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Background: Clinically assisted nutrition and hydration via percutaneous endoscopic gastrostomy (PEG) is a therapeutic option to ameliorate the difficulties associated with enhanced catabolism, weight loss, and dysphagia in Huntington's disease (HD). Objectives: The objective is to provide insights into demographics, staging (Shoulson‐Fahn), complications, weight trajectories, and survival rates in people with HD (pwHD) who underwent PEG. Methods: This retrospective study included 705 consecutive pwHD who attended our HD clinic between July 2006 and March 2024, of whom 52 underwent PEG. A control group (n = 52), comprising pwHD without PEG, were closely matched for sex, stage, age, CAG length, and disease burden score at PEG. The study was registered as a service evaluation at the National Hospital for Neurology and Neurosurgery. Results: PEG prevalence was 15.0% (n = 52/347) among manifest pwHD: 4.8% (n = 3/62) for Stage 3; 33.3% (n = 16/48) for stage 4; and 44.1% (n = 30/68) for stage 5. Commonest indications were dysphagia, weight loss, and inadequate oral intake. Complications included chest infection, tube dislodgement, and peristomal and skin infections. Modeling of weight trajectories after PEG found no difference between PEG and non‐PEG groups. Mortality rate was 34.6% (n = 18/52) in the PEG and 36.5% (n = 19/52) in the non‐PEG groups (P = 0.84). Treatment duration (until study endpoint or death) was 3.48 years (interquartile range = 1.71–6.02; range = 0.23–18.8), with 65.4% (n = 34/52) alive at the study endpoint. Conclusion: PEG in pwHD at‐risk for weight loss may help slow weight loss. Prospective studies are required to strengthen PEG decision‐making in pwHD. PEG survival was much longer than other dementias, highlighting the need to consider PEG independently in pwHD. [ABSTRACT FROM AUTHOR]

The article provides an overview of the use of Global Navigation Satellite System (GNSS) polarimetric radio occultation (PRO) measurements for weather prediction and applications. It summarizes a workshop that brought together participants from various countries to discuss the status and potential of PRO. The article highlights the benefits of PRO in improving weather forecasts and validating cloud microphysical processes. It also discusses ongoing experiments and the potential use of PRO observations in weather forecasting, climate modeling, and evaluating satellite precipitation products. The article also mentions the consideration of future constellations of small satellites for PRO measurements. [Extracted from the article]

An inventory survey of the bird fauna of a small (462 ha) riverine woodland remnant on the Wakool River in the Riverina bioregion in southern inland New South Wales in 2021-2023 recorded 123 species (31 waterbirds and 92 woodland birds) including residents, flood visitors, spring/summer latitudinal migrants and autumn/winter altitudinal migrants. The conservation values of this remnant include habitat value for 22 NSW declining woodland bird species, one waterbird species of conservation concern in NSW, and an additional 9 species (3 woodland birds and 6 waterbirds) of conservation concern in nearby Victoria, as well as landscape connectivity value as part of a major riverine wildlife corridor. Several declining woodland bird species exhibited apparent local preferences for particular vegetation communities, including Gilbert's Whistler Pachycephala inornata (River Red Gum Eucalyptus camaldulensis Forest and Mixed Box-Gum Woodland) and Hooded Robin Melanodryas cucullata (Black Box Eucalyptus largiflorens Woodland). This study highlights the complementary value of small remnants for biodiversity conservation in extensively cleared landscapes and the connectivity role of riverine corridors in these landscapes. [ABSTRACT FROM AUTHOR]

Context: The decline of birds in farmland is of global concern. Aims. The aim of this paper was to provide a local-scale case study of the bird fauna of temperate inland eastern Australia's sheep-wheat belt. Methods. Relationships between species occurrence and various habitat elements in the landscape were examined in a 342 km2 area of agricultural countryside near Wagga Wagga in southern inland New South Wales, Australia. The pre-agricultural bird fauna of this area was also investigated by collating records from previous studies of nearby larger woodland remnants. Key results: The study identified a bird fauna of 115 species compared to 160 species known from nearby woodland remnants. Significant relationships were found with the presence of farm dams, extent of local woodland cover and roadside woodland at the levels of individual species, guilds and total fauna. A small ephemeral wetland also contributed substantially to waterbird diversity. Conclusion. Twenty commonly recorded species typical of the farmland matrix and 15 species considered at particular risk of local extinction were identified. At the guild level, frugivore/granivores, small insectivores and hollow-users were found to be associated with remaining woodland elements in the agricultural landscape. Implications. Ecologically sustainable management of agricultural areas is essential to avoid further local extinctions. Hollow-using species are expected to be particularly affected by the anticipated widespread loss of trees in the landscape over the next century. [ABSTRACT FROM AUTHOR]

Global Navigation Satellite System Interferometric Reflectometry (GNSS‐IR) measures water level using the interference pattern in signal‐to‐noise ratio (SNR) from direct and reflected signals off the sea surface, retrieved from standard geodetic antennas. Significant wave height is also measured by determining the satellite elevation angles where reflections become incoherent. We developed an approach for standard geodetic antennas to simultaneously measure sea levels and waves using a criterion for identifying coherent reflections. We tested the method at an exposed coastal environment at the E.B. Scripps Memorial Pier in California. The 1‐year test captures a broad range of sea states and benefits from several co‐located standard oceanographic sensors. By including GPS, Galileo, and GLONASS observations, the retrieval rate increases by a factor of ∼2 over GPS alone. Uncorrected water levels are estimated with a root‐mean‐square (RMS) error of 18.2 cm with respect to a conventional tide gauge. We further developed a simplified correction to remove the effect of phenomena altering the SNR oscillatory frequency and phase, which reduces RMS errors to 9.4 cm. We estimate the significant wave height with 15 cm RMS error with respect to a traditional wave gauge. The method, however, requires a short calibration. We find the wave height errors increase abruptly beyond a fixed limit when high waves are present, that may be a result of the particular deployment geometry. With this caveat, the technology could be useful to deploy in under‐sampled regions affected by compounded coastal hazards, such as in areas affected by tropical cyclones and flooding. Plain Language Summary: Signals from Global Navigation Satellite Systems (GNSS), such as the Global Positioning System (GPS), that reflect off the ocean surface, when compared to signals that arrive directly at the antenna, reveal variations in signal strength that can be used to determine the elevation of the ocean surface. When the satellite elevation angle is too high above the horizon, the method to measure sea level no longer works. However, observing the elevation angle where this transition occurs allows us to measure the height of the waves that are preventing a strong reflected signal from being recorded. We develop criteria for obtaining the closest agreement between the GNSS‐IR observations and the tide and wave gauge instruments on the Ellen Browning Scripps Memorial Pier in southern California over a 1 year period. Because it simultaneously measures changes in sea level and wave height, the method could be useful for measuring coastal hazards such as storm surge and flooding from hurricanes. Key Points: A new approach simultaneously estimates water level and wave height using Global Navigation Satellite System observations in the Pacific high wave coastal environmentLevels are determined with 9.4 cm error (RMS) and the astronomic tide (with a range over 2 m) is determined with 5.9 cm error, with respect to a traditional gaugeGiven a short calibration, significant wave height achieves an RMS error of 15 cm compared to a traditional gauge [ABSTRACT FROM AUTHOR]

