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The built environment is a ubiquitous factor of modern human life, which fundamentally affects human wellbeing. Most existing research on the psychological effects of urban environments is predominantly based on subjective self-report measures, which provide valuable insights into subjective experiences, but are also affected by conscious and subconscious bias. In the current study, we evaluate a multimodal approach to capturing wellbeing by employing objective mobile physiological and neurophysiological measurement technologies alongside self-reports to capture the impact of two different urban environments. Moreover, we endeavoured to comprehensively measure and, when possible, control the physical aspects of the environment. Our study specifically aimed to discover differences between psychological wellbeing indicators in adults across low-density vs. moderate-density urban environments. Data collection took place in two urban outdoor locations in Australia. Statistical comparison of the two locations indicated that low urban density led to comparatively higher levels of psychological wellbeing compared to moderate urban density. Self-reports indicated that the low-density environment led to higher levels of subjective feelings of comfort and safety and reduced levels of negative mood. In line with the subjective reports, in the low-density environment compared to the moderate-density environment, individuals showed higher levels of EEG theta activity, while EEG beta and heart rate measures were lower. The research outcome provides insights into how urban density affects people's wellbeing and showcases the benefits of employing ecologically-valid multimodal psychological-environmental measurement approaches to effectively evaluate the psychological impacts of built environments.

Abstract In children with cancer, the heterogeneity in ototoxicity occurrence after similar treatment suggests a role for genetic susceptibility. Using a genome-wide association study (GWAS) approach, we identified a genetic variant in TCERG1L (rs893507) to be associated with hearing loss in 390 non-cranial irradiated, cisplatin-treated children with cancer. These results were replicated in two independent, similarly treated cohorts (n = 192 and 188, respectively) (combined cohort: P = 5.3 × 10−10, OR 3.11, 95% CI 2.2–4.5). Modulating TCERG1L expression in cultured human cells revealed significantly altered cellular responses to cisplatin-induced cytokine secretion and toxicity. These results contribute to insights into the genetic and pathophysiological basis of cisplatin-induced ototoxicity.

Low-level clouds (LLCs) cover a wide area of southern West Africa (SWA) during the summer monsoon months and have an important cooling effect on the regional climate. Previous studies of these clouds have focused on modelling and remote sensing via satellite. We present the first comprehensive set of in situ measurements of cloud microphysics from the region, taken during June–July 2016, as part of the DACCIWA (Dynamics–aerosol–chemistry–cloud interactions in West Africa) campaign. This novel dataset allows us to assess spatial, diurnal, and day-to-day variation in the properties of these clouds over the region. LLCs developed overnight and mean cloud cover peaked a few hundred kilometres inland around 10:00 local solar time (LST), before clouds began to dissipate and convection intensified in the afternoon. Regional variation in LLC cover was largely orographic, and no lasting impacts in cloud cover related to pollution plumes were observed downwind of major population centres. The boundary layer cloud drop number concentration (CDNC) was locally variable inland, ranging from 200 to 840 cm−3 (10th and 90th percentiles at standard temperature and pressure), but showed no systematic regional variations. Enhancements were seen in pollution plumes from the coastal cities but were not statistically significant across the region. A significant fraction of accumulation mode aerosols, and therefore cloud condensation nuclei, were from ubiquitous biomass burning smoke transported from the Southern Hemisphere. To assess the relative importance of local and transported aerosol on the cloud field, we isolated the local contribution to the aerosol population by comparing inland and offshore size and composition measurements. A parcel model sensitivity analysis showed that doubling or halving local emissions only changed the calculated cloud drop number concentration by 13 %–22 %, as the high background meant local emissions were a small fraction of total aerosol. As the population of SWA grows, local emissions are expected to rise. Biomass burning smoke transported from the Southern Hemisphere is likely to dampen any effect of these increased local emissions on cloud–aerosol interactions. An integrative analysis between local pollution and Central African biomass burning emissions must be considered when predicting anthropogenic impacts on the regional cloud field during the West African summer monsoon.

