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The Hawaii-Emperor seamount chain stretches westward from the “Big Island” of Hawaii for over 6000 km until the oldest part of the Emperor chain is subducted at the Kuril and Aleutian trenches. Still regarded as the iconic hotspot-generated seamount chain it has been sampled, mapped, and studied to give insights into numerous oceanic phenomena, such as seamount and volcano formation and associated intraplate magma budgets, the past absolute motions of the Pacific plate and the drift of the Hawaiian plume, and the thermal and mechanical properties of oceanic lithosphere. Much early work on determining the flexural rigidity and equivalent elastic plate thickness that supports the large volcano loads that comprise the chain was focussed on the Hawaiian Ridge, with a major multichannel seismic expedition to the Hawaiian Islands in 1982 providing clear and direct evidence of plate flexure, as well as the indirect effect this deformation has on Earth’s gravity field. Numerous studies have since followed. However, the older part of the chain, beyond the ~50 Ma “bend”, has been much less well studied due to its remoteness, but recent expeditions have provided new marine seismic data to allow an estimation of elastic thickness along the Emperor chain and how they compare to the information we have along the Hawaiian Ridge. Here, we present preliminary work on determining the elastic thickness beneath the Emperor Seamounts. Unlike the Hawaiian Ridge, where the age of the lithosphere at the time of loading (i.e., the difference in age between the underlying seafloor and the formation age of a seamount or oceanic island) is remarkably constant, along the Emperor chain there are major variations in the age of loading, compounded by higher uncertainty due to limited seamount age sampling and the chain’s location within the Cretaceous Quiet Zone. Thus, models with variable elastic thickness as a function of location along the Emperor chain are required. In this presentation, we discuss several models that seek to account for the new seismic imaging of the top and base of flexed oceanic crust (i.e. Moho) at Jimmu guyot while at the same time honouring the characteristic gravimetric signature of the Emperor seamount edifices and their flanking moats. The Optimal Regional Separation (ORS) method is used to isolate the flexural loads, while seismic tomography and different velocity/density relations are explored for assigning suitable load and infill densities that vary spatially, and we search for optimal density and elastic parameters which minimize the misfit to both the residual gravity as well as the seismically observed flexure in the vicinity of Jimmu guyot. The first-order result is a clear thinning of the elastic thickness as we move from south to north: the implications of which we examine here for the tectonic evolution of the northwest Pacific Ocean and the long-term (>106 a) mechanical properties of oceanic lithosphere.

Evaluating the trends of extreme indices (EI) is crucial to detect and attribute extreme events (EE) and establish adaptation and mitigation strategies to the current and future climate conditions. However, the observational climate data used for the calculation of these indices often contains many missing values and leads to incomplete and inaccurate EI. This problem is even greater as we go back in time due to the scarcity of the older measurements.To tackle this problem, interpolation techniques such as the kriging method are often used to fill in the gaps. However, it has been shown that such techniques are inadequate to reconstruct specific climatic patterns [1]. Deep-learning based technologies give the possibility to surpass standard statistical methods by learning complex patterns and features in climate data.In this work, we are using an inpainting technique based on a U-Net neural network made of partial convolutional layers and a loss function designed to produce semantically meaningful predictions [1]. Models are trained using vast amounts of climate model data and can be used to reconstruct large and irregular regions of missing data with few computational resources.The efficiency of the method is well demonstrated through its application to the HadEX3 dataset [2]. This dataset contains gridded land surface EI, among which the TX90p index that measures the monthly (or annual) frequency of warm days (defined as a percentage of days where daily maximum temperature is above the 90th percentile). As for other EI, there is a lack of TX90p values in many regions of the world, even in recent years. It is particularly true when looking at an intermediate product of HadEX3 where the station-based indices have been combined without interpolation. This is illustrated by the left map of the figure where the gray pixels correspond to missing values. By training our model using data from the CMIP6 archive, we have been able to reconstruct the missing TX90p values for all the time steps of HadEX3 (see right map in the figure) and detect EE that were not included in the original dataset. The reconstructed dataset is being prepared for the community in the framework of the H2020 CLINT project [3] for further detection and attribution studies.[1] Kadow C. et al., Nat. Geosci., 13, 408-413 (2020)[2] Dunn R.J.H. et al., J. Geophys. Res. Atmos., 125, 1 (2020)[3] https://climateintelligence.eu/

