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Abstract How accurately can citizen science participants identify species, and can the information they provide be used to calculate accurate estimates of species richness, abundance and diversity measures? In this paper, we address these questions using data from a citizen science project assessing slug species diversity in gardens. Sixty participants were selected from over 2700 applicants across Britain to sample their gardens regularly for slugs following a standardised method. All slugs collected during the 30‐min search were posted to the lead investigator for verification throughout the 12‐month project. The resulting data were analysed to explore how accurate participants were in identifying slugs and whether this improved over the study period. Prior experience in slug identification was evaluated as a predictor of accuracy. Participants overestimated slug abundance and species richness, which led to overestimates in species diversity indices, illustrating the importance of verification in citizen science projects involving identification. Accuracy of slug identifications increased significantly over time in quantitative analysis of ecological data. However, self‐defined prior experience of identifying slugs before participation was not a good predictor of participant accuracy. Participants reported perceived improvement in slug identification skills to an evaluation survey after the project. However, confidence in identifying and explaining identification of slugs was lower than confidence in understanding and explaining other new science topics. This citizen science approach, including expert verification of physical specimens, illustrates how this method can be used successfully to provide accurate data on species' abundance and richness, alongside improving identification skills among the public for an understudied taxon. Continued engagement and feedback for participants is key in retaining citizen science participation in a project of this type, particularly if the taxon is challenging to identify correctly to species. Read the free Plain Language Summary for this article on the Journal blog.

Abstract The Perseverance rover has collected seven oriented samples of sedimentary rocks, all likely older than the oldest signs of widespread life on Earth, at the exposed base of the western fan in Jezero crater, Mars. The samples include a sulfate‐ and clay‐bearing mudstone and sandstone, a fluvial sandstone from a stratigraphically low position at the fan front, and a carbonate‐bearing sandstone deposited above the sulfate‐bearing strata. All samples contain aqueously precipitated materials and most or all were aqueously deposited. Although the rover instruments have not confidently detected organic matter in the rocks from the fan front, the much more sensitive terrestrial instruments will still be able to search for remnants of prebiotic chemistries and past life, and study Mars's past habitability in the samples returned to Earth. The hydrated, sulfate‐bearing mudstone has the highest potential to preserve organic matter and biosignatures, whereas the carbonate‐bearing sandstones can be used to constrain when and for how long Jezero crater contained liquid water. Returned sample science analyses of sulfate, carbonate, clay, phosphate and igneous minerals as well as trace metals and volatiles that are present in the samples acquired at the fan front would provide transformative insights into past habitable environments on Mars, the evolution of its magnetic field, atmosphere and climate and the past and present cycling of atmospheric and crustal water, sulfur and carbon.

Abstract Climate models robustly project acceleration of the Brewer‐Dobson circulation (BDC) in response to climate change. However, the BDC trends simulated by comprehensive models are poorly constrained by observations, which cannot even determine the sign of potential trends. Additionally, the changing structure of the troposphere and stratosphere has received increasing attention in recent years. The extent to which vertical shifts of the circulation are driving the acceleration is under debate. In this study, we present a novel method that enables the attribution of advective BDC changes to structural changes of the circulation and of the stratosphere itself. Using this method allows studying the advective BDC trends in unprecedented detail and sheds new light into discrepancies between different data sets (reanalyses and models) at the tropopause and in the lower stratosphere. Our findings provide insights into the reliability of model projections of BDC changes and offer new possibilities for observational constraints.

Abstract Background and Aims Vital sign monitoring needs to be timely and correct to recognize deteriorating patients early and trigger the relevant clinical response. The aim of this study is to retrospectively evaluate compliance specifically toward the regional vital sign monitoring protocol the so called early warning score protocol (EWS‐protocol) 72 h before a medical emergency team response (MET‐response) and thereby illuminate whether poor compliance translates into a worse patient outcome. Methods It was investigated all eligible patients that underwent MET responses during the calendar year 2019. The inclusion criteria encompassed somatic patients above 18 years of age admitted to the hospital and detailed evaluations of the medical records of the included patients were conducted. Results Four hundred and twenty‐nine MET‐responses were included in the final analysis. EWS‐protocol failure was observed for more than half the patients within all the time frames assessed. Thirty‐day mortality was significantly higher for patients subject to EWS protocol failure in the timeframes 24−16, 16−8, 8−0 h before MET response. Adjusting for admission length, age, and gender, patients subject to EWS‐protocol failure had an odds ratio (OR) of 1.9, 2.0, 2.1, 2.3 for mortality in the time frames 72−48, 24−16, 16−8, and 8−0 h before the MET‐response, respectively. The adjusted OR for ICU‐admission was 1.7, and 1.6 for patients subject to EWS‐protocol failure in the time frames 16−8 and 8−0 h before MET‐response, respectively. Conclusion According to all the data analysis in this article, there is evidence that compliance toward the NEWS‐protocol is poor. EWS‐protocol failure is associated with a significant higher mortality and ICU‐admission rate.

