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An operational multimodel forecasting system for air quality has been developed to provide air quality services for urban areas of China. The initial forecasting system included seven state-of-the-art computational models developed and executed in Europe and China (CHIMERE, IFS, EMEP MSC-W, WRF-Chem-MPIM, WRF-Chem-SMS, LOTOS-EUROS, and SILAMtest). Several other models joined the prediction system recently, but are not considered in the present analysis. In addition to the individual models, a simple multimodel ensemble was constructed by deriving statistical quantities such as the median and the mean of the predicted concentrations. The prediction system provides daily forecasts and observational data of surface ozone, nitrogen dioxides, and particulate matter for the 37 largest urban agglomerations in China (population higher than 3 million in 2010). These individual forecasts as well as the multimodel ensemble predictions for the next 72 h are displayed as hourly outputs on a publicly accessible web site (http://www.marcopolo-panda.eu, last access: 27 March 2019). In this paper, the performance of the prediction system (individual models and the multimodel ensemble) for the first operational year (April 2016 until June 2017) has been analyzed through statistical indicators using the surface observational data reported at Chinese national monitoring stations. This evaluation aims to investigate (a) the seasonal behavior, (b) the geographical distribution, and (c) diurnal variations of the ensemble and model skills. Statistical indicators show that the ensemble product usually provides the best performance compared to the individual model forecasts. The ensemble product is robust even if occasionally some individual model results are missing. Overall, and in spite of some discrepancies, the air quality forecasting system is well suited for the prediction of air pollution events and has the ability to provide warning alerts (binary prediction) of air pollution events if bias corrections are applied to improve the ozone predictions.

An operational multi-model forecasting system for air quality including nine different chemical transport models has been developed and provides daily forecasts of ozone, nitrogen oxides, and particulate matter for the 37 largest urban areas of China (population higher than 3 million in 2010). These individual forecasts as well as the mean and median concentrations for the next 3 days are displayed on a publicly accessible website (http://www.marcopolo-panda.eu, last access: 7 December 2018). The paper describes the forecasting system and shows some selected illustrative examples of air quality predictions. It presents an intercomparison of the different forecasts performed during a given period of time (1–15 March 2017) and highlights recurrent differences between the model output as well as systematic biases that appear in the median concentration values. Pathways to improve the forecasts by the multi-model system are suggested.

Abstract To examine temporal changes in patient characteristics, the incidence rate of surgical intervention, and the three-year mortality rate for patients undergoing surgical intervention for mitral valve stenosis (MS) from 2001 to 2021 in Denmark. Utilizing Danish nationwide registries, we identified all adult patients undergoing first-time surgical intervention for MS (2001–2021). Temporal changes in the incidence rate of surgical intervention across calendar periods were investigated (2001–2005, 2006–2010, 2011–2015, and 2016–2021). Using Kaplan-Meier estimates, we computed temporal changes in three-year all-cause mortality across calendar periods. With multivariable Cox regression analysis, we assessed the adjusted rates of mortality. We included 256 patients (median age 60.3 years, 31.3% males). A stepwise decrease in the burden of chronic heart failure was identified (2001–2005: 54%, and 2016–2021: 20%, p-value

ABSTRACT: The present work aims to evaluate the dissociation of casein micelles in diluted skim milk (SM) systems after undergoing solvent- or emulsifying salt-based dissociation coupled with ultra-high-pressure homogenization (UHPH). Specifically, part I evaluated dilute SM solutions combined with varying ethanol concentrations (0%–60%) at varying temperatures (5–65°C) in combination with UHPH (100–300 MPa), and part II evaluated dilute SM solutions combined with varying concentrations (0–100 mM) of either sodium hexametaphosphate (SHMP) or sodium citrate (SC) in combination with UHPH (100–300 MPa). In part I, high concentrations of ethanol (40%–60% vol/vol) at elevated temperatures (45–65°C) achieved extensive dissociation of casein micelles, especially in combination with UHPH at ≥200 MPa, as shown by a reduction in sample absorbance and in casein particle size compared with the control (dilute SM, 65°C) under optimum conditions (dilute SM, 60% ethanol, 65°C, ≥200 MPa). In part II, the level of casein micelle dissociation using emulsifying salts (ES) was dependent on the ES type and concentration. Considerable casein micelle dissociation in dilute SM systems was achieved with SHMP concentrations ≥1 mM and SC concentrations ≥10 mM, resulting in decreased sample absorbance, bimodal casein size distributions, and increased hydrophobicity (∼2-fold increase in intrinsic fluorescence) compared with the control (dilute SM). This dissociation was further enhanced with UHPH (≥200 MPa). These results indicate that both solvent- and ES-based casein dissociation techniques can be optimized when used in combination with UHPH. Together, these processing techniques can be used to extensively dissociate casein micelles with the potential to use these altered systems for value-added applications such as functional ingredients or encapsulation agents.