Supplementary Figures S1-S6. Supplementary Figure S1. Liquid chromatography electrospray ionization tandem mass spectrometry analysis; Supplementary Figure S2. TM4SF1 expression in human breast and colon cancers; Supplementary Figure S3A. Clearance of anti-TM4SF1 antibody from HUVEC surface; Supplementary Figure S3B. Uptake of anti-TM4SF1 antibody in HUVEC; Supplementary Figure S4A. NSCLC killing by anti-TM4SF1 ADC; Supplementary Figure S4B. Tumor cell killing by anti-TM4SF1 ADC; Supplementary Figure S5. Expression level of TM4SF1 and other endothelial cell markers in tumor xenografts; Supplementary Figure S6. Clearance of anti-TM4SF1 ADCs; tolerance in mice.

Background: Most patients with orthopaedic pathology in low to middle-income countries are treated by nonspecialists. A curriculum to prepare undergraduate medical students for this duty should reflect the local pathology and skills that are required to manage patients in a resource-restricted environment. The aim of this study was to establish and prioritize a list of core orthopaedic-related knowledge topics, clinical cases, and skills that are relevant to medical students in southern Africa and areas with a similar clinical context. Methods: A modified Delphi consensus study was conducted with 3 interactive iterative rounds of communication and prioritization of items by experts from Africa, Europe, and North America. Preferred priorities were selected but were limited to 50% of all of the possible items. Percent agreement of ≥75% was defined as consensus on each of these items. Results: Most of the 43 experts who participated were orthopaedic surgeons from 7 different countries in southern Africa, but 28% were general practitioners or doctors working in primary or secondary-level facilities. Experts prioritized cases such as patients with multiple injuries, a limping child, and orthopaedic emergencies. Prioritized skills were manipulation and immobilization of dislocations and fractures. The most important knowledge topics included orthopaedic infections, the treatment of common fractures and dislocations, any red flags alerting to specialist referral, and back pain. Surgical skills for the treatment of urgent care conditions were included by some experts who saw a specific need in their clinical practice, but these were ranked lower. Conclusions: A wide geographic, academic, and expertise-specific footprint of experts informed this international consensus through their various clinical and academic circumstances. Knowledge topics, skills, and cases concerning orthopaedic trauma and infection were prioritized by the highest percent agreement. Acute primary care for fractures and dislocations ranked high. Furthermore, the diagnosis and the treatment of conditions not requiring specialist referral were prioritized. This study can inform national curricula in southern Africa and assist in the allocation of student clinical rotations.

Mosquitoes have profoundly affected human history and continue to threaten human health through the transmission of a diverse array of viruses and pathogens. Because mosquitoes are also highly diverse and globally widespread, their phylogeny has remained either little known or difficult to discern. Here, we used phylogenomic analysis of 709 orthologous nuclear gene sequences from 256 mosquito species to produce a strongly supported phylogeny that resolves the position of the major disease vector species and the major mosquito lineages. Our tree supports an origin of mosquitoes in the early Triassic (~217 mya) with species diversification and host-use patterns within major lineages coinciding in earth history both with major geologic events and with the diversification of vertebrate classes.

Spinal osteomyelitis predominantly affects the anterior vertebral column. Pyogenic infection seldom results in significant deformity but rather the more insidious causes such as tuberculosis. The typical deformity is a single plane kyphosis, other than when the infection affects the more mobile and more loaded lumbar spine where facet subluxation may result in a three-dimensional torsional deformity. Management is dictated by whether the disease process is active versus healed disease, the skeletal maturity of the patient and whether there is ongoing spinal growth expected and associated neurological deficit. Surgical strategies may be anterior only, such as in the sub-axial cervical and thoracic active disease, combined anterior and posterior procedures at the cervico-thoracic and thoracic‐lumbar junctions, but the posterior circumferential vertebral column resection (VCR) is increasingly utilized for rigid healed disease, especially with late presenters and in those patients who have associated neurological impairment.

