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OBJECTIVE: Through a literature review, make recommendations regarding immunizations in people living with Inborn Error of Metabolism (IEM) in Brazil, assess the possible impact on metabolic decompensations after immunization, and if this specific population may have an impaired immune response to vaccines. SOURCE OF DATA: The MeSH Terms vaccination OR vaccine OR immunization associated with the term inborn error of metabolism AND recommendation were used in combination with search databases. Only articles published after 1990, in the languages English, Spanish, French or Portuguese, human-related were included. SYNTHESIS OF DATA: A total of 44 articles were included to make the following recommendations. Individuals with IEMs need to be up to date with their immunizations. Regarding which vaccines should be offered, children and adults should follow the routine immunization schedules locally available, including the COVID-19 vaccines. The only exception is the rotavirus vaccine for hereditary fructose intolerance. The benefit of immunization outweighs the very low risk of metabolic decompensation. Since not all patients will have an adequate immune response, measuring antibody conversion and titers is recommended CONCLUSIONS: All patients should receive age-appropriate immunizations in their respective schedules without delays. The only situation when vaccination may be contraindicated is with oral rotavirus vaccine in hereditary fructose intolerance. Monitoring the levels of antibodies should be done to detect any immune dysfunction or the necessity for boosters. A personalized immunization schedule is ideal for patients with IEMs. The reference organizations could improve their recommendations to address all IEMs, not only some of them.

Most Chinese officials and academics close to the government maintain that China is unique—indeed, superior to other civilizations. Therefore, the only history that counts is Chinese history. Yes, there have been recurring patterns in Chinese history, but they too are unique—not related to any global patterns, such as identified by British scholar Arnold Toynbee. Xin Fan, Associate Professor of History at the State University of New York at Fredonia, finds that national, Chinese history has gradually hijacked the dominant mode of thinking in Chinese historiography. This book examines how four generations of Chinese historians have tried to professionalize the practice of history in China. In the late Qing period, amateur historians working within the framework of neo-Confucianism explored Western ideas received mainly through Japan. Second, a generation of better trained historians in the 1920s and 1930s sought to temper Sino-centrism with greater objectivity, but the pressures resulting from the Japanese invasions pushed them away from objectivity.

Evgeny Zamyatin’s novel WE, blocked from publication by Soviet censors in 1921, has been published in several translations since the 1920s – most recently in 2021. An inspiration for Orwell’s 1984, WE anticipated many features of the totalitarian dictatorships that emerged under Mussolini, Stalin, and Hitler and have reemerged in Communist China and Putin’s Russia, and may be taking root in the United States and other Western countries where modern technologies bolster government capacities to watch and control one another and their subjects. This essay highlights parts of WE as rendered in a fresh translation and suggests how it illuminates some trends in today’s world. It also offers snapshots of dystopias in recent Russian and Chinese science fiction – many of which warn of a totalitarian future. The Russian snapshots are supplemented with an analysis of what the magazine GQ Rossiia in February 2022 termed the eight controversial books everyone must read – beginning with Zamyatin’s WE and ending with several dystopian novels by American writers such as The Giver by Lois Lowry. Most of the eight are dystopian. None is primed to encourage young Russians to adopt a fight-for-the fatherland outlook determined to wipe out Ukrainian traitors. The upshot: Zamyatin and Orwell predicted our realities more accurately than, say, Walt Whitman or even Jack London.

Lost Enlightenment and Polymaths of Islam, each analyzing a different but linked period of Central Asian civilization, is each a masterwork of scholarship. Each author, now at a different stage in his academic career, has put to good use a bevy of languages to unveil the achievements of societies and ways of life smothered by the Sturm und Drang of life including great power aggressions. S. Frederick Starr has led Soviet as well as Central Asian research institutes based in Washington, D.C. He was the first director of the Kennan Institute at the Woodrow Wilson International Center for Scholars and later the founding chairman of the Central Asia-Caucasus Institute and Silk Road Studies Program, now affiliated with the American Foreign Policy Institute. James Pickett is Assistant Professor of Eurasian History at the University of Pittsburgh. Each author has done research in Russia and Central Asia.

