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Humans change climate in many ways. In addition to greenhouse gases, climate models must therefore incorporate a range of other forcings, such as land use change. While studies typically investigate the joint effects of all forcings, here we isolate the impact of afforestation and deforestation on winds in the lowermost 350 m of the atmosphere to assess the relevance of land use change for large-scale wind energy assessments. We use vertically resolved sub-daily output from two regional climate models instead of extrapolating near-surface winds with simplified profiles. Comparing two extreme scenarios, we report that afforestation reduces wind speeds by more than 1 m s−1 in many locations across Europe, even 300 m above ground, underscoring its relevance at hub heights of current and future wind turbines. We show that standard extrapolation with modified parameters approximates long-term means well but fails to capture essential spatio-temporal details, such as changes in the daily cycle, and it is thus insufficient to estimate wind energy potentials. Using adjacent climate model levels to account for spatio-temporal wind profile complexity, we report that wind energy capacity factors are strongly impacted by afforestation and deforestation: they differ by more than 0.1 in absolute terms and up to 50 % in relative terms. Our results confirm earlier studies showing that land use change impacts on wind energy can be severe and that they are generally misrepresented with common extrapolation techniques.

This article deals with the Copenhagen interpretation of quantum mechanics and its epistemological discussion by Ernst Cassirer and Richard Hönigswald. The starting point is Cassirer's treatise Determinism and Indeterminism in Modern Physics, published in Stockholm. Both philosophers and several physicists were involved in the subsequent exchange of letters. From a physical point of view, the Copenhagen interpretation was particularly criticised by v. Laue and Einstein. Both demanded a revision of the foundations of quantum mechanics or a critical examination of essential physical concepts. The epistemological implications of the Copenhagen interpretation were rejected, in particular that the interactions between observation, the observed and the observer in quantum physics experiments should lead to a renunciation of the concept of causality or an objectively unambiguous description of natural processes. Cassirer argues here that quantum mechanics fulfils the epistemological requirement of transforming ontological “concepts of things” into epistemological concepts of relations and is therefore compatible with the neo-critical approach he advocates. At the same time, Hönigswald was working on two major treatises on the structure of physics and the concept of causality. Here he undertakes an epistemological foundation of physics as a whole. A transcendental foundation of the concept of experience and its specifications in principles such as contemplation, observation or experiment appears to be called for. Hönigswald therefore essentially rejects the Copenhagen interpretation, as it draws epistemological consequences by physical means and thus inadmissibly reverses the transcendentally necessary relations of justification. These arguments are examined and could be used for a current discussion on the epistemological foundations of quantum mechanics and physics as a whole. A post-Neo-Kantian, transcendental philosophical foundation of scientific knowledge, especially of modern physics, seems possible and necessary.

Health literacy (HL) in children is essential for healthy decision-making from early on. At six Austrian elementary schools, all children (aged 6-11 years) received 3 years of health education (HE). The participating schools were equipped with teaching materials to convey lessons in a child-oriented way. The teachers were professionally accompanied during the implementation process and received specific training. HL and its subprocesses (obtain, understand, comprehend and apply) in children >8 years were measured with a standardized test (QUIGK-K) after 1, 2 and 3 years of education and compared with values from two comparison schools without such lessons. t-Tests showed a significant increase in HL at the end of the second year of HE. After this period, the children showed above-average values on all subprocesses of HL and performed better than children without HE. The third year did not lead to a further increase. Hence, child-oriented HE is suitable to promote HL in elementary school students within 2 years. It is therefore recommended to start HE as early as possible in order to lay the foundation for a long and healthy life.

Social skills are of key importance in everyday and work life. However, the way in which they are typically assessed via self-report questionnaires has one potential downside; self-reports assess individuals' global self-concepts, which do not necessarily reflect individuals' actual social behaviors. In this research, we aimed to investigate how self-concepts assessed via questionnaires relate to skill expression assessed via behavioral observations after short interpersonal simulations. For this, we used an alternative behavior-based skill assessment approach designed to capture expressions of predefined social skills. Self- and observer ratings were collected to assess three different social skills: agency (i.e., getting ahead in social situations), communion (i.e., getting along in social situations), and interpersonal resilience (i.e., staying calm in social situations). We explored how these skills were related to self-concepts by differentiating between a classic personality measure (i.e., Big Five Inventory 2; BFI-2) and a novel skill questionnaire (i.e., Behavioral, Emotional, and Social Skills Inventory; BESSI). The results (N = 137) showed that both personality and skill self-concepts predicted self-rated skill expression, with the BESSI showing incremental validity. For both personality and skills self-concepts, the relationships with observer-rated skill expression were significant for agency but not for communion or interpersonal resilience. We discuss these results and highlight the theoretical and practical importance of differentiating between skill self-concepts and actual skill expression.

