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BackgroundA wealth of clinically relevant information is only obtainable within unstructured clinical narratives, leading to great interest in clinical natural language processing (NLP). While a multitude of approaches to NLP exist, current algorithm development approaches have limitations that can slow the development process. These limitations are exacerbated when the task is emergent, as is the case currently for NLP extraction of signs and symptoms of COVID-19 and postacute sequelae of SARS-CoV-2 infection (PASC). ObjectiveThis study aims to highlight the current limitations of existing NLP algorithm development approaches that are exacerbated by NLP tasks surrounding emergent clinical concepts and to illustrate our approach to addressing these issues through the use case of developing an NLP system for the signs and symptoms of COVID-19 and PASC. MethodsWe used 2 preexisting studies on PASC as a baseline to determine a set of concepts that should be extracted by NLP. This concept list was then used in conjunction with the Unified Medical Language System to autonomously generate an expanded lexicon to weakly annotate a training set, which was then reviewed by a human expert to generate a fine-tuned NLP algorithm. The annotations from a fully human-annotated test set were then compared with NLP results from the fine-tuned algorithm. The NLP algorithm was then deployed to 10 additional sites that were also running our NLP infrastructure. Of these 10 sites, 5 were used to conduct a federated evaluation of the NLP algorithm. ResultsAn NLP algorithm consisting of 12,234 unique normalized text strings corresponding to 2366 unique concepts was developed to extract COVID-19 or PASC signs and symptoms. An unweighted mean dictionary coverage of 77.8% was found for the 5 sites. ConclusionsThe evolutionary and time-critical nature of the PASC NLP task significantly complicates existing approaches to NLP algorithm development. In this work, we present a hybrid approach using the Open Health Natural Language Processing Toolkit aimed at addressing these needs with a dictionary-based weak labeling step that minimizes the need for additional expert annotation while still preserving the fine-tuning capabilities of expert involvement.

Abstract During the 2015–2016 El Niño, the Amazon basin released almost one gigaton of carbon (GtC) into the atmosphere due to extreme temperatures and drought. The link between the drought impact and recovery of the total carbon pools and its biogeochemical drivers is still unknown. With satellite‐constrained net carbon exchange and its component fluxes including gross primary production and fire emissions, we show that the total carbon loss caused by the 2015–2016 El Niño had not recovered by the end of 2018. Forest ecosystems over the Northeastern (NE) Amazon suffered a cumulative total carbon loss of ∼0.6 GtC through December 2018, driven primarily by a suppression of photosynthesis whereas southeastern savannah carbon loss was driven in part by fire. We attribute the slow recovery to the unexpected large carbon loss caused by the severe atmospheric aridity coupled with a water storage deficit during drought. We show the attenuation of carbon uptake is three times higher than expected from the pre‐drought sensitivity to atmospheric aridity and ground water supply. Our study fills an important knowledge gap in our understanding of the unexpectedly enhanced response of carbon fluxes to atmospheric aridity and water storage deficit and its impact on regional post‐drought recovery as a function of the vegetation types and climate perturbations. Our results suggest that the disproportionate impact of water supply and demand could compromise resiliency of the Amazonian carbon balance to future increases in extreme events.

Avian malaria is expanding upslope with warmer temperatures and driving multiple species of Hawaiian birds towards extinction. Methods to reduce malaria transmission are urgently needed to prevent further declines. Releasing Wolbachia-infected incompatible male mosquitoes could suppress mosquito populations and releasing Wolbachia-infected female mosquitoes (or both sexes) could reduce pathogen transmission if the Wolbachia strain reduced vector competence. We cleared Culex quinquefasciatus of their natural Wolbachia pipientis wPip infection and transinfected them with Wolbachia wAlbB isolated from Aedes albopictus. We show that wAlbB infection was transmitted transovarially, and demonstrate cytoplasmic incompatibility with wild-type mosquitoes infected with wPip from Oahu and Maui, Hawaii. We measured vector competence for avian malaria, Plasmodium relictum, lineage GRW4, of seven mosquito lines (two with wAlbB; three with natural wPip infection, and two cleared of Wolbachia infection) by allowing them to feed on canaries infected with recently collected field isolates of Hawaiian P. relictum. We tested 73 groups (Ntotal = 1176) of mosquitoes for P. relictum infection in abdomens and thoraxes 6-14 days after feeding on a range of parasitemias from 0.028% to 2.49%, as well as a smaller subset of salivary glands. We found no measurable effect of Wolbachia on any endpoint, but strong effects of parasitemia, days post feeding, and mosquito strain on both abdomen and thorax infection prevalence. These results suggest that releasing male wAlbB-infected C. quinquefasciatus mosquitoes could suppress wPip-infected mosquito populations, but would have little positive or negative impact on mosquito vector competence for P. relictum if wAlbB became established in local mosquito populations. More broadly, the lack of Wolbachia effects on vector competence we observed highlights the variable impacts of both native and transinfected Wolbachia infections in mosquitoes.

Abstract Background Self-discharge is a risk factor for readmission and excess mortality. We assess the rate of self-discharge from the emergency department (ED) among presentations for acute recreational drug toxicity and identify factors associated with self-discharge. Methods From the Euro-DEN Plus database of presentations to the ED with acute recreational drug toxicity, we extracted data from 11 centres in seven European countries from 2014 to 2017. Self-discharge was defined as taking one’s own discharge or escaping from the ED before being medically cleared. We used multiple logistic regression analyses to look for factors associated with self-discharge. Results Among 15,135 included presentations, 1807 (11.9%) self-discharged. Self-discharge rates varied from 1.7 to 17.1% between centres. Synthetic cannabinoids were associated with self-discharge, adjusted odds ratio 1.44 (95% confidence interval 1.10–1.89), as were heroin, 1.44 (1.26–1.64), agitation, 1.27 (1.10–1.46), and naloxone treatment, 1.27 (1.07–1.51), while sedation protected from self-discharge, 0.38 (0.30–0.48). Conclusion One in eight presentations self-discharged. There was a large variation in self-discharge rates across the participating centres, possibly partly reflecting different discharge procedures and practices. Measures to improve the management of agitation and cautious administration of naloxone to avoid opioid withdrawal symptoms may be approaches worth exploring to reduce self-discharge.

Abstract Patients exposed to trauma often experience high rates of adverse post-traumatic neuropsychiatric sequelae (APNS). The biological mechanisms promoting APNS are currently unknown, but the microbiota-gut-brain axis offers an avenue to understanding mechanisms as well as possibilities for intervention. Microbiome composition after trauma exposure has been poorly examined regarding neuropsychiatric outcomes. We aimed to determine whether the gut microbiomes of trauma-exposed emergency department patients who develop APNS have dysfunctional gut microbiome profiles and discover potential associated mechanisms. We performed metagenomic analysis on stool samples (n = 51) from a subset of adults enrolled in the Advancing Understanding of RecOvery afteR traumA (AURORA) study. Two-, eight- and twelve-week post-trauma outcomes for post-traumatic stress disorder (PTSD) (PTSD checklist for DSM-5), normalized depression scores (PROMIS Depression Short Form 8b) and somatic symptom counts were collected. Generalized linear models were created for each outcome using microbial abundances and relevant demographics. Mixed-effect random forest machine learning models were used to identify associations between APNS outcomes and microbial features and encoded metabolic pathways from stool metagenomics. Microbial species, including Flavonifractor plautii, Ruminococcus gnavus and, Bifidobacterium species, which are prevalent commensal gut microbes, were found to be important in predicting worse APNS outcomes from microbial abundance data. Notably, through APNS outcome modeling using microbial metabolic pathways, worse APNS outcomes were highly predicted by decreased L-arginine related pathway genes and increased citrulline and ornithine pathways. Common commensal microbial species are enriched in individuals who develop APNS. More notably, we identified a biological mechanism through which the gut microbiome reduces global arginine bioavailability, a metabolic change that has also been demonstrated in the plasma of patients with PTSD.