Abundant evidence from marine, ice-core and terrestrial records demonstrates that Earth’s climate has experienced co-evolution of orbital- and millennial-scale variability through the Pleistocene. The varying magnitude of millennial climate variability (MCV) was linked to orbitally paced glacial cycles over the past 800 kyr. Before this interval, global glaciations were less pronounced but more frequent, yet scarcity of a long-term integration of high-resolution continental and marine records hampers our understanding of the evolution and dynamics of MCV before the mid-Pleistocene transition. Here we present a synthesis of four centennial-resolved elemental time series, which we interpret as proxies for MCV, from North Atlantic, Iberian margin, Balkan Peninsula (Lake Ohrid) and Chinese Loess Plateau. The proxy records reveal that MCV was pervasive and persistent over the mid-latitude Northern Hemisphere during the past 1.5 Myr. Our results suggest that the magnitude of MCV is not only strongly modulated by glacial boundary conditions on Earth after the mid-Pleistocene transition, but also persistently influenced by variations in precession and obliquity through the Pleistocene. The combination of these four proxies into a new MCV stack offers a credible reference for further assessing the dynamical interactions between orbital and millennial climate variability. Orbital forcing consistently influenced the magnitude of millennial-scale climate variability through the Pleistocene, according to an analysis of four high-resolution Northern Hemisphere proxy records covering the past 1.5 Myr.

Compared with penetrating keratoplasty (PK), Descemet membrane endothelial keratoplasty (DMEK) is characterized as lower risk for complications such as immunological graft reaction and faster and better postoperative visual recovery. In patients with endothelial graft failure after PK, DMEK can be used to regenerate PK graft transparency. The surgical technique for DMEK in this specific situation is still under debate, particularly regarding stripping of Descemet membrane (DM) from the failed PK and diameter of the DMEK graft. Here we report a case of a 75-year-old female patient with a failed graft 16 years after PK for Fuchs endothelial dystrophy, who underwent uneventful DMEK surgery. Stripping of DM in this particular case was performed outside the failed PK and demonstrated a biomechanically stable junction between the PK donor and the host DM. Histopathologic analysis of the excised DM showed continuous extracellular matrix connecting the host and donor DM, indicating primary intention wound healing after PK at this tissue level. This case demonstrates that after PK, a biomechanically stable and histologically continuous DM can enable Descemetorhexis outside the failed graft and transplantation of a DMEK graft larger than the previous PK. This may provide more endothelial cells for transplantation.

The future of civilization could be determined by a China that exceeds the United States not only in numbers of people but also in gross domestic product (as measured by purchasing power parity) and in its mastery of high-speed trains and some other technologies. [...]unless all large powers act to slow climate change, all living beings will suffer. [...]neither side makes ideological claims on the other, as did the Soviet Union and the United States: Chinese power—not “communism”—is what China’s neighbors fear. COVID-19 and Other Disasters Khanna praises Prime Minister Narendra Modi as one of Asia’s “elected technocrats” along with Indonesia’s Joko Widodo and Philippine president Rodrigo Duterte.5 Khanna argues (p. 305) that such nonelite leaders with real-world experience governing as mayors or provincial governors are usually a better choice for the top job than well-heeled, upper-class politicians.

High-resolution proxy records help to understand natural forcing of climate variability and improving our capability to predict climate variability on decadal to centennial time scales. Present study from the Mawmluh cave, northeastern India shows sudden shifts in speleothem oxygen isotope values, indicating several abrupt changes in the Indian summer monsoon (ISM) during ~212 BCE to 1986 CE. Moderate ISM conditions prevailed during ~212 BCE to 400 CE punctuated with weak intervals, strong ISM during 400 and 500 CE and from 640 to 1060 CE, whereas weak ISM conditions prevailed during 520–540 CE, 820–850 CE and 940–980 CE and after 1060 CE. The interval from 1060 to 1986 CE witnessed decreased precipitation than the previous millennium. The latter phase of the Medieval Climate Anomaly (MCA; 1060 to 1200 CE) was quite drier in contrast to the earlier intervals. The ISM was generally weak during the Little Ice Age (LIA; 1350 to 1850 CE) with short-term pulses of high precipitation when sun-spot activity was high. The data shows the weakest ISM condition during 1640–1740 CE (Maunder Minimum) of the last two millennia. Variations in extra-tropical northern hemisphere temperatures due to volcanic activity and solar insolation, and accompanying northward/southward shifting of the Inter-Tropical Convergence Zone played a pivotal role in modulating the strength of the ISM during the past two millennia.

