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INTRODUCTION: We previously reported global regional differences in smoking cessation outcomes, with smokers of US origin having lower quit rates than smokers from some other countries. This post-hoc analysis examined global regional differences in individual-level and country-level epidemiological, economic and tobacco regulatory factors that may affect cessation outcomes. METHODS: EAGLES (Evaluating Adverse Events in a Global Smoking Cessation Study) was a randomised controlled trial that evaluated first-line cessation medications and placebo in 8144 smokers with and without psychiatric disorders from 16 countries across seven regions. Generalised linear and stepwise logistic regression models that considered pharmacotherapy treatment, psychiatric diagnoses, traditional individual-level predictors (eg, demographic and smoking characteristics) and country-specific smoking prevalence rates, gross domestic product (GDP) per capita, relative cigarette cost and WHO-derived MPOWER scores were used to predict 7-day point prevalence abstinence at the end of treatment. RESULTS: In addition to several traditional predictors, three of four country-level variables predicted short-term abstinence: GDP (0.54 (95% CI 0.47, 0.63)), cigarette relative income price (0.62 (95% CI 0.53, 0.72)) and MPOWER score (1.03 (95% CI 1.01, 1.06)). Quit rates varied across regions (22.0% in Australasia to 55.9% in Mexico). With northern North America (USA and Canada) as the referent, the likelihood of achieving short-term abstinence was significantly higher in Western Europe (OR 1.4 (95% CI 1.14, 1.61)), but significantly lower in Eastern Europe (0.39 (95% CI 0.22, 0.69)) and South America (0.17 (95% CI 0.08, 0.35)). CONCLUSIONS: Increased tobacco regulation was associated with enhanced quitting among participants in the EAGLES trial. Paradoxically, lower GDP, and more affordable cigarette pricing relative to a countrys GDP, were also associated with higher odds of quitting. Geographical region was also a significant independent predictor. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT01456936.

Introduction: Neurogenic pulmonary edema is a rare and potentially life-threatening condition that can present as severe pulmonary edema after significant neurologic insults. This is the first documented instance that shows a plausible causal link between cannabis consumption, psychogenic polydipsia, and the subsequent development of neurogenic pulmonary edema associated with status epilepticus secondary to acute hyponatremia.Case Report: We report a case of a 34-year-old female who presented to the emergency department altered and postictal after a witnessed new-onset seizure. She developed significant respiratory distress that required intubation. Her sodium was 121 millimoles per liter (mmol/L), from 137 mmol/L 36 hours prior on routine outpatient labs. Further history revealed excessive water ingestion after eating a cannabis edible prior to the seizure.Conclusion: This case highlights the importance of recognizing neurogenic pulmonary edema in connection with psychogenic polydipsia, severe hyponatremia, and status epilepticus subsequent to cannabis consumption.

Arid and semi-arid regions of the world are particularly vulnerable to greenhouse gas-driven hydroclimate change. Climate models are our primary tool for projecting the future hydroclimate that society in these regions must adapt to, but here, we present a concerning discrepancy between observed and model-based historical hydroclimate trends. Over the arid/semi-arid regions of the world, the predominant signal in all model simulations is an increase in atmospheric water vapor, on average, over the last four decades, in association with the increased water vapor-holding capacity of a warmer atmosphere. In observations, this increase in atmospheric water vapor has not happened, suggesting that the availability of moisture to satisfy the increased atmospheric demand is lower in reality than in models in arid/semi-arid regions. This discrepancy is most clear in locations that are arid/semi-arid year round, but it is also apparent in more humid regions during the most arid months of the year. It indicates a major gap in our understanding and modeling capabilities which could have severe implications for hydroclimate projections, including fire hazard, moving forward.

Significance There are sex effects in abstinence outcomes across all smoking cessation medications, but there is limited information regarding sex effects on cessation-related neuropsychiatric adverse events (NPSAEs) or interactions with psychiatric status.MethodsSecondary analysis of data from EAGLES of 8144 adults who smoke cigarettes randomized to varenicline, bupropion, nicotine patch or placebo. Design characteristics included region (within/outside US), psychiatric cohort (absent/present), and treatment. Baseline variables included demographics, smoking history, prior use of study treatments, lifetime suicide-related history, and prior psychiatric co-morbidities and medication use. Design characteristics were forced into logistic regressions models, and then interactions among sex, design elements, and baseline characteristics were evaluated for NPSAEs and 6-month cessation outcomes.ResultsFindings demonstrated a significant interaction of sex and race (p

