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The total aviation effective radiative forcing is dominated by non-CO2 effects. The largest contributors to the non-CO2 effects are contrails and contrail cirrus. There is the possibility of reducing the climate effect of aviation by avoiding flying through ice-supersaturated regions (ISSRs), where contrails can last for hours (so-called persistent contrails). Therefore, a precise prediction of the specific location and time of these regions is needed. But a prediction of the frequency and degree of ice supersaturation (ISS) on cruise altitudes is currently very challenging and associated with great uncertainties because of the strong variability in the water vapour field, the low number of humidity measurements at the air traffic altitude, and the oversimplified parameterisations of cloud physics in weather models. Since ISS is more common in some dynamical regimes than in others, the aim of this study is to find variables/proxies that are related to the formation of ISSRs and to use these in a regression method to predict persistent contrails. To find the best-suited proxies for regressions, we use various methods of information theory. These include the log-likelihood ratios, known from Bayes' theorem, a modified form of the Kullback–Leibler divergence, and mutual information. The variables (the relative humidity with respect to ice, RHiERA5; the temperature, T; the vertical velocity, ω; the divergence, DIV; the relative vorticity, ζ; the potential vorticity, PV; the normalised geopotential height, Z; and the local lapse rate, γ) come from ERA5, and RHiM/I, which we assume as the truth, comes from MOZAIC/IAGOS (Measurement of Ozone and Water Vapour on Airbus In-service Aircraft/In-service Aircraft for a Global Observing System; commercial aircraft measurements). It turns out that RHiERA5 is the most important predictor of ice supersaturation, in spite of its weaknesses, and all other variables do not help much to achieve better results. Without RHiERA5, a regression to predict ISSRs is not successful. Certain modifications of RHiERA5 before the regression (as suggested in recent papers) do not lead to improvements of ISSR prediction. Applying a sensitivity study with artificially modified RHiERA5 distributions points to the origin of the problems with the regression: the conditional distributions of RHiERA5 (conditioned on ISS and non-ISS, from RHiM/I) overlap too heavily in the range of 70 %–100 %, so for any case in that range, it is not clear whether it belongs to an ISSR or not. Evidently, this renders the prediction of contrail persistence very difficult.

The Greenland Ice Sheet (GrIS) has been losing mass since the 1990s as a direct consequence of rising temperatures and has been projected to continue to lose mass at an accelerating pace throughout the 21st century, making it one of the largest contributors to future sea-level rise. The latest Coupled Model Intercomparison Project Phase 6 (CMIP6) models produce a greater Arctic amplification signal and therefore also a notably larger mass loss from the GrIS when compared to the older CMIP5 projections, despite similar forcing levels from greenhouse gas emissions. However, it is also argued that the strength of regional factors, such as melt–albedo feedbacks and cloud-related feedbacks, will partly impact future melt and sea-level rise contribution, yet little is known about the role of these regional factors in producing differences in GrIS surface melt projections between CMIP6 and CMIP5. In this study, we use high-resolution (15 km) regional climate model simulations over the GrIS performed using the Modèle Atmosphérique Régional (MAR) to physically downscale six CMIP5 Representative Concentration Pathway (RCP) 8.5 and five CMIP6 Shared Socioeconomic Pathway (SSP) 5-8.5 extreme high-emission-scenario simulations. Here, we show a greater annual mass loss from the GrIS at the end of the 21st century but also for a given temperature increase over the GrIS, when comparing CMIP6 to CMIP5. We find a greater sensitivity of Greenland surface mass loss in CMIP6 centred around summer and autumn, yet the difference in mass loss is the largest during autumn with a reduction of 27.7 ± 9.5 Gt per season for a regional warming of +6.7 ∘C and 24.6 Gt per season more mass loss than in CMIP5 RCP8.5 simulations for the same warming. Assessment of the surface energy budget and cloud-related feedbacks suggests a reduction in high clouds during summer and autumn – despite enhanced cloud optical depth during autumn – to be the main driver of the additional energy reaching the surface, subsequently leading to enhanced surface melt and mass loss in CMIP6 compared to CMIP5. Our analysis highlights that Greenland is losing more mass in CMIP6 due to two factors: (1) a (known) greater sensitivity to greenhouse gas emissions and therefore warmer temperatures and (2) previously unnotified cloud-related surface energy budget changes that enhance the GrIS sensitivity to warming.