Better Red than dead?” This question was still being debated in Europe when the first batch of US grad students arrived in the USSR under terms of the cultural exchange signed by Willliam Lacy for the US State Department and Soviet Ambassador Georgii Zarubin on January 27, 1958. Most of the twenty American students arrived at Moscow State University (MGU) in September, but a few went to Leningrad State University. Their Soviet counterparts went to Harvard and Columbia—the only US universities the Soviets deemed on a par with MGU and Leningrad. As one of those at MGU, I proposed to the History Faculty that I research “Soviet Disarmament Policy, 1917-1934,” for my Ph.D. at Columbia. A sign of future trouble, when the department typed the title in Russian, it came out as “The Soviet Struggle for Disarmament.” On the positive side, the department assigned as my adviser a retired diplomat specializing in disarmament, Boris Efimovich Shtein, out of favor in the late Stalin years because he had been close to another Jew suspected of pro-Western leanings, Maksim Litvinov.

The three Baltic republics—Estonia, Latvia, Lithuania—are the only units of the former Soviet Union to deal effectively with the complex challenges of transitioning to free market democracy with advancing levels of human development. These countries have developed high levels of societal fitness—defined in complexity science as the ability to cope with multifaceted challenges and opportunities. What are the sources of these achievements? Many factors intertwined to produce what some call the “Baltic miracle.” One key element has been the three revolutions stemming from the Protestant mandate to read and discuss the Bible: mass literacy, free thought and repression, and respect for individual dignity. Protestant influences were strongest in what is now Estonia and Latvia, but they reached Lithuania as well. Religiosity in now low in the Baltic republics, as in the Sweden that once nurtured both Christianity and literacy in its Baltic provinces. But the sparks it ignited in centuries past have shaped the rationalist and humanistic ethos of the region. Religion, of course, is just one of the European influences that conditioned economic and other cultural development in the region. But the dates when the Bible reached all of Europe in the vernacular are strong predictors of human development today. Balts also gained from not being occupied by the Golden Horde. On the other hand, they had to overcome several centuries of Russian and then Soviet domination. Fifty years of Communist rule dimmed but did not extinguish the positive qualities that reemerged with great vitality in the late 20th and early 21st centuries. The Baltic transformations were not "managed" from above or from outside—not from Brussels, not from Washington. They were encouraged and supported by Sweden and other European powers, but each transformation emerged from the bottom-up rather than from the top-down or from outside-in. Balts acted synergistically to contribute to the self-organization that is crucial to meeting complex challenges.

Understanding the spatial and temporal variability of rainfall which is regulated by the strength of Asian monsoon requires an observational network dispersed across the continental landmass. The operation of monsoonal circulation during the last one million years is possible to be reconstructed using the geochemical and isotopic record available from cave speleothems. The monsoonal circulation brings rain and excess precipitation due to interplay of monsoonal wind strength which is governed by the seasonal movement of Intertropical Convergence Zone (ITCZ) from ocean to the continent. A consensual view is that both the operation of East Asian Summer Monsoon (EASM) and Indian Summer Monsoon (ISM) are in accordance with the orbital forcing. However, the lack of terrestrial records of ISM rainfall variability over glacial interglacial time scales precludes insights into pan-Asian monsoon forcing and related mechanisms. Here, we present independent estimates of temperature change from the clumped isotope record in speleothem from Belum cave, continental India, covering glacial interglacial transition (MIS-9). The palaeo data is used in conjugation with the already reported δ¹⁸O records from Chinese caves and Mean Annual Precipitation from Chinese Loess Plateau (CLP), which are influenced by the EASM, to understand the spatial variability of δ¹⁸O records and its significance in regulation of moisture transport process away from equator. A comparative study across latitudes, particularly at the peak of the interglacial period MIS 9 (after ~320 ka) brings to light the intensification of rainfall accompanied by relatively higher temperature (~35°C in Belum cave- 15.10°N) exhibited by both the ISM system and EASM System (Xiao cave 26.04°N). However, shift in δ¹⁸O record of caves above 30° N (Sanbao and Linzhu caves) is less, though the trend is similar. A recent study of CLP (36.35°N) reported a drop in mean precipitation by ~300mm post 320 ka. Such variation of the mid-latitude precipitation intensity may probably be a consequence of the combined effect of ice volume and snow cover in the Northern hemisphere and low latitude climate changes.

