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Due to adverse snow and cloud conditions, only a few inventories are available for the maritime glaciers in New Zealand. These are difficult to compare as different approaches and baseline data have been used to create them. In consequence, glacier fluctuations in New Zealand over the past two decades are only known for a few glaciers based on field observations. Here we present the results of a new inventory for the ‘year 2000’ (some scenes are from 2001 and 2002) that is based on glacier outlines from a recently published inventory for the year 2016 and allowed consistent change assessment for nearly 3000 glaciers over this period. The year 2000 inventory was created by manual on-screen digitizing using Landsat ETM+ satellite imagery (15 m panchromatic band) in the background and the year 2016 outlines as a starting point. Major challenges faced were late and early seasonal snow, clouds and shadow, the geo-location mismatch between Landsat and Sentinel-2 as well as the correct interpretation of ice patches and ice under debris cover. In total, we re-mapped 2967 glaciers covering an area of 885.5 km2 in 2000, which is 91.7 km2 (or 10.4%) more than the 793.8 km2 mapped in 2016. Area change rates (mean rate −0.65% a−1) increase towards smaller glaciers. Strongest area loss from 2000 to 2016 occurred at elevations ~1900 m but the highest relative loss was found below 800 m a.s.l. In total, 109 glaciers split into two or more entities and 264 had wasted away by 2016.

Background Heparin anticoagulation has been used successfully for cardiopulmonary bypass (CPB). However, an alternative anticoagulant approach is desirable due to the cases of heparin-induced thrombocytopenia. Dabigatran provides anticoagulation for an in vitro model of simulated CPB. The current analysis tests the hypothesis that dabigatran provides sufficient anticoagulation for CPB in intact rabbits. Methods Nonlinear mixed effects models were used to estimate dabigatran parameters for a two-compartment pharmacokinetic model in 10 New Zealand White rabbits. A dabigatran infusion designed to maintain a plasma concentration of 90 µg/ml was run throughout CPB based on the pharmacokinetics. Animals were subjected to sternotomy and anticoagulated with IV dabigatran (six animals) or heparin (four animals). Rabbits were cannulated centrally using the right atrium and ascending aorta and CPB was maintained for 120 min. Measurement of activated clotting time, thromboelastometric reaction time, and blood gases were performed during CPB. Then, the animals were euthanized, and the brain and one kidney were removed for histology. Sections of the arterial filters were inspected using electron microscopy. Results The observed dabigatran concentrations during CPB were greater than the target concentration, ranging from 137 ± 40 μg/ml at 5 min of CPB to 428 ± 150 μg/ml at 60 min, and 295 ± 35 μg/ml at 120 min. All rabbits completed 2 h of CPB without visible thrombosis. In the two groups, reaction time values were elevated, reaching 10,262 ± 4,198 s (dabigatran group) and 354 ± 141 s (heparin group) at 120 min of CPB. Brains and kidneys showed no evidence of thrombosis or ultrastructural damage. Sections of the arterial line filter showed minimal or no fibrin. There was no significant difference in outcomes between dabigatran- and heparin-treated animals. Conclusions In this first-use, proof-of-concept study, the authors have shown that dabigatran provides acceptable anticoagulation similar to heparin to prevent thrombosis using a rabbit CPB model. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Psychedelics and related compounds have shown efficacy for the treatment of a variety of conditions that are prevalent among older adults, including mood disorders, the psychological distress associated with a serious medical illness, post-traumatic stress disorder (PTSD), and prolonged grief disorder. Psychedelics also have properties that could help provide therapeutic benefits for patients with dementing disorders, as well as promoting personal growth among healthy older adults. This article focuses on psilocybin, a classic psychedelic, and MDMA, a substituted amphetamine with properties similar to classic psychedelics. Both act on the 5HT

Introduction: Popliteal artery aneurysms are in most cases asymptomatic but cause significant complications if ruptured. An acute popliteal aneurysm rupture is relatively rare, and few cases have been documented secondary to blunt trauma. Common presenting signs and symptoms include distal limb ischemia and absent dorsalis pedis pulses. Timely management and recognition of this rare presentation are crucial as this condition can result in limb loss or death if not treated in a timely manner. Case Report: An 80-year-old man with history of hypertension presented to the emergency department complaining of inability to feel sensation below his left knee after falling from ground level. Physical examination was pertinent for bounding radial and femoral pulses bilaterally, although absent dorsalis pedis and posterior tibial pulses to the left lower extremity. Computed tomography angiography identified occlusion of the left superficial femoral arterial lumen associated with a ruptured popliteal aneurysm, approximately eight centimeters in size. He immediately received unfractionated heparin and was admitted to the hospital for left medial thigh exploration and decompressive dermatofasciotomy. Conclusion: After confirmation of popliteal aneurysmal rupture with advanced imaging, heparinization and vascular surgery consultation are critical steps that should be taken to prevent limb loss.