Abstract Two-dimensional materials have unusual properties and promise applications in nanoelectronics, spintronics, photonics, (electro)catalysis, separations, and elsewhere. Most are inorganic and their properties are difficult to tune. Here we report the preparation of Zn porphene, a member of the previously only hypothetical organic metalloporphene family. Similar to graphene, these also are fully conjugated two-dimensional polymers, but are composed of fused metalloporphyrin rings. Zn porphene is synthesized on water surface by two-dimensional oxidative polymerization of a Langmuir layer of Zn porphyrin with K2IrCl6, reminiscent of known one-dimensional polymerization of pyrroles. It is transferable to other substrates and bridges μm-sized pits. Contrary to previous theoretical predictions of metallic conductivity, it is a p-type semiconductor due to a predicted Peierls distortion of its unit cell from square to rectangular, analogous to the appearance of bond-length alternation in antiaromatic molecules. The observed reversible insertion of various metal ions, possibly carrying a fifth or sixth ligand, promises tunability and even patterning of circuits on an atomic canvas without removing any π centers from conjugation.

Background: For years, surgical debridement with autografting has been considered the standard of care in the treatment of severe burns of the hand. However, in recent years, enzymatic debridement has increasingly been reported as a good alternative, especially for burns of the hand, as it selectively preserves viable tissue. In this study, we aim to evaluate the long-term function of the hand after enzymatic debridement in deep dermal burns. Methods: A retrospective chart review was conducted as well as measurements of subjective and objective outcome measures through physical examination and Disabilities of the Arm, Shoulder, and Hand (DASH), Patient and Observer Scar Assessment Scale (POSAS), and Vancouver Scar Scale (VSS) scores. Results: A total of 32 enzymatically debrided hands of 24 patients were included with a mean age of 42.4 ± 16.8 years and a mean follow-up of 31 months. Postoperatively, 19 of these could be managed conservatively using skin substitutes such as “Suprathel”, 13 had to undergo subsequent autografting. The mean DASH score for the entire study population was eight with a mean value of four in the conservatively managed group and fourteen in the autografted group. The mean Patient, Observer POSAS, and VSS values were nineteen, thirteen, and two. A total of 30 cases showed an effortless complete fist closure, and, also in 30 cases, patients attested to be satisfied with the esthetic appearance of the hand on being asked. Conclusions: The descriptive analysis of these results in our study population suggests that the enzymatic debridement of deep burns of the hand, especially combined with subsequent conservative management with skin substitutes, was associated with low long-term hand disability scores at a follow-up of two years.

BackgroundPost-traumatic stress disorder (PTSD) and substance use (tobacco, alcohol, and cannabis) are highly comorbid. Many factors affect this relationship, including sociodemographic and psychosocial characteristics, other prior traumas, and physical health. However, few prior studies have investigated this prospectively, examining new substance use and the extent to which a wide range of factors may modify the relationship to PTSD.MethodsThe Advancing Understanding of RecOvery afteR traumA (AURORA) study is a prospective cohort of adults presenting at emergency departments (N = 2,943). Participants self-reported PTSD symptoms and the frequency and quantity of tobacco, alcohol, and cannabis use at six total timepoints. We assessed the associations of PTSD and future substance use, lagged by one timepoint, using the Poisson generalized estimating equations. We also stratified by incident and prevalent substance use and generated causal forests to identify the most important effect modifiers of this relationship out of 128 potential variables.ResultsAt baseline, 37.3% (N = 1,099) of participants reported likely PTSD. PTSD was associated with tobacco frequency (incidence rate ratio (IRR): 1.003, 95% CI: 1.00, 1.01, p = 0.02) and quantity (IRR: 1.01, 95% CI: 1.001, 1.01, p = 0.01), and alcohol frequency (IRR: 1.002, 95% CI: 1.00, 1.004, p = 0.03) and quantity (IRR: 1.003, 95% CI: 1.001, 1.01, p = 0.001), but not with cannabis use. There were slight differences in incident compared to prevalent tobacco frequency and quantity of use; prevalent tobacco frequency and quantity were associated with PTSD symptoms, while incident tobacco frequency and quantity were not. Using causal forests, lifetime worst use of cigarettes, overall self-rated physical health, and prior childhood trauma were major moderators of the relationship between PTSD symptoms and the three substances investigated.ConclusionPTSD symptoms were highly associated with tobacco and alcohol use, while the association with prospective cannabis use is not clear. Findings suggest that understanding the different risk stratification that occurs can aid in tailoring interventions to populations at greatest risk to best mitigate the comorbidity between PTSD symptoms and future substance use outcomes. We demonstrate that this is particularly salient for tobacco use and, to some extent, alcohol use, while cannabis is less likely to be impacted by PTSD symptoms across the strata.

[This corrects the article DOI: 10.1371/journal.pgph.0001644.].

Abstract Methane, a powerful greenhouse gas, has a short atmospheric lifetime ( ~ 12 years), so that emissions reductions will have a rapid impact on climate forcing. In megacities such as Los Angeles (LA), natural gas (NG) leakage is the primary atmospheric methane source. The magnitudes and trends of fugitive NG emissions are largely unknown and need to be quantified to verify compliance with emission reduction targets. Here we use atmospheric remote sensing data to show that, in contrast to the observed global increase in methane emissions, LA area emissions decreased during 2011-2020 at a mean rate of (–1.57 ± 0.41) %/yr. However, the NG utility calculations indicate a much larger negative emissions trend of −5.8 %/yr. The large difference between top-down and bottom-up trends reflects the uncertainties in estimating the achieved emissions reductions. Actions taken in LA can be a blueprint for COP28 and future efforts to reduce methane emissions.

Abstract The authors sought to characterize adverse posttraumatic neuropsychiatric sequelae (APNS) symptom trajectories across ten symptom domains (pain, depression, sleep, nightmares, avoidance, re-experiencing, anxiety, hyperarousal, somatic, and mental/fatigue symptoms) in a large, diverse, understudied sample of motor vehicle collision (MVC) survivors. More than two thousand MVC survivors were enrolled in the emergency department (ED) and completed a rotating battery of brief smartphone-based surveys over a 2-month period. Measurement models developed from survey item responses were used in latent growth curve/mixture modeling to characterize homogeneous symptom trajectories. Associations between individual trajectories and pre-trauma and peritraumatic characteristics and traditional outcomes were compared, along with associations within and between trajectories. APNS across all ten symptom domains were common in the first two months after trauma. Many risk factors and associations with high symptom burden trajectories were shared across domains. Both across and within traditional diagnostic boundaries, APNS trajectory intercepts, and slopes were substantially correlated. Across all domains, symptom severity in the immediate aftermath of trauma (trajectory intercepts) had the greatest influence on the outcome. An interactive data visualization tool was developed to allow readers to explore relationships of interest between individual characteristics, symptom trajectories, and traditional outcomes ( http://itr.med.unc.edu/aurora/parcoord/ ). Individuals presenting to the ED after MVC commonly experience a broad constellation of adverse posttraumatic symptoms. Many risk factors for diverse APNS are shared. Individuals diagnosed with a single traditional outcome should be screened for others. The utility of multidimensional categorizations that characterize individuals across traditional diagnostic domains should be explored.