ABSTRACT Malaria rapid diagnostic tests (RDTs), which detect Plasmodium falciparum (Pf)-specific histidine-rich protein-2 (HRP2), have increasing importance for the diagnosis and control of malaria, especially also in regions where routine diagnosis by microscopy is not available. HRP2-based RDTs have a similar sensitivity to expert microscopy, but their reported low specificity can lead to high false positivity rates, particularly in high-endemic areas. Despite the widespread use of RDTs, models investigating the dynamics of HRP2 clearance following Pf treatment focus rather on short-term clearance of the protein. The goal of this observational cohort study was to determine the long-term kinetic of HRP2-levels in peripheral blood after treatment of uncomplicated malaria cases with Pf mono-infection using a 3-day course of artesunate/amodiaquine. HRP2 levels were quantified at enrollment and on days 1, 2, 3, 5, 7, 12, 17, 22, and 28 post-treatment initiation. The findings reveal an unexpectedly prolonged clearance of HRP2 after parasite clearance from capillary blood. Terminal HRP2 half-life was estimated to be 9 days after parasite clearance using a pharmacokinetic two-compartmental elimination model. These results provide evidence that HRP2 clearance has generally been underestimated, as the antigen remains detectable in capillary blood for up to 28 days following successful treatment, influencing RDT-based assessment following a malaria treatment for weeks. A better understanding of the HRP2 clearance dynamics is critical for guiding the diagnosis of malaria when relying on RDTs.IMPORTANCEDetecting Plasmodium falciparum, the parasite responsible for the severest form of malaria, typically involves microscopy, polymerase chain reaction (PCR), or rapid diagnostic tests (RDTs) targeting the histidine-rich protein 2 or 3 (HRP2/3). While microscopy and PCR quickly turn negative after the infection is cleared, HRP2 remains detectable for a prolonged period. The exact duration of HRP2 persistence had not been well defined. Our study in Gabon tracked HRP2 levels over 4 weeks, resulting in a new model for antigen clearance. We discovered that a two-compartment model accurately predicts HRP2 levels, revealing an initial rapid reduction followed by a much slower elimination phase that can take several weeks. These findings are crucial for interpreting RDT results, as lingering HRP2 can lead to false positives, impacting malaria diagnosis and treatment decisions.

Abstract Background The qualities of trainees play a key role in entrustment decisions by clinical supervisors for the assignments of professional tasks and levels of supervision. A recent body of qualitative research has shown that in addition to knowledge and skills, a number of personality traits are relevant in the workplace; however, the relevance of these traits has not been investigated empirically. The aim of this study was to analyse the workplace performance of final-year medical students using an Entrustable Professional Activity (EPA) framework in relation to their personality traits. Methods Medical students at the end of their final clerkship year were invited to participate in an online survey-based, cross-sectional field study. In the survey, the workplace performance was captured using a framework consisting of levels of experienced supervision and a defined set of 12 end-of-undergraduate medical training EPAs. The Big Five personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness) of the participating medical students were measured using the Big Five Inventory-SOEP (BFI-S), which consists of 15 items that are rated on a seven-point Likert scale. The data were analysed using descriptive and inferential statistics. Results The study included 880 final-year medical students (mean age: 27.2 years, SD = 3.0; 65% female). The levels of supervision under which the final-year clerkship students carried out the EPAs varied considerably. Significant correlations were found between the levels of experienced supervision and all Big Five dimensions The correlations with the dimensions of extraversion, agreeableness, conscientiousness and openness were positive, and that for the neuroticism dimension was negative (range r = 0.17 to r = − 0.23). Multiple regression analyses showed that the combination of the Big Five personality traits accounted for 0.8–7.5% of the variance in supervision levels on individual EPAs. Conclusions Using the BFI-S, we found that the levels of supervision on a set of end-of-undergraduate medical training EPAs were related to the personality traits of final-year medical students. The results of this study confirm the existing body of research on the role of conscientiousness and extraversion in entrustment decision-making and, in particular, add the personality trait of neuroticism as a new and relevant trainee quality to be considered.

Objectives: Situational Judgement Tests (SJT) are a cost-efficient method for the assessment of personal characteristics (e.g., empathy, professionalism, ethical thinking) in medical school admission. Recently, complex open-ended response format SJTs have become more feasible to conduct. However, research on their applicability to a German context is missing. This pilot study tests the acceptability, reliability, subgroup differences, and validity of an online SJT with open-ended response format developed in Canada (“Casper”).Methods: German medical school applicants and students from Hamburg were invited to take Casper in 2020 and 2021. The test consisted of 12 video- and text-based scenarios, each followed by three open-ended questions. Participants subsequently evaluated their test experience in an online survey. Data on sociodemographic characteristics, other admission criteria (Abitur, TMS, HAM-Nat, HAM-SJT) and study success (OSCE) was available in a central research database (stav). Results: The full sample consisted of 582 participants. Test-takers’ global perception of Casper was positive. Internal consistency was satisfactory in both years (=0.73; 0.82) while interrater agreement was moderate (ICC(1,2)=0.54). Participants who were female (=0.37) or did not have a migration background (=0.40) received higher scores. Casper scores correlated with HAM-SJT (=.18) but not with OSCE communication stations performance. The test was also related to Abitur grades (=-.15), the TMS (=.18), and HAM-Nat logical reasoning scores (=.23). Conclusion: This study provides positive evidence for the acceptability, internal consistency, and convergent validity of Casper. The selection and training of raters as well as the scenario content require further observation and adjustments to a German context to improve interrater reliability and predictive validity.

Afforestation affects the earth's climate system by changing the biogeochemical and biogeophysical characteristics of the land surface. While the regional effects of afforestation are well understood in the tropics and the high latitudes, its climate impact on the midlatitudes is still the subject of scientific discussions. The general impact of afforestation on the regional climate conditions in Europe during the last decades is investigated in this study. For this purpose, regional climate simulations are performed with different forest cover fractions over Europe. In a first simulation, afforestation in Europe is considered, while this is not the case for a second simulation. We focus on the years 1986–2015, a period in which the forest cover in Europe increased comparatively strongly, accompanied by a strong general warming over the continent. Results show that afforestation has both local and non-local effects on the regional climate system in Europe. Due to an increased transport of turbulent heat (latent + sensible) into the atmosphere, afforestation leads to a significant reduction of the mean local surface temperatures in summer. In northern Europe, mean local surface temperatures were reduced about −0.3 K with afforestation, in central Europe about −0.5 K, and in southern Europe about −0.8 K. During heat periods, this local cooling effect can reach −1.9 K. In winter, afforestation results in a slight local warming in both northern and southern Europe because of the albedo effect of forests. However, this effect is rather small and the mean temperature changes are not significant. In the downwind direction, locally increased evapotranspiration rates with afforestation increase the general cloud cover, which results in a slight non-local warming in winter in several regions of Europe, particularly during cold spells. Thus, afforestation had a discernible impact on the climate change signal in Europe during the period 1986–2015, which may have mitigated the general warming trend in Europe, especially on the local scale in summer.