BACKGROUND Economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternative to usual care, but evidence is mixed. OBJECTIVE The aim was to review the literature on cost-effectiveness of eHealth interventions for mental disorders compared to usual care and to provide an estimate of the monetary benefits of such interventions compared to usual care. METHODS A systematic review and meta-analysis of (1) randomized controlled trials that (2) included participants with symptoms of mental disorders, (3) investigated a telephone or internet-based intervention, (4) included a control condition in the form of treatment as usual, psychological placebo, waiting list control or bibliotherapy, (5) reported outcomes on both quality of life and costs and (6) were published in English, was conducted. Electronic databases PubMed (including Medline), Embase, Emcare, PsycINFO, Web of Science and The Cochrane Library were searched. Data on risk of bias, quality of the economic evaluation, quality-of-life adjusted life years (QALYs) and costs were extracted from included studies and the incremental net benefit (INB) was calculated and pooled. RESULTS The search yielded 6226 abstracts and 37 studies with 14,946 participants were included. Quality of economic evaluations of included studies was rated to be moderate and risk of bias was high. A random-effects approach was maintained. Analyses suggested internet interventions to be slightly more effective than usual care in terms of QALY gain, Hedges’ g=.052 (95% CI .010; .094, P=.016), and equally expensive, Hedges’ g=.002 (95% CI -.080; 0.84, P=.96). The pooled INB was $255, (95% CI $91; $419, P=.002), favoring eHealth interventions over usual care. Perspective of the economic evaluation and targeted mental disorder moderated results. CONCLUSIONS Findings indicate that cost-effectiveness of e-mental health interventions compared to a care-as-usual approach is likely, but generalizability to new studies is poor given the substantial heterogeneity. This is the first study in the area of mental health to pool cost-effectiveness outcomes in an aggregate-data meta-analysis. CLINICALTRIAL Prospero registration https://www.crd.york.ac.uk/PROSPERO/; registration number: CRD42019141659.

Significance We recovered the world’s thickest continuous loess record from the southern margin of the Taklimakan desert, a global-scale dust source area. The continuous high-resolution grain size and flux records of dust emission, reflecting histories of aridity and westerlies climate, indicate an extant dry climate, desert area, and stable land surface supporting continuous loess deposition at least since ∼3.6 Ma, and that global cooling, rather than Tibet uplift, modulated the histories of aridity and westerlies climate changes in inland Asia since ∼3.6 Ma. Moreover, our study may suggest potential positive linkages and feedback among dust emission, marine biogeochemical activity, atmospheric CO2, and global cooling, which might provide insights into dynamics of Earth’s climate system and improve predictions for the future., Midlatitude Asia (MLA), strongly influenced by westerlies-controlled climate, is a key source of global atmospheric dust, and plays a significant role in Earth’s climate system . However, it remains unclear how the westerlies, MLA aridity, and dust flux from this region evolved over time. Here, we report a unique high-resolution eolian dust record covering the past 3.6 Ma, retrieved from the thickest loess borehole sequence (671 m) recovered to date, at the southern margin of the Taklimakan desert in the MLA interior. The results show that eolian dust accumulation, which is closely related to aridity and the westerlies, indicates existence of a dry climate, desert area, and stable land surface, promoting continuous loess deposition since at least ∼3.6 Ma. This region experienced long-term stepwise drying at ∼2.7, 1.1, and 0.5 Ma, coeval with a dominant periodicity shift from 41-ka cyclicity to 100-ka cyclicity between 1.1 Ma and 0.5 Ma. These features match well with global ice volume variability both in the time and frequency domains (including the Mid-Pleistocene Transition), highlighting global cooling-forced aridity and westerlies climate changes on these timescales. Numerical modeling demonstrates that global cooling can dry MLA and intensify the westerlies, which facilitates dust emission and transport, providing an interpretive framework. Increased dust may have promoted positive feedbacks (e.g., decreasing atmospheric CO2 concentrations and modulating radiation budgets), contributing to further cooling. Unraveling the long-term evolution of MLA aridity and westerlies climate is an indispensable component of the unfolding mystery of global climate change.

