Search

The widely used community model GEOS-Chem 12.0.0 and previous versions have been recognized to significantly overestimate the concentrations of gaseous nitric acid, aerosol nitrate, and aerosol ammonium over the United States. The concentrations of nitric acid are also significantly overpredicted in most global models participating in a recent model intercomparison study. In this study, we show that most or all of this overestimation issue appears to be associated with wet scavenging processes. The replacement of constant in-cloud condensation water (ICCW) assumed in GEOS-Chem standard versions with one varying with location and time from the assimilated meteorology significantly reduces mass loadings of nitrate and ammonium during the wintertime, while the employment of an empirical washout rate for nitric acid significantly decreases mass concentrations of nitric acid and ammonium during the summertime. Compared to the standard version, GEOS-Chem with updated ICCW and washout rate significantly reduces the simulated annual mean mass concentrations of nitric acid, nitrate, and ammonium at surface monitoring network sites in the US from 2.04 to 1.03, 1.89 to 0.88, and 1.09 to 0.68 µg m−3, respectively, in much better agreement with corresponding observed values of 0.83, 0.70, and 0.60 µg m−3, respectively. In addition, the agreement of model-simulated seasonal variations of corresponding species with measurements is also improved. The updated wet scavenging scheme improves the skill of the model in predicting nitric acid, nitrate, and ammonium concentrations, which are important species for air quality and climate.

DC, also referred to as Delta-C, measures enhanced light absorption of particulate matter (PM) samples at the near-ultraviolet (UV) range relative to the near-infrared range, which has been proposed previously as a woodsmoke marker due to the presence of enhanced UV light-absorbing materials from wood combustion. In this paper, we further evaluated the applications and limitations of using DC as both a qualitative and semi-quantitative woodsmoke marker via joint continuous measurements of PM2. 5 (by nephelometer pDR-1500) and light-absorptive PM (by 2-wavelength and 7-wavelength Aethalometer®) in three northeastern US cities/towns including Rutland, VT; Saranac Lake, NY and Ithaca, NY. Residential wood combustion has shown to be the predominant source of wintertime primary PM2. 5 emissions in both Rutland and Saranac Lake, where we conducted ambient measurements. In Ithaca, we performed woodsmoke plume measurements. We compared the pDR-1500 against a FEM PM2. 5 sampler (BAM 1020), and identified a close agreement between the two instruments in a woodsmoke-dominated ambient environment. The analysis of seasonal and diurnal trends of DC, black carbon (BC, 880 nm) and PM2. 5 concentrations supports the use of DC as an adequate qualitative marker. The strong linear relationships between PM2. 5 and DC in both woodsmoke-dominated ambient and plume environments suggest that DC can reasonably serve as a semi-quantitative woodsmoke marker. We propose a DC-based indicator for woodsmoke emission, which has shown to exhibit a relatively strong linear relationship with heating demand. While we observed reproducible PM2. 5–DC relationships in similar woodsmoke-dominated ambient environments, those relationships differ significantly with different environments, and among individual woodsmoke sources. Our analysis also indicates the potential for PM2. 5–DC relationships to be utilized to distinguish different combustion and operating conditions of woodsmoke sources, and that DC–heating-demand relationships could be adopted to estimate woodsmoke emissions. However, future studies are needed to elucidate those relationships.

'The Tropospheric Ozone Assessment Report' (TOAR) is an activity of the International Global Atmospheric Chemistry Project. This paper is a component of the report, focusing on the present-day distribution and trends of tropospheric ozone relevant to climate and global atmospheric chemistry model evaluation. Utilizing the TOAR surface ozone database, several figures present the global distribution and trends of daytime average ozone at 2702 non-urban monitoring sites, highlighting the regions and seasons of the world with the greatest ozone levels. Similarly, ozonesonde and commercial aircraft observations reveal ozone’s distribution throughout the depth of the free troposphere. Long-term surface observations are limited in their global spatial coverage, but data from remote locations indicate that ozone in the 21st century is greater than during the 1970s and 1980s. While some remote sites and many sites in the heavily polluted regions of East Asia show ozone increases since 2000, many others show decreases and there is no clear global pattern for surface ozone changes since 2000. Two new satellite products provide detailed views of ozone in the lower troposphere across East Asia and Europe, revealing the full spatial extent of the spring and summer ozone enhancements across eastern China that cannot be assessed from limited surface observations. Sufficient data are now available (ozonesondes, satellite, aircraft) across the tropics from South America eastwards to the western Pacific Ocean, to indicate a likely tropospheric column ozone increase since the 1990s. The 2014–2016 mean tropospheric ozone burden (TOB) between 60°N–60°S from five satellite products is 300 Tg ± 4%. While this agreement is excellent, the products differ in their quantification of TOB trends and further work is required to reconcile the differences. Satellites can now estimate ozone’s global long-wave radiative effect, but evaluation is difficult due to limited in situ observations where the radiative effect is greatest.

Abstract Robust chronologies and time equivalent tephra markers are essential to better understand spatial palaeoenvironmental response to past abrupt climatic changes. Identification of well-dated and widely dispersed volcanic ash by tephra and cryptotephra (microscopic volcanic ash) provides time synchronous tie-points and strongly reduces chronological uncertainties. Here, we present the major, minor and trace element analyses of cryptotephra shards in the Dead Sea Deep Drilling sedimentary record (DSDDP 5017-1A) matching the Campanian Ignimbrite (CI). This geochemical identification expands the known dispersal range of the CI to the southeastern Mediterranean, over 2300 km from the volcanic source. Due to the CI eruption occurring near-synchronous with North Atlantic ice surge of Heinrich Event 4 (HE4), this tephra provides insights into regional responses to large-scale climatic change in the Mediterranean. In the Dead Sea, the CI layer is associated with wetter climatic conditions. This contrasts with the contemporaneous occurrence of the CI deposition and dry conditions in the central and eastern Mediterranean suggesting a possible climate time-transgressive expansion of HE4. Our finding underscores the temporal and spatial complexity of regional climate responses and emphasises the importance of tephra as a time marker for studying large-scale climatic changes verses regional variations.