Abstract Interpreting gaze behavior is essential in evaluating interaction partners, yet the ‘semantics of gaze’ in dynamic interactions are still poorly understood. We aimed to comprehensively investigate effects of gaze behavior patterns in different conversation contexts, using a two-step, qualitative-quantitative procedure. Participants watched video clips of single persons listening to autobiographic narrations by another (invisible) person. The listener’s gaze behavior was manipulated in terms of gaze direction, frequency and direction of gaze shifts, and blink frequency; emotional context was manipulated through the valence of the narration (neutral/negative). In Experiment 1 (qualitative-exploratory), participants freely described which states and traits they attributed to the listener in each condition, allowing us to identify relevant aspects of person perception and to construct distinct rating scales that were implemented in Experiment 2 (quantitative-confirmatory). Results revealed systematic and differential meanings ascribed to the listener’s gaze behavior. For example, rapid blinking and fast gaze shifts were rated more negatively (e.g., restless and unnatural) than slower gaze behavior; downward gaze was evaluated more favorably (e.g., empathetic) than other gaze aversion types, especially in the emotionally negative context. Overall, our study contributes to a more systematic understanding of flexible gaze semantics in social interaction.

Deciduous forests are characterized by a higher albedo, a reduced stomatal resistance, and a deeper root system in comparison to coniferous forests. As a consequence, less solar radiation is absorbed and evapotranspiration is potentially increased, making an increase in the deciduous forest fraction a potentially promising measure to mitigate the burdens of heat extremes for humans and nature. We analyze this potential by means of an idealized 30-year-long regional climate model (RCM) experiment, in which all coniferous forests in Europe are replaced by deciduous forests and compared to a simulation using the actual forest composition. Results show that an increase in the deciduous forest fraction reduces the heat intensity during heat periods in most regions of Europe. During heat periods, there is a slight reduction in the mean daily maximum 2 m temperatures simulated of about 0.2 K locally and 0.1 K non-locally. Regions with a high cooling potential are southwestern France and northern Turkey, where heat period intensities are reduced by up to 1 K. Warming effects are simulated in Scandinavia and eastern Europe. Although the cooling effect on heat period intensities is statistically significant over large parts of Europe, the magnitude of the temperature reduction is small. Consequently, an increase in the deciduous forest fraction only has a limited potential to reduce heat period intensities in Europe and can therefore only be considered as a supporting mitigation measure to complement more effective mitigation strategies.

Leg anerkendes af forskere og praktikere som et grundlæggende aspekt af barndomsudviklingen. Evalueringen af leg er et komplekst og udfordrende undersøgelsesområde. Denne artikel præsenterer en undersøgende gennemgang af to undervisningsforløb på pædagoguddannelsen om evaluering af leg – og giver eksempler på to legende syn på læring, som samskabes. Undervisningsforløbene peger på, at leg er afgørende for udvikling og velvære, men belyser samtidig behovet for et frisættende evalueringsdesign, som kan være platform for værdsætning af legen og det legende. Artiklen understreger vigtigheden af at insistere på leg i uddannelsesmiljøer – som kreativitet, innovation og frisættelse forstået som at turde vove at slippe kontrollen og give plads til det ukontrollerbare. Nøgleord: Leg, legende, kreativitet, innovation, frisættende, ukontrollerbar

The summer of 2018 was an extraordinary season in climatological terms for northern and central Europe, bringing simultaneous, widespread, and concurrent heat and drought extremes in large parts of the continent with extensive impacts on agriculture, forests, water supply, and the socio-economic sector. Here, we present a comprehensive, multi-faceted analysis of the 2018 extreme summer in terms of heat and drought in central and northern Europe, with a particular focus on Germany. The heatwave first affected Scandinavia in mid-July and shifted towards central Europe in late July, while Iberia was primarily affected in early August. The atmospheric circulation was characterized by strongly positive blocking anomalies over Europe, in combination with a positive summer North Atlantic Oscillation and a double jet stream configuration before the initiation of the heatwave. In terms of possible precursors common to previous European heatwaves, the Eurasian double-jet structure and a tripolar sea surface temperature anomaly over the North Atlantic were already identified in spring. While in the early stages over Scandinavia the air masses at mid and upper levels were often of a remote, maritime origin, at later stages over Iberia the air masses primarily had a local-to-regional origin. The drought affected Germany the most, starting with warmer than average conditions in spring, associated with enhanced latent heat release that initiated a severe depletion of soil moisture. During summer, a continued precipitation deficit exacerbated the problem, leading to hydrological and agricultural drought. A probabilistic attribution assessment of the heatwave in Germany showed that such events of prolonged heat have become more likely due to anthropogenic global warming. Regarding future projections, an extreme summer such as that of 2018 is expected to occur every 2 out of 3 years in Europe in a +1.5 ∘C warmer world and virtually every single year in a +2 ∘C warmer world. With such large-scale and impactful extreme events becoming more frequent and intense under anthropogenic climate change, comprehensive and multi-faceted studies like the one presented here quantify the multitude of their effects and provide valuable information as a basis for adaptation and mitigation strategies.

