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The Greenland Ice Sheet is a leading source of global sea level rise, due to surface meltwater runoff and glacier calving. However, given a scarcity of proglacial river gauge measurements, ice sheet runoff remains poorly quantified. This lack of in situ observations is particularly acute in Northwest Greenland, a remote area releasing significant runoff and where traditional river gauging is exceptionally challenging. Here, we demonstrate that georectified time-lapse camera images accurately retrieve stage fluctuations of the proglacial Minturn River, Inglefield Land, over a 3 year study period. Camera images discern the river’s wetted shoreline position, and a terrestrial LiDAR scanner (TLS) scan of riverbank microtopography enables georectification of these positions to vertical estimates of river stage. This non-contact approach captures seasonal, diurnal, and episodic runoff draining a large (∼2,800 km2) lobe of grounded ice at Inglefield Land with good accuracy relative to traditional in situ bubble-gauge measurements (r2 = 0.81, Root Mean Square Error (RMSE) ±0.185 m for image collection at 3-h frequency; r2 = 0.92, RMSE ±0.109 m for resampled average daily frequency). Furthermore, camera images effectively supplement other instrument data gaps during icy and/or low flow conditions, which challenge bubble-gauges and other contact-based instruments. This benefit alone extends the effective seasonal hydrological monitoring period by ∼2–4 weeks each year for the Minturn River. We conclude that low-cost, non-contact time-lapse camera methods offer good promise for monitoring proglacial meltwater runoff from the Greenland Ice Sheet and other harsh polar environments.

Ishith Seth,1 Nimish Seth,2 Gabriella Bulloch,3 Warren M Rozen,4 David J Hunter-Smith4 1Department of Surgery, Bendigo Health, Bendigo, Victoria, 3550, Australia; 2Department of Surgery, The Alfred Hospital, Melbourne, Victoria, 3004, Australia; 3Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, 3010, Australia; 4Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, 3004, AustraliaCorrespondence: David J Hunter-SmithPeninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, AustraliaTel +610359763522Fax +610359763544Email dhuntersmith@mac.comPurpose: The aim of this systematic review is to update and synthesize new evidence on BREAST-Q questionnaire’s ability to reflect patient-reported outcomes in women who have undergone breast reconstruction surgery (BRS) following mastectomy.Methods: PubMed, Science Direct, Google Scholar, Cochrane CENTRAL, and Clincaltrial.gov were searched for relevant studies from January 2009 to September 2021. Any interventional or observational studies that used BREAST-Q to assess patient-reported outcomes in the assessment of BRS following mastectomy were included.Results: A total of 42 studies were eligible for inclusion in the review. Three were randomized controlled trials and 39 were observational studies. Compared with pre-operative scores, there was an improvement in all BREAST-Q outcome domains following BRS including ‘satisfaction with breasts’, “satisfaction with outcome” “psychosocial”, “physical”, and “sexual wellbeing”. Sexual well-being had the lowest BREAST-Q score both pre-and post-operatively (37.8– 80.0 and 39.0– 78.0, respectively). Autologous BRS reports higher satisfaction and overall wellbeing compared to implant-based BRS. BREAST-Q has a higher and narrow internal consistency of 0.81 to 0.96 compared with other patient-reported outcome measures (PROMs; EORTC-QLQ, FACT-B, BR-23, BCTOS). The BREAST-Q questionnaire is the only PROM which allows patients to reflect on their care, surgical outcomes, and satisfaction collectively.Conclusion: This review highlights the fact that BREAST-Q can effectively and reliably measure satisfaction and wellbeing of breast cancer patients after BRS. Comparatively, sexual wellbeing shows poorer outcomes following BRS and more longitudinal studies are necessary to understand the basis for these findings. Compared to other PROMs, BREAST-Q is reliable and specific to breast cancer surgery. Overall, BREAST-Q can help clinicians improve their quality of service, understand patient experiences, and may be used as an auditing tool for surgical outcomes.Keywords: BREAST-Q, patient-reported outcomes, breast reconstruction surgery, mastectomy

