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Increasing urbanization and its implication for human health, outdoor thermal comfort, air quality or energy consumption necessitate a need for high-resolution urban modelling. In this study, we evaluate uSINGV, a coupled urban-atmosphere research model used by the Singapore Meteorological Service, for four clear-day over Singapore using two different spatial resolutions of 300 and 100 m, respectively. The model is modified to incorporate urban morphology and land use/land cover datasets which are based on European Space Agency climate change initiative data (ESA CCI) at 300 and local datasets at 100 m spatial resolution. The evaluation is carried out for near-surface variables such as temperature, specific humidity, wind speed, and turbulent surface fluxes using Kling-Gupta efficiency (KGE'), root mean square error (RMSE) and mean absolute error (MAE) as model evaluation metrics. Results suggest that temperature and specific humidity are similar for 300 m and 100 m spatial resolution. On the other hand, for 100 m (300 m), the 10 m wind speed has a KGE’ of 0.45 (0.15), RMSE of 0.69 (1.42) m/s, and MAE of 0.55 (1.26) m/s, hence showing improvements from 300 to 100 m spatial resolution. In addition, sensible heat flux for 100 m resolution simulations is closer to observations, while latent heat flux is overestimated. Overall, uSINGV is able to produce reliable simulations at 100 m spatial resolution, thereby showing promise for improved understanding of detailed urban climate processes.

This paper studies the features of metabolic parameters, diabetic complications and drug therapy of a single-centre cohort of patients with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) in secondary care and tertiary care over a 15-year period. Methods: Retrospective cross-sectional analysis of four single-centre cohorts between 2004 and 2019. All patients with T1DM or T2DM in secondary care (n = 5571) or tertiary care (n = 2001) were included. Statistical analyses were performed using linear mixed models. Results: Diabetes duration increased in both patients with T1DM and T2DM in secondary care and tertiary care (p < 0.001). Patients in secondary care consistently showed good glycaemic control, while patients in tertiary care showed inadequate glycaemic control. All four cross-sectional cohorts showed a significant increase in the prevalence of nephropathy over time and three out of four cohorts (T1DM and T2DM in secondary care and T2DM in tertiary care) showed an increase in the prevalence of neuropathy (all p < 0.001). The incidence of severe hypoglycaemia was consistently low. The use of insulin pumps and insulin analogues in the therapy of T1DM increased significantly. Conclusions: The increased prevalence of complications is likely due to older age and longer diabetes duration. Low rates of hypoglycaemia, lower limb amputations and good glycaemic control in secondary care patients indicate a good structure of patient care.

A total of 20 urban neighbourhood-scale eddy covariance flux tower datasets are made openly available after being harmonized to create a 50 site–year collection with broad diversity in climate and urban surface characteristics. Variables needed as inputs for land surface models (incoming radiation, temperature, humidity, air pressure, wind and precipitation) are quality controlled, gap-filled and prepended with 10 years of reanalysis-derived local data, enabling an extended spin up to equilibrate models with local climate conditions. For both gap filling and spin up, ERA5 reanalysis meteorological data are bias corrected using tower-based observations, accounting for diurnal, seasonal and local urban effects not modelled in ERA5. The bias correction methods developed perform well compared to methods used in other datasets (e.g. WFDE5 or FLUXNET2015). Other variables (turbulent and upwelling radiation fluxes) are harmonized and quality controlled without gap filling. Site description metadata include local land cover fractions (buildings, roads, trees, grass etc.), building height and morphology, aerodynamic roughness estimates, population density and satellite imagery. This open collection can help extend our understanding of urban environmental processes through observational synthesis studies or in the evaluation of land surface environmental models in a wide range of urban settings. These data can be accessed from https://doi.org/10.5281/zenodo.7104984 (Lipson et al., 2022).