Unmanned aerial vehicles (UAVs) provide images at decametric spatial resolutions. Their flexibility, efficiency, and low cost make it possible to apply UAV remote sensing to multisensor data acquisition. In this frame, the present study aims at employing RGB UAV images (at a 3 cm resolution) and multispectral images (at a 16 cm resolution) with related vegetation indices (VIs) for mapping surfaces according to their illumination. The aim is to map land cover in order to access temperature distribution and compare NDVI and MTVI2 dynamics as a function of their illuminance. The method, which is based on a linear discriminant analysis, is validated at different periods during the phenological cycle of the crops in place. A model based on a given date is evaluated, as well as the use of a generic model. The method provides a good capacity of separation between four classes: vegetation, no-vegetation, shade, and sun (average kappa of 0.93). The effects of agricultural practices on two adjacent plots of maize respectively submitted to conventional and conservation farming are assessed. The transition from shade to sun increases the brightness temperature by 2.4 °C and reduces the NDVI by 26% for non-vegetated surfaces. The conservation farming plot is found to be 1.9 °C warmer on the 11th of July 2019, with no significant difference between vegetation in the sun or shade. The results also indicate that the NDVI of non-vegetated areas is increased by the presence of crop residues on the conservation agriculture plot and by the effect of shade on the conventional plot which is different for MTVI2.

Afforestation is an important mitigation strategy for climate change due to its carbon sequestration potential. Besides this favorable biogeochemical effect on global CO2 concentrations, afforestation also affects the regional climate by changing the biogeophysical land surface characteristics. In this study, we investigate the effects of an idealized global CO2 reduction to pre-industrial conditions by a Europe-wide afforestation experiment on the regional longwave radiation balance, starting in the year 1986 on a continent entirely covered with grassland. Results show that the impact of biogeophysical processes on the surface temperatures is much stronger than that of biogeochemical processes. Furthermore, biogeophysically induced changes of the surface temperatures, atmospheric temperatures, and moisture concentrations are as important for the regional longwave radiation balance as the global CO2 reduction. While the outgoing longwave radiation is increased in winter, it is reduced in summer. In terms of annual total, a Europe-wide afforestation has a regional warming effect despite reduced CO2 concentrations. Thus, even for an idealized reduction of the global CO2 concentrations to pre-industrial levels, the European climate response to afforestation would still be dominated by its biogeophysical effects.

Abstract Background In microbiological diagnosis of periprosthetic joint infection (PJI) there is no consensus regarding the most suitable and optimal number of specimens to be cultured or the most effective technique of tissue processing. This comparative study analysed the accuracy of two semi-automated homogenization methods with special focus on the volume and exact origin of each sample. Methods We investigated a total of 722 periprosthetic tissue samples. PJI was defined according to the new scoring system for preoperative and intraoperative criteria. We compared the performance of our routinely used single tissue processing by disposable high-frequency disperser with the bead milling method. Results Eighty patients were included. Among forty classified PJIs, 34 patients yielded positive culture results. In 23 cases (68%) exact concordant results were generated with both techniques. However, in seven cases (20%) processing by the disperser and in four cases (12%) by bead milling provided additional positive samples, but without significant difference since the major definition criteria were met in all cases. The percentage of positive results was influenced by the volume and origin of the tissue samples. Results for small tissue samples tended to be better using the bead milling method. This might lead to improved preoperative arthroscopic diagnosis, as the volume of biopsies is generally limited. Six patients had negative results due to previous antimicrobial therapy. Forty other patients were classified as aseptic failures. Neither procedure resulted in any contamination. Conclusion Both methods enable reliable processing of tissue samples for diagnosis of PJI and are suitable for routine use.

Seasonal snow cover plays a major role in the climate system of the Northern Hemisphere via its effect on land surface albedo and fluxes. In climate models the parameterization of interactions between snow and atmosphere remains a source of uncertainty and biases in the representation of local and global climate. Here, we evaluate the ability of an ensemble of regional climate models (RCMs) coupled with different land surface models to simulate snow–atmosphere interactions over Europe in winter and spring. We use a previously defined index, the snow-albedo sensitivity index (SASI), to quantify the radiative forcing associated with snow cover anomalies. By comparing RCM-derived SASI values with SASI calculated from reanalyses and satellite retrievals, we show that an accurate simulation of snow cover is essential for correctly reproducing the observed forcing over middle and high latitudes in Europe. The choice of parameterizations, and primarily the choice of the land surface model, strongly influences the representation of SASI as it affects the ability of climate models to simulate snow cover accurately. The degree of agreement between the datasets differs between the accumulation and ablation periods, with the latter one presenting the greatest challenge for the RCMs. Given the dominant role of land surface processes in the simulation of snow cover during the ablation period, the results suggest that, during this time period, the choice of the land surface model is more critical for the representation of SASI than the atmospheric model.

During the summer of July to September 2020, a biodiversity survey on Chironomidae of Baishanzu Nature Reserve, China was made. In total, five Stenochironomus taxa/species were discovered, of which two belong to undescribed species and one (S. okialbus Sasa, 1990) is reported for the first time from China. The male adults of two new species are described and illustrated. Stenochironomus annulus Song & Qi sp. nov. is distinguished in having a wing with two dark spots restricted to the fork area of FCu and RM, the mid- and hind-femur each with a brown annulus, and the inferior volsella with two setae and one strong terminal spine. Stenochironomus baishanzuensis Song & Qi sp. nov. is distinguished by a combination of characters: a single dark spot on the middle part of the wing, fore legs brown to dark brown except for the basal 3/4 of femur, and the inferior volsella with four long setae and one stout terminal spine. The neighbour-joining tree based on public COI barcodes formed distinct clades with clear support for the new species. An updated key to known male adults of Stenochironomus from China is also provided.