Background Recovery from acute myocardial infarction (AMI) has been primarily understood in a narrow medical sense. For patients who survive, secondary prevention focuses largely on enhancing clinical outcomes. As a result, there is a lack of descriptive accounts of patients' experiences after AMI and little is known about how people go about the challenge of recovering from such an event. Objective We conducted a meta-synthesis of the available literature on qualitative accounts of patients' experiences after AMI. Methods We searched for relevant papers that were descriptive, qualitative accounts of participants' experiences after AMI across 4 electronic databases (April 2016). Using an adapted meta-ethnography approach, we analyzed the findings by translating studies into one another and synthesizing the findings from the studies. Results After a review of titles/abstracts, reading each article twice in full, and cross-referencing articles, this process resulted in 17 studies with 224 participants (48% women) aged 23 to 90 years. All participants provided a first-person account of an AMI within the 3-day to 25-year time frame. Two major themes emerged that characterized patients' experiences: navigating lifestyle changes and navigating the emotional reaction to the event-consisting of various subthemes. Conclusion Although AMI tends to be seen as a discrete event, participants are left with little professional guidance as to how to negotiate significant, and often discordant, psychosocial changes that have long-lasting effects on their lives, similar to persons with chronic illnesses but without research in place to figure out how to best support them.

Trabajo presentado en EMS Annual Meeting, celebrado en Bonn (Alemania) del 04 al 09 de septiembre de 2022., Sea breezes can occur on any coast of the world affecting meteorological variables broadly used to detect sea breeze episodes. To date, there is no universal method to identify sea breezes that works all over the globe. Most existing methodologies develop their own selection methods based on thresholds related to the local characteristics of the study site: e.g. wind direction based on the coastline orientation, cloud cover, precipitation, humidity, land-sea air temperature difference, pressure amplitude, insolation, among others. However, detecting past episodes from well-defined criteria makes sea breeze identification dependent on these criteria. This makes most classified events on the same site differ from each other, as well as making extrapolation to other regions difficult. The scarcity of high-resolution observed historical data over land and sea surfaces has limited the sea breeze understanding in many coastal regions across the world. To address the need of developing a universal method applicable to any coastal region of the globe, here we explore deep learning techniques (e.g. deep convolutional neural networks). We train these models using a time-series of high-resolution physical reanalysis (e.g. ERA-5 Land) gridded and observed data, after identifying 5 years of sea breezes manually for random stations around the globe. Results from this study constitute the first historical sea breeze global database spanning approximately the last 40 years. The ability of machine learning models to detect sea breezes allows the development of a simple and universal approach, which will improve the understanding of sea breeze at spatial scales which has not been addressed before, as far as we know.

BACKGROUND CONTEXT Effective alternatives to lumbar fusion for degenerative conditions have remained elusive. Anterior total disc replacement does not address facet pathology or central/recess stenosis, resulting in limited indications. A posterior-based motion-preserving option that allows for neural decompression, facetectomy, and reconstruction of the disc and facets may have a role. PURPOSE The purpose was to compare one-year patient-reported outcomes for a novel, all-posterior, lumbar total joint replacement (LTJR - replacing both the disc and facet joints) against transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar conditions warranting fusion (degenerative spondylolisthesis, recurrent disc herniation, severe foraminal stenosis requiring facet removal, and adjacent segment degeneration). STUDY DESIGN/SETTING A retrospective analysis of prospectively collected data comparing outcomes for LTJR patients to TLIF patients at an academic teaching hospital. PATIENT SAMPLE Analysis was conducted on 156 adult TLIF patients who were propensity matched to the 52 LTJR patients for a total sample of 208. OUTCOME MEASURES Self-reported Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for back and leg pain were compared preoperatively, 3 months and 1 year after surgery. METHODS The implant is a motion-preserving lumbar reconstruction that replaces the function of both the disc and facets and is implanted using a bilateral transforaminal approach with complete facetectomies. Adult patients with degenerative lumbar pathology undergoing either LTJR or open TLIF were analyzed. These degenerative conditions included: grade 1 degenerative spondylolisthesis, recurrent disc herniation, adjacent segment disease, disc degeneration with severe foraminal stenosis). Trauma, tumor, grade 2 or higher spondylolisthesis, spinal deformity, and infection cases were excluded. Propensity score matching was performed to ensure parity between the cohorts. Multivariable regression analyses were done to compare the 1-year results as measured by 3 different standards to assess procedure success. RESULTS At 3 months, both the LTJR and TLIF cohorts showed significant and similar improvements in ODI and NRS back and leg pain. At 1 year, the LTJR cohort showed continued improvement in ODI and NRS back pain, while the TLIF group showed a plateau for ODI, back and leg pain. In a series of three multivariable logistic regressions, LTJR was shown to provide 3.3 times greater odds of achieving the minimal clinical symptom state in disability and pain (ODI

