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Climate change presents complex and wide‐reaching threats to human health. A variable and changing climate can amplify and unmask ecological and socio‐political weaknesses and increase the risk of adverse health outcomes in socially vulnerable regions. When natural disasters occur in such areas, underlying climatic conditions may amplify the public health crisis. We describe an emerging epidemic of Zika virus (ZIKV) in Ecuador following the 2016 earthquake, which coincided with an exceptionally strong El Niño event. We hypothesize that the trigger of a natural disaster during anomalous climate conditions and underlying social vulnerabilities were force multipliers contributing to a dramatic increase in ZIKV cases postearthquake., Key Points When natural disasters occur in areas made vulnerable by climate change, the effects are multipliedClimate change makes vulnerable regions even more vulnerable and plays a role in the root cause of the eventual impacts of natural disastersMultisectoral coordination is needed to implement surveillance and response systems to detect and protect vulnerable communities

Diastolic dysfunction may influence perioperative outcome, early graft function, and long-term survival. We compared the outcomes of double lung transplantation (DLTx) for patients with pulmonary arterial hypertension (PAH) with preoperative left ventricular (LV) diastolic dysfunction with the outcomes of patients without diastolic dysfunction. Of 116 consecutive patients with PAH (who underwent transplantation between January 1995 and December 2013), 44 met our inclusion and exclusion criteria. Fourteen (31.8%) patients with diastolic dysfunction pretransplantation had a higher body mass index (29 [IQR 21.5-32.6] vs 22.4 [IQR 19.9-25.3] kg/m2 ) and mean pulmonary arterial pressure (54.6 ± 10 mmHg vs 47 ± 11.3 mmHg) and right atrial pressure (16.5 ± 5.2 mmHg vs 10.6 ± 5.2 mmHg). The patients received extracorporeal life support more frequently (33% vs 7% [p = 0.02]), had worse APACHE II scores (21.7 ± 7.4 vs 15.3 ± 5.3 [p = 0.02]), and a trend toward worse ventilator-free days (2.5 [IQR 6.5-32.5] vs 17 [IQR 3-23] [p = 0.08]). There was no effect on development of primary graft dysfunction or intensive care unit/hospital survival. One-year survival was worse (hazard ratio [HR] 4.45, 95% confidence interval [CI] 1.3-22, p = 0.02). Diastolic dysfunction was the only variable that correlated with overall survival (HR 5.4, 95% CI 1.3-22, p = 0.02). Diastolic dysfunction leads to early postoperative morbidity and worse survival in patients with PAH after DLTx.

The availability of almost 180 cosmogenic-radionuclide (CRN) surface-exposure ages from moraine boulders and glacially polished bedrock surfaces makes possible an assessment of the timing and character of the local Last Glacial Maximum (LLGM) and subsequent deglaciation in the Colorado Rocky Mountains. A review of glacial chronologies and numerical modeling results indicates that although glaciers across Colorado responded broadly synchronously, apparent differences in the timing and magnitude of glacier retreat following the LLGM suggest that spatially variable regional forcing, possibly precipitation related, played a role in glacier behavior along with more spatially uniform hemispheric or global forcing. Glaciers in the five ranges examined reached their greatest LLGM extents before ~19.5 ka and abandoned their outermost LLGM moraines between ~23.5 and 19.5 ka. Detailed deglaciation chronologies are available for glaciers in four of the ranges. In the Sawatch Range and Sangre de Cristo Mountains, glaciers were near their LLGM extents at 17-16 ka, before retreating rapidly. In the San Juan Mountains and the Front Range, glaciers may have begun their post-LLGM recession earlier, although early deglaciation is indicated by only a few ages on polished bedrock that potentially contains pre-LLGM CRN inheritance, and thus may be too old. Regardless of the timing of the onset of deglaciation, the equilibrium-line rise associated with deglaciation was earlier and significantly larger in the San Juan Mountains than elsewhere in Colorado. This suggests that the San Juan Mountains, located well to the southwest of the other ranges, may have experienced enhanced precipitation during the LLGM, as did areas farther to the south and west, while LLGM conditions may have been drier in the northern and eastern Colorado ranges. A breakdown in this pattern after the LLGM, with precipitation decreasing in the south and west and increasing in the north and east, may have led to the range-to-range differences evident across Colorado. Deglaciation was nearly complete in all four ranges by 15-13 ka. While some proxy records indicate a later Younger Dryas-age cooling in the Colorado mountains, there is not clear moraine evidence of glacier readvance at that time.