Abstract Background Social skills are important for future physicians and are therefore increasingly considered in selection processes. One economic assessment method from which different social skills can be inferred are Situational Judgment Tests (SJTs) in which applicants are asked to rate behavioral responses in context-relevant situations. However, traditional SJTs have so far failed to distinctively measure specified constructs. To address this shortcoming in the medical admission context, we applied a construct-driven approach of SJT development in which test development was deductively guided by agency and communion as target constructs. Method The final version of the construct-driven SJT includes 15 items per construct with three behavioral responses. Medical school applicants (N = 1527) completed the construct-driven SJT, a traditional SJT, and an aptitude test under high-stakes condition as part of their application. A subsample (N = 575) participated in a subsequent voluntary online study with self-report measures of personality and past behavior. Results The proposed two-factor structure and internal consistency of the construct-driven SJT was confirmed. Communal SJT scores were positively associated with self-reported communal personality and communal behavior, yet effects were smaller than expected. Findings for agentic SJT scores were mixed with positive small associations to self-reported agentic personality scores and agentic behavior but unexpected negative relations to communal self-reported measures. Conclusions Results suggest that construct-driven SJTs might overcome validity limitations of traditional SJTs, although their implementation is challenging. Despite first indicators of validity, future research needs to address practical points of application in high-stakes settings, inclusion of other constructs, and especially prediction of actual behavior before the application of construct-driven SJTs for selection purposes in medical admission can be recommended.

Land cover in sub-polar and alpine regions of northern and eastern Europe have already begun changing due to natural and anthropogenic changes such as afforestation. This will impact the regional climate and hydrology upon which societies in these regions are highly reliant. This study aims to identify the impacts of afforestation/reforestation (hereafter afforestation) on snow and the snow-albedo effect and highlight potential improvements for future model development. The study uses an ensemble of nine regional climate models for two different idealised experiments covering a 30-year period; one experiment replaces most land cover in Europe with forest, while the other experiment replaces all forested areas with grass. The ensemble consists of nine regional climate models composed of different combinations of five regional atmospheric models and six land surface models. Results show that afforestation reduces the snow-albedo sensitivity index and enhances snowmelt. While the direction of change is robustly modelled, there is still uncertainty in the magnitude of change. The greatest differences between models emerge in the snowmelt season. One regional climate model uses different land surface models which shows consistent changes between the three simulations during the accumulation period but differs in the snowmelt season. Together these results point to the need for further model development in representing both grass–snow and forest–snow interactions during the snowmelt season. Pathways to accomplishing this include (1) a more sophisticated representation of forest structure, (2) kilometre-scale simulations, and (3) more observational studies on vegetation–snow interactions in northern Europe.

Abstract We report the case of a 58‐year‐old female with severe postcapillary pulmonary hypertension (averaged mean pulmonary arterial pressure was 49 mmHg, pulmonary arterial wedge pressure 29 mmHg, and right atrial pressure 8 mmHg) due to heart failure with preserved ejection fraction. A left‐to‐right atrial shunt was created using an 8 mm cutting balloon, under transesophageal echocardiography guidance. Both pulmonary arterial and wedge pressure dramatically decreased after the procedure. Symptoms immediately improved and benefits were sustained at 6 months of follow‐up. This case suggests that iatrogenic septal defect using a cutting balloon could be an option to treat symptomatic postcapillary pulmonary hypertension.

In the context of the first phase of the Coordinated Regional Climate Downscaling Experiment in the European domain (EURO-CORDEX) flagship plot study on Land Use and Climate Across Scales (LUCAS), we investigate the biophysical impact of afforestation on the seasonal cycle of soil temperature over the European continent with an ensemble of 10 regional climate models. For this purpose, each ensemble member performed two idealized land cover experiments in which Europe is covered either by forests or grasslands. The multi-model mean exhibits a reduction of the annual amplitude of soil temperature (AAST) due to afforestation over all European regions, although this is not a robust feature among the models. In the Mediterranean, the spread of simulated AAST response to afforestation is between −4 and +2 ∘C at 1 m below the ground, while in Scandinavia the inter-model spread ranges from −7 to +1 ∘C. We show that the large range in the simulated AAST response is due to the representation of the summertime climate processes and is largely explained by inter-model differences in leaf area index (LAI), surface albedo, cloud fraction and soil moisture, when all combined into a multiple linear regression. The changes in these drivers essentially determine the ratio between the increased radiative energy at surface (due to lower albedo in forests) and the increased sum of turbulent heat fluxes (due to mixing-facilitating characteristics of forests), and consequently decide the changes in soil heating with afforestation in each model. Finally, we pair FLUXNET sites to compare the simulated results with observation-based evidence of the impact of forest on soil temperature. In line with models, observations indicate a summer ground cooling in forested areas compared to open lands. The vast majority of models agree with the sign of the observed reduction in AAST, although with a large variation in the magnitude of changes. Overall, we aspire to emphasize the biophysical effects of afforestation on soil temperature profile with this study, given that changes in the seasonal cycle of soil temperature potentially perturb crucial biochemical processes. Robust knowledge on biophysical impacts of afforestation on soil conditions and its feedbacks on local and regional climate is needed in support of effective land-based climate mitigation and adaption policies.

Due to global change, cities of the future will have to deal with more intense runoff and longer drought sequences, in addition to a growing urban and peri-urban population. French Mediterranean cities, such as Toulon, are already densely urbanised and exposed to the effects of global warming. The adaptation of their infrastructures is problematic. Cities with high development potential, such as Dakar, offer the opportunity to imagine other solutions for the management of water resources and its extremes in the context of global change. In particular, it is a question of managing the flows of water and substances linked to intense runoff events according to an ecohydrological logic that makes it possible to reduce environmental risks and increase social and economic benefits. To do this, we use a hydrologically-based geomatics model (IRIP) that produces predictive maps of areas of generation, transfer and accumulation of intense runoff and associated nutrients. This allows us to target effective intervention areas to reduce risks and increase water resources, for example by simulating land use change in appropriate locations and at the same time stimulating specific biological processes. The fundamental principle of ecohydrology is to balance energy flows with biological metabolic flows at the sub-catchment scale. The mapping of intense runoff processes is a first step illustrated in this article for the cities of Toulon and Dakar. This first step is part of the Dakar'2030 project, which aims to rethink urban development and adapt it to climate change.

