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International audience; The Anthropocene was conceptualized in 2000 to reflect the extensive impact of human activities on our planet, and subsequent detailed analyses have revealed a substantial Earth System response to these impacts beginning in the mid-20 th century. Key to this understanding was the discovery of a sharp upturn in a multitude of global socioeconomic indicators and Earth System trends at that time; a phenomenon termed the 'Great Acceleration'. It coincides with massive increases in global human-consumed energy and shows the Earth System now on a trajectory far exceeding the earlier variability of the Holocene Epoch, and in some respects the entire Quaternary Period. The evaluation of geological signals similarly shows the mid-20 th century as representing the most appropriate inception for the Anthropocene. A recent mathematical analysis has nonetheless challenged the significance of the original Great Acceleration data. We examine this analytical approach and reiterate the robustness of the original data in supporting the Great Acceleration, while emphasizing that intervals of rapid growth are inevitably time-limited, as recognised at the outset. Moreover, the exceptional magnitude of this growth remains undeniable, reaffirming the centrality of the Great Acceleration in justifying a formal chronostratigraphic Anthropocene at the rank of series/epoch.

The interval from the Valanginian to the Barremian stages (137–121 Ma; Early Cretaceous) is punctuated by several episodes of environmental changes, accompanied by shifts in weathering intensity on the continents and changes in the Tethyan neritic carbonate production. We synthetize here the astrochronology of two recent studies performed in the Neuquén basin, Vocontian Basin and Subbetic Domain (Aguirre-Urreta et al., 2019; Martinez et al., 2020), anchored to CA-ID-TIMS U-Pb ages, which conclusions have been included in the Geologic Time Scale 2020 (Gale et al, in press). We applied this time scale to a compilation of carbon-isotope ratio from belemnites and proxies of detrital supply in the Tethyan area (Vocontian Basin and Subbetic Domain). From this compilation, we show that the episodes of environmental changes are paced by a 2.4-Myr cycle and, with a lower amplitude, a 1.2-Myr cycle. In addition, the new time scale shows the synchronicity between the Weissert Event and the Parana-Etendeka Large Igneous Province. In the series of carbon-isotope ratios measured on belemnite rostra, the amplitude of the 2.4-Myr cycle is twice higher during the Valanginian than in the Late Barremian and three times higher than in the Hauterivian and Early Barremian, suggesting that the activity of the Parana-Etendeka Large Igneous Province amplified the initial orbital forcing to trigger the environmental changes observed during the Mid-Valanginian.Reference:Aguirre-Urreta, B., Martinez, M., Schmitz, M., Lescano, M., Omarini, J., Tunik, M., Kuhnert, H., Concheyro, A., Rawson, P.F., Ramos, V.A., Reboulet, S., Noclin, N., Frederichs, T., Nickl, A.-L., Pälike, H., 2019. Interhemispheric radio-astrochronological calibration of the time scales from the Andean and the Tethyan areas in the Valanginian–Hauterivian (Early Cretaceous). Gondwana Research 70, 104-132. https://doi.org/10.1016/j.gr.2019.01.006.Gale, A.S., Mutterlose, J., Batenburg, S., in press. Chapter 27: The Cretaceous Period, in: Gradstein, F.M., Ogg, J.G., Schmitz, M.D., Ogg, G.M. (Eds.) Geologic Time Scale 2020. Elsevier BV, Amsterdam, The Netherlands, pp. 1023–1086.Martinez, M., Aguado, R., Company, M., Sandoval, J., O’Dogherty, L., 2020. Integrated astrochronology of the Barremian Stage (Early Cretaceous) and its biostratigraphic subdivisions. Global and Planetary Change 195, 103368. https://doi.org/10.1016/j.gloplacha.2020.103368.

Eocrinoids are scarce in the Guanshan Biota (Cambrian Series 2, Stage 4), Yunnan Province, southwest China. Here, we introduce a new gogiid: Kunmingeocrinus cupuliformis n. gen. n. sp. which is characterized by a short stalk and a well-developed attachment disc. Preservation may indicate a weakly biomineralized body for the new taxon. Morphological similarities between the new taxon and other eocrinoids with attachment discs from Cambrian Lagerstatten of Guizhou Province (Series 2, Stage 4 and Miaolingian, Wuliuan) might suggest a similar mode of life. The eocrinoids from the Guanshan Biota possibly utilized different attachment modes.

The variability and dynamics of the Asian monsoon (AM, hereafter indicates both of the summer and winter monsoons.) at orbital and millennial timescales has attracted wide interest. Chinese loess deposits, covering an area of ~500 × 103 km2 and with a thickness of several tens to more than three hundred meters, is an ideal continental archive to reconstruct AM variations during the Quaternary epoch. Over the past thirty years, since the earliest paper published in an international journal that linked the Asian monsoon and Chinese loess deposits, many studies have been undertaken focusing on this research topic. These results have greatly deepened our understanding of the variations of the AM climate and their driving mechanisms during the past ~2.6 Myr. In this paper, we emphasize recent progress on the AM variability and dynamics revealed by Chinese loess records; in particular, we discuss the reliability and precision of the timescale and the monsoon proxy indicators for the loess-paleosol sequences, which are two fundamental aspects for understanding AM behavior. We analyze what we know and discuss what we do not know about the AM. We refine the timescale for the typical loess-paleosol sequence in the central Chinese Loess Plateau (CLP), which can be used as a new timescale to study palaeoclimate and palaeoenvironmental changes in the monsoonal Asia. We conclude that low-latitude insolation changes induced by precession, and global ice volume, temperature at high-latitudes, as well as sea-level changes forced variations of the AM at orbital time scales. High-latitude cooling events and low-latitude hydroclimate process at millennial time scales, such as climate changes associated with Heinrich events and Dansgaard-Oeschger cycles in Northern Atlantic and Greenland, have also modulated AM variability. We suggest that high-latitude forcing of AM variations occurs through ocean and atmospheric circulation linkages, although the roles of atmospheric CO2, ocean and vegetation feedbacks need further investigation. In future study, high-resolution independent dating, novel proxy indices and transient numerical simulations are still basic tools to understand the loess deposition and AM variations that require considerably more work. Issues such as reliable spatial comparison and regional linkages of records (dependent on precise and accurate numerical chronologies), and quantitative reconstruction of the AM variations, should be given priority in the study the past climate change in Asia, and low-latitude hydroclimate process.