In recent years, dual-polarisation Doppler X-band radars have become a widely used part of the atmospheric scientist's toolkit for examining cloud dynamics and microphysics and making quantitative precipitation estimates. This is especially true for research questions that require mobile radars. Here we describe the National Centre for Atmospheric Science (NCAS) mobile X-band dual-polarisation Doppler weather radar (NXPol) and the infrastructure used to deploy the radar and provide an overview of the technical specifications. It is the first radar of its kind in the UK. The NXPol is a Meteor 50DX manufactured by Selex-Gematronik (Selex ES GmbH), modified to operate with a larger 2.4 m diameter antenna that produces a 0.98∘ half-power beam width and without a radome. We provide an overview of the technical specifications of the NXPol with emphasis given to the description of the aspects of the infrastructure developed to deploy the radar as an autonomous observing facility in remote locations. To demonstrate the radar's capabilities, we also present examples of its use in three recent field campaigns and its ongoing observations at the NERC Facility for Atmospheric Radio Research (NFARR).

A nanoporous gold electrocatalytic technique has been reported for detection of gas-phase hydrogen sulfide (H2S) molecules at trace levels relevant to physiological measurements. H2S is a known biomarker generated within the walls of arteries and can be linked to peripheral artery disease (PAD) and small vessel disease (SVD). The detection technique presented herein demonstrates suitability of transdermal monitoring of H2S linked to perfusion rate in order to provide early detection of PAD and SVD. The high surface area and high reactivity rate of nanoporous electrocatalyst in the present device proved to yield a significant amperometric signal for detection of hydrogen sulfide with a limit of detection as low as 2 ppb. Using this approach, permeability of hydrogen sulfide through the skin of Sprague Dawley rats in both excised in-vitro conditions as well as in-vivo experiments were demonstrated. Keywords: Hydrogen sulfide, Blood perfusion, Microvascular flow, Biosensor, Electrocatalysis, Transdermal, Non-invasive

A ground-based field campaign was conducted in southern West Africa from mid-June to the end of July 2016 within the framework of the Dynamics–Aerosol–Chemistry–Cloud Interactions in West Africa (DACCIWA) project. It aimed to provide a high-quality comprehensive data set for process studies, in particular of interactions between low-level clouds (LLCs) and boundary-layer conditions. In this region missing observations are still a major issue. During the campaign, extensive remote sensing and in situ measurements were conducted at three supersites: Kumasi (Ghana), Savè (Benin) and Ile-Ife (Nigeria). Daily radiosoundings were performed at 06:00 UTC, and 15 intensive observation periods (IOPs) were performed during which additional radiosondes were launched, and remotely piloted aerial systems were operated. Extended stratiform LLCs form frequently in southern West Africa during the nighttime and persist long into the following day. They affect the radiation budget and hence the evolution of the atmospheric boundary layer and regional climate. The relevant parameters and processes governing the formation and dissolution of the LLCs are still not fully understood. This paper gives an overview of the diurnal cycles of the energy-balance components, near-surface temperature, humidity, wind speed and direction as well as of the conditions (LLCs, low-level jet) in the boundary layer at the supersites and relates them to synoptic-scale conditions (monsoon layer, harmattan layer, African easterly jet, tropospheric stratification) in the DACCIWA operational area. The characteristics of LLCs vary considerably from day to day, including a few almost cloud-free nights. During cloudy nights we found large differences in the LLCs' formation and dissolution times as well as in the cloud-base height. The differences exist at individual sites and also between the sites. The synoptic conditions are characterized by a monsoon layer with south-westerly winds, on average about 1.9 km deep, and easterly winds above; the depth and strength of the monsoon flow show great day-to-day variability. Within the monsoon layer, a nocturnal low-level jet forms in approximately the same layer as the LLC. Its strength and duration is highly variable from night to night. This unique data set will allow us to test some new hypotheses about the processes involved in the development of LLCs and their interaction with the boundary layer and can also be used for model evaluation.