BackgroundThe workload in health care is increasing and hence, mental health issues are on the rise among health care professionals (HCPs). The digitization of patient care could be related to the increase in stress levels. It remains unclear whether the health information system or systems and digital health technologies (DHTs) being used in health care relieve the professionals or whether they represent a further burden. The mental construct that best describes this burden of technologies is mental workload (MWL). The measurement methods of MWL are particularly relevant in this sensitive setting. ObjectiveThis review aimed to address 2 different but related objectives: identifying the factors that contribute to the MWL of HCPs when using DHT and examining and exploring the applied assessments for the measurement of MWL with a special focus on eye tracking. MethodsFollowing the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement, we conducted a systematic review and processed a literature search in the following databases: MEDLINE (PubMed), Web of Science, Academic Search Premier and CINAHL (EBSCO), and PsycINFO. Studies were eligible if they assessed the MWL of HCPs related to DHT. The review was conducted as per the following steps: literature search, article selection, data extraction, quality assessment (using the Standard Quality Assessment Criteria for Evaluation Primary Research Papers From a Variety of Fields [QualSyst]), data analysis, and data synthesis (narrative and tabular). The process was performed by 2 reviewers (in cases of disagreement, a third reviewer was involved). ResultsThe literature search process resulted in 25 studies that fit the inclusion criteria and examined the MWL of health care workers resulting from the use of DHT in health care settings. Most studies had sample sizes of 10-50 participants, were conducted in the laboratory, and had quasi-experimental or cross-sectional designs. The main results can be grouped into two categories: assessment methods and factors related to DHT that contribute to MWL. Most studies applied subjective methods for the assessment of MWL. Eye tracking did not play a major role in the selected studies. The factors contributing to a higher MWL were clustered into organizational and systemic factors. ConclusionsOur review of 25 papers shows a diverse assessment approach toward the MWL of HCPs related to DHT as well as 2 groups of relevant contributing factors to MWL. Our results are limited in terms of interpretability and causality due to methodological weaknesses of the included studies and may be limited by some shortcomings in the search process. Future research should concentrate on adequate assessments of the MWL of HCPs dependent on the setting, the evaluation of quality criteria, and further assessment of the contributing factors to MWL. Trial RegistrationPROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021233271

In order to investigate the impact of spatial resolution on the discrepancy between simulated δ18O and observed δ18O in Greenland ice cores, regional climate simulations are performed with the isotope-enabled regional climate model (RCM) COSMO_iso. For this purpose, isotope-enabled general circulation model (GCM) simulations with the ECHAM5-wiso general circulation model (GCM) under present-day conditions and the MPI-ESM-wiso GCM under mid-Holocene conditions are dynamically downscaled with COSMO_iso for the Arctic region. The capability of COSMO_iso to reproduce observed isotopic ratios in Greenland ice cores for these two periods is investigated by comparing the simulation results to measured δ18O ratios from snow pit samples, Global Network of Isotopes in Precipitation (GNIP) stations and ice cores. To our knowledge, this is the first time that a mid-Holocene isotope-enabled RCM simulation is performed for the Arctic region. Under present-day conditions, a dynamical downscaling of ECHAM5-wiso (1.1∘×1.1∘) with COSMO_iso to a spatial resolution of 50 km improves the agreement with the measured δ18O ratios for 14 of 19 observational data sets. A further increase in the spatial resolution to 7 km does not yield substantial improvements except for the coastal areas with its complex terrain. For the mid-Holocene, a fully coupled MPI-ESM-wiso time slice simulation is downscaled with COSMO_iso to a spatial resolution of 50 km. In the mid-Holocene, MPI-ESM-wiso already agrees well with observations in Greenland and a downscaling with COSMO_iso does not further improve the model–data agreement. Despite this lack of improvement in model biases, the study shows that in both periods, observed δ18O values at measurement sites constitute isotope ratios which are mainly within the subgrid-scale variability of the global ECHAM5-wiso and MPI-ESM-wiso simulation results. The correct δ18O ratios are consequently not resolved in the GCM simulation results and need to be extracted by a refinement with an RCM. In this context, the RCM simulations provide a spatial δ18O distribution by which the effects of local uncertainties can be taken into account in the comparison between point measurements and model outputs. Thus, an isotope-enabled GCM–RCM model chain with realistically implemented fractionating processes constitutes a useful supplement to reconstruct regional paleo-climate conditions during the mid-Holocene in Greenland. Such model chains might also be applied to reveal the full potential of GCMs in other regions and climate periods, in which large deviations relative to observed isotope ratios are simulated.

In the context of climate change and rising frequency of extreme hydro-meteorological events around the world, flood risk management and mapping of heavy rainfall-related damages represent an ongoing critical challenge. For decades now, remote sensing has been largely used to investigate spatial and temporal changes in land use and water resources. Today, different satellite products provide fast and crucial knowledge for the study of hydrological disasters over large areas, possibly in remote regions, with high spatial resolution and high revisit frequency. Yet, until now, few works have sought to detect the full range of extreme rainfall-related damages with optical imagery, especially those caused by intense rainwater runoff beyond the direct vicinity of major waterways. The work presented in this paper focuses on the Aude severe weather event of October 15th, 2018, in the South of France, for which more than a thousand claims for agricultural disaster were registered, both related to river overflowing and rainwater runoff.The full resources of ground truths, contextual information, land use as well as digital elevation model (DEM) combined to high resolution and high frequency optical imagery (Sentinel-2, Pléiades) are used to develop an automatic damage detection method based on supervised classification algorithms. Through the combination of several indicators characterizing heterogeneous spectral variations among agricultural plots following the event, a Gaussian process classifier achieved various classification accuracies up to 90% on a large comparable and independent photo-interpreted validation sample. This work builds great expectations for applications in other areas with contrasted climate, topography and land cover.

