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Over the past 60 years, scientists have strived to understand the past, present and future of the Antarctic Ice Sheet. One of the key components of this research has been the mapping of Antarctic bed topography and ice thickness parameters that are crucial for modelling ice flow and hence for predicting future ice loss and ensuing sea level rise. Supported by the Scientific Committee on Antarctic Research (SCAR), the Bedmap3 Action Group aims not only to produce new gridded maps of ice thickness and bed topography for the international scientific community, but also to standardize and make available all the geophysical survey data points used in producing the Bedmap gridded products. Here, we document the survey data used in the latest iteration, Bedmap3, incorporating and adding to all of the datasets previously used for Bedmap1 and Bedmap2, including ice-bed, surface and thickness point data from all Antarctic geophysical campaigns since the 1950s. More specifically, we describe the processes used to standardize and make these and future survey and gridded datasets accessible under the ‘Findable, Accessible, Interoperable and Reusable’ (FAIR) data principles. With the goals to make the gridding process reproducible and to allow scientists to re-use the data freely for their own analysis, we introduce the new SCAR Bedmap Data Portal (bedmap.scar.org, last access: 18 October 2022) created to provide unprecedented open access to these important datasets, through a user-friendly webmap interface. We believe that this data release will be a valuable asset to Antarctic research and will greatly extend the life cycle of the data held within it. Data are available from the UK Polar Data Centre: https://data.bas.ac.uk.

Understanding the dynamic behaviour of ice shelves, specifically the controls on their ability to buttress the flow of ice into the ocean, is critical for predicting future ice-sheet contributions to sea level rise. Many large ice shelves, which are predominantly composed of meteoric ice, have a basal layer of marine ice (formed from accumulated platelets at the ice–ocean interface), comprising up to 40% of their thickness locally. Differences in temperature, chemistry and microstructure between marine and meteoric ice mean the rheological properties of the ice vary throughout the ice shelf. These differences are not explicitly accounted for in ice-sheet modelling applications, and may have an important influence on ice shelf dynamics. We tested the sensitivity of a model of an idealised ice shelf to variations in temperature distribution and flow enhancement, and found that incorporating a realistic thermal profile (where the marine ice layer is isothermal) had an order of magnitude greater effect on ice mass flux and thinning than incorporating the mechanical properties of the marine ice. The presence of marine ice at the ice shelf base has the potential to significantly increase deviatoric stresses at the surface and ice mass flux across the front of an ice shelf.

Study Objective The purpose of this study is to rank the factors that are most and least important to patients with symptomatic uterine fibroids when considering surgical treatment options. Materials and Methods Using a best worst scaling (BWS) preference elicitation approach, participants completed an online survey to rank factors associated with fibroid surgical treatments. Survey content was based on a literature review and included the following factors: symptom relief; surgical complications; repeat treatment; recovery time; cosmetic effects; risk of spreading undiagnosed cancer; sexual outcomes; maintenance of child-bearing; continuation of menses; unpredictable menses; and location of procedure. Participants completed 11 BWS tasks. For each task, we presented participants with a subset of 5 factors from the possible 11, and participants chose the most important and least important factor. Participants’ responses were analyzed using conditional logistic regression to determine the relative importance of factors. Patient priorities were further explored via age and race. Results 285 respondents with symptomatic uterine fibroids (69 physician-confirmed and 216 self-reported) who had not undergone prior surgical treatment completed the survey. Respondents were enrolled from two clinical sites (clinical site cohort) and an online consumer panel (panel cohort). Both cohorts identified symptom relief, cancer risk, repeat treatment and complications as the most important factors in selecting surgical treatment options and location of procedure, return to normal activities after surgery, and cosmetic effects like presence of a scar after the surgical treatment as the least important factors. Of note, younger women (≤ 40) placed greater importance on the ability to have children after the procedure. Conclusion Information regarding the factors most and least important to patients with symptomatic uterine fibroids might inform development and regulatory evaluation of new technologies and procedures. Study results may be useful in efforts to develop a set of outcomes to include in future fibroids clinical studies.

