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This study investigates the sensitivity of two brightness temperature differences (BTDs) in the infrared (IR) window of the Spinning Enhanced Visible and Infrared Imager (SEVIRI) to various cloud parameters in order to understand their information content, with a focus on cloud thermodynamic phase. To this end, this study presents radiative transfer calculations, providing an overview of the relative importance of all radiatively relevant cloud parameters, including thermodynamic phase, cloud-top temperature (CTT), optical thickness (τ), effective radius (Reff), and ice crystal habit. By disentangling the roles of cloud absorption and scattering, we are able to explain the relationships of the BTDs to the cloud parameters through spectral differences in the cloud optical properties. In addition, an effect due to the nonlinear transformation from radiances to brightness temperatures contributes to the specific characteristics of the BTDs and their dependence on τ and CTT. We find that the dependence of the BTDs on phase is more complex than sometimes assumed. Although both BTDs are directly sensitive to phase, this sensitivity is comparatively small in contrast to other cloud parameters. Instead, the primary link between phase and the BTDs lies in their sensitivity to CTT (or more generally the surface–cloud temperature contrast), which is associated with phase. One consequence is that distinguishing high ice clouds from low liquid clouds is straightforward, but distinguishing mid-level ice clouds from mid-level liquid clouds is challenging. These findings help to better understand and improve the working principles of phase retrieval algorithms.

For hard-to-survey populations such as ethnic minorities and immigrants, increasing survey response rates is a crucial element of the fieldwork as these populations often show a higher likelihood of not participating compared with the native population. However, no study has so far compared different strategies for mobilisation within this group. Using data from the Immigrant German Election Study II, this experiment systematically compares the effects of home visits and postal reminders for the mobilisation of immigrant-origin non-respondents (i.e. persons classified as being from Turkey or from the former Soviet Union and its successor states) from a randomly drawn sample regarding the likelihood of participation in the first wave, signing up for a multi-wave panel, and taking part in all three panel waves. Multivariate analyses show that those in the treated home-visit group were more likely to take part in all stages of the survey design. Even though costs are higher than conventional postal reminders, home visits might be a useful strategy for cases in which increasing the response rate is an important goal, given a fixed, small number of potential respondents.

Global warming is amplified in the Arctic. However, numerical models struggle to represent key processes that determine Arctic weather and climate. To collect data that help to constrain the models, the HALO–(𝒜𝒞)3 aircraft campaign was conducted over the Norwegian and Greenland seas, the Fram Strait, and the central Arctic Ocean in March and April 2022. The campaign focused on one specific challenge posed by the models, namely the reasonable representation of transformations of air masses during their meridional transport into and out of the Arctic via northward moist- and warm-air intrusions (WAIs) and southward marine cold-air outbreaks (CAOs). Observations were made over areas of open ocean, the marginal sea ice zone, and the central Arctic sea ice. Two low-flying and one long-range, high-altitude research aircraft were flown in colocated formation whenever possible. To follow the air mass transformations, a quasi-Lagrangian flight strategy using trajectory calculations was realized, enabling us to sample the same moving-air parcels twice along their trajectories. Seven distinct WAI and 12 CAO cases were probed. From the quasi-Lagrangian measurements, we have quantified the diabatic heating/cooling and moistening/drying of the transported air masses. During CAOs, maximum values of 3 K h−1 warming and 0.3 g kg−1 h−1 moistening were obtained below 1 km altitude. From the observations of WAIs, diabatic cooling rates of up to 0.4 K h−1 and a moisture loss of up to 0.1 g kg−1 h−1 from the ground to about 5.5 km altitude were derived. Furthermore, the development of cloud macrophysical (cloud-top height and horizontal cloud cover) and microphysical (liquid water path, precipitation, and ice index) properties along the southward pathways of the air masses were documented during CAOs, and the moisture budget during a specific WAI event was estimated. In addition, we discuss the statistical frequency of occurrence of the different thermodynamic phases of Arctic low-level clouds, the interaction of Arctic cirrus clouds with sea ice and water vapor, and the characteristics of microphysical and chemical properties of Arctic aerosol particles. Finally, we provide a proof of concept to measure mesoscale divergence and subsidence in the Arctic using data from dropsondes released during the flights.

How air masses transform during meridional transport into and out of the Arctic is not well represented by numerical models. The airborne field campaign HALO-(𝒜𝒞)3 applied the High Altitude and Long-range Research Aircraft (HALO) within the framework of the collaborative research project on Arctic amplification (𝒜𝒞)3 to address this question by providing a comprehensive observational basis. The campaign took place from 7 March to 12 April 2022 in the North Atlantic sector of the Arctic, a main gateway of atmospheric transport into and out of the Arctic. Here, we investigate to which degree the meteorological and sea ice conditions during the campaign align with the long-term climatology (1979–2022). For this purpose, we use the European Centre for Medium-Range Weather Forecasts (ECMWF) reanalysis v5 (ERA5), satellite data, and measurements at Ny-Ålesund, including atmospheric soundings. The observations and reanalysis data revealed two distinct periods with different weather conditions during HALO-(𝒜𝒞)3: the campaign started with a warm period (11–20 March 2022) where strong southerly winds prevailed that caused poleward transport of warm and moist air masses, so-called moist and warm air intrusions (WAIs). Two WAI events were identified as atmospheric rivers (ARs), which are narrow bands of strong moisture transport. These warm and moist air masses caused the highest measured 2 m temperatures (5.5 °C) and daily precipitation rates (42 mm d−1) at Ny-Ålesund for March since the beginning of the record (1993). Over the sea ice northwest of Svalbard, ERA5 indicated record-breaking rainfall. After the passage of a strong cyclone on 21 March 2022, a cold period followed. Northerly winds advected cold air into the Fram Strait, causing marine cold air outbreaks (MCAOs) until the end of the campaign. This second phase included one of the longest MCAO events found in the ERA5 record (19 d). On average, the entire campaign period was warmer than the climatological mean due to the strong influence of the ARs. In the Fram Strait, the sea ice concentration was well within the climatological variability over the entire campaign duration. However, during the warm period, a large polynya opened northeast of Svalbard, untypical for this season. Compared to previous airborne field campaigns focusing on the evolution of (mixed-phase) clouds, a larger variety of MCAO conditions was observed during HALO-(𝒜𝒞)3. In summary, air mass transport into and out of the Arctic was more pronounced than usual, providing exciting prospects for studying air mass transformation using HALO-(𝒜𝒞)3.

A comprehensive understanding of the cloud thermodynamic phase is crucial for assessing the cloud radiative effect and is a prerequisite for remote sensing retrievals of microphysical cloud properties. While previous algorithms mainly detected ice and liquid phases, there is now a growing awareness for the need to further distinguish between warm liquid, supercooled and mixed-phase clouds. To address this need, we introduce a novel method named ProPS (PRObabilistic cloud top Phase retrieval for SEVIRI), which enables cloud detection and the determination of cloud-top phase using SEVIRI (Spinning Enhanced Visible and Infrared Imager), the geostationary passive imager aboard Meteosat Second Generation. ProPS discriminates between clear sky, optically thin ice (TI) cloud, optically thick ice (IC) cloud, mixed-phase (MP) cloud, supercooled liquid (SC) cloud and warm liquid (LQ) cloud. Our method uses a Bayesian approach based on the cloud mask and cloud phase from the lidar–radar cloud product DARDAR (liDAR/raDAR). The validation of ProPS using 6 months of independent DARDAR data shows promising results: the daytime algorithm successfully detects 93 % of clouds and 86 % of clear-sky pixels. In addition, for phase determination, ProPS accurately classifies 91 % of IC, 78 % of TI, 52 % of MP, 58 % of SC and 86 % of LQ clouds, providing a significant improvement in accurate cloud-top phase discrimination compared to traditional retrieval methods.