La tempête Alex, qui a touché le 2 octobre 2020 les vallées de la Roya, la Tinée, et la Vésubie dans les Alpes-Maritimes, constitue un événement de référence qu’il est important de documenter au mieux pour en conserver la mémoire et permettre son étude ultérieure. Les différents services et opérateurs de l’État se sont largement mobilisés pour acquérir et regrouper des jeux de données décrivant cet événement. Cet article présente une contribution de la communauté scientifique à la reconstitution des débits de pointe des crues, conduite dans le cadre du programme de recherche HyMeX. Des relevés de sections d’écoulement ont permis d’obtenir 32 estimations de débits de pointe, contribuant à la connaissance des crues observées sur les cours d’eau principaux et leurs petits affluents.

Regional climate networks (RCNs) are used to identify heatwaves and droughts in Germany and two subregions for the summer half-years and summer seasons of the period 1951 to 2019. RCNs provide information for whole areas (in contrast to the point-wise information from standard indices), the underlying nodes can be distributed arbitrarily, they are easy to construct, and they provide details otherwise difficult to access, like temporal and spatial extent and localisation of extreme events; this makes them suitable for the statistical analysis of climate model output. The RCNs were constructed on the regular 0.25∘ grid of the E-OBS data set. The season-wise correlation of the time series of daily maximum temperature Tmax and precipitation were used to construct the adjacency matrix of the networks. Based on the results of a sensitivity study, we used the edge density, which increases significantly during extreme events, as the main metrics to characterise the network structure. The standard indices for comparison were the Effective Drought Index and Effective Heat Index (EDI and EHI), respectively, based on the same time series and complemented by other published data. Our results show that the RCNs are generally able to identify severe and moderate extremes and can differentiate between regions and seasons.

Objectives: In the microbiological diagnosis of periprosthetic joint infection (PJI), there is much discussion about the methodology of obtaining proper specimens, the processing technique, and suitable culture media. This retrospective study was conducted to analyse the accuracy of our culture techniques. Methods: Tissue samples and components from 258 patients after revision arthroplasty of the hip, knee, and shoulder were investigated, and the results of tissue cultures (TC) were compared to those of sonicate fluid cultures (SFC). Furthermore, an evaluation was performed of the influence of different culture media on the detection rate. Results: PJI was confirmed in 186 patients. The overall sensitivity of TC was no different to that of SFC (91.3% vs 90.8%, P = 1). In 153 cases (82.3%), TC and SFC showed concordant positive results. Results were discordant in 33 cases (17.7%). When differentiated according to the type of infection, TC showed significantly better results than SFC in detecting polymicrobial infections (97.0% vs 67.0%, P = 0.004). There were also significant differences between the culture media regarding the yield of microorganisms. Conclusions: TC was more effective in detecting co-infections. The best results were obtained using both TC and SFC. The choice of culture media has a significant influence on the quality of results.

Uncertainties in the evapotranspiration response to afforestation constitute a major source of disagreement between model-based studies of the potential climate benefits of forests. Forests typically have higher evapotranspiration rates than grasslands in the tropics, but whether this is also the case in the midlatitudes is still debated. To explore this question and the underlying physical processes behind these varying evapotranspiration rates of forests and grasslands in more detail, a regional model study with idealized afforestation scenarios was performed for Europe. In the first experiment, Europe was maximally forested, and in the second one, all forests were turned into grassland. The results of this modeling study exhibit the same contradicting evapotranspiration characteristics of forests and grasslands as documented in observational studies, but by means of an additional sensitivity simulation in which the surface roughness of the forest was reduced to grassland, the mechanisms behind these varying evapotranspiration rates could be revealed. Due to the higher surface roughness of a forest, solar radiation is more efficiently transformed into turbulent sensible heat fluxes, leading to lower surface temperatures (top of vegetation) than in grassland. The saturation deficit between the vegetation and the atmosphere, which depends on the surface temperature, is consequently reduced over forests. This reduced saturation deficit counteracts the transpiration-facilitating characteristics of a forest (deeper roots, a higher leaf area index, LAI, and lower albedo values than grassland). If the impact of the reduced saturation deficit exceeds the effects of the transpiration-facilitating characteristics of a forest, evapotranspiration is reduced compared to grassland. If not, evapotranspiration rates of forests are higher. The interplay of these two counteracting factors depends on the latitude and the prevailing forest type in a region.

Pluvial floods caused by extreme overland flow inland account for half of all flood damage claims each year along with fluvial floods. In order to increase confidence in pluvial flood susceptibility mapping, overland flow models need to be intensively evaluated using observations from past events. However, most remote-sensing-based flood detection techniques only focus on the identification of degradations and/or water pixels in the close vicinity of overflowing streams after heavy rainfall. Many occurrences of pluvial-flood-induced damages such as soil erosion, gullies, landslides and mudflows located further away from the stream are thus often unrevealed. To fill this gap, a transferable remote sensing fusion method called FuSVIPR, for Fusion of Sentinel-2 & Very high resolution Imagery for Pluvial Runoff, is developed to produce damage-detection maps. Based on very high spatial resolution optical imagery (from Pléiades satellites or airborne sensors) combined with 10 m change images from Sentinel-2 satellites, the Random Forest and U-net machine/deep learning techniques are separately trained and compared to locate pluvial flood footprints on the ground at 0.5 m spatial resolution following heavy weather events. In this work, three flash flood events in the Aude and Alpes-Maritimes departments in the South of France are investigated, covering over more than 160 km2 of rural and periurban areas between 2018 and 2020. Pluvial-flood-detection accuracies hover around 75% (with a minimum area detection ratio for annotated ground truths of 25%), and false-positive rates mostly below 2% are achieved on all three distinct events using a cross-site validation framework. FuSVIPR is then further evaluated on the latest devastating flash floods of April 2022 in the Durban area (South Africa), without additional training. Very good agreement with the impact maps produced in the context of the International Charter “Space and Major Disasters” are reached with similar performance figures. These results emphasize the high generalization capability of this method to locate pluvial floods at any time of the year and over diverse regions worldwide using a very high spatial resolution visible product and two Sentinel-2 images. The resulting impact maps have high potential for helping thorough evaluation and improvement of surface water inundation models and boosting extreme precipitation downscaling at a very high spatial resolution.