Simulations of five November months (2010–2014) using the urban version of the numerical weather prediction system of the Meteorological Service Singapore (uSINGV) are used to analyse the urban effect on convective precipitation over Singapore and Johor Bahru (Malaysia). The model is able to closely predict locations where rainfall peaks occur, but rainfall totals are overestimated compared to radar data. The temporal variability of rainfall in the region shows that urban areas increase the frequency and severity of rainfall events and that such impact increases with the rainfall intensity. Results show that low-level moisture advection is enhanced in this coastal conurbation as a result of the strengthening of wind convergence. The latter is likely caused by increasing sea-breeze strength due to lower surface pressure over the urban area, and higher urban surface roughness, respectively. As a consequence, more precipitable water is available in the region, enhancing convection and increasing the probability of heavy rainfall over the centre and north of Singapore island and Johor Bahru. Stronger convection further increases moisture advection from the vicinity. By studying the temporal variability and the spatial distribution of rainfall events, the present study provides new insights on the urban impact on heavy rainfall in tropical areas. The conclusions are only valid for the November inter-monsoon period, when local forcing, rather than large-scale influences, dominates rainfall generation. National Environment Agency - Singapore, R-109-000-338 236-490

Congenital hyperinsulinism (CHI) is a rare glucose metabolism disorder characterized by unregulated secretion of insulin that leads to hyperinsulinemic hypoglycemia (HH). Most cases are caused by mutations in the KATP-channel genes ABCC8 and KCNJ11. We report 2 patients that experienced severe HH from the first day of life. Patient 1 developed midgut volvulus after initiating diazoxide and required intestinal resection. He was subsequently managed with a high-dose octreotide and glucose-enriched diet. Consistent with diffuse type CHI by 18F-dihydroxyphenylalanine positron emission tomography-computed tomography, genetic testing revealed a homozygous ABCC8 variant, c.1801G>A, p.(Val601Ile). The rare variant was previously reported to be diazoxide-responsive, and the patient responded well to diazoxide monotherapy, with clinical remission at 2 years of age. Patient 2 responded to diazoxide with spontaneous clinical remission at 15 months of age. However, an oral glucose tolerance test at 7 years of age revealed hyperinsulinism. Genetic testing revealed that the proband and several seemingly healthy family members harbored a novel, heterozygous ABCC8 variant, c.1780T>C, p.(Ser594Pro). Genetic findings identified previously unrecognized HH in the proband's mother. The proband's uncle had been diagnosed with monogenic ABCC8-diabetes and was successfully transitioned from insulin to glibenclamide therapy. We report findings of intestinal malrotation and volvulus occurring 2 days after initiation of diazoxide treatment. We also report a novel, heterozygous ABCC8 variant in a family that exhibited cases of CHI in infancy and HH and monogenic diabetes in adult members. The cases demonstrate the importance and clinical utility of genetic analyses for informing and guiding treatment and care.

Model-based solutions for monitoring and control of chemical batch processes have been of interest in research for many decades. However, unlike in continuous processes, in which model-based tools such as Model Predictive Control (MPC) have become a standard in the industry, the reported use of models for batch processes, either for monitoring or control, is rather scarce. This limited use is attributed partly to the inherent complexity of the batch processes (e. g., dynamic, nonlinear, multipurpose) and partly to the lack of appropriate commercial tools in the past. In recent years, algorithms and commercial tools for model-based monitoring and control of batch processes have become more mature and in the era of Industry 4.0 and digitalization they are slowly but steadily gaining more interest in real-word batch applications. This contribution provides a practical example in this application field. Specifically, the use of a grey-box modeling approach, in which a multiway Projection to Latent Structure (PLS) model is combined with a first-principles model, to monitor the evolution of a batch polymerization process and predict in real-time the final batch quality is reported. The modeling approach is described, and the experimental results obtained from an industrial batch laboratory reactor are presented.

In this paper, modeling of storage constraints and material transfer are considered for short-term batch scheduling. The key features of storage and quality checks are inspired from a case study of a multiproduct batch plant. The case study presents two strategies for assigning batch orders to each individual storage tank during batch production, which are modeled in the proposed scheduling formulations as two scenarios of storage policies. A continuous-time MILP formulation is applied for the assignment and sequencing of batches in the multistage processes. The proposed approach is tested using the case study problems, and the computational results illustrate the performance of the scheduling formulations.