Inside the Outbreak “What kind of government is this?” Bella Zhang, a 25-year old perfume saleswoman with tinted blue hair asked as she sat outside a Wuhan hospital in February 2020 with her mother and younger brother, all three hooked to intravenous drips attached to a tree branch Since the hospital had no free beds, the whole family was quarantined at home, but visited the hospital for medication An epidemic could begin in any country, but not every political regime would labor to suppress news of its emergence (although the US president and Iran’s top leaders downplayed its dangers) 1 One saving grace for China was that its system could build new hospitals nearly overnight and regulate population movement to limit contagion Things fall apart;the centre cannot hold;Mere anarchy is loosed upon the world, The blood-dimmed tide is loosed, and everywhere The ceremony of innocence is drowned;Turning and turning in the widening gyre The best lack all conviction, while the worst Are full of passionate intensity The book contains sixty figures and tables illustrating such variables as “Increase in Chinese National Income Generated by One Unit of Fixed-Asset Investment, 1981–2012” and “China’s Gini Coefficient in Comparative Perspective ”

Chaos, machine, or evolving complexity? The butterfly effect suggests a world in chaos—with linkages so random or nuanced that just to measure or pre-state them is virtually impossible. To predict how they will interact is even less feasible. Thanks to “adjacent possibles” and the contradictory impulses of human behavior, much of our world appears to move in random spasms. Every new technology and policy outcome creates opportunities to push society in new and often unforeseen directions, driven by human agents who may introduce crucial but unpredictable goals, strategies, and actions. Against this view, complexity science seeks to identify patterns in interactive relationships. Many patterns can be plotted and, in some cases, foreseen. A comparison of political entities across the globe points to certain factors conducing to societal fitness. Analysis of states that have declined in fitness suggests why their strengths turned to weaknesses. A survey of societies that were relatively democratic points to several factors that contributed to their acquiring authoritarian regimes. Scientists and scholars can unveil some elements of order but should strive to do so without hubris. Wise policymakers will strive to channel both the “actuals” and “adjacent possibles” that then arise toward constructive futures.

Millennial-scale East Asian monsoon variability is closely associated with natural hazards through long-term variability in flood and drought cycles. Therefore, exploring what drives the millennial-scale variability is of significant importance for future prediction of extreme climates. Here we present a new East Asian summer monsoon (EASM) rainfall reconstruction from the northwest Chinese loess plateau spanning the past 650 kyr. The magnitude of millennial-scale variability (MMV) in EASM rainfall is linked to ice volume and greenhouse gas (GHG) at the 100-kyr earth-orbital eccentricity band and to GHG and summer insolation at the precession band. At the glacial-interglacial cycle, gradual changes in CO2 at times of intermediate ice volume leads to increased variability in North Atlantic stratification and Atlantic meridional overturning circulation, propagating abrupt climate changes into East Asia via the westerlies. Within the 100-kyr cycle precession variability further enhances the response, showing that stronger insolation and increased atmospheric GHG cause increases in the MMV of EASM rainfall. These findings indicate increased extreme precipitation events under future warming scenarios, consistent with model results.

Late Pleistocene changes in insolation, greenhouse gas concentrations, and ice sheets have different spatially and seasonally modulated climatic fingerprints. By exploring the seasonality of paleoclimate proxy data, we gain deeper insight into the drivers of climate changes. Here, we investigate changes in alkenone-based annual mean and Globigerinoides ruber Mg/Ca-based summer sea surface temperatures in the East China Sea and their linkages to climate forcing over the past 400,000 years. During interglacial-glacial cycles, there are phase differences between annual mean and seasonal (summer and winter) temperatures, which relate to seasonal insolation changes. These phase differences are most evident during interglacials. During glacial terminations, temperature changes were strongly affected by CO2. Early temperature minima, ~20,000 years before glacial terminations, except the last glacial period, coincide with the largest temperature differences between summer and winter, and with the timing of the lowest atmospheric CO2 concentration. These findings imply the need to consider proxy seasonality and seasonal climate variability to estimate climate sensitivity., How temperatures at different seasons differ in response to different forcings is not well known. Here, the authors reconstruct annual and seasonal sea surface temperatures in the East China Sea and show that they react differently to CO2 and insolation forcing on glacial-interglacial timescales.

