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Laguna Bacalar, one of Mexico's most significant near-coast lakes, remains underexplored in the context of its Late Holocene paleoecology. A 2,40 m long core was retrieved in northern Laguna Bacalar. Palynological and geochemical proxies were isolated and analyzed. Our findings reveal the intricate paleoecological dynamics and hydrodynamic shifts of this vital area in southeastern Mexico. Climate and ecological changes delineate three pivotal phases during the Late Holocene at Laguna Bacalar: (i) a period between 3600 and 3250 cal BP mirroring current climatic conditions with seasonal dry tropical forest and mangroves as the dominant vegetation and evidence of human activities indicated by the presence of fossil maize pollen, (ii) a relatively arid phase from 3250 to 2600 cal BP, influenced by heightened ENSO-driven precipitation variability and sea level rise favoring an estuarine environment at Laguna Bacalar, and (iii) a period between 2600 and 2200 cal BP, exhibiting hydrological conditions akin to contemporary conditions with wetland forest mangrove vegetation. These data ultimately underscore the region's susceptibility to regional climatic fluctuations and ecological resilience, providing a case study from which to predict future conditions and establish modern conservation policy for Laguna Bacalar and similar environments.

Abstract Variations of atmospheric CO2 during the Pleistocene ice-ages have been associated with changes in the drawdown of carbon into the deep-sea. Modelling studies suggest that about one third of the glacial carbon drawdown may not be associated to the deep ocean, but to the thermocline or intermediate ocean. However, the carbon storage capacity of thermocline waters is still poorly constrained. Here we present paired 230Th/U and 14C measurements on scleractinian cold-water corals retrieved from ~ 450 m water depth off the Maldives in the Indian Ocean. Based on these measurements we calculate ∆14C, ∆∆14C and Benthic-Atmosphere (Batm) ages in order to understand the ventilation dynamics of the equatorial Indian Ocean thermocline during the Last Glacial Maximum (LGM). Our results demonstrate a radiocarbon depleted thermocline as low as -250 to -345‰ (∆∆14C), corresponding to ~ 500–2100 years (Batm) old waters at the LGM compared to ~ 380 years today. More broadly, we show that thermocline ventilation ages are one order of magnitude more variable than previously thought. Such a radiocarbon depleted thermocline can at least partly be explained by variable abyssal upwelling of deep-water masses with elevated respired carbon concentrations. Our results therefore have implications for radiocarbon-only based age models and imply that upper thermocline waters as shallow as 400 m depth can also contribute to some of the glacial carbon drawdown.

A model for the pedestal density prediction based on neutral penetration combined with pedestal transport is presented. The model is tested against a pedestal database of JET-ILW Type I ELMy H-modes showing good agreement over a wide range of parameters both in standalone modelling (using the experimental temperature profile) and in full Europed modelling that predicts both density and temperature pedestals simultaneously. The model is further tested for ASDEX Upgrade and MAST-U Type I ELMy H-modes and both are found to agree with the same model parameters as for JET-ILW. The JET-ILW experiment where the isotope of the main ion is varied in a D/T scan at constant gas rate and constant ${\beta _{\text{N}}}$ is successfully modelled as long as the separatrix density ( ${n_{{\text{e,sep}}}})$ and pedestal transport coefficient ratio ( $D/\chi )$ are varied in accordance with the experimentally observed variation of ${n_{{\text{e,sep}}}}$ and the isotope dependence of $D/\chi $ found in gyrokinetic simulations. The predictions are found to be sensitive to ${n_{{\text{e,sep}}}}$ which is why the model is combined with an ${n_{{\text{e,sep}}}}$ model to predict the pedestal for the STEP fusion reactor.

This review provides a community's perspective on air quality research focusing mainly on developments over the past decade. The article provides perspectives on current and future challenges as well as research needs for selected key topics. While this paper is not an exhaustive review of all research areas in the field of air quality, we have selected key topics that we feel are important from air quality research and policy perspectives. After providing a short historical overview, this review focuses on improvements in characterizing sources and emissions of air pollution, new air quality observations and instrumentation, advances in air quality prediction and forecasting, understanding interactions of air quality with meteorology and climate, exposure and health assessment, and air quality management and policy. In conducting the review, specific objectives were (i) to address current developments that push the boundaries of air quality research forward, (ii) to highlight the emerging prominent gaps of knowledge in air quality research, and (iii) to make recommendations to guide the direction for future research within the wider community. This review also identifies areas of particular importance for air quality policy. The original concept of this review was borne at the International Conference on Air Quality 2020 (held online due to the COVID 19 restrictions during 18–26 May 2020), but the article incorporates a wider landscape of research literature within the field of air quality science. On air pollution emissions the review highlights, in particular, the need to reduce uncertainties in emissions from diffuse sources, particulate matter chemical components, shipping emissions, and the importance of considering both indoor and outdoor sources. There is a growing need to have integrated air pollution and related observations from both ground-based and remote sensing instruments, including in particular those on satellites. The research should also capitalize on the growing area of low-cost sensors, while ensuring a quality of the measurements which are regulated by guidelines. Connecting various physical scales in air quality modelling is still a continual issue, with cities being affected by air pollution gradients at local scales and by long-range transport. At the same time, one should allow for the impacts from climate change on a longer timescale. Earth system modelling offers considerable potential by providing a consistent framework for treating scales and processes, especially where there are significant feedbacks, such as those related to aerosols, chemistry, and meteorology. Assessment of exposure to air pollution should consider the impacts of both indoor and outdoor emissions, as well as application of more sophisticated, dynamic modelling approaches to predict concentrations of air pollutants in both environments. With particulate matter being one of the most important pollutants for health, research is indicating the urgent need to understand, in particular, the role of particle number and chemical components in terms of health impact, which in turn requires improved emission inventories and models for predicting high-resolution distributions of these metrics over cities. The review also examines how air pollution management needs to adapt to the above-mentioned new challenges and briefly considers the implications from the COVID-19 pandemic for air quality. Finally, we provide recommendations for air quality research and support for policy.

