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Direct-acting antivirals (DAAs) for hepatitis C virus (HCV) infection have delivered high response rates (>95%) and simplified the management of HCV treatment, permitting non-specialists to manage patients without advanced liver disease. We collected and reviewed global data on the registration and reimbursement (government subsidised) of HCV therapies, including restrictions on reimbursement. Primary data collection occurred between Nov 15, 2021, and July 24, 2023, through the assistance of a global network of 166 HCV experts. We retrieved data for 160 (77%) of 209 countries and juristrictions. By mid-2023, 145 (91%) countries had registered at least one of the following DAA therapies: sofosbuvir–velpatasvir, sofosbuvir–velpatasvir–voxilaprevir, glecaprevir–pibrentasvir, sofosbuvir–daclatasvir, or sofosbuvir. 109 (68%) countries reimbursed at least one DAA therapy. Among 102 low-income and middle-income countries (LMICs), 89 (87%) had registered at least one HCV DAA therapy and 53 (52%) reimbursed at least one DAA therapy. Among all countries with DAA therapy reimbursement (n=109), 66 (61%) required specialist prescribing, eight (7%) had retreatment restrictions, seven (6%) had an illicit drug use restriction, five (5%) had an alcohol use restriction, and three (3%) had liver disease restrictions. Global access to DAA reimbursement remains uneven, with LMICs having comparatively low reimbursement compared with high-income countries. To meet WHO goals for HCV elimination, efforts should be made to assist countries, particularly LMICs, to increase access to DAA reimbursement and remove reimbursement restrictions—especially prescriber-type restrictions—to ensure universal access.

Supplemental Digital Content is Available in the Text.In eyes with neovascular glaucoma treated with antivascular endothelial growth factor injections, intraocular pressure >35 mmHg, use of ≥2 topical glaucoma medications, visual acuity <20/100, proliferative diabetic retinopathy, presenting as a new patient to the Retina Service, and eye pain or discomfort were baseline risk factors for uncontrolled glaucoma.

ObjectiveTo understand community seroprevalence of SARS-CoV-2 in children and adolescents. This is vital to understanding the susceptibility of this cohort to COVID-19 and to inform public health policy for disease control such as immunisation.DesignWe conducted a community-based cross-sectional seroprevalence study in participants aged 0–18 years old recruiting from seven regions in England between October 2019 and June 2021 and collecting extensive demographic and symptom data. Serum samples were tested for antibodies against SARS-CoV-2 spike and nucleocapsid proteins using Roche assays processed at UK Health Security Agency laboratories. Prevalence estimates were calculated for six time periods and were standardised by age group, ethnicity and National Health Service region.ResultsPost-first wave (June–August 2020), the (anti-spike IgG) adjusted seroprevalence was 5.2%, varying from 0.9% (participants 10–14 years old) to 9.5% (participants 5–9 years old). By April–June 2021, this had increased to 19.9%, varying from 13.9% (participants 0–4 years old) to 32.7% (participants 15–18 years old). Minority ethnic groups had higher risk of SARS-CoV-2 seropositivity than white participants (OR 1.4, 95% CI 1.0 to 2.0), after adjusting for sex, age, region, time period, deprivation and urban/rural geography. In children <10 years, there were no symptoms or symptom clusters that reliably predicted seropositivity. Overall, 48% of seropositive participants with complete questionnaire data recalled no symptoms between February 2020 and their study visit.ConclusionsApproximately one-third of participants aged 15–18 years old had evidence of antibodies against SARS-CoV-2 prior to the introduction of widespread vaccination. These data demonstrate that ethnic background is independently associated with risk of SARS-CoV-2 infection in children.Trial registration numberNCT04061382.

Environmental and lifestyle factors play an important role in the natural history of Crohn's disease and ulcerative colitis. A group of international experts from the International Organization for the Study of Inflammatory Bowel Diseases voted on a series of consensus statements to inform the management of inflammatory bowel disease (IBD). The recommendations include avoiding traditional cigarette smoking in patients with Crohn's disease or ulcerative colitis, screening for symptoms of depression, anxiety, and psychosocial stressors at diagnosis and during flares (with referral to mental health professionals when appropriate), and encouraging regular physical activity as tolerated. Patients using dietary approaches for treatment of their IBD should be encouraged to adopt diets that are best supported by evidence and involve monitoring for the objective resolution of inflammation. We recommend formal assessment for obesity and nutritional deficiencies, and patients should be encouraged to maintain a normal body-mass index. A shared decision-making approach to contraception should include the consideration of IBD-related factors, and risk factors for venous thromboembolism. Long-term or frequent use of high-dose non-steroidal anti-inflammatory drugs should be avoided. For primary prevention of disease in the offspring of patients with IBD, we recommend avoiding passive exposure to tobacco, using antibiotics judiciously, and considering breastfeeding when able.

Supplemental Digital Content is Available in the Text.

Hydrogen selenide (H2Se) is a central metabolite in the biological processing of selenium for incorporation into selenoproteins, which play crucial antioxidant roles in biological systems. Despite being integral to proper physiological function, this reactive selenium species (RSeS) has received limited attention. We recently reported an early example of a H2Se donor (TDN1042) that exhibited slow, sustained release through hydrolysis. Here we expand that technology based on the P═Se motif to develop cyclic-PSe compounds with increased rates of hydrolysis and function through well-defined mechanisms as monitored by 31P and 77Se NMR spectroscopy. In addition, we report a colorimetric method based on the reaction of H2Se with NBD-Cl to generate NBD-SeH (λmax= 551 nm), which can be used to detect free H2Se. Furthermore, we use TOF-SIMS (time of flight secondary ion mass spectroscopy) to demonstrate that these H2Se donors are cell permeable and use this technique for spatial mapping of the intracellular Se content after H2Se delivery. Moreover, these H2Se donors reduce endogenous intracellular reactive oxygen species (ROS) levels. Taken together, this work expands the toolbox of H2Se donor technology and sets the stage for future work focused on the biological activity and beneficial applications of H2Se and related bioinorganic RSeS.

To assess the utility of microbiologic culture data for the management of endophthalmitis after cataract surgery.

Purpose: This article compares 2-mg intravitreal triamcinolone (IVT) and 0.7-mg dexamethasone (DEX) implant for the treatment of diabetic macular edema in eyes that had a suboptimal response to antivascular endothelial growth factor therapy.Methods: A single-center, retrospective review was conducted of patients receiving either IVT between January 1, 2013, and January 1, 2018, or patients receiving DEX between October 1, 2015, and January 1, 2018. Visual acuity and central macular thickness (CMT) were recorded at visit of first injection and all subsequent visits.Results: Twenty-five eyes were included in the DEX group and 32 eyes were included in the IVT group. Change in vision from baseline was similar between DEX and IVT at 6-month follow-up (1.1 lines vs 2.3 lines, respectively; P= .24). Mean decrease in CMT from baseline was not different at 6-month follow-up (DEX: 120 µm vs IVT: 185 µm; P= .17).Conclusions: DEX and 2-mg IVT both achieved improvement in vision and CMT with no significant differences between treatment groups at 6-month follow-up.

