, rate of severe hypoglycaemia, length of time within target zones, length of stay in ICU and hospital, ventilator hours and use of renal replacement therapy. Data analysis involved descriptive statistical techniques to allow comparison with other reported outcomes. RESULTS: Thirty-eight (38) patients were included, representing 137 days of insulin infusions and 2537 blood glucose readings. The mean insulin infusion treatment time was 86.4h (sd ± 86.4), median 48 h (IQR 14.4-141.6). The mean insulin dose per day was 97.6 units (sd ± 115.7), with a median of 68.7 (IQR 38.9-108.3). Blood glucose level (BGL) readings were within the desired target (6-9 mmols/L) and/or the buffer zones (4-6 and 9-12 mmols/L), 92.3% of the time. There were no episodes of severe hypoglycaemia (BGL ≤ 2.2 mmols/L). The median length of ICU stay was 5.9 days. Eighty-four (84) % of the cohort received mechanical ventilation and 26% received renal replacement therapy. The mean ventilation and renal replacement duration were days 6.9 and 9.4 days, respectively. The ICU and hospital mortality was 13.2% and 18.4%, respectively. CONCLUSION: The use of this locally developed insulin infusion guideline for hyperglycaemia within this ICU appears safe and effective. When compared to related published randomised controlled trials, the outcomes of this small scale single centre retrospective audit appear congruent. It achieved a severe hypoglycaemic rate of zero, with BGLs within target and buffer zones greater than 90%. It may be worthwhile for intensive care units to consider evaluating their own locally developed insulin infusion guidelines to ensure safety and efficacy.
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Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Unidades de Terapia Intensiva , Guias de Prática Clínica como Assunto , Glicemia/análise , Feminino , Mortalidade Hospitalar , Humanos , Infusões Intravenosas , Tempo de Internação/estatística & dados numéricos , Masculino , Garantia da Qualidade dos Cuidados de Saúde , Terapia de Substituição Renal , Respiração Artificial/estatística & dados numéricos , Estudos RetrospectivosRESUMO
Fugitive methane emissions from municipal solid waste landfills impact global climate change and reliable emissions quantification is of increasing importance. Ground-based cavity ring-down spectrometer (CRDS) measurements were used to determine methane concentrations and isotopic compositions of carbon in CH4. Then, CH4 oxidation through various cover materials was assessed using the Keeling plot method. A novel inverse modeling approach using Gaussian dispersion analysis, termed near-surface Gaussian plume estimation (NSGPE), was developed to predict whole-site landfill methane emissions. The concentration data obtained around the landfill perimeter with the mobile ground-based CRDS were used. Methane concentration data were integrated to parameterize discretized point source emissions from a Gaussian dispersion model. Post-processing algorithms were applied to refine modeling predictions to account for the influence of topographical and meteorological conditions on methane transport. Results indicate spatially resolved and consistent emissions estimates among multiple optimization simulations, with refinements increasing the resolution and spatial trends of emissions. Post-processing algorithms resolve consistent overestimation of emissions commonly observed using conventional Gaussian dispersion models.â¢Ground-based CRDS used to obtain methane concentration and oxidation data.â¢Novel inverse Gaussian dispersion modeling approach developed to predict methane emissions from landfills accounting for site-specific topography and meteorology.â¢Post-processing algorithms refine emissions estimates.
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Representations of the changing global carbon cycle under climatic and environmental perturbations require highly detailed accounting of all atmosphere and biosphere exchange. These fluxes remain unsatisfactory, as a consequence of only having data with limited spatiotemporal coverage and precision, which restrict accurate assessments. Through the nature of intimate coupling of global carbon and oxygen cycles via O2 and CO2 and their unique triple oxygen isotope compositions in the biosphere and atmosphere, greater insight is available. We report analysis of their isotopic compositions with the widest geographical and temporal coverage (123 new measurements for CO2) and constrain, on an annual basis, the global CO2 recycling time (1.5 ± 0.2 year) and gross primary productivities of terrestrial (~ 170-200 PgC/year) and oceanic (~ 90-120 PgC/year) biospheres. Observed inter-annual variations in CO2 triple oxygen isotopic compositions were observed at a magnitude close to the largest contrast set by the terrestrial and oceanic biospheres. The seasonal cycles between the east and west Pacific Ocean were found to be drastically different. This intra-annual variability implies that the entire atmospheric CO2 turnover time is not much longer than the tropospheric mixing time (less than ~ 5 months), verifying the derived recycling time. The new measurements, analyses, and incorporation of other global data sets allow development of an independent approach, providing a strong constraint to biogeochemical models.