Abstract Background Children living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART). The goal of ART in HIV-infected persons is sustained viral suppression. There is limited information on virological non-suppression or failure and its associated factors in children in resource limited countries, particularly Ghana. Methods A cross-sectional study of 250 children aged 8 months to 15 years who had been on ART for at least 6 months attending the Paediatric HIV clinic at Korle Bu Teaching hospital in Ghana was performed. Socio-demographic, clinical, laboratory and ART Adherence related data were collected using questionnaires as well as medical records review. Blood samples were obtained for viral load and CD4+ count determination. Viral load levels > 1000 copies/ml on ART was considered virological non-suppression. Logistic regression was used to identify factors associated with virological non-suppression. Results The mean (±SD) age of the study participants was 11.4 ± 2.4 years and the proportion of males was 53.2%. Of the 250 study participants, 96 (38.4%) had virological non-suppression. After adjustment for significant variables, the factors associated with non-suppressed viral load were female gender (AOR 2.51 [95% CI 1.04–6.07], p = 0.041), having a previous history of treatment of tuberculosis (AOR 4.95 [95% CI 1.58–15.5], p = 0.006), severe CD4 immune suppression status at study recruitment (AOR 24.93 [95% CI 4.92–126.31], p

Abstract Objective To report initial results of a planned multicenter year‐long prospective study examining the risk and impact of COVID‐19 among persons with neuroinflammatory disorders (NID), particularly multiple sclerosis (MS). Methods In April 2020, we deployed online questionnaires to individuals in their home environment to assess the prevalence and potential risk factors of suspected COVID‐19 in persons with NID (PwNID) and change in their neurological care. Results Our cohort included 1115 participants (630 NID, 98% MS; 485 reference) as of 30 April 2020. 202 (18%) participants, residing in areas with high COVID‐19 case prevalence, met the April 2020 CDC symptom criteria for suspected COVID‐19, but only 4% of all participants received testing given testing shortages. Among all participants, those with suspected COVID‐19 were younger, more racially diverse, and reported more depression and liver disease. PwNID had the same rate of suspected COVID‐19 as the reference group. Early changes in disease management included telemedicine visits in 21% and treatment changes in 9% of PwNID. After adjusting for potential confounders, increasing neurological disability was associated with a greater likelihood of suspected COVID‐19 (ORadj = 1.45, 1.17–1.84). Interpretations Our study of real‐time, patient‐reported experience during the COVID‐19 pandemic complements physician‐reported MS case registries which capture an excess of severe cases. Overall, PwNID seem to have a risk of suspected COVID‐19 similar to the reference population.

Abstract Background Aedes aegypti is the principal mosquito vector of Zika, dengue, and yellow fever viruses. Two subspecies of Ae. aegypti exhibit phenotypic divergence with regard to habitat, host preference, and vectorial capacity. Chromosomal inversions have been shown to play a major role in adaptation and speciation in dipteran insects and would be of great utility for studies of Ae. aegypti. However, the large and highly repetitive genome of Ae. aegypti makes it difficult to detect inversions with paired-end short-read sequencing data, and polytene chromosome analysis does not provide sufficient resolution to detect chromosome banding patterns indicative of inversions. Results To characterize chromosomal diversity in this species, we have carried out deep Illumina sequencing of linked-read (10X Genomics) libraries in order to discover inversion loci as well as SNPs. We analyzed individuals from colonies representing the geographic limits of each subspecies, one contact zone between subspecies, and a closely related sister species. Despite genome-wide SNP divergence and abundant microinversions, we do not find any inversions occurring as fixed differences between subspecies. Many microinversions are found in regions that have introgressed and have captured genes that could impact behavior, such as a cluster of odorant-binding proteins that may play a role in host feeding preference. Conclusions Our study shows that inversions are abundant and widely shared among subspecies of Aedes aegypti and that introgression has occurred in regions of secondary contact. This library of 32 novel chromosomal inversions demonstrates the capacity for linked-read sequencing to identify previously intractable genomic rearrangements and provides a foundation for future population genetics studies in this species.

Chromosomal inversion polymorphisms play an important role in adaptation to environmental heterogeneities. For mosquito species in the Anopheles gambiae complex that are significant vectors of human malaria, paracentric inversion polymorphisms are abundant and are associated with ecologically and epidemiologically important phenotypes. Improved understanding of these traits relies on determining mosquito karyotype, which currently depends upon laborious cytogenetic methods whose application is limited both by the requirement for specialized expertise and for properly preserved adult females at specific gonotrophic stages. To overcome this limitation, we developed sets of tag single nucleotide polymorphisms (SNPs) inside inversions whose biallelic genotype is strongly correlated with inversion genotype. We leveraged 1,347 fully sequenced An. gambiae and Anopheles coluzzii genomes in the Ag1000G database of natural variation. Beginning with principal components analysis (PCA) of population samples, applied to windows of the genome containing individual chromosomal rearrangements, we classified samples into three inversion genotypes, distinguishing homozygous inverted and homozygous uninverted groups by inclusion of the small subset of specimens in Ag1000G that are associated with cytogenetic metadata. We then assessed the correlation between candidate tag SNP genotypes and PCA-based inversion genotypes in our training sets, selecting those candidates with >80% agreement. Our initial tests both in held-back validation samples from Ag1000G and in data independent of Ag1000G suggest that when used for in silico inversion genotyping of sequenced mosquitoes, these tags perform better than traditional cytogenetics, even for specimens where only a small subset of the tag SNPs can be successfully ascertained.