Current climate models have difficulty representing realistic wave–mean flow interactions, partly because the contribution from waves with fine vertical scales is poorly known. There are few direct observations of these waves, and most models have difficulty resolving them. This observational challenge cannot be addressed by satellite or sparse ground-based methods. The Strateole-2 long-duration stratospheric superpressure balloons that float with the horizontal wind on constant-density surfaces provide a unique platform for wave observations across a broad range of spatial and temporal scales. For the first time, balloon-borne Global Navigation Satellite System (GNSS) radio occultation (RO) is used to provide high-vertical-resolution equatorial wave observations. By tracking navigation signal refractive delays from GPS satellites near the horizon, 40–50 temperature profiles were retrieved daily, from balloon flight altitude (∼20 km) down to 6–8 km altitude, forming an orthogonal pattern of observations over a broad area (±400 –500 km) surrounding the flight track. The refractivity profiles show an excellent agreement of better than 0.2 % with co-located radiosonde, spaceborne COSMIC-2 RO, and reanalysis products. The 200–500 m vertical resolution and the spatial and temporal continuity of sampling make it possible to extract properties of Kelvin waves and gravity waves with vertical wavelengths as short as 2–3 km. The results illustrate the difference in the Kelvin wave period (20 vs. 16 d) in the Lagrangian versus ground-fixed reference and as much as a 20 % difference in amplitude compared to COSMIC-2, both of which impact estimates of momentum flux. A small dataset from the extra Galileo, GLONASS, and BeiDou constellations demonstrates the feasibility of nearly doubling the sampling density in planned follow-on campaigns when data with full equatorial coverage will contribute to a better estimate of wave forcing on the quasi-biennial oscillation (QBO) and improved QBO representation in models. [ABSTRACT FROM AUTHOR]

The features of Leyendecker's paintings often cited as "coded" or homoerotic - curious positioning of models, homosocial spaces/activities, sartorial semiotics - were common in advertising and other print media in the years that Leyendecker worked. Coded: The Hidden Love of J. C. Leyendecker, directed by Ryan White (New York: Imagine Documentaries, 2021), 28 min. But Leyendecker's commissions declined over the 1930s, which the film attributes to less advertising work during the Depression and industry discrimination due to Leyendecker's homosexuality. [Extracted from the article]

Cytokine RNA in situ hybridization permits individualized molecular phenotyping in biopsies of psoriasis and atopic dermatitis. We describe a unique case of dupilumab-induced psoriasis in the setting of ICPi-associated dermatitis, characterized the immunologic cytokine profiles, and successfully treated ICPi-associated psoriasis with apremilast. Immune checkpoint inhibitors (ICPis) are associated with eczematous reactions that may be treated with dupilumab in corticosteroid-resistant cases.[1] There are also mounting reports of dupilumab triggering or exacerbating psoriasis when used for presumed atopic dermatitis.[2] Here we report a case of eczematous dermatitis associated with pembrolizumab therapy successfully treated with dupilumab that was followed by the development of psoriasis and characterize the cytokine profiles of biopsy specimens before and after dupilumab. [Extracted from the article]

Psoriasis and sarcoidosis are inflammatory skin and systemic diseases that may share a similar immunopathogenesis involving a Th1 and/or Th17 polarized immune response. Although the coexistence of sarcoidosis and psoriasis in the same individuals has been reported, the potential association between these diseases at a population-level in the United States has not been evaluated. To evaluate this association, we performed a matched cross-sectional study in the All of Us research program database. In the multivariable analysis of 4932 psoriasis cases and 19,728 controls, sarcoidosis was found to be significantly associated with psoriasis (OR 2.37 [95% CI 1.73–3.23], p < 0.001). The relative strength of this association between psoriasis and sarcoidosis may be, in part, explained by overlapping immunopathogenesis and common genetic susceptibility of these diseases. Taken together, these observations underscore the need for screening psoriasis patients for development of new cardiopulmonary symptoms. Further research into the mechanism of this relationship and its implications is warranted. [ABSTRACT FROM AUTHOR]

To test our hypothesis of whether the eccrine syringometaplasia may be related to the presence of mpox viral particles within eccrine ducts, we identified a second case of PCR-confirmed mpox viral infection for which skin biopsy tissue was available. Importantly, we observed in two patients with PCR-confirmed mpox virus infection squamous syringometaplasia of the eccrine ducts, a finding that can aid in recognizing this disease, and is explained by the demonstration of viral mRNA within eccrine epithelium by ISH. Https://doi.org/10.1093/bjd/ljac146 Dear Editor, We report two cases of cutaneous mpox virus infection (formerly known as monkeypox),[1],[2] one of which presented with unusual clinical findings, and demonstrate their histopathological, RNA I in situ i hybridization (ISH) and ultrastructural characteristics. [Extracted from the article]