PG 1159-035 is the prototype of the DOV hot pre-white dwarf pulsators. It was observed during the Kepler satellite K2 mission for 69 days in 59 s cadence mode and by the TESS satellite for 25 days in 20 s cadence mode. We present a detailed asteroseismic analysis of those data. We identify a total of 107 frequencies representing 32 l=1 modes, 27 frequencies representing 12 l=2 modes, and 8 combination frequencies. The combination frequencies and the modes with very high k values represent new detections. The multiplet structure reveals an average splitting of 4.0+/-0.4 muHz for l=1 and 6.8+/-0.2 muHz for l=2, indicating a rotation period of 1.4+/-0.1 days in the region of period formation. In the Fourier transform of the light curve, we find a significant peak at 8.904+/-0.003 muHz suggesting a surface rotation period of 1.299+/-0.002 days. We also present evidence that the observed periods change on timescales shorter than those predicted by current evolutionary models. Our asteroseismic analysis finds an average period spacing for l=1 of 21.28+/-0.02 s. The l=2 modes have a mean spacing of 12.97+/-0.4 s. We performed a detailed asteroseismic fit by comparing the observed periods with those of evolutionary models. The best fit model has Teff=129600+/- 11100 K, mass M*=0.565+/-0.024 Msun, and log g=7.41+0.38-0.54, within the uncertainties of the spectroscopic determinations. We argue for future improvements in the current models, e.g., on the overshooting in the He-burning stage, as the best-fit model does not predict excitation for all the pulsations detected in PG~1159-03., 27 pages, 9 tables and 26 figures

The long���term evolution of the East Asian Monsoon and the processes controlling its variability under changing climate boundary conditions remain enigmatic. Here, we integrate new and published high���resolution planktic and benthic foraminiferal isotope data with proxy records for chemical weathering derived from diffuse reflectance spectroscopy at Ocean Drilling Program Site 1146 (South China Sea) to reconstruct the evolution of the summer monsoon between ���17 and 5 Ma. Our records show that an overall warm and humid tropical climate prevailed over southeastern Asia during the Miocene Climatic Optimum, suggesting northward expansion of the tropical rain belt in response to greenhouse gas forcing. By contrast, monsoon seasonality increased during the middle Miocene Climatic Transition in tandem with Antarctic glacial expansion and global cooling. Substantial weakening of the summer monsoon between ���12.7 and 10.9 Ma supports that decreased weathering and riverine input of nutrients and alkalinity contributed to carbonate depletion in the deep ocean during the Carbonate Crash. Intensification of monsoonal circulation and strengthening of the biological pump through the late Miocene promoted carbon burial, drawdown of atmospheric CO2, and climate cooling during the Biogenic Bloom. These results underscore the dynamic evolution of the East Asian Monsoon throughout the middle to late Miocene. Variations in local insolation forcing and in Southern Hemisphere ice volume, influencing the latitudinal thermal gradient, evaporation���moisture budgets, and the strength of the tropical convection, exerted major controls on the development of the monsoon., Key Points: Equable, warm, and humid climate over Southeast Asia during Miocene Climatic Optimum due to latitudinal expansion of tropical convection. Intensification of seasonal monsoonal regime linked to stepwise climate cooling during middle Miocene Climatic Transition. Decreased riverine input of alkalinity to ocean due to summer monsoon decline contributed to middle to late Miocene Carbonate Crash., Deutsche Forschungsgemeinschaft (DFG) http://dx.doi.org/10.13039/501100001659

Purpose The lacrimal caruncle is composed of numerous structures including different glands as well as hair follicles. Accordingly, the spectrum of benign and malignant lesions is broad, and the clinical diagnosis is often challenging. Here we systematically analyzed excised caruncular tumors over the past 22 years with special emphasis on the clinico-pathological correlation to provide a guidance for clinicians. Methods Retrospective evaluation with clinico-pathologic correlation of surgically removed caruncular tumors between 1998 and 2020 at a tertiary referral center. Results Eighty-two caruncular tumors were identified in the respective period. The patients were between 11 and 85 years of age (mean, 46.8 years; median, 49 years). Nevi (n = 35), cystic lesions (n = 14), oncocytoma (n = 9), papilloma (n = 8), sebaceous gland hyperplasia (n = 8), and reactive lymphoid hyperplasia (n = 4) were observed most frequently. Besides, we are the first reporting herniated orbital fat accompanied by a pyogenic granuloma. 2.4% (n = 2) were malignant tumors (sebaceous gland carcinoma, conjunctival intraepithelial neoplasia with pyogenic granuloma). Conclusion Caruncular tumors show a broad spectrum of mostly benign tumors. They can occur in patients of any age. However, 8/9 oncocytomas and both malignant lesions were detected in patients older than 60 years. Although the clinical diagnosis was confirmed in only 68.3% by the histopathological analysis, the two malignant lesions were identified as such already clinically. Caruncular lesions with a history of growth or other signs of malignancy should be excised followed by detailed histopathological examination to allow a final diagnosis and exclude rare malignant tumors with lethal potential.