Introduction The many benefits of exercise for persons with multiple sclerosis (MS) are well established, yet patients often refrain from exercise due to overheating and exhaustion. The present randomised controlled trial tests aspirin (acetylsalicylic acid (ASA)) as a convenient method to prevent overheating and improve exercise performance in persons with MS. The effects of ASA are compared with those of acetaminophen (APAP) and placebo.Methods and analysis Participants are seen for a laboratory maximal exercise test on 3 separate days separated by at least 1 week. At each session, body temperature is measured before oral administration of a standard adult dose (650 mg) of ASA, APAP or placebo. One hour after drug administration, participants perform a maximal ramp test on a cycle ergometer. Primary outcomes are (a) time to exhaustion (that is, time spent cycling to peak exertion) and (b) body temperature change. Crossover analyses will include tests for effects of treatment, period, treatment–period interaction (carryover effect) and sequence.Ethics and dissemination Ethical approval was granted by the institutional review board at Columbia University Irving Medical Center (reference: AAAS2529). Results of the trial will be published in peer-reviewed scientific journals and presented at national and international conferences. Neurologists, physiatrists, primary care physicians and physiotherapists are important stakeholders and will be targeted during dissemination. Positive trial results have the potential to promote aspirin therapy, an inexpensive and readily available treatment, to reduce overheating and allow more persons with MS to benefit from exercise.Trial registration number NCT03824938.

We deployed a helicopter with an infrared optical gas imaging camera to detect hydrocarbon emissions from 3,428 oil and gas facilities (including 3,225 producing oil and gas well pads) in Utah’s Uinta Basin during winter and spring 2018. We also surveyed 419 of the same well pads from the ground. Winter conditions led to poor contrast between emission plumes and the ground, leading to a detection limit for the aerial survey that was between two and six times worse than a previous summertime survey. Because the ground survey was able to use the camera’s high-sensitivity mode, the rate of detected emission plumes was much higher in the ground survey (31% of all surveyed well pads) relative to the aerial survey (0.5%), but colder air temperatures appeared to impair plume detection in the ground survey as well. The aerial survey cost less per facility visited, but the ground survey cost less per emission plume detected. Well pads with detected emissions during the ground and aerial surveys had higher oil and gas production, were younger, were more likely to be oil well pads, and had more liquid storage tanks per pad relative to the entire surveyed population. The majority of observed emission plumes were from liquid storage tanks (75.9% of all observed plumes), including emissions from pressure relief valves and thief hatches on the tank or from piping that connects to the tank. Well pads with control devices to reduce emissions from tanks (combustors or vapor recovery units) were more likely to have detected emissions. This finding does not imply that the control devices themselves were not functioning properly. Instead, gas was escaping into the atmosphere before it reached control devices. Pads with control devices tended to be newer and have higher oil and gas production, which probably explains their higher rate of detected emissions.

This review focuses on providing the history of measurement efforts to quantify and characterize the compounds of reactive mercury (RM), and the current status of measurement methods and knowledge. RM collectively represents gaseous oxidized mercury (GOM) and that bound to particles. The presence of RM was first recognized through measurement of coal-fired power plant emissions. Once discovered, researchers focused on developing methods for measuring RM in ambient air. First, tubular KCl-coated denuders were used for stack gas measurements, followed by mist chambers and annular denuders for ambient air measurements. For ~15 years, thermal desorption of an annular KCl denuder in the Tekran® speciation system was thought to be the gold standard for ambient GOM measurements. Research over the past ~10 years has shown that the KCl denuder does not collect GOM compounds with equal efficiency, and there are interferences with collection. Using a membrane-based system and an automated system—the Detector for Oxidized mercury System (DOHGS)—concentrations measured with the KCl denuder in the Tekran speciation system underestimate GOM concentrations by 1.3 to 13 times. Using nylon membranes it has been demonstrated that GOM/RM chemistry varies across space and time, and that this depends on the oxidant chemistry of the air. Future work should focus on development of better surfaces for collecting GOM/RM compounds, analytical methods to characterize GOM/RM chemistry, and high-resolution, calibrated measurement systems.