The IRIP method, or “indicator of intense pluvial runoff” in English, is a geomatics method that allows mapping the susceptibility of a territory to surface runoff and that provides three maps of susceptibility to the generation, transfer and accumulation of runoff. It is based on the combination of binary maps that represent the impact of a given factor (favourable or not favourable) on runoff. These factors are summed up to provide susceptibility maps for runoff with levels ranging from 0 to 5. To be used for risk prevention, the quality and limitations of the produced maps must be assessed. However, direct runoff data are very scarce and not available everywhere in a territory. Proxy data of impacts related to runoff can provide information useful for the evaluation of the IRIP maps. However, both pieces of information cannot be compared directly, and a specific methodology to compare susceptibility maps and proxy data must be proposed. This paper presents such a method, which accounts for the hazard level, the vulnerability of the study area and possible mitigation actions taken to reduce the risk. The evaluation method is assessed using a comprehensive database of runoff-related impacts collected on an 80 km railway line in Normandy (north of France) and covering the whole 20th century. The results show that the evaluation method is robust, relevant and generic enough for evaluating a non-quantitative method of runoff hazard mapping using localized runoff-related proxy data. In addition, the good performance of the IRIP model in the case study confirms that the susceptibility maps produced by the IRIP model provide relevant information related to runoff and that they can be used to design risk management strategies, as illustrated in the railway context.

The Land Use and Climate Across Scales Flagship Pilot Study (LUCAS FPS) is a coordinated community effort to improve the integration of land use change (LUC) in regional climate models (RCMs) and to quantify the biogeophysical effects of LUC on local to regional climate in Europe. In the first phase of LUCAS, nine RCMs are used to explore the biogeophysical impacts of re-/afforestation over Europe: two idealized experiments representing respectively a non-forested and a maximally forested Europe are compared in order to quantify spatial and temporal variations in the regional climate sensitivity to forestation. We find some robust features in the simulated response to forestation. In particular, all models indicate a year-round decrease in surface albedo, which is most pronounced in winter and spring at high latitudes. This results in a winter warming effect, with values ranging from +0.2 to +1 K on average over Scandinavia depending on models. However, there are also a number of strongly diverging responses. For instance, there is no agreement on the sign of temperature changes in summer with some RCMs predicting a widespread cooling from forestation (well below −2 K in most regions), a widespread warming (around +2 K or above in most regions) or a mixed response. A large part of the inter-model spread is attributed to the representation of land processes. In particular, differences in the partitioning of sensible and latent heat are identified as a key source of uncertainty in summer. Atmospheric processes, such as changes in incoming radiation due to cloud cover feedbacks, also influence the simulated response in most seasons. In conclusion, the multi-model approach we use here has the potential to deliver more robust and reliable information to stakeholders involved in land use planning, as compared to results based on single models. However, given the contradictory responses identified, our results also show that there are still fundamental uncertainties that need to be tackled to better anticipate the possible intended or unintended consequences of LUC on regional climates.

BackgroundHigh blood pressure or hypertension is a vastly prevalent chronic condition among adults that can, if not appropriately treated, contribute to several life-threatening secondary diseases and events, such as stroke. In addition to first-line medication, self-management in daily life is crucial for tertiary prevention and can be supported by mobile health apps, including medication reminders. However, the prescription of medical apps is a relatively novel approach. There is limited information regarding the determinants of acceptance of such mobile health (mHealth) apps among patients as potential users and physicians as impending prescribers in direct comparison. ObjectiveThe present study aims to investigate the determinants of the acceptance of health apps (in terms of intention to use) among patients for personal use and physicians for clinical use in German-speaking countries. Moreover, we assessed patients’ preferences regarding different delivery modes for self-care service (face-to-face services, apps, etc). MethodsBased on an extended model of the unified theory of acceptance and use of technology (UTAUT2), we performed a web-based cross-sectional survey to explore the acceptance of mHealth apps for self-management of hypertension among patients and physicians in Germany. In addition to UTAUT2 variables, we measured self-reported self-efficacy, eHealth literacy, previous experiences with health apps, perceived threat to privacy, and protection motivation as additional determinants of mHealth acceptance. Data from 163 patients and 46 physicians were analyzed using hierarchical regression and mediation analyses. ResultsAs expected, a significant influence of the unified theory of acceptance and use of technology (UTAUT) predictors on intentions to use hypertension apps was confirmed, especially for performance expectancy. Intention to use was moderate in patients (mean 3.5; SD 1.1; range 1-5) and physicians (mean 3.4, SD 0.9), and did not differ between both groups. Among patients, a higher degree of self-reported self-efficacy and protection motivation contributed to an increased explained variance in acceptance with R2=0.09, whereas eHealth literacy was identified as exerting a positive influence on physicians (increased R2=0.10). Furthermore, our findings indicated mediating effects of performance expectancy on the acceptance among patients but not among physicians. ConclusionsIn summary, this study has identified performance expectancy as the most important determinant of the acceptance of mHealth apps for self-management of hypertension among patients and physicians. Concerning patients, we also identified mediating effects of performance expectancy on the relationships between effort expectancy and social influence and the acceptance of apps. Self-efficacy and protection motivation also contributed to an increase in the explained variance in app acceptance among patients, whereas eHealth literacy was a predictor in physicians. Our findings on additional determinants of the acceptance of health apps may help tailor educational material and self-management interventions to the needs and preferences of prospective users of hypertension apps in future research.