Abstract Tropospheric ozone plays a major role in Earth’s atmospheric chemistry processes and also acts as an air pollutant and greenhouse gas. Due to its short lifetime, and dependence on sunlight and precursor emissions from natural and anthropogenic sources, tropospheric ozone’s abundance is highly variable in space and time on seasonal, interannual and decadal time-scales. Recent, and sometimes rapid, changes in observed ozone mixing ratios and ozone precursor emissions inspired us to produce this up-to-date overview of tropospheric ozone’s global distribution and trends. Much of the text is a synthesis of in situ and remotely sensed ozone observations reported in the peer-reviewed literature, but we also include some new and extended analyses using well-known and referenced datasets to draw connections between ozone trends and distributions in different regions of the world. In addition, we provide a brief evaluation of the accuracy of rural or remote surface ozone trends calculated by three state-of-the-science chemistry-climate models, the tools used by scientists to fill the gaps in our knowledge of global tropospheric ozone distribution and trends.

Abstract Background Numerous upper airway anatomy characteristics are risk factors for sleep apnea, which affects 26% of older Americans, and more severe sleep apnea is associated with cognitive impairment. This study explores the pathophysiology and links between upper airway anatomy, sleep, and cognition. Methods Participants in the Multi-Ethnic Study of Atherosclerosis underwent an upper airway MRI, polysomnography to assess sleep measures including the apnea-hypopnea index (AHI) and completed the Cognitive Abilities Screening Instrument (CASI). Two model selection techniques selected from among 67 upper airway measures those that are most strongly associated with CASI score. The associations of selected upper airway measures with AHI, AHI with CASI score, and selected upper airway anatomy measures with CASI score, both alone and after adjustment for AHI, were assessed using linear regression. Results Soft palate volume, maxillary divergence, and upper facial height were significantly positively associated with higher CASI score, indicating better cognition. The coefficients were small, with a 1 standard deviation (SD) increase in these variables being associated with a 0.83, 0.75, and 0.70 point higher CASI score, respectively. Additional adjustment for AHI very slightly attenuated these associations. Larger soft palate volume was significantly associated with higher AHI (15% higher AHI (95% CI 2%,28%) per SD). Higher AHI was marginally associated with higher CASI score (0.43 (95% CI 0.01,0.85) per AHI doubling). Conclusions Three upper airway measures were weakly but significantly associated with higher global cognitive test performance. Sleep apnea did not appear to be the mechanism through which these upper airway and cognition associations were acting. Further research on the selected upper airway measures is recommended.

Abstract Strict emission control policies implemented in two megacities of New York City (NYC) and Beijing show impacts on the non-linear relationship of their ozone (O3) and fine particulate matter (PM2.5) during summertime. Here we show these non-linear O3-PM2.5 relationships including a positive linear part reflecting the O3/PM2.5 co-occurrence and a negative power function part reflecting the O3 formation suppression by PM2.5 based on the multiyear surface observations. The control policies targeting sulfur dioxide and PM2.5, then volatile organic compounds and nitrogen oxides, changed the PM2.5 chemical composition which resulted in an increased linear slope that indicates a weaker O3 control effect than occurred for PM2.5. These policies also enhanced the relative PM2.5 suppression effect as shown by an increase in the power function coefficient. Model simulations suggest that regional equal percentage emission reductions for Beijing and other Chinese megacities will be necessary to avoid further increase in the O3/PM2.5 linear slope and continuing occurrences of high levels of ozone.

Background: The objective of this study was to evaluate if imbalance influences complication rates, radiological outcomes, and patient-reported outcomes (PROMs) following adult spinal deformity (ASD) surgery. Methods: ASD patients with baseline and 2-year radiographic and PROMs were included. Patients were grouped according to whether they answered yes or no to a recent history of pre-operative loss of balance. The groups were propensity-matched by age, pelvic incidence–lumbar lordosis (PI-LL), and surgical invasiveness score. Results: In total, 212 patients were examined (106 in each group). Patients with gait imbalance had worse baseline PROM measures, including Oswestry disability index (45.2 vs. 36.6), SF-36 mental component score (44 vs. 51.8), and SF-36 physical component score (p < 0.001 for all). After 2 years, patients with gait imbalance had less pelvic tilt correction (−1.2 vs. −3.6°, p = 0.039) for a comparable PI-LL correction (−11.9 vs. −15.1°, p = 0.144). Gait imbalance patients had higher rates of radiographic proximal junctional kyphosis (PJK) (26.4% vs. 14.2%) and implant-related complications (47.2% vs. 34.0%). After controlling for age, baseline sagittal parameters, PI-LL correction, and comorbidities, patients with imbalance had 2.2-times-increased odds of PJK after 2 years. Conclusions: Patients with a self-reported loss of balance/unsteady gait have significantly worse PROMs and higher risk of PJK.