We combine methods to identify substorms and geomagnetic storms into a single, novel method that identifies four categories: quiet times, storm only, substorm only, substorms in storms. We employ Birkeland current density data from the Active Magnetosphere and Planetary Electrodynamics Response Experiment (AMPERE) between 2010–2017 and use our new combined identification method to sort data in this range into one of the four categories. We then subsample such that each category comprises the same number of data, in order that each category behaves statistically similarly. We then examine the large global behaviour of each category for the first time. We find that the mean current density is larger during substorms and its standard deviation is larger during geomagnetic storms. We assess the kurtosis and variance of the underlying distributions, and determine that the kurtosis is far higher during geomagnetic storms than during substorms. We use the survival function to quantify the probability of current densities above set thresholds and find that current densities which are above a low threshold are more likely during substorms, but that extreme currents are far more likely during geomagnetic storms. We shift the data into an adaptive coordinate system defined by the boundary between Regions 1 and 2 Birkeland current and demonstrate that extreme currents are most likely to flow within Region 2 current during geomagnetic storms. This is consistent with the literature on geomagnetic storms driving extreme behaviour, but unexpected in a paradigm of the current systems in which Region 1 current is generally larger.

Lunar Vertex is a mission at the intersection of multiple science communities, from planetary geology to space plasma physics. As the first Payloads and Research Investigations on the Surface of the Moon (PRISM1) investigation, scheduled for delivery to the Reiner Gamma (RG) magnetic anomaly in 2024 aboard a commercial lunar lander, Lunar Vertex will unravel the nature of the RG anomaly, the connection to and origin of the associated lunar swirl surface feature, and the structure and impact of the “mini-magnetosphere” in this region. Lunar Vertex includes a suite of magnetometers (Vector Magnetometer – Lander; VML), a fixed-mounted set of cameras (Vertex Camera Array; VCA), and a low-energy ion and electron plasma analyzer (Magnetic Anomaly Plasma Spectrometer; MAPS) on the lander. In addition, a second suite of commercial fluxgate magnetometers (Vector Magnetometer – Rover; VMR) and a multispectral imager (Rover Multispectral Microscope; RMM) are mounted on a dedicated rover that will traverse a distance of at least 500 m from the lander, providing additional multi-point measurements. The combination of magnetic field measurements taken during cruise and descent by VML and during surface operations by both VML and VMR will characterize the surface magnetic field within a strong lunar magnetic anomaly. The combined magnetic field and plasma measurements from VML and MAPS will provide direct observations of plasma populations reaching the lunar surface and the associated local magnetic field configuration. Furthermore, the lunar regolith within the RG magnetic anomaly and over different regions of the associated lunar swirl will be characterized by RMM and VCA to reveal the surface texture, composition, and particle distribution around both the lander and rover locations and the correspondence to potential surface weathering processes.

A multilayer acoustic treatment constructed of fibrous acoustic absorption material combined with dissipative acoustic material achieves a low profile and is lightweight and multi-functional, with properties that are desirable for NVH (noise, vibration, and harshness) treatments. The dissipative material consists of microfibers and acoustically active particles; this material was introduced in the last SAE NVH conference: A Novel Dissipative Acoustic Material [1].In this paper, the acoustic performance of the multilayer treatment was evaluated by using random incidence absorption and transmission loss measurements, as well as in-vehicle experiments. Absorption and transmission loss were additionally modeled using the transmission matrix method (TMM). In the in-vehicle test, an OEM wheelhouse liner with Trim, for an SUV, was evaluated utilizing this new multilayer 3M treatment.