Recent warm atmospheric conditions have damaged the ice shelves of the Antarctic Peninsula through surface melt and hydrofracturing and could potentially initiate future collapse of other Antarctic ice shelves. However, model projections with similar greenhouse gas scenarios suggest large differences in cumulative 21st-century surface melting. So far it remains unclear whether these differences are due to variations in warming rates in individual models or whether local feedback mechanisms of the surface energy budget could also play a notable role. Here we use the polar-oriented regional climate model MAR (Modèle Atmosphérique Régional) to study the physical mechanisms that would control future surface melt over the Antarctic ice shelves in high-emission scenarios RCP8.5 and SSP5-8.5. We show that clouds enhance future surface melt by increasing the atmospheric emissivity and longwave radiation towards the surface. Furthermore, we highlight that differences in meltwater production for the same climate warming rate depend on cloud properties and particularly cloud phase. Clouds containing a larger amount of supercooled liquid water lead to stronger melt, subsequently favouring the absorption of solar radiation due to the snowmelt–albedo feedback. As liquid-containing clouds are projected to increase the melt spread associated with a given warming rate, they could be a major source of uncertainties in projections of the future Antarctic contribution to sea level rise.

In this paper, the effects of ice-supersaturated regions and thin, subvisual cirrus clouds on lapse rates are examined. For that, probability distribution and density functions of the lapse rate and the potential temperature gradients from 10 years of measurement data from the MOZAIC/IAGOS project and ERA5 reanalysis data were produced, and an analysis of an example case of an ice-supersaturated region with a large vertical extent is performed. For the study of the probability distribution and density functions, a distinction is made between ice-subsaturated and ice-supersaturated air masses (persistent contrails) and situations of particularly high ice supersaturation that allow the formation of optically thick and strongly warming contrails. The estimation of the lapse rates involves two adjacent standard pressure levels of the reanalysis surrounding MOZAIC's measurement/flight points. If the upper of these levels is in the stratosphere, the distribution function for subsaturated cases shows much lower lapse rates than those of supersaturated cases. If all levels are in the troposphere, the distributions become more similar, but the average lapse rates are still higher in supersaturated than in subsaturated cases, and the distributions peak at higher values and are narrower in ice-supersaturated regions (ISSRs) than elsewhere. This narrowing is particularly pronounced if there is substantial supersaturation. For the examination of an example case, ERA5 data and forecasts from ICON-EU (DWD) are compared. ERA5 data, in particular, show a large ice-supersaturated region below the tropopause, which was pushed up by uplifting air, while the data of ICON-EU indicate areas of saturation. The lapse rate in this ice-supersaturated region (ISSR), which is large, is associated with clouds and high relative humidity. Supersaturation and cloud formation result from uplifting of air layers. The temperature gradient within an uplifting layer steepens, for both dry and moist air. As soon as condensation or ice formation starts in the upper part of a lifting layer, the release of latent heat begins to decrease the lapse rate, but radiation starts to act in the opposite direction, keeping the lapse rate high. The highest lapse rates close to the stability limit can only be reached in potentially unstable situations.

Abstract Increased intracranial pressure (ICP) ≥15 mmHg is associated with adverse neurological outcomes, but needs invasive intracranial monitoring. Using the publicly available MIMIC-III Waveform Database (2000–2013) from Boston, we developed an artificial intelligence-derived biomarker for elevated ICP (aICP) for adult patients. aICP uses routinely collected extracranial waveform data as input, reducing the need for invasive monitoring. We externally validated aICP with an independent dataset from the Mount Sinai Hospital (2020–2022) in New York City. The AUROC, accuracy, sensitivity, and specificity on the external validation dataset were 0.80 (95% CI, 0.80–0.80), 73.8% (95% CI, 72.0–75.6%), 73.5% (95% CI 72.5–74.5%), and 73.0% (95% CI, 72.0–74.0%), respectively. We also present an exploratory analysis showing aICP predictions are associated with clinical phenotypes. A ten-percentile increment was associated with brain malignancy (OR = 1.68; 95% CI, 1.09-2.60), intracerebral hemorrhage (OR = 1.18; 95% CI, 1.07–1.32), and craniotomy (OR = 1.43; 95% CI, 1.12–1.84; P