Abstract Background Immune thrombocytopenia (ITP) is a common cause of severe thrombocytopenia in dogs. The pathogenesis of nonassociative, primary ITP (pITP) appears complex, with ill‐defined thrombopoietic response. Objectives Develop an immunoassay to measure plasma canine thrombopoietin (TPO) concentration and characterize TPO concentrations in dogs with pITP. Animals Forty‐one healthy dogs, 8 dogs in an induced ITP model (3 control, 5 ITP), and 58 pITP dogs. Methods Recombinant canine TPO (rcTPO) was purchased and its identity confirmed by mass spectrometry. Monoclonal antibodies were raised to rcTPO and used to configure a sandwich ELISA using streptavidin‐biotin detection. Assay performance, coefficients of variability, and healthy dog plasma TPO reference interval (RI) were determined, followed by assay of ITP samples. Results Assay dynamic range was 15 pg/mL (lower limit of detection) to 1000 pg/mL TPO, with limit of quantitation of 62 pg/mL. Plasma TPO RI was 0 to 158 pg/mL, with plasma TPO 6000 pg/mL. In contrast, only 2/58 pITP dogs had TPO values above RI. Conclusions and Clinical Importance Plasma TPO concentration is paradoxically low at diagnosis for most dogs with pITP. This finding suggests that ineffective thrombopoiesis contributes to thrombocytopenia in pITP dogs and supports evaluating TPO receptor agonist treatment as used for pITP in humans. The TPO assay provides a new tool to study thrombopoiesis in pITP and other thrombocytopenic syndromes in dogs.

Unique measurements of vertical size-resolved aerosol particle concentrations, trace gas concentrations and meteorological data were obtained during the Arctic Summer Cloud Ocean Study (ASCOS, www.ascos.se), an International Polar Year project aimed at establishing the processes responsible for formation and evolution of low-level clouds over the high Arctic summer pack ice. The experiment was conducted from on board the Swedish icebreaker Oden, and provided both ship- and helicopter-based measurements. This study focuses on the vertical helicopter profiles and onboard measurements obtained during a three-week period when Oden was anchored to a drifting ice floe, and sheds light on the characteristics of Arctic aerosol particles and their distribution throughout the lower atmosphere. Distinct differences in aerosol particle characteristics within defined atmospheric layers are identified. Within the lowermost couple hundred metres, transport from the marginal ice zone (MIZ), condensational growth and cloud processing develop the aerosol population. During two of the four representative periods defined in this study, such influence is shown. At altitudes above about 1 km, long-range transport occurs frequently. However, only infrequently does large-scale subsidence descend such air masses to become entrained into the mixed layer in the high Arctic, and therefore long-range transport plumes are unlikely to directly influence low-level stratiform cloud formation. Nonetheless, such plumes can influence the radiative balance of the planetary boundary layer (PBL) by influencing formation and evolution of higher clouds, as well as through precipitation transport of particles downwards. New particle formation was occasionally observed, particularly in the near-surface layer. We hypothesize that the origin of these ultrafine particles could be in biological processes, both primary and secondary, within the open leads between the pack ice and/or along the MIZ. In general, local sources, in combination with upstream boundary-layer transport of precursor gases from the MIZ, are considered to constitute the origin of cloud condensation nuclei (CCN) particles and thus be of importance for the formation of interior Arctic low-level clouds during summer, and subsequently, through cloud influences, for the melting and freezing of sea ice.

Abstract Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment‐associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non‐associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel‐designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia.

Abstract Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence‐based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell–containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence‐based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel‐designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non‐PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.