The aviation sector, like most other sectors, is moving towards becoming net zero. In the medium to long term, this will mean an increase in the use of sustainable aviation fuels. Research exists on the impact of fuel composition on non-volatile particulate matter (nvPM) emissions. However, there is more sparsity when considering the impact on volatile particulate matter (vPM) emissions. Here, nine different fuels were tested using an open-source design combustor rig. An aerosol mass spectrometer (AMS) was used to examine the mass-loading and composition of vPM, with a simple linear regression algorithm used to compare relative mass spectrum similarity. The diaromatic, cycloalkane and aromatic contents of the fuels were observed to correlate with the measured total number concentration and nvPM mass concentrations, resulting in an inverse correlation with increasing hydrogen content. The impacts of fuel properties on other physical properties within the combustion process and how they might impact the particulate matter (PM) are considered for future research. Unlike previous studies, fuel had a very limited impact on the organic aerosol’s composition at the combustor exit measurement location. Using a novel combination of Positive Matrix Factorization (PMF) and high-resolution AMS analysis, new insight has been provided into the organic composition. Both the alkane organic aerosol (AlkOA) and quenched organic aerosol (QOA) factors contained CnH2n+1, CnH2n−1 and CnH2n ion series, implying alkanes and alkenes in both, and approximately 12% oxygenated species in the QOA factor. These results highlight the emerging differences in the vPM compositional data observed between combustor rigs and full engines.

Background: The reconstruction of plantar load-bearing foot defects faces many plastic surgeons with a major challenge. The optimal patient- and defect-oriented reconstructive strategy must be selected. Methods: To analyze the current trends and recommendations in reconstruction of plantar load-bearing foot defects, we conducted an international survey among plastic surgeons querying them about their recommendations and experiences. Results: The survey revealed that the most common strategies for reconstruction of the foot sole are locoregional and microvascular free flaps, emphasizing the relevance of plastic surgery. Among microvascular free flaps, muscle and fascio-cutaneous free flaps are by far the most frequently used. The target qualities of the reconstructed tissue to be considered are manifold, with adherence being the most frequently mentioned. We observed a noteworthy correlation between the utilization of muscle flaps and a preference for adherence. In addition, we identified a substantial correlation between the usage of fascio-cutaneous free flaps and further target qualities, such as good skin quality and sensitivity. Conclusions: Our findings provide insights into the clinical reality and highlight important aspects that must be considered in reconstruction of the weight-bearing areas of the foot providing support in the selection of the appropriate therapy.

We present an analysis of high-resolution optical spectra recorded for 30 stars of the split extended main-sequence turnoff of the young (∼40 Myr) Small Magellanic Cloud globular cluster NGC 330. Spectra were obtained with the Michigan/Magellan Fiber System and Magellan Inamori Kyocera Echelle spectrographs located on the Magellan-Clay 6.5 m telescope. These spectra revealed the presence of Be stars, occupying primarily the cool side of the split main sequence. Rotational velocity ( $v\sin i$ ) measurements for most of the targets are consistent with the presence of two populations of stars in the cluster: one made up of rapidly rotating Be stars ( $\langle v\sin i\rangle \approx 200$ km s ^−1 ) and the other consisting of warmer stars with slower rotation ( $\langle v\sin i\rangle \approx 50$ km s ^−1 ). Core emission in the H δ photospheric lines was observed for most of the H α emitters. The shell parameter computed for the targets in our sample indicates that most of the observed stars should have inclinations below 75°. These results confirm the detection of Be stars obtained through photometry but also reveal the presence of narrow H α and H δ features for some targets that cannot be detected with low-resolution spectroscopy or photometry. Asymmetry variability of H α line profiles on the timescales of a few years is also observed and could provide information on the geometry of the decretion disks. Observations revealed the presence of nebular H α emission, strong enough in faint targets to compromise the extraction of spectra and to impact narrow-band photometry used to assess the presence of H α emission.

We investigate the impact of adoption of electric vehicles and cleaner fuels on future surface levels of PM _2.5 and ozone over Delhi for two contrasting seasons, pre-monsoon and post-monsoon. We run the WRF-Chem atmospheric transport model at high resolution (4 km) with two transport emission scenarios for year 2030: (1) a scenario with electrification of two- and three-wheelers and light commercial vehicles, and (2) a scenario which also includes conversion of diesel vehicles to compressed natural gas (CNG). Compared to the baseline values in 2019, the scenario with both electrification and conversion of diesel vehicles to CNG has a greater reduction in PM _2.5 concentrations (up to 5%) than the electrification of two- and three-wheelers and light commercial vehicles alone (within 1%), mainly due to the the greater reduction in primary emissions of PM _2.5 and black carbon from diesel conversion to CNG. Vehicles electrification could result in an increase in the daily maximum 8-hours ozone concentrations, which are partially offset by additionally converting to CNG—by −1.9% and +2.4% during pre-monsoon and post-monsoon seasons. This reflects higher NO _x emissions from the CNG vehicle scenario compared to electrification-alone scenario, which limits the increase of surface ozone in the VOC-limited chemical environment over Delhi. Our findings highlight the importance of a coordinated strategy for PM _2.5 and ozone when considering traffic emission controls, and highlight that the transition to electric vehicles should be accompanied by the conversion of diesel vehicles to CNG to limit surface ozone increase and achieve greater reduction in PM _2.5 concentrations over Delhi. However, the small changes in PM _2.5 and in ozone compared to the baseline scenario highlight the importance of joint emissions reduction from other sectors to achieve substantial progress in PM _2.5 and ozone air quality in Delhi.

Transmission spectroscopy supports the presence of uncharacterized, light-scattering and -absorbing hazes in the atmospheres of many exoplanets. The complexity of factors influencing the formation, 3D transport, radiative impact, and removal of hazes makes it challenging to match theoretical models to the existing data. Our study simplifies these factors to focus on the interaction between planetary general circulation and haze distribution at the planetary limb. We use an intermediate-complexity general circulation model, ExoPlaSim, to simulate idealized organic haze particles as radiatively active tracers in the atmospheres of tidally locked terrestrial planets for 32 rotation rates. We find three distinct 3D spatial haze distributions, corresponding to three circulation regimes, each with a different haze profile at the limb. All regimes display significant terminator asymmetry. In our parameter space, super-Earth-sized planets with rotation periods greater than 13 days have the lowest haze optical depths at the terminator, supporting the choice of slower rotators as observing targets.

Type 2 diabetes mellitus (T2DM) increases the risk of cognitive decline and dementia. Disruptions in the cytochrome P450-soluble epoxide hydrolase (CYP450-sEH) pathway have been reported in T2DM, obesity and cognitive impairment. We examine linoleic acid (LA)-derived CYP450-sEH oxylipins and cognition in T2DM and explore potential differences between obese and nonobese individuals. The study included 51 obese and 57 nonobese participants (mean age 63.0 ± 9.9, 49% women) with T2DM. Executive function was assessed using the Stroop Color-Word Interference Test, FAS-Verbal Fluency Test, Digit Symbol Substitution Test, and Trails Making Test-Part B. Verbal memory was assessed using the California Verbal Learning Test, second Edition. Four LA-derived oxylipins were analyzed by ultra-high-pressure–LC/MS, and the 12,13-dihydroxyoctadecamonoenoic acid (12,13-DiHOME) considered the main species of interest. Models controlled for age, sex, BMI, glycosylated hemoglobin A1c, diabetes duration, depression, hypertension, and education. The sEH-derived 12,13-DiHOME was associated with poorer executive function scores (F1,98 = 7.513, P = 0.007). The CYP450-derived 12(13)-epoxyoctadecamonoenoic acid (12(13)-EpOME) was associated with poorer executive function and verbal memory scores (F1,98 = 7.222, P = 0.008 and F1,98 = 4.621, P = 0.034, respectively). There were interactions between obesity and the 12,13-DiHOME/12(13)-EpOME ratio (F1,97 = 5.498, P = 0.021) and between obesity and 9(10)-epoxyoctadecamonoenoic acid (9(10)-EpOME) concentrations (F1,97 = 4.126, P = 0.045), predicting executive function such that relationships were stronger in obese individuals. These findings suggest that the CYP450-sEH pathway as a potential therapeutic target for cognitive decline in T2DM. For some markers, relationships may be obesity dependent.