Aims Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury which enables early intervention resulting in a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon-directed intraoperative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon-directed TcMEP is presented in terms of viability, safety, and efficacy. Methods We carried out a retrospective review of a single surgeon’s prospectively maintained database of cases in which TcMEP monitoring had been used between 2010 and 2017. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude from the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analyzed. Results Of the 299 cases reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No patient with normal traces had a postoperative clinical neurological deficit. True alerts occurred in 20 cases (6.7%). The diagnoses of the alert group included nine cases of adolescent idiopathic scoliosis (AIS) (45%) and six of congenital scoliosis (30%). The incidence of deterioration based on diagnosis was 9/153 (6%) for AIS, 6/30 (20%) for congenital scoliosis, and 2/16 (12.5%) for spinal tuberculosis. Deterioration was much more common in congenital scoliosis than in AIS (p = 0.020). Overall, 65% of alerts occurred during rod instrumentation: 15% occurred during decompression of the internal apex in vertebral column resection surgery. Four alert cases (20%) awoke with clinically detectable neurological compromise. Conclusion Surgeon-directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress, thereby enabling immediate intervention. In resource constrained environments, surgeon-directed TcMEP is a viable and effective method of intraoperative spinal cord monitoring. Level of evidence: III Cite this article: Bone Joint J 2021;103-B(3):547–552.

Methane (CH4) has a global warming potential (GWP) 28-times that of carbon dioxide (CO2) over a 100-year horizon. Riparian buffers strips are widely implemented for their water quality protection functions along agricultural land, but conditions prevailing within them may increase the emissions of greenhouse gases (GHGs), including CH4. However, only small amount of information is available regarding the dynamics of unintended emissions of soil CH4 in these commonplace features of agroecosystems and how the dynamics compare to those for agricultural land not containing buffer strips. To understand the dynamics of soil CH4 fluxes from a permanent upslope pasture and contiguous riparian buffer strips with different (grass, willow, and woodland) vegetation as well as controls with no buffer vegetation, field measurements were carried out using the static chamber technique on a replicated plot-scale facility. Gas fluxes were measured periodically with soil and environmental variables between June 2018 and February 2019 at Rothamsted Research, North Wyke, United Kingdom. Soils under all treatments were sinks of soil CH4 with the willow riparian buffer (-2555 ± 318.7 g CH4 ha-1) having the lowest soil CH4 flux followed by the grass riparian buffer (-2532 ± 318.7 g CH4 ha-1), woodland riparian buffer (-2318.0 ± 246.4 g CH4 ha-1), no-buffer control (-1938.0 ± 374.4 g CH4 ha-1), and lastly, the upslope pasture (-1328.0 ± 89.0 g CH4 ha-1) which had a higher flux. The three vegetated riparian buffers were more substantial soil CH4 sinks, suggesting that they may help reduce soil CH4 fluxes into the atmosphere in similar agroecosystems.

Atmospheric humidity plays an important role in climate analyses. Here we describe the production and key characteristics of a new quasi-global marine humidity product intended for climate monitoring, HadISDH.marine. It is an in situ multivariable marine humidity product, gridded monthly at a 5∘×5∘ spatial resolution from January 1973 to December 2018 with annual updates planned. Currently, only reanalyses provide up-to-date estimates of marine surface humidity, but there are concerns over their long-term stability. As a result, this new product makes a valuable addition to the climate record and will help address some of the uncertainties around recent changes (e.g. contrasting land and sea trends, relative-humidity drying). Efforts have been made to quality-control the data, ensure spatial and temporal homogeneity as far as possible, adjust for known biases in non-aspirated instruments and ship heights, and also estimate uncertainty in the data. Uncertainty estimates for whole-number reporting and for other measurement errors have not been quantified before for marine humidity. This is a companion product to HadISDH.land, which, when combined, will provide methodologically consistent land and marine estimates of surface humidity. The spatial coverage of HadISDH.marine is good over the Northern Hemisphere outside of the high latitudes but poor over the Southern Hemisphere, especially south of 20∘ S. The trends and variability shown are in line with overall signals of increasing moisture and warmth over oceans from theoretical expectations and other products. Uncertainty in the global average is larger over periods where digital ship metadata are fewer or unavailable but not large enough to cast doubt over trends in specific humidity or air temperature. Hence, we conclude that HadISDH.marine is a useful contribution to our understanding of climate change. However, we note that our ability to monitor surface humidity with any degree of confidence depends on the continued availability of ship data and provision of digitized metadata. HadISDH.marine data, derived diagnostics, and plots are available at http://www.metoffice.gov.uk/hadobs/hadisdh (last access: June 2019) and https://doi.org/10.5285/463b2fcd6a264a39b1e3249dab16c177 (Willett et al., 2020).

