Search Results (10)

Background/Objectives: The administration of propofol without an anesthesiologist (NAAP) during endoscopic procedures is generally considered safe. However, the available data remain limited and fragmented due to legal constraints. This systematic review and meta-analysis aimed to evaluate the incidence of adverse events in adults undergoing procedural sedation with NAAP. Methods: A comprehensive search was conducted in three electronic databases (MEDLINE, EMBASE, and the Cochrane Library) for studies published between 2010 and 2023. Eligible studies included randomized controlled trials and observational studies that reported predefined adverse events in adult patients receiving NAAP for procedural sedation. The analysis encompassed various types of endoscopic procedures and sedation protocols, including both balanced sedation and propofol monotherapy. Clinical heterogeneity was assessed by comparing patient characteristics, sedation methods, and outcome measures across studies. A random effects model was used for the meta-analysis, with results presented as estimated incidence rates. Subgroup analyses were conducted based on the hypoxia severity, sedation approach, and procedure type. Results: The search yielded 2963 records, of which 73 studies met the inclusion criteria, covering a total of 967,238 procedural sedations. Hypoxia was the most frequently reported adverse event, occurring in 40‰ of cases, followed by hypotension (38‰) and bradycardia (9‰). Severe adverse events requiring emergency intervention were rare, with an incidence of 0.12‰. The subgroup analysis indicated a low occurrence (6‰) of severe desaturation (SpO₂ < 80%) and no significant differences in adverse event rates between balanced propofol sedation and propofol-only sedation. However, advanced endoscopic procedures (EUS, ERCP, PEG, enteroscopy, EMR/ESD) were associated with a higher risk of hypoxia (10% vs. 26‰; p < 0.00001) and major complications (3.1‰ vs. 0.1‰; p = 0.015) compared to diagnostic procedures. Conclusions: NAAP-based procedural sedation appears to be generally safe. While the minor adverse event rates vary depending on the sedation regimen and procedure type, major complications remain exceptionally rare. Full article

Agriculture crop residue burning has become a major environmental problem facing the Indo-Gangetic plain, as well as contributing to global warming. This paper reports the results of a comprehensive study, examining the variations in aerosol optical, microphysical, and radiative properties that occur during biomass-burning events at Amity University Haryana (AUH), at a rural station in Gurugram (Latitude: 28.31° N, Longitude: 76.90° E, 285 m AMSL), employing ground-based observations of AERONET and Aethalometer, as well as satellite and model simulations during 7–16 November 2021. The smoke emissions during the burning events enhanced the aerosol optical depth (AOD) and increased the Angstrom exponent (AE), suggesting the dominance of fine-mode aerosols. A smoke event that affected the study region on 11 November 2021 is simulated using the regional NAAPS model to assess the role of smoke in regional aerosol loading that caused an atmospheric forcing of 230.4 W/m². The higher values of BC (black carbon) and BB (biomass burning), and lower values of AAE (absorption Angstrom exponent) are also observed during the peak intensity of the smoke-event period. A notable layer of smoke has been observed, extending from the surface up to an altitude of approximately 3 km. In addition, the observations gathered from CALIPSO regarding the vertical profiles of aerosols show a qualitative agreement with the values obtained from AERONET observations. Further, the smoke plumes that arose due to transport of a wide-spread agricultural crop residue burning are observed nationwide, as shown by MODIS imagery, and HYSPLIT back trajectories. Thus, the present study highlights that the smoke aerosol emissions during crop residue burning occasions play a critical role in the local/regional aerosol microphysical and radiation properties, and hence in the climate variability. Full article