Vanderford Glacier is one of the fastest retreating glaciers in East Antarctica, with approximately 18.6 km of grounding line retreat since 1996. Together with the Totten Glacier, the Vanderford Glacier is a key outlet glacier of the Aurora Subglacial Basin (ASB), which contains approximately 7 m of global sea level equivalent, of which ~3.5 m is vulnerable to ocean driven melting, and is rapidly losing mass. While the Totten Glacier currently discharges almost twice as much ice as the Vanderford Glacier, sediment records from the Sabrina and Knox Coast Sectors indicate that the Vanderford Glacier has had sedimentation rates over twice that at Totten in the past. Here, we examine the current flow configuration between Vanderford and Totten Glaciers and drivers of it, including interactions between the subglacial topography, hydraulic potential, climate, and ice sheet dynamics. We use the Ice-sheet and Sea-level System Model (ISSM) under experiments of heightened ocean warming concentrated at Vanderford Glacier, and heightened surface mass balance at Totten Glacier, to show that the present-day flow configuration between the Totten and Vanderford Glaciers is tenuous. Rerouting towards Vanderford Glacier could occur under even minor changes in surface elevation at both glaciers. Such rerouting potentially exposes large parts of the underbelly of the ASB to enhanced ocean-driven ice shelf melting in the event of rapid retreat of Vanderford Glacier, with implications for global sea level rise.

Mpox is a zoonotic disease caused by monkeypox virus (MPXV) from the Orthopoxvirus genus. Unprecedented transmission events have led to more than 70 000 cases reported worldwide by October 2022. The change in mpox epidemiology has raised concerns of its ability to establish endemicity beyond its traditional geographical locations. In this review, we discuss the current understanding of mpox virology and viral dynamics that are relevant to mpox diagnostics. A synopsis of the traditional and emerging laboratory technologies useful for MPXV detection and in guiding "elimination" strategies is outlined in this review. Importantly, development in MPXV genomics has rapidly advanced our understanding of the role of viral evolution and adaptation in the current outbreak.

Background Beta-lactam therapeutic drug monitoring (BL TDM; drug level testing) can facilitate improved outcomes in critically ill patients. Yet less than 20% of hospitals have implemented BL TDM. The purpose of this study was to characterize provider perceptions and key considerations for successful implementation of BL TDM. Methods This was a sequential mixed methods study from 2020 to 2021 of stakeholders at three academic medical centers with varying degrees of BL TDM implementation - Mayo Clinic (BL TDM not implemented), University of Florida Health Shands (partially implemented), and Royal Brisbane and Women’s Hospital (fully implemented). Stakeholders completed a survey to characterize their knowledge, perceptions, and experience with BL TDM. A diverse group of 30 respondents were then purposively sampled for semi-structured interviews. Results from the two strands were integrated, themes were identified, and findings were situated within implementation science frameworks. Results Among the 138 survey respondents (22% response rate), the majority were physicians (38%) and pharmacists (33%). 71% practiced in critical care and 21% in infectious diseases. The majority of respondents felt BL TDM was relevant to their practice and improved medication effectiveness and safety (Figure 1). Two implementation themes were identified: individual internalization and organizational features. Individuals needed to internalize, make sense of, and agree to BL TDM implementation which was positively influenced by repeated exposure to evidence and expertise. The process of internalization seemed more complex with BL TDM than with other antibiotics (i.e., vancomycin). Organizational considerations relevant to BL TDM implementation included adequate physical and informational infrastructure, access to trained personnel, supportive governance/leadership, and robust process and workflow development. Conclusion We found broad enthusiasm about the relevance and potential benefits of BL TDM among stakeholders. Prior literature suggested the primary barrier to implementation was assay availability, but we identified many more individual and organizational attributes which impacted the scale and spread of BL TDM. Disclosures Sara Ausman, PharmD, Gilead: Honoraria Christina G. Rivera, PharmD, Gilead: Grant/Research Support|Gilead: Honoraria|Insmed: Honoraria Jason Roberts, BPharm(Hons), PhD, FSHP, FISAC, British Society of Chemotherapy: Grant/Research Support|Cipla: Honoraria|Gilead: Advisor/Consultant|MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Board Member|Pfizer: Honoraria|Qpex: Grant/Research Support|Sandoz: Board Member|Summit: Advisor/Consultant|Wolters Kluwer: Advisor/Consultant Marc H. Scheetz, PharmD, MSc, Abbvie: Advisor/Consultant|Allecra: Grant/Research Support|Merck: Advisor/Consultant|Nevakar: Advisor/Consultant|Nevakar: Grant/Research Support|Premier Healthcare Solutions: Honoraria|Spero: Advisor/Consultant|SuperTrans Medical: Advisor/Consultant|SuperTrans Medical: Grant/Research Support|Takeda: Advisor/Consultant|Third Pole Therapeutics: Advisor/Consultant.