Sarcoidosis is an idiopathic inflammatory disorder that is commonly treated with glucocorticoids. An imprecise understanding of the immunologic changes underlying sarcoidosis has limited therapeutic progress. Here in this open-label trial (NCT03910543), 10 patients with cutaneous sarcoidosis are treated with tofacitinib, a Janus kinase inhibitor. The primary outcome is the change in the cutaneous sarcoidosis activity and morphology instrument (CSAMI) activity score after 6 months of treatment. Secondary outcomes included change in internal organ involvement, molecular parameters, and safety. All patients experience improvement in their skin with 6 patients showing a complete response. Improvement in internal organ involvement is also observed. CD4+ T cell-derived IFN-γ is identified as a central cytokine mediator of macrophage activation in sarcoidosis. Additional type 1 cytokines produced by distinct cell types, including IL-6, IL-12, IL-15 and GM-CSF, also associate with pathogenesis. Suppression of the activity of these cytokines, especially IFN-γ, correlates with clinical improvement. Our results thus show that tofacitinib treatment is associated with improved sarcoidosis symptoms, and predominantly acts by inhibiting type 1 immunity. Sarcoidosis is a heterogenous disorder often treated with glucocorticoids. Here the authors show, in an open label, non-randomized, single arm clinical trial involving 10 patients, that treatment with tofacitinib, a Janus kinase inhibitor, is associated with improved clinical symptoms and reduced activity of Th1 cytokines such as IFN-γ and IL-12. [ABSTRACT FROM AUTHOR]

Current climate models have difficulty representing realistic wave-mean flow interactions, partly because the contribution from waves with fine-vertical scales is poorly known. There are few direct observations of these waves and most models have difficulty resolving them. This observational challenge cannot be addressed by satellite or sparse ground-based methods. The Strateole-2 long-duration stratospheric superpressure balloons that drift with the horizontal wind on constant density surfaces provide a unique platform for wave observations across a broad range of spatial and temporal scales. For the first time, balloon-borne Global Navigation Satellite System (GNSS) radio occultation (RO) is used to provide high vertical resolution equatorial wave observations. By tracking navigation signal refractive delays from GPS satellites near the horizon, 40-50 temperature profiles were retrieved daily, from balloon flight altitude (~20 km) down to 6-8 km altitude, forming an orthogonal pattern of observations over a broad area (±400-500 km) surrounding the flight track. The refractivity profiles show an excellent agreement of better than 0.2 % with co-located radiosonde, spaceborne COSMIC-2 RO and reanalysis products. The 200-500 m vertical resolution and consecutive sampling in time and space make it possible to extract properties of Kelvin waves to shorter period gravity waves with vertical wavelengths as short as 2-3 km. A short dataset from the extra Galileo and GLONASS constellations demonstrates the feasibility to nearly double the sampling density in planned follow-on campaigns. The results will contribute to improved estimates of momentum forces for wave driving of the Quasi-biennial Oscillation (QBO) and improved QBO representation in models, and illustrate the importance of measuring intrinsic period in the Lagrangian reference frame. [ABSTRACT FROM AUTHOR]

Current climate models have difficulty representing realistic wave-mean flow interactions, partly because the contribution from waves with fine-vertical scales is poorly known. There are few direct observations of these waves and most models have difficulty resolving them. This observational challenge cannot be addressed by satellite or sparse ground-based methods. The Strateole-2 long-duration stratospheric superpressure balloons that drift with the horizontal wind on constant density surfaces provide a unique platform for wave observations across a broad range of spatial and temporal scales. For the first time, balloon-borne Global Navigation Satellite System (GNSS) radio occultation (RO) is used to provide high vertical resolution equatorial wave observations. By tracking navigation signal refractive delays from GPS satellites near the horizon, 40–50 temperature profiles were retrieved daily, from balloon flight altitude (∼20 km) down to 6–8 km altitude, forming an orthogonal pattern of observations over a broad area (±400–500 km) surrounding the flight track. The refractivity profiles show an excellent agreement of better than 0.2 % with co-located radiosonde, spaceborne COSMIC-2 RO and reanalysis products. The 200–500 m vertical resolution and consecutive sampling in time and space make it possible to extract properties of Kelvin waves to shorter period gravity waves with vertical wavelengths as short as 2–3 km. A short dataset from the extra Galileo and GLONASS constellations demonstrates the feasibility to nearly double the sampling density in planned follow-on campaigns. The results will contribute to improved estimates of momentum forces for wave driving of the Quasi-biennial Oscillation (QBO) and improved QBO representation in models, and illustrate the importance of measuring intrinsic period in the Lagrangian reference frame. [ABSTRACT FROM AUTHOR]

Sarcoidosis is an idiopathic inflammatory disorder that is commonly treated with glucocorticoids. An imprecise understanding of the immunologic changes underlying sarcoidosis has limited therapeutic progress. Here in this open-label trial (NCT03910543), 10 patients with cutaneous sarcoidosis are treated with tofacitinib, a Janus kinase inhibitor. The primary outcome is the change in the cutaneous sarcoidosis activity and morphology instrument (CSAMI) activity score after 6 months of treatment. Secondary outcomes included change in internal organ involvement, molecular parameters, and safety. All patients experience improvement in their skin with 6 patients showing a complete response. Improvement in internal organ involvement is also observed. CD4+ T cell-derived IFN-γ is identified as a central cytokine mediator of macrophage activation in sarcoidosis. Additional type 1 cytokines produced by distinct cell types, including IL-6, IL-12, IL-15 and GM-CSF, also associate with pathogenesis. Suppression of the activity of these cytokines, especially IFN-γ, correlates with clinical improvement. Our results thus show that tofacitinib treatment is associated with improved sarcoidosis symptoms, and predominantly acts by inhibiting type 1 immunity. Sarcoidosis is a heterogenous disorder often treated with glucocorticoids. Here the authors show, in an open label, non-randomized, single arm clinical trial involving 10 patients, that treatment with tofacitinib, a Janus kinase inhibitor, is associated with improved clinical symptoms and reduced activity of Th1 cytokines such as IFN-γ and IL-12. [ABSTRACT FROM AUTHOR]

