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Every year riverine flooding affects millions of people in developing countries, due to the large population exposure in the floodplains and the lack of adequate flood protection. Preparedness and monitoring are effective ways to reduce flood risk. State-of-the-art technologies relying on satellite remote sensing as well as numerical hydrological and meteorological predictions can detect and monitor severe flood events at the global scale. This chapter describes the emerging role of the Global Flood Partnership (GFP), a global network of scientists, users, and private and public organizations active in global flood risk management. Currently, a number of GFP partner institutes regularly share results from their experimental products, developed to predict and monitor where and when flooding is taking place in near real time. Products of the GFP have already been used on several occasions by national environmental agencies and humanitarian organizations to support emergency operations and to reduce the overall socioeconomic impacts of disasters. The chapter includes a discussion on existing challenges and ways forward to improve rapid access to flood information and increase resilience to flooding.

Bisphosphonates remain a first-line treatment for osteoporosis and decrease vertebral and hip fractures without side effects in most patients. With extended treatment, osteonecrosis of the jaw and atypical femoral fracture occur rarely, but fear of side effects has led to not starting or discontinuing treatment. Atrial fibrillation and uveitis are less appreciated by the general public, but their rare incidence must be recognized. A strategy for safe long-term treatment is provided based on 2 major studies. Interruption of treatment after 3 to 5 years is possible for some patients, but those remaining at high fracture risk require longer term therapy.

A reliable flood event inventory that reflects the occurrence and evolution of past floods is important for studies of flood hazards and risks, hydroclimatic extremes, and future flood projections. However, currently available flood inventories are based on single-sourced data and often neglect underreported or less impactful flood events. Furthermore, traditional archives store flood events only at sparse geographic points, which significantly limits their further applicability. Also, few publicly available archives contain all-inclusive records of potential natural flooded area over time. To tackle these challenges, we construct two types of multisourced flood event inventories (MFI) for all river basins across the contiguous United States covering the period 1998–2013 on daily and subcatchment scales, which is publicly available at http://flood.umd.edu/download/CONUS/. These archives integrate flood information from in situ observations, remote sensing observations, hydrological model simulations, and five high-quality precipitation products. The first inventory (MFI-Actual) includes all actual floods that occurred in the presence of flood protection infrastructures, while the second, “natural (undefended)” inventory (MFI-Natural) reconstructs the possible “historical” floods without flood protection, which could be more directly influenced by climate variation. In the proposed two inventories, 2,755 and 4,661 flood events were estimated, respectively. MFI-Natural reconstructed 1,597 floods in ungauged basins, and recovered 608 extreme streamflow events in gauged subcatchments where floods would have happened if there were no flood protection. There is an average of four upstream dams located in these flood-recovered subcatchments, which indicates that modern flood defenses efficiently prevent significant flooding from extreme precipitation in many catchments over the country.

Twenty men with spinal cord injury (SCI) were randomized into two 16-week intervention groups receiving testosterone treatment (TT) or TT combined with resistance training (TT + RT). TT + RT appears to hold the potential to reverse or slow down bone loss following SCI if provided over a longer period. Persons with SCI experience bone loss below the level of injury. The combined effects of resistance training and TT on bone quality following SCI remain unknown. Men with SCI were randomized into 16-week treatments receiving TT or TT + RT. Magnetic resonance imaging (MRI) of the right lower extremity before participation and post-intervention was used to visualize the proximal, middle, and distal femoral shaft, the quadriceps tendon, and the intermuscular fascia of the quadriceps. For the TT + RT group, MRI microarchitecture techniques were utilized to elucidate trabecular changes around the knee. Individual mixed models were used to estimate effect sizes. Twenty participants completed the pilot trial. A small effect for yellow marrow in the distal femur was indicated as increases following TT and decreases following TT + RT were observed. Another small effect was observed as the TT + RT group displayed greater increases in intermuscular fascia length than the TT arm. Distal femur trabecular changes for the TT + RT group were generally small in effect (decreased trabecular thickness variability, spacing, and spacing variability; increased network area). Medium effects were generally observed in the proximal tibia (increased plate width, trabecular thickness, and network area; decreased trabecular spacing and spacing variability). This pilot suggests longer TT + RT interventions may be a viable rehabilitation technique to combat bone loss following SCI. Registered with clinicaltrials.gov : NCT01652040 (07/27/2012).