Background Xeruborbactam (XERU) is a member of a new class of cyclic boronic acid β-lactamase inhibitors with inhibitory activity against major members of Class A, B, C, and D beta-lactamases. This report describes the first safety and pharmacokinetic data following oral administration as the isobutyryloxymethyl prodrug in humans. Methods Forty-eight healthy subjects were enrolled into one of 6 cohorts of 8 subjects each in the single ascending doses (100, 200, 400, 600, 800, and 1000 mg). Subjects were randomly assigned with each cohort to XERU oral prodrug (n = 6), or placebo capsule (n = 2). Intensive plasma (total drug) and ultrafiltrate (free drug) sampling was obtained after dosing and assayed for QPX7831 and XERU content using validated HPLC/MS methods. Results XERU PK parameters following oral administration as the prodrug are shown in the table below. Compared to IV XERU doses (data not shown), XERU bioavailability is 90 - 100% orally bioavailable. No subjects discontinued due to AEs and no SAEs were observed. There was no evidence of increasing numbers or severity of AEs with increasing dose. All AEs were mild in severity. Conclusion Orally administered XERU was safe and well tolerated at all doses tested. Plasma XERU AUC and Cmax increased with increasing dose. XERU exposures (24h free AUC) exceed the predicted PK-PD parameter for stasis with once-daily doses of 400 mg or higher and exceed the PK-PD parameter for 1-log of bacterial killing once daily doses of 800 mg or higher. XERU, administered as an oral prodrug, has plasma PK properties that support once-daily administration. Disclosures David Griffith, n/a, Qpex Biopharma: Employee Jason Roberts, BPharm(Hons), PhD, FSHP, FISAC, British Society of Chemotherapy: Grant/Research Support|Cipla: Honoraria|Gilead: Advisor/Consultant|MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Board Member|Pfizer: Honoraria|Qpex: Grant/Research Support|Sandoz: Board Member|Summit: Advisor/Consultant|Wolters Kluwer: Advisor/Consultant Elizabeth Morgan, n/a, Qpex Biopharma: Employee Michael Dudley, n/a, ArrePath: Board Member|Qpex Biopharma: Board Member|Qpex Biopharma: Employee Jeff Loutit, MBChB, Qpex Biopharma: Employee.

Background Xeruborbactam (XERU) is a member of a new class of cyclic boronic acid β-lactamase inhibitors with inhibitory activity against major members of Class A, B, C, and D beta-lactamases. This report describes the safety and pharmacokinetics of XERU following multiple doses alone and in combination with meropenem. Methods Twenty-four healthy subjects were enrolled into one of 3 cohorts with XERU alone. XERU was administered as a 500 mg loading dose followed by 250 mg q8h or 1000 mg loading dose followed by 500 mg q8h. 15 healthy subjects were enrolled in a single cohort of meropenem alone administered as a 4000 mg loading dose followed by 2000 mg q8h or meropenem in combination with XERU administered as a 500 mg loading dose followed by 250 mg q8h for 10 days. Intensive plasma sampling was obtained after dosing and assayed for drug content using validated LC-MS/MS methods. Results XERU and Meropenem Steady State pharmacokinetic parameters are shown in the table below. No subjects discontinued due to AEs and no SAEs were observed. There was no evidence of increasing numbers or severity of AEs with increasing dose. All AEs were mild or moderate in severity. Conclusion XERU was safe and well-tolerated when administered alone and in combination with meropenem. XERU has unique PK properties that includes a long elimination half-life that provides sustained plasma concentrations. The loading dose of XERU allows for rapid achievement of steady state plasma levels of XERU within the first day of treatment. XERU plasma PK properties, along with a broad spectrum of inhibitory activity, facilitates its use with multiple beta-lactam antibiotics including meropenem. Disclosures David Griffith, n/a, Qpex Biopharma: Employee Jason Roberts, BPharm(Hons), PhD, FSHP, FISAC, British Society of Chemotherapy: Grant/Research Support|Cipla: Honoraria|Gilead: Advisor/Consultant|MSD: Advisor/Consultant|MSD: Honoraria|Pfizer: Board Member|Pfizer: Honoraria|Qpex: Grant/Research Support|Sandoz: Board Member|Summit: Advisor/Consultant|Wolters Kluwer: Advisor/Consultant Elizabeth Morgan, n/a, Qpex Biopharma: Employee Shawnee Gehrke, n/a, Qpex Biopharma: Employee Michael Dudley, n/a, ArrePath: Board Member|Qpex Biopharma: Board Member|Qpex Biopharma: Employee Jeff Loutit, MBChB, Qpex Biopharma: Employee.