The exploitation of the photoelectric effect is a prominent method for the in situ measurement of the absolute work function of a surface. In the case of metallic surfaces, the Fowler theory is routinely applied for fitting or extrapolating the measured photoelectric yield data to determine the work function value. However, for the reliable application of the Fowler method, attention must be paid to the experimental sensitivity to the photoelectric behavior close to the threshold, which is mainly determined by the signal-to-noise ratio for photocurrent detection and the available photon energies used for irradiation. This is illustrated by means of applying a photoelectric work function measurement system during a Cs coating process of a metal surface, where insufficiently low photon energies or an unfavorable noise level can lead to a severe overestimation of the work function of the order of 1 eV. By a sufficient enhancement of the photoelectric sensitivity, it is now unveiled that ultra-low surface work functions of 1.25 ± 0.10 eV can be generated via caesiation of metallic surfaces (here molybdenum and stainless steel) under vacuum conditions of 10−6–10−5 mbar, which is most probably the result of the formation of an oxidized Cs adlayer.

In this study, the dead carbon fraction (DCF) variations in stalagmite M1-5 from Socotra Island in the western Arabian Sea were investigated through a new set of high-precision U-series and radiocarbon (14C) dates. The data reveal an extreme case of very high and also climate-dependent DCF. For M1-5, an average DCF of 56.2±3.4 % is observed between 27 and 18 kyr BP. Such high DCF values indicate a high influence of aged soil organic matter (SOM) and nearly completely closed-system carbonate dissolution conditions. Towards the end of the last glacial period, decreasing Mg∕Ca ratios suggest an increase in precipitation which caused a marked change in the soil carbon cycling as indicated by sharply decreasing DCF. This is in contrast to the relation of soil infiltration and DCF as seen in stalagmites from temperate zones. For Socotra Island, which is influenced by the East African–Indian monsoon, we propose that more humid conditions and enhanced net infiltration after the Last Glacial Maximum (LGM) led to dense vegetation and thus lowered the DCF by increasing 14CO2 input into the soil zone. At the onset of the Younger Dryas (YD) a sudden change in DCF towards much higher, and extremely variable, values is observed. Our study highlights the dramatic variability of soil carbon cycling processes and vegetation feedback on Socotra Island manifested in stalagmite DCF on both long-term trends and sub-centennial timescales, thus providing evidence for climate influence on stalagmite radiocarbon. This is of particular relevance for speleothem studies that aim to reconstruct past atmospheric 14C (e.g., for the purposes of 14C calibration), as these would rely on largely climate-independent soil carbon cycling above the cave.

The western Baltic Sea is impacted by various anthropogenic activities and stressed by high riverine and atmospheric nutrient loads. Atmospheric deposition accounts for up to a third of the nitrogen input into the Baltic Sea and contributes to eutrophication. Amongst other emission sources, the shipping sector is a relevant contributor to the atmospheric concentrations of nitrogen oxides (NOX) in marine regions. Thus, it also contributes to atmospheric deposition of bioavailable oxidized nitrogen into the Baltic Sea. In this study, the contribution of shipping emissions to the nitrogen budget in the western Baltic Sea is evaluated with the coupled three-dimensional physical biogeochemical model MOM–ERGOM (Modular Ocean Model–Ecological ReGional Ocean Model) in order to assess the relevance of shipping emissions for eutrophication. The atmospheric input of bioavailable nitrogen impacts eutrophication differently depending on the time and place of input. The shipping sector contributes up to 5 % to the total nitrogen concentrations in the water. The impact of shipping-related nitrogen is highest in the offshore regions distant from the coast in early summer, but its contribution is considerably reduced during blooms of cyanobacteria in late summer because the cyanobacteria fix molecular nitrogen. Although absolute shipping-related total nitrogen concentrations are high in some coastal regions, the relative contribution of the shipping sector is low in the vicinity of the coast because of high riverine nutrient loads.