soumis a JGR Atmospheres - First posted online: Fri, 8 Oct 2021; International audience; During the extended activity of Mount Etna volcano in February-April 2021, three distinct paroxysmal events took place from 21 to 26 February, which were associated with a very uncommon transport of the injected upper-tropospheric plumes towards the north. Using a synergy of observations and modelling, we characterised the emissions and three-dimensional dispersion for these three plumes, we monitor their downwind distribution and optical properties, and we estimate their radiative impacts at selected locations. With a satellite-based source inversion, we estimate the emitted sulphur dioxide (SO2) mass at an integrated value of 55 kt and plumes injections at up to 12 km altitudes, which qualifies this series as an extreme event for Mount Etna. Then, we combine Lagrangian dispersion modelling, initialised with measured temporally-resolved SO2 emission fluxes and altitudes, with satellite observations to track the dispersion of the three individual plumes. The transport towards the north allowed the height-resolved downwind monitoring of the plumes at selected observatories in France, Italy and Israel, using LiDARs and photometric aerosol observations. Volcanic-specific aerosol optical depths in the visible spectral range ranging from about 0.004 to 0.03 and local daily average shortwave radiative forcing ranging from about -0.2 to -1.2 W/m2 (at the top of atmosphere) and from about -0.2 to -3.0 W/m2 (at the surface) are found. The composition (possible presence of ash), aerosol optical depth and radiative forcing of the plume has a large inter- and intra-plume variability and thus depend strongly on the position of the sampled section of the plumes.

This case series highlights the role of repeat salvage lymph node dissection (sLND) for nodal-recurrent prostate cancer. We provide a descriptive analysis of ten patients who underwent sLND in a total of 23 surgeries (mean 2.3 sLNDs per patient) and their long-term follow-up (median of 158 mo after radical prostatectomy). A complete prostate-specific antigen response was observed in nine/23 cases (39.1%), and an incomplete response in 14 (60.9%). Analysis by anatomical location revealed a trend towards more distant metastases on repeat surgery, with only three in-field recurrences in patients with previously positive nodes. Repeat sLND can be surgically challenging, and major intraoperative complications were observed in three/23 cases (13.0%). Repeat sLND for patients with nodal-recurrent prostate cancer seems to be a feasible treatment option, albeit only in carefully selected patients. Nevertheless, it remains a highly experimental approach with unclear oncological benefit.

OBJECTIVE Given the anatomical complexity and frequently invasive growth of giant pituitary adenomas (GPAs), individually tailored approaches are required. The aim of this study was to assess the treatment strategies and outcomes in a large multicenter series of GPAs in the era of endoscopic transsphenoidal surgery (ETS). METHODS This was a retrospective case-control series of 64 patients with GPAs treated at two tertiary care centers by surgeons with experience in ETS. GPAs were defined by a maximum diameter of ≥ 4 cm and a volume of ≥ 10 cm3 on preoperative isovoxel contrast-enhanced MRI. RESULTS The primary operation was ETS in all cases. Overall gross-total resection rates were 64% in round GPAs, 46% in dumbbell-shaped GPAs, and 8% in multilobular GPAs (p < 0.001). Postoperative outcomes were further stratified into two groups based on extent of resection: group A (gross-total resection or partial resection with intracavernous remnant; 21/64, 33%) and group B (partial resection with intracranial remnant; 43/64, 67%). Growth patterns of GPAs were mostly round (11/14, 79%) in group A and multilobular (33/37, 89%) in group B. In group A, no patients required a second operation, and 2/21 (9%) were treated with adjuvant radiosurgery. In group B, early transcranial reoperation was required in 6/43 (14%) cases due to hemorrhagic transformation of remnants. For the remaining group B patients with remnants, 5/43 (12%) underwent transcranial surgery and 12/43 (28%) underwent delayed second ETS. There were no deaths in this series. Severe complications included stroke (6%), meningitis (6%), hydrocephalus requiring shunting (6%), and loss or distinct worsening of vision (3%). At follow-up (mean 3 years, range 0.5–16 years), stable disease was achieved in 91% of cases. CONCLUSIONS ETS as a primary treatment modality to relieve mass effect in GPAs and extent of resection are dependent on GPA morphology. The pattern of residual pituitary adenoma guides further treatment strategies, including early transcranial reoperation, delayed endoscopic transsphenoidal/transcranial reoperation, and adjuvant radiosurgery.

Context. Mindfulness is a meditation technique whose main goal is keeping the mind calm and educating attention by focusing only on one thing at a time, usually breathing. The reported benefits of its continued practice can be of interest for Software Engineering students and practitioners, especially in tasks like conceptual modeling, in which concentration and clearness of mind are crucial. Goal. In order to evaluate whether Software Engineering students enhance their conceptual modeling performance after several weeks of mindfulness practice, a series of three controlled experiments were carried out at the University of Seville during three consecutive academic years (2013–2016) involving 130 students. Method. In all the experiments, the subjects were divided into two groups. While the experimental group practiced mindfulness, the control group was trained in public speaking as a placebo treatment. All the subjects developed two conceptual models based on a transcript of an interview, one before and another one after the treatment. The results were compared in terms of conceptual modeling quality (measured as effectiveness, i.e. the percentage of model elements correctly identified) and productivity (measured as efficiency, i.e. the number of model elements correctly identified per unit of time). Results. The statistically significant results of the series of experiments revealed that the subjects who practiced mindfulness developed slightly better conceptual models (their quality was 8.16% higher) and they did it faster (they were 46.67% more productive) than the control group, even if they did not have a previous interest in meditation. Conclusions. The practice of mindfulness improves the performance of Software Engineering students in conceptual modeling, especially their productivity. Nevertheless, more experimentation is needed in order to confirm the outcomes in other Software Engineering tasks and populations. Ministerio de Economía y Competitividad TIN2015–70560–R Junta de Andalucía US–1264651 Ministerio de Ciencia, Innovación y Universidades RTI2018–101204–B–C22 Ministerio de Ciencia, Innovación y Universidades RTI2018- 101204–B–C21 Junta de Andalucía P18–FR–2895