Earths orbital geometry exerts a profound influence on climate by regulating changes in incoming solar radiation. Superimposed on orbitally-paced climate change, Pleistocene records reveal substantial millennial-scale variability characterized by trends, tipping points, and rapid swings. However, the extent to which orbital forcing modulates the amplitude and timing of these millennial variations is unclear. Here we isolate the magnitude of millennial-scale variability (MMV) in two well-dated records, both linked to precession cycles (19,000-23,000-year periodicity): atmospheric methane and Chinese speleothem δ¹⁸O, where the latter is commonly interpreted as a proxy for Asian monsoon intensity. At the millennial timescale (1,000-10,000 years), we find a fundamental decoupling wherein precession directly modulates the MMV of methane but not that of speleothem-δ¹⁸O. We hypothesize that mid-to-high latitude insolation modulates the MMV of atmospheric methane, but feedbacks internal to the Earth-climate system modulate the strength of millennial-scale monsoonal circulation.

Understanding past variability and forcing mechanisms of the Asian monsoon system is of key importance for better forecasting its behaviour under future global warming scenarios and how this may affect modern societies and economies. So far, knowledge about long-term monsoon variability in mainland Asia is mainly based on proxy records from Chinese speleothems, primarily recording changes of the East Asian Summer Monsoon (EASM). These records have provided evidence for orbital-scale monsoon variability, driven by Northern Hemisphere summer insolation changes, but also for centennial- to millennial-scale reductions in monsoon precipitation. These so-called Weak Monsoon Intervals (WMIs) occurred synchronously to cold intervals in the North Atlantic realm, e.g. during Heinrich Events, pointing at a close hemisphere-scale climatic teleconnection between the North Atlantic and Asia. However, the exact mechanisms that control short-term monsoon variability are still elusive. Moreover, long-term palaeomonsoon proxy records from the core zone of the Indian Summer Monsoon (ISM) are still relatively scarce compared to those from the EASM realm. To identify possible short-term changes in ISM intensity and reconstruct related hydroclimate and vegetation changes on the Indian subcontinent during the interval ~6–74 ka BP, sediments from IODP Site U1446 in the NW Bay of Bengal have been analysed. This site, being located within the reach of the Mahanadi River, is characterized by high riverine input of terrestrial organic matter and thus ideal for high-resolution analyses of pollen content and the stable hydrogen (δD) and carbon (δ13C) isotope composition of n-alkanes from terrestrial plant leaf waxes. Here we present preliminary results of δD and δ13C analyses on odd-numbered long-chain n-alkanes (n-C27 to n-C33,) extracted from the IODP Site U1446 sediments. These indicate several reductions in ISM precipitation during the last glacial, which occurred parallel to cold events in the North Atlantic realm, e.g. during Heinrich events H1, H2, H4, H5 and H6. In combination with pollen and alkenone-based (UK’37) sea surface temperature data from the same sediments, we aim at (1) providing a comprehensive and high-resolution reconstruction of past ISM variability and associated vegetation changes on the Indian subcontinent and (2) understanding the trigger mechanisms of centennial- to millennial-scale WMIs, particularly in relation to changes in Indian Ocean oceanography.

We report the discovery of short-period photometric variability and modulated Zeeman-split hydrogen emission in SDSSJ125230.93-023417.72 (EPIC 228939929), a variable white dwarf star observed at long cadence in \textit{K2} Campaign 10. The behavior is associated with a magnetic ($B=5.0$ MG) spot on the stellar surface, making the $317.278$-second period a direct measurement of the stellar rotation rate. This object is therefore the fastest-rotating apparently isolated (without a stellar companion) white dwarf yet discovered, and the second found to exhibit chromospheric Balmer emission after GD 356, in which the emission has been attributed to a unipolar inductor mechanism driven by a possible rocky planet. We explore the properties and behavior of this object, and consider whether its evolution may hold implications for white dwarf mergers and their remnants., Comment: 11 pages, 6 figures, 3 tables. Accepted for publication in ApJ