Understanding the response of extreme precipitation (EP) at a city scale to global warming is critical to reducing the respective risk of urban flooding. Yet, current knowledge on this issue is limited. Here, focusing on an urban agglomeration in the tropics, Singapore, we reveal that future global warming enhances both frequency and intensity of EP, based on simulations with a state-of-the-art convection-permitting regional climate model. EP intensification can reach maximum "super" Clausius-Clapeyron rate (>= $\ge $+7% per K warming) rate, implying a "new normal" of "extreme events get more extreme," which is consistently for both Representative Concentration Pathways 8.5 and 4.5. The intensification is lower for moderate and light precipitation. Also, global warming was found to dampen the urban effect on EP events. The EP enhancement is attributed to the increased atmospheric moisture and convective inhibition due to enhanced low-level stratification that delays a convection to develop until it becomes more intense., Earth's Future, 10 (6), ISSN:2328-4277

Objective To assess patent ductus arteriosus treatment variation between Swiss perinatal centers and to determine its effect on outcome in a population-based setting. Study design This was a retrospective cohort study of infants born less than 28 weeks of gestation between 2012 and 2017. Outcomes between surgically ligated and pharmacologically treated infants as well as infants born in centers performing ≤10% ligation (“low” group) and >10% (“high” group) were compared using logistic regression and 1:1 propensity score matching. Matching was based on case-mix and preligation confounders: intraventricular hemorrhages grades 3-4, necrotizing enterocolitis, sepsis, and ≥28 days’ oxygen supply. Results Of 1389 infants, 722 (52%) had pharmacologic treatment and 156 (11.2%) received surgical ligation. Compared with infants who received pharmacologic treatment, ligated infants had greater odds for major morbidities (OR 2.09, 95% CI 1.44-3.04) and 2-year neurodevelopmental impairment (OR 1.81, 95% CI 1.15-2.84). Mortality was comparable after restricting the cohort to infants surviving at least until day 10 to avoid survival bias. In the “low” group, 34 (4.9%) of 696 infants were ligated compared with 122 (17.6%) of 693 infants in the “high” group. Infants in the “high” group had greater odds for major morbidities (OR 1.49, 95% CI 1.11-2.0). Conclusions Our analysis identified a burden on infants receiving surgical ligation vs pharmacologic treatment in a population-based setting where there was no agreed-on common procedure. These results may guide a revision of patent ductus arteriosus treatment practice in Switzerland.

Our aim was to develop and validate a predictive risk score for bronchopulmonary dysplasia (BPD), according to two clinically used definitions: 1. Need for supplementary oxygen during ≥ 28 cumulative days, BPD28, 2. Need for supplementary oxygen at 36 weeks postmenstrual age (PMA), BPD36. Logistic regression was performed in a national cohort (infants born in Switzerland with a birth weight < 1501 g and/or between 23 0/7 and 31 6/7 weeks PMA in 2009 and 2010), to identify predictors of BPD. We built the score as the sum of predicting factors, weighted according to their ORs, and analysed its discriminative properties by calculating the area under the ROC (receiver operating characteristic) curves (AUCs). This score was then applied to the Swiss national cohort from the years 2014–2015 to perform external validation. The incidence of BPD28 was 21.6% in the derivation cohort (n= 1488) and 25.2% in the validation cohort (n= 2006). The corresponding numbers for BPD36 were 11.3% and 11.1%, respectively. We identified gestational age, birth weight, antenatal corticosteroids, surfactant administration, proven infection, patent ductus arteriosus and duration of mechanical ventilation as independent predictors of BPD28. The AUCs of the BPD risk scores in the derivation cohort were 0.90 and 0.89 for the BPD28 and BPD36 definitions, respectively. The corresponding AUCs in the validation cohort were 0.92 and 0.88, respectively.Conclusion: This score allows for predicting the risk of a very low birth weight infant to develop BPD early in life and may be a useful tool in clinical practice and neonatal research.What is Known:• Many studies have proposed scoring systems to predict bronchopulmonary dysplasia (BPD).• Such a risk prediction may be important to identify high-risk patients for counselling parents, research purposes and to identify candidates for specific treatment.What is New:• A predictive risk score for BPD was developed and validated in a large national multicentre cohort and its performance assessed by two indices of accuracy.• The developed scoring system allows to predict the risk of BPD development early but also at any day of life with high validity.