Abstract We present a dataset of approximately 5.5 million subtest scores from over 750,000 adults who completed the NeuroCognitive Performance Test (NCPT; Lumos Labs, Inc.), a validated, self-administered cognitive test accessed via web browser. The dataset includes assessment scores from eight test batteries consisting of 5–11 subtests that collectively span several cognitive domains including working memory, visual attention, and abstract reasoning. In addition to the raw scores and normative data from each subtest, the dataset includes basic demographic information from each participant (age, gender, and educational background). The scale and diversity of the dataset provides an unprecedented opportunity for researchers to investigate population-level variability in cognitive abilities and their relation to demographic factors. To facilitate reuse of this dataset by other researchers, we provide a Python module that supports several common preprocessing steps.

Abstract The tropics is the nexus for many of the remaining gaps in our knowledge of environmental science, including the carbon cycle and atmospheric chemistry, with dire consequences for our ability to describe the Earth system response to a warming world. Difficulties associated with accessibility, coordinated funding models and economic instabilities preclude the establishment of a dense pan-tropical ground-based atmospheric measurement network that would otherwise help to describe the evolving state of tropical ecosystems and the associated biosphere-atmosphere fluxes on decadal timescales. The growing number of relevant sensors aboard sun-synchronous polar orbiters provide invaluable information over the remote tropics, but a large fraction of the data collected along their orbits is from higher latitudes. The International Space Station (ISS), which is in a low-inclination, precessing orbit, has already demonstrated value as a proving ground for Earth observing atmospheric sensors and as a testbed for new technology. Because low-inclination orbits spend more time collecting data over the tropics, we argue that the ISS and its successors, offer key opportunities to host new Earth-observing atmospheric sensors that can lead to a step change in our understanding of tropical carbon fluxes.

The relative importance of the mechanisms underlying species radiation remains unclear. Here, the authors combine reference genome assembly and population genetics analyses to show that neutral forces have contributed to the radiation of the most species-rich tree genus Syzygium.

Abstract Visual components of trauma memories are often vividly re-experienced by survivors with deleterious consequences for normal function. Neuroimaging research on trauma has primarily focused on threat-processing circuitry as core to trauma-related dysfunction. Conversely, limited attention has been given to visual circuitry which may be particularly relevant to posttraumatic stress disorder (PTSD). Prior work suggests that the ventral visual stream is directly related to the cognitive and affective disturbances observed in PTSD and may be predictive of later symptom expression. The present study used multimodal magnetic resonance imaging data (n = 278) collected two weeks after trauma exposure from the AURORA study, a longitudinal, multisite investigation of adverse posttraumatic neuropsychiatric sequelae. Indices of gray and white matter were combined using data fusion to identify a structural covariance network (SCN) of the ventral visual stream 2 weeks after trauma. Participant’s loadings on the SCN were positively associated with both intrusion symptoms and intensity of nightmares. Further, SCN loadings moderated connectivity between a previously observed amygdala-hippocampal functional covariance network and the inferior temporal gyrus. Follow-up MRI data at 6 months showed an inverse relationship between SCN loadings and negative alterations in cognition in mood. Further, individuals who showed decreased strength of the SCN between 2 weeks and 6 months had generally higher PTSD symptom severity over time. The present findings highlight a role for structural integrity of the ventral visual stream in the development of PTSD. The ventral visual stream may be particularly important for the consolidation or retrieval of trauma memories and may contribute to efficient reactivation of visual components of the trauma memory, thereby exacerbating PTSD symptoms. Potentially chronic engagement of the network may lead to reduced structural integrity which becomes a risk factor for lasting PTSD symptoms.

Background: While rare, penoscrotal lymphedema (PL) is accompanied with devastating effects on the quality of life of patients. Moreover, especially for patients with excessive (giant) PL, no standardized curative treatment has been defined. This article therefore retrospectively evaluates the authors’ surgical treatment approach for giant PL, which includes resection alone or in combination with a free vascularized lymph node transfer (VLNT). Methods: A total of ten patients met the inclusion criteria. One patient dropped out of the study before therapy commenced. Eight of the nine remaining patients presented with end-stage (giant) PL. One patient presented with manifest pitting edema. All patients were treated with penoscrotal resection and reconstruction. Additionally, five patients received VLNT into the groin or scrotum. Results: The extent of the lymphedema was specified with a treatment-oriented classification system. The median follow-up was 49.0 months. No patient showed a recurrence. Patients who received VLNT into the scrotum displayed a significantly improved lymphatic transport of the scrotum. Conclusions: Advanced PL should be treated in a standardized surgical fashion as suggested by our proposed algorithm. VLNT from the lateral thoracic region into the scrotum must be considered. If treated correctly, surgical intervention of end-stage PL leads to good results with a low recurrence rate.

TanSat-2, the next-generation Chinese greenhouse gas monitoring satellite for measuring carbon dioxide (CO2), has a new city-scale observing mode. We assess the theoretical capability of TanSat-2 to quantify integrated urban CO2 emissions over the cities of Beijing, Jinan, Los Angeles, and Paris. A high-resolution emission inventory and a column-averaged CO2 (XCO2) transport model are used to build an urban CO2 inversion system. We design a series of numerical experiments describing this observing system to evaluate the impacts of sampling patterns and XCO2 measurement errors on inferring urban CO2 emissions. We find that the correction in systematic and random flux errors is correlated with the signal-to-noise ratio of satellite measurements. The reduction in systematic flux errors for the four cities are sizable, but are subject to unbiased satellite sampling and favorable meteorological conditions (i.e., less cloud cover and lower wind speed). The corresponding correction to the random flux error is 19–28%. Even though clear-sky satellite data from TanSat-2 have the potential to reduce flux errors for cities with high CO2 emissions, quantifying urban emissions by satellite-based measurements is subject to additional limitations and uncertainties.

Intuitive and comfortable physical human–robot interaction (pHRI) can be realized by changing impedance/admittance parameters corresponding to human interaction. However, this dynamic adjustment may result in drastically changed system dynamics, which usually give rise to system instability. We introduce a power envelope regulation strategy designed to constrain the variability of admittance parameters, thereby ensuring system passivity and mitigating the risk of instability. Then, sliding mode control (SMC) is employed to yield stable and robust performance. A new sliding surface is proposed based on feedback linearization, which shows improved tracking performance and stability compared to a conventional sliding surface. The effectiveness of the proposed sliding surface and associated control is theoretically validated. Notably, our modified sliding surface works universally, regardless of the order of the desired admittance equation. The trade-off between system chattering and robustness is effectively managed using a variable–boundary approach, which dynamically adjusts system constraints to optimize performance. In addition, a control algorithm combining acceleration feedback and sliding mode is proposed, showing improved robustness and tracking accuracy performance compared with applying the proposed SMC algorithm exclusively. The efficacy of these methodologies is substantiated through numerical simulations and empirical experiments.

