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A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Specific challenges still exist in our understanding of past greenhouse climate states. Whilst climate model simulations using atmospheric CO 2 concentrations consistent with proxy estimates broadly align with lower latitude proxy temperature estimates, they struggle to reproduce the warming implied by proxies at higher latitudes, especially in the marine realm. This inconsistency has often led to the conclusion that climate models are insufficiently sensitive. Here, we analyse the distribution of photozoan and heterozoan carbonates, which provide important constraints for latitudinal sea surface temperature (SST) gradients, to assess data/model mismatches for the early Eocene Climatic Optimum. The carbonate facies distribution is compared against quantitative geochemical proxy temperature estimates (δ 18 O , Mg/Ca, clumped isotopes and TEX 86) and a new HadCM3L climate simulation. Good correspondence exists between the simulated cold-month SSTs and photozoan carbonates, indicating HadCM3L is effectively reconstructing meridional temperature gradients into mid-latitudes. Whilst there is good agreement between simulated mean annual SSTs and geochemical proxy estimates in low latitudes, the δ 18 O , Mg/Ca and TEX 86 estimates instead align with warm-month SSTs at higher latitudes. In light of the carbonate facies evidence, and consistency between our simulation and available terrestrial proxy temperature estimates, this study supports previous claims that a warm season bias exists in many middle and high latitude SST estimates. This helps resolve the discrepancy between climate simulations and marine proxies and shows that climate models and data might be more closely aligned than is appreciated. Further, we demonstrate that simple, and widely available, proxies can play a fundamental role in contextualising wider paleoclimate uncertainties. • Early Eocene proxy warmth can be difficult to reconcile with climate models. • Proxy/model mismatches are assessed using photozoan and heterozoan carbonates. • Good correspondence exists between the simulation and carbonates assemblages. • Climate models are effectively reconstructing ocean temperature gradients. • Supports the presence of a seasonal bias in some sea surface temperature proxies. [ABSTRACT FROM AUTHOR]

Background. The Centers for Medicare and Medicaid Services (CMS) require physical therapists document patients' functional limitations. The process is not standardized. A systematic approach to determine a patient's functional limitations and responsiveness to change is needed. Objective. The purpose of this study is to compare patient-reported outcomes (PROs) responsiveness to change using 7-level severity/complexity modifier scale proposed by Medicare to a derived scale implemented by Intermountain Healthcare's Rehabilitation Outcomes Management System (ROMS). Design. This was a retrospective, observational cohort design. Methods. 165,183 PROs prior to July 1, 2013, were compared to 46,334 records from July 1, 2013, to December 31, 2015. Histograms and ribbon plots illustrate distribution and change of patients' scores. ROMS raw score ranges were calculated and compared to CMS' severity/complexity levels based on score percentage. Distribution of the population was compared based on the 2 methods. Sensitivity and specificity were compared for responsiveness to change based on minimal clinically important difference (MCID). Results. Histograms demonstrated few patient scores placed in CMS scale levels at the extremes, whereas the majority of scores placed in 2 middle levels (CJ, CK). ROMS distributed scores more evenly across levels. Ribbon plots illustrated advantage of ROMS' using narrower score ranges. Greater chance for patients to change levels was observed with ROMS when an MCID was achieved. ROMS narrower scale levels resulted in greater sensitivity and good specificity. Limitations. Geographic representation for the United States was limited. Without patients' global rating of change, a reference standard to gauge validation of improvement could not be provided. Conclusions. ROMS provides a standard approach to identify accurately functional limitation modifier levels and to detect improvement more accurately than a straight across transposition using the CMS scale. [ABSTRACT FROM AUTHOR]

The authors reflect on the challenges in research to enhance the clinical practice guideline (CPG) for the management of patients with total knee replacement (TKA) by physical therapists. Also cited are the problems faced by researchers like the lack of true placebo-control groups, as well as some tips to overcome the challenges like designing clinical trials of rehabilitation solutions based on theory and conducting multisite trials to achieve higher samples.