Introduction: Alzheimer's disease (AD) is a phenotypically and pathologically heterogenous neurodegenerative disorder. This heterogeneity can be studied and disentangled using data-driven clustering techniques. Methods: We implemented a self-organizing map clustering algorithm on baseline volumetric MRI measures from nine brain regions of interest (ROIs) to cluster 1041 individuals enrolled in the placebo arm of the EXPEDITION3 trial. Volumetric MRI differences were compared among clusters. Demographics as well as baseline and longitudinal cognitive performance metrics were used to evaluate cluster characteristics. Results: Three distinct clusters, with an overall silhouette coefficient of 0.491, were identified based on MRI volumetrics. Cluster 1 (N = 400) had the largest baseline volumetric measures across all ROIs and the best cognitive performance at baseline. Cluster 2 (N = 269) had larger hippocampal and medial temporal lobe volumes, but smaller parietal lobe volumes in comparison with the third cluster (N = 372). Significant between-group mean differences were observed between Clusters 1 and 2 (difference, 2.38; 95% CI, 1.85 to 2.91; P

Abstract. Temporal summation of pain (TSP) is a human proxy for wind-up of dorsal horn neurons as assessed in animals. The common paradigm for eliciting TSP is evoked by repetitive nociceptive stimuli of equal intensity. Various stimulation and assessment protocols have been used. This scoping review aims to provide insight into key elements of TSP stimulation and assessment: modality, instruments, test location, familiarization, train characteristics, and calculations. PubMed, Embase, and Ebsco/CINAHL were searched for studies that measured TSP in adults with musculoskeletal conditions and healthy people. Four hundred six studies were included. Mechanical stimuli were the most commonly used modality (250 studies), followed by thermal stimuli (125 studies). Forty-six different instruments were used. Disregarding studies on widespread musculoskeletal pain and healthy participants, 40 studies evaluated TSP at painful sites, 77 in remote areas, and 66 in both locations. Of the 13 tested locations in patients, the hand (74 studies), lower leg (64 studies), and forearm (59 studies) were most commonly tested. A single practice round was the most common familiarization method (46 studies). Repeated stimuli were applied using 31 different frequencies (0.03-200 Hz) and sustained stimulations ranging from 5 to 1080 seconds were used. Twenty-two different train lengths, 63 different calculations (37 absolute, 19 relative, and 7 alternatives using data directly), and 14 different outcome measures (eg, self-reported pain rating scales and reflex thresholds) were used. Temporal summation of pain protocols vary excessively, hindering the comparison and pooling of results. None of the studies provided substantiation for their protocol choice.