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Methane, a powerful greenhouse gas, has a short atmospheric lifetime ( ~ 12 years), so that emissions reductions will have a rapid impact on climate forcing. In megacities such as Los Angeles (LA), natural gas (NG) leakage is the primary atmospheric methane source. The magnitudes and trends of fugitive NG emissions are largely unknown and need to be quantified to verify compliance with emission reduction targets. Here we use atmospheric remote sensing data to show that, in contrast to the observed global increase in methane emissions, LA area emissions decreased during 2011-2020 at a mean rate of (-1.57 ± 0.41) %/yr. However, the NG utility calculations indicate a much larger negative emissions trend of -5.8 %/yr. The large difference between top-down and bottom-up trends reflects the uncertainties in estimating the achieved emissions reductions. Actions taken in LA can be a blueprint for COP28 and future efforts to reduce methane emissions.
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Methane flux and emissions were obtained at a California landfill concurrently using field measurements, inventory analyses, and modeling. Measured fluxes ranged from -3.7 to 828 g/m2-day and generally decreased from daily to intermediate to final covers. Soil covers with high-plasticity clay had the lowest fluxes. Whole-site emissions ranged from 406 to 47,414 tonnes/year (11,368 to 1,327,592 tonnes CO2-eq./year), and were dominated by intermediate covers with high relative surface area. Emissions estimates from flux chamber tests and California Landfill Methane Inventory Model (CALMIM) with oxidation were similar and low, whereas emissions from aerial measurements and CALMIM without oxidation were similar and high. The inventory analyses provided intermediate emissions and a new Gaussian plume model based on ground cavity ring-down spectrometer measurements provided the highest emissions. The assumptions used and the inherent strengths and limitations of the different approaches resulted in the flux and emissions differences. With varied attributes (experimental/modeling; flux/emissions; whole-site/cover-specific, top-down/bottom-up), the approaches provide envelopes of methane emissions and can be used selectively for the two main purposes of landfill methane emissions analysis: to mechanistically determine the factors that control/limit surface emissions and to provide data for atmospheric methane analysis. To reduce emissions, progression from temporary to permanent cover areas can be accelerated and covers with coarser materials can be amended with plastic fines.
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Background: There is limited literature exploring the relationship between simulation training and extracorporeal cardiopulmonary resuscitation (ECPR) outcomes. We examined whether there was an association between the implementation of an in situ simulation training program and ECPR utilisation, time to extracorporeal membrane oxygenation (ECMO), and neurologically intact survival. Methods: In this retrospective pre-post study of in-hospital cardiac arrests (IHCA) and out-of-hospital cardiac arrests (OHCA), we analysed data for all patients recorded as receiving ECPR from September 2009 to December 2020 at our institution, relative to the implementation of an in situ ECPR simulation training program and a standardised procedure for high-quality ECPR. The primary outcome was Cerebral Performance Category (CPC) 1 or 2 at hospital discharge. Results: There were 27 patients in the pre-intervention period and 39 patients in the post-intervention period. The median ECPR rate per year was 2 pre-intervention and 7 post-intervention (p = 0.073). There was an association between the implementation of the program and decreased median time from OHCA to ECMO flow, from 87 (IQR 78-95) minutes pre-intervention to 70 (IQR 69-72) minutes post-intervention (p = 0.002). Median time from IHCA to ECMO flow was 40 (IQR 20-75) minutes pre-intervention and 28 (IQR 16-41) minutes post-intervention (p = 0.134). Survival with CPC 1 or 2 was 7/27 (25.9%) pre-intervention and 15/39 (38.5%) post-intervention (p = 0.288). Conclusion: We observed an association between the implementation of an ECPR-specific simulation program and decreased time from OHCA to ECMO flow. There was no association between the implementation of the program and neurologically intact survival at hospital discharge.