BackgroundThe COVID-19 pandemic has been characterized by ongoing evolution of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with concomitant variation in viral transmissibility and morbidity. Within specific timeframes and geographic areas, multiple SARS-CoV-2 variants have coexisted in the human population, each characterized by distinct biologic and clinical features, such as varying susceptibility to neutralizing monoclonal antibodies (nMAbs), a major frontline treatment. As part of an observational real-world data study of the effectiveness of nMAbs for treatment of COVID-19, SARS-CoV-2 viral samples were obtained from patients under treatment, generating paired clinical and genomics data. This paper describes the processing pipeline and findings from the genomics portion of this combined data set.MethodsSARS-CoV-2 sequences were generated from 14,796 diagnostic samples from four large U.S. health systems between July 2020 and March 2022. Among nMAbs-treated patients, samples were collected on the same day as, or prior to, treatment with nMAbs. Thus, these samples represent a snapshot of SARS-CoV-2 variants circulating in the respective patient groups, as opposed to variants that arose in response to specific treatments.Health systems collected viral samples and performed library creation and sequencing according to local protocols, using tiled ARTIC amplicon primers. FASTQ files were submitted to a study data platform and processed through a common pipeline. This pipeline enabled a unified approach to quality control, assembly, and production of genomics features for downstream analysis.ResultsAlpha and pre-Alpha SARS-CoV-2 lineages were predominant in the data set prior to June 2021. From June 2021 through November 2021, Delta was the dominant variant. Beginning in December 2021, Omicron was dominant. A variety of mutations associated with decreased nMAbs binding to the spike proteinin vitrowere detected, including lineage-defining mutations and non-lineage-defining mutations such as E340A, G446V, and S494P. Distinct patterns of sequence gaps and ambiguous base calls were associated with distinct variants.ConclusionsThe distribution of SARS-CoV-2 variants, per WHO nomenclature, across epochs in this data set matched concurrent CDC genomic surveillance results across the U.S. Detection of putative nMAbs escape mutations within clinical samples was consistent with FDA decisions to amend EUAs as variants emerged. This genomics data set provides an opportunity to examine associations between SARS-CoV-2 genomic variation and clinical outcomes in the associated EHR data set. The expansion of real-world data sets such as this to study the relationship between viral sequence and treatment outcomes could provide the foundation for future efforts to achieve near-real-time understanding of clinical outcomes related to genomic variation over time, and evidence to update treatment decisions more rapidly and to greater effect during ongoing and future pandemics.

An end of summer snowline (EOSS) photographic dataset for Aotearoa New Zealand contains over four decades of equilibrium line altitude (ELA) observations for more than 50 index glaciers. This dataset provides an opportunity to create a climatological ELA reference series that has several applications. Our work screened out EOSS sites that had low temporal coverage and also removed limited observations when the official survey did not take place. Snowline data from 41 of 50 glaciers in the EOSS dataset were retained and included in a normalised master snowline series that spans 1977–2020. Application of the regionally representative normalised master snowline series in monthly and seasonally resolved climate response function analyses showed consistently strong relationships with austral warm-season temperatures for land-based stations west of the Southern Alps and the central Tasman Sea. There is a trend towards higher regional snowlines since the 1990s that has been steepening in recent decades. If contemporary decadal normalised master snowline series trends are maintained, the average Southern Alps snowline elevation will be displaced at least 200 m higher than normal by the 2025–2034 decade. More frequent extremely high snowlines are expected to drive more extreme cumulative mass-balance losses that will reduce the glacierised area of Aotearoa New Zealand.

Cladding-pumped Raman lasers have often been cited for their potential for brightness enhancement, but so far have never achieved high power and beam quality simultaneously. By utilizing a novel fiber geometry with a larger cladding to core ratio than current high power Raman fiber lasers for brightness enhancement (BE-RFLs), a noise-seeded Raman fiber laser pumped by a 100 ns pulsed laser with record beam quality is achieved with M^2 = 1.3 and 0.4 mJ 1st Stokes output, with an instantaneous brightness enhancement of 60. The results here support the hypothesis that the limiting factor to high beam quality in BE-RFLs is Raman conversion in the pump cladding, rather than higher order core modes as in most conventional fiber lasers.

A large body of research suggests that previously reward-associated stimuli can capture attention. Recent evidence also suggests that value-driven attentional biases can occur for a particular category of objects. However, it is unclear how broadly these category-level attentional biases can generalize. In the present study, we examined whether value-driven attentional biases can generalize to new exemplars of a category or semantically related categories using a modified version of the value-driven attentional capture paradigm. In an initial training phase, participants searched for two categories of objects and were rewarded for correctly fixating members of one target category. In a subsequent test phase, participants searched for two new categories of objects. A new exemplar of one of the previous target categories or a member of a semantically related category could appear as a critical distractor in this phase. Participants were more likely to initially fixate the critical distractor and fixated the distractor longer when it was a new exemplar of the previously rewarded category. However, similar findings were not observed for members of semantically related categories. Together, these findings suggest that the generalization of value-based attentional priority is category-specific.