Abstract Boron (B) isotopes are widely used in the Earth sciences to trace processes ranging from slab recycling in the mantle to changes in ocean pH and atmospheric CO2. Boron isotope analysis is increasingly achieved by multi‐collector inductively coupled plasma mass spectrometry, which requires separation of B from the sample matrix. Traditional column chromatography methods for this separation have a well‐established track record but are time consuming and prone to contamination from airborne blank. Here, we present an extensive array of tests that establish a novel method for B purification using a batch method. We discuss the key controls and limitations on sample loading, matrix removal and B elution including sample volume, ionic strength, buffer to acid ratio and elution volume, all of which may also help optimize column‐based methods. We find consistent, low procedural blanks of 10 ± 16 pg and excellent reproducibility: 10 ng NIST RM 8301 foram [8301f] yields 14.58 ± 0.11‰ 2SD n = 15; 2.5 ng 8301f yields 14.60 ± 0.19‰ 2SD, n = 31; and overall long term 2SD on n = 218 samples pooling different sample sizes yields 14.62 ± 0.21‰ 2SD. This method also offers significant advantages in throughput, allowing the processing of 24 samples in ∼5 hr. This boron batch method thus provides a fast, reproducible, low‐blank method for purification of boron for high precision isotopic analyses.

Abstract Background Despite growing (inter)national awareness and appreciation, age‐specific care is still not always self‐evident and accepted as standard of care for adolescent and young adult (AYA) cancer patients. It is unknown whether long‐term AYA cancer survivors have missed age‐specific care, and if so, which survivors missed it and regarding which topics. Methods The Netherlands Cancer Registry (NCR) identified all long‐term AYA cancer survivors (aged 18–39 years at initial cancer diagnosis, 5–20 years past diagnosis) in the Netherlands, who were invited to participate in a population‐based, observational, cross‐sectional questionnaire study (SURVAYA study), including questions on care needs. Results In total, 3.989 AYAs participated (35.3% response rate). One‐third of them had a need for age‐specific care (33.5%), 41.2% had no need and 25.3% did not know whether they had a need. Those who had a need for age‐specific care were significantly more often female, higher educated, diagnosed at a younger age, and treated with chemotherapy, radiotherapy or hormone therapy. Most frequent topics were disease and treatment (29.7%), emotions (24.1%), friends (22.6%), family and children (15.6%), fertility and pregnancy (14.8%), work and reintegration (10.5%), care not tailored (13.8%), and overarching care and life (27.7%). Palliative care (0.0%), spirituality (0.2%), death (0.7%), complementary care (0.7%), and late effects (1.3%) were mentioned least. Conclusions A substantial proportion of long‐term AYA cancer survivors showed a need for age‐specific care, varying by sociodemographic and clinical factors, on a wide variety of topics, which could be targeted to improve current AYA care services.

Abstract Background The anti‐tumor immune response plays a key role in colorectal cancer (CRC) progression and survival. The T cell‐inflamed gene expression profile (GEP) is a biomarker predicting response to checkpoint inhibitor immunotherapy across immunogenic cancer types, but the prognostic value in CRC is unknown. We evaluated associations with disease‐specific survival, somatic mutations, and examined its differentially expressed genes and pathways among 84 sporadic CRC patients from the Seattle Colon Cancer Family Registry. Methods Gene expression profiling was performed using Nanostring's nCounter PanCancer IO 360 panel. Somatic mutations were identified by a targeted DNA sequencing panel. Results The T cell‐inflamed GEP was positively associated with tumor mutation burden and microsatellite instability high (MSI‐H). Higher T cell‐inflamed GEP had favorable CRC‐specific survival (hazard ratio [HR] per standard deviation unit = 0.50, p = 0.004) regardless of hypermutation or MSI status. Analysis of recurrently mutated genes having at least 10 mutation carriers, suggested that the T cell‐inflamed GEP is positively associated with RYR1, and negatively associated with APC. However, these associations were attenuated after adjusting for hypermutation or MSI status. We also found that expression of genes RPL23, EPCAM, AREG and ITGA6, and the Wnt signaling pathway was negatively associated with the T cell‐inflamed GEP, which might indicate immune‐inhibitory mechanisms. Conclusions Our results show that the T cell‐inflamed GEP is a prognostic biomarker in non‐hypermutated microsatellite‐stable CRC. This also suggests that patient stratification for immunotherapy within this CRC subgroup should be explored further. Moreover, reported immune‐inhibitory gene expression signals may suggest targets for therapeutic combination with immunotherapy.