ABSTRACT Coronavirus disease 2019 (COVID-19) and its associated severity have been linked to uncontrolled inflammation and may be associated with changes in the microbiome of mucosal sites including the gastrointestinal tract and oral cavity. These sites play an important role in host–microbe homeostasis, and disruption of epithelial barrier integrity during COVID-19 may potentially lead to exacerbated inflammation and immune dysfunction. Outcomes in COVID-19 are highly disparate, ranging from asymptomatic to fatal, and the impact of microbial dysbiosis on disease severity is unclear. Here, we obtained plasma, rectal swabs, oropharyngeal swabs, and nasal swabs from 86 patients hospitalized with COVID-19 and 12 healthy volunteers. We performed 16S rRNA sequencing to characterize the microbial communities in the mucosal swabs and measured concentrations of circulating cytokines, markers of gut barrier integrity, and fatty acids in the plasma samples. We compared these plasma concentrations and microbiomes between healthy volunteers and COVID-19 patients, some of whom had unfortunately died by the end of the study enrollment, and performed a correlation analysis between plasma variables and bacterial abundances. Rectal swabs of COVID-19 patients had reduced abundances of several commensal bacteria including Faecalibacterium prausnitzii and an increased abundance of the opportunistic pathogens Eggerthella lenta and Hungatella hathewayi. Furthermore, the oral pathogen Scardovia wiggsiae was more abundant in the oropharyngeal swabs of COVID-19 patients who died. The abundance of both H. hathewayi and S. wiggsiae correlated with circulating inflammatory markers including IL-6, highlighting the possible role of the microbiome in COVID-19 severity and providing potential therapeutic targets for managing COVID-19.IMPORTANCEOutcomes in coronavirus disease 2019 (COVID-19) are highly disparate and are associated with uncontrolled inflammation; however, the individual factors that lead to this uncontrolled inflammation are not fully understood. Here, we report that severe COVID-19 is associated with systemic inflammation, microbial translocation, and microbial dysbiosis. The rectal and oropharyngeal microbiomes of COVID-19 patients were characterized by a decreased abundance of commensal bacteria and an increased abundance of opportunistic pathogens, which positively correlated with markers of inflammation and microbial translocation. These microbial perturbations may, therefore, contribute to disease severity in COVID-19 and highlight the potential for microbiome-based interventions in improving COVID-19 outcomes.

Abstract Spontaneous fermentation of cereals like millet involves a diverse population of microbes from various sources, including raw materials, processing equipment, fermenting receptacles, and the environment. Here, we present data on the predominant microbial species and their succession at each stage of the Hausa koko production process from five regions of Ghana. The isolates were enumerated using selective media, purified, and phenotypically characterised. The LAB isolates were further characterised by 16S rRNA Sanger sequencing, typed using (GTG)5 repetitive-PCR, and whole genome sequencing, while 28S rRNA Sanger sequencing was performed for yeast identification. The pH of the millet grains ranged from mean values of 6.02—6.53 to 3.51—3.99 in the final product, depending on the processors. The mean LAB and yeast counts increased during fermentation then fell to final counts of log 2.77–3.95 CFU/g for LAB and log 2.10–2.98 CFU/g for yeast in Hausa koko samples. At the various processing stages, the counts of LAB and yeast revealed significant variations (p

Abstract Implantable collamer lens implantation (ICL) represents a safe and effective treatment for myopia and myopic astigmatism. To compare the outcomes of a bilateral one-stage same day approach to a two-stage approach, the databases of the University Eye Hospital Munich, Ludwig Maximilians-University and Smile Eyes Linz, Austria were screened for eyes that had undergone ICL implantation. Two-stage surgery was performed at an interval of 1 day (17 patients), 2 days (19 patients) and 1 week (2 patients). Variables analyzed were preoperative, 1-day and last follow-up uncorrected distance (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, refractive spherical equivalent (SEQ), astigmatism, age, endothelial cell count (ECD), intraocular pressure (IOP) and ICL vaulting. In total, 178 eyes (100 eyes one-stage, 78 eyes two-stage) of 89 patients were included in this study. Mean follow-up was 1.1 ± 0.8 and 1.3 ± 0.5 years. Mean preoperative SEQ was − 7.9 ± 2.6 diopters (D) in the one-stage and − 8.0 ± 1.7 D in the two-stage group (p = 0.63) and improved to 0.00 ± 0.40 and − 0.20 ± 0.40 D at end of follow-up, showing slightly better stability in the one-stage group (p = 0.004). There was no difference in the efficacy (1.1 vs. 1.2, p = 0.06) and the safety index (1.2 vs. 1.2, p = 0.60) between the two groups. No eye (0%) in either group lost 2 lines or more of UDVA (p > 0.99). Refraction within ± 0.50 D and ± 1.00 D around target was achieved comparably often (89 vs. 86%, p = 0.65; 99 vs. 99%, p > 0.99). Endothelial cell loss was slightly higher in the two-stage group (1.3 vs. 4.3%). Vaulting at the final follow up was higher in the one-stage group (373.8 ± 205.4 µm vs. 260.3 ± 153.5 µm, p = 0.00007). There were no serious intraoperative complications in either group. In conclusion, this study demonstrates that both the one- and two-stage approaches are equally effective, predictable and safe. Regarding endothelial cell loss, vaulting and SEQ stability, the one-stage group showed slightly better outcomes, but these results are clinically questionable because they are so small. Larger studies are needed to quantitatively evaluate a potential benefit.

The accuracy of reaction theories used to extract properties of exotic nuclei from scattering experiments is often unknown or not quantified, but of utmost importance when, e.g., constraining the equation of state of asymmetric nuclear matter from observables as the neutron-skin thickness. In order to test the Glauber multiple-scattering model, the total interaction cross section of Image 1 on carbon targets was measured at initial beam energies of 400, 550, 650, 800, and 1000 MeV/nucleon. The measurements were performed during the first experiment of the newly constructed R3B (Reaction with Relativistic Radioactive Beams) experiment after the start of FAIR Phase-0 at the GSI/FAIR facility with beam energies of 400, 550, 650, 800, and 1000 MeV/nucleon. The combination of the large-acceptance dipole magnet GLAD and a newly designed and highly efficient Time-of-Flight detector enabled a precise transmission measurement with several target thicknesses for each initial beam energy with an experimental uncertainty of ±0.4%. A comparison with the Glauber model revealed a discrepancy of around 3.1% at higher beam energies, which will serve as a crucial baseline for the model-dependent uncertainty in future fragmentation experiments.