Loggerhead turtles are a globally vulnerable species of marine turtle. Broad-scale patterns of distribution and abundance can provide regional managers a tool to effectively conserve and manage this species at basin and sub-basin scales. In this study, combined aerial and shipboard line transect survey data collected between 2003 and 2018 were used to estimate distribution and abundance throughout the Mediterranean Sea. Approximately 230,000 linear kilometers of survey effort, from seven different surveying organizations were incorporated into a generalized additive model to relate loggerhead density on survey segments to environmental conditions. Two spatial density models estimating loggerhead density, abundance, and distribution were generated – one a long-term annual average covering 2003-2018 and another covering the summer of 2018, when a basin-wide aerial survey, the Agreement on the Conservation of Cetaceans of the Black Sea, Mediterranean Sea and Contiguous Atlantic Area Survey Initiative, was performed. Both models were adjusted for availability bias using dive data from loggerhead turtles tagged with time depth recorders. Mean abundance for the long-term average model was estimated as 1,201,845 (CV=0.22). The summer 2018 abundance estimate was 789,244 turtles and covered a smaller area than the long-term average. These estimates represent the first basin-wide estimates of abundance for loggerhead turtles in the Mediterranean not based on demographic models. Both models predicted similar distributions, with higher abundance predicted in the northern Adriatic Sea, central Mediterranean basin, Tyrrhenian Sea, and south of the Balearic Islands. Lower densities were predicted in the eastern Mediterranean Sea and the Aegean Sea. The highest density areas generally did not coincide with previously established adult loggerhead turtle foraging areas, which are typically neritic, indicating the models are predominantly predicting oceanic distributions, where most of the survey effort occurred. Juvenile loggerhead turtles are predominantly oceanic and comprise most of the population, but care must be taken when using these models as they may not accurately predict distribution of neritic foraging areas, where subadult and adult loggerheads can often be found. Despite this limitation, these models represent a major step forward for conservation planning and understanding basin-wide distribution and abundance patterns of this species.

Kidney transplant patients undergo repeated and frequent venepunctures during allograft management. Microsampling methods that use a finger-prick draw of capillary blood, such as dried blood spots (DBS) and volumetric absorptive microsamplers (VAMS), have the potential to reduce the burden and volume of blood loss with venepuncture.This study aimed to examine microsampling approaches for the simultaneous measurement of tacrolimus, mycophenolic acid, mycophenolic acid glucuronide (MPAG), and prednisolone drug concentrations compared to standard venepuncture in adult kidney transplant patients. Dried blood spots and VAMS were simultaneously collected with venepuncture samples from 40 adult kidney transplant patients immediately before, and 2 h after immunosuppressant dosing. Method comparison was performed using Passing-Bablok regression, and bias was assessed using Bland-Altman analysis. Drug concentrations measured via microsampling and venipuncture were also compared by estimating the median prediction error (MPE) and median absolute percentage prediction error (MAPE).Passing-Bablok regression showed a systematic difference between tacrolimus DBS and venepuncture [slope of 1.06 (1.01-1.13)] and between tacrolimus VAMS and venepuncture [slope of 1.08 (1.03-1.13)]. Tacrolimus values were adjusted for this difference, and the corrected values showed no systematic differences. Moreover, no systematic differences were observed when comparing DBS or VAMS with venepuncture for mycophenolic acid and prednisolone. Tacrolimus (corrected), mycophenolic acid, and prednisolone microsampling values met the MPE and MAPE predefined acceptability limits of15% when compared to the corresponding venepuncture values. DBS and VAMS, collected in a controlled environment, simultaneously measured multiple immunosuppressants.This study demonstrates that accurate results of multiple immunosuppressant concentrations can be generated through the microsampling approach, with a preference for VAMS over DBS.