Summary Background PD-1 and PD-L1 inhibitors are active in metastatic urothelial carcinoma, but positive randomised data supporting their use as a first-line treatment are lacking. In this study we assessed outcomes with first-line pembrolizumab alone or combined with chemotherapy versus chemotherapy for patients with previously untreated advanced urothelial carcinoma. Methods KEYNOTE-361 is a randomised, open-label, phase 3 trial of patients aged at least 18 years, with untreated, locally advanced, unresectable, or metastatic urothelial carcinoma, with an Eastern Cooperative Oncology Group performance status of up to 2. Eligible patients were enrolled from 201 medical centres in 21 countries and randomly allocated (1:1:1) via an interactive voice-web response system to intravenous pembrolizumab 200 mg every 3 weeks for a maximum of 35 cycles plus intravenous chemotherapy (gemcitabine [1000 mg/m2] on days 1 and 8 and investigator's choice of cisplatin [70 mg/m2] or carboplatin [area under the curve 5] on day 1 of every 3-week cycle) for a maximum of six cycles, pembrolizumab alone, or chemotherapy alone, stratified by choice of platinum therapy and PD-L1 combined positive score (CPS). Neither patients nor investigators were masked to the treatment assignment or CPS. At protocol-specified final analysis, sequential hypothesis testing began with superiority of pembrolizumab plus chemotherapy versus chemotherapy alone in the total population (all patients randomly allocated to a treatment) for the dual primary endpoints of progression-free survival (p value boundary 0·0019), assessed by masked, independent central review, and overall survival (p value boundary 0·0142), followed by non-inferiority and superiority of overall survival for pembrolizumab versus chemotherapy in the patient population with CPS of at least 10 and in the total population (also a primary endpoint). Safety was assessed in the as-treated population (all patients who received at least one dose of study treatment). This study is completed and is no longer enrolling patients, and is registered at ClinicalTrials.gov , number NCT02853305 . Findings Between Oct 19, 2016 and June 29, 2018, 1010 patients were enrolled and allocated to receive pembrolizumab plus chemotherapy (n=351), pembrolizumab monotherapy (n=307), or chemotherapy alone (n=352). Median follow-up was 31·7 months (IQR 27·7–36·0). Pembrolizumab plus chemotherapy versus chemotherapy did not significantly improve progression-free survival, with a median progression-free survival of 8·3 months (95% CI 7·5–8·5) in the pembrolizumab plus chemotherapy group versus 7·1 months (6·4–7·9) in the chemotherapy group (hazard ratio [HR] 0·78, 95% CI 0·65–0·93; p=0·0033), or overall survival, with a median overall survival of 17·0 months (14·5–19·5) in the pembrolizumab plus chemotherapy group versus 14·3 months (12·3–16·7) in the chemotherapy group (0·86, 0·72–1·02; p=0·0407). No further formal statistical hypothesis testing was done. In analyses of overall survival with pembrolizumab versus chemotherapy (now exploratory based on hierarchical statistical testing), overall survival was similar between these treatment groups, both in the total population (15·6 months [95% CI 12·1–17·9] with pembrolizumab vs 14·3 months [12·3–16·7] with chemotherapy; HR 0·92, 95% CI 0·77–1·11) and the population with CPS of at least 10 (16·1 months [13·6–19·9] with pembrolizumab vs 15·2 months [11·6–23·3] with chemotherapy; 1·01, 0·77–1·32). The most common grade 3 or 4 adverse event attributed to study treatment was anaemia with pembrolizumab plus chemotherapy (104 [30%] of 349 patients) or chemotherapy alone (112 [33%] of 342 patients), and diarrhoea, fatigue, and hyponatraemia (each affecting four [1%] of 302 patients) with pembrolizumab alone. Six (1%) of 1010 patients died due to an adverse event attributed to study treatment; two patients in each treatment group. One each occurred due to cardiac arrest and device-related sepsis in the pembrolizumab plus chemotherapy group, one each due to cardiac failure and malignant neoplasm progression in the pembrolizumab group, and one each due to myocardial infarction and ischaemic colitis in the chemotherapy group. Interpretation The addition of pembrolizumab to first-line platinum-based chemotherapy did not significantly improve efficacy and should not be widely adopted for treatment of advanced urothelial carcinoma. Funding Merck Sharp and Dohme, a subsidiary of Merck, Kenilworth, NJ, USA.

In this paper, I discuss common endogeneity problems found in entrepreneurship research. I show how entrepreneurship researchers, particularly those working with observational data, typically face several specific endogeneity threats in a given study. I then show through a series of simulated of datasets instrument variable approaches that effectively address endogeneity in a variety of research designs. I discuss best-practice recommendations for integrating instrument variables into entrepreneurship research at the study design phase, and outline potential sources for instruments.