Between 14 March and 21 April 2022, an extensive investigation of an extraordinary Saharan dust intrusion over Europe was performed based on lidar measurements obtained by the European Aerosol Research Lidar Network (EARLINET). The dust episode was divided into two distinct periods, one in March and one in April, characterized by different dust transport paths. The dust aerosol layers were studied over 18 EARLINET stations, examining aerosol characteristics during March and April in four different regions (M-I, M-II, M-III, and M-IV and A-I, A-II, A-III, and A-IV, respectively), focusing on parameters such as aerosol layer thickness, center of mass (CoM), lidar ratio (LR), particle linear depolarization ratio (PLDR), and Ångström exponents (ÅE). In March, regions exhibited varying dust geometrical and optical properties, with mean CoM values ranging from approximately 3.5 to 4.8 km, and mean LR values typically between 36 and 54 sr. PLDR values indicated the presence of both pure and mixed dust aerosols, with values ranging from 0.20 to 0.32 at 355 nm and 0.24 to 0.31 at 532 nm. ÅE values suggested a range of particle sizes, with some regions showing a predominance of coarse particles. Aerosol Optical Depth (AOD) simulations from the NAAPS model indicated significant dust activity across Europe, with AOD values reaching up to 1.60. In April, dust aerosol layers were observed between 3.2 to 5.2 km. Mean LR values typically ranged from 35 to 51 sr at both 355 nm and 532 nm, while PLDR values confirmed the presence of dust aerosols, with mean values between 0.22 and 0.31 at 355 nm and 0.25 to 0.31 at 532 nm. The ÅE values suggested a mixture of particle sizes. The AOD values in April were generally lower, not exceeding 0.8, indicating a less intense dust presence compared to March. The findings highlight spatial and temporal variations in aerosol characteristics across the regions, during the distinctive periods. From 15 to 16 March 2022, Saharan dust significantly reduced UV-B radiation by approximately 14% over the ATZ station (Athens, GR). Backward air mass trajectories showed that the dust originated from the Western and Central Sahara when, during this specific case, the air mass trajectories passed over GRA (Granada, ES) and PAY (Payerne, CH) before reaching ATZ, maintaining high relative humidity and almost stable aerosol properties throughout its transport. Lidar data revealed elevated aerosol backscatter (b_aer) and PLDR values, combined with low LR and ÅE values, indicative of pure dust aerosols. Full article

Dust storms create some of the most critical air quality problems in the world; the Middle East, located in the dust belt, suffers substantially from dust storms. Iran, as a country in the Middle East, is affected by dust storms from multiple internal and external sources that mostly originate from deserts in Iraq and Syria (especially the Mesopotamia region). To determine the highest dust loadings in the south and west of Iran, dust frequencies were investigated in the eight most polluted stations in the west, southwest, and southern Iran for a period of 21 years from 2000 to 2021. During the study’s duration, the dust frequency was much higher from 2008 to 2012, which coincided with severe droughts reported in Iraq and Syria; from which, we investigated two severe dust storms (as well as the dust sources and weather condition effects) that took place on 15–17 September 2008 and 1–3 June 2012; we used secondary data from ground measurement stations, and satellite and modeling products. In both cases, horizontal visibility was reduced to less than 1 km at most weather stations in Iran. The measured $P{M}_{10}$ in the first case reached 834 μg m⁻³ at Ilam station in west Iran and the Iran–Iraq borders while the measured $P{M}_{10}$ in the second case reached 4947 μg m⁻³ at Bushehr station in the northern shore of the Persian Gulf. The MODIS true color images and MODIS AOD detected the dust mass over Iraq, southern Iran, and Saudi Arabia in both cases; the AOD value reached 4 in the first case and 1.8 in the second case over the Persian Gulf. During these two severe dust storms, low-level jets were observed at 930 hPa atmospheric levels in north Iraq (2008 case) and south Iraq (2012 case). The output of the NAPPS model and CALIPSO satellite images show that the dust rose to higher than 5 km in these dust storm cases, confirming the influence of Shamal wind on the dust storm occurrences. Full article

Smoke aerosol dispersion and transport have a significant impact on air quality levels and can be examined by environmental monitoring and modelling techniques. The purpose of this study is to determine the characteristics of the smoke aerosols and the level of air quality during November and December 2019 under the influence of extensive bushfires in the Sydney area, New South Wales (NSW), Australia. To achieve this goal, air quality and meteorological data were analysed in combination with remote sensing satellite measurements. Meteorological and air quality data were obtained from the Bureau of Meteorology (BOM) and Environmental Protection Agency monitoring sites in NSW. In Richmond the daily maximum average hourly concentration of particulate matter (PM₁₀) was 848.9 μg/m³ at 07:00 UTC on 26 November 2019 and 785 μg/m³ at 07:00 UTC on 12 December 2019. On 10 December 2019, the highest PM₁₀ recorded in the Sydney region was 961.5 μg/m³ in St Marys at 01:00 UTC, while the highest PM_2.5 concentration was 714.6 μg/m³ in Oakdale in southwest Sydney at 18:00 UTC. These values all decreased again to the standard level (<50 μg/m³) in a few days. The potential sources of smoke aerosols originated from bushfires to the northwest of Sydney (Blue Mountains) as well as from southwest and northwest NSW. The smoke plumes were revealed by the combined AOD values from Aqua and Terra sensors on the MODIS satellite. In each case, the smoke travelled towards the east coast of Australia and out over the Pacific Ocean. The NAAPS model displays the existence of smoke at ground level, while the CALIPSO satellite data showed that the plumes extended 14 km up into the stratosphere layer. Backward trajectories obtained from the HYSPLIT model agree well with the movement of smoke plumes observed in the MODIS satellite images. Full article

