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Abstract The coherent continental-wide speleothem water isotope records are accompanied by regionally inconsistent moisture patterns within the Asian summer monsoon (ASM) region, leaving a disputed explanation of monsoonal hydroclimate variability at the orbital timescale. Here, the transient simulation forced by orbital parameters during the past 300,000 years in an isotope-enabled fully coupled model shows that the complex ASM response can be understood as a grand dipole pattern of oxygen isotope and rainfall between South Asia and Japan, with South China lying in a hybrid transition region. While the dipole monsoon rainfall change between South Asia and Japan is related to the large-scale circulation adjustment in response to Northern Hemisphere summer insolation, the dipole oxygen isotope pattern is associated with the changing contribution of moisture sources. Our results provide new clues to reconcile ASM hydroclimate patterns at orbital timescale as revealed by the water isotope records and other hydrological proxies.

The International Ocean Discovery Program (IODP) conducted a series of expeditions between 2013 and 2016 that were designed to address the development of monsoon climate systems in Asia and Australia. Significant progress was made in recovering Neogene sections spanning the region from the Arabian Sea to the Sea of Japan and southward to western Australia. High recovery by advanced piston corer (APC) has provided a host of semi-continuous sections that have been used to examine monsoonal evolution. Use of the half-length APC was successful in sampling sand-rich sediment in Indian Ocean submarine fans. The records show that humidity and seasonality developed diachronously across the region, although most regions show drying since the middle Miocene and especially since ∼ 4 Ma, likely linked to global cooling. A transition from C3 to C4 vegetation often accompanied the drying but may be more linked to global cooling. Western Australia and possibly southern China diverge from the general trend in becoming wetter during the late Miocene, with the Australian monsoon being more affected by the Indonesian Throughflow, while the Asian monsoon is tied more to the rising Himalaya in South Asia and to the Tibetan Plateau in East Asia. The monsoon shows sensitivity to orbital forcing, with many regions having a weaker summer monsoon during times of northern hemispheric Glaciation. Stronger monsoons are associated with faster continental erosion but not weathering intensity, which either shows no trend or a decreasing strength since the middle Miocene in Asia. Marine productivity proxies and terrestrial chemical weathering, erosion, and vegetation proxies are often seen to diverge. Future work on the almost unknown Paleogene is needed, as well as the potential of carbonate platforms as archives of paleoceanographic conditions.

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.

BackgroundThe economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternatives to usual care, but the evidence is mixed. ObjectiveThe aim was to review the literature on the cost-effectiveness of internet interventions for mental disorders compared with usual care and to provide an estimate of the monetary benefits of such interventions compared with usual care. MethodsA systematic review and meta-analysis of randomized controlled trials was conducted, which included participants with symptoms of mental disorders; investigated a telephone- or internet-based intervention; included a control condition in the form of treatment as usual, psychological placebo, waiting list control, or bibliotherapy; reported outcomes on both quality of life and costs; and included articles published in English. Electronic databases such as PubMed (including MEDLINE), Embase, Emcare, PsycINFO, Web of Science, and the Cochrane Library were used. Data on risk of bias, quality of the economic evaluation, quality-adjusted life years, and costs were extracted from the included studies, and the incremental net benefit was calculated and pooled. ResultsThe search yielded 6226 abstracts, and 37 studies with 14,946 participants were included. The quality of economic evaluations of the included studies was rated as moderate, and the risk of bias was high. A random-effects approach was maintained. Analyses suggested internet interventions were slightly more effective than usual care in terms of quality-adjusted life years gain (Hedges g=0.052, 95% CI 0.010-0.094; P=.02) and equally expensive (Hedges g=0.002, 95% CI −0.080 to 0.84; P=.96). The pooled incremental net benefit was US $255 (95% CI US $91 to US $419; P=.002), favoring internet interventions over usual care. The perspective of the economic evaluation and targeted mental disorder moderated the results. ConclusionsThe findings indicate that the cost-effectiveness of internet interventions for mental disorders compared with 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 field of mental health to pool cost-effectiveness outcomes in an aggregate data meta-analysis. Trial RegistrationPROSPERO CRD42019141659; https://tinyurl.com/3cu99b34

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.

The mid-Pleistocene transition is recognized as a shift in paleoclimatic periodicity from 41- to 100-kyr cycles. Here the authors present a unique mid-Pleistocene transition of coupled monsoon-vegetation changes from 23- to 100-kyr cycles, which indicates varied sensitivity of past climate to astronomical and ice/CO2 forcing.