This study reports on the glaciochemistry of a deep ice core (182 m long) drilled in 2009 at Mount Elbrus in the Caucasus, Russia. Radiocarbon dating of the particulate organic carbon fraction in the ice suggests that the basal ice dates to 280±400 CE (Common Era). Based on chemical stratigraphy, the upper 168.6 m of the core was dated by counting annual layers. The seasonally resolved chemical records cover the years 1774–2009 CE, thus being useful to reconstruct many aspects of atmospheric pollution in south-eastern Europe from pre-industrial times to the present day. After having examined the extent to which the arrival of large dust plumes originating from the Sahara and Middle East modifies the chemical composition of the Elbrus (ELB) snow and ice layers, we focus on the dust-free sulfur pollution. The ELB dust-free sulfate levels indicate a 6- and 7-fold increase from 1774–1900 to 1980–1995 in winter and summer, respectively. Remaining close to 55±10 ppb during the 19th century, the annual dust-free sulfate levels started to rise at a mean rate of ∼3 ppb per year from 1920 to 1950. The annual increase accelerated between 1950 and 1975 (8 ppb per year), with levels reaching a maximum between 1980 and 1990 (376±10 ppb) and subsequently decreasing to 270±18 ppb at the beginning of the 21st century. Long-term dust-free sulfate trends observed in the ELB ice cores are compared with those previously obtained in Alpine and Altai (Siberia) ice, with the most important differences consisting in a much earlier onset and a more pronounced decrease in the sulfur pollution over the last 3 decades in western Europe than south-eastern Europe and Siberia.

Non-methane volatile organic compounds (NMVOCs) include a large number of chemical species which differ significantly in their chemical characteristics and thus in their impacts on ozone and secondary organic aerosol formation. It is important that chemical transport models (CTMs) simulate the chemical transformation of the different NMVOC species in the troposphere consistently. In most emission inventories, however, only total NMVOC emissions are reported, which need to be decomposed into classes to fit the requirements of CTMs. For instance, the Emissions Database for Global Atmospheric Research (EDGAR) provides spatially resolved global anthropogenic emissions of total NMVOCs. In this study the EDGAR NMVOC inventory was revised and extended in time and in sectors. Moreover the new version of NMVOC emission data in the EDGAR database were disaggregated on a detailed sector resolution to individual species or species groups, thus enhancing the usability of the NMVOC emission data by the modelling community. Region- and source-specific speciation profiles of NMVOC species or species groups are compiled and mapped to EDGAR processes (detailed resolution of sectors), with corresponding quality codes specifying the quality of the mapping. Individual NMVOC species in different profiles are aggregated to 25 species groups, in line with the common classification of the Global Emissions Initiative (GEIA). Global annual grid maps with a resolution of 0.1° × 0.1° for the period 1970–2012 are produced by sector and species. Furthermore, trends in NMVOC composition are analysed, taking road transport and residential sources in Germany and the United Kingdom (UK) as examples.

Four regional chemistry transport models were applied to simulate the concentration and composition of particulate matter (PM) in Europe for 2005 with horizontal resolution ∼ 20 km. The modelled concentrations were compared with the measurements of PM chemical composition by the European Monitoring and Evaluation Programme (EMEP) monitoring network. All models systematically underestimated PM10 and PM2.5 by 10–60 %, depending on the model and the season of the year, when the calculated dry PM mass was compared with the measurements. The average water content at laboratory conditions was estimated between 5 and 20 % for PM2.5 and between 10 and 25 % for PM10. For majority of the PM chemical components, the relative underestimation was smaller than it was for total PM, exceptions being the carbonaceous particles and mineral dust. Some species, such as sea salt and NO3−, were overpredicted by the models. There were notable differences between the models' predictions of the seasonal variations of PM, mainly attributable to different treatments or omission of some source categories and aerosol processes. Benzo(a)pyrene concentrations were overestimated by all the models over the whole year. The study stresses the importance of improving the models' skill in simulating mineral dust and carbonaceous compounds, necessity for high-quality emissions from wildland fires, as well as the need for an explicit consideration of aerosol water content in model–measurement comparison.

The EU FP7 Project MEGAPOLI: "Megacities: Emissions, urban, regional and Global Atmospheric POLlution and climate effects, and Integrated tools for assessment and mitigation" (http://megapoli.info) brings together leading European research groups, state-of-the-art scientific tools and key players from non-European countries to investigate the interactions among megacities, air quality and climate. MEGAPOLI bridges the spatial and temporal scales that connect local emissions, air quality and weather with global atmospheric chemistry and climate. The suggested concept of multi-scale integrated modelling of megacity impact on air quality and climate and vice versa is discussed in the paper. It requires considering different spatial and temporal dimensions: time scales from seconds and hours (to understand the interaction mechanisms) up to years and decades (to consider the climate effects); spatial resolutions: with model down- and up-scaling from street- to global-scale; and two-way interactions between meteorological and chemical processes.