Abstract Malnutrition is a frequently underdiagnosed condition leading to increased morbidity, mortality, and healthcare costs. The Mount Sinai Health System (MSHS) deployed a machine learning model (MUST-Plus) to detect malnutrition upon hospital admission. However, in diverse patient groups, a poorly calibrated model may lead to misdiagnosis, exacerbating health care disparities. We explored the model’s calibration across different variables and methods to improve calibration. Data from adult patients admitted to five MSHS hospitals from January 1, 2021 - December 31, 2022, were analyzed. We compared MUST-Plus prediction to the registered dietitian’s formal assessment. Hierarchical calibration was assessed and compared between the recalibration sample (N = 49,562) of patients admitted between January 1, 2021 - December 31, 2022, and the hold-out sample (N = 17,278) of patients admitted between January 1, 2023 - September 30, 2023. Statistical differences in calibration metrics were tested using bootstrapping with replacement. Before recalibration, the overall model calibration intercept was −1.17 (95% CI: −1.20, −1.14), slope was 1.37 (95% CI: 1.34, 1.40), and Brier score was 0.26 (95% CI: 0.25, 0.26). Both weak and moderate measures of calibration were significantly different between White and Black patients and between male and female patients. Logistic recalibration significantly improved calibration of the model across race and gender in the hold-out sample. The original MUST-Plus model showed significant differences in calibration between White vs. Black patients. It also overestimated malnutrition in females compared to males. Logistic recalibration effectively reduced miscalibration across all patient subgroups. Continual monitoring and timely recalibration can improve model accuracy.

**Background:** Postoperative urinary retention (POUR) is a common and distressing surgical complication that may be associated with the pharmacological reversal technique of neuromuscular blockade (NMB). **Objective:** This study aimed to investigate the impact that POUR has on medical charges. **Methods:** This was a retrospective observational study of adult patients undergoing select surgeries who were administered neuromuscular blockade agent (NMBA), which was pharmacologically reversed between February 2017 and November 2021 using data from the PINC-AI™ Healthcare Database. Patients were divided into 2 groups: those experiencing POUR (composite of retention of urine, insertion of temporary indwelling bladder catheter, insertion of non-indwelling bladder catheter) during index hospitalization following surgery and those without POUR. Surgeries in inpatient and outpatient settings were analyzed separately. A cross-sectional comparison was performed to report total hospital charges for the 2 groups. Furthermore, patients experiencing subsequent POUR events within three days after discharge from index hospitalization were studied. **Results:** A total of 330 838 inpatients and 437 063 outpatients were included. POUR developed in 13 020 inpatients and 2756 outpatients. Unadjusted results showed that POUR was associated with greater charges in both inpatient ($92 529 with POUR vs $78 556 without POUR, _p_

In this work, the previously introduced NeuralSchrödinger PINN is extended towards the use of analytical gradient expressions of the loss function. It is shown that the analytical gradients derived in this work increase the convergence properties for both the BFGS and ADAM optimizers compared to the previously employed numerical gradient implementation. In addition, the use of parallelised GPU computations via CUDA greatly increased the computational performance over the previous implementation using single-core CPU computations. As a consequence, an extension of the NeuralSchrödinger PINN towards two-dimensional quantum systems became feasible as also demonstrated in this work.

Summary: Persistent liver injury triggers a fibrogenic program that causes pathologic remodeling of the hepatic microenvironment (i.e., liver fibrosis) and portal hypertension. The dynamics of gene regulation during liver disease progression and early regression remain understudied. Here, we generated hepatic transcriptome profiles in two well-established liver disease models at peak fibrosis and during spontaneous regression after the removal of the inducing agents. We linked the dynamics of key disease readouts, such as portal pressure, collagen area, and transaminase levels, to differentially expressed genes, enabling the identification of transcriptomic signatures of progressive vs. regressive liver fibrosis and portal hypertension. These candidate biomarkers (e.g., Tcf4, Mmp7, Trem2, Spp1, Scube1, Islr) were validated in RNA sequencing datasets of patients with cirrhosis and portal hypertension, and those cured from hepatitis C infection. Finally, deconvolution identified major cell types and suggested an association of macrophage and portal hepatocyte signatures with portal hypertension and fibrosis area.