Abstract Artificial intelligence (AI) and machine learning (ML) pose a challenge for achieving science that is both reproducible and replicable. The challenge is compounded in supervised models that depend on manually labeled training data, as they introduce additional decision‐making and processes that require thorough documentation and reporting. We address these limitations by providing an approach to hand labeling training data for supervised ML that integrates quantitative content analysis (QCA)—a method from social science research. The QCA approach provides a rigorous and well‐documented hand labeling procedure to improve the replicability and reproducibility of supervised ML applications in Earth systems science (ESS), as well as the ability to evaluate them. Specifically, the approach requires (a) the articulation and documentation of the exact decision‐making process used for assigning hand labels in a “codebook” and (b) an empirical evaluation of the reliability” of the hand labelers. In this paper, we outline the contributions of QCA to the field, along with an overview of the general approach. We then provide a case study to further demonstrate how this framework has and can be applied when developing supervised ML models for applications in ESS. With this approach, we provide an actionable path forward for addressing ethical considerations and goals outlined by recent AGU work on ML ethics in ESS.

PurposeEctasia screening in candidates for laser refractive surgery is mandatory during preoperative evaluation. Despite the availability of modern imaging techniques, refractive surgeons often face borderline decisions when patients present with suspicious tomographic findings. This case series presents refractive candidates with suspicious tomographic findings and demonstrates how to interpret them using Scheimpflug imaging and additional anterior segment optical coherence tomography (AS-OCT).SettingDepartment of Ophthalmology, University Hospital, LMU Munich.Case seriesThis case series examines six potential candidates for refractive surgery with a mean age of 29.2 ± 3.9 years, whose corneal assessments using Scheimpflug imaging raised suspicion for ectasia. Each candidate was additionally examined with AS-OCT and reevaluated. The mean manifest subjective spherical equivalent was -3.67 ± 1.8 diopters. The total corneal thickness measured 537 µm ± 30 µm at its thinnest point. None of the candidates had any reported underlying corneal or ophthalmic diseases, and slit lamp examinations revealed no abnormal morphological findings.ConclusionsBoth Scheimpflug imaging and AS-OCT are appropriate tools for screening refractive candidates for ectasia. While topographic and elevation analyses yielded comparable results regarding corneal structure, the epithelial mapping provided by AS-OCT played a critical role in decision-making for cases with borderline tomographic findings. Establishing a global consensus on the use of epithelial mapping in ectasia screening is necessary.

This study investigates the short- and long-term consequences of armed conflict and displacement on social cohesion among citizens within attacked nations, using Ukraine and Bosnia and Herzegovina as case studies. Through a pre-registered vignette study in Ukraine (December 2022; N = 1,623), we reveal a significant difference in social cohesion between those who stayed in the country during the war and those who left. This difference intensified when those who left did not want to return. A similar difference persists in Bosnia and Herzegovina 30 years after the Bosnian War (May 2023, N = 338), despite extensive reconciliation efforts. Our findings point towards an understudied consequence of armed conflict and displacement on social cohesion within the attacked nation and shed light on the challenges to post-war reconciliation.

Abstract Background Gamma-aminobutyric acid (GABA) is a non-protein amino acid with neuroinhibitory, antidiabetic, and antihypertensive properties and is used as a drug for treating anxiety and depression. Some strains of lactobacilli are known to produce GABA and strengthen the gut barrier function which play an important role in ameliorating the effects caused by the pathogen on the gut barrier. The probiotic bacteria are also known to modulate the human fecal microbiota, however, the role of GABA-producing strains on the gut epithelium permeability and gut microbiota is not known. Results In this study, we report the production of high levels of GABA by potential probiotic bacterium Limosilactobacillus fermentum L18 for the first time. The kinetics of the production of GABA by L18 showed that the maximum production of GABA in the culture supernatant (CS) occurred at 24 h, whereas in fermented milk it took 48 h of fermentation. The effect of L18 on the restoration of lipopolysaccharide (LPS)-disrupted intestinal cell membrane permeability in Caco-2 monolayers showed that it significantly restored the transepithelial electrical resistance (TEER) values, by significantly increasing the levels of junction proteins, occludin and E-cadherin in L18 and LPS-treated Caco-2 cells as compared to only LPS-treated cells. The effect of GABA-secreting L18 on the metataxonome of human stool samples from healthy individuals was investigated by a batch fermentor that mimics the conditions of the human colon. Although, no differences were observed in the α and β diversities of the L18-treated and untreated samples at 24 h, the relative abundances of bacterial families Lactobacillaceae and Bifidobacteriaceae increased in the L18-treated group, but both decreased in the untreated groups. On the other hand, the relative abundance of Enterobacteriaceae decreased in the L18 samples but it increased in the untreated samples. Conclusion These results indicate that Li. fermentum L18 is a promising GABA-secreting strain that strengthens the gut epithelial barrier by increasing junction protein concentrations and positively modulating the gut microbiota. It has the potential to be used as a psychobiotic or for the production of functional foods for the management of anxiety-related illnesses.

Synopsis: Corneal epithelial wavefront error and epithelial thickness variance qualify as highly sensitive and specific biomarkers for epithelial basement membrane dystrophy (EBMD). The biomarkers show a normalization after treatment of EBMD with phototherapeutic keratectomy. Purpose: To gauge the diagnostic value of epithelial basement membrane dystrophy (EBMD), a novel spectral-domain optical coherence tomography (SD-OCT)-based imaging modality for simultaneous morphological (thickness profile) and refractive (optical wavefront) assessment of the corneal epithelial layer in one of the most common but often underdiagnosed corneal dystrophies. Methods: In this prospective observational study, a total of 32 eyes of 32 patients diagnosed with EBMD and 32 eyes of 32 healthy control subjects were examined with high-resolution anterior segment SD-OCT (MS-39; CSO, Florence, Italy). Various epithelial thickness and epithelial wavefront-derived terms were compared between groups and receiver operating characteristic (ROC) curves were computed to analyze the diagnostic capacity of the respective parameters. A total of 17 of 32 EBMD patients underwent treatment with phototherapeutic keratectomy (PTK) and were followed up for 3 months. Results: Epithelial thickness variance (60.4 ± 56.7 µm versus 7.6 ± 6.1 µm) and interquartile range (11.0 ± 6.9 versus 3.3 ± 1.9 µm) were markedly elevated in EBMD patients as compared with healthy controls (both with p < 0.001). Epithelial wavefront analysis showed a highly statistically significant excess in all examined aberration terms in EBMD patients (all with p < 0.001). Significantly greater areas under the curve (AUCs) were yielded by the epithelial wavefront-derived parameters (e.g., total epithelial wavefront error: AUC = 0.966; 95% confidence interval (CI) 0.932–1) than by the epithelial thickness-derived parameters (e.g., variance: AUC = 0.919; 95% CI 0.848–0.990). Conclusions: Corneal epithelial wavefront aberrometry proved valuable as an objective biomarker for EBMD, with high sensitivity and specificity. PTK resulted in a reduction of morphological and refractive epithelial irregularities in EBMD.

Abstract Here we explore the relative contribution of the Madden‐Julian Oscillation (MJO) and El Niño Southern Oscillation (ENSO) to midlatitude subseasonal predictive skill of upper atmospheric circulation over the North Pacific, using an inherently interpretable neural network applied to pre‐industrial control runs of the Community Earth System Model version 2. We find that this interpretable network generally favors the state of ENSO, rather than the MJO, to make correct predictions on a range of subseasonal lead times and predictand averaging windows. Moreover, the predictability of positive circulation anomalies over the North Pacific is comparatively lower than that of their negative counterparts, especially evident when the ENSO state is important. However, when ENSO is in a neutral state, our findings indicate that the MJO provides some predictive information, particularly for positive anomalies. We identify three distinct evolutions of these MJO states, offering fresh insights into opportune forecasting windows for MJO teleconnections.