The Global Precipitation Climatology Project (GPCP) product is a popular combined satellite-gauge precipitation data set in which the long-term standards of consistency and homogeneity are underlined. Here we discuss various high latitude analyses considered in the recently released GPCP V3.2 monthly and daily products. Satellite data are used over land and ocean and obtained from the Special Sensor Microwave Imager (SSMI), Special Sensor Microwave Imager/Sounder (SSMIS), geostationary imagers and polar-orbiting infrared sounders. GPCP uses the Global Precipitation Climatology Centre (GPCC) over land, as its in situ component, but prior to combination with satellite data GPCC estimates are adjusted for gauge undercatch. Advanced sensors aboard the Tropical Rainfall Measuring Mission (TRMM), CloudSat, and Global Precipitation Measurement (GPM) mission have enabled more accurate estimation of rain and snowfall rates in recent years. Starting with GPCP V3.1 these observations are integrated into GPCP through the development of the Tropical Combined Climatology (TCC) used at lower latitudes and the Merged CloudSat, TRMM, and GPM (MCTG) climatology used over the extratropics and higher latitudes. Improved calibrations of Television-Infrared Operational Satellite (TIROS) Operational Vertical Sounder (TOVS) and Advanced Infrared Sounder (AIRS) precipitation are used outside 60ºN-S, where inside this zone the Goddard Profiling (GPROF) algorithm retrievals from SSMI/SSMIS is used to calibrate geostationary IR based precipitation estimate at monthly scale. The Gravity Recovery and Climate Experiment (GRACE) mass change observations are used to determine snowfall accumulations over frozen land and arctic basins and to assess gauge undercatch corrections. Observations of snow on sea ice from NASA’s Operation IceBridge (OIB) flights are utilized as an additional tool for snowfall assessment over sea ice. GPCP V3.2 has a higher spatial resolution (0.5ox0.5o) than earlier versions (e.g., 2.5ox2.5o in V2.3) over both land and ocean, going back to 1983. Version 3 Daily product uses the Integrated Multi-satellitE Retrievals for Global Precipitation Measurement (GPM) mission (IMERG) Final Run V06 estimates as well as rescaled TOVS/AIRS data in high-latitude areas, all calibrated to the GPCP V3.2 Monthly estimate. GPCP V3.2 shows about 5.5% increase in global oceanic precipitation and about 4 % increase over global land and ocean compared to the previous version (V2.3), some major changes occur over the ocean and around 40oS and 60 oS. We will discuss other important changes of GPCP V3.2, compared to the earlier versions, and our future plans. This includes a discussion of some challenges that the team had to deal with, such as consistencies in inter-annual variations of satellite precipitation products and modification of gauge undercatch correction methods.

Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk offuture fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive but may be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the riskfor second fractures is highest in the early post-fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring foradverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). (c) 2019 American Society for Bone and Mineral Research. (Less)

Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fractureamong people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, andsubcutaneous pharmacotherapies are efficaciousandcanreduce risk of future fracture.Patientsneededucation,however, about thebenefitsandrisks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive butmay be beneficial for selected patients at high risk.Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the earlypost-fractureperiod,prompt treatment is recommended.Adequate dietary or supplemental vitaminDand calciumintake shouldbe assured. Individuals beingtreatedfor osteoporosis shouldbe reevaluated for fracture risk routinely, includingvia patienteducationabout osteoporosisandfracturesandmonitoringfor adverse treatment effects.Patients shouldbestronglyencouraged to avoid tobacco, consume alcohol inmoderation atmost, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease).