Mother-to-child-transmission of lead via the placenta is known to result in congenital lead toxicity. Between 2010 and 2021, Médecins Sans Frontières and other stakeholders responded to a severe lead poisoning outbreak related to artisanal gold mining in Northern Nigeria. Extensive environmental remediation occurred following outbreak identification; source control efforts are ongoing within the community. We aimed to describe the prevalence of congenital lead poisoning in this cohort and analyse the association between neonatal blood lead concentration (BLC) and medium-term lead-related outcomes during the study period. Children enrolled in the lead poisoning programme between July 2010 and 25 January 2018 who had a screening BLC at ≤4 weeks of age were included. For time-to-event analysis, medium-term outcomes were classified as lead-related (death from lead encephalopathy, and/or met chelation threshold) and non-lead-related (non-lead-related death, on programme no chelation, exit from programme without chelation). Cox regression analysis and ROC analysis were performed. 1468 children were included. All-cause mortality 2.3%; geometric mean neonatal BLC 13.7 μg/dL; 'lead-related death or treatment' 19.3%. For every doubling in neonatal BLC, there was an almost 8-fold increase in adjusted hazard ratio (HR) for the composite lead-related outcome (p

Fundamental to the efficacy of cognitive training (CT) is its dose. Here we used the power and breadth afforded by a large dataset to measure precisely dose-response (D-R) functions for CT and to examine the generality of their magnitude and form. The present observational study involved 107,000 users of Lumosity, a commercial program comprising computer games designed to provide CT over the internet. In addition to training with Lumosity games, these users took an online battery of cognitive assessments (NeuroCognitive Performance Test, NCPT) on two or more occasions separated by at least 10 weeks. Changes in performance on the NCPT between the first and second assessments were examined as a function of the amount of intervening gameplay. The resulting D-R functions were obtained both for overall performance on the NCPT and performance on its eight subtests. Also examined were differences between D-R functions from demographic groups defined by age, gender, and education. Monotonically increasing D-R functions, well fit by an exponential approach to an asymptote, were found consistently for overall performance on the NCPT, performance on seven of the eight subtests, and at each level of age, education, and gender. By examining how individual parameters of the D-R functions varied across subtests and groups, it was possible to measure separately changes in the effects on NCPT performance of 1) transfer from CT and 2) direct practice due to repeated testing. The impact of both transfer and direct practice varied across subtests. In contrast, while the effects of direct practice diminished with age, those of transfer remained constant. Besides its implications for CT by older adults, this latter finding suggests that direct practice and transfer do not involve identical learning processes, with transfer being limited to learning processes that remain constant across the adult lifespan.

We use the WRF-Chem atmospheric chemical transport model, driven by local emission inventories, to quantify the contribution of on-road transport emissions to surface PM2.5 over Delhi during the post-monsoon season. We compare this contribution to other local (within Delhi) and regional (within the broader National Capital Region, NCR) anthropogenic sectors during the post-monsoon period when seasonal burning and stagnating meteorological conditions exacerbate baseline pollution levels. We find that local on-road transport contributes approximately 10% to daily mean PM2.5 over Delhi, rising to 17% if regional on-road transport sources in the NCR are included. The largest individual contributions to Delhi daily mean PM2.5 are from regional power and industry (14%) and domestic (11%) sectors, dominating nighttime and almost all daytime concentrations. Long range transport contribution from sources beyond the NCR is found to account for approximately 40%. The contribution from the local on-road transport sector to diurnal mean PM2.5 is largest (18%) during the evening traffic peak. It is dominated by contributions from two- and three-wheelers (50%) followed by heavy-duty vehicles (30%), which also collectively represent 60–70% of the total on-road transport sector at any hour of the day. The combined contribution from passenger cars and light duty vehicles and from resuspended road dust to daily mean PM2.5 is small (20%). Our work highlights two important factors which need to be considered in developing effective policies to meet PM2.5 air quality standards in Delhi during post-monsoon. First, a multi-sector and multi-scale approach is needed, which prioritise the reduction in local transport emissions within Delhi, and, in the order, regional industries, domestic and transport emissions from NCR. Second, two-and three-wheelers and heavy-duty vehicles dominate on-road transport impact to PM2.5, thus reductions from these vehicles should be given priority, both within Delhi and in the NCR.

Methane is a powerful greenhouse gas with emissions that are challenging to constrain. Here the authors use 10 years of satellite observations and show tropical terrestrial emissions account for 80% of observed global methane increases.

Tropical wetlands are a significant but understudied source of methane. Here, methane emissions were measured over three years in a perennial tropical swamp in the Okavango Delta, Botswana, finding phenology was the overarching control of emissions.

This paper establishes the practicality of terrestrial microwave power beaming at distances >1 km. To beam microwave power along the surface of the earth, it is necessary to consider and, where possible, exploit the effects of microwave propagation across terrain. Key design considerations include the effect of scattering from surface topography, approaches for characterizing the beam in the presence of multipath, safety, and efficiency. A rapid demonstration at the US Army Research Field in Blossom Point, MD, delivers 1.6 kW of electrical power at a 1046 m standoff from a 5.4-m-diameter X band transmitter. The transmitter is a reflector antenna with a linearly actuated feed horn that can focus the power density at specific standoff distances. Experimental results over cluttered, irregular terrain achieve a 2.3 dB (70%) enhancement in power density at the target site by deliberate exploitation of a ground bounce. A 4 m2 rectenna receiver produces the 1.6 kW of output power at a 73% RF-to-DC conversion efficiency, which exceeds the current state of the art at X band. In addition, a test to destruction of 4 large rectenna arrays demonstrates how overvoltage protection circuits can improve the RF power handling of rectenna arrays by >1 dB. A final experiment demonstrates >1 kW delivered at >1 km distance to a light display. Since these results should readily scale to higher levels of power and performance, recommendations are provided to mature the technology for operational use.

This study aimed to characterize patients admitted to critical care following Emergency Department (ED) presentation with acute recreational drug toxicity and to identify determinants of admission to critical care. A retrospective multicenter matched case-control study was conducted by the European Drug Emergency Network Plus (Euro-DEN Plus) over the period 2014–2021. The cases were ED presentations with acute recreational drug toxicity admitted to critical care, the controls consisted of ED presentations with acute recreational drug toxicity medically discharged directly from the ED. The potential determinants of admission to critical care were assessed through multivariable conditional stepwise logistic regression analysis and multiple imputation was used to account for the missing data. From 2014 to 2021, 3448 Euro-DEN Plus presentations involved patients admitted to critical care (76.9% males; mean age 33.2 years; SD 10.9 years). Patient age ≥35 years (as compared to ≤18 years) was a determinant of admission to critical care following acute recreational drug toxicity (adjusted odds ratio, aOR, 1.51, 95% confidence interval, CI, 1.15–1.99), along with polydrug use (aOR 1.39, 95% CI 1.22–1.59), ethanol co-ingestion (aOR 1.44, 95% CI 1.26–1.64), and the use of gamma-hydroxybutyrate/gamma-butyrolactone (GHB/GBL, aOR 3.08, 95% CI 2.66–3.57). Conversely, lower odds of admission to critical care were associated with the use of cocaine (aOR 0.85, 95% CI 0.74–0.99), cannabis (aOR 0.44, 95% CI 0.37–0.52), heroin (aOR 0.80, 95% CI 0.69–0.93), and amphetamine (aOR 0.65, 95% CI 0.54–0.78), as was the arrival to the ED during the night (8 p.m.–8 a.m., aOR 0.88, 95% CI 0.79–0.98). These findings, which deserve confirmation and further investigation, could contribute to a more complete understanding of the decision-making process underlying the admission to critical care of patients with acute recreational drug toxicity.