A significant concern for public health and visibility is airborne particulate matter, especially during extreme events. Of most relevance for health, air quality, and climate is the role of fine aerosol particles, specifically particulate matter with aerodynamic diameters less than or equal to 2.5 micrometers (PM_2.5). The purpose of this study was to examine PM_2.5 extreme events between 1989 and 2018 at Mesa Verde, Colorado using Interagency Monitoring of Protected Visual Environments (IMPROVE) monitoring data. Extreme events were identified as those with PM_2.5 on a given day exceeding the 90th percentile value for that given month. We examine the weekly, monthly, and interannual trends in the number of extreme events at Mesa Verde, in addition to identifying the sources of the extreme events with the aid of the Navy Aerosol Analysis and Prediction (NAAPS) aerosol model. Four sources were used in the classification scheme: Asian dust, non-Asian dust, smoke, and “other”. Our results show that extreme PM_2.5 events in the spring are driven mostly by the dust categories, whereas summertime events are influenced largely by smoke. The colder winter months have more influence from “other” sources that are thought to be largely anthropogenic in nature. No weekly cycle was observed for the number of events due to each source; however, interannual analysis shows that the relative amount of dust and smoke events compared to “other” events have increased in the last decade, especially smoke since 2008. The results of this work indicate that, to minimize and mitigate the effects of extreme PM_2.5 events in the southwestern Colorado area, it is important to focus mainly on smoke and dust forecasting in the spring and summer months. Wintertime extreme events may be easier to regulate as they derive more from anthropogenic pollutants accumulating in shallow boundary layers in stagnant conditions. Full article

Wildfire occurrence and severity in the Mediterranean region during the summer season is increasing, being favoured by climate change-induced conditions (i.e., drought, heatwaves). Moreover, additional natural sources frequently impact this region, particularly Saharan dust intrusions. This study focuses on the combined effect of wildfires and Saharan dust on the air quality of the central Mediterranean Basin (CMB) during 2017, an exceptional year for forested burned areas in southern Italy. The annual behaviors of PM_2.5, PM₁₀, CO, benzene, and benzo(a)pirene measurements that were recorded at a rural regional-background station located in southern Italy, highlighted a concentration increase during summer. Both Saharan dust and wildfire events were identified while using Navy Aerosol Analysis and Prediction System (NAAPS) model maps, together with high-resolution Weather Research and Forecast—Hybrid Single-Particle Lagrangian Integrated Trajectory (WRF-HYSPLIT) back-trajectories. Additionally, Visible Infrared Imaging Radiometer Suite (VIIRS) satellite detections were considered to establish the enrichment of air masses by wildfire emissions. Finally, the occurrence of these natural sources, and their influence on particulate matter, were examined. In this case study, both PM_2.5 and PM₁₀ exceedances occurred predominantly in conjunction with wildfire events, while Saharan dust events mainly increased PM₁₀ concentration when overlapping with wildfire effects. Full article

It has been revealed from the Modern-Era Retrospective analysis for Research and Applications MERRA analyses, Moderate Resolution Imaging Spectroradiometer MODIS/Terra satellite imageries, Naval Aerosol Analysis and Prediction System NAAPS model outputs, Cloud –Aerosol Lidar and Infrared Pathfinder Satellite Observations CALIPSO imageries, Hybrid Single Particle Lagrangian Integrated Trajectory HYSPLIT model trajectories, atmospheric soundings, and observational records of dust emission that there were multiple dust storms in the far western parts of India from 12 to 15 June 2018 due to thunderstorms. This led to the lifting of the dust from the surface. The entry of dust into the upper air was caused by the generation of a significant amount of turbulent kinetic energy as a function of strong wind shear generated by the negative buoyancy of the cooled air aloft and the convective buoyancy in the lower planetary boundary layer. Elevated dust reached a significant vertical height and was advected towards the northern/northwestern/northeastern parts of India. In the meantime, this dust was carried by northwesterly winds associated with the jets in the upper level, which advected dust towards the skies over Nepal where rainfall was occurring at that time. Consequently, this led to the muddy rain in Nepal. Full article