Atmospheric aqueous chemistry can have profound effects on our environment. The importance of chemistry within the atmospheric aqueous phase started gaining widespread attention in the 1970s as there was growing concern over the negative impacts on ecosystem health from acid deposition. Research at mountaintop observatories including Whiteface Mountain (WFM) showed that gas phase sulfur dioxide emissions react in cloud droplets to form sulfuric acid, which also impacted air quality by increasing aerosol mass loadings. The current study updates the long-term trends in cloud water composition at WFM for the period 1994–2021, with special consideration given to samples that have traditionally been excluded from analysis due to inorganic charge imbalance. We emphasize three major findings: (1) a growing abundance of total organic carbon (TOC), with annual median concentrations more than doubling since measurements began in 2009, (2) a growing imbalance between the measured inorganic cations and anions, consistent with independent rain water observations, implying that a substantial fraction of anions are no longer being measured with the historical suite of measurements, and (3) a growing number of samples exhibiting greater ammonium concentrations than sulfate plus nitrate concentrations, which now routinely describes over one-third of samples. Organic acids are identified as the most likely candidates for the missing anions, since the measured inorganic ion imbalance correlates strongly with measured TOC concentrations. An “inferred cloud droplet pH” is introduced to estimate the pH of the vast majority of cloud droplets as they reside in the atmosphere using a simple method to account for the expected mixing state of calcium and magnesium containing particles. While the inferred cloud droplet pH closely matches the measured bulk cloud water pH during the early years of the cloud water monitoring program, a growing discrepancy is found over the latter half of the record. We interpret these observations as indicating a growing fraction of cloud droplet acidity that is no longer accounted for by the measured sulfate, nitrate and ammonium concentrations. Altogether, these observations indicate that the chemical system at WFM has shifted away from a system dominated by sulfate to a system controlled by base cations, reactive nitrogen species and organic compounds. Further research is required to understand the effects on air quality, climate and ecosystem health.

Knowledge about the timing, amplitude and spatial gradients of Holocene environmental variability in the circum-Baltic region is key to understanding its responses to ongoing climate change. Based on a multi-dating and proxy approach, we reconstruct changes in productivity using total organic carbon (TOC) contents in sediments of Lake Kälksjön (KKJ) from west–central Sweden spanning the last 9612 (+255/-114) years. An exception is the period from 1878 CE until today, in which sedimentation was dominated by anthropogenic lake level lowering and land use. In-lake productivity was higher during periods of warmer winters with shortened ice cover and prolonged growing seasons. A multi-millennial increase in productivity throughout the last ∼ 9600 years is associated with progressively warmer winters in northwestern Europe, likely triggered by the coinciding increase in Northern Hemisphere winter insolation. Decadal to centennial periods of higher productivity in KKJ tend to correspond to warmer winters during a more positive North Atlantic Oscillation (NAO) polarity, as reconstructed for the last 8000 years. In consequence, we assume our decadal to centennial productivity record from KKJ sediments for the complete ∼ 9600 years to provide a qualitative record of NAO polarity. A shift towards higher productivity variability at ∼ 5450 cal a BP is hypothesized to reflect a reinforcement of NAO-like atmospheric circulation variability, possibly driven by more vigorous changes in North Atlantic deep-water formation.

Abstract In-depth understanding of the reorganization of the hydrological cycle in response to global climate change is crucial in highly sensitive regions like the eastern Mediterranean, where water availability is a major factor for socioeconomic and political development. The sediments of Lake Lisan provide a unique record of hydroclimatic change during the last glacial to Holocene transition (ca. 24–11 ka) with its tremendous water level drop of ~ 240 m that finally led to its transition into the present hypersaline water body—the Dead Sea. Here we utilize high-resolution sedimentological analyses from the marginal terraces and deep lake to reconstruct an unprecedented seasonal record of the last millennia of Lake Lisan. Aragonite varve formation in intercalated intervals of our record demonstrates that a stepwise long-term lake level decline was interrupted by almost one millennium of rising or stable water level. Even periods of pronounced water level drops indicated by gypsum deposition were interrupted by decades of positive water budgets. Our results thus highlight that even during major climate change at the end of the last glacial, decadal to millennial periods of relatively stable or positive moisture supply occurred which could have been an important premise for human sedentism.

Background: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. Objective: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. Study Design/Setting: Retrospective cohort study of a prospectively collected multicenter database. Methods: ASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility. Results: A total of 930 patients were considered. Following PSM, 253 “optimal” (O) and 253 “not optimal” (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%, p = 0.021) and major mechanical complications (12% vs. 22%, p = 0.002), and less reoperations (23% vs. 33%, p = 0.008). Adjusted analysis revealed O patients more often met MCID (minimal clinically important difference) in SF-36 PCS, SRS-22 Pain, and Appearance. Cost-utility-adjusted analysis determined that the O group generated better cost-utility by one year and maintained lower overall cost and costs per QALY (both p < 0.001) at two years. Conclusions: Fewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success.

Background: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlordosis (HL). Objective: The objective of the study is to evaluate patterns in treatment for CD patients with baseline (BL) HK and HL and understand how extreme curvature of the spine may influence surgical outcomes. Materials and Methods: Operative CD patients with BL and 1-year (1Y) radiographic data were included in the study. Patients were stratified based on BL C2–C7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (−6.96 ± 21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (

Annual and decadal-scale hydroclimatic variability describes key characteristics that are embedded into climate in situ and is of prime importance in subtropical regions. The study of hydroclimatic variability is therefore crucial to understand its manifestation and implications for climate derivatives such as hydrological phenomena and water availability. However, the study of this variability from modern records is limited due to their relatively short span, whereas model simulations relying on modern dynamics could misrepresent some of its aspects. Here we study annual to decadal hydroclimatic variability in the Levant using two sedimentary sections covering ∼ 700 years each, from the depocenter of the Dead Sea, which has been continuously recording environmental conditions since the Pleistocene. We focus on two series of annually deposited laminated intervals (i.e., varves) that represent two episodes of opposing mean climates, deposited during MIS2 lake-level rise and fall at ∼ 27 and 18 ka, respectively. These two series comprise alternations of authigenic aragonite that precipitated during summer and flood-borne detrital laminae deposited by winter floods. Within this record, aragonite laminae form a proxy of annual inflow and the extent of epilimnion dilution, whereas detrital laminae are comprised of sub-laminae deposited by individual flooding events. The two series depict distinct characteristics with increased mean and variance of annual inflow and flood frequency during “wetter”, with respect to the relatively “dryer”, conditions, reflected by opposite lake-level changes. In addition, decades of intense flood frequency (clusters) are identified, reflecting the in situ impact of shifting centennial-scale climate regimes, which are particularly pronounced during wetter conditions. The combined application of multiple time series analyses suggests that the studied episodes are characterized by weak and non-significant cyclical components of sub-decadal frequencies. The interpretation of these observations using modern synoptic-scale hydroclimatology suggests that Pleistocene climate changes resulted in shifts in the dominance of the key synoptic systems that govern rainfall, annual inflow and flood frequency in the eastern Mediterranean Sea over centennial timescales.

Abstract Here, we report a multi OMIC (transcriptome, proteome, and metabolome) approach to investigate molecular changes in lens fiber cells (FC) of mice exposed to cigarette smoke (CS). Pregnant mice were placed in a whole-body smoke chamber and a few days later pups were born, which were exposed to CS for 5 hours/day, 5 days/week for a total of 3½ months. We examined the mice exposed to CS for CS-related cataractogenesis after completion of the CS exposure but no cataracts were observed. Lenses of CS-exposed and age-matched, untreated control mice were extracted and lens FC were subjected to multi OMIC profiling. We identified 348 genes, 130 proteins, and 14 metabolites exhibiting significant (p

Objectives The Menstrual Practice Needs Scale (MPNS) is a comprehensive measure of menstrual self-care experience including access to sufficient, comfortable materials to catch or absorb bleeding, supportive spaces for managing menstruation and for disposal and laundering of used materials. It addresses a critical measurement gap to improve quantitative menstrual health research and programme evaluation. The scale was validated in a population of adolescent schoolgirls. This study appraises its performance among adult women.Design Cross-sectional survey.Setting and participants Seven cognitive interviews provided insights into the interpretability of scale items. A survey of 525 working women who had menstruated in the past 6 months (435 working in markets, 45 in schools and 45 working in healthcare facilities) in Mukono District, Uganda was used to test the dimensionality, reliability and validity of the measure.Results The 36 scale items were well understood by the study population. Dimensionality was tested for the 28 items relevant to women disposing of menstrual materials and 32 items relevant to those washing and reusing materials. The original subscale structure fit with the data, however, fell short of recommended thresholds for those disposing of materials (root mean squared error of approximation, RMSEA=0.069; Comparative Fit Index, CFI=0.840; Trucker-Lewis Index, TLI=0.824). An alternative subscale structure was an acceptable fit for those disposing (RMSEA=0.051; CFI=0.911; TLI=0.897) and reusing materials (RMSEA=0.053; CFI=0.915; TLI=0.904). MPNS total and subscale scores demonstrated acceptable internal consistency. Higher scores reflected more positive menstrual experiences and were associated with well-being (total score r=0.24, p

Menstrual health and hygiene (MHH) is an emerging public health priority. To support policy and practice, large-scale surveys monitoring water, sanitation, and hygiene and reproductive health have started to incorporate MHH. Insights gained from these surveys are contingent on the quality of the measures used. Performance Monitoring and Accountability 2020 (PMA2020) was one of the first survey programs to include MHH. We undertook four focus group discussions with resident enumerators and one with their female supervisors following the 2018 PMA2020 survey in Niamey, Niger and synthesized their insights on the performance of the MHH measures used. Enumerators reported that questions about menstruation were well tolerated and most were understood conceptually. Discussions identified missing response options for the places used for MHH and suggest that enumerator training should include common brands of menstrual materials to ensure data quality. Further, current questions seeking to capture the privacy and safety of locations used for MHH require modification or more intensive training efforts to consistently capture these concepts. Enumerator perspectives on menstrual needs in Niger highlight topics missing from MHH monitoring. Attending to enumerator expertise has the capacity to strengthen future surveys directed toward understudied health and development challenges such as MHH. HIGHLIGHTS Resident enumerators are a source of expertise on the performance of survey questions.; PMA2020 questions regarding menstrual health and hygiene (MHH) were acceptable to respondents.; Asking respondents to report the ‘privacy’ and ‘safety’ of their menstrual management location was the most challenging question to administer.; Resident enumerators described many MHH needs not captured by PMA2020 questions.;

