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Objectives\ud \ud To develop a nomogram that could predict spontaneous stone passage (SSP) in patients presenting with acute ureteric colic who are suitable for conservative management.\ud \ud \ud \ud Patients and Methods\ud \ud A 2517 patient dataset was utilised from an international multicentre cohort study (MIMIC, A Multi-centre Cohort Study Evaluating the role of Inflammatory Markers In Patients Presenting with Acute Ureteric Colic) of patients presenting with acute ureteric colic across 71 secondary care hospitals in the UK, Ireland, Australia, and New Zealand. Inclusion criteria mandated a non-contrast computed tomography of the kidneys, ureters, and bladder. SSP was defined as the ‘absence of the need for intervention’. The model was developed using logistic regression and backwards selection (to achieve lowest Akaike's information criterion) in a subset from 2009–2015 (n = 1728) and temporally validated on a subset from 2016–2017 (n = 789).\ud \ud \ud \ud Results\ud \ud Of the 2517 patients, 1874 had SSP (74.5%). The mean (SD) age was 47 (14.7) years and 1892 were male (75.2%). At the end of the modelling process, gender: male (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.64–1.01, P = 0.07), neutrophil count (OR 1.03, 95% CI 1.00–1.06, P = 0.08), hydronephrosis (OR 0.79, 95% CI 0.59–1.05, P = 0.1), hydroureter (OR 1.3, 95% CI 0.97–1.75, P = 0.08), stone size >5–7 mm (OR 0.2, 95% CI 0.16–0.25, P 7 mm (OR 0.11, 95% CI 0.08–0.15, P

The Antarctic Ice Sheet (AIS) is out of equilibrium with the current anthropogenic-enhanced climate forcing. Paleoenvironmental records and ice sheet models reveal that the AIS has been tightly coupled to the climate system during the past and indicate the potential for accelerated and sustained Antarctic ice mass loss into the future. Modern observations by contrast suggest that the AIS has only just started to respond to climate change in recent decades. The maximum projected sea level contribution from Antarctica to 2100 has increased significantly since the Intergovernmental Panel on Climate Change (IPCC) 5th Assessment Report, although estimates continue to evolve with new observational and theoretical advances. This review brings together recent literature highlighting the progress made on the known processes and feedbacks that influence the stability of the AIS. Reducing the uncertainty in the magnitude and timing of the future sea level response to AIS change requires a multidisciplinary approach that integrates knowledge of the interactions between the ice sheet, solid Earth, atmosphere, and ocean systems and across time scales of days to millennia. We start by reviewing the processes affecting AIS mass change, from atmospheric and oceanic processes acting on short time scales (days to decades), through to ice processes acting on intermediate time scales (decades to centuries) and the response to solid Earth interactions over longer time scales (decades to millennia). We then review the evidence of AIS changes from the Pliocene to the present and consider the projections of global sea level rise and their consequences. We highlight priority research areas required to improve our understanding of the processes and feedbacks governing AIS change.

The pre-industrial millennium is among the periods selected by the Paleoclimate Model Intercomparison Project (PMIP) for experiments contributing to the sixth phase of the Coupled Model Intercomparison Project (CMIP6) and the fourth phase of the PMIP (PMIP4). The past1000 transient simulations serve to investigate the response to (mainly) natural forcing under background conditions not too different from today, and to discriminate between forced and internally generated variability on interannual to centennial timescales. This paper describes the motivation and the experimental set-ups for the PMIP4-CMIP6 past1000 simulations, and discusses the forcing agents orbital, solar, volcanic, and land use/land cover changes, and variations in greenhouse gas concentrations. The past1000 simulations covering the pre-industrial millennium from 850 Common Era (CE) to 1849 CE have to be complemented by historical simulations (1850 to 2014 CE) following the CMIP6 protocol. The external forcings for the past1000 experiments have been adapted to provide a seamless transition across these time periods. Protocols for the past1000 simulations have been divided into three tiers. A default forcing data set has been defined for the Tier 1 (the CMIP6 past1000) experiment. However, the PMIP community has maintained the flexibility to conduct coordinated sensitivity experiments to explore uncertainty in forcing reconstructions as well as parameter uncertainty in dedicated Tier 2 simulations. Additional experiments (Tier 3) are defined to foster collaborative model experiments focusing on the early instrumental period and to extend the temporal range and the scope of the simulations. This paper outlines current and future research foci and common analyses for collaborative work between the PMIP and the observational communities (reconstructions, instrumental data).