We present riometer and in situ observations of a substorm electron injection on 27 August 2001. The event is seen at more than 20 separate locations (including ground stations and 6 satellites: Cluster, Polar, Chandra, and 3 Los Alamos National Laboratory (LANL) spacecraft). The injection is observed to be dispersionless at 12 of these locations. Combining these observations with information from the GOES-8 geosynchronous satellite we argue that the injection initiated near geosynchronous orbit and expanded poleward (tailward) and equatorward (earthward) afterward. Further, the injection began several minutes after the reconnection identified in the Cluster data, thus providing concrete evidence that, in at least some events, near-Earth reconnection has little if any ionospheric signature.

The aim of the present study was to analyze the frequency of K121Q polymorphism in the ENPP1 gene of Brazilian subjects according to ethnic origin and to determine its possible association with diabetes mellitus (DM) and/or diabetic complications. A cross-sectional study was conducted on 1027 type 2 DM patients and 240 anonymous blood donors (BD). Ethnicity was classified based on self-report of European and African descent. The Q allele frequency was increased in African descendant type 2 DM patients (KK = 25.9%, KQ = 48.2%, and QQ = 25.9%) and BD (KK = 22.0%, KQ = 53.8%, and QQ = 24.2%) compared to European descendant type 2 DM patients (KK = 62.7%, KQ = 33.3%, and QQ = 4.1%) and BD (KK = 61.0%, KQ = 35.6%, and QQ = 3.4%). However, there was no difference in genotype distribution or Q allele frequency between diabetic and non-diabetic subjects (European descendants: DM = 0.21 vs BD = 0.21, P = 0.966, and African descendants: DM = 0.50 vs BD = 0.51, P = 0.899). In addition, there were no differences in clinical, laboratory or insulin resistance indices among the three genotypes. The prevalence of DM complications was also similar. In conclusion, K121Q polymorphism is more common among Afro-Brazilian descendants regardless of glycemic status or insulin sensitivity indices. Likewise, insulin sensitivity and DM chronic complications appear not to be related to the polymorphism in this sample.

A time dependent radial diffusion model is used to quantify the competing effects of inward radial diffusion and losses on the distribution of the outer zone relativistic electrons. The rate of radial diffusion is parameterized by Kp with the loss time as an adjustable parameter. Comparison with HEEF data taken over 500 Combined Release and Radiation Effects Satellite (CRRES) orbits indicates that 1-MeV electron lifetimes near the peak of the outer zone are less than a day during the storm main phase and few days under less disturbed conditions. These values are comparable to independent estimates of the storm time loss rate due to scattering by EMIC waves and chorus emission, and also provide an acceptable representation of electron decay rates following the storm time injection. Although our radial diffusion model, with data derived lifetimes, is able to simulate many features of the variability of outer zone fluxes and predicts fluxes within one order of magnitude accuracy for most of the storms and L values, it fails to reproduce the magnitude of flux changes and the gradual build up of fluxes observed during the recovery phase of many storms. To address these differences future modeling should include an additional local acceleration source and also attempt to simulate the pronounced loss of electrons during the main phase of certain storms.

Nos solos de textura argilosa e muito argilosa, a compactação das camadas superficiais constitui uma das limitações do solo sob plantio direto. Nestas condições, tem sido adotado o revolvimento periódico do solo. As rotações de culturas são indicadas para o manejo físico do solo em razão do maior aporte de matéria orgânica e bioporosidade do solo. O objetivo deste trabalho foi quantificar, num Latossolo Vermelho eutroférrico, algumas propriedades físicas, os teores e a taxa de estratificação do carbono orgânico do solo (COS), após dez anos da instalação de dois sistemas de manejo do solo. Os sistemas de manejo de solo estudados foram: plantio direto com rotação de culturas (PD) e plantio direto com sucessão de culturas, realizando a escarificação do solo antes da semeadura da cultura de verão (PDR). Maiores valores de densidade do solo foram observados no PD e de macroporosidade e porosidade total no PDR. Nos dois sistemas, o volume de macroporos foi maior que 10 %, indicando que as condições de aeração foram adequadas para as raízes das plantas. A curva de retenção de água indicou que o PDR retém mais água que o PD em elevados potenciais, sendo similares para potenciais menores que -0,008 MPa. A resistência do solo à penetração (RP) foi maior no PD até à profundidade de 0,20 m, independentemente da umidade do solo. A partir dos resultados, verificou-se que, no PD, sob condições similares de secamento do solo, os valores de RP foram maiores do que no PDR, podendo atingir valores críticos ao crescimento das plantas. Assim, estratégias de manejo para conservar a umidade no solo são necessárias para manter a RP abaixo de valores impeditivos às plantas. Os teores de C-orgânico do solo foram maiores no PD até 0,10 m de profundidade, enquanto de 0,10-0,40 m, foram constatados maiores valores no PDR. A taxa média de estratificação de COS foi de 1,73 no PD, enquanto no PDR foi de 1,24. Os resultados evidenciam que a maior concentração de COS no PD pode resultar em condições físicas mais estáveis às culturas.In the clay and heavy clay soils, compaction of the surface layer represents one of the limitations under no-tillage. Under such conditions, periodic soil tillage has been adopted. Other techniques, such as crop rotation are indicated for the physical management of the soil due to a larger input of organic matter and bioporosity of the soil. The objective of this study was to quantify some soil physical properties in an eutroferric Red Latosol (rhodic Eutrudox), the organic carbon content and the soil organic stratification rate after ten years of two soil management systems. The soil management systems included: crop rotation under no-tillage (NT), and crop-sucession under no-tillage, but with soil chiseling before the summer crop (CNT). Larger values of bulk density were verified in NT and macroporosity and total porosity in CNT. In both management systems, the air-filled porosity was above 10 %, suggesting that the aeration conditions were appropriate for the plant roots. The soil water retention curve indicated that the soil under CNT retains more water than under NT at high potentials, but they are similar at potentials below -0.008 MPa. The soil penetration resistance (RP) was larger in NT down to the depth of 0.20 m, independently of the soil moisture content. Results suggested that with identical soil dryness the RP can reach restrictive values for plant growth in NT. Thus, management practices to maintain the soil moisture are necessary to keep the RP lower than the levels considered restrictive for plants. The soil organic content (SOC) was higher in NT down to a depth of 0.10 m, while higher values were observed at depths of 0.10-0.40 m in CNT. The SOC stratification rate in the soil was 1.73 in NT while in CNT it was 1.24. Results show that this highest SOC concentration in NT may result in more stable soil physical conditions for crops.

