The Twannberg iron meteorite strewn field in the Swiss Jura mountains: insights for Quaternary environmental conditions

The ~ 10 km 2 strewn field of the Twannberg type IIG iron meteorite is located in the Swiss Jura Mountains, 30 km northwest of Bern. The strewn field has been mapped by a group of citizen scientists since 2006, yielding more than 2000 meteorite fragments with a total mass of 152.7 kg until the end of 2022. With a terrestrial age of 176 ± 19 ka and a minimum pre-atmospheric mass of ~ 250 t, the Twannberg meteorite is a local time marker in an area with a poorly-known paleoenvironmental history. The Twannberg strewn field is located just outside of the maximum extent of ice during the Last Glacial Maximum (LGM). On the Mont Sujet, meteorites are size-sorted in a 6-km long section of the primary strewn field (altitude 945-1370 m a.s.l.), indicating a fall direction from east-northeast to west-southwest (azimuth approximately 250°). On the Twannberg plateau and in the Twannbach gorge, meteorites are not size-sorted and occur in a ~ 5.7-km long area associated with till and recent stream sediments (altitude 430-1075 m a.s.l.). The mass distribution of meteorites on the Twannberg plateau demonstrate that these meteorites were not found where they fell but that they must have been transported up to several km by glacier ice flow after the fall. The distribution of meteorites and of glacially transported Alpine clasts on the Mont Sujet and on the Chasseral chain indicates the presence of local ice caps and of an approximately 200-m higher Alpine ice surface with respect to the LGM at the time of fall. This high ice level during MIS 6 (Marine Isotopic Stage 6, 191-130 ka) indicated by the meteorite distribution is consistent with surface exposure ages of 50-144 ka from nearby resting erratic boulders at altitudes of up to 1290 m a.s.l., including the newly dated Jobert boulder (63 ka). These boulders indicate an ice level ~ 400 m higher than during LGM at a time not later than MIS 6. Post-LGM luminescence ages of loesscontaining meteorites on the Mont Sujet and 14 C ages of materials associated with meteorite finds indicate relatively young pedoturbation and increased oxidation of meteorites since ~ 7300 cal BP, possibly correlated with deforestation and enhanced erosion resulting from increased human activities since the Neolithic. This study shows that Twannberg meteorites in their palaeoenvironmental context provide valuable information about ice levels and transport directions during MIS 6 and about their interaction with the post-LGM environmental conditions. The unique Twannberg strewn field has the potential to reveal more valuable information

Clinical and molecular evaluation of MEFV gene variants in the Turkish population: a study by the National Genetics Consortium

Familial Mediterranean fever (FMF) is a monogenic autoinflammatory disorder with recurrent fever, abdominal pain, serositis, articular manifestations, erysipelas-like erythema, and renal complications as its main features. Caused by the mutations in the MEditerranean FeVer (MEFV) gene, it mainly affects people of Mediterranean descent with a higher incidence in the Turkish, Jewish, Arabic, and Armenian populations. As our understanding of FMF improves, it becomes clearer that we are facing with a more complex picture of FMF with respect to its pathogenesis, penetrance, variant type (gain-of-function vs. loss-of-function), and inheritance. In this study, MEFV gene analysis results and clinical findings of 27,504 patients from 35 universities and institutions in Turkey and Northern Cyprus are combined in an effort to provide a better insight into the genotype-phenotype correlation and how a specific variant contributes to certain clinical findings in FMF patients. Our results may help better understand this complex disease and how the genotype may sometimes contribute to phenotype. Unlike many studies in the literature, our study investigated a broader symptomatic spectrum and the relationship between the genotype and phenotype data. In this sense, we aimed to guide all clinicians and academicians who work in this field to better establish a comprehensive data set for the patients. One of the biggest messages of our study is that lack of uniformity in some clinical and demographic data of participants may become an obstacle in approaching FMF patients and understanding this complex disease

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)