Acetylcholinesterase inhibitors (AChEIs) have been noted to increase bone density and quality in mice. Human studies are limited but suggest an association with improved bone healing after hip fracture. We examined the relationship between AChEI use and fracture risk in a national cohort of 360,015 male veterans aged 65 to 99 years with dementia but without prior fracture using Veterans Affairs (VA) hospital, Medicare, and pharmacy records from 2000 to 2010. Diagnosis of dementia, any clinical fracture (excluding facial and digital), comorbidities, and medications were identified using ICD-9 and drug class codes. Cox proportional hazard models considering AChEI use as a time-varying covariate and adjusting for fall and fracture risk factors compared the time-to-fracture in AChEI users versus non-AChEI users. Potential confounders included demographics (age, race, body mass index), comorbidities associated with fracture or falls (diabetes, lung disease, stroke, Parkinson's, seizures, etc.) and medications associated with fracture or falls (bisphosphonates, glucocorticoids, androgen deprivation therapy [ADT], proton pump inhibitors [PPIs], selective serotonin receptor inhibitors [SSRIs], etc.). Competing mortality risk was considered using the methods of Fine and Gray. To account for persistent effects on bone density or quality that might confer protection after stopping the medication, we completed a secondary analysis using the medication possession ratio (MPR) as a continuous variable in logistic regression models and also compared MPR increments of 10% to minimal/no use (MPR 0 to

Author(s): Durand, Michael; Barros, Ana; Dozier, Jeff; Adler, Robert; Cooley, Sarah; Entekhabi, Dara; Forman, Barton A; Konings, Alexandra G; Kustas, William P; Lundquist, Jessica D; Pavelsky, Tamlin M; Rodell, Matthew; Steele‐Dunne, Susan

Current guidelines recommend primary osteoporosis screening for at-risk men to reduce the morbidity, mortality, and cost associated with osteoporotic fractures. However, analyses in a national Veterans Health Administration cohort of over 4,000,000 men demonstrated that primary osteoporosis screening as it is currently operationalized does not benefit most older Veterans due to inefficient targeting and low subsequent treatment and adherence rates. The overall objective of this study is to determine whether a new model of primary osteoporosis screening reduces fracture risk compared to usual care. We are conducting a pragmatic group randomized trial of 38 primary care teams assigned to usual care or a Bone Health Service (BHS) screening model in which screening and adherence activities are managed by a centralized expert team. The study will: 1) compare the impact of the BHS model on patient-level outcomes strongly associated with fracture rates (eligible proportion screened, proportion meeting treatment criteria who receive osteoporosis medications, medication adherence, and femoral neck bone mineral density); 2) quantify the impact on provider and facility-level outcomes including change in DXA volume, change in metabolic bone disease clinic volume, and PACT provider time and satisfaction; and 3) estimate the impact on health system and policy outcomes using Markov models of screening program cost per quality adjusted life year based from health system and societal perspectives.

IntroductionLong pulse width stimulation (LPWS; 120–150 ms) has the potential to stimulate denervated muscles and to restore muscle size in denervated people with spinal cord injury (SCI). We will determine if testosterone treatment (TT)+LPWS would increase skeletal muscle size, leg lean mass and improve overall metabolic health in persons with SCI with denervation. We hypothesise that the 1-year TT+LPWS will upregulate protein synthesis pathways, downregulate protein degradation pathways and increase overall mitochondrial health.Methods and analysisTwenty-four male participants (aged 18–70 years with chronic SCI) with denervation of both knee extensor muscles and tolerance to the LPWS paradigm will be randomised into either TT+neuromuscular electrical stimulation via telehealth or TT+LPWS. The training sessions will be twice weekly for 1 year. Measurements will be conducted 1 week prior training (baseline; week 0), 6 months following training (postintervention 1) and 1 week after the end of 1 year of training (postintervention 2). Measurements will include body composition assessment using anthropometry, dual X-ray absorptiometry and MRI to measure size of different muscle groups. Metabolic profile will include measuring of basal metabolic rate, followed by blood drawn to measure fasting biomarkers similar to hemoglobin A1c, lipid panels, C reactive protein, interleukin-6 and free fatty acids and then intravenous glucose tolerance test to test for insulin sensitivity and glucose effectiveness. Finally, muscle biopsy will be captured to measure protein expression and intracellular signalling; and mitochondrial electron transport chain function. The participants will fill out 3 days dietary record to monitor their energy intake on a weekly basis.Ethics and disseminationThe study was approved by Institutional Review Board of the McGuire Research Institute (ID # 02189). Dissemination plans will include the Veteran Health Administration and its practitioners, the national SCI/D services office, the general healthcare community and the veteran population, as well as the entire SCI community via submitting quarterly letters or peer-review articles.Trial registration numberNCT03345576.