Understanding global body balance can optimize the postoperative course for patients undergoing spinal or lower limb surgical realignment. This observational cohort study aimed to characterize patients with reported imbalance and identify predictors. The CDC establishes a representative sample annually via the NHANES. All participants who said “yes” (Imbalanced) or “no” (Balanced) to the following question were identified from 1999–2004: “During the past 12 months, have you had dizziness, difficulty with balance or difficulty with falling?” Univariate analyses compared Imbalanced versus Balanced subjects and binary logistic regression modeling predicted for Imbalance. Of 9964 patients, imbalanced (26.5%) were older (65.4 vs. 60.6 years), with more females (60% vs. 48%). Imbalanced subjects reported higher rates of comorbidities, including osteoporosis (14.4% vs. 6.6%), arthritis (51.6% vs. 31.9%), and low back pain (54.4% vs 32.7%). Imbalanced patients had more difficulty with activities, including climbing 10 steps (43.8% vs. 21%) and stooping/crouching/kneeling (74.3% vs. 44.7%), and they needed greater time to walk 20 feet (9.5 vs. 7.1 s). Imbalanced subjects had significantly lower caloric and dietary intake. Regression revealed that difficulties using fingers to grasp small objects (OR: 1.73), female gender (OR: 1.43), difficulties with prolonged standing (OR: 1.29), difficulties stooping/crouching/kneeling (OR: 1.28), and increased time to walk 20 feet (OR: 1.06) were independent predictors of Imbalance (all p < 0.05). Imbalanced patients were found to have identifiable comorbidities and were detectable using simple functional assessments. Structured tests that assess dynamic functional status may be useful for preoperative optimization and risk-stratification for patients undergoing spinal or lower limb surgical realignment.

In the United States, nearly 1.2 million people > 12 years old have human immunodeficiency virus (HIV), which is associated with postoperative complications following orthopedic procedures. Little is known about how asymptomatic HIV (AHIV) patients fare postoperatively. This study compares complications after common spine surgeries between patients with and without AHIV. The Nationwide Inpatient Sample (NIS) was retrospectively reviewed from 2005–2013, identifying patients aged > 18 years who underwent 2–3-level anterior cervical discectomy and fusion (ACDF), ≥4-level thoracolumbar fusion (TLF), or 2–3-level lumbar fusion (LF). Patients with AHIV and without HIV were 1:1 propensity score-matched. Univariate analysis and multivariable binary logistic regression were performed to assess associations between HIV status and outcomes by cohort. 2–3-level ACDF (n = 594 total patients) and ≥4-level TLF (n = 86 total patients) cohorts demonstrated comparable length of stay (LOS), rates of wound-related, implant-related, medical, surgical, and overall complications between AHIV and controls. 2–3-level LF (n = 570 total patients) cohorts had comparable LOS, implant-related, medical, surgical, and overall complications. AHIV patients experienced higher postoperative respiratory complications (4.3% vs. 0.4%,). AHIV was not associated with higher risks of medical, surgical, or overall inpatient postoperative complications following most spine surgical procedures. The results suggest the postoperative course may be improved in patients with baseline control of HIV infection.

Prematurity is associated with surgical complications. This study sought to determine the risk of prematurity on 30-day complications, reoperations, and readmissions following ≥7-level PSF for AIS which has not been established. Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP)-Pediatric dataset, all AIS patients undergoing ≥7-level PSF from 2012–2016 were identified. Cases were 1:1 propensity score-matched to controls by age, sex, and number of spinal levels fused. Prematurity sub-classifications were also evaluated: extremely (

Background: Age-adjusted alignment targets in the context of distal junctional kyphosis (DJK) development have yet to be investigated. Our aim was to assess age-adjusted alignment targets, reciprocal changes, and role of lowest instrumented level orientation in DJK development in cervical deformity (CD) patients. Methods: CD patients were evaluated based on lowest fused level: cervical (C7 or above), upper thoracic (UT: T1–T6), and lower thoracic (LT: T7–T12). Age-adjusted alignment targets were calculated using published formulas for sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), pelvic tilt (PT), T1 pelvic angle (TPA), and LL-thoracic kyphosis (TK). Outcome measures were cervical and global alignment parameters: Cervical SVA (cSVA), cervical lordosis, C2 slope, C2–T3 angle, C2–T3 SVA, TS-CL, PI-LL, PT, and SVA. Subanalysis matched baseline PI to assess age-adjusted alignment between DJK and non-DJK. Results: Seventy-six CD patients included. By 1Y, 20 patients developed DJK. Non-DJK patients had 27% cervical lowest instrumented vertebra (LIV), 68% UT, and 5% LT. DJK patients had 25% cervical, 50% UT, and 25% LT. There were no baseline or 1Y differences for PI, PI-LL, SVA, TPA, or PT for actual and age-adjusted targets. DJK patients had worse baseline cSVA and more severe 1Y cSVA, C2–T3 SVA, and C2 slope (P < 0.05). The distribution of over/under corrected patients and the offset between actual and ideal alignment for SVA, PT, TPA, PI-LL, and LL-TK were similar between DJK and non-DJK patients. DJK patients requiring reoperation had worse postoperative changes in all cervical parameters and trended toward larger offsets for global parameters. Conclusion: CD patients with severe baseline malalignment went on to develop postoperative DJK. Age-adjusted alignment targets did not capture differences in these populations, suggesting the need for cervical-specific goals.

Purpose: The aim is to investigate the relationship between cervical parameters and the modified Japanese Orthopedic Association scale (mJOA). Materials and Methods: Surgical adult cervical deformity (CD) patients were included in this retrospective analysis. After determining data followed a parametric distribution through the Shapiro–Wilk Normality (P = 0.15, P > 0.05), Pearson correlations were run for radiographic parameters and mJOA. For significant correlations, logistic regressions were performed to determine a threshold of radiographic measures for which the correlation with mJOA scores was most significant. mJOA score of 14 and 19° and 45°, χ2 = 7.8, P = 0.005), CL (M:-21° to 3°, χ2 = 8.947, P = 0.004; S: 49°, χ2 = 5.7, P = 0.008), and Frailty (Mild: 0.18–0.27, P = 0.129; Severe: >0.27, P = 0.002). Compared to existing Ames- International Spine Study Group classification, the novel thresholds demonstrated significant predictive value for reoperation and mortality up to 2 years. Conclusions: Collectively, these radiographic values can be utilized in refining existing classifications and developing collective understanding of severity and surgical targets in corrective surgery for adult CD.