Simultaneous measurements of near-surface aerosol (0.12 < R < 9.25 μm) and bubble spectra (13 < R < 620 μm) were made during five buoy deployments in the open ocean of the North Atlantic and used to estimate aerosol fluxes per unit area of whitecap. The measurements were made during two cruises as part of the Sea Spray, Gas Flux, and Whitecaps (SEASAW) project, a UK contribution to the international Surface Ocean Lower Atmosphere Study (SOLAS) program. The mean bubble number concentrations for each deployment are in broad agreement with other open ocean spectra and are consistently one to two orders of magnitude lower than surf zone studies. Production fluxes per unit area of whitecap are estimated from the mean aerosol concentration for each buoy deployment. They are found to increase with wind speed, and span the range of values found by previous laboratory and surf-zone studies for particles with radius at 80% relative humidity, R80 < 1 μm, but to drop off more rapidly with increasing particle size for larger particles. Estimates of the mean sea spray flux were made by scaling the whitecap production fluxes with in situ estimates of whitecap fraction. The sea spray fluxes are also compared with simultaneous individual eddy covariance flux estimates, and with a sea spray source function derived from them.

Background Task-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether spinal anaesthesia failure rates of MOs were non-inferior to those of consultant anaesthesiologists (CA) following a standardised educational curriculum.Methods We performed a randomised, non-inferiority trial in three rural hospitals in Tamil Nadu and Chhattisgarh, India. Patients aged over 18 years with low perioperative risk (ASA I & II) were randomised to receive MO or CA care. Prior to the trial, MOs underwent task-based anaesthesia training, inclusive of remotely accessed lectures, simulation-based training and directly observed anaesthetic procedures and intraoperative care. The primary outcome measure was spinal anaesthesia failure with a non-inferiority margin of 5%. Secondary outcome measures consisted of incidence of perioperative and postoperative complications.Findings Between 12 July 2019 and 8 June 2020, a total of 422 patients undergoing surgical procedures amenable to spinal anaesthesia care were randomised to receive either MO (231, 54.7%) or CA care (191, 45.2%). Spinal anaesthesia failure rate for MOs (7, 3.0%) was non-inferior to those of CA (5, 2.6%); difference in success rate of 0.4% (95% CI=0.36–0.43%; p=0.80). Additionally, there were no statistically significant differences observed between the two groups for intraoperative or postoperative complications, or patients’ experience of pain during the procedure.Interpretation This study demonstrates that failure rates of spinal anaesthesia care provided by trained MOs are non-inferior to care provided by CAs in low-risk surgical patients. This may support policy measures that use task-sharing as a means of expanding anaesthesia care capacity in rural Indian hospitals.Trial registration number NCT04438811.

Observations show that the fractional solubility of Fe (FS-Fe, percentage of dissolved to total Fe) in dust aerosol increases considerably from 0.1 % in regions of high dust mass concentration to 80 % in remote regions where concentrations are low. Here, we combined laboratory geochemical measurements with global aerosol model simulations to test the hypothesis that the increase in FS-Fe is due to physical size sorting during transport. We determined the FS-Fe and fractional solubility of Al (FS-Al) in size-fractionated dust generated from two representative soil samples collected from known Saharan dust source regions using a customized dust re-suspension and collection system. The results show that the FS-Fe is size-dependent and ranges from 0.1–0.3 % in the coarse size fractions (>1 μm) to ~0.2–0.8 % in the fine size fractions (100 μg m−3) to ~0.2 % at low concentrations (–3) due to physical size sorting (i.e., particle gravitational settling). These values are one to two orders of magnitude smaller than those observed on cruises across the tropical and sub-tropical North Atlantic Ocean under an important pathway of Saharan dust plumes for similar dust mass concentrations. Even when the FS-Fe of sub-micrometer size fractions (0.18–0.32 μm, 0.32–0.56 μm, and 0.56–1.0 μm) in the model is increased by a factor of 10 over the measured values, the calculated FS-Fe of the dust is still more than an order of magnitude lower than that measured in the field. Therefore, the physical sorting of dust particles alone is unlikely to be an important factor in the observed inverse relationship between the FS-Fe and FS-Al and the atmospheric mineral dust mass concentrations. The results suggest that processes such as chemical reactions and/or mixing with combustion particles are the main mechanisms to cause the increased FS-Fe in long-range transported dust aerosols.