The advanced energetic particle spectrometer RAPID on board Cluster can provide a complete description of the relevant particle parameters velocity, V , and atomic mass, A, over an energy range from 30 keV up to 1.5 MeV. We present the first measurements taken by RAPID during the commissioning and the early operating phases. The orbit on 14 January 2001, when Cluster was travelling from a perigee near dawn northward across the pole towards an apogee in the solar wind, is used to demonstrate the capabilities of RAPID in investigating a wide variety of particle populations. RAPID, with its unique capability of measuring the complete angular distribution of energetic particles, allows for the simultaneous measurements of local density gradients, as reflected in the anisotropies of 90° particles and the remote sensing of changes in the distant field line topology, as manifested in the variations of loss cone properties. A detailed discussion of angle-angle plots shows considerable differences in the structure of the boundaries between the open and closed field lines on the nightside fraction of the pass and the magnetopause crossing. The 3 March 2001 encounter of Cluster with an FTE just outside the magnetosphere is used to show the first structural plasma investigations of an FTE by energetic multi-spacecraft observations.Key words. Magnetospheric physics (energetic particles, trapped; magnetopause, cusp and boundary layers; magnetosheath)

On board the four Cluster spacecraft, the Cluster Ion Spectrometry (CIS) experiment measures the full, three-dimensional ion distribution of the major magnetospheric ions (H+, He+, He++, and O+) from the thermal energies to about 40 keV/e. The experiment consists of two different instruments: a COmposition and DIstribution Function analyser (CIS1/CODIF), giving the mass per charge composition with medium (22.5°) angular resolution, and a Hot Ion Analyser (CIS2/HIA), which does not offer mass resolution but has a better angular resolution (5.6°) that is adequate for ion beam and solar wind measurements. Each analyser has two different sensitivities in order to increase the dynamic range. First tests of the instruments (commissioning activities) were achieved from early September 2000 to mid January 2001, and the operation phase began on 1 February 2001. In this paper, first results of the CIS instruments are presented showing the high level performances and capabilities of the instruments. Good examples of data were obtained in the central plasma sheet, magnetopause crossings, magnetosheath, solar wind and cusp measurements. Observations in the auroral regions could also be obtained with the Cluster spacecraft at radial distances of 4–6 Earth radii. These results show the tremendous interest of multispacecraft measurements with identical instruments and open a new area in magnetospheric and solar wind-magnetosphere interaction physics.Key words. Magnetospheric physics (magnetopause, cusp and boundary layers; magnetopheric configuration and dynamics; solar wind - magnetosphere interactions)