PurposeTo compare different corneal keratometry readings (swept-source-OCT-assisted biometry and Scheimpflug imaging) with a novel software platform for calculation of toric intraocular lenses.SettingDepartment of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.DesignRetrospective, non-randomized, clinical trial.MethodsTwenty-three eyes undergoing toric intraocular lens implantation were included. Inclusion criteria were preoperative regular corneal astigmatism of at least 1.00 D, no previous refractive surgery, no ocular surface diseases and no maculopathies. Lens exchange was performed with CALLISTO eye (Zeiss). For each patient, the expected postoperative residual refraction was calculated depending on three different corneal parameters of two different devices: standard K-front (K) and total keratometry (TK) obtained by a swept-source-OCT-assisted biometry system (IOL Master 700, Zeiss) as well as total corneal refractive power (TCRP) obtained by a Scheimpflug device (Pentacam AXL, Oculus). Barrett’s formula for toric intraocular lenses was used for all calculations within a novel software platform (EQ workplace, Zeiss FORUM®). Results were statistically compared with postoperative refraction calculated according to the Harris dioptric power matrix.ResultsThe standard K values (mean PE 0.02 D ± 0.45 D) and TK values (mean PE 0.09 D ± 0.43 D) of the IOL Master 700 reached similar results (p = 0.96). 78% of eyes in both K and TK groups achieved SE within ±0.5 D of attempted correction and all eyes (100%) were within ±1.0 D of attempted correction in both groups. By contrast, the prediction error in the IOL calculation using the TCRP of the Scheimpflug device was significantly greater (mean PE −0.56 D ± 0.49 D; p = 0.00 vs. standard K and p = 0.00 vs. TK) with adjusted refractive indices. Thirty-nine and Ninety-one percentage of eyes in the TCRP group achieved SE within ±0.5 D (p = 0.008 K vs. TCRP and p = 0.005 TK vs. TCRP) and ± 1.0 D (p = 0.14 vs. TCRP) of attempted correction, respectively.ConclusionAll three corneal parameters (standard K, TK, TCRP) performed well in calculating toric IOLs. The most accurate refractive outcomes in toric IOL implantation were achieved by IOL calculations based on swept-source-OCT-assisted biometry. The SS-OCT-based K-front and TK values achieve comparable results in the calculation of toric IOLs.

This work aims to investigate the temporal stability and reliability of trends in air–sea heat fluxes from ERA5 forecasts over the North Atlantic basin for the period 1950–2019. Driving forces of the trends are investigated using analyzed state quantities from ERA5. Estimating trends from reanalysis data can be challenging as changes in the observing system may introduce temporal inconsistencies. To this end, the impact of analysis increments is discussed. For individual sub-regions in the North Atlantic basin, parametrization formulas for latent and sensible heat fluxes are linearized to quantitatively attribute trends to long-term changes in wind speed, moisture, and temperature. Our results suggest good temporal stability and reliability of air–sea heat fluxes from ERA5 forecasts on sub-basin scales and below. Regional averages show that trends are largely driven by changes in the skin temperature and atmospheric advection (e.g., of warmer or drier air masses). The influence of modes of climate variability, such as the North Atlantic Oscillation (NAO) and Atlantic Multidecadal Oscillation, on the patterns found is discussed as well. Results indicate a significant impact on trends in the Irminger and Labrador seas associated with more positive NAO phases during the past 4 decades. Finally, we use basin-wide trends of air–sea heat fluxes in combination with an observational ocean heat content estimate to provide an energy-budget-based trend estimate of the Atlantic Meridional Overturning Circulation (AMOC). A decrease in area-averaged air–sea heat fluxes in the North Atlantic basin suggests a decline in the AMOC over the study period. However, basin-wide flux trends are deemed partially artificial, as indicated by temporally varying moisture increments. Thus, the exact magnitude of change is uncertain, but its sign appears robust and adds complementary evidence that the AMOC has weakened over the past 70 years.

AIM: To evaluate the postoperative intraocular lens (IOL) rotational stability and residual refractive astigmatism following combined 25-gauge vitrectomy and cataract surgery with implantation of a plate haptic toric IOL. METHODS: In this retrospective case series, 32 eyes of 32 patients underwent a combined 25-gauge vitrectomy and phacoemulsification for vitreoretinal diseases and cataract with regular corneal astigmatism of at least 1 diopter (D). A plate haptic toric IOL (AT Torbi 709M, Carl Zeiss Meditec AG) was implanted in all eyes. The outcome measures were rotational stability and refractive astigmatism up to 6mo postoperatively as well as the best corrected visual acuity (BCVA). RESULTS: Preoperative refractive astigmatism was 2.14±1.17 D, which was significantly reduced to 0.77±0.37 D six to eight weeks postoperatively and remained stable throughout the observation period (0.67±0.44 D at three months and 0.75±0.25 D at six months; for all groups: P

Background Recent trials suggest that programmed cell death 1 (PD-1)-directed immunotherapy may be beneficial for some patients with anal squamous cell carcinoma and biomarkers predictive of response are greatly needed.Methods This multicenter phase II clinical trial (NCT02919969) enrolled patients with metastatic or locally advanced incurable anal squamous cell carcinoma (n=32). Patients received pembrolizumab 200 mg every 3 weeks. The primary endpoint of the trial was objective response rate (ORR). Exploratory objectives included analysis of potential predictive biomarkers including assessment of tumor-associated immune cell populations with multichannel immunofluorescence and analysis of circulating tumor tissue modified viral-human papillomavirus DNA (TTMV-HPV DNA) using serially collected blood samples. To characterize the clinical features of long-term responders, we combined data from our prospective trial with a retrospective cohort of patients with anal cancer treated with anti-PD-1 immunotherapy (n=18).Results In the phase II study, the ORR to pembrolizumab monotherapy was 9.4% and the median progression-free survival was 2.2 months. Despite the high level of HPV positivity observed with circulating TTMV-HPV DNA testing, the majority of patients had low levels of tumor-associated CD8+PD-1+ T cells on pretreatment biopsy. Patients who benefited from pembrolizumab had decreasing TTMV-HPV DNA scores and a complete responder’s TTMV-HPV DNA became undetectable. Long-term pembrolizumab responses were observed in one patient from the trial (5.3 years) and three patients (2.5, 6, and 8 years) from the retrospective cohort. Long-term responders had HPV-positive tumors, lacked liver metastases, and achieved a radiological complete response.Conclusions Pembrolizumab has durable efficacy in a rare subset of anal cancers. However, despite persistence of HPV infection, indicated by circulating HPV DNA, most advanced anal cancers have low numbers of tumor-associated CD8+PD-1+ T cells and are resistant to pembrolizumab.

Abstract The incidence and biochemical consequences of rare tumor subtypes are often hard to study. Fibrolamellar liver cancer (FLC) is a rare malignancy affecting adolescents and young adults. To better characterize the incidence and biochemical consequences of this disease, we combined a comprehensive analysis of the electronic medical record and national payer data and found that FLC incidence is likely five to eight times higher than previous estimates. By employing unsupervised learning on clinical laboratory data from patients with hyperammonemia, we find that FLC-associated hyperammonemia mirrors metabolic dysregulation in urea cycle disorders. Our findings demonstrate that advanced computational analysis of rich clinical datasets can provide key clinical and biochemical insights into rare cancers.