ImportanceEvidence on the effectiveness and safety of COVID-19 therapies across a diverse population with varied risk factors is needed to inform clinical practice.ObjectiveTo assess the safety of neutralizing monoclonal antibodies (nMAbs) for the treatment of COVID-19 and their association with adverse outcomes.Design, Setting, and ParticipantsThis retrospective cohort study included 167 183 patients from a consortium of 4 health care systems based in California, Minnesota, Texas, and Utah. The study included nonhospitalized patients 12 years and older with a positive COVID-19 laboratory test collected between November 9, 2020, and January 31, 2022, who met at least 1 emergency use authorization criterion for risk of a poor outcome.ExposureFour nMAb products (bamlanivimab, bamlanivimab-etesevimab, casirivimab-imdevimab, and sotrovimab) administered in the outpatient setting.Main Outcomes and MeasuresClinical and SARS-CoV-2 genomic sequence data and propensity-adjusted marginal structural models were used to assess the association between treatment with nMAbs and 4 outcomes: all-cause emergency department (ED) visits, hospitalization, death, and a composite of hospitalization or death within 14 days and 30 days of the index date (defined as the date of the first positive COVID-19 test or the date of referral). Patient index dates were categorized into 4 variant epochs: pre-Delta (November 9, 2020, to June 30, 2021), Delta (July 1 to November 30, 2021), Delta and Omicron BA.1 (December 1 to 31, 2021), and Omicron BA.1 (January 1 to 31, 2022).ResultsAmong 167 183 patients, the mean (SD) age was 47.0 (18.5) years; 95 669 patients (57.2%) were female at birth, 139 379 (83.4%) were White, and 138 900 (83.1%) were non-Hispanic. A total of 25 241 patients received treatment with nMAbs. Treatment with nMAbs was associated with lower odds of ED visits within 14 days (odds ratio [OR], 0.76; 95% CI, 0.68-0.85), hospitalization within 14 days (OR, 0.52; 95% CI, 0.45-0.59), and death within 30 days (OR, 0.14; 95% CI, 0.10-0.20). The association between nMAbs and reduced risk of hospitalization was stronger in unvaccinated patients (14-day hospitalization: OR, 0.51; 95% CI, 0.44-0.59), and the associations with hospitalization and death were stronger in immunocompromised patients (hospitalization within 14 days: OR, 0.31 [95% CI, 0.24-0.41]; death within 30 days: OR, 0.13 [95% CI, 0.06-0.27]). The strength of associations of nMAbs increased incrementally among patients with a greater probability of poor outcomes; for example, the ORs for hospitalization within 14 days were 0.58 (95% CI, 0.48-0.72) among those in the third (moderate) risk stratum and 0.41 (95% CI, 0.32-0.53) among those in the fifth (highest) risk stratum. The association of nMAb treatment with reduced risk of hospitalizations within 14 days was strongest during the Delta variant epoch (OR, 0.37; 95% CI, 0.31-0.43) but not during the Omicron BA.1 epoch (OR, 1.29; 95% CI, 0.68-2.47). These findings were corroborated in the subset of patients with viral genomic data. Treatment with nMAbs was associated with a significant mortality benefit in all variant epochs (pre-Delta: OR, 0.16 [95% CI, 0.08-0.33]; Delta: OR, 0.14 [95% CI, 0.09-0.22]; Delta and Omicron BA.1: OR, 0.10 [95% CI, 0.03-0.35]; and Omicron BA.1: OR, 0.13 [95% CI, 0.02-0.93]). Potential adverse drug events were identified in 38 treated patients (0.2%).Conclusions and RelevanceIn this study, nMAb treatment for COVID-19 was safe and associated with reductions in ED visits, hospitalization, and death, although it was not associated with reduced risk of hospitalization during the Omicron BA.1 epoch. These findings suggest that targeted risk stratification strategies may help optimize future nMAb treatment decisions.

Cladding-pumped Raman lasers have often been cited for their potential for brightness enhancement, but so far have never achieved high power and beam quality simultaneously. By utilizing a fiber geometry with a larger cladding to core ratio than current high power Raman fiber lasers for brightness enhancement (BE-RFLs), a noise-seeded Raman fiber laser pumped by a 100 ns pulsed laser with record beam quality is achieved with M2=1.3 and 0.4 mJ first Stokes output, with an instantaneous brightness enhancement of 60. The results here support the hypothesis that the limiting factor to high beam quality in BE-RFLs is Raman conversion in the pump cladding, rather than higher order core modes as in most conventional fiber lasers.

Karst geology is characterized by the presence of sinkholes and voids, which may pose significant risk to existing infrastructure. Sinkhole formation is often observed near active quarries, where dewatering operations can alter regional groundwater flow patterns leading to subsidence and increased void formation. In these areas, identifying locations which may be susceptible to sinkhole formation requires an ability to map dissolution features within the rock. Traditional geotechnical explorations alone are not well-suited to this effort as they only provide subsurface information at discrete points and therefore may miss voids within the rock. Geophysical methods offer a means to produce continuous profiles of the rock surface and possible locations for voids but interpreting the results of these tests in karstic geology can be challenging. This study uses 2D electrical resistivity and seismic surveys at a site with previous sinkhole activity along an interstate in central Alabama. The site is adjacent to a limestone quarry. Resistivity data is collected using 2D dipole-dipole and strong-gradient arrays. The seismic data is processed using a full waveform inversion (FWI) technique. Subsurface profiles interpreted from the geophysical surveys are then compared to borehole data from previous site investigations. Results from the geophysical surveys are found to be consistent with borehole data regarding variation of bedrock depth and identification of possible sinkhole features. Potential limitations and sources of error pertaining to each survey type are considered.