The past 2000 years (the “2k” interval) provides critical context for our understanding of recent anthropogenic forcing of the climate, as well as baseline information about Earth’s natural climate variability. It also provides opportunities to improve the interpretation of paleoclimate proxy observations, and to perform out-of-sample evaluation of the climate and earth system models that are used to generate projections of future climate change.

The pre-industrial millennium is among the periods selected by the Paleoclimate Model Intercomparison Project (PMIP) for experiments contributing to the sixth phase of the Coupled Model Intercomparison Project (CMIP6) and the fourth phase of the PMIP (PMIP4). The past1000 transient simulations serve to investigate the response to (mainly) natural forcing under background conditions not too different from today, and to discriminate between forced and internally generated variability on interannual to centennial timescales. This paper describes the motivation and the experimental set-ups for the PMIP4-CMIP6 past1000 simulations, and discusses the forcing agents orbital, solar, volcanic, and land use/land cover changes, and variations in greenhouse gas concentrations. The past1000 simulations covering the pre-industrial millennium from 850 Common Era (CE) to 1849 CE have to be complemented by historical simulations (1850 to 2014 CE) following the CMIP6 protocol. The external forcings for the past1000 experiments have been adapted to provide a seamless transition across these time periods. Protocols for the past1000 simulations have been divided into three tiers. A default forcing data set has been defined for the Tier 1 (the CMIP6 past1000) experiment. However, the PMIP community has maintained the flexibility to conduct coordinated sensitivity experiments to explore uncertainty in forcing reconstructions as well as parameter uncertainty in dedicated Tier 2 simulations. Additional experiments (Tier 3) are defined to foster collaborative model experiments focusing on the early instrumental period and to extend the temporal range and the scope of the simulations. This paper outlines current and future research foci and common analyses for collaborative work between the PMIP and the observational communities (reconstructions, instrumental data).

The stable oxygen isotope parameter δ18O remains the most widely utilised speleothem proxy for past climate reconstructions. Uncertainty can be introduced into stalagmite δ18O from a number of factors, one of which is the heterogeneity of groundwater flow in karstified aquifers. Here, we present a lumped parameter hydrological model, KarstFor, which is capable of generating monthly simulations of surface water – ground water – stalagmite δ18O for more than thousand-year time periods. Using a variety of climate input series, we use this model for the first time to compare observational with modelled (pseudoproxy) stalagmite δ18O series for a site at Assynt, NW Scotland, where our knowledge of δ18O systematics is relatively well understood. The use of forward modelling allows us to quantify the relative contributions of climate, peat and karst hydrology, and disequilibrium effects in stalagmite δ18O, from which we can identify potential stalagmite δ18O responses to climate variability. Comparison of the modelled and actual stalagmite δ18O for two stalagmites from the site demonstrates that, for the period of overlapping growth, the two series do not correlate with one another, but forward modelling demonstrates that this falls within the range explicable by differences in flow routing to the stalagmites. Pseudoproxy δ18O stalagmite series highlight the potential significance of peat hydrology in controlling stalagmite δ18O over the last 1000 yr at this site.

Objective: Contemporary models of trauma suggest that posttraumatic stress and growth should be related and that symptoms of stress resulting from a perceived trauma (e.g., childhood cancer) are prerequisite for posttraumatic growth (PTG) to occur. However, empirical data regarding the relationship of posttraumatic stress and growth have been equivocal. The purpose of this study is to examine the relationship between posttraumatic stress symptoms (PTSS) and PTG among adult survivors of childhood cancer. Methods: Survey methods were used to collect data from 6,162 survivors participating in the Childhood Cancer Survivor Study (CCSS). Nonparametric correlation was examined pairwise between PTG and PTSS using Spearman's correlation coefficient with 95% confidence intervals, with nonlinear canonical correlation analysis being conducted to examine relationships between subscales. A multivariable partial proportional odds model was also fit for PTG total quartiles focusing on associations with PTSS total quartiles while adjusting for sociodemographic and medical variables. Results: Examination of unadjusted PTSS and PTG total scores revealed a Spearman correlation of 0.11 (p

We conducted a meta-analysis of Parkinson's disease genome-wide association studies using a common set of 7,893,274 variants across 13,708 cases and 95,282 controls. Twenty-six loci were identified as having genome-wide significant association; these and 6 additional previously reported loci were then tested in an independent set of 5,353 cases and 5,551 controls. Of the 32 tested SNPs, 24 replicated, including 6 newly identified loci. Conditional analyses within loci showed that four loci, including GBA, GAK-DGKQ, SNCA and the HLA region, contain a secondary independent risk variant. In total, we identified and replicated 28 independent risk variants for Parkinson's disease across 24 loci. Although the effect of each individual locus was small, risk profile analysis showed substantial cumulative risk in a comparison of the highest and lowest quintiles of genetic risk (odds ratio (OR) = 3.31, 95% confidence interval (CI) = 2.55-4.30; P = 2 × 10-16). We also show six risk loci associated with proximal gene expression or DNA methylation. © 2014 Nature America, Inc. All rights reserved.