BACKGROUND AND OBJECTIVE:To evaluate the outcomes of in-office laser demarcation (LD) for peripheral rhegmatogenous retinal detachments (RRDs).PATIENTS AND METHODS:This was a retrospective analysis of peripheral RRDs treated with LD. Patient demographics, visual acuity (VA), and RRD characteristics were recorded. Complications requiring additional procedures were recorded. Multiple logistic regression was used to characterize the association of RRD anatomy to treatment complications.RESULTS:A total of 112 eyes of 107 patients were analyzed with mean follow-up of 20 ± 12 months. VA at baseline and last follow-up was equivalent (0.16 logMAR, Snellen equivalent 20/29). Ninety-five (84.8%) eyes were successfully treated without an additional procedure. In multivariate analysis, the presence of VH (odds ratio [OR] = 4.0; 95% confidence interval [CI], 1.1–17; A total of 112 eyes of 107 patients were analyzed with mean follow-up of 20 ± 12 months. VA at baseline and last follow-up was equivalent (0.16 logMAR, Snellen equivalent 20/29). Ninety-five (84.8%) eyes were successfully treated without an additional procedure. In multivariate analysis, the presence of VH (odds ratio [OR] = 4.0; 95% confidence interval [CI], 1.1–17; P= .04) and RRDs in the inferior 6 clock hours (OR = 6.2; 95% CI, 1.5–29; P= .01) were associated with complications.CONCLUSIONS:LD is successful in treating peripheral RRDs. RRD characteristics less conducive to laser include presence of VH and inferior RRD.[[Ophthalmic Surg Lasers Imaging Retina.2020;51:428–434.]

IMPORTANCE: Some eyes with neovascular age-related macular degeneration (AMD) have persistent exudation despite frequent intravitreal anti–vascular endothelial growth factor (VEGF) injections. Adjuvant therapies that further reduce edema may improve vision outcomes. OBJECTIVE: To compare the short-term effect of topical dorzolamide-timolol vs placebo in eyes with neovascular AMD that have persistent exudation following intravitreal anti-VEGF injections. DESIGN, SETTING, AND PARTICIPANTS: Randomized placebo-controlled clinical trial with enrollment from March 1, 2017, through October 30, 2018. Multicenter trial at 4 clinical sites in the United States. Sixty-three patients with neovascular AMD who had persistent exudation despite intravitreal anti-VEGF injections at 4-week, 5-week, or 6-week intervals. INTERVENTIONS: Patients were randomized to use dorzolamide-timolol or artificial tears for the study duration. They continued to receive the same anti-VEGF drug at the same interval as the 2 visits before enrollment for 3 additional study visits. MAIN OUTCOMES AND MEASURES: The primary outcome measure was change in mean central subfield thickness on optical coherence tomography from baseline to visit 3 (approximately 3 months). Secondary measures included change in mean maximum subretinal fluid height, mean maximum pigment epithelial detachment height, and mean visual acuity (VA). RESULTS: This trial included 52 patients. All 27 patients (100%) assigned to dorzolamide-timolol and 23 of 25 (92%) assigned to placebo were analyzed for the primary outcome. Mean (SD) age was 78.4 (7) years, and 34 of 50 patients (68%) were women. Mean (SD) injections were 20.5 (14) (range, 4-58) before enrollment. Mean (SD) baseline logMAR VA was 0.361 (0.26) (approximate Snellen equivalent, 20/50). Comparing the dorzolamide-timolol with placebo group from baseline to visit 3, mean (SD) change in central subfield thickness (primary outcome) was −36.6 (54) μm vs 1.7 (52.3) μm (difference, 30.8; 95% CI, 0.3-61.3; P = .04); secondary outcomes: maximum PED height was −39.1 (65) μm vs 1.1 (16) μm (difference, 39.6; 95% CI, 9.6-69.6; P = .01) and change in VA from baseline to visit 3 was −2.3 (5) vs 0.3 (1) letters (difference, 2.6 letters; 95% CI, −1.9 to 7.1 letters; P = .78). CONCLUSIONS AND RELEVANCE: These findings suggest use of dorzolamide-timolol in patients with neovascular AMD with persistent exudation resulted in anatomic but not visual acuity improvements compared with placebo at approximately 3 months. Additional clinical trials with longer follow-up and larger sample sizes presumably would be needed to determine the role, if any, of dorzolamide-timolol in neovascular AMD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03034772

To determine outcomes of eyes with neovascular age-related macular degeneration (nAMD) receiving intravitreal anti–vascular endothelial growth factor (VEGF) injections who return after a period of being lost to follow-up (LTFU).

Process-based models capture our understanding of key processes that interact to determine productivity and environmental outcomes. Combining measurements and modelling together help assess the consequences of these interactions, identify knowledge gaps and improve understanding of these processes. Here, we present a dataset (collected in a two-month fallow period) and list potential issues related to use of the APSIM model in predicting fluxes of soil water, heat, nitrogen (N) and carbon (C). Within the APSIM framework, two soil water modules (SoilWat and SWIM3) were used to predict soil evaporation and soil moisture content. SWIM3 tended to overestimate soil evaporation immediately after rainfall events, and SoilWat provided better predictions of evaporation. Our results highlight the need for testing the modules using data that includes wetting and drying cycles. Two soil temperature modules were also evaluated. Predictions of soil temperature were better for SoilTemp than the default module. APSIM configured with different combinations of soil water and temperature modules predicted nitrate dynamics well, but poorly predicted ammonium-N dynamics. The predicted ammonium-N pool empties several weeks after fertilisation, which was not observed, indicating that the processes of mineralisation and nitrification in APSIM require improvements. The fluxes of soil respiration and nitrous oxide, measured by chamber and micrometeorological methods, were roughly captured by APSIM. Discrepancies between the fluxes measured with chamber and micrometeorological techniques highlight difficulties in obtaining accurate measurements for evaluating performance of APSIM to predict gaseous fluxes. There was uncertainty associated with soil depth, which contributed to surface emissions. Our results showed that APSIM performance in simulating N2O fluxes should be considered in relation to data precision and uncertainty, especially the soil depths included in simulations. Finally, there was a major disconnection between the predicted N loss from denitrification (N2 + N2O) and that measured using the 15N balance technique.

We report the electron flux modulations without corresponding magnetic fluctuations from unique multipoint satellite observations of the Arase (Exploration of Energization and Radiation in Geospace) and the Van Allen Probe (Radiation Belt Storm Probe [RBSP])‐B satellites. On 30 March 2017, both Arase and RBSP‐B observed periodic fluctuations in the relativistic electron flux with energies ranging from 500 keV to 2 MeV when they were located near the magnetic equator in the morning and dusk local time sectors, respectively. Arase did not observe Pc5 pulsations, while they were observed by RBSP‐B. The clear dispersion signature of the relativistic electron fluctuations observed by Arase indicates that the source region is limited to the postnoon to the dusk sector. This is confirmed by RBSP‐B and ground‐magnetometer observations, where Pc5 pulsations are observed to drift‐resonate with relativistic electrons on the duskside. Thus, Arase observed the drift‐resonance signatures “remotely,” whereas RBSP‐B observed them “locally.” Magnetohydrodynamic waves in the outer radiation belt with periods of ~150–250 s occasionally cause the acceleration of energetic electrons drifting eastward around the Earth. We examined the longitudinal distributions of the interaction region in which magnetohydrodynamic waves with periods of ~150–250 s interacted with energetic electrons on 30 March 2017, using simultaneously observed data by multisatellite observations from the Arase and the Radiation Belt Storm Probe (RBSP)‐B satellites. Both satellites observed radiation belts at different local times but at almost the same Earth radii. The Arase satellite located in the dawn sector observed energetic electron flux modulations that had clear energy dispersion signatures, while magnetohydrodynamic waves with the same period were not identified. However, the RBSP‐B located in the dusk sector simultaneously observed magnetohydrodynamic waves and the energetic electron modulations with the characteristics of the interaction. This multipoint measurement indicates that the interaction region is limited from the postnoon to the dusk sector. Arase observed flux modulations of relativistic electrons at 04 MLT without variations in the ambient magnetic and electric fieldsTime‐of‐flight analysis from the energy dispersion of relativistic electrons identified the drift‐resonant region to be 14–18 MLTThe interactions between Pc5 waves and relativistic electrons occurred at a limited local time even though the estimated mnumber is small

