Search

The individual approach in the treatment of heart failure (HF) and personalized medicine have been the main topic in recent years in all scientific forums. The combination of chronic obstructive pulmonary disease (COPD) and sleep apnea (SA) further complicates the clinical presentation in patients with HF. The overlap of all three diseases requires a team of specialists and additional therapeutic approach for better control and to improve the prognosis. A large number of the pathophysiological mechanisms of the three diseases also overlap. The novel therapies for HF have shown good results, both in COPD and CA subgroups. Noninvasive ventilation during hospitalization and at home is an established method in the individual groups. In a combination of the three diseases, definitive data from randomized trials are still lacking.

Estuaries are an important contributor to the global carbon budget, facilitating carbon removal, transfer, and transformation between land and the coastal ocean. Estuaries are susceptible to global climate change and anthropogenic perturbations. We find that a long-term significant mid-estuary increase in dissolved inorganic carbon (DIC) of 6–21 µmol kg−1 yr−1 (1997–2020) in a temperate estuary in Germany (Elbe Estuary) was driven by an increase in upper-estuary particulate organic carbon (POC) content of 8–14 µmol kg−1 yr−1. The temporal POC increase was due to an overall improvement in water quality observed in the form of high rates of primary production and a significant drop in biological oxygen demand. The magnitude of mid-estuary DIC gain was equivalent to the increased POC production in the upper estuary, suggesting that POC is effectively remineralized and retained as DIC in the mid-estuary, with the estuary acting as an efficient natural filter for POC. In the context of this significant long-term DIC increase, a recent extended drought period (2014–2020) significantly lowered the annual mean river discharge (468 ± 234 m3 s−1) compared to the long-term mean (690 ± 441 m3 s−1, 1960–2020), while the late spring internal DIC load in the estuary doubled. The drought induced a longer dry season, starting in May (earlier than normal), increased the residence time in the estuary and allowed for a more complete remineralization period of POC. Annually, 77 %–94 % of the total DIC export was laterally transported to the coastal waters, reaching 89 ± 4.8 Gmol C yr−1, and thus, between 1997 and 2020, only an estimated maximum of 23 % (10 Gmol C yr−1) was released via carbon dioxide (CO2) evasion. Export of DIC to coastal waters decreased significantly during the drought, on average by 24 % (2014–2020: 38 ± 5.4 Gmol C yr−1), compared to the non-drought period. In contrast, there was no change in the water–air CO2 flux during the drought. We have identified that seasonal changes in DIC processing in an estuary require consideration when estimating both the long-term and future changes in water–air CO2 flux and DIC export to coastal waters. Regional and global carbon budgets should therefore take into account carbon cycling estimates in estuaries, as well as their changes over time in relation to impacts of water quality changes and extreme hydrological events.

Nitrous oxide (N2O) is a greenhouse gas, with a global warming potential 298 times that of carbon dioxide. Estuaries can be sources of N2O, but their emission estimates have significant uncertainties due to limited data availability and high spatiotemporal variability. We investigated the spatial and seasonal variability of dissolved N2O and its emissions along the Elbe Estuary (Germany), a well-mixed temperate estuary with high nutrient loading from agriculture. During nine research cruises performed between 2017 and 2022, we measured dissolved N2O concentrations, as well as dissolved nutrient and oxygen concentrations along the estuary, and calculated N2O saturations, flux densities, and emissions. We found that the estuary was a year-round source of N2O, with the highest emissions in winter when dissolved inorganic nitrogen (DIN) loads and wind speeds are high. However, in spring and summer, N2O saturations and emissions did not decrease alongside lower riverine nitrogen loads, suggesting that estuarine in situ N2O production is an important source of N2O. We identified two hotspot areas of N2O production: the Port of Hamburg, a major port region, and the mesohaline estuary near the maximum turbidity zone (MTZ). N2O production was fueled by the decomposition of riverine organic matter in the Hamburg Port and by marine organic matter in the MTZ. A comparison with previous measurements in the Elbe Estuary revealed that N2O saturation did not decrease alongside the decrease in DIN concentrations after a significant improvement of water quality in the 1990s that allowed for phytoplankton growth to re-establish in the river and estuary. The overarching control of phytoplankton growth on organic matter and, subsequently, on N2O production highlights the fact that eutrophication and elevated agricultural nutrient input can increase N2O emissions in estuaries.