Background. Medicare beneficiaries frequently receive physical therapy for musculoskeletal conditions. Little information is available about this care.Objective. The purposes of this study were: (1) to describe characteristics, clinical outcomes, and utilization for Medicare beneficiaries receiving physical therapy in outpatient clinics within one integrated health care system; (2) to compare characteristics, outcomes, and utilization based on the body region affected; and (3) to examine factors predictive of outcomes and utilization.Design. This was a prospective, longitudinal study. Methods. Medicare beneficiaries aged 65 years or older (n1,840 episodes of care) participated in the study. Descriptive statistics were calculated for patient characteristics and outcomes. Comparisons were made based on body region. Regression models evaluated factors associated with change in pain, improved outcome,and utilization. Results. The patients' mean age was 74.2 years (SD6.3), and 65.3% were female. The most common body regions were the lumbar spine, shoulder, and knee, collectively accounting for 71.3% of the episodes of care. Patients attended a mean of 6.8 visits (SD4.7), and 63.9% experienced an improved outcome. Episodes of care for lumbar spine conditions had less reduction in pain, whereas shoulder conditions and foot/ankle conditions showed the greatest improvement. Care for hip conditions was least likely to result in an improved outcome. Knee conditions were most likely to have an improved outcome. Care for shoulder and knee conditions had the highest number of visits. Factors associated with greater reduction in pain and improved outcomes included greater initial pain or disability and attending more visits. Factors associated with greater utilization included a postsurgical condition and higher initial pain rating. Limitations. The study was performed in one geographic region within a single health care delivery system. Conclusion. The results provide information on outcomes of physical therapy or Medicare beneficiaries in one health care system. Further research is needed to examine optimal utilization and care for these patients. [ABSTRACT FROM AUTHOR]

Objective The coronavirus disease-2019 pandemic has facilitated the emergence of telerehabilitation, but it is unclear which patients are most likely to respond to physical therapy provided this way. The purpose of this study was to examine the relationship between individual patient factors and substantial clinical benefit from telerehabilitation among a cohort of patients with chronic low back pain (LBP). Methods This is a secondary analysis of data collected during a prospective longitudinal cohort study. Patients with chronic LBP (N  = 98) were provided with a standardized physical therapy protocol adapted for telerehabilitation. We examined the relationship between patient factors and substantial clinical benefit with telerehabilitation, defined as a ≥50% improvement in disability at 10 weeks, measured using the Oswestry Disability Index. Results Sixteen (16.3%) patients reported a substantial clinical benefit from telerehabilitation. Patients reporting substantial clinical benefit from telerehabilitation had lower initial pain intensity, lower psychosocial risk per the STarT Back Screening Tool, higher levels of pain self-efficacy, and reported higher therapeutic alliance with their physical therapist compared to other patients. Conclusion Patients with lower psychosocial risk and higher pain-self efficacy experienced substantial clinical benefit from telerehabilitation for chronic LBP more often than other patients in our cohort. Therapeutic alliance was higher among patients who experienced a substantial clinical benefit compared to those who did not. Impact This study indicates that psychosocial factors play an important role in the outcomes of patients receiving telerehabilitation for chronic LBP. Baseline psychosocial screening may serve as a method for identifying patients likely to benefit from this approach. [ABSTRACT FROM AUTHOR]

Global reconstructions of Pliocene climate provide important insights into how the climate system operates under elevated temperatures and atmospheric CO2 levels. These reconstructions have been used extensively in paleoclimate modeling experiments for comparison to simulated conditions, and as boundary conditions. Most previous work focused on the Late Pliocene interval known as the mid PiacenzianWarm Period (mPWP), the interval originally identified by the U.S. Geological Survey Pliocene Research, Interpretation and Synoptic Mapping Project (PRISM) as the PRISM interval or Mid Pliocene Warm Period. The term Mid Pliocene Warm Period is a misnomer due to changes to the geological time scale, and its use should be discontinued. The Pliocene Model Intercomparison Project (PlioMIP), now in its third phase, is expanding to include a focus on the Early Pliocene (Zanclean). PlioMIP3 experimentswill allow comparison of environmental and climatic conditions before and after closure of the Central American Seaway (CAS). PlioMIP3 used the annual insolation pattern at the top of the atmosphere to determine time slices in the Zanclean that have orbital configurations that are most similar to modern. Two have been selected by PlioMIP and adopted by PRISM for inclusion in future studies: PRISM5.1 (4.474 Ma) and PRISM5.2 (4.870 Ma). Here we establish the stratigraphic framework for these Early Pliocene time slices and furnish information to help locate these intervals in proxy records of paleoenvironmental data using oxygen isotope stratigraphy, paleomagnetic stratigraphy, biostratigraphy, and biochronology (calibrated planktic foraminifer and calcareous nannofossil events). [ABSTRACT FROM AUTHOR]