During geomagnetic storms, the rapid depletion of the high‐energy (several MeV) outer radiation belt electrons is the result of loss to the interplanetary medium through the magnetopause, outward radial diffusion, and loss to the atmosphere due to wave‐particle interactions. We have performed a statistical study of 110 storms using pitch angle resolved electron flux measurements from the Van Allen Probes mission and found that inside of the radiation belt (L*= 3 − 5) the number of storms that result in depletion of electrons with equatorial pitch angle αeq= 30∘is higher than number of storms that result in depletion of electrons with equatorial pitch angle αeq= 75∘. We conclude that this result is consistent with electron scattering by whistler and electromagnetic ion cyclotron waves. At the outer edge of the radiation belt (L*≥ 5.2) the number of storms that result in depletion is also large (~40–50%), emphasizing the significance of the magnetopause shadowing effect and outward radial transport. Up to 49% of the studied storms result in a depletion of multi‐MeV electrons, with most depletions at L*< 5.2are consistent with EMIC wavesThe percentage of storms that result in multi‐MeV electron depletions is dependent upon pitch angleThe number of storm depletions at small pitch angles is higher (increase up to 19%) than the number of depletions at large pitch angles Protons and electrons form a radiation environment around Earth that can change drastically during so called geomagnetic storms. In this study, we looked at 110 storms to understand how high‐energy electrons can disappear due to different phenomena. We found that it is very common to observe a loss of high‐energy electrons after storms. More often such a loss happens far away from the Earth as the electrons cross the boundary of the magnetosphere. However, closer to Earth the electrons are lost most likely due to the interaction with whistlerand electromagnetic ion cyclotron waves, which play an important role in the dynamics of the radiation environment.

In previous work, the similarity relationship for the water vapor variance in the interfacial layer (IL) at the top of the convective boundary layer (CBL) was proposed to be proportional to the convective velocity scale and the gradients of the water vapor mixing ratio and the Brunt‐Vaisala frequency in the entrainment zone. In the presence of wind shear in the IL, the similarity relationship was hypothesized to also include a dependence on the gradient Richardson number. Simultaneous measurements of the surface buoyancy flux, wind‐shear profiles from a radar wind profiler, water vapor mixing ratio and temperature measurements and their gradients from a Raman lidar provide a unique opportunity to thoroughly examine the function used in defining the variance and validate it. These observations were made over the Atmospheric Radiation Measurement Southern Great Plains site. We identified 19 cases from 2016 during which the CBL was quasi‐stationary and well mixed for at least 2 hr in the afternoon. Furthermore, we simulated the CBL using a large‐eddy simulation (LES) model for these cases and derived the water vapor variance and other profiles to test the similarity function. Utilizing this unique combination of observations and LES, we demonstrate that the water vapor variance in the IL has little‐to‐no dependence on wind shear. Furthermore, we demonstrate that the predicted variance using the original similarity function matches the observed and LES‐modeled variance very well, with linear correlations between the two variances of 0.82 and 0.95, respectively. Numerical weather prediction and global circulation models need to be able to predict the variance in water vapor in the atmosphere, as this is an important signature of turbulent mixing. However, the variance is something that is not directly resolved by the model and must be approximated using variables that the models actually resolve such as gradients in water vapor, temperature, and wind. This study evaluates a commonly used approximation approach, illustrates its shortcomings, and suggests how the approximation can be improved. A similarity relationship is used to predict water vapor variance in the interfacial layer from other variablesWind shear is shown to be unimportant for the prediction of water vapor variance in the interfacial layerThere is very high correlation between the true and predicted variance in both the observations and LES data

The second Radiative Heating in Underexplored Bands Campaign (RHUBC‐II) was conducted in 2009 by the U.S. Department of Energy Atmospheric Radiation Measurement program to improve water vapor spectroscopy in the far‐infrared spectral region. RHUBC‐II was located in an extremely dry region of Chile to ensure very low opacities in this spectral region. Spectrally resolved measurements by a far‐infrared spectrometer and a submillimeter interferometer from RHUBC‐II are compared with line‐by‐line radiative transfer model calculations. Water vapor amounts and temperatures used in the calculations come from collocated radiosondes, with extensive adjustments to correct for issues due to the campaign's dry conditions and mountainous terrain. A reanalysis is also performed of far‐infrared measurements taken at the Atmospheric Radiation Measurement North Slope of Alaska site before and during the first RHUBC campaign. These analyses determine that differences between the measurements and model calculations using existing spectroscopic parameters are significant in the far‐infrared and submillimeter regions, leading to the derivation of improved water vapor continuum absorption coefficients and air‐broadened widths of 74 water vapor lines. The foreign continuum is increased by more than 50% in part of the far‐infrared and the widths of more than 20 lines are changed by more than 10%. The uncertainty in the foreign continuum coefficients is estimated as greater than 20% in some spectral regions, primarily a consequence of the uncertainty in the specification of water vapor. The improved far‐infrared spectroscopic parameters have a notable impact on calculated spectral radiances and a modest impact on broadband radiative fluxes and heating rates. Radiomteric measurements from two Atmospheric Radiation Measurement program field campaigns, held in dry locations, have been analyzedImproved spectroscopic parameters for the water vapor continuum and lines in the far‐infrared and submillimeter regions have been derivedThe improved far‐infrared spectroscopic parameters have a notable impact on calculated spectral radiances and a modest impact on broadband radiative fluxes and heating rates

A shock in the solar wind was observed shortly after 05:00 by heliospheric spacecraft stationed at L1. Behind the shock, protons and electrons in the tens to hundreds of keV energy range were found to be enhanced several‐fold. The shock reached the Earth precisely at 06:00 and was detected by particle sensors aboard GOES and ARTEMIS, and by ground‐based magnetometers. In addition, the arrival of the shock was seen promptly by the magnetometer investigation aboard MMS, which at the time was located 16 REdown the geomagnetic tail. However, the arrival of the energetic particles at MMS was delayed for ~23 min, and first arrived moving earthward up the geomagnetic tail. Timing considerations between the solar wind speed and the energetic particles indicated that the solar particles first gained access to field lines connected to MMS around 115 REdownstream. Once the shock and its entrained solar particles passed the access region, the solar particles were no longer seen. A shock arrived at the Earth at 06:00 on 16 July 2017 behind which was a region of increased solar energetic particles as observed by several near‐Earth spacecraftTwenty‐three minutes later, MMS observed Earth‐directed particles in the magnetotail with the same composition, spectra, and time profilesThe sum of the observations indicate that there must have been a reconnection point located around 100 RE downstream of the Earth giving access to the magnetotail