Trends in the CO andC2H6 partial columns ~0–15 km) have been estimated from four European ground-based solar FTIR (Fourier Transform InfraRed) stations for the 1996–2006 time period. The CO trends from the four stations Jungfraujoch, Zugspitze, Harestua and Kiruna have been estimated to −0.45 ± 0.16% yr−1, −1.00 ± 0.24% yr−1, −0.62 ± 0.19 % yr−1 and −0.61 ± 0.16% yr−1, respectively. The corresponding trends for C2H6 are −1.51 ± 0.23% yr−1, −2.11 ± 0.30% yr−1, −1.09 ± 0.25% yr−1 and −1.14 ± 0.18% yr−1. All trends are presented with their 2-σ confidence intervals. To find possible reasons for the CO trends, the global-scale EMEP MSC-W chemical transport model has been used in a series of sensitivity scenarios. It is shown that the trends are consistent with the combination of a 20% decrease in the anthropogenic CO emissions seen in Europe and North America during the 1996–2006 period and a 20% increase in the anthropogenic CO emissions in East Asia, during the same time period. The possible impacts of CH4 and biogenic volatile organic compounds (BVOCs) are also considered. The European and global-scale EMEP models have been evaluated against the measured CO and C2H6 partial columns from Jungfraujoch, Zugspitze, Bremen, Harestua, Kiruna and Ny-Ålesund. The European model reproduces, on average the measurements at the different sites fairly well and within 10–22% deviation for CO and 14–31% deviation for C2H6. Their seasonal amplitude is captured within 6–35% and 9–124% for CO and C2H6, respectively. However, 61–98% of the CO and C2H6 partial columns in the European model are shown to arise from the boundary conditions, making the global-scale model a more suitable alternative when modeling these two species. In the evaluation of the global model the average partial columns for 2006 are shown to be within 1–9% and 37–50% of the measurements for CO and C2H6, respectively. The global model sensitivity for assumptions made in this paper is also analyzed.

Total columns measured with the ground-based solar FTIR technique are highly variable in time due to atmospheric chemistry and dynamics in the atmosphere above the measurement station. In this paper, a multiple regression model with anomalies of air pressure, total columns of hydrogen fluoride (HF) and carbon monoxide (CO) and tropopause height are used to reduce the variability in the methane (CH4) and nitrous oxide (N2O) total columns to estimate reliable linear trends with as small uncertainties as possible. The method is developed at the Harestua station (60° N, 11° E, 600 m a.s.l.) and used on three other European FTIR stations, i.e. Jungfraujoch (47° N, 8° E, 3600 m a.s.l.), Zugspitze (47° N, 11° E, 3000 m a.s.l.), and Kiruna (68° N, 20° E, 400 m a.s.l.). Linear CH4 trends between 0.13 ± 0.01-0.25 ± 0.02 % yr−1 were estimated for all stations in the 1996-2009 period. A piecewise model with three separate linear trends, connected at change points, was used to estimate the short term fluctuations in the CH4 total columns. This model shows a growth in 1996–1999 followed by a period of steady state until 2007. From 2007 until 2009 the atmospheric CH4 amount increases between 0.57 ± 0.22–1.15 ± 0.17 % yr−1. Linear N2O trends between 0.19 ± 0.01–0.40 ± 0.02 % yr−1 were estimated for all stations in the 1996-2007 period, here with the strongest trend at Harestua and Kiruna and the lowest at the Alp stations. From the N2O total columns crude tropospheric and stratospheric partial columns were derived, indicating that the observed difference in the N2O trends between the FTIR sites is of stratospheric origin. This agrees well with the N2O measurements by the SMR instrument onboard the Odin satellite showing the highest trends at Harestua, 0.98 ± 0.28 % yr−1, and considerably smaller trends at lower latitudes, 0.27 ± 0.25 % yr−1. The multiple regression model was compared with two other trend methods, the ordinary linear regression and a Bootstrap algorithm. The multiple regression model estimated CH4 and N2O trends that differed up to 31 % compared to the other two methods and had uncertainties that were up to 300 % lower. Since the multiple regression method were carefully validated this stresses the importance to account for variability in the total columns when estimating trend from solar FTIR data.

Total column concentrations of methane have been retrieved from ground-based solar absorption FTIR spectra in the near-infrared recorded in Paramaribo (Suriname). The methane FTIR observations are compared with TM5 model simulations and satellite observations from SCIAMACHY, and represent the first validation of SCIAMACHY retrievals in the inner tropics using ground-based remote sensing techniques. Apart from local biomass burning features, our methane FTIR observations agree well with TM5 model simulations. The comparison of the direct measured CH4/CO2 ratios by FTIR and satellite reveals that the satellite can hardly detect methane emissions of tropical biomass burning due to the used retrieval method.