Water storage plays an important role in mitigating heat and flooding in urban areas. Assessment of the capacity of cities to store water remains challenging due to the extreme heterogeneity of the...

In the process industry, various types of degradation occur in processing plants, resulting in significant economic losses. Modeling of degradation is important because it provides quantitative insights for consideration of degradation impacts in the operations of process manufacturing. This paper studies batch processes that show a periodic pattern for the evolution of degradation. A new data structure, the campaign, is applied for data-driven modeling of the periodic batch-to-batch evolution of degradation using a new multiway partial least squares approach, and it is further employed to predict the evolution of degradation in a series of batch runs. The proposed approach is illustrated and applied in a comprehensive industrial case study. The example illustrates the efficacy of the proposed model and presents a fair potential for applications of degradation prediction. © 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Degradation such as fouling has significant negative impact on the efficiency of process manufacturing. Creating transparency about degradation is essential in the operations of the plants. This paper focuses on the state estimation of fouling in a multipurpose batch process, and the problem is formulated using an industrial case study. Due to the lack of a good model of fouling, the state estimation is integrated with parameter estimation using the expectation maximization (EM) algorithm, where the variational approximation method is employed for the intermediate robust state estimation in the E-step. The proposed state estimation is applied in the case study, which demonstrates the efficacy of the estimation of a recipe-independent key performance indicator for the batch-to-batch fouling. © 2019, IFAC (International Federation of Automatic Control) Hosting by Elsevier Ltd. All rights reserved.

Background Stress during ambulance transportation has been described in adult healthy volunteers where indicators of stress such as heart rate, blood pressure, and cortisol increased significantly. In neonates, a few studies have described stress in ambulance with behavioural scales. However, there is no study in neonates assessing both behavioural and physiological indicators of stress simultaneously during ambulance transportation. Objective To assess the feasibility of a study aiming at identifying stress in clinically stable neonates during ambulance transportation in non-emergency situations. Methods Stable neonates transported by ambulance from September 2015 to January 2016 were eligible. Physiological and behavioural parameters of stress were measured during the entire transfer procedure, starting on the ward of departure until hospitalisation at destination. Physiological parameters included salivary cortisol concentration, heart rate, respiratory rate, and oxygen saturation. Behavioural parameters were measured with the Comfort Behavior and the Premature Infant Pain Profile-Revised scales. Results Twenty neonates were included. The study proved to be feasible, but collection of saliva for cortisol measurement was problematic. To reach a sufficient amount of saliva, the collection time had to be extended from 90 to 300 s. Physiological parameters demonstrated heterogeneous patterns of stress. Behavioural scores increased during the entire transfer procedure and did not return to baseline values, indicating discomfort, specifically during transfer from the cot into the transport incubator. Conclusions Salivary cortisol values were variable. Behavioural measurement of stress provided a more sensitive measure to detect low level of stress, as shown in our sample of stable neonates, during non-emergency transportation.

The objective of this study was to identify risk factors and study the causes of neonatal mortality of LBW newborns referred to the Institute of Nutrition and Child Health. Material and Methods: This is a prospective descriptive and analytical study from March 1 to August 31, 2015, involving 250 newborns referred to the Neonatology Department of the Institute of Child Nutrition and Health (INSE). Results: During our study period, we recorded 1169 newborns, 250 of whom were referred, representing a referral frequency of 21.38%. The overall mortality rate for transferring newborns was 46.8%. Risk factors associated with neonatal mortality were gravidity (p = 0.0019), parity (p = 0.0323), occupational activities requiring physical effort (p = 0.0257), birth weight (p = 0.0008) and prematurity (p = 0.0039). Conclusion: Neonatal mortality associated with referrals is a major health problem in developing countries. There is currently no doubt that it is possible to significantly reduce perinatal mortality and morbidity rates by organizing the identification of “mother-child” couples at risk, to refer them intently to centres better equipped with technical and human resources to care for them.