Objective: Compare health care utilization and charges for low-back-pain (LBP) patients receiving advanced imaging or physical therapy as a first management strategy following a new primary care consultation.Data Source: Electronic medical record (EMR) and insurance claims data.Study Design: Retrospective analysis of propensity-matched groups.Data Collection/extraction: Claims and EMR data were used. Utilization and LBP-related charges over a 1-year period were extracted from claims data.Principal Findings: In the propensity-matched sample (n = 406), advanced imaging recipients had higher odds of all utilization outcomes. Charges were higher with advanced imaging by an average $4,793 (95 percent CI: $3,676, $5,910).Conclusions: For patients with LBP whom newly consulted primary care referred for additional management, advanced imaging as a first management was associated with higher health care utilization and charges than physical therapy. [ABSTRACT FROM AUTHOR]

The Pliocene Epoch (5.2 to 2.58 Ma) has often been targeted to investigate the nature of warm climates. However, climate records for the Pliocene exhibit significant variability and show intervals that apparently experienced a cooler than modern climate. Marine Isotope Stage (MIS) M2 (~ 3.3 Ma) is a globally recognisable cooling event that disturbs an otherwise relatively (compared to present-day) warm background climate state. It remains unclear whether this event corresponds to significant ice sheet build-up in the Northern and Southern Hemisphere. Estimates of sea level for this interval vary, and range from modern values to estimates of 65 m sea level fall with respect to present day. Here we implement plausible M2 ice sheet configurations into a coupled atmosphere–ocean climate model to test the hypothesis that larger-than-modern ice sheet configurations may have existed at M2. Climate model results are compared with proxy climate data available for M2 to assess the plausibility of each ice sheet configuration. Whilst the outcomes of our data/model comparisons are not in all cases straight forward to interpret, there is little indication that results from model simulations in which significant ice masses have been prescribed in the Northern Hemisphere are incompatible with proxy data from the North Atlantic, Northeast Arctic Russia, North Africa and the Southern Ocean. Therefore, our model results do not preclude the possibility of the existence of larger ice masses during M2 in the Northern or Southern Hemisphere. Specifically they are not able to discount the possibility of significant ice masses in the Northern Hemisphere during the M2 event, consistent with a global sea-level fall of between 40 m and 60 m. This study highlights the general need for more focused and coordinated data generation in the future to improve the coverage and consistency in proxy records for M2, which will allow these and future M2 sensitivity tests to be interrogated further. [ABSTRACT FROM AUTHOR]

Objective This study sought to develop and validate an original prediction formula that estimated the probability of success for patients with low back pain (LBP) to achieve a minimal clinically important difference (MCID) on the Modified Low Back Disability Questionnaire (MDQ). Methods Patients were 10 to 90 years old in this retrospective cohort study. Data were extracted from Intermountain Healthcare's registry, Rehabilitation Outcomes Management System: 62,858 patients admitted to physical therapy from 2002 to 2013 formed the training dataset, and 15,128 patients admitted 2015 to 2016 formed the verification dataset. Predicted probability to achieve MCID was compared with the actual percentage who succeeded. Two models were developed: 6-point improvement and 30% improvement. MDQ assessed disability, and numeric pain score assessed pain intensity. Predictive models used restricted cubic splines on age, initial pain, and disability scores for non-linear effects. Sex, symptom duration, and payer type were included as indicator variables. Predicted chance of success was compared with the actual percentage of patients that succeeded. Relative change in R -squared was calculated to assess variable importance in predicting success. Odds ratios for duration of injury and payer were calculated. Results A positive trend was observed in both models between predicted and actual success achieved. Both "verification" models appear accurate and closely approximate the "training dataset." Baseline MDQ score was the most important factor to predict a 6-point improvement. Payer type and injury duration were important factors to predict 30% improvement. Best odds to achieve an MCID was having a workers compensation insurance payer and seeking care within 14 days. Conclusion The 2 models demonstrated an accurate visualization of the chance of patients achieving significant improvement compared with the usual representation of the average rate of improvement for all patients. Impact Enhancing physical therapists' understanding of the probability of a patient achieving significant clinical improvement can enhance decision-making processes and help physical therapists manage a patient's care more effectively. [ABSTRACT FROM AUTHOR]