Background: Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular treatment option for complex 3- and 4-part proximal humerus fractures in elderly patients. The literature has demonstrated that tuberosity repair likely improves postoperative range of motion (ROM). However, the difference between tuberosity repair and excision may not be appreciable to patients in their day-to-day lives. This case series reports both objective and subjective clinical outcomes of patients who underwent RTSA with tuberosity excision for proximal humerus fractures. Methods: We reviewed the records of 41 patients who underwent RTSA for complex 3- and 4- part proximal humerus fractures. All RTSA procedures were performed by a single surgeon between 2014 and 2017. All patients underwent RTSA with extended proximal stem cementation and tuberosity excision. Postoperative outcomes were measured at least 2 years postoperatively and included ROM measurements for forward flexion, internal rotation, abduction, and external rotation. Patient-reported outcome measures included Simple Shoulder Test scores, American Shoulder and Elbow Surgeons scores, and Penn Shoulder Score were also reported. Results: In this case series, we report on 41 patients, 33 females and 8 males. Objective measurements of ROM for forward flexion, abduction, and external rotation were 125, 95, and 36 degrees, respectively. On average, patients had an internal rotation score of 2.06 and were able to get their thumb to their iliac crest. Clinical outcome scores of these patients were 9.11, 77.79, and 74.12 for the Simple Shoulder Test, American Shoulder and Elbow Surgeons, and Penn Shoulder Score, respectively. Strength of the deltoid was 5/5 in all 41 patients. Conclusions: When compared with the current literature, our tuberosity excision patients demonstrated deficits in forward flexion and abduction, with preserved external rotation. Our clinical outcome score measurements were consistent with clinical outcome measurements from previous studies of patients undergoing RTSA with tuberosity repair. We believe that tuberosity excision may be a reasonable and simpler surgical option for surgeons with lower volumes of shoulder fractures and patients with multiple comorbidities and higher surgical risk, owing to the similarity of outcome scores between our cohort and previous tuberosity repair groups.

Background Myxopapillary ependymomas (MPE) with anaplastic features are rarely reported with only 21 cases identified to date, and long-term recurrence is rarely presented. The purpose of this case series is to expand understanding of this disease by describing three unique cases, including two that arose from myxopapillary ependymoma after a prolonged clinical course. Methods A review of literature and three cases of MPE with anaplastic features are described. Results Patient 1 is a 13-year-old male who presented with an avidly enhancing intradural lumbar mass. Upon gross total resection, the tumor was found to be a solid mass with areas of myxopapillary architecture and a MIB-1 (Ki-67) index of 12%. Patient 2 is a female who initially presented at age 22 with a lumbosacral tumor that treated with surgery and radiation. A recurrent tumor was resected at age 24. Twenty-six years later, at age 50, the patient presented with a large heterogeneous exophytic mass in the sacrum extending into the presacral space and Ki-67 index of 8%. This was treated with complete resection. Patient 3 is a male who initially presented at age 35 with a lower thoracic, upper lumbar mass at L2 extending into the sacrum. Following resection and radiation, a metastatic focus followed an indolent course until causing pain at the age of 48. The Ki-67 index was 16%. Conclusions The presented cases of MPE with anaplastic features make a total of 24 cases on record in the medical literature and demonstrate two examples of late recurrence.

Refractory epilepsy can develop as a late complication for survivors of pediatric cancer with central nervous system involvement who undergo chemoradiation therapy. This case series reports three such patients who presented with atypical non-convulsive seizures up to 14 years after cancer diagnosis. We hypothesize that the development of refractory epilepsy may be a late effect of radiation treatment, as each patient underwent whole brain radiation. Given the high morbidity and mortality associated with epilepsy, early identification is crucial to improve outcomes and quality of life for this vulnerable population.

Objective The aim of this study was to evaluate demographic, clinical, laboratory, imaging, histopathology characteristics, and treatment responses of children with Chronic nonbacterial osteomyelitis (CNO). Methods Retrospective multi-center case series study of pediatric patients diagnosed with CNO treated at five tertiary centers in south China. Results Totally there were 18 patients diagnosed as CNO between 2014 and 2020. The median age of onset was 9.2 years (range 3.7–13.1) and 55.6% were female. Median delay in diagnosis was 10.9 months (range 1.0–72.0). The most frequent presenting symptoms were bone pain (100%) and fever (44.4%). Most patients had more than one lesion (median of 5, range 1–7). Most frequently affected bones were tibiofibula (88.9%) and femur (77.8%). The MRI characteristics mainly presented as bone edema and hyperintensity in bone marrow. Bone biopsy was conducted in 11 patients (61.1%) with inflammatory cells infiltration manifested as chronic osteomyelitis, and none showed bacterial infection or tumor. In treatment, non-steroid anti-inflamatory drugs (NSAIDs) is used as the first-line drug followed by steriods, methotexate (MTX), salazosulfadimidine (SASP), Bisphosphonates and TNF-α inhibitor. Two refractory cases received combination therapy with Bisphosphonates and TNF-α inhibitor, and achieved good therapeutic effect. Conclusions The present study described a multicenter series of CNO from south China and highlighted the clinical features, laboratory tests, imaging characteristics and treatment outcomes. Increasing awareness of this disease is important to decrease time to diagnosis, improve access to treatment, and reduce complications.

We study the associations between daily mortality and short-term variations in the ambient concentrations of fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3) in four cities in Canada. First, a novel multivariate time series model within Bayesian framework is proposed for exposure assessment, where the response is a mixture of Gamma and Half-Cauchy distributions and the correlations between pollutants vary seasonally. A case-crossover design and conditional logistic regression model is used to relate exposure to disease data for each city, which then are combined to obtain a global estimate of exposure health effects allowing exposure uncertainty. The results suggest that every 10 ppb increase in O3 is associated with a 3.88% (95% credible interval [CI], 2.5%, 5.18%) increase in all-cause mortality, a 5.04% (2.84%, 7.43%) increase in circulatory mortality, a 7.87% (2.4%, 12.9%) increase in respiratory mortality, a 0.76% (0.19%, 1.35%) increase in all-cause morbidity and a 6.6% (0.58%, 12.7%) increase in respiratory morbidity. Similarly, every 10 ppb increase in NO2 is associated with a 2.13% (0.42%, 3.87%) increase in circulatory morbidity. The health impacts of PM2.5 are not found to be present once other pollutants are accounted for.

Understanding the variation regularity of water extent can provide insights into lake conservation and management. In this study, inter- and inner-annual variations of water extent during the period of 1987–2020 were analyzed to understand the temporal and spatial distribution characteristics of Dongting Lake. We applied the Multiple Index Water Detection Rule to extract the Dongting Lake water extent quickly and accurately based on Google Earth Engine platform, and then assessed the extraction accuracy. The water surface analysis results showed that (1) based on sustainable development goals (SDG) 6.6.1, the trend of water extent showed the downward fluctuating trend from 1987 to 2020, with the overall average water extent being 1894.48 km². (2) Among the monthly average water area, the largest extent was 2477.14km² (July) and the smallest was 848.14 km² (January). Among the seasonal mean water area, summer was the largest, with an area of 2438.06 km², and winter was the smallest at 967.34 km². (3) For the water inundation frequency, seasonal water bodies accounted for the largest proportion, with 1577.85 km²; the nonwater area was the smallest, with the area of 573.02 km²; and the permanent water area was 1086.21 km². Through the analysis of the historical water body extent of the long time series of Dongting Lake, this study reflected support for SDG, for which the research idea and design can help us understand the importance and feasibility of the SDG 6.6.1 indicator.

