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Annette Eidam,1 Anja Roth,1 Eduard Frick,2 Michael Metzner,2 Anette Lampert,2,3 Hanna M Seidling,2,3 Walter E Haefeli,2,3 Jürgen M Bauer1,4 1Center for Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany; 2Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg, Germany; 3Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg, Germany; 4Network Aging Research (NAR), Heidelberg University, Heidelberg, GermanyCorrespondence: Annette Eidam, Center for Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany, Tel +49 6221-319-1795, Fax +49 6221-319-1505, Email Annette.Eidam@agaplesion.dePurpose: Medical decision-making in older adults with multiple chronic conditions and polypharmacy should include the individual patient’s treatment preferences. We developed and pilot-tested an electronic instrument (PolyPref) to elicit patient preferences in geriatric polypharmacy.Patients and Methods: PolyPref follows a two-stage direct approach to preference assessment. Stage 1 generates an individual preselection of relevant health outcomes and medication regimen characteristics, followed by stage 2, in which their importance is assessed using the Q-sort methodology. The feasibility of the instrument was tested in adults aged ≥ 70 years with ≥ 2 chronic conditions and regular intake of ≥ 5 medicines. After the assessment with PolyPref, the patients rated the tool with regard to its comprehensibility and usability and assessed the accuracy of the personal result. Evaluators rated the patients’ understanding of the task.Results: Eighteen short-term health outcomes, 3 long-term health outcomes, and 8 medication regimen characteristics were included in the instrument. The final population for the pilot study comprised 15 inpatients at a clinic for geriatric rehabilitation with a mean age of 80.6 (± 6.0) years, a median score of 28 (range 25– 30) points on the Mini-Mental State Examination, and a mean of 11.6 (± 3.6) regularly taken medicines. Feedback by the patients and the evaluators revealed ratings in favor of understanding and comprehensibility of 86.7% to 100%. The majority of the patients stated that their final result summarized the most important aspects of their pharmacotherapy (93.3%) and that its ranking order reflected their personal opinion (100%). Preference assessment took an average of 35 (± 8.5) min, with the instrument being handled by the evaluator in 14 of the 15 participants.Conclusion: Preference assessment with PolyPref was feasible in older adults with multiple chronic conditions and polypharmacy, offering a new strategy for the standardized evaluation of patient priorities in geriatric pharmacotherapy.Keywords: geriatric pharmacotherapy, medication priorities, multimorbidity, multiple chronic conditions, patient-centered, preference assessment

Annette Eidam, 1 Anja Roth, 1 André Lacroix, 1 Sabine Goisser, 1, 2 Hanna M Seidling, 3, 4 Walter E Haefeli, 3, 4 Jürgen M Bauer 1, 2 1Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg 69126, Germany; 2Network Aging Research (NAR), Heidelberg University, Heidelberg 69115, Germany; 3Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg 69120, Germany; 4Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg 69120, GermanyCorrespondence: Annette EidamCenter of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Rohrbacher Straße 149, Heidelberg 69126, GermanyTel +49 6221-319-1795Fax +49 6221-319-1505Email Annette.Eidam@bethanien-heidelberg.dePurpose: The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy.Material and Methods: Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy.Results: Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were “medication willingness” (description of a specific medication with inquiry of the participant’s willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, “MediMol” questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy.Conclusion: Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population.Keywords: polypharmacy, outcome priorities, multimorbidity, older adults, multiple chronic conditions, patient-centered

Sediment discharged from the Greenland Ice Sheet delivers nutrients to marine ecosystems around Greenland and shapes seafloor habitats. Current estimates of the total sediment flux are constrained by observations from land-terminating glaciers only. Addressing this gap, our study presents a budget derived from observations at 30 marine-margin locations. Analyzing sediment cores from nine glaciated fjords, we assess spatial deposition since 1950. A significant correlation is established between mass accumulation rates, normalized by surface runoff, and distance down-fjord. This enables calculating annual sediment flux at any fjord point based on nearby marine-terminating outlet glacier melt data. Findings reveal a total annual sediment flux of 1.324 + /- 0.79 Gt yr-1 over the period 2010-2020 from all marine-terminating glaciers to the fjords. These estimates are valuable for studies aiming to understand the basal ice sheet conditions and for studies predicting ecosystem changes in Greenlands fjords and offshore areas as the ice sheet melts and sediment discharge increase.

Through the Sediment, Ice, & Learning on the Tanana (SILT) project, a team of university scientists engaged two middle school student groups in testing innovative environmental research technologies to measure sediment flowing underneath river ice. The culturally responsive, place-based pilot program tests these technologies as a strategy to increase students' science interest and science self-efficacy. Over a series of three workshops, 39 students built and deployed low-cost turbidity sensors to measure sediment flowing underneath river ice and designed model payload attachment systems to attach the sensors to drones for measuring sediment fluxes during spring river ice breakup. Students' changes in science interest and self-efficacy were measured using both a true pre- and post-program survey and a retrospective pre-program survey.