Warm periods in Earth’s history offer opportunities to understand the dynamics of the Earth system under conditions that are similar to those expected in the near future. The Middle Pliocene warm period (MPWP), from 3.3 to 3.0 My B.P, is the most recent time when atmospheric CO2 levels were as high as today. However, climate model simulations of the Pliocene underestimate high-latitude warming that has been reconstructed from fossil pollen samples and other geological archives. One possible reason for this is that enhanced non-CO2 trace gas radiative forcing during the Pliocene, including from methane (CH4), has not been included in modeling. We use a suite of terrestrial biogeochemistry models forced with MPWP climate model simulations from four different climate models to produce a comprehensive reconstruction of the MPWP CH4 cycle, including uncertainty. We simulate an atmospheric CH4 mixing ratio of 1,000 to 1,200 ppbv, which in combination with estimates of radiative forcing from N2O and O3, contributes a non-CO2 radiative forcing of 0.9 W.m² (range 0.6 to 1.1), which is 43% (range 36 to 56%) of the CO2 radiative forcing used in MPWP climate simulations. This additional forcing would cause a global surface temperature increase of 0.6 to 1.0 °C, with amplified changes at high latitudes, improving agreement with geological evidence of Middle Pliocene climate. We conclude that natural trace gas feedbacks are critical for interpreting climate warmth during the Pliocene and potentially many other warm phases of the Cenezoic. These results also imply that using Pliocene CO2 and temperature reconstructions alone may lead to overestimates of the fast or Charney climate sensitivity. [ABSTRACT FROM AUTHOR]

Thermodynamic arguments imply that global mean rainfall increases in a warmer atmosphere; however, dynamical effects may result in more significant diversity of regional precipitation change. Here we investigate rainfall changes in the mid-Pliocene Warm Period (~ 3 Ma), a time when temperatures were 2–3ºC warmer than the pre-industrial era, using output from the Pliocene Model Intercomparison Projects phases 1 and 2 and sensitivity climate model experiments. In the Mid-Pliocene simulations, the higher rates of warming in the northern hemisphere create an interhemispheric temperature gradient that enhances the southward cross-equatorial energy flux by up to 48%. This intensified energy flux reorganizes the atmospheric circulation leading to a northward shift of the Inter-Tropical Convergence Zone and a weakened and poleward displaced Southern Hemisphere Subtropical Convergences Zones. These changes result in drier-than-normal Southern Hemisphere tropics and subtropics. The evaluation of the mid-Pliocene adds a constraint to possible future warmer scenarios associated with differing rates of warming between hemispheres. [ABSTRACT FROM AUTHOR]

Low back pain (LBP) is one of the most prevalent and potentially disabling conditions for which people seek health care. Patients, providers, and payers agree that greater effort is needed to prevent acute LBP from transitioning to chronic LBP. The TARGET (Targeted Interventions to Prevent Chronic Low Back Pain in High-Risk Patients) Trial is a primary care-based, multisite, cluster randomized, pragmatic trial comparing guideline-based care (GBC) to GBC + referral to Psychologically Informed Physical Therapy (PIPT) for patients presenting with acute LBP and identified as high risk for persistent disabling symptoms. Study sites include primary care clinics within each of five geographical regions in the United States, with clinics randomized to either GBC or GBC + PIPT. Acute LBP patients at all clinics are risk stratified (high, medium, low) using the STarT Back Tool. The primary outcomes are the presence of chronic LBP and LBP-related functional disability determined by the Oswestry Disability Index at 6 months. Secondary outcomes are LBP-related processes of health care and utilization of services over 12 months, determined through electronic medical records. Study enrollment began in May 2016 and concluded in June 2018. The trial was powered to include at least 1860 high-risk patients in the randomized controlled trial cohort. A prospective observational cohort of approximately 6900 low and medium-risk acute LBP patients was enrolled concurrently. The TARGET pragmatic trial aims to establish the effectiveness of the stratified approach to acute LBP intervention targeting high-risk patients with GBC and PIPT. Trial Registration: ClinicalTrials.gov NCT02647658 Registered Jan. 6, 2016. [ABSTRACT FROM AUTHOR]