Introduction: Osteotomies are commonly performed to correct sagittal malalignment in cervical deformity (CD). However, the risks and benefits of performing a major osteotomy for cervical deformity correction have been understudied. The objective of this retrospective cohort study was to investigate the risks and benefits of performing a major osteotomy for CD correction. Methods: Patients stratified based on major osteotomy (MAJ) or minor (MIN). Independent t-tests and Chi-squared tests were used to assess differences between MAJ and MIN. A sub-analysis compared patients with flexible versus rigid CL. Results: 137 CD patients were included (62 years, 65% F). 19.0% CD patients underwent a MAJ osteotomy. After propensity score matching for cSVA, 52 patients were included. About 19.0% CD patients underwent a MAJ osteotomy. MAJ patients had more minor complications (P = 0.045), despite similar surgical outcomes as MIN. At 3M, MAJ and MIN patients had similar NDI, mJOA, and EQ5D scores, however by 1 year, MAJ patients reached MCID for NDI less than MIN patients (P = 0.003). MAJ patients with rigid deformities had higher rates of complications (79% vs. 29%, P = 0.056) and were less likely to show improvement in NDI at 1 year (0.95 vs. 0.54, P = 0.027). Both groups had similar sagittal realignment at 1 year (all P > 0.05). Conclusions: Cervical deformity patients who underwent a major osteotomy had similar clinical outcomes at 3-months but worse outcomes at 1-year as compared to minor osteotomies, likely due to differences in baseline deformity. Patients with rigid deformities who underwent a major osteotomy had higher complication rates and worse clinical improvement despite similar realignment at 1 year.

Introduction: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), though patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD-corrective surgery with regards to HK and hyperlordosis (HL). Materials and Methods: Operative CD patients (C2-C7 Cobb >10°, cervical lordosis [CL] >10°, cervical sagittal vertical axis [cSVA] >4 cm, chin-brow vertical angle >25°) with baseline (BL) and 1Y radiographic data. Patients were stratified based on BL C2-7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (−6.96° ±21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (≤28.43°) depending on directionality. Patients within 1 SD were considered the control group. Results: One hundred and two surgical CD pts (61 years, 65%F, 30 kg/m2) with BL and 1Y radiographic data were included. Twenty pts met definitions for HK and 21 pts met definitions for HL. No differences in demographics or disability were noted. HK had higher estimated blood loss (EBL) with anterior approaches than HL but similar EBL with the posterior approach. Op-time did not differ between groups. Control, HL, and HK groups differed in BL TS-CL (36.6° vs. 22.5° vs. 60.7°, P < 0.001) and BL-sagittal vertical axis (SVA) (10.8 vs. 7.0 vs. −47.8 mm, P = 0.001). HL pts had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had × 3 revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, P = 0.046). At 1Y, HL pts had higher cSVA, and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK pts had higher McGregor's-slope (16.1° vs. −3.3°, P = 0.001) and C0-C2 Cobb (43.3° vs. 26.9°, P < 0.001), however postoperative differences in McGregor's slope and C0-C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary computed tomography (38.1%), upper thoracic (23.8%), and C (14.3%) drivers. Conclusions: Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1Y postoperative, perhaps due to undercorrection compared to kyphotic etiologies.

Reports of school and work absences due to unmet menstrual needs have prompted increased attention to menstruation in policy and practice. However, there appear to be few quantitative studies reported in published literature capturing the prevalence of this hypothesised absenteeism. This study undertook secondary analysis of nationally representative Performance Monitoring and Accountability 2020 (PMA2020) data from Burkina Faso and Nigeria, and city-representative data from Niamey, Niger to determine the extent of women’s and girls’ self-reported absence from school and work due to menstruation. Among women and adolescent girls aged 15–49 years who had worked outside the household in the past month in Burkina Faso (n = 998), Niger (n = 212) and Nigeria (n = 3638), 19%, 11% and 17%, respectively, reported missing work due to menstruation. Among those aged 15–24 years who attended school in the past year in Burkina Faso (n = 461), Niger (n = 213) and Nigeria (n = 1574), 17%, 15% and 23% reported missing school in the past year due to menstruation. Findings support the assertion that menstruation is a source of absenteeism in West Africa and indicate that greater attention from research, practice, and policy is needed. In presenting this data we also reflect critically on the performance of questions regarding menstrual-related absenteeism in national monitoring surveys. Future monitoring efforts should consider the interpretability of similar survey data when many respondents did not attend any school or work and were ineligible to answer questions regarding absenteeism. Further, without additional research identifying the reasons for absenteeism, findings from similar survey questions may be difficult to interpret with relevance for policy decision making.

