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Modern consensus panel guidelines recommend restriction from most organized sports for patients with moderate or severe aortic stenosis (AS). However, there is little published data on how frequently physicians deviate from guidelines, how well patients adhere to exercise restrictions, or the effect of restriction on patient-reported quality of life. In this study, we surveyed 93 subjects with AS and their cardiologists regarding participation in organized sports, physical activity, weightlifting, and exercise restriction. Subjects completed the pediatric quality of life inventory (PedsQL) and the pediatric cardiac quality of life inventory (PCQLI). We found that subjects with severe AS (n = 3) were commonly, but not universally, restricted from organized sports (n = 2, 66%). Subjects with moderate AS (n = 40) were rarely restricted from organized sports (n = 6, 17%). No physician-specific characteristics were associated with increased likelihood of recommending exercise restriction. Subjects were more likely to be restricted if they were older (16 years vs. 13 years, p 0.02) and had moderate versus mild AS (p 0.013). PCQLI scores for teens and young adults with AS (age 13–25) were lower than a comparison group of patients with mild congenital heart disease. For all age groups, the PedsQL social functioning score was lower for subjects with exercise restriction (p 0.052). In summary, cardiologists apply consensus guidelines leniently when restricting patients with moderate/severe AS from organized sports and weightlifting. Patients with AS routinely adhere to exercise restriction recommendations. Children and young adults with AS and exercise restriction have lower QOL scores in the social functioning domain. [ABSTRACT FROM AUTHOR]

Breaking atmospheric gravity waves (GWs) in the tropical stratosphere are essential in driving the roughly 2‐year oscillation of zonal winds in this region known as the Quasi‐Biennial Oscillation (QBO). As Global Climate Models (GCM)s are not typically able to directly resolve the spectrum of waves required to drive the QBO, parameterizations are necessary. Such parameterizations often require knowledge of poorly constrained physical parameters. In the case of the spectral gravity parameterization used in this work, these parameters are the total equatorial GW stress and the half width of phase speed distribution. Radiosonde observations are used to obtain the period and amplitude of the QBO, which are compared against values obtained from a GCM. We utilize two established calibration techniques to obtain estimates of the range of plausible parameter values: History matching & Ensemble Kalman Inversion (EKI). History matching is found to reduce the size of the initial range of plausible parameters by a factor of 98%, requiring only 60 model integrations. EKI cannot natively provide any uncertainty quantification but is able to produce a single best estimate of the calibrated values in 25 integrations. When directly comparing the approaches using the Calibrate, Emulate, Sample method to produce a posterior estimate from EKI, history matching produces more compact posteriors with fewer model integrations at lower ensemble sizes compared to EKI; however, these differences become less apparent at higher ensemble sizes. Plain Language Summary: Atmospheric gravity waves (GWs) are buoyancy driven oscillations which propagate through the atmosphere and deposit momentum where they break. This momentum exchange plays a significant role in setting various large‐scale atmospheric phenomena, of which a prominent example is the Quasi‐Biennial Oscillation (QBO), a roughly 2‐year oscillation of winds in the tropical stratosphere. Many of the waves responsible for creating these large scale patterns are too small to be simulated by climate models. Thus, we use parameterizations to estimate their impact on the large scale. These parameterizations have settings that require tuning, to enable the model to produce variability that matches the observed climate. In this work, we utilize and compare two techniques: History matching and Ensemble Kalman Inversion. These methods are combined with observations of the QBO to tune the settings for the GW parameterization. Key Points: History matching and Ensemble Kalman Inversion (EKI) were used to calibrate two parameters in a gravity wave parameterization to Quasi‐Biennial Oscillation observationsHistory matching was found to rapidly and compactly produce an estimate of the plausible space of parameters when compared to EKIEKI was found to be strong at single best estimates of the calibrated parameters at low ensemble sizes requiring few iterations [ABSTRACT FROM AUTHOR]