Objectives To investigate the slowdown in mortality improvement in the United States, United Kingdom, and comparator countries observed in the first decade of the twenty-first century and critically evaluate proposed explanations. Methods Change-point analysis to identify the year of change in comparison of national mortality trends and linear spline models in the investigation of subnational differences using data from the Human Mortality Database, Global Burden of Disease cause-specific data, and, for the United Kingdom, national statistics data. Consideration of the impact of using different methods to estimate overall mortality is also concluded together with a review of methodological assumptions made in previous studies. Results The results confirm the slowdown in mortality improvement observed in the early twenty-first century but indicate that proposed explanations for this are inadequate on a range of counts. Discussion Mortality improvement slowed down in the early twenty-first century but the explanations advanced, such as opioid use in the United States or influenza epidemics and austerity programs in the United Kingdom, seem unlikely to account for this. Further research considering longer-term life course and cohort influences is needed. [ABSTRACT FROM AUTHOR]

A 60‐year‐old man with metastatic renal cell carcinoma presented with a 6‐month history of a pruritic, exquisitely painful genital eruption appearing 3 months after initiation of nivolumab. Examination demonstrated a poorly defined, lichenified scrotal plaque studded with erosions, yellow crust, and tense vesicles. There was no other lesion on the body or mucosae. Histopathology revealed a subepidermal blister with a mixed lymphocytic, neutrophilic, and eosinophilic infiltrate. Direct immunofluorescence of perilesional skin demonstrated subclinical blister and linear/fibrillary patchy IgG and IgA along the dermoepidermal junction. Bullous pemphigoid (BP) serologies revealed normal IgG BP230 antibodies and minimally elevated IgG BP180 antibodies. Indirect immunofluorescence revealed positive IgG at the basement membrane ("epidermal pattern") in human split skin and monkey esophagus substrates; no IgA antibodies were detected. The patient was diagnosed with nivolumab‐induced localized genital BP (LGBP). BP is a reported adverse effect of immune checkpoint inhibitors including nivolumab; however, cases are typically generalized. LGBP is a rare BP variant typically presenting in children and females; there are few reports of LGBP in adult males. We report a novel case of nivolumab‐induced LGBP with unique histopathologic and clinical challenges. LGBP should be considered in patients on immune checkpoint inhibitor therapy with bullous genital eruptions. [ABSTRACT FROM AUTHOR]

A company COVID-19 Heating, Ventilation, and Air Conditioning Guideline was implemented globally, as part of a larger control measure toolset, to minimize the potential for SARS-CoV-2 aerosol transmission. The COVID-19 Heating, Ventilation, and Air Conditioning Guideline informed and provided the process to optimize existing ventilation systems, set occupancy duration limits, and set clearance periods for a given space. Aerosol transmission modeling was used extensively to determine space limitations to reduce the potential for aerosol transmission in various manufacturing, lab, warehouse, aircraft, and administrative workspaces. This paper focuses on the modeling completed for administrative spaces (e.g., offices, conference rooms, restrooms, elevators) due to their lower ventilation rates, higher occupant densities, and greater vocalization levels. A detailed description of how the Guideline was implemented, with examples showing the evaluation and determinations made for specific spaces, is provided. World-wide implementation of this Guideline, as one of the layers of protection, was a key component in the overall strategy to reduce aerosol transmission of the SARS-CoV-2 virus. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if strategic placement of portable air purifiers would improve effectiveness of aerosol reduction in a space as compared to use as a general room air purifier. Two sizes of portable air purifiers were placed in two different positions intended to function similar to either a local exhaust ventilation hood or an air curtain to determine if strategic placement would lead to a reduction of particles in a worker's position at a desk in an office environment. Particle generators were used to introduce particulate into the air and personal aerosol monitors measured particles during each test condition. Results showed that when the medium room portable air purifiers used in this study were set to high, corresponding to 98 CFM, and placed near the breathing zone of each office worker with the unit's filter cover removed, the particle concentration was reduced 35% beyond the reduction that would be expected if the same units were placed on the floor behind the occupant's workstation. Results also indicated that the larger portable air purifier tested, positioned as close as reasonable to each occupant's breathing zone with the largest capture area possible (i.e., removing the unit's filter cover), delivers the best aerosol reduction performance. The authors concluded that as a layer of protection against transmission of airborne infectious organisms for office occupants, installing a portable air purifier, sized and operated similar to the units tested in this study on the desk 12 inches from the breathing zone of the worker, has the potential to reduce airborne particulate to a greater degree than if the same units were placed outside of the breathing zone, in the general cubicle area. [ABSTRACT FROM AUTHOR]

Murphy MJJ, Sivarajah B, Grégoire DC, Vermaire JC. 2022. Assessing the ecological responses of a shallow mesotrophic lake to multiple environmental stressors using paleolimnological techniques. Lake Reserv Manage. 38:67–79. White Lake, located in southeastern Ontario, Canada is a long, shallow, multibasin lake that supports recreational activities year-round and has 1538 private and commercial dwelling units. The construction of a dam at Waba Creek in 1845 resulted in the minimum water level at White Lake increasing by ∼1.5 m, and several water-level management strategies have been implemented since the mid 20th century. The lake has also been impacted by land-clearance activities and shoreline development along the eastern shores and is presently mesotrophic. More recently, White Lake was colonized by zebra mussels (Dreissena polymorpha) in 2015, and annual algal blooms have also been observed. In this paleolimnological study, diatom-based approaches and loss on ignition were used to track past changes in water quality and sediment characteristics, respectively, to inform the White Lake Property Owners Association's ongoing lake monitoring program. The diatom-inferred total phosphorus (DI-TP) reconstruction suggests that White Lake has been mesotrophic (DI-TP range 11.5 − 17 µg/L) over the past ∼200 years. Notable changes in the diatom assemblages and declines in sedimentary organic content were recorded around the 1890s in the sediment core retrieved near Hardwood Island. The decrease in sedimentary organic content was likely a response to early land-clearance activities around the lake as erosion often leads to greater inorganic export from the catchment to the lake. The switch among benthic fragilarioid diatom taxa suggests that the light conditions at this shallow lake may have changed in response to higher allochthonous inputs. Continuous monitoring of White Lake is needed to ensure that the cumulative impacts from emerging environmental stressors (e.g., climate-mediated changes, invasion by dreissenids) are considered when making management decisions. [ABSTRACT FROM AUTHOR]