Abstract Objectives To assess the patient preferences and utility scores for the different conventional and innovative treatment modalities for localised prostate cancer (PCa). Subjects and Methods Patients treated for localised PCa and healthy volunteers were invited to fill out a treatment‐outcome scenario questionnaire. Participants ranked six different treatments for localised PCa from most to least favourable, prior to information. In a next step, treatment procedures, toxicity, risk of biochemical recurrence and follow‐up regimen were comprehensibly described for each of the six treatments (i.e. treatment‐outcome scenarios), after which patients re‐ranked the six treatments. Additionally, participants gave a visual analogue scale (VAS) and time trade‐off (TTO) score for each scenario. Differences between utility scores were tested by Friedman tests with post hoc Wilcoxon signed‐rank tests. Results Eighty patients and twenty‐nine healthy volunteers were included in the study. Before receiving treatment‐outcome scenario information, participants ranked magnetic resonance‐guided adaptive radiotherapy most often as their first choice (35%). After treatment information was received, active surveillance was most often ranked as the first choice (41%). Utility scores were significantly different between the six treatment‐outcome scenarios, and active surveillance, non‐ and minimal‐invasive treatments received higher scores. Conclusions Active surveillance and non‐invasive treatment for localised PCa were the most preferred options by PCa patients and healthy volunteers and received among the highest utility scores. Treatment preferences change after treatment information is received.

Abstract Background Adolescents and young adults (AYAs) diagnosed with cancer fulfill their cancer‐related information needs often via the Internet. Healthcare professionals (HCPs) have a crucial role in guiding patients in finding appropriate online information and eHealth sources, a role that is often overlooked. Misperceptions of AYAs' needs by HCPs may lead to suboptimal guidance. We aimed to examine the extent to which AYAs' online information and eHealth needs corresponded with HCPs' perceptions of these needs. Methods Two cross‐sectional online surveys (AYAs, n = 299; HCP, n = 80) on online information and eHealth needs were conducted. HCPs provided indications of their perceptions of AYA's needs. Results AYAs reported significantly more online information needs compared with HCPs' perceptions regarding: survival rates (AYA = 69%, HCP = 35%, p

Abstract The dissonant development of positive and negative lightning leaders is a central question in atmospheric electricity. It is also the likely root cause of other reported asymmetries between positive and negative lightning flashes, including the ones regarding: stroke multiplicity, recoil activity, leader velocities, and emission of energetic radiation. In an effort to contrast lightning leaders of different polarities, we highlight the staggering differences between two rocket‐triggered lightning flashes. The flash beginning with upward positive leaders exhibits an initial continuous current stage followed by multiple sequences of dart leaders and return strokes. On the other, in its opposite‐polarity counterpart, the upward development of negative leaders is by itself the entire flash. As a result, the flash with negative leaders is faster, briefer, transfers less charge to the ground, has lower currents, and smaller spatial extent. We conclude by presenting a discussion on the three fundamental leader propagation modes.

Abstract Interactions between whistler mode chorus waves and electrons are a dominant mechanism for particle acceleration and loss in the outer radiation belt. One form of this loss is electron microburst precipitation: a sub‐second intense burst of electrons. Despite previous investigations, details regarding the microburst‐chorus scattering mechanism—such as dominant resonance harmonic—are largely unconstrained. One way to observationally probe this is via the time‐of‐flight energy dispersion. If a single cyclotron resonance is dominant, then higher energy electrons will resonate at higher magnetic latitudes: sometimes resulting in an inverse time‐of‐flight dispersion with lower‐energy electrons leading. Here we present a clear example of this phenomena, observed by a FIREBIRD‐II CubeSat on 27 August 2015, that shows good agreement with the Miyoshi‐Saito time‐of‐flight model. When constrained by this observation, the Miyoshi‐Saito model predicts that a relatively narrowband chorus wave with a ∼0.2 of the equatorial electron gyrofrequency scattered the microburst.