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Previous studies suggested that the Amazon, the largest rainforest on Earth, changes from a CO2 sink to a CO2 source during the dry/fire season. However, the biospheric contributions to atmospheric CO2 are not well understood during the two main seasons, the dry/fire season and the wet season. In this article, we utilize Orbiting Carbon Observatory 2 (OCO-2) Solar-Induced Fluorescence (SIF) to explore photosynthetic activity during the different seasons. The spatiotemporal variability of OCO-2 SIF, OCO-2 CO2, precipitation, and burned area are investigated over the Amazon from September 2014 to December 2019. Averaging over the entire Amazon region, we found a positive temporal correlation (0.94) between OCO-2 SIF and Global Precipitation Climatology Project precipitation and a negative temporal correlation (-0.64) between OCO-2 SIF and OCO-2 CO2, consistent with the fact that precipitation enhances photosynthesis, which results in higher values for SIF and rate of removal of CO2 from the atmosphere above the Amazon region. We also observed seasonality in the spatial variability of these variables within the Amazon region. During the dry/fire (August-October) season, low SIF values, low precipitation, high vapor pressure deficit (VPD), large burned areas, and high atmospheric CO2 are mainly found over the southern Amazon region. In contrast, during the wet season (January-March), high SIF values, high precipitation, low VPD, smaller burned areas, and low CO2 are found over both the central and southern Amazon regions. The seasonal difference in SIF suggests that photosynthetic activity is reduced during the dry/fire season relative to the wet season as a result of low precipitation and high VPD, especially over the southern Amazon region, which will contribute to more CO2 in the atmosphere during the dry/fire season.
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Urban regions emit a large fraction of anthropogenic emissions of greenhouse gases (GHG) such as carbon dioxide (CO2) and methane (CH4) that contribute to modern-day climate change. As such, a growing number of urban policymakers and stakeholders are adopting emission reduction targets and implementing policies to reach those targets. Over the past two decades research teams have established urban GHG monitoring networks to determine how much, where, and why a particular city emits GHGs, and to track changes in emissions over time. Coordination among these efforts has been limited, restricting the scope of analyses and insights. Here we present a harmonized data set synthesizing urban GHG observations from cities with monitoring networks across North America that will facilitate cross-city analyses and address scientific questions that are difficult to address in isolation.
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Plant polyphenol oxidases (PPOs) are ubiquitous plastid-localized enzymes. A precise analysis of PPO function in plants has been complicated by the presence of several family members with immunological cross reactivity. Previously we reported the isolation of genomic clones coding for the seven members of the tomato (Solanum lycopersicum) PPO family (A, A', B, C, D, E, and F). Here we report the complex spatial and temporal expression of one of the members, PPO B. The PPO B promoter was sequenced and subjected to homology analysis. Sequence similarities were found to nucleotide sequences of genes encoding enzymes/proteins active in the following systems: phenylpropanoid biosynthesis, signal transduction and responsiveness to hormones and stresses, fruit and seed proteins/enzymes, and photosynthesis. Chimeric gene fusions were constructed linking PPO B 5' flanking regions to the reporter gene, b-glucuronidase (GUS). The resultant transgenic plants were histochemically analyzed for GUS activity in various vegetative and reproductive tissues, and evaluated for PPO B responsiveness to ethylene induction. It was shown that PPO B expression was tissue specific, developmentally regulated, ethylene induced, and localized predominantly to mitotic or apoptotic tissues.