Patients with acquired immunodeficiency syndrome (AIDS) are at an increased susceptibility to pathogens and associated malignancies which can present with a unique constellation of symptoms. In this article, we describe a case of Castleman disease in a patient with AIDS, nonadherent with antiretroviral therapy (ART), who presented with fevers, constant abdominal pain, nausea, and vomiting. After an extensive work up, a lymph node biopsy confirmed a diagnosis of human herpesvirus-8 (HHV-8)-associated multicentric Castleman disease. Patients presenting with AIDS and fever have broad differential diagnoses; therefore, reaching a diagnosis as rare as Castleman disease can be challenging. HHV-8 has a propensity to CD20 positive B cells, which allows rituximab to be an effect treatment.

Background Although there has been movement in cardiology to advance patient‐centered approaches to postacute myocardial infarction (AMI) care, work remains to be done in aligning patient preferences with clinical care. Our objective was to characterize patients’ experience of AMI and treatment to develop a new conceptual framework of patient‐centered recovery in cardiology. Methods and Results We conducted in‐depth interviews with people who previously experienced an AMI (2016–2019). The interview focused on participants’ experiences of their recovery, which were audio‐recorded, transcribed verbatim, and analyzed using a phenomenological framework. The overarching theme described by the 42 participants was feeling like a “different person” after the AMI. This shift manifested itself in both losses and gains, each of which posed new challenges to everyday life. The experience appeared to be an active process requiring people to take responsibility for their health. In terms of loss, participants describe how the AMI threatened their sense of safety and security and led to social isolation, fragility, uncertainty about the future, and difficulty expressing emotions accompanied this new fear. A conceptual framework describing the relationship between AMI, identity change, and functioning was developed. Conclusions Participants experienced the AMI as an unexpected disruption in their lives that had far‐reaching effects on their daily functioning, and were resolved in numerous ways. The conceptual framework may assist in providing a theoretical basis for future interventions in cardiology that not only engage and retain patients in care but also improve long‐term adherence to secondary prevention and other aspects of self‐care.

With the ongoing warming of the globe, it is important to quantify changes in the recent behaviour of extreme events given their impacts on human health, infrastructure and the natural environment. We use the sub-daily, multi-variate, station-based HadISD dataset to study the changes in the statistical distributions of temperature, dewpoint temperature and wind speeds. Firstly, we use zonally averaged quantities to show that the lowest temperatures during both day and night are changing more rapidly than the highest, with the effect more pronounced in the northern high latitudes. Along with an increases in the zonally-averaged mean temperature, the standard deviation has decreased and the skew increased (increasing positive tail/decreasing negative tail) over the last 45 years, again with a stronger, more robust signal at higher latitudes. Changes in the distribution of dewpoint temperature are similar to those of temperature. However, changes in the distribution of wind speeds indicate a more rapid change at higher speeds than at lower. Secondly, to assess in more detail the spatial distribution of changes as well as across seasons and hours of the day we study each station individually. For stations which show clear indications of change in the statistical moments, the higher the statistical moment, generally the more spatially heterogenous the patterns of change. The standard deviation of temperatures are increasing in a band stretching from Europe through to China, but are decreasing across North America and in the high northern latitudes, indicating broadening and narrowing of the distributions respectively. Large seasonal differences are found in the change of standard deviations of temperatures over North America and eastern China. Temperatures in Eastern Asia also have increasing skew in the winter in contrast to the remainder of the year. The dewpoint temperatures show smaller variation in all of the moments, but similar patterns to the temperatures. For wind speeds, apart from the USA, standard deviations are decreasing across the world, indicating a decrease in variability. Finally, we use quantile regression to show changes in the percentiles of distributions over time. These show an increase of high quantiles of temperature in eastern Europe during the summer, and also in northern Europe for low quantiles in the winter, also indicating broadening and narrowing of the distributions respectively. In North America, the largest changes are at the lower quantiles in northern latitudes for autumn and winter. Quantiles of dewpoint temperature are changing most in the autumn and winter, especially in the northern parts of Europe.