Estuaries are nutrient filters and change riverine nutrient loads before they reach coastal oceans. Their morphology have been extensively changed by anthropogenic activities like draining, deepening and dredging to meet economic and social demand, causing significant regime changes like tidal amplifications and in some cases to hyper-turbid conditions. Furthermore, increased nutrient loads, especially nitrogen, mainly by agriculture cause coastal eutrophication. Estuaries can either act as a sink or as a source of nitrate, depending on environmental and geomorphological conditions. These factors vary along an estuary, and change nitrogen turnover in the system. Here, we investigate the factors controlling nitrogen turnover in the hyper-turbid Ems estuary (Northern Germany), which has been strongly impacted by human activities. During two research cruises in August 2014 and June 2020, we measured water column properties, dissolved inorganic nitrogen, dual stable isotopes of nitrate and dissolved nitrous oxide concentration along the estuary. We found that three distinct biogeochemical zones exist along the estuary. A strong fractionation (∼26 ‰) of nitrate stable isotopes points towards nitrate removal via water column denitrification in the hyper-turbid tidal river, driven by anoxic conditions in deeper water layers. In the middle reaches of the estuary nitrification gains importance, turning this section into a net nitrate source. The outer reaches are dominated by mixing, with nitrate uptake in 2020. We find that the overarching control on biogeochemical nitrogen cycling, zonation and nitrous oxide production in the Ems estuary is exerted by suspended particulate matter concentrations and the linked oxygen deficits.

Marine uptake of carbon dioxide reduces the accumulation of carbon dioxide in the atmosphere. Continental shelf seas are essential for carbon uptake from the atmosphere, but are also highly variable environments, for which uncertainties of carbon budget estimates are large. Recent studies indicate that their carbon sink capacity is weakening. A way to reduce the uncertainty of carbon budgets is to increase our observational capacity, for example through FerryBox installations on Ships-of-Opportunity. Here, we compare FerryBox observations in the North Sea for the fall seasons of 2019 and 2020. We show that short-lived mesoscale events can be characterized when the sampling resolution is adequately high, and that these events cause changes in essential environmental variables on the same magnitude as seasonal cycles. Whether advective or biological in origin, these events rapidly lowered seawater pCO2 by 8–10% and influenced the carbon uptake capacity. We demonstrate the importance of resolving and integrating the variability of these smaller features in regional carbon budget assessments and advocate for the tuning of models in order to capture this small-scale variability.

The German Bight was exposed to record high riverine discharges in June 2013, as a result of flooding of the Elbe and Weser rivers. Several anomalous observations suggested that the hydrodynamical and biogeochemical states of the system were impacted by this event. In this study, we developed a biogeochemical model and coupled it with a previously introduced high-resolution hydrodynamical model of the southern North Sea in order to better characterize these impacts and gain insight into the underlying processes. Performance of the model was assessed using an extensive set of in situ measurements for the period 2011–2014. We first improved the realism of the hydrodynamic model with regard to the representation of cross-shore gradients, mainly through inclusion of flow-dependent horizontal mixing. Among other characteristic features of the system, the coupled model system can reproduce the low salinities, high nutrient concentrations and low oxygen concentrations in the bottom layers observed within the German Bight following the flood event. Through a scenario analysis, we examined the sensitivity of the patterns observed during July 2013 to the hydrological and meteorological forcing in isolation. Within the region of freshwater influence (ROFI) of the Elbe–Weser rivers, the flood event clearly dominated the changes in salinity and nutrient concentrations, as expected. However, our findings point to the relevance of the peculiarities in the meteorological conditions in 2013 as well: a combination of low wind speeds, warm air temperatures and cold bottom-water temperatures resulted in a strong thermal stratification in the outer regions and limited vertical nutrient transport to the surface layers. Within the central region, the thermal and haline dynamics interactively resulted in an intense density stratification. This intense stratification, in turn, led to enhanced primary production within the central region enriched by nutrients due to the flood but led to reduction within the nutrient-limited outer region, and it caused a widespread oxygen depletion in bottom waters. Our results further point to the enhancement of the current velocities at the surface as a result of haline stratification and to intensification of the thermohaline estuarine-like circulation in the Wadden Sea, both driven by the flood event.