Desert dust accounts for most of the atmosphere's aerosol burden by mass and produces numerous important impacts on the Earth system. However, current global climate models (GCMs) and land-surface models (LSMs) struggle to accurately represent key dust emission processes, in part because of inadequate representations of soil particle sizes that affect the dust emission threshold, surface roughness elements that absorb wind momentum, and boundary-layer characteristics that control wind fluctuations. Furthermore, because dust emission is driven by small-scale (~ 1 km or smaller) processes, simulating the global cycle of desert dust in GCMs with coarse horizontal resolutions (~100 km) presents a fundamental challenge. This representation problem is exacerbated by dust emission fluxes scaling nonlinearly with wind speed above a threshold wind speed that is sensitive to land-surface characteristics. Here, we address these fundamental problems underlying the simulation of dust emissions in GCMs and LSMs by developing improved descriptions of (1) the effect of soil texture on the dust emission threshold, (2) the effects of nonerodible roughness elements (both rocks and green vegetation) on the surface wind stress, and (3) the effects of boundary-layer turbulence on driving intermittent dust emissions. We then use the resulting revised dust emission parameterization to simulate global dust emissions in a standalone model forced by reanalysis meteorology and land-surface fields. We further propose (4) a simple methodology to rescale lower-resolution dust emission simulations to match the spatial variability of higher-resolution emission simulations in GCMs. The resulting dust emission simulation shows substantially improved agreement against regional dust emissions observationally constrained by inverse modeling. We thus find that our revised dust emission parameterization can substantially improve dust emission simulations in GCMs and LSMs.

Global estimates of the land carbon sink are often based on simulations by terrestrial biosphere models (TBMs). The use of a large number of models that differ in their underlying hypotheses, structure and parameters is one way to assess the uncertainty in the historical land carbon sink. Here we show that the atmospheric forcing datasets used to drive these TBMs represent a significant source of uncertainty that is currently not systematically accounted for in land carbon cycle evaluations. We present results from three TBMs each forced with three different historical atmospheric forcing reconstructions over the period 1850-2015. We perform an analysis of variance to quantify the relative uncertainty in carbon fluxes arising from the models themselves, atmospheric forcing, and model-forcing interactions. We find that atmospheric forcing in this set of simulations plays a dominant role on uncertainties in global gross primary productivity (GPP) (75% of variability) and autotrophic respiration (90%), and a significant but reduced role on net primary productivity and heterotrophic respiration (30%). Atmospheric forcing is the dominant driver (52%) of variability for the net ecosystem exchange flux, defined as the difference between GPP and respiration (both autotrophic and heterotrophic respiration). In contrast, for wildfire-driven carbon emissions model uncertainties dominate and, as a result, model uncertainties dominate for net ecosystem productivity. At regional scales, the contribution of atmospheric forcing to uncertainty shows a very heterogeneous pattern and is smaller on average than at the global scale. We find that this difference in the relative importance of forcing uncertainty between global and regional scales is related to large differences in regional model flux estimates, which partially offset each other when integrated globally, while the flux differences driven by forcing are mainly consistent across the world and therefore add up to a larger fractional contribution to global uncertainty.

ImportanceImproving treatment outcomes for smokers with major depressive disorder (MDD) can have significant public health implications.ObjectiveTo evaluate the safety and efficacy of smoking cessation pharmacotherapy among smokers with MDD.DesignSecondary analysis of a randomized, double-blind, active- (nicotine patch) and placebo-controlled trial of 12 weeks of either varenicline or bupropion with a 12-week follow-up.ParticipantsCommunity volunteers 18-75 years of age; smoke 10+ cigarettes/day; with clinically stable MDD (N = 2635) or no psychiatric disorder (N = 4028), from 140 sites in 16 countries.InterventionTwelve weeks of pharmacotherapy (placebo [PLA], nicotine replacement therapy [NRT], bupropion [BUP], varenicline [VAR]) plus brief cessation counseling.Measure(s)Primary safety outcome: the occurrence of ≥1 treatment-emergent, moderate to severe neuropsychiatric adverse event (NPSAE). Primary efficacy outcome: biochemically confirmed continuous abstinence (CA) during the final 4 weeks of treatment (Weeks 9-12).ResultsA total of 6653 participants (56% female; 39% MDD) ~47 years old. Risk of NPSAEs did not differ by medication for MDD. MDD had higher risk (p

Biophysical effects from deforestation have the potential to amplify carbon losses but are often neglected in carbon accounting systems. Here we use both Earth system model simulations and satellite-derived estimates of aboveground biomass to assess losses of vegetation carbon caused by the influence of tropical deforestation on regional climate across different continents. In the Amazon, warming and drying arising from deforestation result in an additional 5.1 ± 3.7% loss of aboveground biomass. Biophysical effects also amplify carbon losses in the Congo (3.8 ± 2.5%) but do not lead to significant additional carbon losses in tropical Asia due to its high levels of annual mean precipitation. These findings indicate that tropical forests may be undervalued in carbon accounting systems that neglect climate feedbacks from surface biophysical changes and that the positive carbon-climate feedback from deforestation-driven climate change is higher than the feedback originating from fossil fuel emissions.