Antarctic geothermal heat flow (GHF) affects the thermal regime of ice sheets and simulations of ice and subglacial meltwater discharge to the ocean, but remains poorly constrained. We use an ice sheet model to investigate the impact of GHF anomalies on subglacial meltwater production in the Aurora Subglacial Basin, East Antarctica. We find that spatially-variable GHF fields produce more meltwater than a constant GHF with the same background mean, and meltwater production increases as the resolution of GHF anomalies increases. Our results suggest that model simulations of this region systematically underestimate meltwater production using current GHF models. We determine the minimum basal heating required to bring the basal ice temperature to the pressure melting point, which should be taken together with the scale-length of likely local variability in targeting in-situ GHF field campaigns.

Populations of invasive alien plants create disruptive plant communities that are extremely adaptable, imposing severe ecological impacts on agriculture, biodiversity and human activities. To minimise these impacts, prevention and effective weed management strategies are urgently required, including the identification of satellite populations before they invade new areas. This is a critical element that allows weed management practices to become both successful and cost-effective.

The intrusion of weeds into fertile areas has resulted in significant global economic and environmental impacts on agricultural production systems and native ecosystems, hence without ongoing and repeated management actions, the maintenance or restoration of these systems will become increasingly challenging. The establishment of herbicide resistance in many species and unwanted pollution caused by synthetic herbicides has ushered in the need for alternative, eco-friendly sustainable management strategies, such as the use of bioherbicides. Of the array of bioherbicides currently available, the most successful products appear to be sourced from fungi (mycoherbicides), with at least 16 products being developed for commercial use globally. Over the last few decades, bioherbicides sourced from bacteria and plant extracts (such as allelochemicals and essential oils), together with viruses, have also shown marked success in controlling various weeds. Despite this encouraging trend, ongoing research is still required for these compounds to be economically viable and successful in the long term. It is apparent that more focused research is required for (i) the improvement of the commercialisation processes, including the cost-effectiveness and scale of production of these materials; (ii) the discovery of new production sources, such as bacteria, fungi, plants or viruses and (iii) the understanding of the environmental influence on the efficacy of these compounds, such as atmospheric CO2, humidity, soil water stress, temperature and UV radiation.

Rapid diagnosis and whole genome sequencing confirmed a case of monkeypox in an HIV-positive individual receiving antiretroviral therapy. The patient had a normal CD4+ T-cell count and suppressed HIV viral load and presented with a genital rash in Melbourne, Australia after return from Europe in May 2022. He subsequently developed systemic illness and disseminated rash and 11 days after symptom onset, he was hospitalised to manage painful bacterial cellulitis of the genital area.

African lovegrass [Eragrostis curvula (Schrad.) Nees] is an invasive weed that is threatening biodiversity around the world and will continue to do so unless its efficient management is achieved. Consequently, laboratory and field-based experiments were performed to analyse several measures of germination to determine the effect of drought stress, radiant heat stress and burial depth and duration (longevity) on E. curvula seeds. This study investigated seeds from four spatially varied populations across Australia: Maffra and Shepparton, Victoria; Tenterfield, New South Wales; and Midvale, Western Australia. Results showed that increasing drought stress reduced and slowed germination for all populations. Maffra (24% vs. 83%) and Shepparton (41% vs. 74%) were reduced at the osmotic potential of ≤-0.4 MPa, whilst Tenterfield (35% vs. 98.6%) and Midvale (32% vs. 91%) were reduced at ≤-0.6 MPa, compared to the mean of all other osmotic potentials. Radiant heat at 100 C significantly reduced and slowed germination compared to 40 C for Tenterfield (62% vs. 100%), Shepparton (15% vs. 89%) and Midvale (41% vs. 100%); whilst Maffra (75% vs. 86%) had consistent germination. For the effect of burial depth and duration (longevity), there was no significant difference across the fourteen-month period, however, the 0 cm burial depth had a significantly lower final germination percentage compared to depths of 3, 5 and 10 cm (24% vs. 55%). Although each trial was conducted independently, their results can be used to help identify efficient control measures to reduce infesting populations. Such measures recommended include using soil moisture monitoring to detect which conditions will promote germination, as germination is encouraged when the osmotic potential is >-0.6 MPa; exposing seeds to radiant heat (>100 C) using methods such as prescribed burning; and limiting soil disturbance over time to reduce seed establishment.

