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Background Erythromycin is a potent stimulator of gastrointestinal motility. Recent studies have examined the use of intravenous erythromycin to clear the stomach of blood before oesophago-gastroduodenoscopy (EGD) for acute upper gastrointestinal haemorrhage (UGIH). These studies have shown clinical effectiveness. Aim To evaluate the cost-effectiveness of this intervention. Methods We sought to determine the cost-effectiveness of erythromycin before EGD from the payer’s perspective. We found three relevant studies of erythromycin and used these data for the analysis. We obtained costs for intravenous erythromycin and charges for peptic ulcer hospitalization, EGD, surgery, and angiographic embolization. Complication rates were also incorporated from the literature. We implemented a model of health-related quality of life to measure the impact of the intervention. We created a decision-analysis tree and performed a probabilistic sensitivity analysis. Results A strategy of erythromycin prior to EGD resulted in a cost-effective outcome in a majority of trials using willingness-to-pay figures of $0, $50 000 and $100 000 (US) per quality-adjusted life-year (QALY). Conclusion Because of the implications for cost saving and increase in QALY, we would recommend giving erythromycin prior to EGD for UGIH. [ABSTRACT FROM AUTHOR]

In June of 2021 the Southwest United States experienced a record‐breaking heatwave. This heatwave came at a time when the region was in severe drought. As drought alters the surface energy budget in ways that affect lower atmosphere temperature and circulations, it is possible that the combined drought‐heat event was a cascading climate hazard, in which preexisting drought exacerbated the heatwave. We apply satellite observation and numerical experiments with the Weather Research and Forecasting (WRF) model to test for land‐atmosphere feedbacks during the heatwave consistent with drought influence. We find a modest positive drought‐heat effect, as WRF simulations that include the drought have marginally higher air temperatures than those that exclude the initial drought conditions, with more substantial effects in wetter, forested areas. Evidence of drought‐heat‐drought‐coupled feedbacks was similarly modest in our simulations, as accounting for drought preconditioning led to a small reduction in simulated precipitation in the region. Plain Language Summary: In June 2021 the Southwest United States was hit by a record‐breaking heatwave at the same time as a severe drought. In this study, we look into the response of both events effect on one another. The WRF computer model is designed to test the observed events besides the use of satellite images during the same time. We find a small positive response between the two events that was more considerable over wetter and green regions. We also find a decrease in rainfall over the study region as a response to the drought‐heatwave conditions. Key Points: The record‐setting 2021 US heatwave struck at a time when surface conditions were anomalously dry, bright, and barren due to droughtSatellite observations indicate that drought led to anomalous land‐atmosphere fluxesModel simulations also indicate a small but systematic positive feedback of drought on heat [ABSTRACT FROM AUTHOR]

Background We analysed nationwide in-patient data from 2002 to 2007 to determine significant demographic variables when predicting mortality and receipt of prompt oesophagogastroduodenoscopy ( OGD) for acute variceal haemorrhage ( AVH) and nonvariceal upper gastrointestinal haemorrhage ( NVUGIH). Aim To study the effects of demographic variables in predicting time to endoscopy and mortality in AVH and NVUGIH. Methods We analysed the United States' Nationwide Inpatient Sample ( NIS), for risk factors for mortality and receipt of OGD within 1 day of admission for upper gastrointestinal haemorrhage. Results Risk factors for increased mortality in AVH included: age >60, men, African Americans, comorbidities, insurance type and delayed OGD. Risk factors for increased mortality in NVUGIH were similar to AVH, except race which was not significant. After correction for factors such as insurance type, comorbidity, hospital location and time to endoscopy, this increased risk of mortality persisted, suggesting that none of these factors was the primary cause of the observed differences. For AVH, OGD within 1 day of admission was more likely in men, White Americans, patients aged 18-40 years, privately insured and those with no comorbidities. OGD within 1 day of admission in NVUGIH was more likely in men, patients age 40-60, Whites, Hispanics, privately insured and those with a single comorbidity. Conclusions In multivariate analysis, in-patient mortality in AVH and NVUGIH increased with age, comorbidity, male gender, and delayed time to endoscopy. Young, healthier men were most likely to receive OGD within 1 day of admission. African Americans were less likely to receive OGD within 1 day of admission and had increased mortality in cases of AVH. [ABSTRACT FROM AUTHOR]

Satellite-borne synthetic aperture radar (SAR) offers the potential for remotely sensing surface wind speed both over the open sea and in close proximity to the coast. The resolution improvement of SAR over scatterometers is of particular advantage near coasts. Thus, there is a need to verify the performance of SAR wind speed retrieval in coastal environments adjacent to very complex terrain and subject to strong synoptic forcing. Mountainous coasts present a challenge because the wind direction values required for SAR wind speed retrieval algorithms cannot be obtained from global model analyses with as much accuracy there as over the open ocean or adjacent to gentle coasts where most previous SAR accuracy studies have been conducted. The performance of SAR wind speed retrieval in this challenging environment is tested using a 7-yr dataset from the mountainous coast of the Gulf of Alaska. SAR-derived wind speeds are compared with direct measurements from three U.S. Navy Oceanographic Meteorological Automatic Device (NOMAD) buoys. Both of the commonly used SAR wind speed retrieval models, CMOD4 and CMOD5, were tested, as was the impact of correcting the buoy-derived wind speed profile for surface-layer stability. Both SAR wind speed retrieval models performed well although there was some wind speed–dependent bias. This may be either a SAR wind speed retrieval issue or a buoy issue because buoys can underestimate winds as wind speed and thus sea state increase. The full set of tests is performed twice, once using wind directions from the U.S. Navy Operational Global Atmospheric Prediction System (NOGAPS) model analyses and once using wind direction observations from the buoys themselves. It is concluded that useful wind speeds can be derived from SAR backscatter and global model wind directions even in proximity to mountainous coastlines. [ABSTRACT FROM AUTHOR]

The viability of synthetic aperture radar (SAR) as a tool for finescale marine meteorological surface analyses of synoptic-scale fronts is demonstrated. In particular, it is shown that SAR can reveal the presence of, and the mesoscale and microscale substructures associated with, synoptic-scale cold fronts, warm fronts, occluded fronts, and secluded fronts. The basis for these findings is the analysis of some 6000 RADARSAT-1 SAR images from the Gulf of Alaska and from off the east coast of North America. This analysis yielded 158 cases of well-defined frontal signatures: 22 warm fronts, 37 cold fronts, 3 stationary fronts, 32 occluded fronts, and 64 secluded fronts. The potential synergies between SAR and a range of other data sources are discussed for representative fronts of each type. [ABSTRACT FROM AUTHOR]