Background Coronary flow reserve (CFR) and microvascular resistance reserve (MRR) are physiological parameters to assess coronary microvascular dysfunction. CFR and MRR can be assessed using bolus or continuous thermodilution, and the correlation between these methods has not been clarified. Furthermore, their association with angina and quality of life is unknown. Methods and Results In total, 246 consecutive patients with angina and nonobstructive coronary arteries from the multicenter Netherlands Registry of Invasive Coronary Vasomotor Function Testing (NL‐CFT) were investigated. The 36‐item Short Form Health Survey Quality of Life and Seattle Angina questionnaires were completed by 153 patients before the invasive measurements. CFR and MRR were measured consecutively with bolus and continuous thermodilution. Mean continuous thermodilution‐derived coronary flow reserve (CFRabs) was significantly lower than mean bolus thermodilution‐derived coronary flow reserve (CFRbolus) (2.6±1.0 versus 3.5±1.8; P

Abstract During the last decades, the Baltic Sea has been among the fastest warming seas in the world. The warming is mainly driven by increasing air temperatures but deeper water layers can also be warmed by lateral advection of heat. By analyzing a 159 years long (1850–2008) hindcast simulation of the Baltic Sea, we link the exceptionally strong bottom water warming in the western Baltic Sea to a shift in the seasonality of saltwater inflows from the North Sea to the Baltic Sea. Over the model period, warm summer and early autumn inflows have increased while cold winter inflows have decreased. Sensitivity experiments reveal that these changes were partly driven by a shift in river runoff seasonality. The strong warming could lead to faster oxygen depletion in the affected layers and thus have ecological consequences.

Abstract Effective coastal management requires a fundamental understanding of the impacts of anthropogenic activities on sediment dynamics, yet it is challenging to isolate individual impacts in heavily altered regions. The Ayeyarwady Delta, Myanmar has been extensively deforested for agriculture but has few levees/polders. In this study, the relative resilience to subsidence was compared between a 45‐year‐old agricultural field and a nearby mangrove‐forest preserve. At both sites, water velocity and turbidity were measured in tidal channels, topography was mapped, and sediment cores were collected during 2018–2019. There was net sediment import at both sites due to sediment trapping by vegetation. Relative elevations were equivalent, suggesting that the field has aggraded at rates similar to the forest (0.7 cm/year). Unleveed fields may be less vulnerable to subsidence than leveed fields. However, uncertainties remain and the decision to replace mangroves with agricultural fields should weigh all the benefits provided by each environment.

Abstract The North Atlantic Oscillation (“NAO”) and the East Atlantic Pattern (“EAP”) dominate winter atmospheric variability over the North Atlantic. Unlike the NAO, seasonal predictability of the EAP has remained elusive. A multi‐model ensemble of seasonal predictions yields skillful forecasts of the EAP in late autumn and early winter, complementing NAO prediction skill in winter. The shift in prediction skill from EAP to NAO reflects the ability of the ensemble to forecast the evolving influence of the El Niño South Oscillation on the North Atlantic region. In early winter, the ensemble correctly forecasts the key tropical–extratropical teleconnections, resulting in skillful predictions of the EAP and western European temperatures and rainfall. However, the modeled tropical–extratropical teleconnections are weak compared to observations, contributing to a signal to noise error in predictions of the EAP. Improving the strength of such teleconnections would improve predictions of the EAP and associated surface climate.