The authors conducted an experiment to determine the effects of gender, race, online video gaming experience, and the experimental context in which participants played the video game (online vs. offline vs. no information control) on avatar selection. The qualities of the avatar compared were based on eight objective differences between avatars and individuals: attractiveness, skin tone, height, girth chest size, waist size, hip size, and height. As predicted, those with online gaming experience selected avatars that were taller, thinner, and more attractive relative to their real selves than did participants with no prior online game experience. Non-white participants selected avatars with lighter skin-tones, whereas white participants selected avatars with darker skin-tones. Surprisingly, male participants selected shorter avatars than female counterparts did.

Aims HIV predisposes patients to opportunistic infections. However, with the establishment of Highly Active Anti-Retroviral Therapy (HAART), patients’ CD4 counts are maintained, as is a near normal life expectancy. This study aimed to establish the impact of HIV on the bacteriology of spondylodiscitis in a region in which tuberculosis (TB) is endemic, and to identify factors that might distinguish between them. Patients and Methods Between January 2014 and December 2015, 63 consecutive cases of spontaneous spondylodiscitis were identified from a single-centre, prospectively maintained database. Demographics, presenting symptoms, blood results, HIV status, bacteriology, imaging, and procedure undertaken were reviewed and comparisons made of TB, non-TB, and HIV groups. There were 63 patients (22 male, 41 female) with a mean age of 42.0 years (11 to 78; sd 15.0). Results In total, 53 patients had tuberculous, nine bacterial, and one cryptococcal spondylodiscitis. There were 29 HIV-positive patients, 29 HIV-negative patients, and five patients with unknown HIV status. The local incidence of TB spondylodiscitis was 1.54/100 000 and that of non-TB spondylodiscitis was 0.29/100 000 per annum. TB patients were younger with similar clinical presentation and infective markers, but were more likely to have a paraspinal abscess. They were also less likely to have a hyperintense disc on MRI. There was no difference between the two HIV groups. Conclusion In areas of endemic TB and HIV, TB remains the most common cause of spondylodiscitis at five times the rate of non-tuberculous causes. HIV managed with HAART increases the rate of infection but does not influence the bacteriology unless there is a low CD4. There was little to differentiate the groups. TB /HIV co-infected patients were younger than non-TB and HIV-negative patients. Non-TB patients were more likely to have disc hyperintensity on MRI and TB patients were more likely to have abscess formation, but as both groups exhibited these features, neither was diagnostic. Culture confirmation remains necessary. Cite this article: Bone Joint J 2019;101-B:617–620.

Study Design: Systematic review. Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease, ultimately resulting in paralysis and death. The condition is considered to be caused by a complex interaction between environmental and genetic factors. Although vast genetic research has deciphered many of the molecular factors in ALS pathogenesis, the environmental factors have remained largely unknown. Recent evidence suggests that participation in certain types of sporting activities are associated with increased risk for ALS. Objective: To test the hypothesis that competitive sports at the highest level that involve repetitive concussive head and cervical spinal trauma result in an increased risk of ALS compared with the general population or nonsport controls. Methods: Electronic databases from inception to November 22, 2017 and reference lists of key articles were searched to identify studies meeting inclusion criteria. Results: Sixteen studies met the inclusion criteria. Sports assessed (professional or nonprofessional) included soccer (n = 5), American football (n = 2), basketball (n = 1), cycling (n = 1), marathon or triathlon (n = 1), skating (n = 1), and general sports not specified (n = 11). Soccer and American football were considered sports involving repetitive concussive head and cervical spinal trauma. Professional sports prone to repetitive concussive head and cervical spinal trauma were associated with substantially greater effects (pooled rate ratio [RR] 8.52, 95% CI 5.18-14.0) compared with ( a) nonprofessional sports prone to repetitive concussive head and cervical spinal trauma (pooled RR 0.60, 95% CI 0.12-3.06); ( b) professional sports not prone to repetitive head and neck trauma (pooled RR 1.35, 95% CI 0.67-2.71); or ( c) nonprofessional sports not prone to repetitive concussive head and cervical spinal trauma (pooled RR 1.17, 95% CI 0.79-1.71). Conclusions: Our review suggests that increased susceptibility to ALS is significantly and independently associated with 2 factors: professional sports and sports prone to repetitive concussive head and cervical spinal trauma. Their combination resulted in an additive effect, further increasing this association to ALS.