African lovegrass [Eragrostis curvula (Schrad.) Nees] is a highly invasive C4 perennial grass that threatens global biodiversity. Appropriate management of this species has been hampered by a lack of knowledge concerning its seed ecology, resulting in significant economic and environmental impacts within various environments. Consequently, this study explored the effects of a selection of environmental factors (photoperiod, alternating temperature, pH, and salinity) by analyzing several measures of germination on four geographically distinct populations of E. curvula to assist in its extirpation from infested sites. Seeds were collected in Australia from Maffra and Shepparton, VIC; Tenterfield, NSW; and Midvale, WA. Key results showed that seeds from Maffra (54% vs. 79%), Tenterfield (38% vs. 61%), and Shepparton (34% vs. 71%) had significantly reduced germination in complete darkness compared with an alternating 12-h light and 12-h dark photoperiod, whereas Midvale had consistent germination (91% vs. 99%). Temperatures between 17/7 C reduced germination for Maffra (42% vs. 73%), Tenterfield (34% vs. 55%), and Shepparton (33% vs. 59%) compared with the mean of all other temperature combinations, whereas Midvale had consistent germination. Furthermore, germination for all populations was consistent between pH 4 and 9. For salinity, germination was significantly reduced at ≥100 mM for Maffra (29% vs. 67%), ≥150 mM for Tenterfield (29% vs. 94%) and Shepparton (39.5% vs. 81.5%), and 250 mM for Midvale (39% vs. 82%) compared with the mean of all other concentrations. Although each trial was conducted independently, the data can be used to generate species-targeted management. Such strategies include maintaining high levels of quarantine and hygiene programs to avoid future spread; where practical, applying light-limiting strategies (mulching, tilling, or scraping) for the Maffra, Tenterfield, and Shepparton populations; and maintaining management efforts year-round, as the species can germinate under a wide range of conditions.

Most of the scholarship on far-right hooliganism in Europe and Russia mentions only marginally the Russian far-right MMA gear and tournament brand White Rex (WR). A few authors have discussed WR’s right-wing connections and activities. Yet both the structures that enabled WR and, now, other similar brands to exert ideological and political influence and the influence itself bear further examination. This paper presents a qualitative analysis of information from intelligence reports, social media, open media, and interviews to show how WR modeled and cultivated a professionalizing trend in several far-right combat sport tournaments. We argue that WR’s entrance into the Western European far-right combat sport scene was a key development in the emergence of professionally organized, fight-focused events with explicit political messaging targeted at a far-right, primarily trans-European audience and a surrounding infrastructure of far-right organizations shaping the character of this developing scene. The business model that WR developed in Russia proved to be something the emerging European far-right combat sport scene could adopt in order to grow. Finally, we elaborate on how WR’s founder, Denis Kapustin, was able to establish a Western European network that temporarily gave him influence over one of the far right’s most significant cultural scenes.

Accurate prediction of sea level rise requires detailed understanding of processes contributing to ice sheet mass loss. Antarctica’s ice shelves are thinning, resulting in enhanced flow of grounded ice due to weakened ice shelf buttressing. Glaciers feeding ice shelves with the highest melt rates are also experiencing some of the most rapid grounding zone retreat. However, these ice shelf melt rates reach values that cannot be explained by ocean forcing alone and are not reproduced in ocean models. We present subglacial hydrology model outputs for four major Antarctic glaciers (Pine Island, Thwaites, Totten and Denman), which flow through the deepest and most extensive Antarctic marine subglacial basins and feed rapidly thinning ice shelves. We show that the areas of high ice shelf melting rates and grounding line retreat coincide closely with areas of high subglacial discharge. We posit that the subglacial discharge provides the missing component driving the high melt rates, and identify positive feedbacks between ice dynamics, steepening of ice shelf basal slope, and subglacial outflow. If surface temperatures increase as expected in Antarctica over the coming decades, surface meltwater could flow to the ice sheet base, as observed in Greenland. The surface meltwater hydrological cycle could therefore contribute to seasonal variations in subglacial meltwater and ice shelf basal melt, leading to accelerated grounding line retreat into Antarctica’s deepest subglacial basins. Invoking these feedbacks could reconcile sea level records and ice sheet model simulations that remain overly stable in warmer periods.