Abstract Objectives To investigate factors predictive of postoperative recurrence and complications in patients undergoing urethroplasty for stricture repair at a single center. Patients and methods We retrospectively reviewed the records of 108 men who underwent urethroplasty for urethral stricture disease (USD) at a single center from 2016 to 2020. Demographic data, comorbidities, stricture history including etiology and prior treatments, patient‐reported symptoms, and outcomes data were collected for analysis. Data were analyzed in aggregate, then, stratified by type of urethroplasty performed. Descriptive statistics, univariate analysis, multivariate logistic regression, and intergroup comparisons were completed using STATA, with an alpha value of 0.05 and a confidence interval of 95%. Results The median age of our patients was 58 years (interquartile range: 42‐69; range: 29‐83), with a median stricture length of 2.0 cm (interquartile range: 1.0‐4.5; range: 0.5‐10). The most common stricture etiology was iatrogenic (n = 33, 31%) and the most common urethroplasty was anterior anastomotic urethroplasty (n = 38, 35%), followed by buccal mucosal graft (BMG) urethroplasty (n = 35, 32%). Twenty‐four patients (22%) had stricture recurrence. Within the aggregate data, recurrence was significantly predicted by obesity (BMI > 30) (Odds Ratio [OR] 3.2, 95% Confidence Interval [CI]: 1.06‐10), and the presence of postoperative complications (OR 6.3, CI: 1.9‐21). The presence of any postoperative complications within 90 days was significantly predicted by stricture length ≥ 5 cm (OR 3.5, CI 1.09‐12) and recurrence (OR 6.0, CI 1.7‐21). Conclusion Despite serving as the most definitive treatment for urethral stricture management, stricture recurrence and postoperative complications are not uncommon after urethroplasty. Obesity and stricture length negatively impact outcomes while a penile stricture location is associated with a lower recurrence rate, though this is not statistically significant.

Background Women continue to be underrepresented in cardiology and even more so in leadership positions. We evaluated the trends and gender differences in the guideline writing groups of the American College of Cardiology/American Heart Association (ACC/AHA), Canadian Cardiovascular Society (CCS), and European Society of Cardiology (ESC) guidelines from 2006 to 2020. Methods and Results We extracted all guidelines authors from 2006 to 2020, assessed their gender from publicly available profiles, and compared differences based on subspecialties and specific societies. Stratified and trend analyses were performed using χ2 and average annual percentage change/average 5 year percentage change. A total of 80 ACC/AHA (1288 authors [28% women]), 64 CCS (988 authors [26% women]), and 59 ESC (1157 authors [16% women]) guidelines were analyzed. A significant increase in inclusion of women was seen in ACC/AHA (12.6% [2006] to 42.6% [2020]; average annual percentage change, 6.6% [2.3% to 11.1%]; P=0.005) and ESC (7.1% [2006] to 25.8% [2020]; average annual percentage change, 6.6% [0.2% to 13.5%]; P=0.04), but the trend remained similar in CCS (20.6% [2006] to 36.3% [2020]; average annual percentage change, −0.1% (−3.7% to 3.5%); P=0.94), guideline authors. More women were coauthors in the ACC/AHA and ESC guidelines when women were chairs of guidelines. There was a persistent disparity of women among guideline authors for general cardiology and all subspecialties, except for pediatric cardiology and heart failure guidelines. The appointment of women authors as a chair was significantly low in all societies (22.4% [ACC/AHA], 16.9% [CCS], and 7.2% [ESC]; P=0.008). Conclusions There is a significant disparity in the inclusion of women on all national guideline committees, in addition to serving as a chair of cardiology guidelines. Further advocacy is required to promote equity, diversity, and inclusion in our cardiology guidelines globally.

Abstract Methane‐rich water moves through conduits beneath the seafloor whose surfaces are formed through precipitation reactions. To understand how such submarine fluid conduit and venting systems form and grow, we develop a detailed mathematical model for this reaction‐advection system and we quantify the evolution of an ensemble of similar filaments. We show that this growth can be described by a superposition of advection and dispersion. We analyze analog laboratory experiments of chemical‐garden type to study the growth of a single filament undergoing a precipitation reaction with the surrounding environment. We apply these findings to geological fluid conduit and venting systems, showing that their irregular trajectories can lead to very effective spreading within the surrounding seabed, thus enhancing contact and exchanges of chemicals between the conduit and external fluids. We discuss how this methane venting leads to the formation of marine authigenic carbonate rocks, and for confirmation, we analyze two field samples from the Gulf of Cadiz for composition and mineralogy of the precipitates. We note the implications of this work for hydrate melting and methane escape from the seabed.