The shell material of marine benthic bivalves provides a sensitive archive of water chemistry immediately above the sediment–water interface, which in turn is affected by sedimentary geochemistry and redox reactions. Sulfate has a major controlling effect on sedimentary carbon cycling, particularly the processes of methane production and oxidation, with lower concentrations of sulfate likely resulting in an increase in sedimentary methane production. Whilst it is accepted that ocean sulfate varied markedly across the Phanerozoic, evidence of changes in methane production in sediments has so far been lacking. There is potential for the oxidation products of sedimentary methane to be preserved and detected in marine fossils. Here we present the results of high resolution carbonate isotope records from two taxa of well-preserved shallow-infaunal bivalve ( Lahillia and Cucullaea ) collected from the marine shelf succession across the Cretaceous–Paleogene (K–Pg) boundary in Seymour Island, Antarctica. The succession has pre-existing subtle indications of more abundant methane, and the time period is characterized by much lower marine sulfate concentrations than modern. These shell carbonate–carbon isotope records vary widely: at one extreme, shells have typical average values and small ranges compatible with a contemporaneous marine dissolved inorganic carbon (DIC) source and modern-style sedimentary carbon cycling. At the other, the shells have large-amplitude annual cycles of carbon isotopic variability of up to 23.8‰ within a single year of growth and shell carbonate δ 13 C compositions as negative as −34‰. Shells with these increased ranges and unusually negative values are found at discrete intervals and across both bivalve taxa. The contribution of methane required to explain the most negative carbonate–carbon isotopic values in the bivalve shells is extremely high (between 30 to 85% of bottom-water DIC based on mass balance calculations). Records of organic-carbon isotopes from the same succession remained between −26.1 and −21.7‰ throughout, suggesting that methane influence was restricted to bottom-waters. A lack of authigenic carbonate in the section indicates that methane oxidation progressed aerobically and may have provided a significant driver for transient bottom water de-oxygenation. Where methane addition is indicated, the seasonal sensitivity precludes control by methane hydrates. We argue that these data represent the increased importance and sensitivity of methanogenesis in the sediments, enabled by lower ocean sulfate concentrations during the Late Cretaceous. The tendency towards a more dynamic role for marine methane production and oxidation is likely to apply to other times of low marine sulfate in Earth's history. [ABSTRACT FROM AUTHOR]

Examining the nature of ice sheet and sea level response to past episodes of enhanced greenhouse gas forcing may help constrain future sea level change. Here, for the first time, we present the transient nature of ice sheets and sea level during the late Pliocene. The transient ice sheet predictions are forced by multiple climate snapshots derived from a climate model set up with late Pliocene boundary conditions, forced with different orbital forcing scenarios appropriate to two Marine Isotope Stages (MISs), MIS KM5c, and K1. Our results indicate that during MIS KM5c both the Antarctic and Greenland ice sheets contributed to sea level rise relative to present and were relatively stable. Insolation forcing between the hemispheres was out of phase during MIS K1 and led to an asynchronous response of ice volume globally. Therefore, when variations of precession were high, inferring the behavior of ice sheets from benthic isotope or sea level records is complex. [ABSTRACT FROM AUTHOR]

A buoyant plume model is used to explore the ability of flood basalt eruptions to inject climate-relevant gases into the stratosphere. An example from the 1986 Izu-Oshima basaltic fissure eruption validates the model's ability to reproduce the observed maximum plume heights of 12–16 km above sea level, sustained above fire-fountains. The model predicts maximum plume heights of 13–17 km for source widths of between 4–16 m when 32% (by mass) of the erupted magma is fragmented and involved in the buoyant plume (effective volatile content of 6 wt%). Assuming that the Miocene-age Roza eruption (part of the Columbia River Basalt Group) sustained fire-fountains of similar height to Izu-Oshima (1.6 km above the vent), we show that the Roza eruption could have sustained buoyant ash and gas plumes that extended into the stratosphere at ∼ 45 ° N . Assuming 5 km long active fissure segments and 9000 Mt of SO 2 released during explosive phases over a 10–15 year duration, the ∼ 180 km of known Roza fissure length could have supported ∼36 explosive events/phases, each with a duration of 3–4 days. Each 5 km fissure segment could have emitted 62 Mt of SO 2 per day into the stratosphere while actively fountaining, the equivalent of about three 1991 Mount Pinatubo eruptions per day. Each fissure segment could have had one to several vents, which subsequently produced lava without significant fountaining for a longer period within the decades-long eruption. Sensitivity of plume rise height to ancient atmospheric conditions is explored. Although eruptions in the Deccan Traps ( ∼ 66 Ma ) may have generated buoyant plumes that rose to altitudes in excess of 18 km, they may not have reached the stratosphere because the tropopause was substantially higher in the late Cretaceous. Our results indicate that some flood basalt eruptions, such as Roza, were capable of repeatedly injecting large masses of SO 2 into the stratosphere. Thus sustained flood basalt eruptions could have influenced climate on time scales of decades to centuries but the location (i.e., latitude) of the province and relevant paleoclimate is important and must be considered. [ABSTRACT FROM AUTHOR]