The VAMOS Ocean-Cloud-Atmosphere-Land Regional Experiment (VOCALS-REx) was conducted from 15 October to 15 November 2008 in the South East Pacific (SEP) region to investigate interactions between land, sea and atmosphere in this unique tropical eastern ocean environment and to improve the skill of global and regional models in representing the region. This study synthesises selected aircraft, ship and surface site observations from VOCALS-REx to statistically summarise and characterise the atmospheric composition and variability of the Marine Boundary Layer (MBL) and Free Troposphere (FT) along the 20° S parallel between 70° W and 85° W. Significant zonal gradients in mean MBL sub-micron aerosol particle size and composition, carbon monoxide, sulphur dioxide and ozone were seen over the campaign, with a generally more variable and polluted coastal environment and a less variable, more pristine remote maritime regime. Gradients in aerosol and trace gas concentrations were observed to be associated with strong gradients in cloud droplet number. The FT was often more polluted in terms of trace gases than the MBL in the mean; however increased variability in the FT composition suggests an episodic nature to elevated concentrations. This is consistent with a complex vertical interleaving of airmasses with diverse sources and hence pollutant concentrations as seen by generalised back trajectory analysis, which suggests contributions from both local and long-range sources. Furthermore, back trajectory analysis demonstrates that the observed zonal gradients both in the boundary layer and the free troposphere are characteristic of marked changes in airmass history with distance offshore – coastal boundary layer airmasses having been in recent contact with the local land surface and remote maritime airmasses having resided over ocean for in excess of ten days. Boundary layer composition to the east of 75° W was observed to be dominated by coastal emissions from sources to the west of the Andes, with evidence for diurnal pumping of the Andean boundary layer above the height of the marine capping inversion. Analysis of intra-campaign variability in atmospheric composition was not found to be significantly correlated with observed low-frequency variability in the large scale flow pattern; campaign-average interquartile ranges of CO, SO2 and O3 concentrations at all longitudes were observed to dominate over much smaller differences in median concentrations calculated between periods of different flow regimes. The campaign climatology presented here aims to provide a valuable dataset to inform model simulation and future process studies, particularly in the context of aerosol-cloud interaction and further evaluation of dynamical processes in the SEP region for conditions analogous to those during VOCALS-REx. To this end, our results are discussed in terms of coastal, transitional and remote spatial regimes in the MBL and FT and a gridded dataset are provided as a resource.

Abstract Background The use of systems engineering tools, including the development and use of care cascades using routinely collected data, process mapping, and continuous quality improvement, is used for frontline healthcare workers to devise systems level change. South Africa experiences high rates of tuberculosis (TB) infection and disease as well as HIV co-infection. The Department of Health has made significant gains in HIV services over the last two decades, reaching their set “90–90-90” targets for HIV. However, TB services, although robust, have lagged in comparison for both disease and infection. The Systems Analysis and Improvement Approach (SAIA) is a five-step implementation science method, drawn from systems engineering, to identify, define, and implement workflow modifications using cascade analysis, process mapping, and repeated quality improvement cycles within healthcare facilities. Methods This stepped-wedge cluster randomized trial will evaluate the effectiveness of SAIA on TB (SAIA-TB) cascade optimization for patients with TB and high-risk contacts across 16 clinics in four local municipalities in the Sarah Baartman district, Eastern Cape, South Africa. We hypothesize that SAIA-TB implementation will lead to a 20% increase in each of: TB screening, TB preventive treatment initiation, and TB disease treatment initiation during the 18-month intervention period. Focus group discussions and key informant interviews with clinic staff will also be conducted to determine drivers of implementation variability across clinics. Discussion This study has the potential to improve TB screening, treatment initiation, and completion for both active disease and preventive measures among individuals with and without HIV in a high burden setting. SAIA-TB provides frontline health care workers with a systems-level view of their care delivery system with the aim of sustainable systems-level improvements. Trial registration Clinicaltrials.gov, NCT06314386. Registered 18 March 2024, https://clinicaltrials.gov/study/NCT06314386 . NCT06314386.