Previous studies investigated the content of rap music within the context of traditional media and found that rap often contains antisocial themes associated with negative effects. The current content analysis investigates whether rap’s lyrical themes consumed and shared online are more diverse and less anti-social than rap aired on traditional outlets. The analysis revealed that songs shared on Facebook were less antisocial and more prosocial than the songs that made the Billboard charts. Additionally, online lyrical themes were more diverse than traditionally distributed lyrics. Rap consumption and sharing behaviors will be discussed in light of the theory of selective exposure

Recent observations indicate that ice-ocean interaction drives much of the recent increase in mass loss from the Greenland Ice Sheet; however, the role of ocean forcing in driving past glacier change is poorly understood. To extend the observational record and our understanding of the ocean-cryosphere link, we used a multi-proxy approach that combines new data from proglacial lake sediments, 14 C-dated in situ moss that recently emerged from beneath cold-based ice caps, and 10 Be ages to reconstruct centennial-scale records of mountain glacier activity for the past ∼10 k.y. in West Greenland. Proglacial lake sediment records and 14 C dating of moss indicate the onset of Neoglaciation in West Greenland at ca. 5 ka with substantial snowline lowering and glacier expansion at ca. 3.7 ka followed by additional ice expansion phases at ca. 2.9, ca. 1.7, and ca. 1.4 ka and during the Little Ice Age. We find that widespread glacier growth at ca. 3.7 ka in West Greenland coincides with marked cooling and reduced strength of the West Greenland Current in Disko Bugt. The transition to cooler ocean conditions at ca. 3.7 ka identified in Disko Bugt is registered by marine proxy data farther afield in East Greenland and on the northwestern Icelandic shelf, implying large-scale paleoceanographic changes across the North Atlantic during this interval. The similarity between glacier change on West Greenland and multiple marine and terrestrial records across the North Atlantic suggests that glaciers are strongly influenced by changes in ocean circulation and consequently implies that the ocean-cryosphere teleconnection is a persistent feature of the Arctic system.

Fish feeding ecology has been shown to vary over a 24-h period in terms of the prey consumed and feeding intensity. Consequently, in order to best determine the interspecific feeding associations within a fish community, examination of the diet at multiple times over a 24-h period is often necessary. We examined the diel feeding ecology of three fish species that were numerically dominant in a Lake Ontario embayment during summer. The diet of each of the three species, young-of-year Pumpkinseed Lepomis gibbosus, Golden Shiner Notemigonus crysoleucas, and Brook Silverside Labidesthes sicculus, was distinct with no significant overlap in diet composition occurring within any of the 4-h time intervals. The diet composition of each species suggested that Brook Silverside were feeding at the surface (terrestrial invertebrates and aquatic surface dwelling hemipterans), whereas young-of-year Pumpkinseed (amphipods) and Golden Shiner (tipulids) were feeding on different benthic prey. Differences in feeding periodicity were most pronounced for young-of-year Pumpkinseed. Our findings provide valuable insights on interspecific feeding associations among these three fish species during summer in a Lake Ontario embayment.