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Catecol Oxidase/metabolismo , Etilenos/farmacologia , Regulação Enzimológica da Expressão Gênica , Regulação da Expressão Gênica de Plantas , Solanum lycopersicum/enzimologia , Sequência de Bases , Catecol Oxidase/genética , Glucuronidase/genética , Solanum lycopersicum/fisiologia , Dados de Sequência Molecular , Fotossíntese , Plantas Geneticamente Modificadas , Regiões Promotoras Genéticas , Transdução de SinaisRESUMO
Combustion of fossil fuel is the dominant source of greenhouse gas emissions to the atmosphere in California. Here, we describe radiocarbon (14CO2) measurements and atmospheric inverse modeling to estimate fossil fuel CO2 (ffCO2) emissions for 2009-2012 from a site in central California, and for June 2013-May 2014 from two sites in southern California. A priori predicted ffCO2 mixing ratios are computed based on regional atmospheric transport model (WRF-STILT) footprints and an hourly ffCO2 prior emission map (Vulcan 2.2). Regional inversions using observations from the central California site suggest that emissions from the San Francisco Bay Area (SFBA) are higher in winter and lower in summer. Taking all years together, the average of a total of fifteen 3-month inversions from 2009 to 2012 suggests ffCO2 emissions from SFBA were within 6⯱â¯35% of the a priori estimate for that region, where posterior emission uncertainties are reported as 95% confidence intervals. Results for four 3-month inversions using measurements in Los Angeles South Coast Air Basin (SoCAB) during June 2013-May 2014 suggest that emissions in SoCAB are within 13⯱â¯28% of the a priori estimate for that region, with marginal detection of any seasonality. While emissions from the SFBA and SoCAB urban regions (containing ~50% of prior emissions from California) are constrained by the observations, emissions from the remaining regions are less constrained, suggesting that additional observations will be valuable to more accurately estimate total ffCO2 emissions from California as a whole.
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Recent measurements of methane (CH4) by the Mars Science Laboratory (MSL) now confront us with robust data that demand interpretation. Thus far, the MSL data have revealed a baseline level of CH4 (â¼0.4 parts per billion by volume [ppbv]), with seasonal variations, as well as greatly enhanced spikes of CH4 with peak abundances of â¼7 ppbv. What do these CH4 revelations with drastically different abundances and temporal signatures represent in terms of interior geochemical processes, or is martian CH4 a biosignature? Discerning how CH4 generation occurs on Mars may shed light on the potential habitability of Mars. There is no evidence of life on the surface of Mars today, but microbes might reside beneath the surface. In this case, the carbon flux represented by CH4 would serve as a link between a putative subterranean biosphere on Mars and what we can measure above the surface. Alternatively, CH4 records modern geochemical activity. Here we ask the fundamental question: how active is Mars, geochemically and/or biologically? In this article, we examine geological, geochemical, and biogeochemical processes related to our overarching question. The martian atmosphere and surface are an overwhelmingly oxidizing environment, and life requires pairing of electron donors and electron acceptors, that is, redox gradients, as an essential source of energy. Therefore, a fundamental and critical question regarding the possibility of life on Mars is, "Where can we find redox gradients as energy sources for life on Mars?" Hence, regardless of the pathway that generates CH4 on Mars, the presence of CH4, a reduced species in an oxidant-rich environment, suggests the possibility of redox gradients supporting life and habitability on Mars. Recent missions such as ExoMars Trace Gas Orbiter may provide mapping of the global distribution of CH4. To discriminate between abiotic and biotic sources of CH4 on Mars, future studies should use a series of diagnostic geochemical analyses, preferably performed below the ground or at the ground/atmosphere interface, including measurements of CH4 isotopes, methane/ethane ratios, H2 gas concentration, and species such as acetic acid. Advances in the fields of Mars exploration and instrumentation will be driven, augmented, and supported by an improved understanding of atmospheric chemistry and dynamics, deep subsurface biogeochemistry, astrobiology, planetary geology, and geophysics. Future Mars exploration programs will have to expand the integration of complementary areas of expertise to generate synergistic and innovative ideas to realize breakthroughs in advancing our understanding of the potential of life and habitable conditions having existed on Mars. In this spirit, we conducted a set of interdisciplinary workshops. From this series has emerged a vision of technological, theoretical, and methodological innovations to explore the martian subsurface and to enhance spatial tracking of key volatiles, such as CH4.