We study the response of the outer Van Allen radiation belt during an intense magnetic storm on 15–22 February 2014. Four interplanetary coronal mass ejections (ICMEs) arrived at Earth, of which the three last ones were interacting. Using data from the Van Allen Probes, we report the first detailed investigation of electron fluxes from source (tens of kiloelectron volts) to core (megaelectron volts) energies and possible loss and acceleration mechanisms as a response to substructures (shock, sheath and ejecta, and regions of shock‐compressed ejecta) in multiple interacting ICMEs. After an initial enhancement induced by a shock compression of the magnetosphere, core fluxes strongly depleted and stayed low for 4 days. This sustained depletion can be related to a sequence of ICME substructures and their conditions that influenced the Earth's magnetosphere. In particular, the main depletions occurred during a high‐dynamic pressure sheath and shock‐compressed southward ejecta fields. These structures compressed/eroded the magnetopause close to geostationary orbit and induced intense and diverse wave activity in the inner magnetosphere (ULF Pc5, electromagnetic ion cyclotron, and hiss) facilitating both effective magnetopause shadowing and precipitation losses. Seed and source electrons in turn experienced stronger variations throughout the studied interval. The core fluxes recovered during the last ICME that made a glancing blow to Earth. This period was characterized by a concurrent lack of losses and sustained acceleration by chorus and Pc5 waves. Our study highlights that the seemingly complex behavior of the outer belt during interacting ICMEs can be understood by the knowledge of electron dynamics during different substructures. Detailed response of the outer belt to substructures in a complex solar wind driver is investigatedMost substructures in the interacting ICMEs here deplete the core radiation belt population but inject source electronsCore electrons were enhanced during sustained chorus and Pc5 activity and lack of losses

We describe a new, more accurate procedure for estimating and removing inner zone background contamination from Van Allen Probes Magnetic Electron Ion Spectrometer (MagEIS) radiation belt measurements. This new procedure is based on the underlying assumption that the primary source of background contamination in the electron measurements at Lshells less than three, energetic inner belt protons, is relatively stable. Since a magnetic spectrometer can readily distinguish between foreground electrons and background signals, we are able to exploit the proton stability to construct a model of the background contamination in each MagEIS detector by only considering times when the measurements are known to be background dominated. We demonstrate, for relativistic electron measurements in the inner zone, that the new technique is a significant improvement upon the routine background corrections that are used in the standard MagEIS data processing, which can “overcorrect” and therefore remove real (but small) electron fluxes. As an example, we show that the previously reported 1‐MeV injection into the inner zone that occurred in June of 2015 was distributed more broadly in Land persisted in the inner zone longer than suggested by previous estimates. Such differences can have important implications for both scientific studies and spacecraft engineering applications that make use of MagEIS electron data in the inner zone at relativistic energies. We compare these new results with prior work and present more recent observations that also show a 1‐MeV electron injection into the inner zone following the September 2017 interplanetary shock passage. All measurements suffer from error, which can arise from a variety of sources, including from the instrument itself (“noise”), as well as measured signals that are not the intended observation (“background”). When measurement errors can be quantified and accounted for, measurement accuracy, precision, and uncertainty can all be improved. This often leads to new discoveries in science. This work describes a new technique for quantifying and mitigating measurement error due to backgrounds in the Earth's Van Allen radiation belts. This allows us to measure the inner radiation belt with an increased level of accuracy and precision, enabling new scientific understanding. Specifically, we find that the inner radiation belt is longer lived and of greater intensity than suggested by previous work. Such findings are important scientifically, as they provide ground truth for radiation belt models and allow us to test various theories regarding the growth and decay of the inner radiation belt. This work is also important from a practical standpoint, as it helps improve statistical models that are used for spacecraft design, to determine how best to shield spacecraft and sensitive electronics from the damaging effects of the inner radiation belt. A new background correction algorithm for relativistic inner zone electrons is developedWe find important differences versus the standard algorithm, with several new/clarified features revealedData from the new algorithm should be used for quantitative inner zone studies at energies >0.7 MeV

A statistical study was conducted of Earth's radiation belt electron response to geomagnetic storms using NASA's Van Allen Probes mission. Data for electrons with energies ranging from 30 keV to 6.3 MeV were included and examined as a function of L‐shell, energy, and epoch time during 110 storms with SYM‐H≤−50 nT during September 2012 to September 2017 (inclusive). The radiation belt response revealed clear energy and L‐shell dependencies, with tens of keV electrons enhanced at all L‐shells (2.5 ≤ L ≤ 6) in all storms during the storm commencement and main phase and then quickly decaying away during the early recovery phase, low hundreds of keV electrons enhanced at lower L‐shells (~3 ≤ L ≤ ~4) in upward of 90% of all storms and then decaying gradually during the recovery phase, and relativistic electrons throughout the outer belt showing main phase dropouts with subsequent and generally unpredictable levels of replenishment during the recovery phase. Compared to prestorm levels, electrons with energies >1 MeV also revealed a marked increase in likelihood of a depletion at all L‐shells through the outer belt (3.5 ≤ L ≤ 6). Additional statistics were compiled revealing the storm time morphology of the radiation belts, confirming the aforementioned qualitative behavior. Considering storm drivers in the solar wind: storms driven by coronal mass ejection (CME) shocks/sheaths and CME ejecta only are most likely to result in a depletion of >1‐MeV electrons throughout the outer belt, while storms driven by full CMEs and stream interaction regions are most likely to produce an enhancement of MeV electrons at lower (L < ~5) and higher (L > ~4.5) L‐shells, respectively. CME sheaths intriguingly result in a distinct enhancement of ~1‐MeV electrons around L~5.5, and on average, CME sheaths and stream interaction regions result in double outer belt structures. A statistical model of electron radiation belt response to storms as a function of energy and L‐shell is developedStorm‐time morphology of the electron radiation belts is qualitatively predictableResults are better organized when the solar wind drivers of storms are identified

The evolution of the radiation belts in L‐shell (L), energy (E), and equatorial pitch angle (α0) is analyzed during the calm 11‐day interval (4–15 March) following the 1 March 2013 storm. Magnetic Electron and Ion Spectrometer (MagEIS) observations from Van Allen Probes are interpreted alongside 1D and 3D Fokker‐Planck simulations combined with consistent event‐driven scattering modeling from whistler mode hiss waves. Three (L, E, α0) regions persist through 11 days of hiss wave scattering; the pitch angle‐dependent inner belt core (L~ <2.2 and E< 700 keV), pitch angle homogeneous outer belt low‐energy core (L> ~5 and E~ < 100 keV), and a distinct pocket of electrons (L~ [4.5, 5.5] and E~ [0.7, 2] MeV). The pitch angle homogeneous outer belt is explained by the diffusion coefficients that are roughly constant for α0~ <60°, E> 100 keV, 3.5 < L< Lpp~ 6. Thus, observed unidirectional flux decays can be used to estimate local pitch angle diffusion rates in that region. Top‐hat distributions are computed and observed at L~ 3–3.5 and E= 100–300 keV. We study the evolution of the radiation belts during quiet geomagnetic times from satellite observations and numerical codes. We reach a global understanding of the trapped electrons variation with time, space, energy, and pitch angle (the angle of the velocity vector with the magnetic field). We exhibit three stable regions, which are less sensitive to scattering from hiss waves, while, on the other hand, hiss causes flux decay over 12 days that forms the slot region between the inner and outer belt. The existing theory explains why the outer belt electron decay is independent of pitch angle but dependent upon energy. This implies that satellite observations can reveal local pitch angle diffusion rates, themselves intimately connected with the wave properties. Thus, a connection is made between observed wave properties and observed/computed scattered electron flux, consistent with theory. Regions where the flux is pitch angle dependent are isolated in the low‐energy slot region where we show that the real shape is a smoothed version of the ideal top‐hat distribution computed from theory. The impact of this work is improved understanding of the belt evolution for space weather prediction, with a proposed event‐driven method that accurately (within ×2) predicts the electron flux decay after storms. Global computations of the (L, E, α0) structure of the evolving radiation belt during quiet times agree well with observationsThe inner belt decay is pitch angle dependent, while the outer belt is much more homogeneous with two distinct (L, E) regionsThe homogeneity of the pitch angle diffusion coefficient due to hiss waves explains the uniform outer belt decay and why 1D and 3D simulations agree