Avital Avriel,1 Dmitry Rozenberg,2 Yael Raviv,1 Dov Heimer,1 Amir Bar-Shai,3 Rachel Gavish,4 Jony Sheynin,5,6 Amos Douvdevani6 1Department of Medicine, Pulmonology Institute, Soroka MedicalCenter, Ben-Gurion University, Beer-Sheva, Israel; 2Divisionof Respirology, Departmentof Medicine, University Health Network, University of Toronto, Toronto, ON, Canada; 3Department ofMedicine, Pulmonology Institute, TelAviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, 4Faculty of HealthSciences, Ben-Gurion University, Beer-Sheva, Israel; 5Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; 6Department of Clinical Biochemistry, Faculty of Health Sciences, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel Background: Chronic obstructive pulmonary disease exacerbations (COPDEs) are associated with increased morbidity and mortality. Cell-free DNA (cfDNA) is a novel biomarker associated with clinical outcomes in several disease states but has not been studied in COPD. The objectives of this study were to assess cfDNA levels during a COPDE, to evaluate the association of cfDNA with clinical parameters and to explore the prognostic implications of cfDNA levels on long-term survival.Methods: This was an observational study that assessed cfDNA levels in patients admitted to hospital for a COPDE. Plasma cfDNA levels of COPDE patients were compared to those of matched stable COPD patients and healthy controls. Multivariable and Cox regression analyses were used to assess the association of cfDNA levels with blood gas parameters and long-termsurvival.Results: A total of 62 patients (46 males, forced expiratory volume in 1 second [FEV1] 38%±13%) were included. The median cfDNA levels on admission for COPDE patients was 1,634 ng/mL (interquartile range [IQR] 1,016–2,319) compared to 781 ng/mL (IQR 523–855) for stable COPD patients, matched for age and disease severity, and 352 ng/mL (IQR 209–636) for healthy controls (P

Post-operative pulmonary complications in coronary artery bypass grafting (CABG) surgery are mostly reversible. We report a patient who developed pulmonary arterial hypertension (PAH) post-CABG and did not have pulmonary hypertension prior to surgery. PAH Group 1 was diagnosed after right and left heart catheterization. To the best of our knowledge, this is the only reported case of a patient developing PAH post-CABG surgery. This could be explained by immunological and/or haemostatic changes triggered by cardiopulmonary bypass. We hope that as more knowledge is gained regarding the pathophysiology of PAH, cases like these could be better understood.

Post‐operative pulmonary complications in coronary artery bypass grafting (CABG) surgery are mostly reversible. We report a patient who developed pulmonary arterial hypertension (PAH) post‐CABG and did not have pulmonary hypertension prior to surgery. PAH Group 1 was diagnosed after right and left heart catheterization. To the best of our knowledge, this is the only reported case of a patient developing PAH post‐CABG surgery. This could be explained by immunological and/or haemostatic changes triggered by cardiopulmonary bypass. We hope that as more knowledge is gained regarding the pathophysiology of PAH, cases like these could be better understood.

Convex endobronchial ultrasound transbronchial needle aspiration (C-EBUS-TBNA) has become an essential modality for diagnosis and staging of hilar, mediastinal, and central pulmonary lesions. A Trans-thoracic pleural biopsy is the accepted practice for diagnosing pleural nodules. However, the diagnostic yield of a pleural biopsy is limited and surgical procedures pose a greater risk. We report a unique case of using a C- EBUS scope for the diagnosis of pleural nodules and mediastinal lymph node metastasis in a man with metastatic renal cell carcinoma.

Pour voir chaque détail du diamant qu’il travaille, chaque beauté à rehausser, chaque fissure à éviter, le bijoutier dispose d’une « lentille convexe et grossissante qui donne des objets une image virtuelle droite et agrandie ». On peut dire que le traducteur se sert d’une loupe mentale, car il examine « avec grande minutie » le microcosme du texte, c’est-à-dire chaque mot, chaque virgule, chaque silence, sans exception – travail fastidieux, sans doute, pour qui ne le trouverait pas fascinant...

The aim of this study was to investigate whether therapeutic intravascular ultrasound pulmonary artery denervation (PDN) is safe and reduces pulmonary vascular resistance (PVR) in patients with pulmonary arterial hypertension (PAH) on a minimum of dual oral therapy.Early studies have suggested that PDN can reduce PVR in patients with PAH.TROPHY1 (Treatment of Pulmonary Hypertension 1) was a multicenter, international, open-label trial undertaken at 8 specialist centers. Patients 18 to 75 years of age with PAH were eligible if taking dual oral or triple nonparenteral therapy and not responsive to acute vasodilator testing. Eligible patients underwent PDN (TIVUS System). The primary safety endpoint was procedure-related adverse events at 30 days. Secondary endpoints included procedure-related adverse events, disease worsening and death to 12 months, and efficacy endpoints that included change in pulmonary hemodynamic status, 6-min walk distance, and quality of life from baseline to 4 or 6 months. Patients were to remain on disease-specific medication for the duration of the study.Twenty-three patients underwent PDN, with no procedure-related serious adverse events reported. The reduction in PVR at 4- or 6-month follow-up was 94 ± 151 dyn·s·cmIn this multicenter early feasibility study, PDN with an intravascular ultrasound catheter was performed without procedure-related adverse events and was associated with a reduction in PVR and increases in 6-min walk distance and daily activity in patients with PAH on background dual or triple therapy.