The ability to make measurements of phosphate (PO43–) concentrations at temporal and spatial scales beyond those offered by shipboard observations offers new opportunities for investigations of the marine phosphorus cycle. We here report the first in situ PO43– dataset from an underwater glider (Kongsberg Seaglider) equipped with a PO43– Lab-on-Chip (LoC) analyser. Over 44 days, a 120 km transect was conducted in the northern North Sea during late summer (August and September). Surface depletion of PO43– (

One key challenge of marine monitoring programs is to reasonably combine information from different in situ observations spread in space and time. In that context, we suggest the use of Lagrangian transport simulations extending both forward and backward in time to identify the movements of water bodies from the time they were observed to the time of their synopsis. We present examples of how synoptic maps of salinity generated by this method support the identification and tracing of river plumes in coastal regions. We also demonstrate how we can use synoptic maps to delineate different water masses in coastal margins. These examples involve quasi-continuous observations of salinity taken along ferry routes. A third application is the synchronization of measurements between fixed stations and nearby moving platforms. Both observational platforms often see the same water body, but at different times. We demonstrate how the measurements from a fixed platform can be synchronized to measurements from a moving platform by taking into account simulation-based time shifts.

Within the context of the predicted and observed increase in droughts and floods with climate change, large summer floods are likely to become more frequent. These extreme events can alter typical biogeochemical patterns in coastal systems. The extreme Elbe River flood in June 2013 not only caused major damages in several European countries but also generated large-scale biogeochemical changes in the Elbe estuary and the adjacent German Bight. The high-frequency monitoring network within the Coastal Observing System for Northern and Arctic Seas (COSYNA) captured the flood influence on the German Bight. Data from a FerryBox station in the Elbe estuary (Cuxhaven) and from a FerryBox platform aboard the M/V Funny Girl ferry (traveling between Büsum and Helgoland) documented the salinity changes in the German Bight, which persisted for about 2 months after the peak discharge. The Elbe flood generated a large influx of nutrients and dissolved and particulate organic carbon on the coast. These conditions subsequently led to the onset of a phytoplankton bloom, observed by dissolved oxygen supersaturation, and higher than usual pH in surface coastal waters. The prolonged stratification also led to widespread bottom water dissolved oxygen depletion, unusual for the southeastern German Bight in the summer.

Background : Acute decompensated heart failure (ADHF) is a condition with a high frequency of hospitalizations and mortality, and obstructive sleep apnea (OSA) is a common comorbidity. Continuous positive airway pressure (CPAP) therapy at home can be a good adjunctive non-drug therapy for these patients. Methods : We conducted a single-center, prospective cohort study from 150 consecutive patients hospitalized for heart failure exacerbation in the cardiology department. Of these, 57 patients had obstructive sleep apnea. After discharge, CPAP therapy at home was offered. We divided them into two groups and followed them for 1 year. All patients received optimal medical treatment. At the end of the period, patients underwent a follow-up physical examination, a follow-up echocardiography, and a follow-up evaluation of the Epworth Sleepiness Scale (ESS). Results : From 81 patients with sleep apnea, 72.8% (n = 59) had obstructive sleep apnea (OSA) and 27.2% (n = 22) had central sleep apnea (CSA). There was a statistically significant difference in body mass index (BMI), ESS, systolic blood pressure (SBP), diastolic blood pressure (DBP), and left ventricular ejection fraction (LVEF%) in the group with CPAP therapy compared to the no-CPAP group. The CPAP group had a median survival of 11.7 months vs. 10.1 months in the no-CPAP group (log-rank (Mantel-Cox) p = 0.044). Conclusions : This study suggests that obstructive sleep apnea is a common comorbidity in patients with acute decompensated heart failure. The addition of CPAP therapy in these patients improves the symptoms and the prognosis.