Background SARS-CoV-2 infection is associated with a significant risk of hospitalisation, death, and prolonged impact on quality of life. Evaluation of new treatment options and optimising therapeutic management of people hospitalised with SARS-CoV-2 infection remains essential, but rapid changes in pandemic conditions and potential therapies have limited the utility of traditional approaches to randomised controlled trials. Methods ASCOT ADAPT is an international, investigator-initiated, adaptive platform, randomised controlled trial of therapeutics for non-critically ill patients hospitalised with COVID-19. The study design is open label and pragmatic. Potential participants are hospitalised adults with PCR confirmed, symptomatic, SARS-CoV-2 infection, within 14 days of symptom onset. Domains include antiviral, antibody and anticoagulant interventions, with a composite primary outcome of 28-day mortality or progression to intensive-care level respiratory or haemodynamic support. Initial interventions include intravenous nafamostat and variable dose anticoagulation. A range of secondary endpoints, and substudies for specific domains and interventions are outlined. Discussion This paper presents the trial protocol and management structure, including international governance, remote site monitoring and biobanking activities and provides commentary on ethical and pragmatic considerations in establishing the ASCOT ADAPT trial under pandemic conditions. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12620000445976) and ClinicalTrials.gov (NCT04483960).

Background: There is a growing body of recent literature regarding the occurrence of pseudotumors associated with modular junctions and various bearing surfaces after total hip arthroplasty (THA). Revision surgery is often technically challenging and high complication rates have been reported. The optimal management of these patients and outcomes after operative treatment remain poorly understood. Methods: We report the case of a 77-year-old male with progressive unilateral lower extremity swelling, pain, and neuropathy 9 years after revision THA for polyethylene liner wear. Imaging and biopsy confirmed a massive intrapelvic pseudotumor exerting compressive effects. Radiographs demonstrated extensive femoral and pelvic osteolysis without evidence of component loosening. Debulking of the intrapelvic portion of the pseudotumor was performed via the lateral window of the ilioinguinal approach with component retention. Results: Debulking of the intrapelvic mass resulted in resolution of symptoms. One year postoperatively the patient reported pain free ambulation using a walker and no recurrence of symptoms. Radiographs demonstrated stable THA components in comparison with preoperative films. Discussion and Conclusion: This case demonstrates a rare finding of intrapelvic pseudotumor causing neurovascular compression after revision THA. Clinicians should be aware of intrapelvic pseudotumor as a possible cause of limb swelling and neuropathy, and that debulking of the mass is a potential treatment option in the setting of well-fixed implants.

ObjectivesA multistakeholder expert group under the Women’s Health Technology Coordinated Registry Network (WHT-CRN) was organized to develop the foundation for national infrastructure capturing the performance of long-acting and permanent contraceptives. The group, consisting of representatives from professional societies, the US Food and Drug Administration, academia, industry and the patient community, was assembled to discuss the role and feasibility of the CRN and to identify the core data elements needed to assess contraceptive medical product technologies.DesignWe applied a Delphi survey method approach to achieve consensus on a core minimum data set for the future CRN. A series of surveys were sent to the panel and answered by each expert anonymously and individually. Results from the surveys were collected, collated and analyzed by a study design team from Weill Cornell Medicine. After the first survey, questions for subsequent surveys were based on the analysis process and conference call discussions with group members. This process was repeated two times over a 6-month time period until consensus was achieved.ResultsTwenty-three experts participated in the Delphi process. Participation rates in the first and second round of the Delphi survey were 83% and 100%, respectively. The working group reached final consensus on 121 core data elements capturing reproductive/gynecological history, surgical history, general medical history, encounter information, long-acting/permanent contraceptive index procedures and follow-up, procedures performed in conjunction with the index procedure, product removal, medications, complications related to the long-acting and/or permanent contraceptive procedure, pregnancy and evaluation of safety and effectiveness outcomes.ConclusionsThe WHT-CRN expert group produced a consensus-based core set of data elements that allow the study of current and future contraceptives. These data elements influence patient and provider decisions about treatments and include important outcomes related to safety and effectiveness of these medical devices, which may benefit other women’s health stakeholders.

Populations of invasive alien plants create disruptive plant communities that are extremely adaptable, imposing severe ecological impacts on agriculture, biodiversity and human activities. To minimise these impacts, prevention and effective weed management strategies are urgently required, including the identification of satellite populations before they invade new areas. This is a critical element that allows weed management practices to become both successful and cost-effective. Mimosa pigra L. (Giant sensitive plant) is an invasive weed that has spread across various environments around the world and is considered one of the world’s top 100 most invasive plant species. Being adaptable to a wide range of soil types, in addition to its woody protective prickles and low palatability, M. pigra has quickly spread and established itself in a range of habitats. Current control methods of this species include biological, chemical and physical methods, together with attempts of integrated application. Reports suggest that integrated management appears to be the most effective means of controlling M. pigra since the use of any single method has not yet proved suitable. In this regard, this review synthesises and explores the available global literature and current research gaps relating to the biology, distribution, impacts and management of M. pigra. The contribution of this work will help guide land managers to design appropriate and sustainable management programs to control M. pigra.