The first ground-based remote sensing measurements of the column averaged volume mixing ratio of CO2 (XCO2) in tropical South America have been obtained at Paramaribo, Suriname (5.8° N, 55.2° W). The remote sensing observations are complemented by surface air-samples collected at the site, analyzed for CO2 and 13CO2. The surface in-situ measurements are strongly influenced by local sources. From the isotopic composition of the air samples the local source component is suggested to be dominated by the terrestrial biosphere. Using δ13C from the NOAA/ESRL stations Ascension Is. (ASC), 7.9° S, 14.4° W, and Ragged Point (RPB), 13.2° N, 59.4° W, the data has been corrected for the local source component. Due to the migration of the Intertropical Convergence Zone (ITCZ) over the measurement site the sampled air masses belong to the Northern or Southern Hemisphere depending on the time of the year. Comparison to analyzed CO2 fields based on TM3 model simulations using optimized fluxes indicate agreement for the seasonality in XCO2 as well as for the corrected CO2 mixing ratios at the surface for the long dry season, when Paramaribo belongs to the Southern Hemisphere. A slightly worse agreement during the short dry season is attributed to a larger representation error during this time of the year. Overall the comparison indicates that the TM3 model is capable to simulate the seasonal variation of surface concentrations as well as column densities of CO2 correctly at Paramaribo. It has been also shown that the column measurements currently performed at Paramaribo have a limited precision and lack the link to the in situ measurements. Solutions for future improvements have been suggested.

Background: There are no generally accepted criteria for selecting patients with recurrent glioblastoma for surgery. This retrospective study in a Danish population-based cohort aimed to identify prognostic factors affecting postoperative survival after repeated surgery for recurrent glioblastoma and to test if the preoperative New Scale for Recurrent Glioblastoma Surgery (NSGS) developed by Park CK et al could assist in the selection of patients for repeat glioblastoma surgery. Methods: Clinical data from 66 patients with recurrent glioblastoma and repeated surgery were analyzed. Kaplan–Meier plots were produced to illustrate survival in each of the three NSGS prognostic groups, and Cox proportional hazard regression was used to identify prognostic variables. Multivariable analysis was used to identify differences in survival in the three prognostic groups. Results: Six variables significantly affected postoperative survival: preoperative Karnofsky Performance Status (KPS)

Medical students (MS) are at higher risk for depression than their peers. Incoming U.S. MS completed a survey that included the validated RS-14, which measures resilience and its two subcomponents: self-assuredness and drive. Surveys were administered before classes started in 2019 (pre-pandemic-cohort; n = 178) and 2020 (pandemic-cohort; n = 181). Resiliency, self-assuredness, and drive were not different between cohorts. Demographic subgroup analyses revealed that underrepresented in medicine (URiM) MS in the pre-pandemic-cohort scored higher on drive (p = 0.007) than non-URiM MS (6.07 ± 1.00 vs. 5.59 ± 0.97); however, this difference was not significant in the pandemic-cohort. Additionally, students in the pandemic-cohort were more likely to agree that peer discussions about emotional challenges would be beneficial (p = 0.014). Qualitative analysis revealed that 45.9% of pandemic-cohort respondents felt more motivated to pursue medicine. This is the first study to report differences in drive between URiM MS cohorts matriculating before and during a pandemic, a positive correlation between multiple-mini-interview (MMI) scores and drive, and a negative correlation between MCAT scores and drive. Collectively, these results suggest that the circumstances of 2020 may have negatively influenced the drive of URiM students, positively impacted the receptivity of MS to peer discussions, and motivated students to pursue medicine.