Abstract Conflict between stakeholders with opposing interests can hamper biodiversity conservation. When conflicts become entrenched, evidence from applied ecology can reveal new ways forward for their management. In particular, where disagreement exists over the efficacy or ethics of management actions, research clarifying the uncertain impacts of management on wildlife can move debates forwards to conciliation. Here, we explore a case‐study of entrenched conflict where uncertainty exists over the impacts of multiple management actions: namely, moorlands managed for the shooting of red grouse (willow ptarmigan) Lagopus lagopus in the United Kingdom (UK). Debate over how UK moorlands should be managed is increasingly polarized. We evaluate, for the first time at a regional scale, the relative impacts of two major moorland management practices—predator control and heather burning—on nontarget bird species of conservation concern. Birds were surveyed on 18 estates across Northern England and Southeast Scotland. Sites ranged from intensively managed grouse moors to moorland sites with no management for grouse shooting. We hypothesised that both targeted predator control and burning regimes would enhance ground‐nesting wader numbers and, as a consequence of this, and of increased grouse numbers, nontarget avian predators should also be more abundant on heavily managed sites. There were positive associations between predator control and the abundance of the three most widespread species of ground‐nesting wader: strong effects for European golden plover Pluvialis apricaria and Eurasian curlew Numenius arquata and, less strongly, for common snipe Gallinago gallinago. These effects saturated at low levels of predator control. Evidence for effects of burning was much weaker. We found no evidence of enhanced numbers of nontarget predators on heavily managed sites.

Abstract The melanocortin‐4 receptor (MC4R) antagonistic peptide TCMCB07 was developed for the treatment of cachexia. The objectives of this study were to examine pharmacokinetics and safety of TCMCB07 administered subcutaneously to healthy dogs. Dogs were treated with high‐ (2.25 mg kg−1) (n = 5) and low‐dose TCMCB07 (0.75 mg kg−1) (n = 5) once daily for 28 days with a 14‐day washout period between groups. Histamine levels, complete blood count, chemistry panel, blood pressure, 24‐hour Holter recording, and pharmacokinetic parameters were monitored in the high‐dose group. Physical examination changes were limited to weight gain and darkening of the coat color. There was no elevation of plasma histamine within 24 hours of injection but there was a significant elevation of plasma histamine across time. An approximately doubled eosinophil count and an approximately 25% increase, and then 25% decrease back to pre‐treatment plasma phosphorous were also found, although both remained within the reference interval. Serial blood pressure and 24‐hour Holter monitors revealed no clinically relevant changes. A difference was found in the AUC between dosing groups and a significant effect of dose, time, and interaction was noted for Vd. Low‐dose TCMCB07 had a Cmax of 2.1 ug ml−1 at day 28, compared to high‐dose TCMCB07 which had a Cmax 3.6 ug ml−1 at day 28. Once‐daily subcutaneous administration of TCMCB07 was well‐tolerated for up to 28 days in dogs when administered at doses one and three times (0.75 mg kg−1 and 2.25 mg kg−1) the predicted therapeutic dose and pharmacokinetic parameters are described. Significance Statement Melanocortin‐4 receptor (MC4R) antagonistic peptide TCMCB07 is safe at both low and high doses in dogs. Therapy was tolerated well as determined by physical examination, clinical pathology, and cardiovascular parameters; darkening of the coat was noted with treatment and resolved with discontinuation. Pharmacokinetics are described and further study in the naturally occurring canine model is warranted.

Abstract Conservation conflicts are damaging for humans and wildlife, with differences in people's objectives fuelling challenges of managing complex, dynamic systems. We investigate the relative importance of economic, psychological (affect, trust and risk perception) and ecological factors in determining farmers' management preferences, using Greenland barnacle geese (Branta leucopsis) on Islay, Scotland, as a case study. Barnacle geese reduce agricultural productivity on Islay, negatively impacting household economies. Since 1992, farmers have received partial compensation but a new culling scheme has escalated conflict between conservation and agricultural interests. Using a questionnaire, we collected data from 75% of the farmers receiving goose payments. We found that affect was a strong driver of both risk perception and management preferences. However, we revealed complexity in these relationships, with trust and economic factors also influencing decision‐making. Psychological and economic factors surrounding wildlife management must be understood if we are to achieve conservation objectives in human dominated landscapes.