Earth and its magnetosphere are immersed in the supersonic flow of the solar-wind plasma that fills interplanetary space. As the solar wind slows and deflects to flow around Earth, or any other obstacle, a ‘bow shock’ forms within the flow. Under almost all solar-wind conditions, planetary bow shocks such as Earth’s are collisionless, supercritical shocks, meaning that they reflect and accelerate a fraction of the incident solar-wind ions as an energy dissipation mechanism1,2, which results in the formation of a region called the ion foreshock3. In the foreshock, large-scale, transient phenomena can develop, such as ‘hot flow anomalies’4–9, which are concentrations of shock-reflected, suprathermal ions that are channelled and accumulated along certain structures in the upstream magnetic field. Hot flow anomalies evolve explosively, often resulting in the formation of new shocks along their upstream edges5,10, and potentially contribute to particle acceleration11–13, but there have hitherto been no observations to constrain this acceleration or to confirm the underlying mechanism. Here we report observations of a hot flow anomaly accelerating solar-wind ions from roughly 1–10 kiloelectronvolts up to almost 1,000 kiloelectronvolts. The acceleration mechanism depends on the mass and charge state of the ions and is consistent with first-order Fermi acceleration14,15. The acceleration that we observe results from only the interaction of Earth’s bow shock with the solar wind, but produces a much, much larger number of energetic particles compared to what would typically be produced in the foreshock from acceleration at the bow shock. Such autogenous and efficient acceleration at quasi-parallel bow shocks (the normal direction of which are within about 45 degrees of the interplanetary magnetic field direction) provides a potential solution to Fermi’s ‘injection problem’, which requires an as-yet-unexplained seed population of energetic particles, and implies that foreshock transients may be important in the generation of cosmic rays at astrophysical shocks throughout the cosmos.

The Energetic Particle Detector (EPD) suite onboard the Magnetospheric Multiscale (MMS) spacecraft observes dispersive and repetitive fluxes of high‐energy (50–400 keV) electrons within the Pc5 frequency band (2–8 MHz) in the dusk to midnight region of Earth's magnetotail. These microinjections are a new phenomenon in this region of the magnetosphere, presently poorly understood, but clearly a new signature that remotely senses large‐scale magnetospheric boundary dynamics. It is therefore important to understand their properties and driver mechanisms. Here we have combined global magnetohydrodynamic simulations and particle tracing results with the MMS EPD Fly's Eye Energetic Particle Spectrometer (FEEPS) observations to investigate possible origins and source regions of the electron microinjections. Our simulation results suggest that the electron microinjections, observed in the dusk to premidnight sector, are associated with Kelvin‐Helmholtz waves (KHWs) and flux transfer events (FTEs). Energetic electrons launched from a limited range of locations near the postnoon dusk magnetopause and at times when KHWs and FTEs pass by that region have drift paths that connect with MMS and thus create time‐dependent microinjection electron signatures. Test‐particle tracing results in the magnetohydrodynamic fields also support the field‐aligned nature of electron microinjections observed by MMS. Though identifying the mechanism by which KHWs and FTEs might periodically inject electrons is beyond the scope of this work, our study does identify these duskside magnetopause boundary phenomena as likely agents of microinjection origins. Microinjections are a new observation with an unknown sourceSimulations point to a source on the postnoon magnetopauseSimulation results suggest Kelvin‐Helmholtz waves (KHWs) and flux transfer events (FTEs) as the source mechanisms for the observed microinjections in the current case study

We survey radiation belt enhancement events during the Van Allen Probes era to determine what mechanism is the dominant cause of enhancements and where it is most effective. Two primary mechanisms have been proposed: (1) betatron/Fermi acceleration due to the Earthward radial transport of electrons, which produces monotonic gradients in phase space density (PSD), and (2) “local acceleration” due to gyro/Landau resonant interaction with electromagnetic waves, which produces radially localized growing peaks in PSD. To differentiate between these processes, we examine radial profiles of PSD in adiabatic coordinates using data from the Van Allen Probes and Time History of Events and Macroscale Interactions during Substorms satellites for 80 outer belt enhancement events from October 2012 to April 2017 This study shows that local acceleration is the dominant acceleration mechanism for MeV electrons in the outer belt, with 87% of the enhancement events exhibiting growing peaks. The strong correlation of the location of these with geomagnetic activity further supports this conclusion. The radiation belts are regions of space around the Earth that are known for their high‐energy particle populations. One of the key open questions to understanding how the radiation belts evolve is as follows: How do these particles get accelerated to such high energies? To address this question, two types of acceleration processes have been proposed. The first process takes particles located far from the Earth and moves them inward, energizing the particles as they move into the stronger magnetic field close to the Earth. The second process takes particles located in the heart of the radiation belts and energizes via interactions with electromagnetic waves in a process known as local acceleration. Differentiating between these processes has been historically difficult, and only recently are quality observations available for a long‐enough time period to understand when and where and how often each process is dominant. In this paper, we examine observations of the radiation belts from the last 4.5 years and show that local acceleration is the dominant acceleration process in the outer radiation belt. Local acceleration is the dominant acceleration mechanism for most MeV electron enhancements in the outer beltLocal acceleration is observed for both storm time and non–storm time eventsThe radial location of phase space density peaks are well correlated with geomagnetic activity and the plasmapause location

This study explores water vapor turbulence in the convective boundary layer (CBL) using the Raman lidar observations from the Atmospheric Radiation Measurement site located at Darwin, Australia. An autocovariance technique was used to separate out the random instrument error from the atmospheric variability during time periods when the CBL is cloud‐free, quasi‐stationary, and well mixed. We identified 45 cases, comprising of 8 wet and 37 dry seasons events, over the 5‐year data record period. The dry season in Darwin is known by warm and dry sunny days, while the wet season is characterized by high humidity and monsoonal rains. The inherent variability of the latter resulted in a more limited number of cases during the wet season. Profiles of the integral scale, variance, coefficient of the structure function, and skewness were analyzed and compared with similar observations from the Raman lidar at the Atmospheric Radiation Measurement Southern Great Plains (SGP) site. The wet season shows larger median variance profiles than the dry season, while the median profile of the variance from the dry season and the SGP site are found to be more comparable particularly between 0.4 and 0.75 zi. The variance and coefficient of the structure function show qualitatively the same vertical pattern. Furthermore, deeper CBL, larger gradient of water vapor mixing ratio at zi, and the strong correlation with the water vapor variance at ziare seen during the dry season. The median value in the skewness is mostly positive below 0.6 ziunlike the SGP site. Analysis of water vapor turbulence profiles was performed for the wet and dry season cases separatelyComparisons of turbulent statistics revealed that the dry season is more comparable to observations in Oklahoma than to the wet seasonThe dry season showed deeper CBL, larger gradient of water vapor mixing at zi, and smaller variance