These results highlight that treatment of GA is often unsatisfactory and there is a substantial QoL burden from GA, including from symptoms. The survey contained items on demographics, GA history, symptoms, treatments and quality of life (QoL); the latter was assessed using Skindex-16.[3] Identifying information was not collected. Dear Editor, Granuloma annulare (GA) is an inflammatory skin disease that is estimated to affect 0-06-0-1% of individuals in the USA.[1],[2] Currently, there are no treatments approved by the Food and Drug Administration or European Medicines Agency and very little is known about the impact of this disease on patients. [Extracted from the article]

The 2022 report of the Lancet countdown on health and climate change: health at the mercy of fossil fuels. One estimate attributed 4.4% of annual carbon dioxide emissions to the health services of 36 major countries; predictably, hospitals were the main sources.[6] At the very least, this should prompt us to focus on our own carbon dioxide emissions. The existence of direct and specific links between climate change and clinical biochemistry is not obvious. [Extracted from the article]

A survey of a small (206 ha) riverine woodland remnant on the Murray River recorded 97 bird species (23 waterbirds and 74 woodland birds) including residents, spring/summer latitudinal migrants and winter altitudinal migrants. The conservation values of this remnant include habitat value for 15 declining woodland bird species and three waterbird species of conservation concern, as well as landscape connectivity value as part of a major riverine wildlife corridor. Several declining woodland bird species exhibited local preferences for particular vegetation communities. [ABSTRACT FROM AUTHOR]

Landfalling atmospheric rivers (ARs) over the western US are responsible for ∼30%–50% of the annual precipitation, and their accurate forecasts are essential for aiding water management decisions and reducing flood risks. Sparse coverage of conventional observations over the Pacific Ocean, which can cause inadequate upstream initial conditions for numerical weather prediction models, may limit the improvement of forecast skill for these events. A targeted field program called AR Reconnaissance (Recon) was initiated in 2016 to better understand and reduce forecast errors of landfalling ARs at 1–5 days lead times. During the winter seasons of 2016, 2018, and 2019, 15 Intensive Observation Periods (IOPs) sampled the upstream conditions for landfalling ARs. This study evaluates the impact on forecast accuracy of assimilating these dropsonde data. Data denial experiments with (WithDROP) and without (NoDROP) dropsonde data were conducted using the Weather Research and Forecasting model with the Gridpoint Statistical Interpolation four‐dimensional ensemble variational system. Comparisons between the 15 paired NoDROP and WithDROP experiments demonstrate that AR Recon dropsondes reduced the root‐mean‐square error in integrated vapor transport (IVT) and inland precipitation for more than 70% of the IOPs, averaged over all forecast lead times from 1 to 6 days. Dropsondes have improved the spatial pattern of forecasts of IVT and precipitation in all 15 IOPs. Significant improvements in skill are found beyond the short range (1–2 days). IOP sequences (i.e., back‐to‐back IOPs every other day) show the most improvement of inland precipitation forecast skill. Plain Language Summary: Atmospheric rivers (ARs) are long and narrow corridors of water vapor transport in the atmosphere from the tropics to higher latitudes. Up to half of the annual precipitation in the western US states is related to landfalling ARs. Therefore, accurate forecasts of these events are important to reduce socio‐economic damage from the associated high‐impact weather and to better manage water resources over the western US. However, the forecast accuracy can be limited by sparse observations upstream over the Pacific Ocean. To fill observation gaps and improve forecast skills, a weather reconnaissance mission called Atmospheric River Reconnaissance was initiated in 2016 to release dropsondes from aircraft in key upstream sensitive regions. This study assesses the value of these observations in improving the initial conditions and the forecast skill of a regional model operated at the Center for Western Weather and Water Extremes for near real‐time weather forecasts. We found that the use of these additional observations collected during 2016, 2018, and 2019 has a positive impact on reducing the forecast error of water vapor transport within the Northeastern Pacific domain and the inland precipitation skill over the western US. These observations have more impact in poorly forecasted cases. Key Points: Dropsondes have reduced the forecast error of water vapor transport over the Northeast Pacific with continuous improvement out to day 3Dropsondes overall improved the precipitation forecast over the US West Coast in 11 out of 15 Intensive Observation Periods (IOPs)IOP sequences (i.e., back‐to‐back IOPs every other day) have the most positive impact on improving the precipitation forecast skill [ABSTRACT FROM AUTHOR]

Fire is a major ecological driver in many Australian ecosystems, and large‐scale wildfires can impact on faunal assemblages at a landscape scale. Monitoring the response of the avian community and individual bird species following a 92 039 ha wildfire in the Pilliga Forest, in temperate inland south‐eastern Australia, showed an initial decline in species richness and changes in community composition, followed by gradual recovery. Recovery was not complete by the end of the seven‐year study. Eighteen species (including Speckled Warbler Chthonicola sagittata and Eastern Yellow Robin Eopsaltria australis) were identified as likely to be fire sensitive and nine species (including Australian Magpie Cracticus tibicen and Red‐capped Robin Petroica goodenovii) as likely to respond positively to fire at the time scale of this study. Another 11 species (including Dusky Woodswallow Artamus cyanopterus and Jacky Winter Microeca fascinans) appeared to favour burnt areas close to the fire edge. Guild‐level patterns included an overall negative response to fire by insectivores, granivores/frugivores and declining woodland birds and a positive response by predators. The avian community recovered more quickly at burnt sites close to (within 2 km of) the fire edge compared to more remote sites more than 4 km from unburnt habitat, suggesting that proximity to unburnt areas (and therefore fire extent) is likely to be a key consideration in understanding the post‐fire recovery of birds. [ABSTRACT FROM AUTHOR]