The Silurian Croagh Patrick succession, which crops out just south of a fundamental Caledonian structural zone near Clew Bay, western Ireland, is a series of psammites and pelites with a strong penetrative cleavage. These rocks are intruded by the Corvock granite. A suite of minor intrusions associated with the granite contains the regional cleavage whereas the Corvock granite is undeformed. New U–Pb dates are 413 +7 / –4 Ma for a strongly cleaved sill and 410 ± 4 Ma for the main granite, and closely constrain the age of crystallization of the granite and coeval cleavage formation as Lower Devonian (Lochkovian or Pragian), implying syn- to late-kinematic granite emplacement. These data are consistent with evidence for strong sinistral shear shown by the Ox Mountains granodiorite just to the northeast dated at 412.3 ± 0.8 Ma. This Devonian cleavage is superimposed on Ordovician rocks of the South Mayo Trough. The localisation of the strong deformation is interpreted as being due to its position at a restraining bend during regional sinistral motion on a segment of the Fair Head – Clew Bay Line to the north. Contemporaneous deformation in the syn-kinematic Donegal batholith suggests a transfer of sinistral motion to this intra-Grampian structure rather than simple along-strike linkage to the Highland Boundary Fault in Scotland. Our new data indicate diachronous deformation during the late Silurian and early Devonian history of the Irish and Scottish Caledonides and also support previous interpretations of diachronous deformation between these areas and the Appalachian orogens.

International audience; Fostered by the upcoming BIOMASS mission, this article explores long-term trends of P-band temporal decorrelation over a tropical forest due to a time series of 617 days acquired during the TropiScat-2 experiment. The interest in this unique time series is twofold. First, it provides consistent statistics to monitor the yearly evolution of temporal coherences according to specific time scales of the BIOMASS tomographic and interferometric phases. Second, it provides key insights to explore new processing approaches with the combination of data from different orbit directions (ascending/descending) and different mission cycles separated by about seven months according to the current acquisition plan. For the first time, this study shows that 18-day coherences (corresponding to the time interval between the first and last acquisitions of the BIOMASS tomographic processing) can vary significantly according to rainy and dry seasons (medians from 0.3 to 0.9). The extension to time intervals of up to 90 days within both seasons and over two consecutive years puts forward the key role of the typical sporadic rainfalls occurring during dry periods in tropical rainforests, with a stronger impact on temporal coherence evolution compared to the more reproducible rainy seasons. Furthermore, outstanding values significantly above zero have been obtained for the 7and 14-month coherences (medians of 0.35 and 0.2, respectively), opening the way to new methods of change detection. Overall, this study highlights the role of P-band temporal decorrelation not only as a disturbance factor for coherent applications but also as a relevant indicator of forest changes.

Introduction: Synchronous and metachronous tumors are a unique entity. In the setting of endometrial cancer, most concomitant primary sites include ovarian, colon, and breast cancer. The coexistenc...

OBJECTIVE Pediatric stereoelectroencephalography (SEEG) has been increasingly performed in the United States, with published literature being limited primarily to large single-center case series. The purpose of this study was to evaluate the experience of pediatric epilepsy centers, where the technique has been adopted in the last several years, via a multicenter case series studying patient demographics, outcomes, and complications. METHODS A retrospective cohort methodology was used based on the STROBE criteria. ANOVA was used to evaluate for significant differences between the means of continuous variables among centers. Dichotomous outcomes were assessed between centers using a univariate and multivariate logistic regression. RESULTS A total of 170 SEEG insertion procedures were included in the study from 6 different level 4 pediatric epilepsy centers. The mean patient age at time of SEEG insertion was 12.3 ± 4.7 years. There was no significant difference between the mean age at the time of SEEG insertion between centers (p = 0.3). The mean number of SEEG trajectories per patient was 11.3 ± 3.6, with significant variation between centers (p < 0.001). Epileptogenic loci were identified in 84.7% of cases (144/170). Patients in 140 cases (140/170, 82.4%) underwent a follow-up surgical intervention, with 47.1% (66/140) being seizure free at a mean follow-up of 30.6 months. An overall postoperative hemorrhage rate of 5.3% (9/170) was noted, with patients in 4 of these cases (4/170, 2.4%) experiencing a symptomatic hemorrhage and patients in 3 of these cases (3/170, 1.8%) requiring operative evacuation of the hemorrhage. There were no mortalities or long-term complications. CONCLUSIONS As the first multicenter case series in pediatric SEEG, this study has aided in establishing normative practice patterns in the application of a novel surgical technique, provided a framework for anticipated outcomes that is generalizable and useful for patient selection, and allowed for discussion of what is an acceptable complication rate relative to the experiences of multiple institutions.

A sub-bottom acoustic profile survey encountered a mass transport deposit (MTD) bed, 5–7 m thick, interbedded within glaciolacustrine deposits of glacial Lake Ojibway at Frederick House Lake, Ontario, Canada. Analysis of the thickness patterns of rhythmic couplets in recovered core samples revealed that the Connaught sequence, the youngest of the Timiskaming varve series, immediately underlie and overlie the MTD. Comparison to regional published varve series reveals two possible interpretations for the varve numbering: varve (v) 2066 to v2115, which requires the inference of a 55 varve year (vyr) disconformity just below the Connaught sequence, while the alternative numbering, v2011a to v2060a (a = alternative), extends continuously from older varves. Circumstantial evidence supporting the alternative numbering is as follows: (i) the uncertainty of applying a common 55 vyr disconformity to three varve series located up to 23 km apart and which otherwise exhibit closely matching thickness plots; (ii) the lack of evidence of an erosive unconformity in the sub-bottom acoustic profiles from Frederick House Lake; and (iii) the uncertain varve count within a key part of the Matagami series, located about 300 km away and from which the 55 vyr disconformity is extrapolated. At Frederick House Lake, the alternative numbering indicates that the maximum position of the Cochrane ice advance and the Connaught varves may be, in effect, contemporary in age. More broadly, the alternative numbering indicates that the youngest known varve that formed before the terminal drainage of glacial Lake Ojibway is v2074a rather than v2129 in the original numbering.