It has been reported that the dynamics of energetic (tens to hundreds of keV) electrons and ions is inconsistent with the theoretical picture in which the large‐scale electric field is a superposition of corotation and convection electric fields. Combining one year of measurements by the Super Dual Auroral Radar Network, DMSP F‐18, and the Van Allen Probes, we show that subauroral polarization streams (SAPSs) are observed when energetic electrons have penetrated below L = 4. Outside the plasmasphere in the premidnight region, potential energy is subtracted from the total energy of ions and added to the total energy of electrons during SAPS onset. This potential energy is converted into radial motion as the energetic particles drift around Earth and leave the SAPS azimuthal sector. As a result, energetic electrons are injected deeper than energetic ions when SAPSs are included in the large‐scale electric field picture, in line with observations. The interaction between the Sun and the Earth's magnetic field often transmits significant energy to the electrons and protons present in the magnetospheric tail, a region of space located far from the Earth's nightside. As a result, these particles move closer to the Earth. They are “injected” into the Earth's inner space environment. Since the 1970s, scientists have theorized that electrons and protons with the same initial kinetic energy starting from the same radial location have about the same distance of closest approach to the Earth. Yet recent observations from the Van Allen Probes reveal that this is not the case! Electrons appear to be systematically injected “deeper” than protons. So what happens along the way to make electrons approach Earth at closer distances? To answer this question, we combine observations from both space and the ground. We show that a localized source of electric fields called a subauroral polarization stream (aka a “SAPS”) is always present during these injections. We argue that a SAPS acts like a marathon aid station for electrons in that it provides them with additional energy. As a result, electrons “move faster” and approach the Earth at closer distances. There is a high correlation between the times of energetic electron injections and the times of SAPS onsetsAccording to Van Allen Probes electric drift data, SAPS electric potentials are large enough to affect energetic particle dynamicsEnergetic electrons penetrate deeper than energetic ions when SAPS onset is included in the large‐scale electric field configuration

Using the total radiation belt electron content calculated from Van Allen Probe phase space density, the time‐dependent and global response of the outer radiation belt during storms is statistically studied. Using phase space density reduces the impacts of adiabatic changes in the main phase, allowing a separation of adiabatic and nonadiabatic effects and revealing a clear modality and repeatable sequence of events in storm time radiation belt electron dynamics. This sequence exhibits an important first adiabatic invariant (μ)‐dependent behavior in the seed (150 MeV/G), relativistic (1,000 MeV/G), and ultrarelativistic (4,000 MeV/G) populations. The outer radiation belt statistically shows an initial phase dominated by loss followed by a second phase of rapid acceleration, while the seed population shows little loss and immediate enhancement. The time sequence of the transition to the acceleration is also strongly μdependent and occurs at low μfirst, appearing to be repeatable from storm to storm. The Earth's outer radiation belt is a region of near‐Earth space composed of highly energetic electrons. Typically, the outer radiation belt is in a quiet state; however, during geomagnetic storms the outer radiation belt becomes extremely dynamic. During these storms rapid changes in the number of energetic electrons in the outer radiation belt can lead to satellite failures. Our new research has found a level repeatability in storm time outer radiation belt dynamics not previously appreciated and offers important insights into radiation belt modeling and forecasting. This new work can be used to mitigate the negative effects radiation belt electrons can have on satellite infrastructure. Statistical assessment of the global and repeatable response of the outer radiation belt to stormsUsing radiation belt content derived from phase space density reduces impacts from adiabatic changes revealing a clear sequence of eventsThe statistical response is characterized by a fast genuine‐loss dominated phase followed by a clear acceleration phase

AbstractImproving the performance of direct-drive cryogenic targets at the Omega Laser Facility requires the development of a new cryogenic system to (1) field nonpermeable targets with a fill tube and (2) provide a clean environment around the target. This capability is to demonstrate that imploding a scaled-down version of the direct-drive ignition target for the National Ignition Facility (NIF) on the OMEGA laser will generate the hot-spot pressure that is needed for ignition; this will justify future cryogenic direct-drive experiments on the NIF cryogenic targets. The paper describes the target, the cryogenic equipment that is being constructed to achieve this goal, and the proposed target delivery process. Thermal calculations, fill tube–based target designs, and structural/vibrational analyses are provided to demonstrate the credibility of the design.This new design will include capabilities not available (or possible) with the existing OMEGA cryogenic system, with the emphasis being to preserve a pristinely clean environment around the target and to provide upgraded diagnostics to characterize both the ice layer and the target’s surface. The conceptual design is complete and testing of prototypes and subcomponents is underway. The rationale and capabilities of the new design are discussed.

Atmospheric methane (CH4) mixing ratios exhibited a plateau between 1995 and 2006 and have subsequently been increasing. While there are a number of competing explanations for the temporal evolution of this greenhouse gas, these prominent features in the temporal trajectory of atmospheric CH4are expected to perturb the surface energy balance through radiative forcing, largely due to the infrared radiative absorption features of CH4. However, to date this has been determined strictly through radiative transfer calculations. Here, we present a quantified observation of the time series of clear-sky radiative forcing by CH4at the surface from 2002 to 2012 at a single site derived from spectroscopic measurements along with line-by-line calculations using ancillary data. There was no significant trend in CH4forcing between 2002 and 2006, but since then, the trend in forcing was 0.026 ± 0.006 (99.7% CI) W m2yr−1. The seasonal-cycle amplitude and secular trends in observed forcing are influenced by a corresponding seasonal cycle and trend in atmospheric CH4. However, we find that we must account for the overlapping absorption effects of atmospheric water vapour (H2O) and CH4to explain the observations fully. Thus, the determination of CH4radiative forcing requires accurate observations of both the spatiotemporal distribution of CH4and the vertically resolved trends in H2O. Observations of the radiative forcing from methane at the Earth’s surface are influenced by absorption effects from water vapour, according to spectroscopic measurements and line-by-line calculations.

In 2015, the second cycle of the CONCORD programme established global surveillance of cancer survival as a metric of the effectiveness of health systems and to inform global policy on cancer control. CONCORD-3 updates the worldwide surveillance of cancer survival to 2014.

The occurrence of spatially and temporally variable reconnection at the Earth's magnetopause leads to the complex interaction of magnetic fields from the magnetosphere and magnetosheath. Flux transfer events (FTEs) constitute one such type of interaction. Their main characteristics are (1) an enhanced core magnetic field magnitude and (2) a bipolar magnetic field signature in the component normal to the magnetopause, reminiscent of a large‐scale helicoidal flux tube magnetic configuration. However, other geometrical configurations which do not fit this classical picture have also been observed. Using high‐resolution measurements from the Magnetospheric Multiscale mission, we investigate an event in the vicinity of the Earth's magnetopause on 7 November 2015. Despite signatures that, at first glance, appear consistent with a classic FTE, based on detailed geometrical and dynamical analyses as well as on topological signatures revealed by suprathermal electron properties, we demonstrate that this event is not consistent with a single, homogenous helicoidal structure. Our analysis rather suggests that it consists of the interaction of two separate sets of magnetic field lines with different connectivities. This complex three‐dimensional interaction constructively conspires to produce signatures partially consistent with that of an FTE. We also show that, at the interface between the two sets of field lines, where the observed magnetic pileup occurs, a thin and strong current sheet forms with a large ion jet, which may be consistent with magnetic flux dissipation through magnetic reconnection in the interaction region. We characterized the scale, geometry, and propagation of an ion scale current structure resulting from the interaction between interlaced flux tubesSome signatures of magnetic reconnection are found at the interaction interfaceThe intrinsic properties of this event are inconsistent with a single, homogenous helicoidal magnetic structure as expected from a typical flux transfer event (FTE)