Middle to distal-third clavicular shaft fractures are commonly treated with precontoured anterior plating. Some surgeons use mini-fragment plate fixation and position these plates on the anterior clavicle. Recent studies demonstrated the advantages of anterior clavicle plating, including a possible biomechanical advantage with cantilever bending forces and less subsequent implant removal. The insertion and positioning of anteriorly based clavicle plates requires the release of a portion of the anterior deltoid origin from the lateral clavicle. The purpose of this study is to evaluate the anatomy of the deltoid in relation to the clavicle and to determine the percentage of the deltoid origin released to place modern anterior precontoured plates.Six right and 4 left cadaver shoulders were dissected, each from separate cadaveric specimens (6 male and 4 female). All measurements were made with digital calipers. The length of the clavicle was measured from the acromioclavicular joint to the sternoclavicular joint. The length of deltoid origin on the lateral clavicle was measured from the acromioclavicular joint to the most medial attachment of the deltoid on the clavicle. Percentage of clavicle with deltoid origin was subsequently calculated.The average length of the cadaveric clavicles was 164.4 mm with a range from 134.3 to 178.1 mm. The average amount of deltoid origin on the clavicle was 58.7 mm with a range from 43.4 to 69 mm. On average 35.5% of the clavicle had deltoid origin, with a range from 30.2% to 38.8%.On average, 35.5% of the clavicular osseous anatomy contains deltoid origin. This should be taken into consideration when performing anterior plating for clavicle fractures. With a significant portion of deltoid origin elevated, surgeons may consider altering postoperative protocols until some interval healing has occurred to this anterior head of the deltoid.

In patients undergoing emergent operation for trauma, surgeons must decide whether to perform a definitive or damage control (DC) procedure. DC surgery (abbreviated initial surgery followed by planned reoperation after a period of resuscitation in the intensive care unit) has been suggested to most benefit patients more likely to succumb from the “vicious cycle” of hypothermia, acidosis, and coagulopathy and/or postoperative abdominal compartment syndrome (ACS) than the failure to complete organ repairs. However, there currently exists no unbiased evidence to support that DC surgery benefits injured patients. Further, the procedure is associated with substantial morbidity, long lengths of intensive care unit and hospital stay, increased healthcare resource utilization, and possibly a reduced quality of life among survivors. Therefore, it is important to ensure that DC laparotomy is only utilized in situations where the expected procedural benefits are expected to outweigh the expected procedural harms. In this manuscript, we review the comparative effectiveness and safety of DC surgery when used for different procedural indications. We also review recent studies suggesting variation in use of DC surgery between trauma centers and the potential harms associated with overuse of the procedure. We also review published consensus indications for the appropriate use of DC surgery and specific abdominal, pelvic, and vascular DC interventions in civilian trauma patients. We conclude by providing recommendations as to how the above list of published appropriateness indications may be used to guide medical and surgical education, quality improvement, and surgical practice.

Non-compressible torso haemorrhage (NCTH) (i.e., bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this manuscript, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude the above by providing recommendations as to when each of these methods may be best when indicated to manage injured patients with NCTH.

In the late fourth- or early fifth-century bilingual Codex Bezae (D), Lk. 6.5 includes the following agraphon in Greek and Latin: ‘On the same day, when [Jesus] saw someone working on the Sabbath, he said to him, “Man, if you know what you are doing you are blessed, but if you do not know then you are cursed and a transgressor of the law”’. Although scholars generally agree that this passage did not originate with the author of Luke, its precise origin and meaning remain contested. Previous studies implicitly agreed that the agraphon’s origin must be sought in the texts and traditions of the earliest Christian era. Based on literary parallels between Lk. 6.5D and the writings of Church Fathers, especially from the fourth century ce, this article argues that the Sabbath-Worker agraphon originated in the throes of later Christian polemic against Jewish and Judaizing practices of Sabbath observance.