In this paper, the China’s first global ocean Climate Data Records (CDRs) are used to analyze and predict the sea level changes in the Yellow Sea with obvious seasonal changes. Based on the singular spectrum analysis (SSA) method, the spatiotemporal and time series of sea level anomalies (SLAs) in the Yellow Sea are decomposed and de-noised. Then the long short-term memory (LSTM) neural network is combined with the SSA to establish the SSA-LSTM combined model to predict the sea level trends of the Yellow Sea. Compared with the traditional methods, the prediction accuracy of SSA-LSTM combined model is significantly improved with minimum 35.04 mm RMSE values for the SLA time series prediction. For the one-year prediction of spatiotemporal series of SLA, the minimum RMSE values are only 19.68 mm. The law of spatial and temporal differentiation of the sea level change in the Yellow Sea is also analyzed by temporal empirical orthogonal function. It is found that the sea level trend of the Yellow Sea is highly consistent and significantly related to the season and latitude. According to the SSA-LSTM combined model, the sea level rise rate of the Yellow Sea will remain at 3.65 ± 0.79 mm/year in the next ten years.

Background Systemic sclerosis (SSc) is a rare detrimental disease warranting global research efforts. Evaluating how socio-economic factors impact country research output on SSc could help to identify solutions advancing research. Methods Publication production on SSc during 1969–2018 and data for structural and policy factors for WHO member countries were collected from public sources. Associations between SSc research output and country-level factors were investigated through panel regression. Difference-in-differences analysis further assessed the causal effects of rare disease legislation. Results SSc publications demonstrated exponential growth (r = 0.9410, as against an r = 0.8845 after linear adjustment), but were concentrated in high-income countries (HICs). Ten countries, nine of which were HICs, published 12,261 (77.5%) SSc publications but another 87 countries produced none. Gross domestic products (GDP), population and expenditure on research and development were positively associated with SSc publications (p p p Conclusions SSc research output increased over time with substantial country disparities. Effective health policies facilitating research should be expanded especially among MICs to accelerate research advancement.

The detailed sedimentary study of the deposit sequences of the ancient hominid sector (SahelanthropustchadensisalisToumai) of Toros-Menalla, presented here addresses new aspects of the sedimentary geology of the Chad Basin through an original field study of Moi-sediments: Pliocene of the northern basin of CHAD. This is an original contribution that sheds light on new knowledge of sedimentary series of fluvio-lacustrine and aeolian origin in the Djourab desert which are essential for understanding the paleoenvironments and paleoclimates of Chad, the Sahara and Africa. Aged from the Terminal Miocene to the present day, these deposits which constitute the last stages of the filling of this basin are exclusively of the continental type and concern in the broad sense the following four major sedimentary systems: Fluvial, deltaic, lacustrine and aeolian. From a lithological point of view, these sedimentary series are very heterogeneous and include sandstones, sands, clays and diatomites. Key words: Sedimentary deposit, Djourab, Toros-Menalla, Chad, fluvio-lacustrine, Aeolian.

This research explored the precision of diverse time-series models for COVID-19 epidemic detection in all the thirty-six different states and the Federal Capital Territory (FCT) in Nigeria with the maximum count of daily cumulative of confirmed, recovered and death cases as of 4 November 2020 of COVID-19 and populace of each state. A 14-multi step ahead forecast system for active coronavirus cases was built, analyzed and compared for six (6) different deep learning-stimulated and statistical time-series models using two openly accessible datasets. The results obtained showed that based on RMSE metric, ARIMA model obtained the best values for four of the states (0.002537, 0.001969.12E-058, 5.36E-05 values for Lagos, FCT, Edo and Delta states respectively). While no method is all-encompassing for predicting daily active coronavirus cases for different states in Nigeria, ARIMA model obtains the highest-ranking prediction performance and attained a good position results in other states.

BACKGROUND Non-clear cell (ncc) metastatic renal-cell carcinoma (RCC) has dismal results with standard systemic therapies and a generally worse prognosis when compared to its clear-cell counterpart. New systemic combination therapies have emerged for metastatic RCC (mRCC), but the pivotal phase III trials excluded patients with nccRCC, which constitute about 30% of metastatic RCC cases. AIM To provide a piece of real-life evidence on the use of pazopanib in this patient subgroup. METHODS The present study is a multicenter retrospective observational analysis aiming to assess the activity, efficacy, and safety of pazopanib as first-line therapy for advanced nccRCC patients treated in a real-life setting. RESULTS Overall, 48 patients were included. At the median follow-up of 40.6 mo, the objective response rate was 27.1%, the disease control rate was 83.3%, and the median progression-free survival and overall survival were 12.3 (95% confidence interval [CI]: 3.6-20.9) and 27.7 (95%CI: 18.2-37.1) mo, respectively. Grade 3 adverse events occurred in 20% of patients, and no grade 4 or 5 toxicities were found. CONCLUSION Pazopanib should be considered as a good first-line option for metastatic RCC with variant histology.

Background: Radiosurgery has demonstrated good safety and efficacy in the treatment of multiple brain metastases (BMs). However, multi-target dose planning can be challenging and time-consuming. A recently developed real-time inverse treatment planning (IP) by convex optimization has been demonstrated to produce high-quality treatment plans with good conformity and selectivity in single-target plans. We intended to test the capacity of this IP to rapidly generate efficient plans while optimizing the preservation of normal tissue in multiple BM. Methods: Seventy-nine patients (mean age 62.4, age range 22–85) with a total of 272 BMs were treated by Gamma Knife Radiosurgery. All subjects were treated using a forward planning (FP) technique by an expert neurosurgeon. The new Intuitive Plan was applied and able to automatically generate an alternative plan for each patient. All planning variables were collected from the IP to be compared with the corresponding measurements obtained from the FP. A paired sample t test was applied to compare the 2 plans for the following variables: brain volumes receiving 10 Gy (V10) (primary endpoint), and 12 Gy (V12), planning indices (selectivity, coverage, gradient, and Paddick Conformity Index [PCI]), beam-on time (BOT), and integral doses. Additionally, the noninferiority margin for each item was calculated, and the 2 plans were compared for noninferiority using a paired t test. Results: The mean age of patients was 62.4 years old (age range 22–85), with a sex ratio of 1.02. The average number of lesions per patient was 3.4 (range 1–12). The mean prescription dose was 21.46 Gy (range 14–24 Gy). Noninferiority of the IP was concluded for V10, V12, prescription isodose volume, BOT, PCI, and selectivity. The V10 (and V12) was significantly lower with the IP (p < 0.001). These volumes were 8.69 cm3 ± 11.39 and 5.47 cm3 ± 7.03, respectively, for the FP and 7.57 cm3 ± 9.44 and 4.78 cm3 ± 5.86 for the IP. Only the coverage was significantly lower with the IP (−2.3%, p < 0.001), but both selectivity (+17%) and PCI (+15%) were significantly higher with the IP than FP (p < 0.001). Conclusion: This IP demonstrated its capacity to generate multi-target plans rapidly, with a dose to the brain (V10) and BOT noninferior to the one of a human expert planner. These results would benefit from confirmation in a larger prospective series.