From regenerating sea slugs to self-medicating sheep, a biologist probes the origins and evolution of behavior

A large number of recent studies have aimed at understanding short-duration rainfall extremes, due to their impacts on flash floods, landslides and debris flows and potential for these to worsen with global warming. This has been led in a concerted international effort by the INTENSE Crosscutting Project of the GEWEX (Global Energy and Water Exchanges) Hydroclimatology Panel. Here, we summarize the main findings so far and suggest future directions for research, including: the benefits of convection-permitting climate modelling; towards understanding mechanisms of change; the usefulness of temperature-scaling relations; towards detecting and attributing extreme rainfall change; and the need for international coordination and collaboration. Evidence suggests that the intensity of long-duration (1 day+) heavy precipitation increases with climate warming close to the Clausius–Clapeyron (CC) rate (6–7% K −1 ), although large-scale circulation changes affect this response regionally. However, rare events can scale at higher rates, and localized heavy short-duration (hourly and sub-hourly) intensities can respond more strongly (e.g. 2 × CC instead of CC). Day-to-day scaling of short-duration intensities supports a higher scaling, with mechanisms proposed for this related to local-scale dynamics of convective storms, but its relevance to climate change is not clear. Uncertainty in changes to precipitation extremes remains and is influenced by many factors, including large-scale circulation, convective storm dynamics andstratification. Despite this, recent research has increased confidence in both the detectability and understanding of changes in various aspects of intense short-duration rainfall. To make further progress, the international coordination of datasets, model experiments and evaluations will be required, with consistent and standardized comparison methods and metrics, and recommendations are made for these frameworks. This article is part of a discussion meeting issue ‘Intensification of short-duration rainfall extremes and implications for flash flood risks’.

The new HadCRUT5 data set combines meteorological station air temperature records with sea-surface temperature measurements in a data set of near-surface temperature anomalies from the year 1850 to present. Major developments in HadCRUT5 include: updates to underpinning observation data holdings; use of an updated assessment of the impacts of changing marine measurement methods; and adoption of a statistical gridding method to extend estimates into sparsely observed regions of the globe, such as the Arctic. The data are presented as a 200-member ensemble that spans the assessed uncertainty associated with adjustments for long-term observational biases, observing platform measurement errors and the interaction of observational sampling with gridding methods. The impacts of methodological changes in HadCRUT5 on diagnostics of the global climate will be discussed and compared to results derived from other state-of-the-art global data sets.

Background. The COVID-19 pandemic has impacted on the global surgery landscape. Objectives. To analyse and describe the initial impact of the COVID-19 pandemic on orthopaedic surgery at Groote Schuur Hospital, a tertiary academic hospital in South Africa. Methods. The number of orthopaedic surgical cases, emergency theatre patient waiting times, and numbers of outpatient clinic visits, ward admissions, bed occupancies and total inpatient days for January - April 2019 (pre-COVID-19) were compared with the same time frame in 2020 (COVID-19). The COVID-19 timeframe included initiation of a national ‘hard lockdown’ from 26 March 2020, in preparation for an increasing volume of COVID-19 cases. Results. April 2020, the time of the imposed hard lockdown, was the most affected month, although the number of surgical cases had started to decrease slowly during the 3 preceding months. The total number of surgeries, outpatient visits and ward admissions decreased significantly during April 2020 (55.2%, 69.1% and 60.6%, respectively) compared with April 2019 ( p

The Hawaiian-Emperor seamount chain in the Pacific Ocean has provided fundamental insights into hotspot generated intraplate volcanism and the long-term strength of oceanic lithosphere. However, only a few seismic experiments to determine crustal and upper mantle structure have been carried out on the Hawaiian Ridge, and no deep imaging has ever been carried out along the Emperor seamounts. Here, we present the results of an active source seismic experiment using 29 Ocean-Bottom Seismometers (OBS) carried out along a strike profile of the seamounts in the region of Jimmu and Suiko guyots. Joint reflection and refraction tomographic inversion of the OBS data show the upper crust is highly heterogeneous with P wave velocities