Abstract Background Transcranial direct current stimulation (tDCS) is a non-invasive type of brain stimulation that uses electrical currents to modulate neuronal activity. A small number of studies have investigated the effects of tDCS on cognition in patients with Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD), and have demonstrated variable effects. Emerging evidence suggests that tDCS is most effective when applied to active brain circuits. Aerobic exercise is known to increase cortical excitability and improve brain network connectivity. Exercise may therefore be an effective, yet previously unexplored primer for tDCS to improve cognition in MCI and mild AD. Methods Participants with MCI or AD will be randomized to receive 10 sessions over 2 weeks of either exercise primed tDCS, exercise primed sham tDCS, or tDCS alone in a blinded, parallel-design trial. Those randomized to an exercise intervention will receive individualized 30-min aerobic exercise prescriptions to achieve a moderate-intensity dosage, equivalent to the ventilatory anaerobic threshold determined by cardiopulmonary assessment, to sufficiently increase cortical excitability. The tDCS protocol consists of 20 min sessions at 2 mA, 5 times per week for 2 weeks applied through 35 cm2 bitemporal electrodes. Our primary aim is to assess the efficacy of exercise primed tDCS for improving global cognition using the Montreal Cognitive Assessment (MoCA). Our secondary aims are to evaluate the efficacy of exercise primed tDCS for improving specific cognitive domains using various cognitive tests (n-back, Word Recall and Word Recognition Tasks from the Alzheimer’s Disease Assessment Scale-Cognitive subscale) and neuropsychiatric symptoms (Neuropsychiatric Inventory). We will also explore whether exercise primed tDCS is associated with an increase in markers of neurogenesis, oxidative stress and angiogenesis, and if changes in these markers are correlated with cognitive improvement. Discussion We describe a novel clinical trial to investigate the effects of exercise priming before tDCS in patients with MCI or mild AD. This proof-of-concept study may identify a previously unexplored, non-invasive, non-pharmacological combination intervention that improves cognitive symptoms in patients. Findings from this study may also identify potential mechanistic actions of tDCS in MCI and mild AD. Trial registration Clinicaltrials.gov, NCT03670615 . Registered on September 13, 2018.

Background: Type 2 diabetes mellitus (T2DM) is a significant health burden globally, with uncontrolled DM often resulting in short- and long-term complications. Unfortunately, healthcare providers have little control over patients’ necessary lifestyle modification practices outside the consultation room. Aim: To determine the level of knowledge, attitude and practice (KAP) of lifestyle modifications among patients with T2DM attending the National District Hospital Outpatient Department, Bloemfontein, and identify possible barriers to lifestyle modifications experienced by patients. Setting: Outpatient Department at a Free State hospital. Methods: Using a cross-sectional study, patients with previously diagnosed T2DM were invited to participate. Respondents completed a structured questionnaire to assess their KAP regarding lifestyle modifications. Results: Of the 149 respondents, 64.4% (n = 94) were obese and 24.0% (n = 35) overweight despite good knowledge of lifestyle modifications. Respondents displayed a positive attitude toward physical exercise but less so to adjusting their diets. In practice, 63.4% (n = 83) claimed to exercise regularly, but two-thirds irregularly monitored their weight. The practice of a controlled and planned diet was poor. Perceived barriers to lifestyle modifications included being too busy to engage in physical exercise, bad weather and financial constraints. Conclusion: Despite displaying good knowledge regarding lifestyle modifications, the attitude and practice thereof remain poor. It is essential to re-emphasise to patients why it is crucial to engage in lifestyle modification practices and assess whether they are doing so correctly. Contribution: It highlights the importance of lifestyle considerations of T2DM patients in the clinical context.

Abstract Objectives To assess: (1) the prevalence of mental health and substance use in patients presenting to the emergency department (ED) through use of a computer adaptive test (CAT‐MH), (2) the correlation among CAT‐MH scores and self‐ and clinician‐reported assessments, and (3) the association between CAT‐MH scores and ED utilization in the year prior and 30 days after enrollment. Methods This was a single‐center observational study of adult patients presenting to the ED for somatic complaints (97%) from May 2019 to March 2020. The main outcomes were computer‐adaptive‐assessed domains of suicidality, depression, anxiety, post‐traumatic stress disorder (PTSD), and substance use. We conducted Pearson correlations and logistic regression for objectives 2 and 3, respectively. Results From a sample of 794 patients, the proportion of those at moderate/severe risk was: 24.1% (suicidality), 8.3% (depression), 16.5% (anxiety), 12.3% (PTSD), and 20.4% (substance use). CAT‐MH domains were highly correlated with self‐report assessments (r = 0.49–0.79). Individuals who had 2 or more ED visits in the prior year had 62% increased odds of being in the intermediate‐high suicide risk category (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.07–2.44) compared to those with zero prior ED visits. Individuals who scored in the intermediate‐high‐suicide risk group had 63% greater odds of an ED visit within 30 days after enrollment compared to those who scored as low risk (OR, 1.63; 95% CI, 1.09, 2.44). Conclusion The CAT‐MH documented that a considerable proportion of ED patients presenting for somatic problems had mental health conditions, even if mild. Mental health problems were also associated with ED utilization.

Female and male reproductive traits co-evolve through pre- and post-copulatory sexual selection and sexual conflict. Although males typically transfer many sperm during copulation, only a small proportion reach the fertilization site because females often actively or passively reduce sperm number in their reproductive tract. Males may transfer accessory substances to protect their ejaculates against female selective processes, which benefits males but can harm females. In turn, females may use accessory gland fluids to control paternity or sperm storage. Female yellow dung flies (Scathophaga stercoraria) have paired accessory glands that produce fluids involved in fertilization and egg laying. One proposed function for these fluids is spermicide. Alternatively, female accessory gland fluid may help keep sperm alive to avoid fertilization failure or encourage sperm competition. Using yellow dung flies, we investigated the interaction of female accessory gland fluid with sperm in vitro. Significantly more sperm remained alive when exposed to accessory gland fluid compared to buffer only (63% vs. 44%). We conclude that female accessory gland fluid in yellow dung flies can help nourish rather than kill male sperm, although selective nourishment of sperm is as consistent with cryptic female choice as is selective spermicide.

Songbirds and humans share the ability to adaptively modify their vocalizations based on sensory feedback. Prior studies have focused primarily on the role that auditory feedback plays in shaping vocal output throughout life. In contrast, it is unclear how non-auditory information drives vocal plasticity. Here, we first used a reinforcement learning paradigm to establish that somatosensory feedback (cutaneous electrical stimulation) can drive vocal learning in adult songbirds. We then assessed the role of a songbird basal ganglia thalamocortical pathway critical to auditory vocal learning in this novel form of vocal plasticity. We found that both this circuit and its dopaminergic inputs are necessary for non-auditory vocal learning, demonstrating that this pathway is critical for guiding adaptive vocal changes based on both auditory and somatosensory signals. The ability of this circuit to use both auditory and somatosensory information to guide vocal learning may reflect a general principle for the neural systems that support vocal plasticity across species.