Background: Assessing the pre- and post-test probability of disease in the context of routine health care is challenging. We wished to study how test performance parameters relating to clinical utility vary by clinical indication in a 'real-world' setting. Methods: The diagnostic accuracy of serum total B12 and Active-B12® (holotranscobalamin) was evaluated in a primary care population, using serum methylmalonic acid as the reference standard. We used electronic requesting to establish the clinical indication for each request. Routine requests from primary care for serum total B12 were included if creatinine was also measured and estimated glomerular filtration rate was at least 60 mL/min/1.73 m2. Results: Clinical indications included peripheral neuropathy (n = 168), anaemia (n = 168), cognitive decline (n = 125), suspected dietary deficiency (n = 76), other (n = 362). For peripheral neuropathy, the area under the receiver operator curve ± 95% confidence interval (AUC ± CI) was 0.63 (0.54–0.71) (P = 0.002) for total B12 and 0.68 (0.60–0.77) (P < 0.0001) for Active-B12®. For anaemia, AUC ± CI was 0.56 (0.47–0.66) (P = 0.10) for total B12 and 0.69 (0.59–0.78) (P < 0.0001) for Active-B12®. For cognitive decline, AUC ± CI was 0.54 (0.43–0.65) (P = 0.26) for total B12 and 0.69 (0.58–0.80) (P = 0.0002) for Active-B12®. The pre–post-test change in probability of disease varied by clinical indication. Conclusion: Combining diagnostic accuracy studies and electronic testing in a 'real-world' setting allows clinical utility to be assessed by clinical indication. Wider application of this would permit more personalised laboratory medicine. In this study, diagnostic performance of total B12 and Active-B12® varied across all indications. Active-B12® provided better discrimination, but this may have reflected the cut-offs used. [ABSTRACT FROM AUTHOR]

Patients bearing ICD-10-CM code L43 (excluding L43.2: Lichenoid drug reaction) and/or SNOMED 4776004 were considered to have LP, while those with ICD-10-CM code H20 and/or SNOMED 128473001 (excluding 410,477,000: Infective uveitis) were considered to have uveitis. LP patients were more likely to have uveitis (2.9% vs 1.1%) and all autoimmune diseases (Table 1). Lichen planus (LP) is an inflammatory disease that can affect the skin and/or mucous membranes. [Extracted from the article]

In order to effectively prepare students for medical decisions with complex, ethical disagreements and value-laden conflicts, a progression from simpler case analysis to multi-layered conflicts is often helpful. Presented here is a unique case of pregnancy in a true hermaphrodite from recent medical literature. The case is artificially layered with additional, medical and discoverable contextual issues to help analyze three distinct questions in medical ethics: 1) Is it ethically permissible to perform an elective termination of pregnancy (ETOP) on a minor, 2) Is it ethically permissible to keep this information from the parents, and 3) are additional and complicating medical features included in confidentiality agreements involving minors? The pedagogical goals include introducing and effectively utilizing the Orr-Shelton, four box method of clinical ethics assessment, demonstrating the need to uncover/discover important contextual (cultural, religious, family, etc.) features not usually incorporated fully into patient charts, to prepare medical students to research and become familiar with the local legal environment, and to illustrate that what appears to be a single a single ethical dilemma is likely far more complex requiring a multi-focused assessment. [ABSTRACT FROM AUTHOR]

In order to effectively prepare students for medical decisions with complex, ethical disagreements and value-laden conflicts, a progression from simpler case analysis to multi-layered conflicts is often helpful. Presented here is a unique case of pregnancy in a true hermaphrodite from recent medical literature. The case is artificially layered with additional, medical and discoverable contextual issues to help analyze three distinct questions in medical ethics: 1) Is it ethically permissible to perform an elective termination of pregnancy (ETOP) on a minor, 2) Is it ethically permissible to keep this information from the parents, and 3) are additional and complicating medical features included in confidentiality agreements involving minors? The pedagogical goals include introducing and effectively utilizing the Orr-Shelton, four box method of clinical ethics assessment, demonstrating the need to uncover/discover important contextual (cultural, religious, family, etc.) features not usually incorporated fully into patient charts, to prepare medical students to research and become familiar with the local legal environment, and to illustrate that what appears to be a single a single ethical dilemma is likely far more complex requiring a multi-focused assessment. [ABSTRACT FROM AUTHOR]

The sun moth Synemon laeta (Castniidae) was previously only known from Queensland until it was recorded in 2014 at two sites in the northern part of the Pilliga Forest, in the Brigalow Belt South bioregion in northern inland New South Wales. This paper documents a further two recent site records of the species, indicating a broader distribution in the Pilliga Forest. [ABSTRACT FROM AUTHOR]

An editorial is presented on clinical biochemists adding value by participating with other health professionals in the delivery of a high-quality service. Topics include allowing for differences in the nature, size, and staffing of hospital laboratories; and generating the data in reinforcing awareness of the effect of reflex thresholds on the metrics of both reflex and reflective testing.

Our findings demonstrate the persistence and widening of geographic disparities in dupilumab access over time and may provide a useful baseline for evaluating the future impact of newly approved therapies on the AD treatment landscape. Our study is limited in that geographic and specialty data were only available for prescribers with >=10 dupilumab claims submitted to Medicare and that the Medicare population may not be the main users of dupilumab in the USA. Trends in the total number of prescribers, beneficiaries, claims, and total cost of dupilumab in the Medicare population from 2017 to 2019. [Extracted from the article]

This paper describes two new records of Kershaw's Panda-snail Pygmipanda kershawi (Brazier, 1872) (Pulmonata: Caryodidae) from New South Wales, both representing new localities for the species. There have been very few records of this native land snail from the state in the last century. A record from the Khancoban area represents a northern extension of the species' known range in New South Wales and a record from the Running Waters area in the Snowy River valley is the southernmost in the state. Pygmipanda kershawi is considered to be of conservation concern in New South Wales. [ABSTRACT FROM AUTHOR]