On 21 August 2017, a solar eclipse occurred over the continental United States resulting in a rapid reduction and subsequent increase of solar radiation over a large region of the country. The eclipse's effect on the land‐atmosphere system is documented in unprecedented detail using a unique array of sensors deployed at three sites in north‐central Oklahoma. The observations showed that turbulent fluxes of heat and momentum at the surface responded quickly to the change in solar radiation. The decrease in the sensible heat flux resulted in a decrease in the air temperature below 200 m, and a large decrease in turbulent motions throughout the boundary layer. Furthermore, the turbulent mixing in the boundary layer lagged behind the change in the surface fluxes, and this lag depended on the height above the surface. The turbulent motions increased and the convective boundary layer was reestablished as the sensible heat flux recovered. Turbulent motions in the lower part of the atmosphere are driven strongly by the heating of the surface of the earth by the sun during the daytime. Observations during the 2017 solar eclipse provide a detailed look at how the turbulent nature of the atmosphere changed as the solar energy at the surface responded as the moon moved across the sun during the eclipse. The 2017 solar eclipse provides a unique opportunity to evaluate land‐atmosphere interactionsComprehensive surface fluxes and boundary layer profiling observations were made at three sites during the eclipse eventThe turbulence and stability in the boundary layer evolved dramatically during the event, with time scales that depended on height

Mirror mode waves are ubiquitous in the Earth's magnetosheath, in particular behind the quasi‐perpendicular shock. Embedded in these nonlinear structures, intense lion roars are often observed. Lion roars are characterized by whistler wave packets at a frequency ∼100 Hz, which are thought to be generated in the magnetic field minima. In this study, we make use of the high time resolution instruments on board the Magnetospheric MultiScale mission to investigate these waves and the associated electron dynamics in the quasi‐perpendicular magnetosheath on 22 January 2016. We show that despite a core electron parallel anisotropy, lion roars can be generated locally in the range 0.05–0.2fceby the perpendicular anisotropy of electrons in a particular energy range. We also show that intense lion roars can be observed up to higher frequencies due to the sharp nonlinear peaks of the signal, which appear as sharp spikes in the dynamic spectra. As a result, a high sampling rate is needed to estimate correctly their amplitude, and the latter might have been underestimated in previous studies using lower time resolution instruments. We also present for the first‐time 3‐D high time resolution electron velocity distribution functions in mirror modes. We demonstrate that the dynamics of electrons trapped in the mirror mode structures are consistent with the Kivelson and Southwood (1996) model. However, these electrons can also interact with the embedded lion roars: first signatures of electron quasi‐linear pitch angle diffusion and possible signatures of nonlinear interaction with high‐amplitude wave packets are presented. These processes can lead to electron untrapping from mirror modes. Intense lion roars are observed in mirror modes by high time resolution instruments on board Magnetospheric MultiScale missionNonlinear lion roars are observed up to 0.4fcedue to their high amplitude, which may have been underestimated in previous studiesPossible signatures of linear and nonlinear resonant interaction between lion roars and electrons, which can be untrapped from mirror modes

Whistler mode chorus waves are a naturally occurring electromagnetic emission observed in Earth's magnetosphere. Here, for the first time, data from NASA's Magnetospheric Multiscale (MMS) mission were used to analyze chorus waves in detail, including the calculation of chorus wave normal vectors, k. A case study was examined from a period of substorm activity around the time of a conjunction between the MMS constellation and NASA's Van Allen Probes mission on 07 April 2016. Chorus wave activity was simultaneously observed by all six spacecraft over a broad range of Lshells (5.5 < L< 8.5), magnetic local time (06:00 < MLT < 09:00), and magnetic latitude (−32° < MLAT < −15°), implying a large chorus active region. Eight chorus elements and their substructure were analyzed in detail with MMS. These chorus elements were all lower band and rising tone emissions, right‐handed and nearly circularly polarized, and propagating away from the magnetic equator when they were observed at MMS (MLAT~−31°). Most of the elements had “hook”‐like signatures on their wave power spectra, characterized by enhanced wave power at flat or falling frequency following the peak, and all the elements exhibited complex and well‐organized substructure observed consistently at all four MMS spacecraft at separations up to 70 km (60 km perpendicular and 38 km parallel to the background magnetic field). The waveforms in field‐aligned coordinates also demonstrated that these waves were all phase coherent, allowing for the direct calculation of k. Error estimates on calculated krevealed that the plane wave approximation was valid for six of the eight elements and most of the subelements. The wave normal vectors were within 20–30° from the direction antiparallel to the background field for all elements and changed from subelement to subelement through at least two of the eight elements. The azimuthal angle of kin the perpendicular plane was oriented earthward and was oblique to that of the Poynting vector, which has implications for the validity of cold plasma theory. Cross‐correlation analysis was used to calculate the wave normal vector for eight rising tone lower band chorus elements and several subelementsSubstructure and wave phase were consistently coherent at all four MMS; plane wave approximation valid for six of eight elements up to 70 km scaleElements observed at L~8.2, MLT~06:53, MLAT~−31°; kwas consistently oriented earthward and significantly oblique to B0and S

Once daily regimens are preferred for HIV-1 treatment, to facilitate adherence and improve quality of life. We compared a new once daily formulation of raltegravir to the currently marketed twice daily formulation.

It is recognized that patients may become sensitized to donor‐specific HLAantigens as a result of previous antigenic exposures, classically through previous transplantation, pregnancy, or blood transfusion. We present an unusual case of a patient who unexpectedly developed a range of anti‐HLAantibodies following orthopedic surgery where a bone graft was deployed intraoperatively. We describe the case of a 52‐year‐old man awaiting a renal transplantation, undergoing elective orthopedic surgery requiring a small‐volume bone graft. His postoperative antibody profile was found to be substantially changed compared to his previous negative samples, with the presence of HLA‐DR,DQ, and DPspecificities, at levels that would be likely to give a positive flow cytometry crossmatch and therefore according to local procedures required listing as unacceptable antigens for organ allocation. We perform a literature review of all previous cases of allosensitization following bone graft. This case is the first to demonstrate allosensitization following minor surgery with ;low‐volume bone graft. Previous evidence is very limited and pertains only to massive osteochondral surgery for trauma or malignancy, and is confounded by potential concomitant blood transfusion. Clinicians should be aware of the risk of allosensitization where bone grafts are used. This unusual case describes allosensitization following minor surgery with a low‐volume bone graft.

We present simulations of the loss of radiation belt electrons by resonant pitch angle diffusion caused by whistler mode hiss waves for March 2013. Pitch angle diffusion coefficients are computed from the wave properties and the ambient plasma data obtained by the Van Allen Probes with a resolution of 8 h and 0.1 Lshell. Loss rates follow a complex dynamic structure, imposed by the wave and plasma properties. Hiss effects can be strong, with minimum lifetimes (of ~1 day) moving from energies of ~100 keV at L~ 5 up to ~2 MeV at L~ 2 and stop abruptly, similarly to the observed energy‐dependent inner belt edge. Periods when the plasmasphere extends beyond L~ 5 favor long‐lasting hiss losses from the outer belt. Such loss rates are embedded in a reduced Fokker‐Planck code and validated against Magnetic Electron and Ion Spectrometer observations of the belts at all energy. Results are complemented with a sensitivity study involving different radial diffusion and lifetime models. Validation is carried out globally at all Lshells and energies. The good agreement between simulations and observations demonstrates that hiss waves drive the slot formation during quiet times. Combined with transport, they sculpt the energy structure of the outer belt into an “S shape.” Low energy electrons (<0.3 MeV) are less subject to hiss scattering below L= 4. In contrast, 0.3–1.5 MeV electrons evolve in an environment that depopulates them as they migrate from L~ 5 to L~ 2.5. Ultrarelativistic electrons are not affected by hiss losses until L~ 2–3. Computations of daily pitch angle diffusion coefficients and electron lifetimes from properties of hiss waves observed in March 2013Good agreement found between MagEIS flux observations and 1‐D Fokker‐Planck simulations based on our hiss loss term for quiet timesCombined with transport, hiss waves loss drives the daily energy structure of the radiation belts, with a typical S‐shaped outer belt