Osteoporosis is a major health problem. Little is known about the risk factors in premenopause. Sixty 40-50-year old patients with regular menses were studied cross-sectionally. None of the patients were on drugs known to interfere with bone mass. Patients answered a dietary inquiry and had their bone mineral density (BMD) measured. The Z scores were used for the comparisons. A blood sample was taken for the determination of FSH, SHBG, estradiol, testosterone, calcium and alkaline phosphatase. Calcium and creatinine were measured in 24-h urine. A Z score less than -1 was observed for the lumbar spine of 14 patients (23.3%), and for the femur of 24 patients (40%). Patients with a Z score less than -1 for the lumbar spine were older than patients with a Z score ³-1 (45.7 vs 43.8 years) and presented higher values of alkaline phosphatase (71.1 ± 18.2 vs 57.1 ± 14.3 IU/l). Multiple regression analysis showed that a lower lumbar spine BMD was associated with higher values of alkaline phosphatase, lower calcium ingestion, a smaller body mass index (BMI), less frequent exercising, and older age. The patients with a Z score less than -1 for the femur were shorter than patients with a Z score ³-1 (158.2 vs 161.3 cm). Multiple regression analysis showed that a lower femoral BMD was associated with lower BMI, higher alkaline phosphatase and caffeine intake, and less frequent exercising. A lower than expected BMD was observed in a significant proportion of premenopausal women and was associated with lower calcium intake, relatively lower physical activity and lower BMI. We conclude that the classical risk factors for osteoporosis may be present before ovarian failure, and their effect may be partly independent of estrogen levels.

Abstract Background The concern posed by the confluence of aging and cognitive impairment is growing in importance as the U.S. population rapidly ages. As such, we sought to examine the predictive power of physical functioning (PF) and general health status (GHS) trajectories on mortality outcomes among persons with cognitive impairment (PCIs). Methods We used group-based trajectory models to identify latent group memberships for PF trajectories in 1,641 PCIs and GHS trajectories in 2,021 PCIs from the National Health and Aging Trends Survey (2011–2018) and applied logistic regressions to predict mortality using these memberships controlling for individual characteristics. Results We identified six trajectory groups for PF and four groups for GHS. Trajectory group memberships for both outcomes significantly predicted mortality. For PF, group memberships largely captured the average levels over time, and worse trajectories (i.e., lower baselines and faster declines) were associated with higher odds of death. The highest mortality risk was associated with the group experiencing a sharp decline early in its PF trajectory, although its average level across time was not the lowest. For GHS, we observed two groups with comparable average levels across time, but the one with a convex-shape trajectory had much higher mortality risks compared to the one with a concave-shape trajectory. Conclusions Our findings highlighted that health trajectories predicted mortality among PCIs, not only because of general levels but also because of the shapes of declines. Close monitoring health deterioration of PCIs is crucial to understand the health burden of this population and to make subsequent actions.

Abstract INTRODUCTION After emergency department (ED) discharge, persons living with cognitive impairment (PLWCI) and their care partners are particularly at risk for adverse outcomes. We sought to identify the barriers experienced by care partners of PLWCI during ED discharge care transitions. METHODS We conducted a qualitative study of 25 care partners of PLWCI discharged from four EDs. We used the validated 4AT and care partner‐completed AD8 screening tools, respectively, to exclude care partners of older adults with concern for delirium and include care partners of older adults with cognitive impairment. We conducted recorded, semi‐structured interviews using a standardized guide, and two team members coded and analyzed all professional transcriptions to identify emerging themes and representative quotations. RESULTS Care partners’ mean age was 56.7 years, 80% were female, and 24% identified as African American. We identified four major barriers regarding ED discharge care transitions among care partners of PLWCI: (1) unique care considerations while in the ED setting impact the perceived success of the care transition, (2) poor communication and lack of care partner engagement was a commonplace during the ED discharge process, (3) care partners experienced challenges and additional responsibilities when aiding during acute illness and recovery phases, and (4) navigating the health care system after an ED encounter was perceived as difficult by care partners. DISCUSSION Our findings demonstrate critical barriers faced during ED discharge care transitions among care partners of PLWCI. Findings from this work may inform the development of novel care partner‐reported outcome measures as well as ED discharge care transition interventions targeting care partners.

This mixed methods, 8-month pilot study investigated graduate students’ (n = 11) experiences in Breaking Grad, a peer coaching program derived from mentorship, motivational interviewing, and Co-Active Life Coaching. Offered to address stress and anxiety, while enhancing resilience, participants’ psychosocial experiences of the program were assessed via individual semi-structured interviews and validated questionnaires at pre-, mid-, and immediate post-intervention. Qualitatively, participants viewed the intervention as positively impacting their ability to cope with stress and anxiety and enhancing resilience. Quantitatively, one-way, repeated-measures ANOVAs indicated no statistical significance. The qualitative findings are encouraging. This intervention should be assessed with a larger sample.

The purpose of this academic-year-long pilot study was to explore senior Kinesiology students’ (i.e., ‘mentors’; N = 30) experiences in an undergraduate course focused on building resilience among first-years via physical activity (PA) and mentorship. The psychosocial experiences of mentors were also tracked via qualitative interviews and validated questionnaires at pre-, mid-, and post-intervention. Inductive content analysis revealed mentors’ perspectives of the program’s positive influence on their PA, resilience, and mental health; and some added stressors. One-way, repeated-measures ANOVAs indicated few statistically significant findings over time regarding participants’ levels of: resilience [F(2, 54) = 8.82 , p < .05]; behavioural control [F(2, 54) = 25.44, p < .05 ]; and positive affect [F(2, 54) = 52.97, p < .05 ]. This pilot program demonstrates promise for future university-based interventions.