Study design: Secondary analysis of a clinical trial Objectives: To perform a secondary analysis on the effects of neuromuscular electrical stimulation resistance training (RT) combined with testosterone replacement therapy (TRT) compared to TRT on the untrained muscles after spinal cord injury (SCI). Setting: Medical research center Methods: Twenty-two men with chronic motor complete SCI were randomized into TRT+RT group (n=11) or TRT group (n=11). Both groups received 16 weeks of TRT (2-6 mg/day) via testosterone patches. The TRT+RT group received twice-weekly progressive RT of the knee extensor muscles using electrical stimulation and ankle weights. Magnetic resonance images were captured to measure cross-sectional areas (CSAs) of trunk, glutei, and leg muscles. Results: Total and absolute gluteus maximus m. (14%, P= 0.003 and 16%, P= 0.001), gluteus medius m. (10%; P= 0.008 and 14%; P= 0.02) and total glutei m. (8%, P= 0.01 and 11%, P= 0.005) CSAs increased overtime for the TRT+RT group. Mean between group differences of 2.86 (95% CI:0.30, 5.4), 1.89 (95% CI:0.23, 3.58) and 5.27 (95% CI:0.90, 9.69) cm2 were noted for absolute gluteus maximus, total gluteus medius and total glutei CSAs, respectively (P< 0.05). Trunk muscle CSAs showed a trend towards an interaction between groups. Conclusion: RT combined with low-dose TRT results in significant hypertrophy compared to TRT only on the adjacent untrained glutei muscles. Trunk muscles may require direct stimulation to evoke hypertrophy. These exploratory findings may be of clinical relevance in the reduction of incidence and severity of pelvic pressure injuries.

Diabetes mellitus among older men has been associated with increased bone mineral density but paradoxically increased fracture risk. Given the interactions among medication treatment, glycemic control, and diabetes-associated comorbidities, the relative effects of each factor remains unclear. This retrospective study includes 652,901 male veterans aged ≥65 years with diabetes and baseline hemoglobin A1c (HbA1c) value. All subjects received primary care in the Veterans Health Administration (VHA) from 2000 to 2010. Administrative data included ICD9 diagnoses and pharmacy records and was linked to Medicare fee-for-service data. Hazard ratios (HR) for any clinical fracture and hip fracture were calculated using competing risk hazards models, adjusted for fracture risk factors including age, race/ethnicity, body mass index (BMI), alcohol and tobacco use, rheumatoid arthritis, corticosteroid use, as well as diabetes-related comorbidities including cardiovascular disease, chronic kidney disease, and peripheral neuropathy. HbA1c

We present Multi-Source Weighted-Ensemble Precipitation, version 2 (MSWEP V2), a gridded precipitation P dataset spanning 1979–2017. MSWEP V2 is unique in several aspects: i) full global coverage (all land and oceans); ii) high spatial (0.1°) and temporal (3 hourly) resolution; iii) optimal merging of P estimates based on gauges [WorldClim, Global Historical Climatology Network-Daily (GHCN-D), Global Summary of the Day (GSOD), Global Precipitation Climatology Centre (GPCC), and others], satellites [Climate Prediction Center morphing technique (CMORPH), Gridded Satellite (GridSat), Global Satellite Mapping of Precipitation (GSMaP), and Tropical Rainfall Measuring Mission (TRMM) Multisatellite Precipitation Analysis (TMPA) 3B42RT)], and reanalyses [European Centre for Medium-Range Weather Forecasts (ECMWF) interim reanalysis (ERA-Interim) and Japanese 55-year Reanalysis (JRA-55)]; iv) distributional bias corrections, mainly to improve the P frequency; v) correction of systematic terrestrial P biases using river discharge Q observations from 13,762 stations across the globe; vi) incorporation of daily observations from 76,747 gauges worldwide; and vii) correction for regional differences in gauge reporting times. MSWEP V2 compares substantially better with Stage IV gauge–radar P data than other state-of-the-art P datasets for the United States, demonstrating the effectiveness of the MSWEP V2 methodology. Global comparisons suggest that MSWEP V2 exhibits more realistic spatial patterns in mean, magnitude, and frequency. Long-term mean P estimates for the global, land, and ocean domains based on MSWEP V2 are 955, 781, and 1,025 mm yr−1, respectively. Other P datasets consistently underestimate P amounts in mountainous regions. Using MSWEP V2, P was estimated to occur 15.5%, 12.3%, and 16.9% of the time on average for the global, land, and ocean domains, respectively. MSWEP V2 provides unique opportunities to explore spatiotemporal variations in P, improve our understanding of hydrological processes and their parameterization, and enhance hydrological model performance.