Background Chronic obstructive pulmonary disease (COPD) is an inflammatory disease characterized by a progressive and irreversible deterioration of lung function. Exacerbations of COPD have prolonged negative effects on pulmonary function and a major impact on health status and outcomes. NLRP3 inflammasome is a cardinal component of the inflammatory response, with marked evidence in stable and exacerbations of COPD. The aim of our study was to evaluate the NLRP3 inflammasome activity during COPD exacerbation by using an in vitro model. Methods A549 cells were stimulated with different concentrations (10%, 4%, 2%) of cigarette smoke extract (CSE) with or without LPS (0.1μg/ml) for 24 hours. Cell viability was assessed by using XTT test. Levels of inflammatory cytokines (IL-8, MCP-1, and IL-1β) were measured by ELISA and the activity level of NLRP-3 was evaluated by flow cytometry. Results Cells exposed to CSE present an increase in inflammatory cytokines (IL-8 and MCP-1) production in a dose-dependent manner. Incubation with LPS to these cells results in higher levels of IL-8 and MCP-1 compared to stimulation of CSE alone. NLRP3 inflammasome activity and IL-1β levels were significantly increased in cells exposed to both CSE and LPS compared to CSE alone. Conclusions NLRP3 inflammasome is upregulated in an in-vitro model of COPD and COPD exacerbation. Our findings provide novel biomarkers for COPD exacerbation and may present new targets for future research.

The growing understanding that transdisciplinary research is required for sustainable land management (i.e., co-production of knowledge by researchers and land managers) stems from the complexity and unpredictability of social-ecological systems. However, many scientists feel that the large gap between the agendas and worldviews of scientists and land managers makes it difficult to co-produce knowledge. This challenge was the focus of our study in Cairngorms National Park (CNP), Long-Term Social-Ecological Research Platform (LTSER), Scotland. Semi-structured interviews were conducted with 18 land managers and 15 scientists, who are active in CNP, focussed on their individual perception of the park's social-ecological system. The findings point to differences in interests between the two groups. Land managers are mainly troubled by local economic and legacy problems, while scientists are more concerned by environmental and global questions. However, the findings also indicated a shared sense of uncertainty about the future of the region along with willingness for both groups to work together. These findings suggest a need for transdisciplinary research that co-produces science best future vision; i.e., a synthesis of scientific knowledge and land managers' practical knowledge, motivations and aspirations to create a resilient socio-ecological system.

Youth receive a myriad of messages pertaining to their ethnicity and race daily. Youth today are overtly exposed to both interpersonal and institutional discrimination through dominating social media platforms, informed by the 24-hour news cycle. The world of social media serves as a critical platform for exposure, discourse, and engagment, underscoring the viral impact of ethnic-racial discrimination. Social media outlets, intended to foster rapid communication and community response, quickly become additional sources of marginalization and racial trauma, particularly for youth of color. The constant barrage of discriminatory content on social media, in which people of color are often dehumanized, not only distorts attitudes toward communities of color, but also shapes how youth perceive themselves and their communities. This chapter will discuss developmental implications for youth when discrimination “goes viral”. Applying a bioecological framework, this chapter unpacks the consequences of ethnic-racial discrimination in the digital social media environment and need for school, family, and policy related intervention. We conclude by identifying sources of adaptive coping and resilience to help educators, parents, and youth navigate and transform experiences with online ethnic-racial discrimination. Directions for future research, including the utility of algorithmic tools, are discussed.