Abstract Background The US Veterans Administration (VA) has developed a robust and mature computational infrastructure in support of its electronic health record (EHR). Web technology offers a powerful set of tools for structuring clinical decision support (CDS) around clinical care. This paper describes informatics challenges and design issues that were confronted in the process of building three Web-based CDS systems in the context of the VA EHR. Methods Over the course of several years, we implemented three Web-based CDS systems that extract patient data from the VA EHR environment to provide patient-specific CDS. These were 1) the VACS (Veterans Aging Cohort Study) Index Calculator which estimates prognosis for HIV+ patients, 2) Neuropath/CDS which assists in the medical management of patients with neuropathic pain, and 3) TRIM (Tool to Reduce Inappropriate Medications) which identifies potentially inappropriate medications in older adults and provides recommendations for improving the medication regimen. Results The paper provides an overview of the VA EHR environment and discusses specific informatics issues/challenges that arose in the context of each of the three Web-based CDS systems. We discuss specific informatics methods and provide details of approaches that may be useful within this setting. Conclusions Informatics issues and challenges relating to data access and data availability arose because of the particular architecture of the national VA infrastructure and the need to link to that infrastructure from local Web-based CDS systems. Idiosyncrasies of VA patient data, especially the medication data, also posed challenges. Other issues related to specific functional needs of individual CDS systems. The goal of this paper is to describe these issues so that our experience may serve as a useful foundation to assist others who wish to build such systems in the future.

Polypharmacy is common among older adults and is associated with adverse outcomes. Polypharmacy increases the likelihood of receiving a potentially inappropriate medication (PIM). PIMs have traditionally been defined as medications that have either no benefit (e.g. therapeutic duplication) or increased risk (e.g. altered pharmacodynamics/kinetics with aging). A growing literature supports the notion that these represent only a subset of the potential risks of medications prescribed to older adults. Different authors have proposed new sets of criteria for evaluating medication appropriateness. This narrative review had two objectives: 1) to summarize the contents of these criteria in order to obtain preliminary information about where clinical consensus exists regarding appropriateness; 2) The second was to describe studies examining the risks and benefits of medications identified by the criteria to determine the strength of the evidence supporting the derivation of these criteria. We identified 13 articles sharing overlapping criteria for evaluating appropriateness including: (1) delayed time to benefit; (2) altered benefit–harm ratios in the face of competing risks; (3) effects that do not match patients’ goals; and (4) nonadherence. The similarities across the articles suggested strong clinical consensus; however, the articles presented little data directly supporting these criteria. Additional studies provide evidence for the proof of concept that average estimates of benefit and harm derived from randomized controlled trials may differ from the benefits and harms experienced by older persons. However, more data are required to characterize the benefits and harms of medications in the context of the regimen as a whole and the individual’s health status.

Stress is a campus problem. This pre-post pilot study assessed the impact of Motivational Interviewing via Co-Active Life Coaching (MI-via-CALC) on the stress management of 30 full-time, English-speaking Canadian undergraduate students, aged 17-24 years. Participants were assessed using the Perceived Stress Scale and Hospital Anxiety and Depression Scale at pre-, mid-, and post-intervention. Three one-way, repeated-measures ANOVAs were completed. Statistically significant differences in stress reduction were found between pre-intervention to mid-intervention and between pre-intervention to post-intervention. No statistically significant differences occurred between mid- to post-intervention. Inductive content analysis of qualitative interviews at pre-, mid-, and post-intervention revealed participants’ positive experiences.

Electrospun fibers have emerged as a relatively new delivery platform to improve active agent retention and delivery for intravaginal applications. While uniaxial fibers have been explored in a variety of applications including intravaginal delivery, the consideration of more advanced fiber architectures may offer new options to improve delivery to the female reproductive tract. In this review, we summarize the advancements of electrospun coaxial, multilayered, and nanoparticle-fiber architectures utilized in other applications and discuss how different material combinations within these architectures provide varied durations of release, here categorized as either transient (within 24 h), short-term (24 h to one week), or sustained (beyond one week). We seek to systematically relate material type and fiber architecture to active agent release kinetics. Last, we explore how lessons derived from these architectures may be applied to address the needs of future intravaginal delivery platforms for a given prophylactic or therapeutic application. The overall goal of this review is to provide a summary of different fiber architectures that have been useful for active agent delivery and to provide guidelines for the development of new formulations that exhibit release kinetics relevant to the time frames and the diversity of active agents needed in next-generation multipurpose applications.

Dengue is a major cause of illness among travelers and a threat to military troops operating in areas to which it is endemic. Before and during World War II, dengue frequently occurred in US military personnel in Asia and the South Pacific. From the 1960s into the 1990s, dengue often occurred in US troops in Vietnam, the Philippines, Somalia, and Haiti. We found attack rates as high as 80% and periods of convalescence up to 3-1/2 weeks beyond the acute illness. The increase in dengue throughout the world suggests that it will remain a problem for military personnel until an effective vaccine is licensed.