There is a paucity of clinical data to support the hypothesis that external beam radiation therapy causes iatrogenic hypogonadism in prostate cancer patients. All prostate cancer patients treated at a single institution with radiation therapy between 2002 and 2010 were retrospectively evaluated. Patients treated with brachytherapy alone received 0 Gy of external beam radiation therapy and served as the control group. Patients treated with combination external beam radiation therapy + brachytherapy, or external beam radiation therapy alone were categorized into groups who received 45–54 Gy or > 60 Gy of external beam radiation therapy, respectively. Serum testosterone levels were routinely measured with prostate-specific antigen tests. The median follow-up periods for 149 evaluable patients in the control group (0 Gy), the 45–54 Gy group, and > 60 Gy group were 57, 62, and 55 months, respectively (p = 0.43). Among patients who underwent external beam radiation therapy, 53% were treated with intensity-modulated radiation therapy, 65% with pelvic lymph node coverage, and 78% with 18 megavoltage photons. There were no differences in serum testosterone level declines over time between the 45–54 Gy group (p = 0.32) or the > 60 Gy group (p = 0.14) when compared to the control group (0 Gy). While body mass index was associated with baseline testosterone levels in univariate analysis (p

Glucocorticoid-induced osteoporosis remains the most common type of secondary osteoporosis, mostly due to use of oral glucocorticoids rather than due to endogenous overproduction of cortisol. Partly because glucocorticoids are prescribed by a wide variety of clinicians for many different inflammatory disorders, only a minority of older individuals have adequate and timely assessment of their enhanced fracture risk, and fewer are offered treatment. Assessment should include bone density, the FRAX calculation, and, in many cases, images of the spine. Glucocorticoids decrease osteoblast function and increase apoptosis of osteoblasts and osteocytes, leading to increased fracture risk soon after starting glucocorticoids. Guidelines provide evidence-based recommendations for evaluation and treatment, but there are differences in extant guidelines, and methods to improve adherence to the guidelines have mostly failed. A strong case can be made to use anabolic drugs first in high-risk patients based on pathophysiology and head-to-head clinical trials.

Glucocorticoid-induced osteoporosis remains the most common type of secondary osteoporosis because about 1% of the adult population has been prescribed oral glucocorticoids at any time. Glucocorticoids profoundly decrease osteoblastic function, quickly leading to increased fracture risk. Short-term management requires recognition of the acute increased fracture risk. For some patient groups, such as women of childbearing age, therapy is based on expert opinion. For long-term management, the general principle has been to continue osteoporosis treatment as long as the patient remains on oral glucocorticoids. Some side effects of bisphosphonate therapy may be increased in patients on glucocorticoid. For the patient at highest risk of fracture and likely to need long-term glucocorticoid treatment, use of an anabolic agent first should be considered.