Background: Hemiarthroplasty for acute proximal humeral fractures gives disappointing results, often due to rotator cuff insufficiency. Better tuberosity fixation might improve results. Therefore, the aim of this study was to: 1) report the outcome of a stemmed hemiarthroplasty with a common platform system and a modular suture collar; 2) compare the outcome with that of a standard stemmed hemiarthroplasty; 3) report the feasibility of revision arthroplasty with retention of the stem; and 4) to evaluate the association between tuberosity healing and functional outcome. Methods: Forty-four fractures that were deemed not suitable for nonsurgical treatment or open reduction and internal fixation were treated with the Global Unite fracture system between January 2017 and July 2019. The functional and radiographic results at 2 years were compared with the results of 44 Global Fx arthroplasties. The results of patients who had adequate healing of the greater tuberosity were compared with the results of patients who had severe malunion or nonunion (resorption). Results: Mean Oxford Shoulder Score, Constant-Murley Score, and Western Ontario Osteoarthritis of the Shoulder index was 33 (range: 10 to 48), 40 (range: 10 to 98), and 68 (range: 18 to 98) at 2 years. There were no differences in functional outcome scores or in the risk of inadequate healing of the greater tuberosity between the Global Unite and the Global Fx systems. Five (11%) patients underwent revision surgery with retention of the stem. Inadequate tuberosity healing was associated with an inferior Constant-Murley Score (mean difference: 6; 95% confidence interval: 1 to 10, P = .01) and an inferior Oxford Shoulder Score (mean difference: 9; 95% confidence interval: 1 to 16, P = .03). Conclusion: The use of stemmed hemiarthroplasty with a suture collar did not improve the healing of the greater tuberosity or the functional outcome. Five arthroplasties were revised with retention of the stem. This possibility could be arguments for using the Global Unite system when a stemmed hemiarthroplasty is used for acute proximal humeral fractures.

The common snipe (Gallinago gallinago) is a wader that breeds in subarctic regions from Iceland to Russia, and for which global populations are in decline. We studied snipe breeding in western Iceland between 1998 and 2020, locating nests and ringing birds annually. In 2019 and 2020, we deployed geolocators on nesting adults to estimate the timing of their annual migration and the location of overwintering areas. Birds moved principally between breeding locations in Iceland to wintering areas in Ireland, although some birds may winter farther north. We also found that apparent annual adult survival averaged 66%, but was higher in years with warmer, wetter winters. Given the similarity of our survival estimates to those from snipe elsewhere, we suggest that adult survival is unlikely a major contributor to declining populations, and other factors like habitat loss may be of more concern.

Intro: There is sparse data on SARS-CoV-2 infection among paediatric patients from low-middle income countries (LMICs), including from sub-Saharan Africa. We describe the burden and severity of disease in children treated with SARS- CoV-2 infection at an academic hospital in Soweto, South Africa from 30 March 2020 through 30 June 2022. Methods: SARS-CoV-2 was detected using reverse transcriptase polymerase chain reaction (RT-PCR) of nasopharyngeal swab specimens. Clinical diagnoses, HIV status, admission C-reactive protein (CRP), blood culture results and clinical outcomes were captured. Epidemic waves were designated as follows: Wave 1 (01 March to 14 October 2020); Wave 2 (15 October 2020 to 17 May 2021); Wave 3 (18 May to 14 November 2021); Wave 4 (15 November 2021 to 14 March 2022); Wave 5 (15 March to 30 June 2022). Findings: There were 797 SARS-CoV-2 positive paediatric hospitalisations in the study period. SARS-CoV-2 detection prevalence was 4.6% (77/1,673) in Wave 1, 3.9% (134/3,426) in Wave 2, 7.1% (187/2,618) in Wave 3, 12.5% (261/2,088) in Wave 4 and 5.9% (138/2,320) in Wave 5. Among SARS-CoV-2 positive cases, the prevalence of respiratory admission diagnoses increased over time (16.9% in Wave 1 to 42.8% in Wave 5). Conversely, the prevalence of multisystem inflammatory syndrom of childhood (MIS-C) and case fatailty ratios (CFRs) declined from Wave 1 to Wave 5 (MIS-C: 20.8% to 2.2%; CFR: 9.1% to 3.6%). Death was significantly associated with younger age (median age 3.4 versus 16.9 months), positive admission blood cultures (24.0% versus 8.4%), MIS-C (20.7% versus 6.5%), and HIV infection (21.1% versus 4.5%). Conclusion: The omicron dominated fourth and fifth waves of SARS-CoV-2 infection were associated with a higher prevalence of respiratory admission diagnoses, but lower case fatality compared to the ancestral first wave in South African children. Optimisation of antenatal maternal SARS-CoV-2 vaccination and early HIV diagnosis may impact on paediatric SARS-CoV-2 CFR.