BACKGROUND The expansion of telehealth use during the COVID-19 pandemic increased access to health care services for many US residents. This is particularly true for provider-to-patient telehealth communication. In rural communities, telehealth can increase access to health care services that would otherwise be limited due to geographic and distance barriers. The adoption of telehealth in rural communities, however, has been hindered by technology barriers, lack of community awareness, and lack of provider buy-in. The purpose of this study was to explore community-identified approaches to improving telehealth access in rural North Central Washington. OBJECTIVE The aim of this study was to identify, group, and rate approaches to expanding and integrating telehealth in rural communities in North Central Washington. METHODS We used group concept mapping, a participant-engaged, mixed method approach, to explore participant perspectives and preferences. Purposively sampled participants were community leaders and stakeholders in rural North Central Washington. Participants brainstormed strategies for implementing and expanding community telehealth access in their community and sorted them into conceptually similar groups. Strategies were then rated by participants in terms of potential impact, feasibility, and the cost of implementation. Quantitative analyses included multidimensional scaling and hierarchical cluster analysis to produce a cluster map and pattern match graph for interpreting the community members’ ideas and preferences. RESULTS Participant brainstorming yielded 70 strategies for implementing telehealth in rural North Central Washington. Strategies were individually sorted into groups (point map stress value 0.21), producing a 6-cluster solution. The clusters were “Community infrastructure,” “Ensuring access to telehealth technology,” “Technology infrastructure for telehealth,” “Training/awareness of telehealth,” “State- and policy-level considerations,” and “Health care systems engagement and delivery.” Participants rated “Training/awareness of telehealth” and “Health care systems engagement and delivery” to be highly impactful and feasible approaches. The “Training/awareness of telehealth” cluster included strategies such as educating community members that telehealth is an easy, reliable, convenient, and private way to access health care and providing community training on how to access health care remotely. The latter cluster, “Health care systems engagement and delivery,” included approaches that were ranked as highly feasible and impactful, such as engaging with clinics and providers on overcoming barriers to implementing telehealth services or ensuring that local health clinic staff is on board with telehealth as an alternative platform to provide services. CONCLUSIONS Strategies identified and rated by participants incorporate the importance of community engagement in telehealth implementation, including educating community members about telehealth and engaging with community health clinics to facilitate use by providers. Community partners in North Central Washington will use these findings, along with additional community survey data, broadband speed test data, and provider input, to increase access to telehealth in their rural and remote communities.

Fox Glacier/Te Moeka o Tuawe is a fast-responding maritime glacier that has undergone multiple advance and retreat phases during recent decades. Here we use a combination of repeat photography, Str...

Glaciers are unique indicators of climate change. While recent global-scale glacier decline has been attributed to anthropogenic forcing, direct links between human-induced climate warming and extreme glacier mass-loss years have not been documented. Here we apply event attribution methods to document this at the regional scale, targeting the highest mass-loss years (2011 and 2018) across New Zealand’s Southern Alps. Glacier mass balance is simulated using temperature and precipitation from multiple climate model ensembles. We estimate extreme mass loss was at least six times (2011) and ten times (2018) (>90% confidence) more likely to occur with anthropogenic forcing than without. This increased likelihood is driven by present-day temperatures ~1.0 °C above the pre-industrial average, confirming a connection between anthropogenic emissions and high annual ice loss. These results suggest that as warming and extreme heat events continue and intensify, there will be an increasingly visible human fingerprint on extreme glacier mass-loss years in the coming decades. Detecting a human role in a given year of extreme glacier mass loss is difficult at regional scales. Event attribution methods estimate that two extreme mass-loss years in the New Zealand Southern Alps, 2011 and 2018, were at least six and ten times more likely with anthropogenic climate warming.

Wide adoption of electronic health records (EHRs) has raised the expectation that data obtained during routine clinical care, termed “real-world” data, will be accumulated across health care systems and analyzed on a large scale to produce improvements in patient outcomes and the use of health care resources. To facilitate a learning health system, EHRs must contain clinically meaningful structured data elements that can be readily exchanged, and the data must be of adequate quality to draw valid inferences. At the present time, the majority of EHR content is unstructured and locked into proprietary systems that pose significant challenges to conducting accurate analyses of many clinical outcomes. This article details the current state of data obtained at the point of care and describes the changes necessary to use the EHR to build a learning health system.