The central China summer precipitation (CCSP) is of great importance to the people’s livelihood of this densely populated region, including the agriculture, ecosystems, water resources, economies, and health. Based on the observed precipitation, sea surface temperature (SST), and atmospheric reanalysis datasets, the present study investigates the effects of El Nino in the developing stage on the CCSP during 1960–2014. The results show that the CCSP anomalies exhibit significant negative correlations with the El Nino-related SST anomalies in both the simultaneous summer and the following winter, implying that the developing El Nino is important for modulating the CCSP. However, this climatic teleconnection of El Nino is unstable, with an obvious interdecadal change around the late 1980s. Specifically, the negative correlation is not statistically significant in the previous epoch before the late 1980s (1960–1988), but dramatically strengthens since the late 1980s (the post epoch for 1989–2014). Such an interdecadal change is closely associated with the change of the El Nino-related SST anomaly pattern. Compared to the previous epoch, the central Pacific El Nino occurs more frequently in the post epoch, leading to an interdecadal shift of the maximum warm SST anomalies from the eastern Pacific to the central Pacific. The resultant westward extension of the atmospheric circulation responses induces an anomalous low-level cyclone covering South China in the post epoch. It would prevent the southwest monsoon from delivering the moisture to the north and hence reduce the CCSP. While, in the previous epoch, the anomalous cyclone locates east of South China, exerting insignificant influence on the CCSP. This work highlights a strengthening effect of El Nino on the CCSP since the late 1980s, with great implications for the regional seasonal climate prediction.

Background: Coronavirus disease has become a worldwide threat affecting almost every country in the world. The spread of the virus is likely to continue unabated. The aim of this study is to compare between Autoregressive Integrated Moving Average (ARIMA) model, Fuzzy time series and Holt-Winters – No seasonal for forecasting the COVID-19 new cases in Algeria. Methods: Three different models to predict the number of Covid-19 new cases in Algeria were used. The number of new cases of COVID-19 in Algeria during the period from 24th February 2020 to 31th July 2021 was modeled according to ARIMA(4,1,2) model, Five based Fuzzy time series models including the Chen model, Heuristic Huareng model, Singh model, Abbasov-Manedova model and NFTS model, and Holt-Winters – No seasonal. Results: The predictive values were obtained from the 1st August 2021 to 31th December 2021. According to a set of criteria (ME, MAE, MSE, RMSE, U), we found that the FTNS model is the most accurate and best generating model for the values of the number of new cases of Covid-19. Conclusion: To the best of our knowledge, this is the first comparative study of three models of forecasting of Covid-19 new cases in Algeria. This study shows that ARIMA models with optimally selected covariates are useful tools for monitoring and predicting trends of COVID-19 cases in Algeria. Moreover, this forecast will help the Health authorities to be better prepared to fight the epidemic by engaging their healthcare facilities.

This paper investigates links between rainfall variability in the Ogooué River Basin (ORB) and El Niño Southern Oscillation (ENSO) in the Pacific Ocean. Recent hydroclimatology studies of the ORB and surrounding areas resulting in contrasting conclusions about links between rainfall variability and ENSO. Thus, to make the issue clearer, this study investigates the links between ENSO and rainfall in the ORB over the period 1940–1999. The principal component analysis of monthly rainfall in the ORB was done. The temporal mode of the first component corresponds to the interannual variations of rainfall on the ORB. Also, the pattern of the spatial mode of the first component shows that the ORB is a homogeneous hydroclimatic zone. However, no leading mode is significantly correlated to the ENSO index. A cross-wavelet analysis of the time series of basin-scale rainfall and the ENSO index was therefore carried out. The result is a set of periodogram structures corresponding to some ENSO episodes recorded over the study period. And wavelet coherence analysis of both time series confirms that there are significant links between ENSO and rainfall in the ORB.

The failure and instability of a kind of specific rock structural bodies, such as the spalling-induced thin rock plates and the slender rock pillars, are the key inducing factors of rock engineering disasters and they are closely related to the shape effect, i.e., the height-to-width (H/W) ratio. For application in engineering practice, the strength characteristics and failure modes of the rock structural bodies when their H/W ratios vary in a wide range should be specially concerned, whereas this seems to be seriously ignored in previous studies. To support this purpose, a numerical scheme that integrates the statistical meso-damage constitutive model and the finite deformation formulation is proposed, to consider both the material failure and buckling instability of the rock structural bodies. The numerical results of a series of uniaxial compression tests of rock samples with relatively low H/W ratios (0.5–4) are completely consistent with the findings obtained from experiments. The behaviors of rock samples with high H/W ratios (6–28) show that the failure of rock samples is affected by both the H/W ratio and the strength of the rock material. That is, as the H/W ratio increases, the failure of rock samples gradually transforms from material failure dominated to structural (buckling) instability dominated, and the increase of the strength of rock material can facilitate this transition. The presented results have established an envelope about the failure and instability of rocks, and obtained the critical boundary line (CBL) for distinguishing different failure modes and determining the boundary between low and high H/W ratio.

Examining historical variations of hydroclimatic variables can provide crucial information about changes of water resources in a water cycle. In this study, the Mann–Kendall (MK) and Innovative Polygon Trend Analysis (IPTA) methods were applied to 56-year precipitation data collected at 8 measuring stations. These stations are located in Eastern Black Sea Basin (EBSB), which has a significant amount of annual precipitation and hydroelectric potential in Turkey. This study has two objectives: (1) investigating possible changes in the monthly precipitation and (2) comparing the results achieved by a classical (MK) and one of the latest trend analysis methods presented in the literature (IPTA). Based on the results, MK achieved no trend for most of months, while it reached an increasing trend for March at most of the stations. Likewise, IPTA determined an increasing trend for March precipitation. However, an increasing/decreasing trend was obtained by IPTA for most of the months and stations. In other words, comparing the trend analysis results obtained by IPTA and MK indicates a significant discrepancy between the numbers of months with detected trends primarily because the former is relatively more sensitive in trend identification. To be more precise, IPTA and MK determined trends in approximately 81.25% and 12.5% of all months, respectively. Furthermore, the former identified quite the same trends in every month which the latter reported a trend. Moreover, the polygon of the mean and standard deviation graphs developed by IPTA provides a year cycle, which brings about useful information for water utility sectors and decision makers of the study area. Finally, the findings of this study contribute to a large amount of research that attempts to explore spatio-temporal variations of hydroclimatic variables around the globe not only to enhance humans’ knowledge about changes in a water cycle but also assess climate change impacts.