Aim Determining which species are more prone to extinction is vital for conserving Earth's biodiversity and for providing insight into macroevolutionary processes. This paper utilizes the Pliocene to Recent fossil record of mollusks to identify determinants of species' extinction over the past three million years of Earth history. Location Western Atlantic. Methods We focus on 92 bivalve and gastropod species that lived during the mid-Pliocene Warm Period ( mPWP; ∼3.264-3.025 Ma) and have either since gone extinct or are still extant. We used ecological niche modeling ( ENM) to assess the vulnerability of these species to extinction as a function of both fundamental ( FN) and realized ( RN) niche breadth proxies, geographic range size, and amount of suitable area available to them during the Last Glacial Maximum ( LGM; ∼21 Ka). Results Geographic range size emerged as a key predictor of extinction for the studied mollusk species, with RN breadth and amount of suitable area available during the LGM as secondary predictors. By contrast, FN breadth was not a significant predictor of extinction risk. Main conclusions The failure to recover FN breadth as a predictor of extinction may suggest that extinction resistance is achieved when species are more successful in filling the geographic extent of their fundamental tolerances. That is, when it comes to species' survival, being a generalist or specialist sensu stricto may be secondary to the unique historical, dispersal, and biotic constraints that dictate a species' occupation of suitable environments, and consequently of geographic space, at a particular time. Identifying the factors that promote extinction is important because of the time-intensive nature of estimating extinction risk for individual species and populations, and because of the rising concerns about the future of marine ecosystems and biodiversity. [ABSTRACT FROM AUTHOR]

The traditional view of the Pliocene is one of an epoch with higher than present global mean annual temperatures (∼2 to 3 °C) and stable climate conditions. Published data-model comparisons for the mid-Pliocene Warm Period (mPWP: ∼3.3 to 3 million years ago) have identified specific regions of concordance and discord between climate model outputs and marine/terrestrial proxy data. Due to the time averaged nature of global palaeoenvironmental syntheses, it has been hypothesised that climate variability during interglacial events within the mPWP could contribute to site-specific data/model disagreement. The Hadley Centre Coupled Climate Model Version 3 (HadCM3) is used to assess the nature of climate variability around two interglacial events within the mPWP that have different characteristics of orbital forcing (Marine Isotope Stages KM5c and K1). Model results indicate that ±20 kyr on either side of the MIS KM5c, orbital forcing produced a less than 1 °C change in global mean annual temperatures. Regionally, mean annual surface air temperature (SAT) variability can reach 2 to 3 °C. Seasonal variations exceed those predicted for the annual mean and can locally exceed 5 °C. Simulations 20 kyr on either side of MIS K1 show considerably increased variability in relation to KM5c. We demonstrate that orbitally-forced changes in surface air temperature during interglacial events within the mPWP can be substantial, and could therefore contribute to data/model discord. This is especially likely if proxies preserve growing season rather than mean annual temperatures. Model results indicate that peak MIS KM5c and K1 interglacial temperatures were not globally synchronous, highlighting leads and lags in temperature in different regions. This highlights the potential pitfalls in aligning peaks in proxy-derived temperatures across geographically diverse data sites, and indicates that a single climate model simulation for an interglacial event is inadequate to capture peak temperature change in all regions. We conclude that the premise of sustained global warmth and stable Pliocene climate conditions is incomplete. We also contend that the likely nature of Pliocene interglacial climate variability is more akin to interglacial events within the Quaternary, where the character of interglacials is known to be diverse. In the future, the utility of Pliocene data/model comparisons is dependent upon 1) establishing precise chronology of the proxy data, 2) providing climate models with fully proxy-consistent boundary conditions and 3) in utilising ensembles of climate simulations that can adequately capture orbital variability around any studied interval. [ABSTRACT FROM AUTHOR]