We track the progression of height-integrated conductances over the course of an average substorm in a narrow local time sector of the nightside polar cap. These conductances are calculated from the mean energy flux and energy flux of precipitation, as estimated from a ratio of auroral emissions of the Lyman-Birge-Hopfield long and short band obtained by multiple polar region crossings of the Defence Meteorological Satellite Program F16, F17, and F18 spacecraft. Contributing auroral emission data span 1 January 2005 to 31 December 2017. Both Pedersen and Hall conductances are considered, as well as the influence of the magnetic latitude of substorm onset. Substorm onset times and magnitudes are provided by the SuperMAG network and SOPHIE substorm lists. We compare superimposed epoch ordered conductances with similarly averaged field aligned currents from the Active Magnetosphere and Planetary Electrodynamics Response Experiment (AMPERE). Shortly before onset, conductances increase in a low latitude region, before an increase in conductance seen at all latitudes at the time of onset. The energy flux is shown to peak quickly after substorm onset, followed by mean energy. The conductances, energy flux, and mean energy are ordered by magnetic latitude of substorm onset, so that the lowest onset latitudes correspond to the highest value of any given parameter. Conductances recover quicker to pre-substorm levels for those substorms with higher onset magnetic latitudes.

Subauroral polarization streams (SAPS) typically refer to an enhanced westward plasma flow channel in the duskside subauroral ionosphere. SAPS overlap with the low-latitude part of downward Region-2 field-aligned currents (FACs). The relatively low subauroral conductance in this region requires a strong electric field for current closure, which drives the fast sunward plasma flow. Observations have shown dynamic variability of SAPS under various solar wind and interplanetary magnetic field (IMF) conditions, which are related to the variability of FACs and auroral precipitation, as well as their source regions in the ring current and plasmasheet. In this study, we use satellite observations and numerical simulations with the state-of-the-art Multiscale Atmosphere Geospace Environment (MAGE) model to investigate: 1) The role of diffuse electron precipitation in the formation of SAPS; 2) SAPS variability under IMF BY; and 3) Dawnside (as opposed to the more conventional duskside) SAPS as a unique feature of major geomagnetic storms. With data-model comparison, we will demonstrate that SAPS result from the different behaviors of ring current ions and plasma sheet electrons, and the corresponding self-consistent response of the ionosphere-thermosphere system via electrodynamic and particle coupling with the magnetosphere. We conclude that SAPS distribution and variability represent a fundamental feature of the geospace response to solar disturbances during storm time.

Glaciers in every region on Earth have lost mass over the past two decades as global temperature has risen 0.5C. Retreating glaciers symbolize climate change and present societal challenges across the globe. To better quantify the consequences of climate change, previous studies have established methods to calculate the anthropogenic component of extreme weather and climate events. Previously, we established a framework using existing event attribution methods together with glacier mass balance modeling to determine the increase in probability of extreme annual mass loss of New Zealand glaciers occurring with climate change. Here, we look to expand our developed attribution framework to calculate the change in probability and amount of extreme annual mass loss for glaciers around the world. To do this, we simulate glacier mass balance using a degree-day model, driven with general circulation model (GCM) output from available CMIP6 models and ensemble members. Historical natural simulations define climate without anthropogenic forcing, and SSP5 8.5 simulations define climate with anthropogenic forcing. We use the two different climate forcings to produce scenarios of glacier mass change with and without climate change. The differences in these scenarios are compared with measurements from the highest annual glacier mass loss years. We develop the attribution method though application to several glaciers around the world, including South Cascade Glacier (USA), Gries Glacier (Switzerland), and Brewster Glacier (New Zealand). Our initial results show large increases in probability and amount of annual glacier mass loss occurring due to climate change for all three glaciers. Difficulties in applying the attribution framework to glaciers globally include accessing modern glacier outlines and reconciling differences between glaciological and geodetic measurements of glacier mass change.

We quantify the contributions of different convection states to the magnetic flux through-put of the magnetosphere during 2010. To do this we provide a continuous classification of convection state for the duration of 2010 based upon observations of the solar wind and interplanetary magnetic field, geomagnetic indices, and field-aligned currents measured by the Active Magnetosphere and Planetary Electrodynamics Response Experiment (AMPERE). Convection states are defined as 1) quiet and 2) weak activity, substorm 3) growth, 4) expansion, and 5) recovery phases, 6) substorm driven phase (when relatively steady magnetospheric convection occurs), 7) recovery bays (when recovery phase is accompanied by a negative excursion of the AL electrojet index), and 8) periods of multiple intensifications (storm-time periods when continuous short-period AL activity occur). The magnetosphere is quiet for 46% of the time, when very little convection takes place. The majority of convection occurs during growth and driven phases (21% and 38%, respectively, of open magnetic flux accumulation by dayside reconnection). We discuss these results in the context of the expanding/contracting polar cap model of convection, and describe a framework within which isolated substorms and disturbances during periods of more continuous solar wind-magnetosphere driving can be understood.