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Exobiologia , Meio Ambiente Extraterreno , Marte , Metano/análise , Análise Espectral , Fatores de TempoRESUMO
The abundance variations of near surface atmospheric CO2 isotopologues (primarily 16O12C16O, 16O13C16O, 17O12C16O, and 18O12C16O) represent an integrated signal from anthropogenic/biogeochemical processes, including fossil fuel burning, biospheric photosynthesis and respiration, hydrospheric isotope exchange with water, and stratospheric photochemistry. Oxygen isotopes, in particular, are affected by the carbon and water cycles. Being a useful tracer that directly probes governing processes in CO2 biogeochemical cycles, Δ17O (=ln(1 + δ17O) - 0.516 × ln(1 + δ18O)) provides an alternative constraint on the strengths of the associated cycles involving CO2. Here, we analyze Δ17O data from four places (Taipei, Taiwan; South China Sea; La Jolla, United States; Jerusalem, Israel) in the northern hemisphere (with a total of 455 measurements) and find a rather narrow range (0.326 ± 0.005). A conservative estimate places a lower limit of 345 ± 70 PgC year-1 on the cycling flux between the terrestrial biosphere and atmosphere and infers a residence time of CO2 of 1.9 ± 0.3 years (upper limit) in the atmosphere. A Monte Carlo simulation that takes various plant uptake scenarios into account yields a terrestrial gross primary productivity of 120 ± 30 PgC year-1 and soil invasion of 110 ± 30 PgC year-1, providing a quantitative assessment utilizing the oxygen isotope anomaly for quantifying CO2 cycling.
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We report continuous surface observations of carbon dioxide (CO2) and methane (CH4) from the Los Angeles (LA) Megacity Carbon Project during 2015. We devised a calibration strategy, methods for selection of background air masses, calculation of urban enhancements, and a detailed algorithm for estimating uncertainties in urban-scale CO2 and CH4 measurements. These methods are essential for understanding carbon fluxes from the LA megacity and other complex urban environments globally. We estimate background mole fractions entering LA using observations from four "extra-urban" sites including two "marine" sites located south of LA in La Jolla (LJO) and offshore on San Clemente Island (SCI), one "continental" site located in Victorville (VIC), in the high desert northeast of LA, and one "continental/mid-troposphere" site located on Mount Wilson (MWO) in the San Gabriel Mountains. We find that a local marine background can be established to within ~1 ppm CO2 and ~10 ppb CH4 using these local measurement sites. Overall, atmospheric carbon dioxide and methane levels are highly variable across Los Angeles. "Urban" and "suburban" sites show moderate to large CO2 and CH4 enhancements relative to a marine background estimate. The USC (University of Southern California) site near downtown LA exhibits median hourly enhancements of ~20 ppm CO2 and ~150 ppb CH4 during 2015 as well as ~15 ppm CO2 and ~80 ppb CH4 during mid-afternoon hours (12:00-16:00 LT, local time), which is the typical period of focus for flux inversions. The estimated measurement uncertainty is typically better than 0.1 ppm CO2 and 1 ppb CH4 based on the repeated standard gas measurements from the LA sites during the last 2 years, similar to Andrews et al. (2014). The largest component of the measurement uncertainty is due to the single-point calibration method; however, the uncertainty in the background mole fraction is much larger than the measurement uncertainty. The background uncertainty for the marine background estimate is ~10 and ~15 % of the median mid-afternoon enhancement near downtown LA for CO2 and CH4, respectively. Overall, analytical and background uncertainties are small relative to the local CO2 and CH4 enhancements; however, our results suggest that reducing the uncertainty to less than 5 % of the median mid-afternoon enhancement will require detailed assessment of the impact of meteorology on background conditions.
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Activation of STAT1 and the IFN-gamma response are thought to be mediated exclusively through the Y440 motif of the human IFNGR1 receptor subunit. Contrary to this accepted dogma, here it is shown that IFNGR1 with a mutant (Y440F) motif, when stably expressed in IFNGR1-negative human fibroblasts at levels similar to wild type, can sustain a substantial IFN-gamma response. The mutant receptor supports selective induction of IFN-gamma-inducible genes but is notably defective in the CIITA, class II HLA, suppressor of cytokine signaling and antiviral responses. Remarkably, similar selective defects are observed in human fibrosarcoma cells expressing a mutant JAK1. The phenotypes are novel and appear distinct from those observed in response to the inhibition of known additional pathways. Data from different cell types further emphasizes the importance of cellular background in determining the response.