This thesis is an investigation into the styles and voices of the non-dramatic Greek poetry of the fourth century BC. This has been a neglected area of study in Greek literary history, and the extant poems of the fourth century have either been largely ignored or regarded contemptuously by modern critics. I seek to redress this balance by providing close readings of surviving poems, and aim to show that contrary to widespread opinion, there are signs that this is a period of dynamic creativity. The first section looks more closely at the various factors that have led to a neglect of fourth-century poetry, including issues of periodization, the transmission of texts and the canonisation of poetry, the impact of musical and technological innovations and of social changes. Scholarship on late-classical Greek art is also discussed as a comparison. I then turn to discuss specific texts in depth, focussing on the way poems characterise themselves through speakers and addressees. I begin with inscribed poetry (epigrams and hymns), in which I observe tendencies both to conform to a generic model and occasionally to produce more apparently literary-conscious works. The sometimes intrusive presence of the learned author-narrator is discussed in ‘bookish’ poems; the final section is devoted to various kinds of sung poetry, including enkomia, burlesque and parody. Although the texts I analyse are diverse in genre and character, they are sufficient to point to a wider vitality of literary activity throughout the century.

The earliest observations that acoustic shockwaves could fragment brittle materials were made in the 1950s. The first experience of treating renal calculi in humans using extracorporeal shockwave lithotripsy (SWL) was reported in 19801 and by 1983 the first commercially-produced lithotriptor was available, the Dornier HM-3. Its use quickly became wide-spread and it revolutionised themanagement of urinary stone disease from what had previously been entirely surgical to what has become almost exclusively minimally invasive. Although stone fragmentation rates were impressive, treatment with the HM-3 required general anaesthesia. The development of second-generation lithotriptors allowed local anaesthetic treatment but at the cost of less efficient stone fragmentation. Outcomes of treatment with the most contemporary fourth generation lithotriptors approach those of the HM-3, but as an out-patient procedure with oral or intravenous analgesia.2 Today, approximately 80% of all upper tract urinary stone disease is treated with SWL. This topic has been a perennial discussion point amongst urologists; although the latest guidelines have suggested that the stone-free rates for ureteroscopy are higher than with extracorporeal shockwave lithotripsy (ESWL), it is well recognised that the evidence base is weak with many of the studies being retrospective, with precious few randomised clinical trials. This controversy is well argued on both sides by the two sets of authors who are eminent in the field of ureteric stone treatment. However, for the practicing urologist, the decision-making process is not always so straightforward and the decision to intervene must be based not only on the clinical situation faced by the patient, but also by the level of resource available locally. The EAU Guidelines (2008) suggest that 98% of stones 15 mm); (ii) impacted stones; (iii) unfavourable anatomy; and (iv) those in whom two sessions of ESWL have failed to achieve successful fragmentation (T Knoll et al. EAU Update Series 3, 2005). In these scenarios, intervention in the form of ureteroscopy is to be preferred, whilst, in the mid-ureter, the options are equal given the issues in respect of locally available resources and expertise. In the distal ureter, traditionally ureteroscopy is the modality of choice due to the ease of access, high stone-free rates and minimum of complications.

N.º4, p.263-267 The Arrábida chain - located in the southern segment of the Lusitanian basin - is a S-wards directed fold and thrust belt of Miocene age of deformation. ENE-WSW striking frontal ramps and associated folds are connected to sinistral NNE-SSW and N-S striking lateral ramps, that show left-lateral and SE-wards reverse movements. Both frontal and oblique ramps form imbricate duplexes. Constriction increases SE-wards due to the presence of a basin boundary fault (SetúbaI- Pinhal Novo fault) that acts as a buttress to the oblique thrust movement. Kilometre scale transpressive structures can be observed along the basin boundary fault. A map scale sheath fold like structure can be observed at the Viso anticline, which is a consequence of a strong anisotropy contrast of the Mesocenozoic strata.The Arrábida chain thrusts migrated backward, i.e. to the north, according to an overstep model. Detailed geometrical reconstruction and kinematic analysis of the structures of the eastern region of Arrábida (Formosinho, Vise and Serra de S. Luis anticlines) show that a thin-skinned tectonic model (Ribeiro, A. et aI., 1990) fits very well with the geometry of the structures of the Arrábida chain.