The stable isotopes of nitrogen in nitrate archived in polar ice have been interpreted as reflecting a shift in reactive nitrogen sources or changes in atmospheric chemical reactivity. Here, we present a novel concentration and isotopic record of nitrate (δ15N-NO3−) from a central Tibetan Plateau ice core over the last ~200 years. We find that nitrate concentration increased from 6.0 ± 2.3 μeq/L (mean ± 1σ) in the preindustrial period (prior to 1900s) to 7.3 ± 2.7 μeq/L in post-1950. Over the same time period, the δ15N-NO3− decreased from 8.7 ± 3.7‰ to 4.2 ± 3.1‰, with much larger interannual variation in δ15N-NO3− during the preindustrial period. We present a useful framework for quantifying the sensitivity of the isotopic composition of atmospheric nitrate to changes in both sources and chemistry (gas and aerosol phase). After 1950, nitrogen deposition is primarily driven by fertilizer use, leading to significant increases in concentration and decreases in δ15N-NO3−. The large interannual variability of ice core δ15N-NO3− in the preindustrial reflects natural processes, namely the El Niño Southern Oscillation (ENSO) and dust events. Our results highlight a new connection between the nitrogen cycle and ENSO, and the overprinting of natural climate signals by recent anthropogenic increases in reactive nitrogen release. Keywords: Ice core, Nitrogen stable isotope, Agriculture NOx emissions, Climate variability

Abstract X‐ray fluorescence (XRF) core scanning of marine and lake sediments has been extensively used to study changes in past environmental and climatic processes over a range of timescales. The interpretation of XRF‐derived element ratios in paleoclimatic and paleoceanographic studies primarily considers differences in the relative abundances of particular elements. Here we present new XRF core scanning data from two long sediment cores in the Andaman Sea in the northern Indian Ocean and show that sea level related processes influence terrigenous inputs based proxies such as Ti/Ca, Fe/Ca, and elemental concentrations of the transition metals (e.g., Mn). Zr/Rb ratios are mainly a function of changes in median grain size of lithogenic particles and often covary with changes in Ca concentrations that reflect changes in biogenic calcium carbonate production. This suggests that a common process (i.e., sea level) influences both records. The interpretation of lighter element data (e.g., Si and Al) based on low XRF counts is complicated as variations in mean grain size and water content result in systematic artifacts and signal intensities not related to the Al or Si content of the sediments. This highlights the need for calibration of XRF core scanning data based on discrete sample analyses and careful examination of sediment properties such as porosity/water content for reliably disentangling environmental signals from other physical properties. In the case of the Andaman Sea, reliable extraction of a monsoon signal requires accounting for the sea level influence on the XRF data.

The underlying mechanisms driving the variability of the East Asia Monsoon during the late Pleistocene remain unclear. Here, the authors present a record of local precipitation and runoff from the East Chain Sea, which indicates strong sensitivity to greenhouse gases and high latitude ice sheet forcing.

The late Miocene period allows investigation of climate-carbon cycle dynamics on a warmer-than-modern Earth. Here, the authors show that changes in the global carbon cycle drove climate cooling, culminating in ephemeral Northern Hemisphere glaciations and intensification of the Asian winter monsoon from 7 to 5.5 Ma.

Abstract The Quaternary hemipelagic sediments of the Japan Sea are characterized by centimeter- to decimeter-scale alternation of dark and light clay to silty clay, which are bio-siliceous and/or bio-calcareous to a various degree. Each of the dark and light layers are considered as deposited synchronously throughout the deeper (> 500 m) part of the sea. However, attempts for correlation and age estimation of individual layers are limited to the upper few tens of meters. In addition, the exact timing of the depositional onset of these dark and light layers and its synchronicity throughout the deeper part of the sea have not been explored previously, although the onset timing was roughly estimated as ~ 1.5 Ma based on the result of Ocean Drilling Program legs 127/128. Consequently, it is not certain exactly when their deposition started, whether deposition of dark and light layers was synchronous and whether they are correlatable also in the earlier part of their depositional history. The Quaternary hemipelagic sediments of the Japan Sea were drilled at seven sites during Integrated Ocean Drilling Program Expedition 346 in 2013. Alternation of dark and light layers was recovered at six sites whose water depths are > ~ 900 m, and continuous composite columns were constructed at each site. Here, we report our effort to correlate individual dark layers and estimate their ages based on a newly constructed age model at Site U1424 using the best available paleomagnetic datum and marker tephras. The age model is further tuned to LR04 δ18O curve using gamma ray attenuation density (GRA) since it reflects diatom contents that are higher during interglacial high-stands. The constructed age model for Site U1424 is projected to other sites using correlation of dark layers to form a high-resolution and high-precision paleo-observatory network that allows to reconstruct changes in material fluxes with high spatio-temporal resolutions.

The objective of this research is to compare the Day 1 and Day 2 dietary intakes of adults in What We Eat in America, National Health and Nutrition Examination Survey (WWEIA, NHANES) 2013–2016. Dietary recalls of males (n = 2599) and females (n = 2624) 20+ years who had both a Day 1 and Day 2 recall and reported their intake as usual on both days in WWEIA, NHANES 2013–2016 were examined. Mean (±SE) energy intake for males was 2425 ± 26 kcal for Day 1 and 2334 ± 32 kcal for Day 2 (p = 0.004). For females, 1832 ± 18 kcal and 1775 ± 26 kcal were reported for Day 1 and 2, respectively (p = 0.020). There were no significant differences between energy intake on Day 1 and Day 2 within males and females by ten-year age groups. Comparing 20 year age groups for males and females by race/ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic) and income (350% of poverty level) also showed no significant differences in energy intake between Day 1 and Day 2. Mean energy intake of adults was not statistically different between the two days of recall by sex, race/ethnicity or income within selected age groups. Overall, the difference in energy intake was less than 4% for both males and females.