Abstract Background Incidence is one of the most important epidemiologic indices in surveillance. However, determining incidence is complex and requires time-consuming cohort studies or registries with date of diagnosis. Estimating incidence from prevalence using mathematical relationships may facilitate surveillance efforts. The aim of this study was to examine whether a partial differential equation (PDE) can be used to estimate diabetes incidence from prevalence in youth. Methods We used age-, sex-, and race/ethnicity-specific estimates of prevalence in 2001 and 2009 as reported in the SEARCH for Diabetes in Youth study. Using these data, a PDE was applied to estimate the average incidence rates of type 1 and type 2 diabetes for the period between 2001 and 2009. Estimates were compared to annual incidence rates observed in SEARCH. Precision of the estimates was evaluated using 95% bootstrap confidence intervals. Results Despite the long period between prevalence measures, the estimated average incidence rates mirror the average of the observed annual incidence rates. Absolute values of the age-standardized sex- and type-specific mean relative errors are below 8%. Conclusions Incidence of diabetes can be accurately estimated from prevalence. Since only cross-sectional prevalence data is required, employing this methodology in future studies may result in considerable cost savings.

Mapping rice area is a critical resource planning task in many South Asia countries where rice is the primary crop. Remote-sensing-based methods typically rely on domain knowledge, such as crop calendar and crop phenology, and supervised classification with ground truth samples. Applying such methods on Google Earth engine (GEE) has been proven effective, especially at large scale owing to the comprehensive and up-to-date data catalog and massive server-side processing power. However, writing scripts through the code editor requires users to program in JavaScript and understand GEE application programming interface (API), which can be challenging for many researchers. Thus, this article presents a GEE-based web application that aims to eliminate the programming requirements for data selection, preprocessing, and visualizations so that users can easily produce rice maps and refine ground truth collections through intuitive graphical user interfaces (GUI). This software includes three submodule apps, namely the ground truth collection app, threshold-based rice mapping app, and classification-based rice mapping app. Users can customize data processing flow using GUI designed with Bootstrap, and the backend server uses GEE Python API, and a Google service account for authentication to execute the workflow on Google cloud servers. The experiment shows that both the overall accuracy and Kappa scores of the mapping result are higher than 0.9, which suggests that RiceMapEngine can significantly reduce the complexity and time costs it takes to produce the accurate rice area maps and meet the demands of real-world stakeholders.

Detailed γ-ray spectroscopy of the exotic neon isotope 28Ne has been performed for the first time using the one-neutron removal reaction from 29Ne on a liquid hydrogen target at 240 MeV/nucleon. Based on an analysis of parallel momentum distributions, a level scheme with spin-parity assignments has been constructed for 28Ne and the negative-parity states are identified for the first time. The measured partial cross sections and momentum distributions reveal a significant intruder p-wave strength providing evidence of the breakdown of the N=20 and N=28 shell gaps. Only a weak, possible f-wave strength was observed to bound final states. Large-scale shell-model calculations with different effective interactions do not reproduce the large p-wave and small f-wave strength observed experimentally, indicating an ongoing challenge for a complete theoretical description of the transition into the island of inversion along the Ne isotopic chain.

Wild pigs (Sus scrofa) cause damage to agricultural crops in their native range as well as in the portions of the globe where they have been introduced. In the US, states with the highest introduced wild pig populations are Alabama, Arkansas, California, Florida, Georgia, Louisiana, Mississippi, Missouri, North Carolina, South Carolina, and Texas. The present study summarizes the first survey-based effort to value the full extent of wild pig damage to producers of six crops in these eleven US states. The survey was distributed by the USDA National Agricultural Statistical Service in the summer of 2022 to a sample of 11,495 producers of corn (Zea mays), soybeans (Glycine max), wheat (Triticum spp.), rice (Oryza sativa), peanuts (Arachis hypogaea), and sorghum (Sorghum bicolor) in these 11 states. Our findings suggest that the economic burden of wild pigs on producers of these crops is substantial and not limited to the direct and most identifiable categories of crop damage (i.e., production value lost due to depredation, trampling and rooting). We estimate that the annual cost to producers of these six crops in the surveyed states in 2021 was almost USD 700 million.

Metabolic disease is a significant risk factor for severe COVID-19 infection, but the contributing pathways are not yet fully elucidated. Using data from two randomized controlled trials across 13 U.S. academic centers, our goal was to characterize metabolic features that predict severe COVID-19 and define a novel baseline metabolomic signature. Individuals (n = 133) were dichotomized as having mild or moderate/severe COVID-19 disease based on the WHO ordinal scale. Blood samples were analyzed using the Biocrates platform, providing 630 targeted metabolites for analysis. Resampling techniques and machine learning models were used to determine metabolomic features associated with severe disease. Ingenuity Pathway Analysis (IPA) was used for functional enrichment analysis. To aid in clinical decision making, we created baseline metabolomics signatures of low-correlated molecules. Multivariable logistic regression models were fit to associate these signatures with severe disease on training data. A three-metabolite signature, lysophosphatidylcholine a C17:0, dihydroceramide (d18:0/24:1), and triacylglyceride (20:4_36:4), resulted in the best discrimination performance with an average test AUROC of 0.978 and F1 score of 0.942. Pathways related to amino acids were significantly enriched from the IPA analyses, and the mitogen-activated protein kinase kinase 5 (MAP2K5) was differentially activated between groups. In conclusion, metabolites related to lipid metabolism efficiently discriminated between mild vs. moderate/severe disease. SDMA and GABA demonstrated the potential to discriminate between these two groups as well. The mitogen-activated protein kinase kinase 5 (MAP2K5) regulator is differentially activated between groups, suggesting further investigation as a potential therapeutic pathway.

Little is known about the role of post-exercise protein intake on post-exercise glycemia. Secondary analyses were conducted to evaluate the role of post-exercise protein intake on post-exercise glycemia using data from an exercise pilot study. Adults with T1D (n = 11), with an average age of 33.0 ± 11.4 years and BMI of 25.1 ± 3.4, participated in isoenergetic sessions of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT). Participants completed food records on the days of exercise and provided continuous glucose monitoring data throughout the study, from which time in range (TIR, 70–180 mg/dL), time above range (TAR, >180 mg/dL), and time below range (TBR, p-values ≥ 0.07); however, a borderline significant reduction of −1.9% (95% CI: −3.9%, 0.0%; p = 0.05) TBR per 20 g protein was observed following MICT in analyses stratified by exercise mode. Increasing post-exercise protein intake may be a promising strategy to mitigate the risk of hypoglycemia following MICT.