During August 2016, a quasi-stationary high-pressure system spreading over Central and North-Eastern Europe, caused weather conditions that allowed for 24/7 observations of aerosol optical properties by using a complex multi-wavelength PollyXT lidar system with Raman, polarization and water vapour capabilities, based at the European Aerosol Research Lidar Network (EARLINET network) urban site in Warsaw, Poland. During 24–30 August 2016, the lidar-derived products (boundary layer height, aerosol optical depth, Ångström exponent, lidar ratio, depolarization ratio) were analysed in terms of air mass transport (HYSPLIT model), aerosol load (CAMS data) and type (NAAPS model) and confronted with active and passive remote sensing at the ground level (PolandAOD, AERONET, WIOS-AQ networks) and aboard satellites (SEVIRI, MODIS, CATS sensors). Optical properties for less than a day-old fresh biomass burning aerosol, advected into Warsaw’s boundary layer from over Ukraine, were compared with the properties of long-range transported 3–5 day-old aged biomass burning aerosol detected in the free troposphere over Warsaw. Analyses of temporal changes of aerosol properties within the boundary layer, revealed an increase of aerosol optical depth and Ångström exponent accompanied by an increase of surface PM₁₀ and PM_2.5. Intrusions of advected biomass burning particles into the urban boundary layer seem to affect not only the optical properties observed but also the top height of the boundary layer, by moderating its increase. Full article

During an exceptionally warm September in 2016, unique and stable weather conditions contributed to a heat wave over Poland, allowing for observations of aerosol optical properties, using a variety of ground-based and satellite remote sensors. The data set collected during 11–16 September 2016 was analysed in terms of aerosol transport (HYbrid Single-Particle Lagrangian Integrated Trajectory model (HYSPLIT)), aerosol load model simulations (Copernicus Atmosphere Monitoring Service (CAMS), Navy Aerosol Analysis and Prediction System (NAAPS), Global Environmental Multiscale-Air Quality (GEM-AQ), columnar aerosol load measured at ground level (Aerosol Robotic NETwork (AERONET), Polish Aerosol Research Network (PolandAOD)) and from satellites (Spinning Enhanced Visible and Infrared Imager (SEVIRI), Moderate Resolution Imaging Spectroradiometer (MODIS)), as well as with 24/7 PollyXT Raman Lidar observations at the European Aerosol Research Lidar Network (EARLINET) site in Warsaw. Analyses revealed a single day of a relatively clean background aerosol related to an Arctic air-mass inflow, surrounded by a few days with a well increased aerosol load of differing origin: pollution transported from Germany and biomass burning from Ukraine. Such conditions proved excellent to test developed-in-house algorithms designed for near real-time aerosol optical depth (AOD) derivation from the SEVIRI sensor. The SEVIRI AOD maps derived over the territory of Poland, with an exceptionally high resolution (every 15 min; 5.5 × 5.5 km²), revealed on an hourly scale, very low aerosol variability due to heat wave conditions. Comparisons of SEVIRI with NAAPS and CAMS AOD maps show strong qualitative similarities; however, NAAPS underestimates AOD and CAMS tends to underestimate it on relatively clean days (<0.2), and overestimate it for a high aerosol load (>0.4). A slight underestimation of the SEVIRI AOD is reported for pixel-to-column comparisons with AODs of several radiometers (AERONET, PolandAOD) and Lidar (EARLINET) with high correlation coefficients (r² of 0.8–0.91) and low root-mean-square error (RMSE of 0.03–0.05). A heat wave driven increase of the boundary layer height of 10% is accompanied with the AOD increase of 8–12% for an urban site dominated by anthropogenic pollution. Contrary trend, with an AOD decrease of around 4% for a rural site dominated by a long-range transported biomass burning aerosol is reported. There is a positive feedback of heat wave conditions on local and transported pollution and an extenuating effect on transported biomass burning aerosol. The daytime mean SEVIRI PM2.5 converted from the SEVIRI AODs at a pixel representative for Warsaw is in agreement with the daily mean PM2.5 surface measurements, whereby SEVIRI PM2.5 and Lidar-derived Ångström exponent are anti-correlated. Full article