Sixty-three butterfly species representing five families have been recorded from the Pilliga Forest in northern inland New South Wales – the largest surviving remnant of native forest on the western slopes of the Great Dividing Range. This is one of the richest recorded butterfly faunas of any location on the New South Wales western slopes and adjacent plains, reflecting the location of the Pilliga Forest in a biogeographic overlap zone between northern and southern faunal assemblages with proximity to both the western plains and outliers of the mesic eastern highlands. No narrow-range endemic species or species of state or national conservation concern were recorded; however, half of the species recorded have patchy, discontinuous distributions within their broad range due to specific habitat requirements. Some minor western range extensions are recorded and two hilltopping sites are documented. This study highlights the significant biodiversity conservation value of the Pilliga Forest in the predominantly cleared western slopes bioregions. Sixty-three butterfly species have been recorded from the Pilliga Forest on the western slopes of the Great Dividing Range in northern New South Wales. This is one of the richest recorded butterfly faunas of any location on the New South Wales western slopes and adjacent plains and highlights the significant conservation value of the Pilliga Forest in the predominantly cleared western slopes bioregions. [ABSTRACT FROM AUTHOR]

Holistic ethics education in the professions is never fully served by a reliance on regulatory compliance alone. Data obtained from penalties due to corporate non-compliance in specific professions rarely describe the underlying ethical failures that are the foundation for "rule-breaking" in the professions. However, "violations" data may serve as a springboard for an educational discussion and approach that helps professionals (and those studying to become professionals) to understand the basic moral reasoning that underlies the "good" that is served by adhering to professional Codes of Conduct, Codes of Practice, Codes of Ethics, and the professional regulatory environment. We here use data obtained from the US FDA, US DOJ, and from Violations Tracker and compare these data with the IFPMA (International Federation of Pharmaceutical Manufacturing Association) Ethos and guiding principles. These side-by-side linkages serve as a mechanism to help students assess which ethical principles are at the core of each such violation in the pharmaceutical industry. We further recommend that this approach be incorporated into ethics education, especially beginning at the undergraduate level, as prophylaxis to ethical lapses in later professional life. [ABSTRACT FROM AUTHOR]

Aims Efforts to improve ablation success rates in persistent atrial fibrillation (AF) patients by targeting re-entrant driver (RD) sites have been hindered by weak mechanistic understanding regarding emergent RDs localization following initial fibrotic substrate modification. This study aimed to systematically assess arrhythmia dynamics after virtual ablation of RD sites in computational models. Methods and results Simulations were conducted in 12 patient-specific atrial models reconstructed from pre-procedure late gadolinium-enhanced magnetic resonance imaging scans. In a previous study involving these same models, we comprehensively characterized pre-ablation RDs in simulations conducted with either 'average human AF'-based electrophysiology (i.e. EPavg) or ±10% action potential duration or conduction velocity (i.e. EPvar). Re-entrant drivers seen under the EPavgcondition were virtually ablated and the AF initiation protocol was re-applied. Twenty-one emergent RDs were observed in 9/12 atrial models (1.75 ± 1.35 emergent RDs per model); these dynamically localized to boundary regions between fibrotic and non-fibrotic tissue. Most emergent RD locations (15/21, 71.4%) were within 0.1 cm of sites where RDs were seen pre-ablation in simulations under EPvarconditions. Importantly, this suggests that the level of uncertainty in our models' ability to predict patient-specific ablation targets can be substantially mitigated by running additional simulations that include virtual ablation of RDs. In 7/12 atrial models, at least one episode of macro-reentry around ablation lesion(s) was observed. Conclusion Arrhythmia episodes after virtual RD ablation are perpetuated by both emergent RDs and by macro-reentrant circuits formed around lesions. Custom-tailoring of ablation procedures based on models should take steps to mitigate these sources of AF recurrence. [ABSTRACT FROM AUTHOR]

Aims: Efforts to improve ablation success rates in persistent atrial fibrillation (AF) patients by targeting re-entrant driver (RD) sites have been hindered by weak mechanistic understanding regarding emergent RDs localization following initial fibrotic substrate modification. This study aimed to systematically assess arrhythmia dynamics after virtual ablation of RD sites in computational models.Methods and Results: Simulations were conducted in 12 patient-specific atrial models reconstructed from pre-procedure late gadolinium-enhanced magnetic resonance imaging scans. In a previous study involving these same models, we comprehensively characterized pre-ablation RDs in simulations conducted with either 'average human AF'-based electrophysiology (i.e. EPavg) or ±10% action potential duration or conduction velocity (i.e. EPvar). Re-entrant drivers seen under the EPavg condition were virtually ablated and the AF initiation protocol was re-applied. Twenty-one emergent RDs were observed in 9/12 atrial models (1.75 ± 1.35 emergent RDs per model); these dynamically localized to boundary regions between fibrotic and non-fibrotic tissue. Most emergent RD locations (15/21, 71.4%) were within 0.1 cm of sites where RDs were seen pre-ablation in simulations under EPvar conditions. Importantly, this suggests that the level of uncertainty in our models' ability to predict patient-specific ablation targets can be substantially mitigated by running additional simulations that include virtual ablation of RDs. In 7/12 atrial models, at least one episode of macro-reentry around ablation lesion(s) was observed.Conclusion: Arrhythmia episodes after virtual RD ablation are perpetuated by both emergent RDs and by macro-reentrant circuits formed around lesions. Custom-tailoring of ablation procedures based on models should take steps to mitigate these sources of AF recurrence. [ABSTRACT FROM AUTHOR]