As initiatives to support menstrual health are implemented globally, monitoring progress through a set of comprehensive indicators provides important feedback to direct policies and programs. One proposed core indicator is awareness of menstruation at menarche. That is, at the time of menarche an adolescent girl knowing that menstrual bleeding is something she will experience. In this investigation, we undertook secondary analysis of data collected across four studies to support interpretation of this indicator. We (1) describe the proportion of each sample aware of menstruation at menarche, (2) test variations in awareness according to sociodemographic characteristics, and (3) describe the associations between this indicator and self-reported experience at menarche, social support, and confidence to manage menstruation. Studies included cross-sectional survey data from 421 schoolgirls in Magway, Myanmar, 537 schoolgirls in Soroti, Uganda, 1,359 schoolgirls in Netrokona, Bangladesh, and 599 adult women working in Mukono, Uganda. Awareness of menstruation at menarche varied from 84% in Myanmar to 34% in Bangladesh. Older age at menarche was associated with awareness. Awareness at menarche was not associated with household poverty in the adolescent samples, but greater poverty was associated with lower levels of awareness among adult women. In Myanmar, girls aware of menstruation had significantly higher odds of reporting that they felt prepared (2.85 95% CI 1.34–6.08), happy (OR = 3.81 95% CI 1.74–8.37) and knew what was happening at menarche (OR = 2.37 95% CI 1.34–4.19). However, they also reported higher levels of embarrassment (OR = 1.76 95% CI 1.04–2.97) and did not report significantly less fear (OR = 1.24 95% CI 0.82–1.85). Awareness of menstruation at menarche was associated with higher scores on a menstrual knowledge quiz in both Myanmar (b = 9.51 95% CI 3.99–15.04) and Bangladesh (b = 4.78 95% CI 1.70–7.87). In these studies girls aware of menstruation at menarche also had higher odds of reporting they felt confident discussing menstruation with support sources and managing menstruation at school, while these differences were not significant among schoolgirls in Uganda. Findings support the usefulness of awareness of menstruation at menarche as an indicator to describe minimal knowledge of menstruation and suggest that awareness may signal greater knowledge, social support, and confidence in some settings.

Varved lake sediments provide climatic records with seasonal to annual resolution and low associated age uncertainty. Robust and detailed comparison of well-dated and annually laminated sediment records is crucial for reconstructing abrupt and regionally time-transgressive changes as well as validation of spatial and temporal trajectories of past climatic changes. The VARved sediments DAtabase (VARDA) presented here is the first data compilation for varve chronologies and associated palaeoclimatic proxy records. The current version 1.0 allows detailed comparison of published varve records from 95 lakes. VARDA is freely accessible and was created to assess outputs from climate models with high-resolution terrestrial palaeoclimatic proxies. VARDA additionally provides a technical environment that enables us to explore the database of varved lake sediments using a connected data model and can generate a state-of-the-art graphic representation of a multisite comparison. This allows the reassessment of existing chronologies and tephra events to synchronize and compare even distant varved lake records. Furthermore, the present version of VARDA permits the exploration of varve thickness data. In this paper, we report in detail on the data-mining and compilation strategies for the identification of varved lakes and assimilation of high-resolution chronologies, as well as the technical infrastructure of the database. Additional palaeoclimatic proxy data will be provided in forthcoming updates. The VARDA graph database and user interface can be accessed online at https://varve.gfz-potsdam.de (last access: 15 September 2020), all datasets of version 1.0 are available at https://doi.org/10.5880/GFZ.4.3.2019.003 (Ramisch et al., 2019).

Atmospheric particles can act as cloud condensation nuclei (CCN) and modify cloud properties and precipitation and thus indirectly impact the hydrological cycle and climate. New particle formation (NPF or nucleation), frequently observed at locations around the globe, is an important source of ultrafine particles and CCN in the atmosphere. In this study, wintertime NPF over the Northeastern United States (NEUS) is simulated with WRF-Chem coupled with a size-resolved (sectional) advanced particle microphysics (APM) model. Model-simulated variations in particle number concentrations during a 2-month period (November–December 2013) are in agreement with corresponding measurements taken at Pinnacle State Park (PSP), New York, and Appalachian State University (APP), North Carolina. We show that, even during wintertime, regional nucleation occurs and contributes significantly to ultrafine-particle and CCN number concentrations over the NEUS. The model shows that, due to low biogenic emissions during this period, wintertime regional nucleation is solely controlled by inorganic species and the newly developed ternary ion-mediated nucleation scheme is able to capture the variations in observed particle number concentrations (ranging from ∼200 to 20 000 cm−3) at both PSP and APP. Total particle and CCN number concentrations dramatically increase following NPF events and have the highest values over the Ohio Valley region, where elevated [SO2] is sustained by power plants. Secondary particles dominate particle number abundance over the NEUS, and their fraction increases with altitude from ≳85 % near the surface to ≳95 % in the upper troposphere. The secondary fraction of CCN also increases with altitude, from 20 %–50 % in the lower boundary layer to 50 %–60 % in the middle troposphere to 70 %–85 % in the upper troposphere.

Cells exhibit exceptional chemical sensitivity, yet we haven’t fully understood how they achieve it. Here the authors consider the mutual information between signals and two coupled sensors as a proxy for sensing performance and show its optimisation depending on noise level and signal statistics.

This study describes women's menstrual health needs at work in Uganda and explores the associations between unmet needs and women's work and wellbeing. We undertook a cross-sectional survey of women working in marketplaces, public primary schools, and health care facilities in Mukono district, central Uganda. Survey questions were designed to capture women's experiences of managing menstrual bleeding, pain, social support, and the social environment. A total 435 women working in markets, 45 teachers and 45 health care facility workers participated. Of these, 15% missed work due to their last period, and 41% would prefer not to work during menstruation. Unmet menstrual health needs were associated with consequences for women's work and psychological wellbeing. Experiencing menstrual pain (aPR 3.65 95%CI 1.48-9.00), along with the use of improvised menstrual materials (aPR 1.41 95%CI 1.08-1.83), not feeling comfortable to discuss menstruation at work (aPR 1.54 95%CI 1.01-2.34) and the expectation that women should stay home when menstruating (aPR 2.44 95%CI 1.30-4.60) were associated with absenteeism due to menstruation. In contrast, not having menstrual management needs met (aPR 1.45 95%CI 1.17-1.79) and the attitude that menstruating women are dirty (aPR 1.94 95%CI 1.50-2.51), along with pain (aPR 1.59 95%CI 1.12-2.24) and norms around absenteeism were associated with wanting to miss work. After adjustment for age and poverty, unmet menstrual management needs (b = -5.97, 95%CI -8.89, -2.97), pain (b = -3.89, 95%CI -7.71, -0.08) and poor social support (b = -5.40, 95%CI -9.22, -1.57) were associated with lower wellbeing measured using the WHO-5. Attitudes that menstruation should be kept secret (b = 4.48, 95%CI 0.79, 8.17) and is dirty (b = 4.59, 95%CI 0.79, 8.40) were associated with higher wellbeing. Findings suggest that supporting care for menstrual pain, addressing secrecy surrounding menstruation and the perception of menstruation as dirty, and improving access to materials and facilities for managing menstrual bleeding are avenues for programs and policies to support working women.