The tropics experienced a unique monsoon climate that drove important changes in socio-economic conditions and shaped different phases of human history during the late Quaternary across the Indian subcontinent. This study presents a new high-resolution speleothem-record of Indian summer monsoon (ISM) variability ranging from ~45,000 to 34,000 yr BP combined with a published record up to 5500 yr BP from the Mawmluh cave, northeastern India. We document significant changes in solar insolation and precession harmonics, implicating solar activity as one of the major forcing factors for rapid monsoonal shifts. Our new δ18O time series shows high-amplitude shifts in the ISM during the marine isotope stage 3 (MIS 3), similar to Dansgaard-Oeschger (D-O) oscillations recorded at high northern latitudes, which mimic the Greenland ice sheet record. The sun driven Northern Hemisphere high latitude climate anomalies played an active role in driving ISM variability and changes in the regional hydrological cycle on centennial to millennial time scales across the Indian subcontinent.

The surface hydrography of the Indian Ocean (north of the equator) is influenced by the seasonal wind reversals, which affect the thermocline depth and mixed layer thickness as well as sea surface temperature (SST). We analyzed the surface-subsurface hydrographic changes in the Tropical Eastern Indian Ocean (TEIO) during the late Neogene and Quaternary, using planktic foraminiferal census data from ODP Hole 758A combined with surface-dwelling planktic foraminiferal stable oxygen and carbon isotope ratios. The occurrence of dominant thermocline-dwelling species and high surface productivity during the latest Miocene - Early Pliocene (between 6 and 3.4 Ma) reflects an intense Indian summer monsoon (ISM). Deepening of the thermocline and thickening of the mixed layer in the TEIO were driven by the weakening of the ISM after 3.4 Ma, causing fluctuations in surface productivity. Heat budget capacity increased after 3.4 Ma in the TEIO due to the thickening of the mixed layer, which may have also reduced the heat transport towards the South Pole. Further, the hydrography of the TEIO was affected by the advection of nutrient-rich saline water from the western Indian Ocean by the strong equatorial eastward flow between 2.7 and 1.2 Ma. We suggest that the development of the equatorial zonal Westerlies (Walker circulation) across the tropical Indian Ocean was a gradual process starting at ~3.4 Ma, which intensified at 2.7 Ma due to regional strengthening of the Indian winter monsoon.

Chinese loess and stalagmites are two classic terrestrial archives that have been intensively studied to reconstruct the characteristics and dynamics of orbital- and millennial-scale monsoon variability. However, comparability between these two representative records remains contested due to chronological uncertainty and proxy complexity. Here five high-sedimentation-rate loess records on the Chinese Loess Plateau are investigated to assess East Asian monsoon variability at orbital and millennial timescales. By correlating loess grain size (a winter monsoon proxy) to speleothem δ18O (a summer monsoon proxy), we establish an independent speleothem-based chronology for Chinese loess-paleosol sequences over the past 640 ka. The synchronized loess grain-size records indicate that winter monsoon variability is spatially consistent on glacial-interglacial to millennial timescales, exhibiting distinctive precession- and millennial-scale changes similar to those of speleothem δ18O records. However, as affected by the complex processes of deposition and weathering, magnetic susceptibility variations are spatially different in terms of both amplitude and frequencies. Cross-spectral results of a loess grain-size stack with benthic oxygen isotope and orbital parameters reveal that ice volume has played a more dominant (70–75%) role than insolation (25–30%) in driving orbital-scale winter monsoon fluctuation. Comparison of high-frequency (

High-resolution multi-proxy records are pivotal to analyze Indian monsoon variability and its linkages with socio-economic growth in South Asia. To constrain short-term shifts in the Indian monsoon, we analyzed a speleothem sample from Meghalaya, northeastern India encompassing ∼15.4 to 10.1 kilo year before the Present (kyr BP). Our new speleothem data from Meghalaya suggests wet conditions in northeastern India during ∼15.4 to 12.9 kyr BP and ∼11.3 to 10.1 kyr BP, punctuated by a dry phase during ∼12.9 to 11.3 kyr BP including the Younger Dryas (YD) cold interval. We suggest a southward shift of the Intertropical Convergence Zone (ITCZ) in addition to weak Atlantic Meridional Overturning Circulation and land-sea heat contrast during the YD event leading to a weak Indian summer monsoon. The Northern Hemisphere atmospheric heating shift the ITCZ northward, but our data shows high-frequency shifts in the ISM during ∼11.3 to 10.1 kyr BP following termination of the YD cold event. This interval also shows a higher growth rate of the studied speleothem sample.