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Receptores de Interferon/fisiologia , Transdução de Sinais/fisiologia , Fibroblastos/química , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Interferon gama/farmacologia , Janus Quinase 1 , Mutação , Proteínas Nucleares/fisiologia , Fosfatidilinositol 3-Quinases/fisiologia , Fosforilação , Proteínas Tirosina Quinases/fisiologia , Receptores de Interferon/análise , Fator de Transcrição STAT1/fisiologia , Fator de Transcrição STAT3/fisiologia , Transativadores/fisiologia , Receptor de Interferon gamaRESUMO
OBJECTIVE: To compare the prevalence of criteria suggesting acute intrapartum hypoxia in children with cerebral palsy who have and have not been the subjects of clinical negligence legal claims. DESIGN: Nested cohort study within a geographically defined cohort. SETTING: The former Oxfordshire Health Authority. POPULATION: Singleton children with cerebral palsy born between 1984 and 1993, excluding cases with a recognised postnatal cause for cerebral palsy. METHODS: Retrospective review of medical records by blinded observer. MAIN OUTCOME MEASURES: Three 'essential' criteria defined by the International Cerebral Palsy Task Force which identify acute intrapartum hypoxia. RESULTS: One-fifth (27/138) of all singleton cerebral palsy children were the subject of a legal claim. The presence of all three criteria was significantly more likely to lead to a legal claim (P < 0.01), but in 74% (20/27) of claims, all three were not fulfilled and 36% (4/11) of those satisfying all three criteria did not claim. At least one of the three criteria was met in 82% (91/111) of the cases where there was no claim. Data on fetal or neonatal arterial blood gases were available in only 57% (78/138). Of the 27 claims, 12 were discontinued, 8 were settled and in 7 the legal process is still pending. The presence of the three essential criteria for acute intrapartum hypoxia did not increase the likelihood of a legal claim being settled. CONCLUSION: The prevalence of the 'template essential' criteria is high in all cases of cerebral palsy. Although the presence of all three essential criteria was more likely in the claims group, this did not appear to influence the outcome of a claim. It remains to be seen whether the existence of the template leads to change in the pattern of decisions made by the courts.
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Paralisia Cerebral/etiologia , Hipóxia Encefálica/etiologia , Imperícia/legislação & jurisprudência , Assistência Perinatal/legislação & jurisprudência , Adulto , Paralisia Cerebral/epidemiologia , Estudos de Coortes , Consenso , Inglaterra/epidemiologia , Feminino , Hospitais Públicos/legislação & jurisprudência , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Hipóxia Encefálica/epidemiologia , Recém-Nascido , Função Jurisdicional , Responsabilidade Legal , Imperícia/estatística & dados numéricos , Erros Médicos/classificação , Erros Médicos/legislação & jurisprudência , Erros Médicos/estatística & dados numéricos , Assistência Perinatal/normas , Assistência Perinatal/estatística & dados numéricos , Sistema de Registros , Estudos Retrospectivos , Vigilância de Evento SentinelaRESUMO
Signaling through Janus kinases (JAKs) and signal transducers and activators of transcription (STATs) is central to the responses to the majority of cytokines and some growth factors, including the interferons (IFNs) and the IL-6 family of cytokines. The biological responses to stimulation through the widely distributed IL-6 and IFN-gamma receptors are, however, completely different. Remarkably, it is shown here that, in mouse embryo fibroblasts lacking STAT3, IL-6 mediates an IFN-gamma-like response including prolonged activation of STAT1, the induction of multiple IFN-gamma-inducible genes, the expression of class II MHC antigens, and an antiviral state. Normal cells exposed to IL-6 thus require a STAT3-dependent function(s) to down-regulate STAT1 activity and prevent an IFN-gamma-like response. The data encourage the view that the very disparate IFN-gamma and IL-6 JAK/receptor complexes mediate a common set of generic or "core" signals which are subject to STAT3-dependent modulation to provide IL-6 specificity. The switching of one cytokine response to one closely mimicking another as a result of the loss of a single signaling component has profound implications, for example, for the interpretation of the phenotypes of knockout mice and for the clinical use of inhibitors of signaling.