Background The COVID-19 pandemic has further challenged the world's most vulnerable populations' access to adequate food. The UN World Food Program estimates that COVID-19 will increase worldwide food insecurity from 135 million to 265 million people by 2021. In March, 2020, Walking Palms Global Health (WPGH) initiated their More than Food Emergency Relief Program in Bahia de Caraquez, Ecuador, working with local government to deliver food and supplies to at-risk households. We aim to assess how WPGH's response affected households early in the 2020 pandemic. Methods Between March and July, 2020, rations were delivered to 225 families in rural, urban, and peri-urban communities within the city of Bahia de Caraquez located in the province of Manabi on Ecuador's west coast. These specific communities face frequent piped water disruptions, power outages, and mosquito-transmitted diseases such as dengue are endemic. In June, 2020, WPGH administered evaluations in the urban and rural communities, which included the World Food Program Food Confidence Score to address food consumption, food accessibility stress, and presence of chronic diseases. Findings Evaluations were conducted in 21 of 45 urban households (47%) and 45 of 50 rural households (90%). Overall, 66 households (69%) completed surveys and 29 (31%) opted out. The association between household income before COVID-19 and food insecurity was significant (p=0·04). Before the first programme delivery, 59 participants (92%) worried that their household would experience food insecurity and most often felt nervous or stressed about possible food insecurity (n=55 [85%]). Insufficient access to food led to 55 respondents (85%) skipping meals. Food confidence scores remained stable over the pandemic's most challenging period (Food confidence score=37·68% before deliveries and 38·11% during deliveries). Respondents (n=61 [95%]) reported that boxes allowed them to prepare enjoyable and culturally appropriate meals. The most common combination of meals cooked with box items was rice and beans, stews, corviche, empanadas, and plantains with 98% of participants finding every box item useful. There was no relation between food insecurity and number of children (p=0·26) or number of people in households (p=1·00). There was no significant association between chronic disease and pre-COVID-19 household income (p=0·24) or respondents' food security (p=0·82). Interpretation In communities that had high food insecurity before the pandemic, WPGH's response allowed households to maintain overall food consumption throughout the most challenging lockdown period. WPGH is currently working to innovatively and sustainably increase food security in the communities where they work. Limitations include programme administration relying on donor participation for financial support. Funding None.

A significantly high correlation between reduced activity of Annexin A5 by the flow cytometric assay (FCA) and the diagnosis of antiphospholipid syndrome (APS) has been reported. The aim of this study was to assess the clinical and laboratory significance of the Annexin A5 competition assay among patients with systemic lupus erythematosus (SLE). The FCA competition assay was performed on blood samples from 57 consecutive SLE patients. The FCA was performed according to a previously validated method. Forty-seven patients (82.5 %) had SLE without APS and ten (17.5 %) had SLE with APS. Twenty-four (42 %) of the patients had mean levels of AnxA5 fluorescence below the mean and standard deviation of the controls and were considered positive. SLE patients with a positive FCA were found to have an increased risk for a hypercoagulable or vascular state (86 % of the patients had cerebrovascular disease, 89 % had Raynaud’s phenomenon, and 80 % had deep vein thrombosis). The risk for any hypercoagulable or vascular state was significantly increased (P = 0.012, RR−2.3, 95 % CI 1.4–3.8). A positive FCA assay was found in 90 % of the patients with APS (P < 0.001), with a sensitivity of 90 % and a specificity of 68 % for this diagnosis. The positive and negative predictive values were 0.4 and 0.97, respectively. Correlations were found between positive FCA and positive Anti-Cardiolipin antibody (P < 0.001), and Anti-β2 glycoprotein I levels (P = 0.013). Our findings suggest that the FCA is a practical assay for the detection of clinically relevant APS among patients with SLE.

This study explores the effectiveness of applying optimal control techniques to the flight control law clearance problem, which is the challenge of ensuring the safety of an aircraft’s flight control system for all allowable inputs. The specific criterion chosen was the angle-of-attack limit exceeding criterion, and two different cost functions were constructed that accurately describe it. Using Aero-Data Model in a Research Environment to obtain realistic aerodynamic coefficients, a longitudinal short-period model was developed. It was proven that the general system has a bang-bang worst-case input when the states are unbounded, and a possible bang-singular-bang worst-case input when one or more states are bounded. These results were validated with simulations using General Pseudospectral Optimal Control Software. In the physical domain these results translate into actuator rate limiting issues; thus, limited elevator deflection and rate of elevator deflection can lead to even more extreme worst-case per...