Abstract: The thickest uppermost Cretaceous to lowermost Paleogene (Maastrichtian to Danian) sedimentary succession in the world is exposed on southern Seymour Island (65° South) in the James Ross Basin, Antarctic Peninsula. This fossiliferous shallow marine sequence, which spans the Cretaceous–Paleogene boundary, has allowed a high-resolution analysis of well-preserved marine palynomorphs. Previous correlation of Cretaceous–Paleogene marine palynomorph assemblages in the south polar region relied on dinoflagellate cyst biozonations from New Zealand and southern Australia. The age model of the southern Seymour Island succession is refined and placed within the stratigraphical context of the mid to high southern palaeolatitudes. Quantitative palynological analysis of a new 1102m continuous stratigraphical section comprising the uppermost Snow Hill Island Formation and the López de Bertodano Formation (Marambio Group) across southern Seymour Island was undertaken. We propose the first formal late Maastrichtian to early Danian dinoflagellate cyst zonation scheme for the Antarctic based on this exceptional succession. Two new late Maastrichtian zones, including three subzones, and one new early Danian zone are defined. The oldest beds correlate well with the late Maastrichtian of New Zealand. In a wider context, a new South Polar Province based on Maastrichtian to Danian dinoflagellate cysts is proposed, which excludes most southern South American marine palynofloras. This interpretation is supported by models of ocean currents around Antarctica and implies an unrestricted oceanic connection across Antarctica between southern South America and the Tasman Sea. [Copyright &y& Elsevier]

Abstract: Examination of the mid-Pliocene Warm Period (mPWP; ~3.3 to 3.0Ma BP) provides an excellent opportunity to test the ability of climate models to reproduce warm climate states, thereby assessing our confidence in model predictions. To do this it is necessary to relate the uncertainty in model simulations of mPWP climate to uncertainties in projections of future climate change. The uncertainties introduced by the model can be estimated through the use of a Perturbed Physics Ensemble (PPE). Developing on the UK Met Office Quantifying Uncertainty in Model Predictions (QUMP) Project, this paper presents the results from an initial investigation using the end members of a PPE in a fully coupled atmosphere–ocean model (HadCM3) running with appropriate mPWP boundary conditions. Prior work has shown that the unperturbed version of HadCM3 may underestimate mPWP sea surface temperatures at higher latitudes. Initial results indicate that neither the low sensitivity nor the high sensitivity simulations produce unequivocally improved mPWP climatology relative to the standard. Whilst the high sensitivity simulation was able to reconcile up to 6°C of the data/model mismatch in sea surface temperatures in the high latitudes of the Northern Hemisphere (relative to the standard simulation), it did not produce a better prediction of global vegetation than the standard simulation. Overall the low sensitivity simulation was degraded compared to the standard and high sensitivity simulations in all aspects of the data/model comparison. The results have shown that a PPE has the potential to explore weaknesses in mPWP modelling simulations which have been identified by geological proxies, but that a ‘best fit’ simulation will more likely come from a full ensemble in which simulations that contain the strengths of the two end member simulations shown here are combined. [Copyright &y& Elsevier]