Abstract Studying anterior lens capsule cutting edge profiles from femtosecond laser-assisted capsulotomy procedures performed before and after lens fragmentation. Twenty eyes (10 patients) with age-related cataract underwent femtosecond laser-assisted surgery (FLACS) using the Ziemer Z8 platform. First step of laser surgery was either capsulotomy (group first) or fragmentation (group second). One eye of each patient was assigned randomly, the second eye treated with the different sequence of procedures. After anterior capsule removal, tissue was fixed in cacodylate-buffered solution and cutting-edge profiles were analysed using scanning electron microscopy (SEM). All cases had cataract grade 2 and 3 based on LOCS III grading. SEM analysis showed more smooth edges in the first group, especially in cases with pseudoexfoliation (P = 0.037); more tags and bridges and a significant number of staggered cutting patterns (7 out of 10 cases) in the second group. All cases evolved the same microgroves with “valleys and mountains “ as signs of the photodisruption process. Femtosecond laser capsulotomy should be performed before lens fragmentation minimizing the rate of cutting errors. Especially in eyes with advanced cataract, as intracapsular pressure may increase due to lens fragmentation without anterior capsular opening.

Abstract Little is known about the connection between preoperative keratometry and postoperative results of myopic small-incision lenticule extraction (SMILE). To determine the influence of extreme (flat and steep) corneal keratometry on the safety and efficacy of SMILE, the databases of the Department of Ophthalmology, Ludwig-Maximilians-University Munich, Germany, and SMILE Eyes Linz, Austria, were screened for patients with steep and flat keratometry who had undergone SMILE. In this cross-sectional matched comparative cohort study, eyes with markedly flat (

Abstract With global demand for SARS-CoV-2 testing ever rising, shortages in commercially available viral transport media pose a serious problem for laboratories and health care providers. For reliable diagnosis of SARS-CoV-2 and other respiratory viruses, executed by Real-time PCR, the quality of respiratory specimens, predominantly determined by transport and storage conditions, is crucial. Therefore, our aim was to explore the reliability of minimal transport media, comprising saline or the CDC recommended Viral Transport Media (HBSS VTM), for the diagnosis of SARS-CoV-2 and other respiratory viruses (influenza A, respiratory syncytial virus, adenovirus, rhinovirus and human metapneumovirus) compared to commercial products, such as the Universal Transport Media (UTM). We question the assumptions, that the choice of medium and temperature for storage and transport affect the accuracy of viral detection by RT-PCR. Both alternatives to the commercial transport medium (UTM), HBSS VTM or saline, allow adequate detection of SARS-CoV-2 and other respiratory viruses, regardless of storage temperatures up to 28 °C and storage times up to 28 days. Our study revealed the high resilience of SARS-CoV-2 and other respiratory viruses, enabling proper detection in clinical specimens even after long-time storage at high temperatures, independent of the transport medium’s composition.

When does anger lead to greater polarization? As societal polarization and political polarization increase so does academic interest in its antecedents. One important cause of polarization appears to be anger. However, existing research linking anger and political polarization has focused primarily on the context of partisanship and did not distinguish between different types of anger nor different forms of polarization. To address this gap in the literature, we analyze how generalized versus issue-specific anger amplify issue-based and affective polarization in the highly charged context of the COVID-19 pandemic. We test these relationships through a survey experiment embedded in a national German sample ( n = 2857) and show that anger is linked to polarization. However, we also show that different forms of anger influence different aspects of polarization. Issue polarization is driven primarily by generalized anger, while corona-specific anger increases affective polarization. Together, these results underline the importance of understanding the emotional nuances of polarization. More generally, the results illustrate the problems policy makers face when navigating heavily contested and emotionally charged topics. While increased anger may be helpful for mobilizing support among already supportive citizens, it does little to convince skeptical citizens and carries the cost of increasing societal polarization.

Introduction Female gender is associated with a lower risk for aggressive behaviour and violent offending. Well established risk factors for aggressive behaviour are alcohol and other substance use, but previous studies focused mainly on male offenders and the general population. However, for therapeutic and prognostic reasons it is important to understand pathways to female offending. Objectives To examine a sample of female forensic-psychiatric inpatients regarding the association of alcohol (AUD) and other substance use disorders (SUD) with violent offending (homicide, assault, robbery). Methods We conducted a retrospective cohort study of 334 female patients discharged before 01.01.2019 from a secure psychiatric hospital in Germany. Results In total, 72% of the patients with AUD committed a violent crime, leading to admission to secure psychiatric treatment. In comparison a statistically significant lower rate (19%) of the SUD group was convicted of violent offending. Over 70% of the participants with AUD had a family history of AUD, and over 83% experienced physical violence in adulthood. We found no group differences (AUD vs. SUD) regarding aggressive behaviour during inpatient treatment. Conclusions According to our results, AUD compared to other SUD, is a significant risk factor for violent offending in women. A family background with AUD and a history of physical abuse might function as a risk factor for both: developing an AUD and violent offending. The comparable rates of aggression in both groups during inpatient treatment suggest that abstinence is a protective factor. Disclosure No significant relationships.

Residual stress is a considerable challenge in welding. Due to the local heat input high temperature gradients occur between weld seam and base material, which lead to thermal and transformation induced stress. With targeted alloying in the weld seam the martensitic phase transformation can be shifted to lower temperatures, called Low Transformation Temperature (LTT) effect. This effect uses the volume expansion during the martensitic phase transformation, which counteracts the stress accumulation while cooling of the specimen. In most cases, a flux cored filler wire with a typical alloy composition of 10%-Cr and 10%-Ni is used to exploit the LTT effect. In this paper, however, the aim is to alloy in-situ while combining conventional materials of different types. Combinations of high-alloyed base material (1.4301) with low-alloyed solid filler wire (G3Si1) are analysed. For comparison, similar welds with high-alloyed solid filler wire (G19 9) are also carried out. The chemical compositions are generated within a laser beam welding process and examined by EDS-Analysis. In order to measure the influence of chemical compositions on residual stress, hole drilling measurements are performed. Furthermore, dilatometry tests help to determine the change of phase transformation temperature as well as elongation. EBSD analysis show the changes in phase transformation due to the variation of chemical compositions. It is proven, that a reduction of residual stress by the means of targeted alloying with conventional materials in an austenitic stainless steel is possible.

Soil contamination by trace elements (TEs) is a major concern for sustainable land management. A potential source of excessive inputs of TEs into agricultural soils are organic amendments. Here, we used dynamic simulations carried out with the Intermediate Dynamic Model for Metals (IDMM) to describe the observed trends of topsoil Zn (zinc), Cu (copper), Pb (lead) and Cd (cadmium) concentrations in a long-term (>60-year) crop trial in Switzerland, where soil plots have been treated with different organic amendments (farmyard manure, sewage sludge and compost). The observed ethylenediaminetetraacetic acid disodium salt (EDTA)-extractable concentrations ranged between 2.6 and 27.1 mg kg−1 for Zn, 4.9 and 29.0 mg kg−1 for Cu, 6.1–26.2 mg kg−1 for Pb, and 0.08 and 0.66 mg kg−1 for Cd. Metal input rates were initially estimated based on literature data. An additional, calibrated metal flux, tentatively attributed to mineral weathering, was necessary to fit the observed data. Dissolved organic carbon fluxes were estimated using a soil organic carbon model. The model adequately reproduced the EDTA-extractable (labile) concentrations when input rates were optimised and soil lateral mixing was invoked to account for the edge effect of mechanically ploughing the trial plots. The global average root mean square error (RMSE) was 2.7, and the average bias (overestimation) was −1.66, −2.18, −4.34 and −0.05 mg kg−1 for Zn, Cu, Pb and Cd, respectively. The calibrated model was used to project the long-term metal trends in field conditions (without soil lateral mixing), under stable climate and management practices, with soil organic carbon estimated by modelling and assumed trends in soil pH. Labile metal concentrations to 2100 were largely projected to remain near constant or to decline, except for some metals in plots receiving compost. Ecotoxicological thresholds (critical limits) were predicted to be exceeded presently under sewage sludge inputs and to remain so until 2100. Ecological risks were largely not indicated in the other plots, although some minor exceedances of critical limits were projected to occur for Zn before 2100. This study advances our understanding of TEs' long-term dynamics in agricultural fields, paving the way to quantitative applications of modelling at field scales.