We present a new version of the Met Office Hadley Centre/Climatic Research Unit global surface temperature dataset, HadCRUT5. HadCRUT5 presents monthly average near-surface temperature anomalies, relative to the 1961-1990 period, on a regular 5° latitude by 5° longitude grid from 1850 to 2018. HadCRUT5 is a combination of sea-surface temperature measurements over the ocean from ships and buoys and near-surface air temperature measurements from weather stations over the land surface. These data have been sourced from updated compilations and the adjustments applied to mitigate the impact of changes in sea-surface temperature measurement methods have been revised. Two variants of HadCRUT5 have been produced for use in different applications. The first represents temperature anomaly data on a grid for locations where measurement data are available. The second, more spatially complete, variant uses a Gaussian process based statistical method to make better use of the available observations, extending temperature anomaly estimates into regions for which the underlying measurements are informative. Each is provided as a 200-member ensemble accompanied by additional uncertainty information. The combination of revised input datasets and statistical analysis results in greater warming of the global average over the course of the whole record. In recent years, increased warming results from an improved representation of Arctic warming and a better understanding of evolving biases sea-surface temperature measurements from ships. These updates result in greater consistency with other independent global surface temperature datasets, despite their different approaches to dataset construction, and further increase confidence in our understanding of changes seen.

High quality and well-managed climate data are the cornerstone of all climate services. Consistently assessing how well the data are managed is one way to establish or demonstrate the trustworthiness of the data. This paper presents the World Meteorological Organization’s (WMO) Stewardship Maturity Matrix for Climate Data (SMM-CD) and the subsidiary SMM-CD for National and Regional Purposes (SMM-CD_NRP). Both these matrices have been developed with the support of the WMO and its High-Quality Global Data Management Framework for Climate (HQ-GDMFC). These self-assessment tools enable data managers to discover WMO recommended data stewardship practices, determine a roadmap for future development and improvement, as well as compare their process against other data providers. Datasets which have been maturity assessed are included in the WMO Climate Data Catalogue, where users can include the results of these maturity assessments into their decision-making process. The SMM-CD contains four categories (data access, usability and usage, quality management, and data management) each of which has a number of aspects, with scores assigned to one of five levels. A smaller number of categories in the SMM-CD_NRP are assigned to four levels appropriate for operationally produced datasets which are national or regional in scope. We explore a number of case studies where these matrices have been applied, as well as supply links to where the Guidance Documents and Assessment Templates (which may be updated) can be found. Robert Dunn was supported by the Met Office Hadley Centre Climate Programme funded by BEIS and Defra. Ge Peng was supported by NOAA National Centers for Environmental Information (NCEI) through the Cooperative Institute for Satellite Earth System Studies (CISESS) under Cooperative Agreement NA19NES4320002. Markus Donat was supported by the Spanish Ministry for the Economy, Industry and Competitiveness, grant reference RYC-2017-22964. KNMI hosted the EIG-CDM workshop and the development and maintenance of the WMO Catalogue for Climate Data.

Stroke of the cerebellum represents about 10% of strokes of the brain. Both infarction and hemorrhage manifest with symptoms related to the location and extent of the lesion(s). Bilateral cerebellar infarcts constitute up to one third of all cerebellar infarctions. The leading cause of cerebellar infarcts is emboli of cardiac origin or from intra-arterial sources. Potential complications include brainstem compression and hydrocephalus. Malignant cerebellar edema is a life-threatening complication of ischemic posterior circulation stroke requiring urgent management. The advent of MRI has revolutionized the early diagnosis in vivo, showing small and large territorial infarcts, hemorrhages, and venous infarcts. Endovascular procedures are growingly applied and are impacting on the prognosis of stroke, although cerebellar stroke from occlusion of small cerebellar arteries is currently not accessible to thrombectomy. Surgical procedures of space-occupying stroke include external ventricular drainage, suboccipital craniotomy, or combined procedures. In 1849, Robert Dunn (1799-1877), an English surgeon, reported the details of a case of apoplexy of the cerebellum in a 52-year-old man, pointing to the importance of post-mortem studies of patients followed meticulously during lifetime. Dunn discussed inflammation surrounding hemorrhage as a source of cerebral degeneration, linking for the first time cerebellar stroke, neuroinflammation, and atherosclerosis.