Abstract Sediment discharged from the Greenland Ice Sheet delivers nutrients to marine ecosystems around Greenland and shapes seafloor habitats. Current estimates of the total sediment flux are constrained by observations from land-terminating glaciers only. Addressing this gap, our study presents a budget derived from observations at 30 marine-margin locations. Analyzing sediment cores from nine glaciated fjords, we assess spatial deposition since 1950. A significant correlation is established between mass accumulation rates, normalized by surface runoff, and distance down-fjord. This enables calculating annual sediment flux at any fjord point based on nearby marine-terminating outlet glacier melt data. Findings reveal a total annual sediment flux of 1.324 + /− 0.79 Gt yr-1 over the period 2010-2020 from all marine-terminating glaciers to the fjords. These estimates are valuable for studies aiming to understand the basal ice sheet conditions and for studies predicting ecosystem changes in Greenland’s fjords and offshore areas as the ice sheet melts and sediment discharge increase.

Abstract Background Anorexia of aging is characterized by an age‐associated reduction of appetite, whose aetiology in most cases is multifactorial and which often triggers malnutrition. The Simplified Nutritional Appetite Questionnaire (SNAQ) is an established screening tool. This study aimed to investigate reliability, validity, and feasibility of its telephone administration (T‐SNAQ) in German community‐dwelling older adults. Methods This cross‐sectional single‐centre study recruited participants from April 2021 to September 2021. First, the SNAQ was translated into German according to an established methodology. After translation, reliability, construct validity, and feasibility of the T‐SNAQ were analysed. A convenience sample of community‐dwelling older adults aged ≥70 years was recruited. The following measurements were applied to all participants: T‐SNAQ, Mini Nutritional Assessment – Short Form (MNA‐SF), six‐item Katz index of independence in activities of daily living (ADL), eight‐item Lawton instrumental activities of daily living (IADL), telephone Montreal Cognitive Assessment (T‐MoCA); FRAIL scale, Geriatric Depression Scale (GDS‐15) and Charlson co‐morbidity index as well as daily caloric and protein intake. Results One hundred twenty participants (59.2% female) with a mean age of 78.0 ± 5.8 years were included in the present study. The percentage of participants identified with poor appetite based on T‐SNAQ was 20.8% (n = 25). T‐SNAQ showed a good internal reliability with a Cronbach's alpha coefficient of 0.64 and a good test–retest reliability [intraclass coefficient of 0.95 (P

Abstract Himalayan lakes represent critical water resources, culturally important waterbodies, and potential hazards. Some of these lakes experience dramatic water-level changes, responding to seasonal monsoon rains and post-monsoonal draining. To address the paucity of direct observations of hydrology in retreating mountain glacial systems, we describe a field program in a series of high altitude lakes in Sagarmatha National Park, adjacent to Ngozumba, the largest glacier in Nepal. In situ observations find extreme (>12 m) seasonal water-level changes in a 60-m deep lateral-moraine-dammed lake (lacking surface outflow), during a 16-month period, equivalent to a 5 $$\times 10^6$$ × 10 6 m $$^3$$ 3 volume change annually. The water column thermal structure was also monitored over the same period. A hydraulic model is constructed, validated against observed water levels, and used to estimate hydraulic conductivities of the moraine soils damming the lake and improves our understanding of this complex hydrological system. Our findings indicate that lake level compared to the damming glacier surface height is the key criterion for large lake fluctuations, while lakes lying below the glacier surface, regulated by surface outflow, possess only minor seasonal water-level fluctuations. Thus, lakes adjacent to glaciers may exhibit very different filling/draining dynamics based on presence/absence of surface outflows and elevation relative to retreating glaciers, and consequently may have very different fates in the next few decades as the climate warms.

Frontal ablation, the combination of submarine melting and iceberg calving, changes the geometry of a glacier's terminus, influencing glacier dynamics, the fate of upwelling plumes and the distribution of submarine meltwater input into the ocean. Directly observing frontal ablation and terminus morphology below the waterline is difficult, however, limiting our understanding of these coupled ice–ocean processes. To investigate the evolution of a tidewater glacier's submarine terminus, we combine 3-D multibeam point clouds of the subsurface ice face at LeConte Glacier, Alaska, with concurrent observations of environmental conditions during three field campaigns between 2016 and 2018. We observe terminus morphology that was predominately overcut (52% in August 2016, 63% in May 2017 and 74% in September 2018), accompanied by high multibeam sonar-derived melt rates (4.84 m d−1 in 2016, 1.13 m d−1 in 2017 and 1.85 m d−1 in 2018). We find that periods of high subglacial discharge lead to localized undercut discharge outlets, but adjacent to these outlets the terminus maintains significantly overcut geometry, with an ice ramp that protrudes 75 m into the fjord in 2017 and 125 m in 2018. Our data challenge the assumption that tidewater glacier termini are largely undercut during periods of high submarine melting.