Precipitation retrieval is a challenging topic, especially in high latitudes (HL), and current precipitation products face ample challenges over these regions. This study investigates the potential of the Advanced Very High-Resolution Radiometer (AVHRR) for snowfall retrieval in HL using CloudSat radar information and machine learning (ML). With all the known limitations, AVHRR observations should be considered for HL snowfall retrieval because (1) AVHRR data have been continuously collected for about four decades on multiple platforms with global coverage, and similar observations will likely continue in the future; (2) current passive microwave satellite precipitation products have several issues over snow and ice surfaces; and (3) good coincident observations between AVHRR and CloudSat are available for training ML algorithms. Using ML, snowfall rate was retrieved from AVHRR’s brightness temperature and cloud probability, as well as auxiliary information provided by numerical reanalysis. The results indicate that the ML-based retrieval algorithm is capable of detection and estimation of snowfall with comparable or better statistical scores than those obtained from the Atmospheric Infrared Sounder (AIRS) and two passive microwave sensors contributing to the Global Precipitation Measurement (GPM) mission constellation. The outcomes also suggest that AVHRR-based snowfall retrievals are spatially and temporally reasonable and can be considered as a quantitatively useful input to the merged precipitation products that require frequent sampling or long-term records.

The Global Precipitation Climatology Project (GPCP) is currently providing a next-generation Version 3.1 Monthly product, which covers the period 1983-2019. This modernized product includes higher spatial resolution (0.5°x0.5°); a wider coverage (60°N-S) by geosynchronous IR estimates, now based on the Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks-Climate Data Record (PERSIANN-CDR) algorithm, with monthly recalibration using Goddard Profiling (GPROF) algorithm retrievals from selected passive microwave sensors; and improved calibrations of Television-Infrared Operational Satellite (TIROS) Operational Vertical Sounder (TOVS) and Advanced Infrared Sounder (AIRS) precipitation, used outside 60ºN-S. The merged satellite estimate is adjusted to the Tropical Combined Climatology (TCC) at lower latitudes, and the Merged CloudSat, TRMM, and GPM (MCTG) climatology at higher latitudes. Finally, V3.1 provides a merger of the satellite-only estimates with the Global Precipitation Climatology Centre (GPCC) monthly 1°x1° gauge analyses. As well, the GPCP team is advancing a companion global Version 3 Daily product, in which the Integrated Multi-satellitE Retrievals for Global Precipitation Measurement (GPM) mission (IMERG) Final Run V06 estimates are used where available (initially restricted to 60°N-S), and rescaled TOVS/AIRS data in high-latitude areas, all calibrated to the GPCP V3.1 Monthly estimate. Since IMERG currently extends back to June 2000, daily PERSIANN-CDR data will be used for the period January 1983–May 2000 to complete the record.This presentation will provide early results for, and the latest status of, the Monthly and Daily GPCP products as a function of time and region. Key points include examining homogeneity over time and across time and space boundaries between input datasets. One key activity is to refine the V3 products while we continue to produce the Version 2 GPCP products for on-going use.

As SARS-CoV-2 stunned and overtook everyone's lives, multiple daily briefings, protocols, policies and incident command committees were mobilized to provide frontline staff with the tools, supplies and infrastructure needed to address the COVID-19 pandemic. Medical resources were immediately shifted. In light of the necessity for self-isolation, telemedicine was expanded, although there has been concern than non-pandemic disorders were being ignored. Ambulatory care services such as bone densitometry and osteoporosis centered clinics came to a near halt. Progress with fracture prevention has been challenged. Despite the prolonged pandemic and the consequent sense of exhaustion, we must re-engage with chronic bone health concerns and fracture prevention. Creating triaging systems for bone mineral testing and in person visits, treating individuals designated as high risk of fracture using fracture risk assessment tools such as FRAX, maintaining telemedicine, leveraging other bone health care team members to monitor and care for osteoporotic patients, and re-engaging our primary care colleagues will remain paramount but challenging. The pandemic persists. Thus, we will summarize what we have learned about COVID-19 and bone health and provide a framework for osteoporosis diagnosis, treatment, and follow-up with the extended COVID-19 pandemic. The goal is to preserve bone health, with focused interventions to sustain osteoporosis screening and treatment initiation/maintenance rates.