A snapshot of web pages describing the site location informationand observations used in the Urban-PLUMBER model evaluation projectfor urban areas. Observational data files themselves are NOT included. Access to observational data files must be separately negotiated with data owners. Webpage available at:https://urban-plumber.github.io/sites

Two neonates were presented at the Neonatology Department of the Institute of Child Nutrition and Health in Conakry, Guinea, with tension pneumothoraces as confirmed by chest X-ray. They were initially managed with needle thoracentesis but required continuous thoracic drainage. Due to scarce resources in the public health sector, no prepacked and dedicated pleural drainage systems were available as is the case in many developing countries. Therefore, we fabricated an improvised underwater seal drain out of a plastic infusion bottle and a Heimlich valve out of a vicryl fingerstall. Both devices have shown to be effective. Pneumothorax is a common and potentially life-threatening disease in neonates that often requires prompt treatment. This case series demonstrates how tension pneumothorax in two newborns was successfully managed by improvising different chest drainage systems. The depicted techniques shall serve as an instruction manual to healthcare professionals working in low-resource settings and facing similar challenges.

Large spatial differences in canopy-layer air temperature are found across the city as a consequence of distinct urban morphologies and anthropogenic activities throughout the urban landscape. Model-based studies investigating the spatial and temporal variability of air temperature are commonly employed to assess heat mitigation strategies in cities. It is therefore important that models are capable to accurately predict air temperature variability across the city to account for the local climate context. This study explores the sensitivity of the Weather Research and Forecasting (WRF) model coupled with a multi-layer urban scheme (BEP-BEM) to simulate intra-urban variations of 2-m air temperature during different synoptic conditions in a tropical city, Singapore. An accurate representation of the real heterogeneous urban morphology of Singapore is implemented in the model. Two one-month long simulations are conducted for distinct synoptic weather conditions: (a) a relatively wet period during the SW monsoon and (b) a very dry period during the NE monsoon. The performance of the model is firstly evaluated against micrometeorological data collected by a tall eddy covariance flux tower in a representative low-rise residential neighbourhood. Overall good performance is obtained for wind speed and direction, turbulence parameters and surface energy balance components, in particular during dry conditions. Some difficulties are found in predicting intermittent cloud cover, which results in an overestimation of net radiation increasing model errors during the wetter period. Hence the comparison of 2-m air temperatures against observations results in slightly higher errors during the latter period (RMSE

Background Neonatal mortality in Guinea accounts for about 30% of all fatalities in children younger than five years. Countrywide, specialized neonatal intensive care is provided in one single clinic with markedly limited resources. To implement targeted measures, prospective data on patient characteristics and factors of neonatal death are needed. Objective To determine the rates of morbidity and mortality, to describe clinical characteristics of admitted newborns requiring intensive care, to assess the quality of disease management, and to identify factors contributing to neonatal mortality. Methods Prospective observational cohort study of newborns admitted to the hospital between mid-February and mid-March 2019 after birth in other institutions. Data were collected on maternal/prenatal history, delivery, and in-hospital care via convenience sampling. Associations of patient characteristics with in-hospital death were assessed using cause-specific Cox proportional-hazards models. Results Half of the 168 admitted newborns underwent postnatal cardiopulmonary resuscitation. Reasons for admission included respiratory distress (49.4%), poor postnatal adaptation (45.8%), prematurity (46.2%), and infections (37.1%). 101 newborns (61.2%) arrived in serious/critical general condition; 90 children (53.9%) showed clinical signs of neurological damage. Quality of care was poor: Only 59.4% of the 64 newborns admitted with hypothermia were externally heated; likewise, 57.1% of 45 jaundiced infants did not receive phototherapy. Death occurred in 56 children (33.3%) due to birth asphyxia (42.9%), prematurity (33.9%), and sepsis (12.5%). Newborns in serious/critical general condition at admission had about a fivefold higher hazard to die than those admitted in good condition (HR 5.21 95%-CI 2.42–11.25, p = Conclusion Neonatal mortality was strikingly high. Birth asphyxia, prematurity, and infection accounted for 89.3% of death, aggravated by poor quality of in-hospital care. Children with serious general condition at admission had poor chances of survival. The whole concept of perinatal care in Guinea requires reconsideration.