RESUMO Formação é a ideia de uma educação comprometida com a dignidade humana. A tarefa da escola consiste em possibilitar a formação nesse sentido. A educação não é nada mais do que a mediação e a promoção de capacidades que são necessárias para a vida em sociedades complexas. A pergunta central da formação constitui a pergunta pelo sentido e finalidade da educação em geral: como é possível uma vida para si mesma independente, em comum, autodeterminada e, ao mesmo tempo, responsável? A ideia de formação é, com isso, a pergunta do ser humano por si mesmo: quem somos nós? O que podemos ser? O que podemos e devemos ser uns para os outros?

We present a highly stable, easy-to-use, table-top coherent XUV source delivering a brightness of >1kW/(mm²sr)/1%BW at 130eV (9.5nm). It is based on high-harmonic generation driven by an ultrastable ytterbium-based fiber laser and a multipass-cell-based post- compression to 35fs.

Ice formation is generally considered to exclude many particles and most solutes and thus be relatively pure compared to ambient waters. Because river ice forms by a combination of thermal and mechanical processes, some level of sediment entrainment in the ice column is likely, though reports of sediment in river ice are limited. We observed high and sporadic levels of silt and sand in ice of the Kuskokwim and Tanana rivers (Alaska, the United States) during routine field studies. These observations led us to make a more comprehensive survey of sediment entrainment in river ice of the Kuskokwim and Yukon rivers and several of their tributaries. We collected and subsampled 48 ice cores from 19 different river locations in March 2023, which included concurrent measurements of water turbidity, velocity, and depth. Approximately 60% of cores contained detectable levels of sediment, averaging 438 mg/L with median concentrations exceeding 1000 mg/L in three cores from the Yukon and Kuskokwim main stems. Many cores had even higher concentrations at certain intervals, with seven cores having subsamples exceeding 2000 mg/L; these were often located in the middle or lower portion of the ice column. Jumble ice, formed mechanically by frazil‐pan jamming during freeze‐up, was generally the best predictor of higher sediment entrainment, and these locations often had higher under‐ice velocities and depths. Our observation of high and widespread sediment entrainment in northern river ice, particularly in jumble‐ice fields, may have implications for sediment transport regimes, ice strength and transportation safety, and how rivers break up in the springtime. [ABSTRACT FROM AUTHOR]

Seasonal sea ice impacts Arctic delta morphology by limiting wave and river influences and altering river‐to‐ocean sediment pathways. However, the long‐term effects of sea ice on delta morphology remain poorly known. To address this gap, 1D morphologic and hydrodynamic simulations were set up in Delft3D to study the 1500‐year development of Arctic deltas during the most energetic Arctic seasons: spring break‐up/freshet, summer open‐water, and autumn freeze‐up. The model focused on the deltaic clinoform (i.e., the vertical cross‐sectional view of a delta) and used a floating barge structure to mimic the effects of sea ice on nearshore waters. From the simulations we find that ice‐affected deltas form a compound clinoform morphology, that is, a coupled subaerial and subaqueous delta separated by a subaqueous platform that resembles the shallow platform observed offshore of Arctic deltas. Nearshore sea ice affects river dynamics and promotes sediment bypassing during sea ice break‐up, forming an offshore depocenter and building a subaqueous platform. A second depocenter forms closer to shore during the open‐water season at the subaerial foreset that aids in outbuilding the subaerial delta and assists in developing the compound clinoform morphology. Simulations of increased wave activity and reduced sea‐ice, likely futures under a warming Arctic climate, show that deltas may lose their shallow platform on centennial timescales by (a) sediment infill and/or (b) wave erosion. This study highlights the importance of sea ice on Arctic delta morphology and the potential morphologic transitions these high‐latitude deltas may experience as the Arctic continues to warm. Plain Language Summary: The shape of a river delta is affected by river, wave, and tidal forces. In the Arctic, the presence of seasonal sea ice is also thought to play an important role in shaping high‐latitude deltas. To investigate the effects of sea ice on Arctic delta shape, we used a popular computer model with a new representation of sea ice to examine delta growth. Our results showed that sea ice limits delta growth near the shoreline, but accelerates growth further away at sea. It leads to a large underwater platform, which is consistent with the morphology (shape) of Arctic deltas. The results were used to test future Arctic warming conditions when a reduction in sea ice coverage is likely. Future modeled simulations showed that Arctic deltas may lose the shallow underwater platform from increases in infilling by river sediments or increases in wave erosion. These results shed light on the impacts sea ice has on shaping Arctic deltas and potential changes that may occur to these delta systems as the Arctic continues to warm. Key Points: 1D Delft3D simulations of delta growth under sea‐ice show compound clinoform developmentNearshore sea‐ice promotes sediment bypassing and the development of a shallow subaqueous topset (2‐m deep)Arctic deltas may lose the shallow 2‐m‐deep topset if future sea ice coverage continues to decline and river and wave influence grows [ABSTRACT FROM AUTHOR]