The text of Psalm 122 displays strong affinities with the ceremony of dedication to the city wall of Jerusalem (Neh 12,27-43). Further parallels even suggest that the two parts of Psalm 122 (vv. 1-5 and vv. 6-9) were the texts sung by the two choirs participating in the ceremony. According to the description related in Neh 12,27-43, it is likely that the claims of the two choirs, first sung separately on the city wall, progressively mixed in antiphonal fashion when the two processions joined at the temple. This mode of performance is defined as shifting responsa because the mixing of the two dialoging voices induces a gradual shift, at each round of the performance, between the verses paired from the two choirs. In Psalm 122, this process generates a coherent composite text of 40 verselines displaying emergent structural properties and coherent literary meanings ignored by the linear reading. These findings reveal that Psalm 122 is not a naive song of pilgrimage but a skillfully composed piece of ...

In situ cosmogenic nuclide exposure age distributions on Ice Age nunataks act as past ice thickness indicators and provide valuable targets for ice sheet model simulations of the Last Glacial Maximum. Several locations along West Greenland have been identified as being potential nunataks due to their weathered nature and their high cosmogenic nuclide inventories with little evidence for ice sheet burial. We present new in situ cosmogenic 14C measurements from four high elevation surfaces in the central Uummannaq Fjord system that were identified as potential nunataks in prior work. Building on previous work, we model cosmogenic radionuclide production and decay, and consider a range of ice sheet history scenarios. Since our results require more burial or shielding under ice than what independent methods suggest for Holocene ice cap cover, we propose that these locations were not nunataks during the Last Glacial Maximum, but rather were buried during the peak of the Last Glacial Maximum. However, we cannot confirm whether these sites were buried by the Greenland Ice Sheet or local glaciers.

[Departement_IRSTEA]Eaux [TR1_IRSTEA]QUASARE [ADD1_IRSTEA]Systèmes aquatiques soumis à des pressions multiples; International audience; With an overarching goal of addressing global and regional sustainability challenges, Long Term Socio-Ecological Research Platforms (LTSER) aim to conduct place-based research, to collect and synthesize both environmental and socio-economic data, and to involve a broader stakeholder pool to set the research agenda. To date there have been few studies examining the output from LTSER platforms. In this study we enquire if the socio-ecological research from 25 self-selected LTSER platforms of the International Long-Term Ecological Research (ILTER) network has produced research products which fulfil the aims and ambitions of the paradigm shift from ecological to socio-ecological research envisaged at the turn of the century. In total we assessed 4983 publically available publications, of which 1112 were deemed relevant to the socio-ecological objectives of the platform. A series of 22 questions were scored for each publication, assessing relevance of responses in terms of the disciplinary focus of research, consideration of human health and well-being, degree of stakeholder engagement, and other relevant variables. The results reflected the diverse origins of the individual platforms and revealed a wide range in foci, temporal periods and quantity of output from participating platforms, supporting the premise that there is a growing trend in socio-ecological research at long-term monitoring platforms. Our review highlights the challenges of realizing the top-down goal to harmonize international network activities and objectives and the need for bottom-up, self-definition for research platforms. This provides support for increasing the consistency of LTSER research while preserving the diversity of regional experiences.

Communities often lack a framework to guide research and action by which to mitigate complex socio-ecological challenges in the face of conflicting interests and poorly understood ecological and socio-political mechanisms. In an effort to provide such a framework, this article offers an approach for the systematic analysis of societal interactions with the landscape as well as for the structure and function of the ecosystem. Using an approach informed both by transdisciplinary research (TdR) and participatory action research (PAR), modeling is employed to identify trajectories of human influence on the ecosystem, which is illustrated using a case from the Negev Highlands of Israel. The approach identifies several cascades of effects, allowing diverse stakeholders to better understand the mechanisms by which human activities change the capacity of the ecosystem to support human well-being over time, as well as building capacity for stakeholder cooperation for sustainable management.