Glucocorticoid-induced osteoporosis (GIOP) remains the most common form of drug-induced osteoporosis. Patients may fracture at a different bone mineral density (BMD) threshold and absolute fracture risk using FRAX should be adjusted for glucocorticoid dose. Sufficient calcium and vitamin D are necessary but are generally insufficient for higher risk persons. The use of bone therapy in GIOP is motivated by an understanding of GIOP pathophysiology, including effects on heightened bone resorption and reduced bone formation. Osteoblast and osteocyte apoptosis contributes to both GIOP and glucocorticoid-associated osteonecrosis. Bisphosphonates, teriparatide, raloxifene, and denosumab stabilize or improve BMD more than placebo. Teriparatide, zoledronic acid, and denosumab increased BMD more so than an oral bisphosphonate. Teriparatide also reduced a small number of vertebral fractures more so than risedronate. All drugs tested in GIOP have had reasonable safety profiles, considering the significant comorbidity burden of those being treated with glucocorticoids. International guidelines advocate early and aggressive management of GIOP in order to lower fracture morbidity.

Bisphosphonates (BPs) remain first-line treatment for osteoporosis; long-term management is based on registration trial extensions. In one, postmenopausal women after 5 years of alendronate (ALN) were rerandomized to 5 more years of ALN or placebo. In another, women receiving three annual zoledronic acid (ZOL) infusions were rerandomized to three more active or placebo infusions. Continuing ALN led to fewer clinical vertebral fractures; continuing ZOL led to fewer morphometric vertebral fractures. Fracture risk reduction must be weighed against risks of osteonecrosis of the jaw and atypical femoral fractures. The American Society for Bone and Mineral Research Task Force approach remains valid. Patients at high fracture risk after 5 years (oral) or 3 years (intravenous) BP should continue treatment with periodic reassessment. Treatment beyond 10 years is guided by clinical judgment, and new long-term studies are unlikely. Alternative treatments are an option, but bone loss resumes immediately after discontinuation of all osteoporosis medications other than BPs.

The Third International Conference on Controversies in Vitamin D was held in Gubbio, Italy, September 10-13, 2019. The conference was held as a follow-up to previous meetings held in 2017 and 2018 to address topics of controversy in vitamin D research. The specific topics were selected by the steering committee of the conference and based upon areas that remain controversial from the preceding conferences. Other topics were selected anew that reflect specific topics that have surfaced since the last international conference. Consensus was achieved after formal presentations and open discussions among experts. As will be detailed in this article, consensus was achieved with regard to the following: the importance and prevalence of nutritional rickets, amounts of vitamin D that are typically generated by sun exposure, worldwide prevalence of vitamin D deficiency, the importance of circulating concentrations of 25OHD as the best index of vitamin D stores, definitions and thresholds of vitamin D deficiency, and efficacy of vitamin D analogues in the treatment of psoriasis. Areas of uncertainly and controversy include the following: daily doses of vitamin D needed to maintain a normal level of 25OHD in the general population, recommendations for supplementation in patients with metabolic bone diseases, cutaneous production of vitamin D by UVB exposure, hepatic regulation of 25OHD metabolites, definition of vitamin D excess, vitamin D deficiency in acute illness, vitamin D requirements during reproduction, potential for a broad spectrum of cellular and organ activities under the influence of the vitamin D receptor, and potential links between vitamin D and major human diseases. With specific regard to the latter area, the proceedings of the conference led to recommendations for areas in need of further investigation through appropriately designed intervention trials. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research. ispartof: JBMR PLUS vol:4 issue:12 ispartof: location:England status: published