BackgroundRural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming. ObjectiveThe purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients. MethodsA total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry–derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ≥25 and approved patients for participation to receive a personalized referral letter via mail. ResultsOut of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P

Contamination of fomites by human norovirus (HuNoV) can initiate and prolong outbreaks. Fomite swabbing is necessary to predict HuNoV exposure and target interventions. Historically, swab recovered HuNoV has been measured by molecular methods that detect viral RNA but not infectious HuNoV. The recent development of HuNoV cultivation in human intestinal enteroids (HIEs) enables detection of infectious HuNoV. It is unknown if the swabbing process and swab matrix will allow for cultivation of fomite recovered HuNoV. We used HIEs to culture swab-recovered HuNoV GII.4 Sydney from experimentally infected surfaces—a hospital bed tray (N = 32), door handle (N = 10), and sanitizer dispenser (N = 11). Each surface was swabbed with macrofoam swabs premoistened in PBS plus 0.02% Tween80. Swab eluate was tested for infectious HuNoV by cultivation in HIE monolayers. Infectious HuNoV can be recovered from surfaces inoculated with at least 105 HuNoV genome equivalents/3 cm2. In total, 57% (N = 53) of recovered swabs contained infectious HuNoV detected by HIEs. No difference in percent positive swabs was observed between the three surfaces at p = 0.2. We demonstrate that fomite swabbing can be combined with the HIE method to cultivate high titer infectious HuNoV from the environment, filling a significant gap in HuNoV detection. Currently, high titers of HuNoV are required to measure growth in HIEs and the HIE system precludes absolute quantification of infectious viruses. However, the HIE system can provide a binary indication of infectious HuNoV which enhances existing detection methods. Identification of infectious HuNoVs from swabs can increase monitoring accuracy, enhance risk estimates, and help prevent outbreaks.

Introduction: Correction of cervical deformity (CD) often involves different types of osteotomies to address sagittal malalignment. This study assessed the relationship between osteotomy grade and vertebral level on alignment and clinical outcomes. Methods: Retrospective review of a multi-center prospectively collected CD database. CD was defined as at least one of the following: C2–C7 Cobb >10°, cervical lordosis (CL) >10°, C2–C7 sagittal vertical axis (cSVA) >4 cm, and chin-brow vertical angle > 25°. Patients were evaluated for level and type of cervical osteotomy. Results: 86 CD patients were included (61.4 ± 10.6 years, 66.3% female, body mass index 29.1 kg/m2). 141 osteotomies were in the cervical spine and 79 were in the thoracic spine. There were 19 major osteotomies performed, with 47% at T1. Patients with an osteotomy in the cervical spine improved in T1 slope minus CL (TS − CL), CL, and C2 slope (all P < 0.05). Patients with upper thoracic osteotomies improved in TS − CL, cSVA, C2–T3, C2–T3 sagittal vertical axis (SVA), and C2 slope (all P < 0.05). Minor osteotomies in the upper thoracic spine showed improvement in cSVA (63 mm to 49 mm, P = 0.022), C2–T3 ( P = 0.007), and SVA (−16 mm to 27 mm, P < 0.001). The greatest amount of C2–T3 angular change occurred for patients with a major osteotomy at T2 (39.1° change), then T3 (15.7°), C7 (16.9°°), and T1 (13.5°°). Patients with a major osteotomy in the upper thoracic spine showed similar radiographic changes from pre- to post-operative as patients with three or more minor osteotomies, although C2–T3 SVA trended toward greater improvement with a major osteotomy (−22.5 mm vs. +5.9 mm, P = 0.058) due to lever arm effect. Conclusions: CD patients undergoing osteotomies in the cervical and upper thoracic spine experienced improvement in TS–−CL and C2 slope. In the upper thoracic spine, multiple minor osteotomies achieved similar alignment changes to major osteotomies at a single level, while a major osteotomy focused at T2 had the greatest overall impact in cervicothoracic and global alignment in CD patients.

Statistical inference is central to many scientific endeavors, yet how it works remains unresolved. Answering this requires a quantitative understanding of the intrinsic interplay between statistical models, inference methods, and the structure in the data. To this end, we characterize the efficacy of direct coupling analysis (DCA)—a highly successful method for analyzing amino acid sequence data—in inferring pairwise interactions from samples of ferromagnetic Ising models on random graphs. Our approach allows for physically motivated exploration of qualitatively distinct data regimes separated by phase transitions. We show that inference quality depends strongly on the nature of data-generating distributions: optimal accuracy occurs at an intermediate temperature where the detrimental effects from macroscopic order and thermal noise are minimal. Importantly our results indicate that DCA does not always outperform its local-statistics-based predecessors; while DCA excels at low temperatures, it becomes inferior to simple correlation thresholding at virtually all temperatures when data are limited. Our findings offer insights into the regime in which DCA operates so successfully, and more broadly, how inference interacts with the structure in the data.