Introduction We present findings from the International Collaborative Effusion database, a European Respiratory Society clinical research collaboration. Nonspecific pleuritis (NSP) is a broad term that describes chronic pleural inflammation. Various aetiologies lead to NSP, which poses a diagnostic challenge for clinicians. A significant proportion of patients with this finding eventually develop a malignant diagnosis. Methods 12 sites across nine countries contributed anonymised data on 187 patients. 175 records were suitable for analysis. Results The commonest aetiology for NSP was recorded as idiopathic (80 out of 175, 44%). This was followed by pleural infection (15%), benign asbestos disease (12%), malignancy (6%) and cardiac failure (6%). The malignant diagnoses were predominantly mesothelioma (six out of 175, 3.4%) and lung adenocarcinoma (four out of 175, 2.3%). The median time to malignant diagnosis was 12.2 months (range 0.8–32 months). There was a signal towards greater asbestos exposure in the malignant NSP group compared to the benign group (0.63 versus 0.27, p=0.07). Neither recurrence of effusion requiring further therapeutic intervention nor initial biopsy approach were associated with a false-negative biopsy. A computed tomography finding of a mass lesion was the only imaging feature to demonstrate a significant association (0.18 versus 0.01, p=0.02), although sonographic pleural thickening also suggested an association (0.27 versus 0.09, p=0.09). Discussion This is the first multicentre study of NSP and its associated outcomes. While some of our findings are reflected by the established body of literature, other findings have highlighted important areas for future research, not previously studied in NSP.

Abstract Migratory species have geographically separate distributions during their annual cycle, and these areas can vary between populations and individuals. This can lead to differential stress levels being experienced across a species range. Gathering information on the areas used during the annual cycle of red‐throated divers (RTDs; Gavia stellata) has become an increasingly pressing issue, as they are a species of concern when considering the effects of disturbance from offshore wind farms and the associated ship traffic. Here, we use light‐based geolocator tags, deployed during the summer breeding season, to determine the non‐breeding winter location of RTDs from breeding locations in Scotland, Finland, and Iceland. We also use δ15N and δ13C isotope signatures, from feather samples, to link population‐level differences in areas used in the molt period to population‐level differences in isotope signatures. We found from geolocator data that RTDs from the three different breeding locations did not overlap in their winter distributions. Differences in isotope signatures suggested this spatial separation was also evident in the molting period, when geolocation data were unavailable. We also found that of the three populations, RTDs breeding in Iceland moved the shortest distance from their breeding grounds to their wintering grounds. In contrast, RTDs breeding in Finland moved the furthest, with a westward migration from the Baltic into the southern North Sea. Overall, these results suggest that RTDs breeding in Finland are likely to encounter anthropogenic activity during the winter period, where they currently overlap with areas of future planned developments. Icelandic and Scottish birds are less likely to be affected, due to less ship activity and few or no offshore wind farms in their wintering distributions. We also demonstrate that separating the three populations isotopically is possible and suggest further work to allocate breeding individuals to wintering areas based solely on feather samples.

We present a typology of ‘Stayers’ and ‘Leavers’ among rural island youth (aged 18-30) to illustrate their employment-education-location decision, based on semi-structured interviews with 30 young adults, and 81 older adults, in rural locations in Ireland, Newfoundland, Faroe Islands, and Shetland. Although there are exceptions, rural labour markets tend to be less diverse, and jobs in the primary sector, which have historically sustained these communities, face restructuring and decline in many places. Regardless of location, young people typically struggle to find good-quality work because of their relative lack of credentials and/or experience, and a shortage of local options can trap some, and force others to look ‘away’. Outmigration decisions are based on economics, but also social and emotional factors. Thus, even in places with low unemployment, young adults must consider where to live, and what to do next, and down the road. The reviewed literature suggests that there are commonalities among the choices typically facing those in rural and remote communities, whether on an island or on a mainland. We believe, though, that this dilemma can be exacerbated for those living on islands because of the logistical and psychological complexity of the ‘stay or leave’ decision. Rather than presenting detailed summaries from the young islanders whom we interviewed, our intended contribution is to present our typology as a way to spur on research towards specific policy remedies. The challenges facing any young rural islander can be complicated and individualized. Nonetheless, after conducting dozens of interviews in many island communities, some clear patterns of Stayers and Leavers emerged across the various jurisdictions. In turn, we argue for the development of social and economic policies tailored to suit each category of rural island youth.