We investigated the effects of testosterone replacement therapy (TRT) with and without evoked resistance training (RT) on protein expression of key metabolic and hypertrophy regulators, muscle fiber cross-sectional area (CSA), and markers of mitochondrial health after spinal cord injury (SCI). Twenty-two men with chronic motor complete SCI were randomly assigned to either TRT + RT (n = 11) or TRT (n = 11) for 16 wk. TRT + RT men underwent twice weekly progressive RT using electrical stimulation with ankle weights. TRT was administered via testosterone patches (2-6 mg/day). Muscle biopsies were obtained before and after 16 wk from the right vastus lateralis. Expression of proteins associated with oxidative muscles and mechanical loading (PGC-1α and FAK), muscle hypertrophy (total and phosphorylated Akt, total and phosphorylated mTOR), and cellular metabolism (total and phosphorylated AMPK and GLUT4) were evaluated. Immunohistochemistry analysis was performed to measure fiber CSA and succinate dehydrogenase (SDH) activity as well as mitochondrial citrate synthase (CS) activity and complex III (CIII) activities. TRT + RT demonstrated a robust 27.5% increase in average fiber CSA compared with a -9% decrease following TRT only (P = 0.01). GLUT4 protein expression was elevated in the TRT + RT group compared with TRT only (P = 0.005). Total Akt (P = 0.06) and phosphorylated Akt Ser389 (P = 0.049) were also elevated in the TRT + RT group. Mitochondrial activity of SDH (P = 0.03) and CS (P = 0.006) increased in the TRT + RT group, with no changes in the TRT-only group. Sixteen weeks of TRT with RT resulted in fiber hypertrophy and beneficial changes in markers of skeletal muscle health and function.NEW & NOTEWORTHY Fiber cross-sectional area (CSA), protein expression, mitochondrial citrate synthase (CS), and succinate dehydrogenase (SDH) were measured following 16 wk of low-dose testosterone replacement therapy (TRT) with and without electrically evoked resistance training (RT) in men with spinal cord injury (SCI). Fiber CSA and protein expression of total GLUT4, total Akt, and phosphorylated Akt increased following TRT + RT but not in the TRT-only group. Mitochondrial CS and SDH increased after TRT + RT but not in TRT-only group.

Natural Resources and Natural Law Part I: Prior Appropriation analyzed claims by some western ranchers, grounded in natural law, that they have property rights in grazing resources on federal public lands through prior appropriation. Those individuals advocated their position in part through civil disobedience and armed standoffs with federal officials. They also asserted that their duty to obey theistic natural law overrode any duty to obey the Nation’s positive law. Similar claims that individual religious beliefs override positive law have been made recently regarding a range of other controversial issues, such as same-sex marriage, public insurance for birth control, and the right to bear arms. Prior appropriation doctrine is consistent with secular natural law theory. Existing positive law, however, accepts prior appropriation for western water rights but rejects its application to grazing rights on federal public lands, for reasons consistent with secular natural law. Natural law doctrine allows citizens to advocate for change but requires them to respect the positive law of the societies in which they live. Separation of church and state also bars natural law claims based on religious doctrine unless those principles are also adopted in secular positive law. This sequel addresses claims from the opposite side of the political-environmental spectrum, that natural law provides one justification for the public trust doctrine, and that courts should enforce an atmospheric public trust to redress catastrophic global climate change. Although some religious groups have embraced environmental agendas supported by religious doctrine, public trust claims are secular in origin. Just as natural law provides support for prior appropriation, it supports the idea that some resources, such as water, wildlife, and air, should be held in common rather than made available for private ownership. From this perspective, the two doctrines merge into a single issue of resource allocation. Which resources are best made available for appropriation as private property, and which are best left in common? Natural law theory helps to explain the liberty and welfare goals that inform those choices. Positive law embraces the public trust doctrine with respect to some natural resources, and does not preclude its applicability to the atmosphere or other common resources.

Global precipitation means and variations over the last 40 years are described using information from the Global Precipitation Climatology Project (GPCP). The GPCP international program is outlined along with the satellite and conventional data and techniques used. Global climatological values and patterns are examined and are shown to compare generally well to recent measurements from new satellite missions and with results from water balance studies. Global precipitation totals are tied to ENSO events, with small global increases during El Ninos, and noticeable global decreases associated with major volcanic eruptions. A very slight significant trend is noted in the global precipitation mean value during this period of planetary warming, with a rate of ~1%/K. However, there is a pattern of larger positive and negative trends across the planet with increases over tropical oceans and decreases over some middle latitude regions. Significant trends in intensity at the monthly time scale are noted with the GPCP analyses, with larger rainfall magnitudes increasing, moderate rainfall values decreasing and dry areas expanding. These results indicate the value of the GPCP data set, but also call for continuing revision and improvement as the record lengthens, and as new, more sophisticated observations are integrated into this type of analysis system.