Summary: Background: Mental health is a public health issue for European young people, with great heterogeneity in resource allocation. Representative population-based studies are needed. The Global Burden of Disease (GBD) Study 2019 provides internationally comparable information on trends in the health status of populations and changes in the leading causes of disease burden over time. Methods: Prevalence, incidence, Years Lived with Disability (YLDs) and Years of Life Lost (YLLs) from mental disorders (MDs), substance use disorders (SUDs) and self-harm were estimated for young people aged 10-24 years in 31 European countries. Rates per 100,000 population, percentage changes in 1990-2019, 95% Uncertainty Intervals (UIs), and correlations with Sociodemographic Index (SDI), were estimated. Findings: In 2019, rates per 100,000 population were 16,983 (95% UI 12,823 – 21,630) for MDs, 3,891 (3,020 - 4,905) for SUDs, and 89·1 (63·8 - 123·1) for self-harm. In terms of disability, anxiety contributed to 647·3 (432–912·3) YLDs, while in terms of premature death, self-harm contributed to 319·6 (248·9–412·8) YLLs, per 100,000 population. Over the 30 years studied, YLDs increased in eating disorders (14·9%;9·4-20·1) and drug use disorders (16·9%;8·9-26·3), and decreased in idiopathic developmental intellectual disability (–29·1%;23·8-38·5). YLLs decreased in self-harm (–27·9%;38·3-18·7). Variations were found by sex, age-group and country. The burden of SUDs and self-harm was higher in countries with lower SDI, MDs were associated with SUDs. Interpretation: Mental health conditions represent an important burden among young people living in Europe. National policies should strengthen mental health, with a specific focus on young people. Funding: The Bill and Melinda Gates Foundation

Background: Mycoplasma mycoides subsp. mycoides is the causative organism of Contagious Bovine Pleuropneumonia (CBPP). It is a trans-boundary disease (TAD) and an endemic in Nigeria having caused serious financial loss for the country’s economy. Aim: This study was undertaken to isolate and confirm the presence of Mycoplasma mycoides subsp. mycoides (Mmm) in cattle, from three selected South-Eastern states of Nigeria. Method: A total of Ninety (90) bovine samples (25 pleural fluids and 65 lung tissues) suggestive of CBPP were collected from different abattoirs in the three selected South-eastern states of Nigeria (Anambra, Enugu and Imo), for the isolation of Mmm by employing cultural method, whereas for confirmation Polymerase Chain Reaction (PCR) approach was used. The collected samples were cultured on Pleuropneumonia like organism (PPLO) agar according to specific protocols. Results: Twenty five (25) of the samples (lungs and pleural fluid) were positive for Mmm on PPLO agar giving an isolation rate of 27.7%. Only twenty one (21) of the isolates were further confirmed using PCR. The PCR amplification of the isolates produced a product of 1.1kbp which is specific for Mmm. No positive isolates were recovered from Imo state. Conclusion: This study confirms the presence of Mmm as the causative organism of CBPP in Southeast Nigeria. It is recommended that active surveillance and vaccination protocol should be undertaken in the region for the control and prevention of this disease.

Experimental demonstration of quantum speedup that scales with the system size is the goal of near-term quantum computing. Here, the authors demonstrate such scaling advantage for a D-Wave quantum annealer over analogous classical algorithms in simulations of frustrated quantum magnets.

Measurement(s) genetic variation • SNP • Linkage Disequilibrium Technology Type(s) DNA sequencing • bioinformatics analysis • computational phylogenetic analysis Sample Characteristic - Organism Glycine soja • Glycine max Machine-accessible metadata file describing the reported data: https://doi.org/10.6084/m9.figshare.13568552

Power beaming is the efficient point-to-point transfer of electrical energy across free space by a directive electromagnetic beam. This paper clarifies the basic principles of power beaming in simple terms, and proposes a benchmarking methodology for improving the comparative assessment of power beaming systems and technology. An in-depth historical overview tracing the worldwide progress in microwave and millimeter wave (mmWave) experimental demonstrations over the past 60 years shows clear evidence of a significant increase in activity during the last 5 years. In addition, a review of progress in scalable rectenna arrays for the reception of microwave power beaming shows sufficient maturity for new research to initiate on the ruggedization, productization, and system integration aspects of the technology. A review of regulatory issues including spectrum management and safety indicates the need for additional technical solutions and international coordination. Breaking results reported in this paper include 1) data from the first in-orbit flight test of a solar-to-RF “sandwich module”, 2) the construction of multiple US in-orbit demonstrations, planned for 2023 launch, that will demonstrate key technologies for space-based solar power, and 3) a 100-kW mmWave power beaming transmitter demonstrating inherent human life safety.

Understanding how the pressure level affects the efficiency of liquid piston gas compression is essential for a greater applicability of the technology in compressed air energy storage. To explore the impacts, compression starting at three different initial pressure levels (1, 2, 3 bar) with a pressure ratio of 2 is performed, and how isothermal compression efficiencies are affected depending on the initial pressures is analyzed. Under the experimental conditions, higher initial pressure leads to lower isothermal efficiency. Air dissolution during the compression is also investigated because the chamber is a pressure-varying and a liquid-containing environment, where the gas solubility changes during the process. Evaluating the dissolution is critical as it affects the energy output when the compressed air is expanded to regenerate the energy. The changes in the air mass and the retrievable volume of the air after expansion are quantified based on Henry’s law. For a compression at higher pressure, because the air solubility is proportional to pressure, a greater reduction in the air mass and volume percentages is expected. This trend of the mass decreasing with the pressure level leads to less energy output than the originally intended output when the stored energy is retrieved in a discharging process.

Monitoring national and global greenhouse gas (GHG) emissions is a critical component of the Paris Agreement, necessary to verify collective activities to reduce GHG emissions. Top-down approaches to infer GHG emission estimates from atmospheric data are widely recognized as a useful tool to independently verify emission inventories reported by individual countries under the United Nation Framework Convention on Climate Change. Conventional top-down atmospheric inversion methods often prescribe fossil fuel CO _2 emissions (FFCO2) and fit the resulting model values to atmospheric CO _2 observations by adjusting natural terrestrial and ocean flux estimates. This approach implicitly assumes that we have perfect knowledge of FFCO2 and that any gap in our understanding of atmospheric CO _2 data can be explained by natural fluxes; consequently, it also limits our ability to quantify non-FFCO2 emissions. Using two independent FFCO2 emission inventories, we show that differences in sub-annual emission distributions are aliased to the corresponding posterior natural flux estimates. Over China, for example, where the two inventories show significantly different seasonal variations in FFCO2, the resulting differences in national-scale flux estimates are small but are significant on the subnational scale. We compare natural CO _2 flux estimates inferred from in-situ and satellite observations. We find that sparsely distributed in-situ observations are best suited for quantifying natural fluxes and large-scale carbon budgets and less suitable for quantifying FFCO2 errors. Satellite data provide us with the best opportunity to quantify FFCO2 emission errors; a similar result is achievable using dense, regional in-situ measurement networks. Enhancing the top-down flux estimation capability for inventory verification requires a coordinated activity to (a) improve GHG inventories; (b) extend methods that take full advantage of measurements of trace gases that are co-emitted during combustion; and (c) improve atmospheric transport models.