There are concerns about the potential for unintentional harms when clinical practice guidelines are applied to patients with multimorbidity. The objective was to summarize the evidence regarding the effect(s) of comorbidity on the outcomes of medication for an index chronic condition.A systematic review was conducted of studies published in MEDLINE and Cochrane Trials before May 2012. The search strategy was constructed to identify articles indexed with "comorbidity" or a related term or by a given condition and one or more additional specified comorbid conditions. The search yielded 3252 articles, of which 37 passed the title/abstract screening process, and 22 were included after full-text review. An additional 23 articles were identified by screening the reference lists for included articles. Information was extracted on study design; population; therapy; comparison groups; outcome(s); main findings.Indexing of articles was inconsistent, with no term for "multimorbidity," and rare use of "comorbidity". Only one article examined the effects of comorbidity per se, finding no benefit of tight control of DM among persons with high comorbidity, defined using a comorbidity index. The remainder examined pairs of conditions, the majority of which were post-hoc analyses of randomized controlled trials and which found no difference in outcomes according to whether a comorbid condition was present. Several demonstrated no difference or an increased risk of adverse outcome among persons with DM and tight control of HTN as compared to usual control. Several demonstrated lack of benefit of statins among persons with end-stage renal disease.There is limited evidence regarding the effects of multiple comorbidities on treatment outcomes. The majority of studies demonstrated no effect of a single comorbid condition on outcomes. Additional studies examining a broad range of comorbidity are required, along with clear and consistent indexing to allow for improved synthesis of the evidence.

BACKGROUND:Malaria incidence is in decline in many parts of SE Asia leading to a decreasing proportion of febrile illness that is attributable to malaria. However in the absence of rapid, affordable and accurate diagnostic tests, the non-malaria causes of these illnesses cannot be reliably identified. Studies on the aetiology of febrile illness have indicated that the causes are likely to vary by geographical location within countries (i.e. be spatially heterogeneous) and that national empirical treatment policies based on the aetiology measured in a single location could lead to inappropriate treatment. METHODS:Using data from Vientiane as a reference for the incidence of major febrile illnesses in the Lao People's Democratic Republic (Laos) and estimated incidences, plausible incidence in other Lao provinces were generated using a mathematical model for a range of national and local scale variations. For a range of treatment protocols, the mean number of appropriate treatments was predicted and the potential impact of a spatially explicit national empirical treatment protocol assessed. FINDINGS:The model predicted a negative correlation between number of appropriate treatments and the level of spatial heterogeneity. A spatially explicit national treatment protocol was predicted to increase the number of appropriate treatments by 50% for intermediate levels of spatial heterogeneity. CONCLUSIONS:The results suggest that given even only moderate spatial variation, a spatially explicit treatment algorithm will result in a significant improvement in the outcome of undifferentiated fevers in Laos and other similar resource poor settings.

It is unclear whether dengue serotypes differ in their propensity to cause severe disease. We analyzed differences in serotype-specific disease severity in children presenting for medical attention in Bangkok, Thailand.Prospective studies were conducted from 1994 to 2006. Univariate and multivariate logistic and multinomial logistic regressions were used to determine if dengue hemorrhagic fever (DHF) and signs of severe clinical disease (pleural effusion, ascites, thrombocytopenia, hemoconcentration) were associated with serotype. Crude and adjusted odds ratios were calculated. There were 162 (36%) cases with DENV-1, 102 (23%) with DENV-2, 123 (27%) with DENV-3, and 64 (14%) with DENV-4. There was no significant difference in the rates of DHF by serotype: DENV-2 (43%), DENV-3 (39%), DENV-1 (34%), DENV-4 (31%). DENV-2 was significantly associated with increased odds of DHF grade I compared to DF (OR 2.9 95% CI 1.1, 8.0), when using DENV-1 as the reference. Though not statistically significant, DENV-2 had an increased odds of total DHF and DHF grades II, III, and IV. Secondary serologic response was significantly associated with DHF (OR 6.2) and increased when considering more severe grades of DHF. DENV-2 (9%) and -4 (3%) were significantly less often associated with primary disease than DENV-1 (28%) and -3 (33%). Restricting analysis to secondary cases, we found DENV-2 and DENV-3 to be twice as likely to result in DHF as DEN-4 (p = 0.05). Comparing study years, we found the rate of DHF to be significantly less in 1999, 2000, 2004, and 2005 than in 1994, the study year with the highest percentage of DHF cases, even when controlling for other variables.As in other studies, we find secondary disease to be strongly associated with DHF and with more severe grades of DHF. DENV-2 appears to be marginally associated with more severe dengue disease as evidenced by a significant association with DHF grade I when compared to DENV-1. In addition, we found non-significant trends with other grades of DHF. Restricting the analysis to secondary disease we found DENV-2 and -3 to be twice as likely to result in DHF as DEN-4. Differences in severity by study year may suggest that other factors besides serotype play a role in disease severity.