Abstract Background Primary immune thrombocytopenia (pITP) in dogs presents a diagnostic challenge, and clinical markers of severity are lacking. Objectives Identify clinicopathologic features that differentiate pITP from secondary ITP (sITP) and markers related to bleeding severity, transfusion, and survival of dogs with pITP. Animals Ninety‐eight thrombocytopenic dogs (58 pITP and 40 sITP). Methods Client‐owned dogs with platelet counts

The North Atlantic Marine Boundary Layer Experiment (NAMBLEX), involving over 50 scientists from 12 institutions, took place at Mace Head, Ireland (53.32° N, 9.90° W), between 23 July and 4 September 2002. A wide range of state-of-the-art instrumentation enabled detailed measurements of the boundary layer structure and atmospheric composition in the gas and aerosol phase to be made, providing one of the most comprehensive in situ studies of the marine boundary layer to date. This overview paper describes the aims of the NAMBLEX project in the context of previous field campaigns in the Marine Boundary Layer (MBL), the overall layout of the site, a summary of the instrumentation deployed, the temporal coverage of the measurement data, and the numerical models used to interpret the field data. Measurements of some trace species were made for the first time during the campaign, which was characterised by predominantly clean air of marine origin, but more polluted air with higher levels of NOx originating from continental regions was also experienced. This paper provides a summary of the meteorological measurements and Planetary Boundary Layer (PBL) structure measurements, presents time series of some of the longer-lived trace species (O3, CO, H2, DMS, CH4, NMHC, NOx, NOy, PAN) and summarises measurements of other species that are described in more detail in other papers within this special issue, namely oxygenated VOCs, HCHO, peroxides, organo-halogenated species, a range of shorter lived halogen species (I2, OIO, IO, BrO), NO3 radicals, photolysis frequencies, the free radicals OH, HO2 and (HO2+Σ RO2), as well as a summary of the aerosol measurements. NAMBLEX was supported by measurements made in the vicinity of Mace Head using the NERC Dornier-228 aircraft. Using ECMWF wind-fields, calculations were made of the air-mass trajectories arriving at Mace Head during NAMBLEX, and were analysed together with both meteorological and trace-gas measurements. In this paper a chemical climatology for the duration of the campaign is presented to interpret the distribution of air-mass origins and emission sources, and to provide a convenient framework of air-mass classification that is used by other papers in this issue for the interpretation of observed variability in levels of trace gases and aerosols.

This paper presents an overview of the meteorology and planetary boundary layer structure observed during the NAMBLEX field campaign to aid interpretation of the chemical and aerosol measurements. The campaign has been separated into five periods corresponding to the prevailing synoptic condition. Comparisons between meteorological measurements (UHF wind profiler, Doppler sodar, sonic aneometers mounted on a tower at varying heights and a standard anemometer) and the ECMWF analysis at 10m and 1100 m identified days when the internal boundary layer was decoupled from the synoptic flow aloft. Generally the agreement was remarkably good apart from during period one and on a few days during period four when the diurnal swing in wind direction implies a sea/land breeze circulation near the surface. During these periods the origin of air sampled at Mace Head would not be accurately represented by back trajectories following the winds resolved in ECMWF analyses. The wind profiler observations give a detailed record of boundary layer structure including an indication of its depth, average wind speed and direction. Turbulence statistics have been used to assess the height to which the developing internal boundary layer, caused by the increased surface drag at the coast, reaches the sampling location under a wide range of marine conditions. Sampling conducted below 10 m will be impacted by emission sources at the shoreline in all wind directions and tidal conditions, whereas sampling above 15 m is unlikely to be affected in any of the wind directions and tidal heights sampled during the experiment.