The climate model hierarchy encompasses models of varying complexity along different axes, ranging from idealized models that elegantly describe isolated mechanisms to fully coupled Earth system models that aspire to provide useable climate projections. Based on the second Model Hierarchies Workshop, which took place in 2022, we present perspectives on how this field has evolved since the first Model Hierarchies Workshop in 2016. In this period, we have witnessed a dramatic increase in the use of (a) machine learning in climate modeling and (b) climate models to estimate risks and influence decision making under climate change. Here, we discuss the implications of these growing areas of research and how we expect them to become integrated into the model hierarchies framework. Plain Language Summary: The climate modeling community often describes the variety of models used to understand and simulate climate processes as a hierarchy in complexity. Simple idealized models exist at the bottom of the hierarchy and are useful for explaining underlying physics, while fully coupled Earth system models exist at the top of the hierarchy and aim to provide useable climate projections. We present perspectives on how the model hierarchy field is evolving, focusing on two noticeable changes in recent years. Firstly, models are increasingly using machine learning, and secondly, there has been a growing interest in the usability of climate models, for instance, for estimating risks associated with climate change. Here, we discuss the implications of these growing areas of interest and how we expect them to become integrated into the model hierarchies framework. Key Points: Inspired by the 2022 Model Hierarchies workshop, we present perspectives on how the field is evolvingFirstly, we note the growing interest in the use of machine learning which presents another way to ascend or descend the model hierarchySecondly, we discuss the role of the model hierarchy for actionable climate science and decision‐making [ABSTRACT FROM AUTHOR]

Central arterial pressure rises to much higher levels during heavy isometric exercise compared to other forms of exercise. For this reason, patients with bicuspid aortic valves (BAV) are often restricted from heavy isometric exercise. Although this approach may be theoretically appealing, no data exist regarding the efficacy of this activity restriction.Patients between 12 and 21 years old with isolated BAV were enrolled if they had a previous echocardiogram at least 2 years prior to the current clinic visit. Patients were excluded if they had additional congenital heart disease, a diagnosed syndrome, or had undergone a procedure involving the aortic valve or ascending aorta. Patients completed a questionnaire regarding frequency and intensity of isometric exercise during the 3-month period prior to the visit. We compared aortic dimensions (Z-score), aortic stenosis, and aortic insufficiency between an echocardiogram performed as part of the current visit and one obtained 2–5 years previously using paired t tests and multivariable regression controlling for age, gender, degree of aortic stenosis, and the presence of isometric exercise. In this sample of 50 adolescents with isolated bicuspid aortic valve, 30 (60%) subjects did not participate in any isometric exercise. Over an average of 2.9 years (SD 0.9 years), we did not find a significant difference between changes in the Z-score diameters of the aortic root (0.9 vs 0.9, p = 0.913) and ascending aorta Z-score (2.9 vs 2.9, p = 0.757), between subjects engaging and not engaging in isometric exercise. Further, we did not find that changes in valve function (i.e., aortic stenosis and aortic insufficiency) differed between the two groups.In this sample of adolescents with isolated bicuspid aortic valve, there was no medium-term increase in aortic dilation or worsening valve function in those who engaged in isometric exercise versus those who refrained from isometric exercise. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had a dramatic impact on practicing physicians, with effects in clinical practice, academic pursuits, research endeavors, and personal lives. Women in medicine have been uniquely impacted. We examined the impact of the pandemic on the careers of pediatric cardiologists in the Northeast with an anonymous online survey. Participants reported demographic data, information on work hours, administrative burden, career satisfaction, academic productivity, and burnout. We approached 490 cardiologists and received 127 completed surveys (response rate 26%; 49% female). Among all respondents, 72% reported increased burnout, 43% reported decreased career satisfaction, and 57% reported decreased academic productivity. In multivariable ordinal regression analysis, when compared to male physicians, females were 2.4 times more likely to report decreased overall career satisfaction (p = 0.027), 2.6 times more likely to report decreased academic productivity (p = 0.028), and 2.6 times more likely to report increased feelings of burnout "to a large degree" (p = 0.022). Among all respondents, decreased career satisfaction was independently associated with increased household responsibility (OR = 4.4, p = 0.001). Increased administrative burden was independently associated with decreased academic productivity (OR = 2.6, p = 0.038). Open-ended responses highlighted loss of community due to remote work and blurring of the boundaries between work and home. Conversely, respondents appreciated flexibility to work remotely. In conclusion, the majority of pediatric cardiologists in the Northeast experienced negative career impacts due to the COVID-19 pandemic. Important gender differences emerged, with female physicians disproportionately reporting increased burnout, decreased career satisfaction, and decreased academic productivity. [ABSTRACT FROM AUTHOR]