Recent work has highlighted the large role of methane emissions from the Sudd wetland and surrounding ecosystems on the global atmospheric growth rate of methane since 2010. These emissions are driven by high rainfall over basin catchments linked with the positive phase of the Indian Ocean Dipole. We reconstruct flood inundation for the Sudd wetland over a 38-year period at a spatial resolution of 30 m using a new satellite Earth Observation (EO) wetland mapping tool. We reveal considerable changes in the wet season extent of the wetland, including an increase >300% since 2019 compared to the median 1984–2022 extent. We report major increases in flood extent within grassland-dominated floodplains outside of the area currently defined Sudd wetland region. These year-to-year changes in wetland extent are corroborated with total water storage anomalies inferred from satellite data (Pearson correlation R = 0.92), Lake Victoria levels ( R = 0.73), and anomalies in reported annual mean global methane growth rates since 2009 ( R = 0.88). Our analysis shows that flood water inundation is dominated by inundated vegetation and aquatic vegetation, accounting for an average of 40% and 50% of total extent, respectively, compared to open water that accounted for just 9% of inundation in a typical year. This is consistent with recent studies that report wetland methane emissions are focused on areas with inundated vegetation. Our findings also support recent studies that highlight the significant role of the Sudd wetland in driving anomalously large global atmospheric annual growth rates, 2020–2022. By capturing high resolution information on inundated vegetation, our EO wetland mapping tool has significant potential for improved wetland emission estimates of methane. Vascular plants common in the Sudd wetland, e.g. macrophytes including Phragmites Australis and Cyperus Papyrus , seem to play a key role in methane emissions and we recommend they should be the focus of future research.

Cloud cover at the planetary limb of water-rich Earth-like planets is likely to weaken chemical signatures in transmission spectra, impeding attempts to characterize these atmospheres. However, based on observations of Earth and Solar System worlds, exoplanets with atmospheres should have both short-term weather and long-term climate variability, implying that cloud cover may be less during some observing periods. We identify and describe a mechanism driving periodic clear sky events at the terminators in simulations of tidally locked Earth-like planets. A feedback between dayside cloud–radiative effects, incoming stellar radiation and heating, and the dynamical state of the atmosphere, especially the zonal wavenumber 1 Rossby wave identified in past work on tidally locked planets, leads to oscillations in Rossby wave phase speeds and in the position of Rossby gyres, and this results in advection of clouds to or away from the planet’s eastern terminator. We study this oscillation in simulations of Proxima Centauri b, TRAPPIST-1e, and rapidly rotating versions of these worlds located at the inner edge of their stars’ habitable zones. We simulate time series of the transit depths of the 1.4 μ m water feature and 2.7 μ m carbon dioxide feature. The impact of atmospheric variability on the transmission spectra is sensitive to the structure of the dayside cloud cover and the location of the Rossby gyres, but none of our simulations have variability significant enough to be detectable with current methods.

Cultivated peanut (Arachis hypogaea) is an important oil, food, and feed crop worldwide. The USDA peanut germplasm collection currently contains 8,982 accessions. In the 1990s, 812 accessions were selected as a core collection on the basis of phenotype and country of origin. The present study reports genotyping results for the entire available core collection. Each accession was genotyped with the Arachis_Axiom2 SNP array, yielding 14,430 high-quality, informative SNPs across the collection. Additionally, a subset of 253 accessions was replicated, using between two and five seeds per accession, to assess heterogeneity within these accessions. The genotypic diversity of the core is mostly captured in five genotypic clusters, which have some correspondence with botanical variety and market type. There is little genetic clustering by country of origin, reflecting peanut’s rapid global dispersion in the 18th and 19th centuries. A genetic cluster associated with the hypogaea/aequatoriana/peruviana varieties, with accessions coming primarily from Bolivia, Peru, and Ecuador, is consistent with these having been the earliest landraces. The genetics, phenotypic characteristics, and biogeography are all consistent with previous reports of tetraploid peanut originating in Southeast Bolivia. Analysis of the genotype data indicates an early genetic radiation, followed by regional distribution of major genetic classes through South America, and then a global dissemination that retains much of the early genetic diversity in peanut. Comparison of the genotypic data relative to alleles from the diploid progenitors also indicates that subgenome exchanges, both large and small, have been major contributors to the genetic diversity in peanut.

Class IC antiarrhythmics are generally considered a safe means of treating many common arrhythmias such as atrial fibrillation (a-fib), atrial flutter (a-flutter), and paroxysmal supraventricular tachycardia (PSVT). Essentially, flecainide works by binding and blocking sodium channels more effectively at higher heart rates. However, this class of drugs is known to exhibit use dependence which could predispose patients to the development of malignant arrhythmias during episodes of tachycardia. In this case, we present a patient who was being treated with flecainide for a-fib who ultimately developed a wide complex tachycardia after her metoprolol was held.

ObjectiveWhether short-term, low-potency opioid prescriptions for acute pain lead to future at-risk opioid use remains controversial and inadequately characterized. Our objective was to measure the association between emergency department (ED) opioid analgesic exposure after a physical, trauma-related event and subsequent opioid use. We hypothesized ED opioid analgesic exposure is associated with subsequent at-risk opioid use.MethodsParticipants were enrolled in AURORA, a prospective cohort study of adult patients in 29 U.S., urban EDs receiving care for a traumatic event. Exclusion criteria were hospital admission, persons reporting any non-medical opioid use (e.g., opioids without prescription or taking more than prescribed for euphoria) in the 30 days before enrollment, and missing or incomplete data regarding opioid exposure or pain. We used multivariable logistic regression to assess the relationship between ED opioid exposure and at-risk opioid use, defined as any self-reported non-medical opioid use after initial ED encounter or prescription opioid use at 3-months.ResultsOf 1441 subjects completing 3-month follow-up, 872 participants were included for analysis. At-risk opioid use occurred within 3 months in 33/620 (5.3%, CI: 3.7,7.4) participants without ED opioid analgesic exposure; 4/16 (25.0%, CI: 8.3, 52.6) with ED opioid prescription only; 17/146 (11.6%, CI: 7.1, 18.3) with ED opioid administration only; 12/90 (13.3%, CI: 7.4, 22.5) with both. Controlling for clinical factors, adjusted odds ratios (aORs) for at-risk opioid use after ED opioid exposure were: ED prescription only: 4.9 (95% CI 1.4, 17.4); ED administration for analgesia only: 2.0 (CI 1.0, 3.8); both: 2.8 (CI 1.2, 6.5).ConclusionsED opioids were associated with subsequent at-risk opioid use within three months in a geographically diverse cohort of adult trauma patients. This supports need for prospective studies focused on the long-term consequences of ED opioid analgesic exposure to estimate individual risk and guide therapeutic decision-making.

During the 2015–2016 El Niño, the Amazon basin released almost one gigaton of carbon (GtC) into the atmosphere due to extreme temperatures and drought. The link between the drought impact and recovery of the total carbon pools and its biogeochemical drivers is still unknown. With satellite-constrained net carbon exchange and its component fluxes including gross primary production and fire emissions, we show that the total carbon loss caused by the 2015–2016 El Niño had not recovered by the end of 2018. Forest ecosystems over the Northeastern (NE) Amazon suffered a cumulative total carbon loss of ∼0.6 GtC through December 2018, driven primarily by a suppression of photosynthesis whereas southeastern savannah carbon loss was driven in part by fire. We attribute the slow recovery to the unexpected large carbon loss caused by the severe atmospheric aridity coupled with a water storage deficit during drought. We show the attenuation of carbon uptake is three times higher than expected from the pre-drought sensitivity to atmospheric aridity and ground water supply. Our study fills an important knowledge gap in our understanding of the unexpectedly enhanced response of carbon fluxes to atmospheric aridity and water storage deficit and its impact on regional post-drought recovery as a function of the vegetation types and climate perturbations. Our results suggest that the disproportionate impact of water supply and demand could compromise resiliency of the Amazonian carbon balance to future increases in extreme events.