There are many ways in which a story can be told, and languages throughout time and across the world have developed strategies that work in tandem with their respective linguistic structure to create organized, coherent narratives. Gorwaa, a South Cushitic language spoken by around 133,000 people in the Tanzanian Rift Valley, also has a number of strategies included in a narrative structure, ranging from interjections, to complex referent tracking over long stretches of narrative, to discourse organization. In this article I will be specifically focusing on discourse organization, by which I mean the structuring of events as to create a coherent, understandable, sequence in a narrative using organizational tools such as interjections, discourse managing markers, and speaker-hearer interaction. All of these tools are employed frequently and in a plethora of different ways, creating an interesting narratival landscape while at the same time making sure the information flow remains coherent to the hearer. Additionally, Gorwaa shows a remarkable interconnection between lower-level discourse organizational elements, such as interjections and rhetorical questions, and the organization of a narrative as a whole – showcasing the importance of a broad perspective when analyzing narrative structures. The article first looks at the discourse organizing markers, interjections and conjunctions, and then looks at the construction of narratives in three major parts: introduction, intermediate speaker-hearer contact, and conclusions.

The prevalence of overweight and obesity in young people with type 1 diabetes (T1D) now parallels that of the general population. Excess adiposity increases the risk of cardiovascular disease, which is already elevated up to 10-fold in T1D, underscoring a compelling need to address weight management as part of routine T1D care. Sustainable weight management requires both diet and physical activity (PA). Diet and PA approaches must be optimized towards the underlying metabolic and behavioral challenges unique to T1D to support glycemic control throughout the day. Diet strategies for people with T1D need to take into consideration glycemic management, metabolic status, clinical goals, personal preferences, and sociocultural considerations. A major barrier to weight management in this high-risk population is the challenge of integrating regular PA with day-to-day management of T1D. Specifically, exercise poses a substantial challenge due to the increased risk of hypoglycemia and/or hyperglycemia. Indeed, about two-thirds of individuals with T1D do not engage in the recommended amount of PA. Hypoglycemia presents a serious health risk, yet prevention and treatment often necessitates the consumption of additional calories, which may prohibit weight loss over time. Exercising safely is a concern and challenge with weight management and maintaining cardiometabolic health for individuals living with T1D and many healthcare professionals. Thus, a tremendous opportunity exists to improve exercise participation and cardiometabolic outcomes in this population. This article will review dietary strategies, the role of combined PA and diet for weight management, current resources for PA and glucose management, barriers to PA adherence in adults with T1D, as well as findings and lessons learned from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON).

This study developed a rapid rice yield estimation workflow and customized yield prediction model by integrating remote sensing and meteorological data with machine learning (ML). Several issues need to be addressed while developing a crop yield estimation model, including data quality issues, data processing issues, selecting a suitable machine learning model that can learn from few available time-series data, and understanding the non-linear relationship between historical crop yield and remote sensing and meteorological factors. This study applied a series of data processing techniques and a customized ML model to improve the accuracy of crop yield estimation at the district level in Nepal. It was found that remote sensing-derived NDVI product alone was not sufficient for accurate estimation of crop yield. After incorporating other meteorological variables into the ML models, estimation accuracy improved dramatically. Along with NDVI, the meteorological variables of rainfall, soil moisture, and evapotranspiration also exhibited a strong association with rice yield. This study also found that stacking multiple tree-based regression models together could achieve better accuracy than benchmark linear regression or standalone ML models. Due to the unique and distinct physio-geographical setting of each district, a variation in estimation accuracy from district to district could be observed. Our data processing and ML model workflow achieved an average of 92% accuracy of yield estimation with RMSE 328.06 kg/ha and MAE 317.21 kg/ha. This methodological workflow can be replicated in other study areas and the results can help the local authorities and stakeholders understand the factors affecting crop yields as well as estimating crop yield before harvesting season to ensure food security and sustainability.

Nutritional strategies are needed to aid people with type 1 diabetes (T1D) in managing glycemia following exercise. Secondary analyses were conducted from a randomized trial of an adaptive behavioral intervention to assess the relationship between post-exercise and daily protein (g/kg) intake on glycemia following moderate-to-vigorous physical activity (MVPA) among adolescents with T1D. Adolescents (n = 112) with T1D, 14.5 (13.8, 15.7) years of age, and 36.6% overweight or obese, provided measures of glycemia using continuous glucose monitoring (percent time above range [TAR, >180 mg/dL], time-in-range [TIR, 70–180 mg/dL], time-below-range [TBR, p = 0.03) greater TIR and −8.0% (p = 0.02) less TAR following exercise, however, no association was observed between post-exercise protein intake and post-exercise glycemia. Following current sports nutrition guidelines for daily protein intake may promote improved glycemia following exercise among adolescents with T1D.

Breeding cows grazing seasonally dry rangelands usually lose substantial live weight (LW) during the dry season, when in late pregnancy. An experiment investigated the effects of feeding a N-based supplement to cows in late pregnancy on voluntary intake, total live weight (T-LW), body condition score (CS) and estimated body net energy content (Body-NE), as well as carry-over effects during lactation. In Phase A for 139 days from mid-pregnancy, mature Bos indicus cross breeders [initially 438 kg T-LW and 5.7 CS units (9-point scale)] were fed in pens on low quality tropical grass hay alone (Control) or with a N supplement (Supplemented). Most (17/22) of the cows calved during this interval. Voluntary hay intake averaged 6.74 g DM/kg T-LW/d in Control cows, and was increased by 35% (P

Currently, testing for coronavirus is performed with time and personnel consuming PCR assays. The aim of this study was to evaluate the sensitivity, specificity and capacity of a fully automated, random access high-throughput real-time PCR-based diagnostic platform for the detection of SARS-CoV-2. The NeuMoDx N96 system displayed an equal or better detection rate for SARS-CoV-2 compared with the LightCycler 480II system and showed a specificity of 100%. The median PCR run time for all 28 PCR runs was 91 (IQR 84–97) minutes. The capacity of the NeuMoDx N96 could easily surpass the capacity of most currently used molecular test systems and significantly reduce the turn-around time.

Background: Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability. Methods: An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice. Results: A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss. Conclusions: Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.