Focal impulse and rotor mapping (FIRM) involves intracardiac detection and catheter ablation of re-entrant drivers (RDs), some of which may contribute to arrhythmia perpetuation in persistent atrial fibrillation (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) has the potential to non-invasively identify all areas of the fibrotic substrate where RDs could potentially be sustained, including locations where RDs may not manifest during mapped AF episodes. The objective of this study was to carry out multi-modal assessment of the arrhythmogenic propensity of the fibrotic substrate in PsAF patients by comparing locations of RD-harboring regions found in simulations and detected by FIRM (RDsim and RDFIRM) and analyze implications for ablation strategies predicated on targeting RDs. For 11 PsAF patients who underwent pre-procedure LGE-MRI and FIRM-guided ablation, we retrospectively simulated AF in individualized atrial models, with geometry and fibrosis distribution reconstructed from pre-ablation LGE-MRI scans, and identified RDsim sites. Regions harboring RDsim and RDFIRM were compared. RDsim were found in 38 atrial regions (median [inter-quartile range (IQR)] = 4 [3; 4] per model). RDFIRM were identified and subsequently ablated in 24 atrial regions (2 [1; 3] per patient), which was significantly fewer than the number of RDsim-harboring regions in corresponding models (p < 0.05). Computational modeling predicted RDsim in 20 of 24 (83%) atrial regions identified as RDFIRM-harboring during clinical mapping. In a large number of cases, we uncovered RDsim-harboring regions in which RDFIRM were never observed (18/22 regions that differed between the two modalities; 82%); we termed such cases “latent” RDsim sites. During follow-up (230 [180; 326] days), AF recurrence occurred in 7/11 (64%) individuals. Interestingly, latent RDsim sites were observed in all seven computational models corresponding to patients who experienced recurrent AF (2 [2; 2] per patient); in contrast, latent RDsim sites were only discovered in two of four patients who were free from AF during follow-up (0.5 [0; 1.5] per patient; p < 0.05 vs. patients with AF recurrence). We conclude that substrate-based ablation based on computational modeling could improve outcomes. [ABSTRACT FROM AUTHOR]

This paper summarises information on the occurrence of the Common Wombat in the Pilliga Forest, based on 12 years of observations and collation of records from additional sources. The core of the species' distribution in the Pilliga Forest appears to coincide with the most topographically rugged areas, which contain forested hillslopes providing suitable burrow sites and a slightly more mesic microclimate than the broader Pilliga Forest. Outlying records are located where higher quality soils occur in proximity to topographically rugged areas. The paper also notes the regional conservation significance of this edge-of-range population and highlights the local climate refuge value of the south-eastern Pilliga Forest for wombats and other mesic-dependent fauna in the Pilliga Forest. [ABSTRACT FROM AUTHOR]

Electrocardiographic mapping (ECGI) detects reentrant drivers (RDs) that perpetuate arrhythmia in persistent AF (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) identify all latent sites in the fibrotic substrate that could potentially sustain RDs, not just those manifested during mapped AF. The objective of this study was to compare RDs from simulations and ECGI (RDsim/RDECGI) and analyze implications for ablation. We considered 12 PsAF patients who underwent RDECGI ablation. For the same cohort, we simulated AF and identified RDsim sites in patient-specific models with geometry and fibrosis distribution from pre-ablation LGE-MRI. RDsim- and RDECGI-harboring regions were compared, and the extent of agreement between macroscopic locations of RDs identified by simulations and ECGI was assessed. Effects of ablating RDECGI/RDsim were analyzed. RDsim were predicted in 28 atrial regions (median [inter-quartile range (IQR)] = 3.0 [1.0; 3.0] per model). ECGI detected 42 RDECGI-harboring regions (4.0 [2.0; 5.0] per patient). The number of regions with RDsim and RDECGI per individual was not significantly correlated (R = 0.46, P = ns). The overall rate of regional agreement was fair (modified Cohen's κ0 statistic = 0.11), as expected, based on the different mechanistic underpinning of RDsim- and RDECGI. nineteen regions were found to harbor both RDsim and RDECGI, suggesting that a subset of clinically observed RDs was fibrosis-mediated. The most frequent source of differences (23/32 regions) between the two modalities was the presence of RDECGI perpetuated by mechanisms other than the fibrotic substrate. In 6/12 patients, there was at least one region where a latent RD was observed in simulations but was not manifested during clinical mapping. Ablation of fibrosis-mediated RDECGI (i.e., targets in regions that also harbored RDsim) trended toward a higher rate of positive response compared to ablation of other RDECGI targets (57 vs. 41%, P = ns). Our analysis suggests that RDs in human PsAF are at least partially fibrosis-mediated. Substrate-based ablation combining simulations with ECGI could improve outcomes. [ABSTRACT FROM AUTHOR]

Background: The risk of type 2 diabetes is increasing in teenage girls, and is associated with their greater insulin resistance (IR). Hypothesis: We hypothesized that the adverse metabolic profile of girls (compared with boys) would persist from childhood through adolescence. Patients and Methods: Community‐based longitudinal cohort of 292 children (147 boys) studied annually from 9 to 16 years. Measures: IR (homeostasis‐model‐assessment‐2), high‐density lipoprotein‐cholesterol (HDL‐C), triglycerides, % body‐fat (dual‐energy x‐ray absorptiometry), pubertal stage (age at peak height velocity), physical activity (accelerometry). Multi‐level modelling established the age‐related trends in IR and lipids and the influence of covariates. Results: Each year from 9 to 15 years, girls had 21% to 63% higher IR than boys (girls mean IR 0.73‐1.33, boys 0.51‐0.89, P < .005). At 16 years the gender difference was not significant (girls IR 0.60, boys 0.56, P = .45). Girls had lower HDL‐C from 9 to 12 years, higher triglycerides from 9 to 14 years, greater adiposity throughout, and earlier puberty, but boys were more active than girls (all P < .05). After adjustment for %‐fat, puberty and activity, the gender difference in IR between girls and boys aged 9 to 15 years became non‐significant (IR girls 0.66‐1.01, boys 0.65‐1.04, P > .07). However, after adjustment at 16 years, girls’ IR was 25% lower than boys’ (girls 0.44, boys 0.63, P = .001), and they had 22% higher HDL‐C (P < .001) and 20% lower triglycerides (P = .003). Conclusions: The higher IR of prepubertal and early pubertal girls diminishes during late puberty, and boys begin to exhibit greater metabolic risk. Despite being leaner and more active, boys at 16 years have higher IR than girls, suggesting future higher risk for diabetes, thus we reject our hypothesis. [ABSTRACT FROM AUTHOR]