In populated cities, pedestrian mortality is higher compared to other traffic mortalities. The current study aimed to describe the trend of pedestrian mortality in the East-Azerbaijan (Northwest of Iran) province from 2006 to 2019 and find the factors that affect the mortality number. Pedestrian mortality data from March 2006 to March 2019 was obtained from the Legal Medicine Organization database of Iran. Generalized Linear Auto Regressive Moving Average (GLARMA) models were used to assess the trend, and affecting factors of pedestrian mortality. According to the traffic accident data from 21 March 2006 until 20 March 2019 in East-Azerbaijan 24.11% of mortalities are related to pedestrians. Pedestrian mortality had a decreasing seasonal trend during 2006-2019. The result of the GLARMA model showed that age >65, being non-educated, cases with head trauma death cause, pre-hospital death, accident inside the city, vehicle type and self-employed jobs had a direct relation to pedestrian's mortality.

Italian scientific biopics experienced a period of extraordinary media hype in the 1970s, when some intellectuals personally committed to bringing the lives of the scientists of the past to television in order to discuss the relationship between knowledge and power in the present. Nevertheless, might we properly speak of “Italian-style” historical-scientific fictional drama? To answer this question, we will focus on Roberto Rossellini, Liliana Cavani and, above all, Lucio Lombardo Radice, a promoter, scientific consultant, author and presenter of, and sometimes even actor in, some of the most controversial of these scientific biopics. This article aims, first of all, to reconstruct this history, explaining the reasons for the success of the genre, starting in the 1960s, and the crisis it underwent in the 1980s; secondly, to ascertain the influences these ideological works exerted on choices, approaches and styles of the next generation of science historians and communicators.

The anthropological composition of the population buried at the cemetery of the Scythian Age near Svitlovodsk city (Kirovograd region) is analyzed in the paper. The burial ground is located on the border of the Forest-Steppe and Steppe Zones of the Right Bank of the Dnieper. The anthropological material under study comes from cemetery without mounds. Archaeologists date the main massif of burials to the 4th century BC. The anthropological composition of the population that was buried at this burial ground was not homogenous. The male series of skulls is characterized by a long, medium-wide, high, dolichocranic skull. The face is of medium size, it is mesognathic. The horizontal profile of the face at the upper level is medium, but with a tendency to the sharp; at the middle level, the face is strongly profiled. The orbital and nasal indexes are medium. The bones of the nose are moderately protruding. The average characteristics of the male population fit into the range of variations of the Scythian series. The male series belongs morphologically and statistically to the circle of the steppe Scythian groups. The male group from the burial ground near the city of Svitlovodsk is close to the series from the Nikolaevka burial ground on the Dnister River, the group of skulls from the burial mounds near the village of Shirokoe (Left Bank of the Dnieper River), the group of skulls from the burial mounds near the village of Vyshchetarassivka, a series of skulls from the Mykhailivka burial ground. Of the forest-steppe series, only the combined group of skulls from the Trypillya region is somewhat close to it. All these statistically and morphologically similar groups originate from different territories. This illustrates the specifics of the settlement and demonstrates the mobility of the Scythian groups. The female series from the burial ground is characterized by a long, narrow, medium-high skull, mesocranic in shape. The size of the face is small, it is mesognathic. The horizontal profile of the face at the upper level is moderate, at the zygomaxilar level it belongs to the category of sharp, but with a tendency to moderate. The orbital index is medium, the nasal index belongs to the large category. The bones of the nose are medium protruding. The female series from Svitlovodsk burial ground turns out to be the most gracile among the Scythian series in Ukraine. For this reason, it differs significantly from the entire massif of the steppe Scythian series. The closest to the Svitlovodsk series is a group from mounds near Nikopol.

Exacerbated by climate change, Europe has experienced series of hot and dry summer since the beginning of the 21st century. The importance of land conditions became an international concern with a dedicated sustainable development goal (SDG), the SDG 15. It calls for developing and finding innovative solu- tions to follow and evaluate impacts of changing land condi- tions induced by various driving forces. In Switzerland, drought risk will significantly increase in the coming decades with severe consequences on agriculture, energy production and vegeta- tion. In this paper, we used a 35-year satellite-derived annual and seasonal times-series of normalized difference water index (NDWI) to follow vegetation water content evolution at different spatial and temporal scales across Switzerland and related them to temperature and precipitation to investigate possible responses of changing climatic conditions. Results indicate that there is a small and slow drying tendency at the country scale with a NDWI mean decreasing slope of −0.22%/year for the 23% significant pixels across Switzerland. This tendency is mostly visible below 2000 m above sea level (m.a.s.l.) and in all biogeographical regions. The Southern Alps regions appear to be more responsive to changing drying conditions with a significant and slight negative NDWI trend (−0.39%/year) over the last 35 years. Moreover, NDWI values are mostly a func- tion of temperature at elevations below the tree line rather than precipitation. Findings suggest that multi-annual and seasonal NDWI can be a valuable indicator to monitor vegetation water content at different scales, but other components such as land cover type and evapotranspiration should be considered to better characterize NDWI variability. Satellite Earth Observations data can provide valuable complementary obser- vations for national statistics on the ecological state of vegeta- tion to support SDG 15 to monitor land affected by drying conditions.

The SARS-CoV-2 variant of concern (VOC) “Delta” is currently defined by PANGOLIN as a cluster of 33 different AY sublineages. Delta (in particular B.1.617.2) is largely and rapidly replacing the Alpha VOC as the dominant clade in most countries. To date, variations in the Spike protein of the Delta VOC have largely been limited. We report here the results of a genomic surveillance programme from Northern Italy. We identified several Delta sublineages harbouring mutations previously reported in GISAID at extremely low frequencies and in different combinations. Two patients (one of them vaccinated) tested positive for a Delta sublineage harbouring S71F, T250I, T572I and K854N. More patients tested positive for G769 V plus C1248F, A352S, and R158G and C1248F, respectively. Genomic surveillance of Delta variants should be encouraged to anticipate immune escape and deploy countermeasures.