Background: International guidelines recommend quantitative neuromuscular monitoring when administering neuromuscular blocking agents. The train-of-four count is important for determining the depth of block and appropriate reversal agents and doses. However, identifying valid compound motor action potentials (cMAPs) during surgery can be challenging because of low-amplitude signals and an inability to observe motor responses. A convolutional neural network (CNN) to classify cMAPs as valid or not might improve the accuracy of such determinations. Methods: We modified a high-accuracy CNN originally developed to identify handwritten numbers. For training, we used digitised electromyograph waveforms (TetraGraph) from a previous study of 29 patients and tuned the model parameters using leave-one-out cross-validation. External validation used a dataset of 19 patients from another study with the same neuromuscular block monitor but with different patient, surgical, and protocol characteristics. All patients underwent ulnar nerve stimulation at the wrist and the surface electromyogram was recorded from the adductor pollicis muscle. Results: The tuned CNN performed highly on the validation dataset, with an accuracy of 0.9997 (99% confidence interval 0.9994–0.9999) and F1 score=0.9998. Performance was equally good for classifying the four individual responses in the train-of-four sequence. The calibration plot showed excellent agreement between the predicted probabilities and the actual prevalence of valid cMAPs. Ten-fold cross-validation using all data showed similar high performance. Conclusions: The CNN distinguished valid cMAPs from artifacts after ulnar nerve stimulation at the wrist with >99.5% accuracy. Incorporation of such a process within quantitative electromyographic neuromuscular block monitors is feasible.

A major uncertainty in predicting the behaviour of marine-terminating glaciers is ice dynamics driven by non-linear calving front retreat, which is poorly understood and modelled. Using 124919 calving front positions for 149 marine-terminating glaciers in Svalbard from 1985 to 2023, generated with deep learning, we identify pervasive calving front retreats for non-surging glaciers over the past 38 years. We observe widespread seasonal cycles in calving front position for over half of the glaciers. At the seasonal timescale, peak retreat rates exhibit a several-month phase lag, with changes on the west coast occurring before those on the east coast, coincident with regional ocean warming. This spatial variability in seasonal patterns is linked to different timings of warm ocean water inflow from the West Spitsbergen Current, demonstrating the dominant role of ice-ocean interaction in seasonal front changes. The interannual variability of calving front retreat shows a strong sensitivity to both atmospheric and oceanic warming, with immediate responses to large air and ocean temperature anomalies in 2016 and 2019, likely driven by atmospheric blocking that can influence extreme temperature variability. With more frequent blocking occurring and continued regional warming, future calving front retreats will likely intensify, leading to more significant glacier mass loss., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. Crown.)