The Active Magnetosphere and Planetary Electrodynamics Response Experiment (AMPERE) has revolutionized the way in which we can study the electrical current systems present over the poles of Earth. With high cadence measurements taken in both hemispheres, the data has proven invaluable in developing our understanding of the current systems that couple the magnetosphere and ionosphere and how they change in response to space weather. By employing the AMPERE data set, we aim to offer new insights into the complex and dynamic region 1 and region 2 current systems as they respond to the impact of solar wind disturbances on the magnetosphere and the driving of geomagnetic storms.We investigate the relationship between the hemispherically-integrated current flowing into or out of each pole and upstream solar wind parameters to understand how these currents are driven. As expected, current magnitude increases with increasing interplanetary magnetic field strength and solar wind speed. A key aim of the analysis is to determine if current magnitude saturates under strongly driven conditions, in the same way that the cross-polar cap potential is known to saturate. We present preliminary results, indicating a variety of behaviours at high driving, and discuss these in terms of theories of solar wind-magnetosphere coupling.

The World Magnetic Model (WMM) is a geomagnetic main field model that is widely used for navigation by governments, industry and the general public. In recent years, the model has been derived using high accuracy magnetometer data from the Swarm mission. This study explores the possibility of developing future WMMs in the post-Swarm era using data from the Iridium satellite constellation. Iridium magnetometers are primarily used for attitude control, so they are not designed to produce the same level of accuracy as magnetic data from scientific missions. Iridium magnetometer errors range from 30 nT quantization to hundreds of nT errors due to spacecraft contamination and calibration uncertainty, whereas Swarm measurements are accurate to about 1 nT. The calibration uncertainty in the Iridium measurements is identified as a major error source, and a method is developed to calibrate the spacecraft measurements using data from a subset of the INTERMAGNET observatory network producing quasi-definitive data on a regular basis. After calibration, the Iridium data produced main field models with approximately 20 nT average error and 40 nT maximum error as compared to the CHAOS-7.2 model. For many scientific and precision navigation applications, highly accurate Swarm-like measurements are still necessary, however, the Iridium-based models were shown to meet the WMM error tolerances, indicating that Iridium is a viable data source for future WMMs. Graphical Abstract

Despite our best intentions, physically salient but entirely task-irrelevant stimuli can sometimes capture our attention. With learning, it is possible to more efficiently ignore such stimuli, although specifically how the visual system accomplishes this remains to be clarified. Using a sample of young-adult participants, we examined the time course of eye movements to targets and distractors. We replicate a reduced frequency of eye movements to the distractor when appearing in a location at which distractors are frequently encountered. This reduction was observed even for the earliest saccades, when selection tends to be most stimulus-driven. When the distractor appeared at the high-probability location, saccadic reaction time was slowed specifically for distractor-going saccades, suggesting a slowing of priority accumulation at this location. In the event that the distractor was fixated, disengagement from the distractor was also faster when it appeared in the high-probability location. Both proactive and reactive mechanisms of distractor suppression work together to minimize attentional capture by frequently-encountered distractors.

Slope failures in roadway embankments are common occurrences and can lead to traffic disruptions and large costs to repair damage. In areas with high-plasticity clays, special attention must be paid to characterizing both the stratigraphy and the potential for strength loss. This study demonstrates the use of an integrated site characterization approach, which seeks to utilize results from geotechnical and geophysical tests to understand the behavior of a landslide in west Alabama. The timing and mechanism of the initial failure causing the preexisting shear plane at this site are not known. Results from electrical resistivity and seismic geophysical tests are integrated with information from borings and index tests to develop a representative cross-section for the landslide, and torsional ring shear results are used to measure the drained fully softened and residual strengths. Both the limit equilibrium (LEM) and strength reduction method (SRM) analyses are used to examine possible failure mechanisms. The results show good agreement between noncircular LEM and SRM analyses and indicate that the initial failure was likely due to undrained loading of the clay. Analyses utilizing the residual drained strength envelopes produce FS values significantly lower than 1 indicating the slope to be unstable when soil on the failure plane exists at the residual state. Sensitivity analyses suggest that the combined effect of lowering the water table and strength recovery may explain the intermittent nature of movements.