Objective To compare length of stay (LOS) in neonatal care for babies born extremely preterm admitted to networks participating in the International Network for Evaluating Outcomes of Neonates (iNeo). Study design Data were extracted for babies admitted from 2014 to 2016 and born at 24 to 28 weeks of gestational age (n = 28 204). Median LOS was calculated for each network for babies who survived and those who died while in neonatal care. A linear regression model was used to investigate differences in LOS between networks after adjusting for gestational age, birth weight z score, sex, and multiplicity. A sensitivity analysis was conducted for babies who were discharged home directly. Results Observed median LOS for babies who survived was longest in Japan (107 days); this result persisted after adjustment (20.7 days more than reference, 95% CI 19.3-22.1). Finland had the shortest adjusted LOS (−4.8 days less than reference, 95% CI –7.3 to −2.3). For each week's increase in gestational age at birth, LOS decreased by 12.1 days (95% CI –12.3 to −11.9). Multiplicity and male sex predicted mean increases in LOS of 2.6 (95% CI 2.0-3.2) and 2.1 (95% CI 1.6-2.6) days, respectively. Conclusions We identified between-network differences in LOS of up to 3 weeks for babies born extremely preterm. Some of these may be partly explained by differences in mortality, but unexplained variations also may be related to differences in clinical care practices and healthcare systems between countries.

This is a comment to the paper "Magnitude of urban heat islands largely explained by climate and population" by Manoli et al. (2019, Nature 573 p. 55-60; https://doi.org/10.1038/s41586-019-1512-9)

Background Perinatal mortality represents a major health care problem in particular in low and middle-income countries, which account for 97% of all late fetal and 98% of all neonatal deaths. Our objectif was to analyse perinatal morbidity and mortality at the largest maternity clinic of Guinea, in sub-Saharan Africa. Patients & Methods: Prospective observational evaluation of the perinatal morbidity and mortality between May 1st and June 30th 2019 at the Clinic of Obstetrics of the University Hospital Ignace Deen in Conakry, Guinea. Results Of the 1189 deliveries, 98 (82‰) fetus were born dead, 58.1% of them with signs of maceration. 14.1% of all infants had low birth weight ( 4000 g). The rate of preterm infants was 9.3% and 99 infants (8.3%) showed signs of post-maturity. At birth, 6.8% of all live born infants had asphyxia, 10.9% respiratory distress, 1.9% infection, 0.3% malformation, and nine infants died within the first postnatal minutes. Need for any resuscitation manoeuvres showed 304 infants (27.9%), 68.8% of them needed bag and mask ventilation and 27.0% chest compressions. Infants with bad Apgar score at 1 and 5 minutes did improve by 10 minutes thanks to respiratory support, but not due to chest compression. As there is no neonatal unit in the same hospital, 192 infants (17.6%) had to be transferred across Conakry to the only tertiary neonatal unit. Due to lack of any (para-)medical transport system for newborn infants, mortality of these neonates is very high and adds to the total perinatal mortality of 143.8 deaths/1000 deliveries. Conclusions Late pregnancy control is very poor in Conakry, leading to delayed referral of high-risk pregnancies to the university hospital. This goes along with high rates of stillbirths, post-term and macrosome infants with increased risk for delivery complications like postnatal adaptation problems and asphyxia. Resuscitation algorithm needs to be adapted to the local context. A hospital-based neonatal unit for primary stabilization and a medicalised neonatal transport system within Conakry needs to be implemented to decrease the high mortality rate.