Objective: Treatment approaches for endometrial cancer became more personalized in the last decade, mainly due to two key advancements - sentinel lymph node (SLN) mapping and molecular classification. However, their prognostic interaction remains relatively unexplored., Methods: This retrospective cohort study included patients with endometrial cancer, who underwent surgical treatment including SLN mapping at the Bern University Hospital, Switzerland. Ultrastaging of the SLNs and a molecular analysis on the primary tumor was performed., Results: The study cohort included 206 patients, of which 197 tumor samples underwent molecular classification. 11.2 % were classified as POLEmut, 25.9 % as MMRd, 46.2 % as NSMP, and 16.8 % as p53abn. Overall, 834 SLN were removed. SLN macrometastasis were most prevalent in patients with p53abn tumors (24.2 %), followed by MMRd (13.7 %), NSMP (5.5 %), and POLEmut (0 %) tumors (p = .006). Mean follow-up time was 70.9 months. SLN macrometastasis was significantly associated with a higher risk of recurrence in the entire study cohort (p > .001) and the NSMP subgroup (p > .001). In the MMRd subgroup, SLN macrometastasis remained a significant predictor of recurrence (p = .030) and disease-specific death (p = .047) in multivariate Cox regression analysis. For patients with p53abn endometrial cancer, there was no association between SLN macrometastasis and risk of recurrence (p = .618) or disease specific death (p = .798)., Conclusions: SLN macrometastasis is an independent predictor of recurrence and disease-specific death in patients with MMRd endometrial cancer. In the subgroup of p53abn endometrial cancers, SLN macrometastasis did not have an added impact on oncological outcome., Competing Interests: Declaration of competing interest Franziska Siegenthaler, Sara Imboden, Carol Büchi, Lucine Christe, Wiebke Solass, Flurina Saner, Claudia Rauh, Seline Hofer, Bettina Schlatter, Stefan Mohr, Andrea Papadia, Maria Anokhina, Wolfgang Göring, Michael D. Mueller: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Tilman T. Rau: The author is an Associate Editor for [The YGYNO of Pathology: Clinical Research] and was not involved in the editorial review or the decision to publish this article. Julian Wampfler: The author declare the following financial interests/personal relationships which may be considered as potential competing interests: Travel Expenses: AstraZeneca, MSD. Advisory Role (advisory boards, paid talks): AstraZeneca, Daiichi Sankyo, ExactSciences, Gilead, GSK, MSD, Sanofi., (Copyright © 2025. Published by Elsevier Inc.)

To foster a circular economy, the EU will increase recycling targets for packaging materials, including aluminum, ferrous metals and glass. Recovery of packaging metals from incineration bottom ashes (IBA) from municipal solid waste incineration can contribute to achieving these targets. Nevertheless, recoverable metal and glass amounts from IBA, and in particular IBA from fluidized bed combustion, are rarely investigated. Therefore, this work aims to assess the recoverable amounts of aluminum, magnetic ferrous metals and glass > 4 mm from different types of IBA through enhanced treatment. In an industrial-scale treatment experiment with one batch of IBA from grate and one from fluidized bed combustion, masses and compositions of all output flows of the treatment plant were determined. Material flow analysis was used to study the distribution of the investigated materials during the treatment process. Results show that glass separation was not feasible for the grate IBA, which only contained 7 % glass > 4 mm. The fluidized bed IBA contained 42 % glass > 4 mm, of which 72 % were recovered. More aluminum and magnetic ferrous metals > 4 mm were found in the fluidized bed IBA, also exhibiting less mineral agglomeration compared to those from grate IBA. The study demonstrated that enhanced industrial IBA treatment can recover > 95 % of aluminum and magnetic ferrous metals > 4 mm, not observing significant differences between these metals. Thus, a cutting-edge IBA treatment can enable the recovery of recyclable material from IBA and therefore contribute to a circular economy. Furthermore, fluidized bed IBA shows advantages regarding its recycling options compared to grate IBA., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To study the crosstalk between maternal immune cells and the developing embryo by investigating the immunogenic properties of human blastocyst spent media (SM) on dendritic cells., Methods: In this prospective multicenter experimental study, human preimplantation embryo spent media were collected after blastocyst formation, grouped based on successful or unsuccessful implantation, and analyzed by protein array or used to stimulate monocyte derived dendritic cells (moDC). The immunomodulatory properties of SM on moDC were investigated by analyzing changes in phenotype, cytokine secretion, indoleamine 2,3-dioxygenase (IDO) activity, and ability to activate T cells., Results: A plethora of cytokines and growth factors secreted from preimplantation embryos was detected. Exposure to embryo SM altered the phenotype of moDC in a manner dependent on the implantation outcome. Specifically, SM from non-implanted embryos increased the expression of co-stimulatory molecules and activation markers on moDC. Furthermore, SM treated dendritic cells secreted low levels of cytokines and growth factors and were able to stimulate naïve T cells. Activation of IDO was decreased in moDC after stimulation with SM., Conclusions: Our findings show that human preimplantation embryos secrete an abundance of molecules with the ability to significantly affect and even regulate immune cells in their environment., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the ethics committee of the Medical University of Innsbruck, Austria (EK Nr AN2014-0312 343/4.6) and the ethics committee of “Land Vorarlberg” (EK-2-9/2020). Signed informed consent was obtained from all subjects involved in the study. Consent for publication: Not applicable. Animal research: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)