We measured the spatial distribution and composition of ozone-forming hydrocarbons, alcohols, and carbonyls in Utah’s Uinta Basin during the winter months of 2019 and 2020. The Uinta Basin contains about 10,000 producing oil and gas wells. Snow cover and the region’s unique topography (i.e., a large basin entirely surrounded by mountains) promote strong, multi-day temperature inversion episodes that concentrate pollution and lead to wintertime ozone production. Indeed, organic compound concentrations were about eight times higher during inversion episodes than during snow-free springtime conditions. We examined spatial associations between wintertime concentrations of organics and oil and gas sources in the region, and we found that concentrations of highly reactive alkenes were higher in areas with dense oil production than in areas with dense gas production. Total alkene+acetylene concentrations were 267 (42, 1146; lower and upper 95% confidence limits) µg m−3 at locations with 340 or more producing oil wells within 10 km (i.e., 75th percentile) versus 12 (9, 23) µg m−3 at locations with 15 or fewer oil wells (i.e., 25th percentile). Twenty-eight percent of the potential for organic compounds to produce ozone was due to alkenes in areas with dense oil production. Spatial correlations and organic compound ratios indicated that the most likely source of excess alkenes in oil-producing areas was natural gas-fueled engines, especially lean-burning (i.e., high air:fuel ratio) artificial lift engines.

High concentrations of ground-level ozone have been observed during wintertime in the Uinta Basin of western Utah, USA, beginning in 2010. We analyze existing ozone and ozone precursor concentration data from 38 sites over 11 winter seasons and conclude that there has been a statistically significant (p < 0.02) decline in ozone concentration over the previous decade. Daily exceedances of the National Ambient Air Quality Standard for ozone (70 ppb) have been trending downward at the rate of nearly four per year. Ozone and NOx concentrations have been trending downward at the rates of about 3 and 0.3 ppb per year, respectively. Concentrations of organics in 2018 were at about 30% of their values in 2012 or 2013. Several markers, annual ozone exceedance counts and median ozone and NOx concentrations, were at their largest values in the period 2010 to 2013 and have never recovered since then. We attribute the decline to (1) weakening global demand for oil and natural gas and (2) more stringent pollution regulations and controls, both of which have occurred over the previous decade. We also see evidence of ozone titration when snow cover is absent.

Hypercalcemia from tumors has been associated with Posterior Reversible Encephalopathy Syndrome (PRES) but the mechanism remains unclear. In this article, we describe a case of PRES caused by hypercalcemia from lymphoma. We summarize the available scientific evidence linking hypercalcemia to failure of cerebral autoregulation and potentially PRES. A major link is the hypomagnesemia induced by hypercalcemia. While this concept requires further clinical testing and validation, it is clinically significant for the management of PRES, even when not directly caused by hypercalcemia. Keywords: PRES, Lymphoma, Hypercalcemia, Magnesium, Paraneoplastic

Abstract Mercury contamination in the Great Lakes continues to have important public health and wildlife ecotoxicology impacts, and atmospheric deposition is a significant ongoing loading pathway. The objective of this study was to estimate the amount and source-attribution for atmospheric mercury deposition to each lake, information needed to prioritize amelioration efforts. A new global, Eulerian version of the HYSPLIT-Hg model was used to simulate the 2005 global atmospheric transport and deposition of mercury to the Great Lakes. In addition to the base case, 10 alternative model configurations were used to examine sensitivity to uncertainties in atmospheric mercury chemistry and surface exchange. A novel atmospheric lifetime analysis was used to characterize fate and transport processes within the model. Model-estimated wet deposition and atmospheric concentrations of gaseous elemental mercury (Hg(0)) were generally within ∼10% of measurements in the Great Lakes region. The model overestimated non-Hg(0) concentrations by a factor of 2–3, similar to other modeling studies. Potential reasons for this disagreement include model inaccuracies, differences in atmospheric Hg fractions being compared, and the measurements being biased low. Lake Erie, downwind of significant local/regional emissions sources, was estimated by the model to be the most impacted by direct anthropogenic emissions (58% of the base case total deposition), while Lake Superior, with the fewest upwind local/regional sources, was the least impacted (27%). The U.S. was the largest national contributor, followed by China, contributing 25% and 6%, respectively, on average, for the Great Lakes. The contribution of U.S. direct anthropogenic emissions to total mercury deposition varied between 46% for the base case (with a range of 24–51% over all model configurations) for Lake Erie and 11% (range 6–13%) for Lake Superior. These results illustrate the importance of atmospheric chemistry, as well as emissions strength, speciation, and proximity, to the amount and source-attribution of mercury deposition.