The increase in urban air temperature caused by urban heat and climate change can have negative effects on the outdoor thermal comfort (OTC) as well as on the energy demand for air-conditioning. Nature-based solutions, such as the increase in urban biomass, are often proposed to mitigate excessive urban heat. Trees are expected to decrease temperatures due to shade provision on surfaces and evapotranspiration but their canopy blocks wind flow, thus potentially induce warming by reduction of heat removal. Several studies have shown that trees have a varying potential for air temperature reduction throughout the diurnal cycle as well as in different climates. Studies that partition and attribute the temperature reduction to the aforementioned effects are still lacking though, thus making the explanation of the observed differences difficult. To address this knowledge gap, we use the mechanistic urban ecohydrological model, Urban Tethys-Chloris (UT&C, Meili et al. 2019), which accounts for radiation, evapotranspiration and roughness effects of trees in the urban canyon. Turning these components on and off by means of virtual experiments allows us to quantify their contribution to the air and surface temperature modification caused by the tree cover. The results are analysed for compact low-rise residential areas (LCZ3) in four different climates (Phoenix, Singapore, Melbourne, Zurich). We find that tree evapotranspiration is able to lower 2 m air temperature at maximum by 3-4°C in all four climates as stomatal closure due to high vapour pressure deficits in dry and hot cities limit the transpirative cooling effect during mid-day. Counterintuitively, tree-radiation interaction increases the 2 m air temperature up to 2°C at noon time even though a decrease in surface temperatures is observed. While the surfaces underneath the tree canopy receive less radiation due to shading, the overall absorbed solar radiation within the canyon increases due to radiation trapping. In the analysed scenarios, the presence of trees leads to a decrease in the city roughness hindering turbulent energy exchange and thus, increasing the 2 m air temperature in all climates during daytime. The tree-radiation and tree-roughness effects on 2 m air temperature during night vary in different climates due to atmospheric stability effects. Combining the different tree effects as in the real world, leads to a distinct diurnal pattern of air temperature reduction which is consistent with the observations in the literature. The numerical experiment allows reconciling differences in temperature changes induced by trees across the diurnal cycle and in various climates. The results could be used to guide green cover and tree type selection in cities and inform future studies aimed at optimizing the role of urban greening for improving local microclimatic conditions., EGUsphere

Background Very preterm infants are at high risk of death or severe morbidity. The objective was to determine the significance of severe congenital heart defects ( CHDs ) for these risks. Methods and Results This cohort study included infants from 10 countries born from 2007–2015 at 24 to 31 weeks’ gestation with birth weights CHDs were defined by International Classification of Diseases, Ninth Revision ( ICD‐9 ) and Tenth ( ICD‐10 ) codes and categorized as those compromising systemic output, causing sustained cyanosis, or resulting in congestive heart failure. The primary outcome was in‐hospital mortality. Secondary outcomes were neonatal brain injury, necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity. Adjusted and propensity score–matched odds ratios ( ORs ) were calculated. Analyses were stratified by type of CHD , gestational age, and network. A total of 609 (0.77%) infants had severe CHD and 76 371 without any malformation served as controls. The mean gestational age and birth weight were 27.8 weeks and 1018 g, respectively. The mortality rate was 18.6% in infants with CHD and 8.9% in controls (propensity score–matched OR , 2.30; 95% CI , 1.61–3.27). Severe CHD was not associated with neonatal brain injury, necrotizing enterocolitis, or retinopathy of prematurity, whereas the OR for bronchopulmonary dysplasia increased. Mortality was higher in all types, with the highest propensity score–matched OR (4.96; 95% CI, 2.11–11.7) for CHD causing congestive heart failure. While mortality did not differ between groups at OR for mortality in infants with CHD increased to 10.9 (95% CI, 5.76–20.70) at 31 weeks’ gestational age. Rates of CHD and mortality differed significantly between networks. Conclusions Severe CHD is associated with significantly increased mortality in very preterm infants.

Management of patients at high risk of extreme premature birth between 23 and 26 weeks should be performed by an experienced multidisciplinary team. In order to optimize guidance for couples with regard to this complex decision, we developed joint guidelines between obstetricians and neonatologists, in order to standardize practices and insure individualized care plans. Fetal outcome is not solely associated with gestational age but is multifactorial, and this should be considered when counseling parents. Thus, enhancement of fetal lung maturation, a major prognostic factor, should be promptly acted upon when delivery is anticipated. Antenatal corticosteroids should not be withheld while awaiting the parents' ultimate decision on neonatal care.La prise en charge des patientes à haut risque d’accouchement prématuré entre 23 et 26 semaines d’aménorrhée (SA) doit être faite par une équipe périnatale expérimentée. Afin d’améliorer la prise en charge des couples dans cette situation particulièrement difficile, nous avons élaboré un protocole commun entre obstétriciens et néonatologues. Cette réflexion vise à uniformiser les pratiques au sein du CHUV et à assurer aux couples des soins personnalisés. Le pronostic fœtal ne dépend pas uniquement de l’âge gestationnel mais d’un ensemble de facteurs dont il est important de tenir compte dans la discussion avec les parents. Ainsi la corticothérapie, facteur pronostique majeur, doit être réalisée le plus rapidement possible en cas de menace sévère. L’injection ne doit pas être différée par la réflexion des couples sur les soins néonataux.