Abstract: The stability of the Earth''s major ice sheets is a critical uncertainty in predictions of future climate and sea level change. One method of investigating the behaviour of the Greenland and the Antarctic ice sheets in a warmer-than-modern climate is to look back at past warm periods of Earth history, for example the Pliocene. This paper presents climate and ice sheet modelling results for the mid-Pliocene warm period (mPWP; 3.3 to 3.0million years ago), which has been identified as a key interval for understanding warmer-than-modern climates (). Using boundary conditions supplied by the United States Geological Survey PRISM Group (Pliocene Research, Interpretation and Synoptic Mapping), the Hadley Centre coupled ocean–atmosphere climate model (HadCM3) and the British Antarctic Survey Ice Sheet Model (BASISM), we show large reductions in the Greenland and East Antarctic Ice Sheets (GrIS and EAIS) compared to modern in standard mPWP experiments. We also present the first results illustrating the variability of the ice sheets due to realistic orbital forcing during the mid-Pliocene. While GrIS volumes are lower than modern under even the most extreme (cold) mid-Pliocene orbit (losing at least 35% of its ice mass), the EAIS can both grow and shrink, losing up to 20% or gaining up to 10% of its present-day volume. The changes in ice sheet volume incurred by altering orbital forcing alone means that global sea level can vary by more than 25m during the mid-Pliocene. However, we have also shown that the response of the ice sheets to mPWP orbital hemispheric forcing can be in anti-phase, whereby the greatest reductions in EAIS volume are concurrent with the smallest reductions of the GrIS. If this anti-phase relationship is in operation throughout the mPWP, then the total eustatic sea level response would be dampened compared to the ice sheet fluctuations that are theoretically possible. This suggests that maximum eustatic sea level rise does not correspond to orbital maxima, but occurs at times where the anti-phasing of Northern and Southern Hemisphere ice sheet retreat is minimised. [Copyright &y& Elsevier]

Abstract: For the Tortonian age of the Miocene Epoch (11.6–7.25Ma) we present a global palaeobotanical and palaeoecologically-based vegetation dataset, combined with a best-fit Late Miocene climate-vegetation model experiment to create an advanced global data–model hybrid biome reconstruction. This new palaeoecological database and global vegetation reconstruction can be used both for the purposes of validating future palaeoclimate model simulations, as well as a land cover dataset to initialise palaeoclimate modelling experiments. Our Tortonian reconstruction shows significant changes in the distribution of vegetation compared to modern natural vegetation. For example in contrast to the modern scenario in the Northern Hemisphere, boreal forests reached 80°N and temperate forests were present above 60°N. Warm–temperate forests covered much of Europe, coastal North America and South-East Asia. Our reconstruction shows a spread of temperate savanna in central USA, the Middle East and on the Tibetan Plateau. Evidence for arid deserts is sparse, with the exception of the Atacama region (South America). Areas that exhibit arid desert today in the Tortonian were instead covered by shrublands, grasslands, savannas and woodlands. The extent of tropical forests in South America was likely reduced but expanded in the Indian sub-continent and East Africa. This pattern of global vegetation in the Late Miocene suggests a warmer and wetter world, which is supported by the pattern of climate anomalies predicted by our best-fit palaeoclimate-vegetation model experiment. Global mean annual temperature may have been as much as 4.5°C higher than present day with many regions experiencing higher than modern amounts of precipitation over the annual cycle. The pattern of temperature and precipitation change reconstructed palaeobotanically, and predicted within our climate model experiment, infers a global forcing agent on Tortonian climate (e.g. such as elevated concentrations of greenhouse gases) to explain the observed and modelled climate anomalies. This is in contrast to current proxy records of Tortonian atmospheric CO2 which range from Last Glacial Maximum to mid-20th Century levels. [Copyright &y& Elsevier]

The article discusses physical therapy given to people with acute low back pain (LBP). It is said that a retrospective review was undertaken by patients age 18-60 with acute LBP receiving physical therapy covered by one insurance provider. Active care associated with better clinical outcomes will reduce the use of prescription medication, magnetic resonance imaging (MRI) and injections.

The characteristics of the mid-Pliocene warm period (mPWP: 3.264-3.025 Ma BP) have been examined using geological proxies and climate models. While there is agreement between models and data, details of regional climate differ. Uncertainties in prescribed forcings and in proxy data limit the utility of the interval to understand the dynamics of a warmer than present climate or evaluate models. This uncertainty comes, in part, from the reconstruction of a time slab rather than a time slice, where forcings required by climate models can be more adequately constrained. Here, we describe the rationale and approach for identifying a time slice(s) for Pliocene environmental reconstruction. A time slice centred on 3.205 Ma BP (3.204-3.207 Ma BP) has been identified as a priority for investigation. It is a warm interval characterized by a negative benthic oxygen isotope excursion (0.21-0.23‰) centred on marine isotope stage KM5c (KM5.3). It occurred during a period of orbital forcing that was very similar to present day. Climate model simulations indicate that proxy temperature estimates are unlikely to be significantly affected by orbital forcing for at least a precession cycle centred on the time slice, with the North Atlantic potentially being an important exception. [ABSTRACT FROM AUTHOR]