Background Stroke is a serious complication of hypertensive disorders of pregnancy (HDP), with potentially severe and long‐term sequelae. However, the temporal trends, predictors, and outcomes of stroke in women with HDP at delivery remain unknown. Methods and Results All HDP delivery hospitalizations with or without stroke event (ischemic, hemorrhagic, or unspecified) between 2004 and 2014 in the United States National Inpatient Sample were analyzed to examine incidence, predictors, and prognostic impact of stroke. Of 4 240 284 HDP delivery hospitalizations, 3391 (0.08%) women had stroke. While the prevalence of HDP increased over time, incident stroke rates decreased from 10 to 6 per 10 000 HDP delivery hospitalizations between 2004 and 2014. Women with stroke were increasingly multimorbid, with some risk factors being more strongly associated with ischemic strokes, including congenital heart disease, peripheral vascular disease, dyslipidemia, and sickle cell disease. Delivery complications were also associated with stroke, including cesarean section (odds ratio [OR], 1.58; 95% CI, 1.33–1.86), postpartum hemorrhage (OR, 1.91; 95% CI, 1.33–1.86), and maternal mortality (OR, 99.78; 95% CI, 59.15–168.31), independently of potential confounders. Women with stroke had longer hospital stays (median, 6 versus 3 days), higher hospital charges (median, $14 655 versus $4762), and a higher proportion of nonroutine discharge locations (38% versus 4%). Conclusions The incidence of stroke in women with HDP has declined over time. While a relatively rare event, identification of women at highest risk of ischemic or hemorrhagic stroke on admission for delivery is important to reduce long‐term sequelae.

Background Timely recognition of patients with acute coronary syndromes (ACS) is important for successful treatment. Previous research has suggested that women with ACS present with different symptoms compared with men. This review assessed the extent of sex differences in symptom presentation in patients with confirmed ACS. Methods and Results A systematic literature search was conducted in PubMed, Embase, and Cochrane up to June 2019. Two reviewers independently screened title‐abstracts and full‐texts according to predefined inclusion and exclusion criteria. Methodological quality was assessed using the Newcastle‐Ottawa Scale. Pooled odds ratios (OR) with 95% CI of a symptom being present were calculated using aggregated and cumulative meta‐analyses as well as sex‐specific pooled prevalences for each symptom. Twenty‐seven studies were included. Compared with men, women with ACS had higher odds of presenting with pain between the shoulder blades (OR 2.15; 95% CI, 1.95–2.37), nausea or vomiting (OR 1.64; 95% CI, 1.48–1.82) and shortness of breath (OR 1.34; 95% CI, 1.21–1.48). Women had lower odds of presenting with chest pain (OR 0.70; 95% CI, 0.63–0.78) and diaphoresis (OR 0.84; 95% CI, 0.76–0.94). Both sexes presented most often with chest pain (pooled prevalences, men 79%; 95% CI, 72–85, pooled prevalences, women 74%; 95% CI, 72–85). Other symptoms also showed substantial overlap in prevalence. The presence of sex differences has been established since the early 2000s. Newer studies did not materially change cumulative findings. Conclusions Women with ACS do have different symptoms at presentation than men with ACS, but there is also considerable overlap. Since these differences have been shown for years, symptoms should no longer be labeled as “atypical” or “typical.”

Abstract Liquid ethane is present in the lakes and seas observed on Titan's surface by the Cassini‐Huygens mission. While interaction between liquid hydrocarbons and water ice is expected to result in the formation of clathrate hydrates, such reaction (and its kinetics) has not yet been demonstrated for cryogenic liquids under relevant planetary conditions. In this paper, we report the first experimental evidence for rapid formation of clathrates upon direct contact of liquid ethane with water ice at 1 bar using micro‐Raman spectroscopy. Kinetics experiments conducted in the temperature range 150–173 K yield an activation energy of 14.8 ± 2.2 kJ/mol, which is suggestive of a diffusion‐controlled mechanism for clathrate formation. This implies that a clathrate reservoir can form within seasonal time scales on Titan if liquid ethane comes into contact with a pre‐existing icy bedrock, which may hold important implications for the structure and dynamics of Titan's crust and its global evolution.

Abstract Tubular structures self‐assemble from precipitating magnesium salts under the chemical garden chemobrionic growth process. Two experimental procedures, the dissolution of magnesium salt pellets and the injection of magnesium salt solutions into silicate solutions, were explored to reproduce in the laboratory the geochemical conditions under which similar structures may form from mineral‐rich fluids at some seafloor hydrothermal vents driven by serpentinization. X‐ray diffraction and Raman microspectroscopy applied to the materials formed indicated the presence of layers of magnesium silicate and magnesium oxide/hydroxide. Quantum mechanical calculations based on density functional theory were performed on models of hydrated magnesium silicate surfaces and related minerals to explain the Raman spectroscopy results. We examine the precipitate morphology, chemical structure, and crystal or mineral structure in our experiments and how these change with the reaction conditions. This is a fascinating example in geochemistry of a self‐organizing nonequilibrium process that creates complex structures.