Objective This study aimed to describe intrapartum and postpartum exposures possibly associated with the risk of in-hospital maternal mortality in Guinea. Study Design Data were collected in the Western Sub-Saharan Africa setting at the university hospital in Conakry, Guinea, during 2016−2017. Case-control study design was applied. The cases comprised all intrapartum and postpartum maternal deaths recorded during the study period. The controls were selected by random sampling from patients discharged alive following hospitalization due to vaginal delivery or cesarean section. Maternal mortality ratio (MMR) was defined as a quotient of the number of maternal deaths per 100,000 live births. Multivariable logistic regression was applied to generate odds ratios (OR) and 95 % confidence intervals (95 %CI). Results A total of 10,208 live births and 144 maternal deaths were recorded. The MMR was at 1411 per 100,000 live births. The main causes of maternal death included postpartum hemorrhage (56 %), retroplacental hematoma (10 %), and eclampsia (9%). The ORs of maternal death were significantly elevated in case of transfer from another hospital (OR 24.60, 95 %CI 11.32–53.46), misoprostol-induced labor (OR 4.26, 95 %CI 2.51–7.91), non-use of partogram (OR 3.70, 95 %CI 1.31–5.20), duration of labor ≥24 h (OR 2.87, 95 %CI 1.35–5.29), and positive history of cesarean section (OR 2.54, 95 %CI 1.12–6.19). Conclusion To stop preventable maternal mortality in Sub-Saharan Africa, continued efforts are needed to provide perinatal monitoring, to reorganize the obstetric reference system, and to decrease the number of avoidable cesarean sections. Furthermore, the internal supervision of misoprostol doses used for labor induction should be a priority.

Heavy PM2.5 (particulate matter with aerodynamic diameter equal to or less than 2.5 mu m) pollution and urban heat island (UHI) pose increasing threats to human health and living environment in populated cities. However, how PM2.5 pollution affects the UHI intensity (UHII) has not been fully understood. The impacts of PM2.5 on the wintertime UHII in the Beijing-Tianjin-Hebei megalopolis of China are explored during 2013-2017. The results show that the UHII at the time of daily maximum/minimum temperature (UHIImax/UHIImin) exhibits a decreasing/increasing tendency as PM2.5 concentration increases, causing a continuous decrease in the diurnal temperature range. These effects are mediated via aerosol-radiation interaction (aerosol-cloud interaction) under clear-sky (cloudy) condition. The changes in PM2.5 concentration further cause different relative trends of UHII(ma)x/UHIImin/diurnal temperature range across different cities in the Beijing-Tianjin-Hebei region, which are likely related to the differences in both the PM2.5 composition and city size. This study provides insights on how air pollution affects urban climate and would help to design effective mitigation strategies. Plain Language Summary A detailed understanding of the relationship between PM2.5 (particulate matter with aerodynamic diameter equal to or less than 2.5 mu m) and the urban heat island (UHI) effect is significant for climate change adaption, planning, and sustainable development in urban regions. While the Beijing-Tianjin-Hebei (BTH) megalopolis of China is among the areas with the highest population densities and fastest urbanization rates in the world, the impacts of PM2.5 pollution on UHI, along with their regional differences in the BTH megalopolis, remain unclear. This study demonstrates that different PM2.5 concentrations in the BTH region pose various influences on the UHI intensities and their change rates in different cities of varying sizes. The UHI intensities during daytime and nighttime, respectively, exhibit weakening and strengthening tendency as PM2.5 concentration increases. These effects are mediated via aerosol-radiation interaction under clear-sky condition and aerosol-cloud interaction in cloudy weather. The relative changes in the UHI magnitudes were mainly determined by PM2.5 composition and city size. The asymmetrical influences of PM2.5 on the daytime and nighttime UHI intensities caused continuous decreases in the diurnal temperature ranges in the urban areas as the pollution level increased. Our study improves the understanding of urban climate affected by air pollution and provides a scientific basis for the mitigation of UHI impacts.