Aims. The aim of this study is to examine the efficacy of adding a dipeptidyl peptidase-4 (DPP-4) inhibitor to patients with type 2 diabetes inadequately controlled by metformin and sulphonylurea combination treatment. The response of Asian and non-Asian patients to this regimen was also examined. Methods. The medical and computerized records of 80 patients were examined. These patients had baseline HbA1c levels ranging from 7.0 to 12.5% and had a DPP-4 inhibitor add-on therapy for a minimum period of 12 weeks. The primary endpoint was the change in HbA1c level before and after DPP-4 inhibitor treatment. Results. During oral triple therapy, there was a reduction of HbA1c from 8.3% (7.7–8.9) to 7.2% (6.8–7.6) and 26 patients (32.5%) achieved an HbA1c

Objectives To estimate the economic impact of failure to find and treat tuberculosis disease and prevent tuberculosis infection from progressing to active disease.Design Estimating the economic cost of not finding and treating a patient suffering from tuberculosis.Setting Estimation methodology is developed in the Indian context, as informed by local costs and reported tuberculosis epidemiology.Participants No individual participants were included.Primary and secondary outcome measures The primary outcome measure is the total cost of patients with drug-susceptible and drug-resistant tuberculosis who are and are not found and treated by tuberculosis programmes, including costs for medications, lost productivity, healthcare services and furthered transmission. We calculate the economic burdens by varying the number of individuals a person sick with tuberculosis infects (10 or 15 people) and the risk of progression to tuberculosis disease if infected (5 or 8%). The secondary outcome measure is the amount saved by finding a patient early or who would not have otherwise been found. All costs are presented in US dollars (exchange rate: 72 Indian rupees/1 US$).Results By finding and treating a patient early before furthered transmission occurs—or stopping progression of tuberculosis infection to tuberculosis disease with preventive therapy—the Indian health system can save US$5502 to US$15 825 and US$5846 to US$25 575, for each individual with drug-susceptible and drug-resistant tuberculosis, respectively, across scenarios.Conclusions These estimates provide crude, lower bounds for the potential costs of not appropriately diagnosing and treating a single patient with active tuberculosis in a timely manner, or preventing a patient with tuberculosis infection from progressing to active disease. The actual financial burden on society is far higher than estimated using this simple, short-term cost-effective analyses. Our results highlight the limitations of tuberculosis costing models to date, and demonstrate the importance of accounting for airborne transmission of tuberculosis.

PurposeTo evaluate the diagnostic value of symptoms used by daycares and schools to screen children and adolescents for SARS-CoV-2 infection, we analyzed data from a primary care setting.MethodsThis cohort study included all patients ≤17 years old who were evaluated at Providence Community Health Centers (PCHC; Providence, U.S.), for COVID-19 symptoms and/or exposure, and received SARS-CoV-2 polymerase chain reaction (PCR) testing between March-June 2020. Participants were identified from PCHC electronic medical records. For three age groups- 0-4, 5-11, and 12-17 years-we estimated the sensitivity, specificity, and area under the receiver operating curve (AUC) of individual symptoms and three symptom combinations: a case definition published by the Rhode Island Department of Health (RIDOH), and two novel combinations generated by different statistical approaches to maximize sensitivity, specificity, and AUC. We evaluated symptom combinations both with and without consideration of COVID-19 exposure. Myalgia, headache, sore throat, abdominal pain, nausea, anosmia, and ageusia were not assessed in 0-4 year-olds due to the lower reliability of these symptoms in this group.ResultsOf 555 participants, 217 (39.1%) were SARS-CoV-2-infected. Fever was more common among 0-4 years-olds (p = 0.002); older children more frequently reported fatigue (p = 0.02). In children ≥5 years old, anosmia or ageusia had 94-98% specificity. In all ages, exposure history most accurately predicted infection. With respect to individual symptoms, cough most accurately predicted infection in 95% but specificity ConclusionsAnosmia or ageusia in children ≥5 years old should raise providers' index of suspicion for COVID-19. However, our overall findings underscore the limited diagnostic value of symptoms.