Prior studies of microburst precipitation have largely relied on estimates of the spatial scale and temporal duration of the microburst region in order to determine the radiation belt loss rate of relativistic electrons. These estimates have often relied on the statistical distribution of microburst events. However, few studies have directly observed the spatial and temporal evolution of a single microburst event. In this study, we combine Balloon Array for Radiation belt Relativistic Electron Losses balloon‐borne X‐ray measurements with Focused Investigations of Relativistic Electron Burst: Intensity, Range, and Dynamics II and AeroCube‐6 CubeSat electron measurements to determine the spatial and temporal evolution of a microburst region in the morning MLT sector on 13 August 2015. The microburst region is found to extend across at least 4 h in local time in the morning sector, from 09:00 to 13:00 MLT, and from Lof 5 out to 10. The microburst event lasts for nearly 9 h. Smaller scale structure is investigated using the dual AeroCube‐6 CubeSats, and is found to be consistent with the spatial size of whistler mode chorus wave observations near the equatorial plane. Microbursts are very short (quarter of a second) bursts of electron radiation occurring in the highest levels of Earth's atmosphere. The causes of microbursts are as yet unproven. This study carefully analyzes the spatial location and temporal evolution of microbursts in a new and novel way, utilizing data from satellites as well as balloon‐based measurements. Our findings help to establish a correlation between this important Space Physics phenomenon and possible causes that exist in Earth's Magnetosphere. Balloon and CubeSat data constrain the spatial extent and temporal evolution of a microburst regionThe 13 August 2015 microburst event lasted for nearly 9 h beginning at 06:15 UTThe 13 August 2015 microburst region extended from MLT of 09:00 to 13:00 and from Lof 5 to 10

Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia.

Particle injections in the magnetosphere transport electrons and ions from the magnetotail to the radiation belts. Here we consider generation mechanisms of “dispersionless” injections, namely, those with simultaneous increase of the particle flux over a wide energy range. In this study we take advantage of multisatellite observations which simultaneously monitor Earth's magnetospheric dynamics from the tail toward the radiation belts during a substorm event. Dispersionless injections are associated with instabilities in the plasma sheet during the growth phase of the substorm, with a dipolarization front at the onset and with magnetic flux pileup during the expansion phase. They show different spatial spread and propagation characteristics. Injection associated with the dipolarization front is the most penetrating. At geosynchronous orbit (6.6 RE), the electron distributions do not have a classic power law fit but instead a bump on tail centered on ∼120 keV during dispersionless electron injections. However, electron distributions of injections associated with magnetic flux pileup in the magnetotail (13 RE) do not show such a signature. We surmise that an additional resonant acceleration occurs in between these locations. We relate the acceleration mechanism to the electron drift resonance with ultralow frequency waves localized in the inner magnetosphere. Generation mechanisms, propagation, and acceleration of dispersionless injections during a substorm are investigatedThe injection associated with the substorm onset is the strongest and fills the radiation belts with particlesSignatures of resonant acceleration are observed during electron injections in the inner magnetosphere but not in the magnetotail

The most significant unknown regarding relativistic electrons in Earth's outer Van Allen radiation belt is the relative contribution of loss, transport, and acceleration processes within the inner magnetosphere. Detangling each individual process is critical to improve the understanding of radiation belt dynamics, but determining a single component is challenging due to sparse measurements in diverse spatial and temporal regimes. However, there are currently an unprecedented number of spacecraft taking measurements that sample different regions of the inner magnetosphere. With the increasing number of varied observational platforms, system dynamics can begin to be unraveled. In this work, we employ in situ measurements during the 13–14 January 2013 enhancement event to isolate transport, loss, and source dynamics in a one‐dimensional radial diffusion model. We then validate the results by comparing them to Van Allen Probes and Time History of Events and Macroscale Interactions during Substorms observations, indicating that the three terms have been accurately and individually quantified for the event. Finally, a direct comparison is performed between the model containing event‐specific terms and various models containing terms parameterized by geomagnetic index. Models using a simple 3/Kploss time scale show deviation from the event‐specific model of nearly 2 orders of magnitude within 72 h of the enhancement event. However, models using alternative loss time scales closely resemble the event‐specific model. Transport, loss, and source terms individually determined for enhancement eventModel results using event‐specific terms are validated by using Van Allen Probe and THEMIS observations1‐D diffusion models, with various loss and transport terms, are compared

We present measurements of relativistic electrons (0.7–1.5 MeV) in the inner zone and slot region obtained by the Magnetic Electron and Ion Spectrometer (MagEIS) instrument on Van Allen Probes. The data presented are corrected for background contamination, which is primarily due to inner‐belt protons in these low‐Lregions. We find that ∼1 MeV electrons were transported into the inner zone following the two largest geomagnetic storms of the Van Allen Probes era to date, the March and June 2015 events. As ∼1 MeV electrons were not observed in Van Allen Probes data in the inner zone prior to these two events, the injections created a new inner belt that persisted for at least 1.5 years. In contrast, we find that electrons injected into the slot region decay on much faster timescales, approximately tens of days. Furthermore, we find no evidence of >1.5 MeV electrons in the inner zone during the entire time interval considered (April 2013 through September 2016). The energies we examine thus span a transition range in the steeply falling inner zone electron spectrum, where modest intensities are observed at 0.7 MeV, and no electrons are observed at 1.5 MeV. To validate the results obtained from the background corrected flux measurements, we also present detailed pulse‐height spectra from individual MagEIS detectors. These measurements confirm our results and also reveal low‐intensity inner zone and slot region electrons that are not captured in the standard background corrected data product. Finally, we briefly discuss efforts to refine the upper limit of inner zone MeV electron flux obtained in earlier work. ∼1 MeV electrons can be injected into the inner zone during large storms, forming new belts that decay very slowly0.7–1.5 MeV electrons that are transported into the slot region decay rapidly (∼10 days)We find no evidence of electrons >1.5 MeV in the inner zone during the interval considered (April 2013 through September 2016)

Using observations from NASA's Van Allen Probes, we study the role of sudden particle enhancements at low L shells (SPELLS) as a source of inner radiation belt electrons. SPELLS events are characterized by electron intensity enhancements of approximately an order of magnitude or more in less than 1 day at L < 3. During quiet and average geomagnetic conditions, the phase space density radial distributions for fixed first and second adiabatic invariants are peaked at 2 < L < 3 for electrons ranging in energy from ~50 keV to ~1 MeV, indicating that slow inward radial diffusion is not the dominant source of inner belt electrons under quiet/average conditions. During SPELLS events, the evolution of electron distributions reveals an enhancement of phase space density that can exceed 3 orders of magnitude in the slot region and continues into the inner radiation belt, which is evidence that these events are an important—and potentially dominant—source of inner belt electrons. Electron fluxes from September 2012 through February 2016 reveal that SPELLS occur frequently (~2.5/month at 200 keV), but the number of observed events decreases exponentially with increasing electron energy for ≥100 keV. After SPELLS events, the slot region reforms due to slow energy‐dependent decay over several day time scales, consistent with losses due to interactions with plasmaspheric hiss. Combined, these results indicate that the peaked phase space density distributions in the inner electron radiation belt result from an “on/off,” geomagnetic‐activity‐dependent source from higher radial distances. Phase space density distributions of tens to hundreds of keV electrons in the inner belt are peaked in L* during quiet and average conditionsSudden flux enhancements during active conditions are the dominant source of hundreds of keV electrons in the inner beltThe occurrence of sudden flux enhancements at low L is strongly dependent on energy