The performance of stormwater treatment trains and of their individual green infrastructures was evaluated near Montreal, Canada. Three treatment trains were studied: Train 1 – five bioretention cells in series with a wet retention pond; Train 2 – an infiltration trench in series with a dry detention pond; and Train 3 – Train 2 in series with a wet retention pond. A total of 47 rain events were monitored to quantity the hydrological performance, while water quality samples were taken during 24 rainfall events. During the summer, the bioretention cells led to a reduction in runoff volumes varying from 8 to 100%. Overall, the three studied treatment trains and all of the individual infrastructures, except for the dry pond, provided reductions in the mean concentrations of total suspended solids, chemical oxygen demand, total nitrogen and total phosphorous. Results also showed that the use of a train of stormwater infrastructures can be more effective to reach Quebec's legislated targets than single infrastructures, but only if the infrastructures are sequenced properly. Indeed, the addition of a dry basin at the end of Train 2 affected negatively the removal efficiency of the four studied contaminants. HIGHLIGHTS Hydrological and water quality performance of single and in-series (train) stormwater control infrastructures was assessed.; The use of a train can be more effective for removing contaminants if sequenced properly.; Adding a dry basin at the end of a train affected negatively the removal efficiency of the four studied contaminants.; The mean removal efficiency of total suspended solids was positive during the winter months.

This retrospective case series demonstrates the combination of 0.05% atropine with MiSight® 1 day (Cooper vision, Sar Ramon, CA, USA) in rapid progression of myopia of 4 children. MiSight® 1 day is a peripheral defocus, center-distance soft contact lens and is effective at controlling moderate progression of myopia during the course of 1 year. The current case series included 2 females and 2 males with an average age of 9.68 ± 0.26 years and an average axial length of 24.81 ± 0.92 mm. Their myopic progression during the previous year was −1.45 ± 0.27 D. The children had not attempted any myopia control thus far. This relatively high increase prompted a combination treatment of daily instillation of 0.05% atropine and MiSight, a daily replacement soft contact lens. Cycloplegic refraction and a slit-lamp evaluation were performed every 6 months to confirm no adverse reactions or staining was present. The 8-item contact lens dry eye questionnaire (CLDEQ-8) score of these children was 10.66 ± 1.52. The average myopia progression at the end of 1 year decreased to −0.41 ± 0.11 D, and the average axial length increase was 0.28 ± 0.08 mm. To the best of the authors’ knowledge, this is the first published study showing a combination of 0.05% atropine and peripheral defocus soft contact lenses indicating efficacy at controlling moderate myopia progression.

To observe the efficacy and safety of roxadustat, an inhibitor of proline hydroxylase, in renal allograft anemia patients.This prospective study collected the clinical data of renal transplant patients treated with roxadustat for anemia at the Kidney Disease Center of the First Affiliated Hospital of Zhejiang University from April to August 2020. The patients were followed up every 2 weeks, and the changes in their hemoglobin index and any adverse reactions were recorded during 10 weeks of treatment. The efficacy of roxadustat for treatment of anemia after kidney transplantation was analyzed by comparing the change and increase in average hemoglobin levels before and after treatment. Rates of treatment response and achievement of the standard hemoglobin level were statistically analyzed. In addition, any potential adverse events and the glomerular filtration rate were recorded for 10 weeks to assess the safety of roxadustat in renal allograft anemia patients.After 10 weeks of roxadustat treatment, the mean hemoglobin level was 10.4±3.9 g/dL, which was significantly higher than at baseline. Over the entire period, treatment was observed to have a therapeutic effect at weeks 2-4, with mean hemoglobin levels increasing as treatment time increased. At the 10-week endpoint, the percentage of patients reaching the standard hemoglobin level and exhibiting a response to treatment was 52.4% and 71.4%, respectively. During the treatment, there was no rejection, and the glomerular filtration rate was stable. Only one person showed symptoms of fatigue, and there were no other obvious adverse reactions reported.Roxadustat significantly improves hemoglobin levels and can be safely used in renal transplant anemia patients.

Background: As the COVID-19 pandemic began, wellness leadership at a large Mid-west public university anticipated an increase in mental health problems among faculty and staff. A two-part weekly webinar series entitled "Staying Calm and Well in the Midst of the COVID-19 Storm" was launched to assist faculty and staff in coping with stressful issues related to the pandemic and enhancing their well-being. This series provided the university community with evidence-based knowledge, skills, and resources to enhance their ability in taking good self-care. Aim: To assess participant mental health outcomes during the two-part mental health and well-being educational webinar series over time. Methods: A longitudinal outcomes evaluation was conducted. Evaluation data was obtained from the participants via an anonymous post-webinar survey, which included questions from the Patient-Health Questionnaire-4 (PHQ-4) to assess symptoms of anxiety and depression. The first series was conducted over the course of 8 weeks and the second series took place over 7 weeks. Descriptive statistics were used to assess responses to the PHQ-4 over time to evaluate outcomes of the webinar series. An open-ended question also asked participants about the 2 to 3 biggest concerns and worries they had at that moment. Results: The average amount of survey responses received were 1,470.25 (SD = ± 240.3) for Series One and 926.4 (SD = ± 164.3) for Series Two. Ninety-five percent of participants put the skills they learned during both series into practice. When participants reported experiencing anxiety or depressive symptoms, they most frequently reported experiencing them several days a week. The number of participants reporting no depressive or anxiety symptoms increased as the webinar series progressed over time. The types of concerns and worries reported varied across time. Conclusion: The Staying Calm and Well During the COVID-19 Pandemic webinar participants had a reduction in symptoms associated with anxiety and depression after completing the series.

Objective Pineal parenchymal tumors of intermediate differentiation (PPTID) are rare tumors of the pineal gland. Their treatment is often heterogeneous due to the lack of literature to compile standardized treatments. Although no single institution has large numbers of cases, our experience has been that the clinical course is more varied and complicated than reported. Methods We reviewed the clinical data for all patients with pathology found to be consistent with PPTID at our institution between the years 2006 and 2019. Results Nine patients were identified. At initial diagnosis, all were treated with surgery and 4 of 9 patients underwent gross total resection. Adjuvant radiation therapy to the resection bed was administered in 6 of 9 patients. Mean follow-up time was 95.3 months. Mean progression-free survival was 50.5 months, with a tendency to be longer for male sex and after gross total resection. Seven patients developed a recurrence. Five of 6 known locations of first recurrences had either distant metastases or dissemination of disease. First recurrences were treated with radiation alone in 5 patients, craniospinal radiation with multiagent chemotherapy in 1 patient, and surgery with radiation therapy in 1. At last follow-up, 2 patients had died. Conclusions Herein, we report clinical patterns of disease progression and treatment patterns of PPTID. Many patients progressed during the follow-up period. Disseminated disease was the most common presentation at recurrence. Ultimately, given the risk of recurrence and dissemination at recurrence, more aggressive treatment strategies should be considered. Specifically, our series suggests a benefit of adjuvant radiation at initial diagnosis for grade II patients.