The article "Correction: Isometric Exercise Does Not Affect the Diameter of the Ascending Aorta in Youth with Bicuspid Aortic Valves" published in Pediatric Cardiology corrects a previous error in the title, which mistakenly stated that isometric exercise increases the diameter of the ascending aorta in youth with bicuspid aortic valves. The corrected title clarifies that isometric exercise does not have this effect. The study was conducted by researchers from Harvard Medical School and Boston Children's Hospital in the USA. [Extracted from the article]

Gender disparities for female physicians in academic medicine are longstanding. Female pediatric cardiologists experience inequities in scholarship opportunities, promotion, leadership positions, and compensation. Mentorship groups have been successfully implemented in other subspecialities with promising results. We created a peer mentorship group for female pediatric cardiologists in the Northeast and completed a needs assessment survey of eligible participants. Our goal was to better understand the current challenges and identify resources to overcome these barriers. Our objectives were to (1) describe the creation of a novel mentorship program for female pediatric cardiologists and trainees in the Northeast United States, and (2) report the results of a formal needs assessment survey of all eligible participants. All female pediatric cardiology fellows and practicing pediatric and adult congenital heart disease specialists from 15 academic centers in New England were invited to join a free group with virtual meetings. A formal needs assessment survey was provided electronically to all eligible members. The vast majority of respondents agreed that the Women in Pediatric Cardiology (WIPC) group is a valuable networking and mentorship experience (90%) and would recommend this group to a colleague (95%). Members have witnessed or experienced inequities in a broad range of settings. Common challenges experienced by respondents include dependent care demands, lack of mentorship, inadequate research support, and inequitable clinical responsibilities. Resources suggested to overcome these barriers include mentorship, sponsorship, transparency in compensation, and physician coaching. Mentorship groups have the potential to address many challenges faced by women in medicine. The WIPC Northeast program provides a forum for community, collaboration, education, and scholarship. [ABSTRACT FROM AUTHOR]

By the Summer of 1945, the 4-year University of Alabama School of Medicine had been established in Birmingham at the 17-story Jefferson Hospital. This school provided the 2 year basic science program, originally available in TuscaIoosa, as well as the final 2 years of medical training that had not formerly existed within the state, which comprised the seed that would grow into the University of Alabama at Birmingham (UAB). Students who wish to expand their experience outside Alabama may participate in the Medical Student Enrichment Program, which provides service and training opportunities in developing countries and underserved areas throughout the world.

For the 2008 Folkestone Triennial artists Heather and Ivan Morsion developed the work Tales of Time and Space, transforming a 1954 Green Goddess fire engine into a self-sufficient house truck and library. The library was comprised entirely of apocalypse-themed fiction with the interior’s soft furnishings fashioned from atomic era fabric. Housing a library that contained various visions of the future, the fictional accounts served as handbooks for the occupant—presenting a playful take on how to survive the coming apocalypse. Throughout the duration of the Triennial, the mobile library parked at different sites across Folkstone, inviting local residents to spend time inside, browsing through the collection of dystopian science-fiction whilst enjoying a nice cup of tea brewed on the truck's wood burning stove. The artwork draws on both a tradition of West Coast American house trucks, in particular the Californian New American Gypsy Movement, which sought to escape modern society and a history of mobile libraries. Reflecting upon the Morison’s work the essay discusses a notion of the library as a space of both escape and home. [ABSTRACT FROM PUBLISHER]