The Madden–Julian Oscillation (MJO) is known to force extratropical weather days to weeks following an MJO event through excitation of stationary Rossby waves, also referred to as tropical–extratropical teleconnections. Prior research has demonstrated that this tropically forced midlatitude response leads to increased prediction skill on subseasonal to seasonal (S2S) timescales. Furthermore, the Quasi-Biennial Oscillation (QBO) has been shown to possibly alter these teleconnections through modulation of the MJO itself and the atmospheric basic state upon which the Rossby waves propagate. This implies that the MJO–QBO relationship may affect midlatitude circulation prediction skill on S2S timescales. In this study, we quantify midlatitude circulation sensitivity and prediction skill following active MJOs and QBOs across the Northern Hemisphere on S2S timescales through an examination of the 500 hPa geopotential height field. First, a comparison of the spatial distribution of Northern Hemisphere sensitivity to the MJO during different QBO phases is performed for European Centre for Medium-Range Weather Forecasts (ECMWF) ERA-Interim reanalysis and ECMWF and the National Centers for Environmental Prediction (NCEP) hindcasts. Secondly, differences in prediction skill in ECMWF and NCEP hindcasts are quantified following MJO–QBO activity. In both hindcast systems, we find that regions across the Pacific, North America, and the Atlantic demonstrate an enhanced MJO impact on prediction skill during strong QBO periods with lead times of 1–4 weeks compared to MJO events during neutral QBO periods.

Abstract Background Posterior capsule opacification (PCO) after cataract surgery is influenced by intraocular lens (IOL) design and material. The following is an ex vivo comparison of PCO between the Clareon vs. the AcrySof IOL in human capsular bags. Methods Twenty cadaver capsular bags from 10 human donors were used, with the novel hydrophobic IOL (Clareon, CNA0T0) being implanted in one eye and the other eye of the same donor receiving the AcrySof IOL (SN60WF) following phacoemulsification cataract surgery. Five capsular bags of 3 donors served as controls without IOL. Cellular growth of lens epithelial cells was photo-documented daily. The primary endpoint was the time until full coverage of the posterior capsule by cells. Furthermore, immunofluorescence staining of capsular bags for the fibrotic markers f-actin, fibronectin, alpha smooth muscle actin, and collagen type 1 were performed. Results The new Clareon IOL did not show any disadvantages in terms of days until full cell coverage of the posterior capsule in comparison to the AcrySof (p > 0.99). Both, the Clareon (p = 0.01, 14.8 days) and the AcrySof IOL (p = 0.005, 15.7 days) showed a slower PCO development in comparison to the control (8.6 days). The fibrotic markers f-actin, fibronectin, alpha smooth muscle actin, and collagen type 1 were equally distributed between the two IOLs and differed from the control. Conclusions A comparable performance has been found in the ex vivo formation of PCO between the two IOLs. Long-term clinical studies are necessary to reach final conclusions.

Objective. Hyperglycemia early in the course of type 1 diabetes (T1D) may increase the risk of cardiometabolic complications later in life. We tested the hypothesis that there were temporal trends in population-level glycemia and insulin pump use near T1D diagnosis among incident youth cohorts diagnosed between 2002 and 2016. Methods. Weighted and adjusted regression models were applied to data from the SEARCH for Diabetes in Youth study to analyze trends in hemoglobin A1c (HbA1c), suboptimal glycemia (HbA1c>9% or not), and insulin pump use among youth with T1D within 30 months of diagnosis. We tested the interaction of year with race and ethnicity, sex, and insulin regimen to assess potential disparities. Results. Among the 3,956 youth with T1D, there was a small, clinically insignificant reduction in HbA1c between 2002 (7.9%±1.5) and 2016 (7.8%±2.4) (fully adjusted change by year (-0.013% [95% CI -0.026, -0.0008], p=0.04). The proportion of youth with suboptimal glycemia increased with each year, but the adjusted odds did not change. Insulin pump use increased more than fivefold. Although interaction effects of time with race and ethnicity, sex, and insulin regimen were not detected, in 2016, suboptimal glycemia was 4.3 and 1.8 times more prevalent among Black and Hispanic than among non-Hispanic White youth, respectively. Conclusions. There was not a clinically significant population-level improvement in glycemia across incident youth cohorts early in the course of T1D, despite severalfold increases in insulin pump use. Comprehensive clinical interventions to improve glycemia early in the T1D course and address disparities are urgently needed.

Aims. To explore how changes in insulin regimen are associated with estimated adiposity over time among youths and young adults with type 1 diabetes and whether any associations differ according to sex. Materials and Methods. Longitudinal data were analyzed from youths and young adults with type 1 diabetes in the SEARCH for Diabetes in Youth study. Participants were classified according to insulin regimen categorized as exclusive pump (“pump only”), exclusive injections (“injections only”), injection-pump transition (“injections-pump”), or pump-injection transition (“pump-injections”) for each follow-up visit completed. Estimated body fat percentage (eBFP) was calculated using validated equations. Sex-specific, linear mixed effects models examined the relationship between the insulin regimen group and change in eBFP during follow-up, adjusted for baseline eBFP, baseline insulin regimen, time-varying insulin dose, sociodemographic factors, and baseline HbA1c (≥9.0% vs.

The aim of this study was to evaluate the long-time results of highly concentrated autologous platelet-rich plasma (PRP) used as an adjunct in lamellar macular hole (LMH) surgery. Nineteen eyes of nineteen patients with progressive LMH were enrolled in this interventional case series, on which 23/25-gauge pars plana vitrectomy was performed and 0.1 mL of highly concentrated autologous platelet-rich plasma was applied under air tamponade. Posterior vitreous detachment was induced, and the peeling of tractive epiretinal membranes, whenever present, was performed. In cases of phakic lens status, combined surgery was carried out. Postoperatively, all patients were instructed to remain in a supine position for the first two postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, and spectral domain optical coherence tomography (SD-OCT) were carried out preoperatively and at minimum 6 months (in median 12 months) postoperatively. Foveal configuration was postoperatively restored in 19 of 19 patients. Two patients who had not undergone ILM peeling showed a recurring defect at 6-month follow-up. Best-corrected visual acuity improved significantly from 0.29 ± 0.08 to 0.14 ± 0.13 logMAR (p = 0.028, Wilcoxon signed-rank test). Microperimetry remained unchanged (23.38 ± 2.53 preoperatively; 23.0 ± 2.49 dB postoperatively; p = 0.67). No patients experienced vision loss after surgery, and no significant intra- or postoperative complications were observed. Using PRP as an adjunct in macular hole surgery significantly improves morphological and functional outcomes. Additionally, it might be an effective prophylaxis to further progression and also the formation of a secondary full-thickness macular hole. The results of this study might contribute to a paradigm shift in macular hole surgery towards early intervention.

Identifying predictable states of the climate system allows for enhanced prediction skill on the generally low-skill subseasonal timescale via forecasts with higher confidence and accuracy, known as forecasts of opportunity. This study takes a neural network approach to explore decadal variability of subseasonal predictability, particularly during forecasts of opportunity. Specifically, this work quantifies subseasonal prediction skill provided by the tropics within the Community Earth System Model Version 2 (CESM2) Large Ensemble and assesses how this skill evolves on decadal timescales. Utilizing the networks’ confidence and explainable artificial intelligence, physically meaningful sources of predictability associated with periods of enhanced skill are identified. Using these networks, we find that tropically-driven subseasonal predictability varies on decadal timescales during forecasts of opportunity. Further, we investigate the drivers of the low frequency modulation of the tropical-extratropical teleconnection and discuss the implications. Analysis is extended to ECMWF Reanalysis v5 data, revealing that the relationships learned within the CESM2-Large Ensemble holds in modern reanalysis data. These results indicate that the neural networks are capable of identifying predictable decadal states of the climate system within CESM2 that are useful for making confident, accurate subseasonal precipitation predictions in the real world.