Evolution of the Maximum Upper Level Divergence Field in Gulf-Atlantic Tropical Cyclogenesis

Upper-level (horizontal) divergence (ULD) is an important variable in tropical weather systems. As part of the circulation within a tropical cyclone (TC), it carries air in the upper troposphere away from the center of circulation (COC). To date, most research assumes the 200 hPa pressure level (approximately 12 km, varying with latitude and time of year) as the height for maximum ULD in a TC, possibly because weather observation at the 200 hPa level by radiosonde have remained mandatory for aviation purposes. The more recent availability of gridded, high-spatial-resolution, global “reanalysis” data at multiple levels, along with improvements in spatial interpolation techniques, has allowed for more precise and accurate determination of the heights at which peak ULD actually occurs, how that level varies temporally prior to and after tropical cyclogenesis (TCG), and how the spatial and temporal attributes of the three-dimensional zone of the maximum ULD field vary by storm. This research addresses these questions. Prediction of TCs is improving rapidly as scientific understanding of the atmospheric and oceanic conditions that characterize TCG, along with tools available for measuring the associated variables, are becoming more advanced and widespread. Results using the 2005 Atlantic tropical cyclone season suggest peak mean ULD during TCG occurs predominantly at 175 hPa and is typically located in the northeastern quadrant of the storm, hundreds of kilometers from the COC. The mean conditions showed a steady increase in magnitude of ULD from TCG ‒12 hours to TCG +6 hours and levels off or reduces at TCG +12 hours. Mean ULD is less organized on most levels before TCG and becomes more organized and concentrated between 200 hPa and 150 hPa from TCG to TCG +12 hours. Peak ULD during individual cyclogenesis occurrences varies widely in magnitude, temporally, and vertically. Therefore, each cyclone should be evaluated individually. In general, this research supports the notion that confinement of ULD analysis to a single pressure level could diminish research or model outcome as ULD location is variable in four-dimensional space. These results may be useful in weather and climate modeling as evolution of TC outflow can be better understood

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians

Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendations

Purpose Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians

Inter-annual hydroclimatic variability in coastal Tanzania

Climatic controls regulate the coupled natural and human systems in coastal Tanzania, where mangrove wetlands provide a wealth of ecosystem services to coastal communities. Previous research has explained the precipitation seasonality of eastern Africa in terms of the local monsoons. This research examines a wider range of hydroclimatic variables, including water vapour flux, evapotranspiration, runoff, and ocean salinity, and the sources of low-frequency atmosphere–ocean variability that support mangrove productivity and associated ecosystem services. Results confirm previous work suggesting that the northeast monsoon (kaskazi) largely corresponds to the “short rains” of October–December and extends through February, while the southeast monsoon (kusi) corresponds to the “long rains” of March–May and the drier June–September. The Indian Ocean Dipole (IOD) and, to a lesser extent, El Niño–Southern Oscillation (ENSO) are important modulators not only of precipitation (as has been shown previously) but also of water vapour flux, evapotranspiration, runoff, and salinity variability. During kaskazi, positive (negative) hydroclimatic anomalies occur during positive (negative) IOD, with a stronger IOD influence occurring during its positive phase, when seasonal anomalies of precipitation, evapotranspiration, and runoff exceed +50, 25, and 100%, and nearby salinity decreases by 0.5 practical salinity units. During kusi, the contrast between the positive and negative IOD modes is subtler, and the pattern is dictated more by variability in “long rains” months than in the dry months. The coincidence of the positive IOD and El Niño amplify this hydroclimatic signal. Because previous work suggests the likelihood of increased tendency for positive IOD and increased moisture variability associated with El Niño events in the future, wetter conditions may accompany the kaskazi, with less change expected during the kusi. These results advance understanding of the key environmental drivers controlling mangrove productivity and wetland spatial distribution that provide ecosystem services essential to the well-being of the human population

Biosensor-Enabled Multiplexed On-Site Therapeutic Drug Monitoring of Antibiotics

Personalized antibiotherapy ensures that the antibiotic concentration remains in the optimal therapeutic window to maximize efficacy, minimize side effects, and avoid the emergence of drug resistance due to insufficient dosing. However, such individualized schemes need frequent sampling to tailor the blood antibiotic concentrations. To optimally integrate therapeutic drug monitoring (TDM) into the clinical workflow, antibiotic levels can either be measured in blood using point-of-care testing (POCT), or can rely on noninvasive sampling. Here, a versatile biosensor with an antibody-free assay for on-site TDM is presented. The platform is evaluated with an animal study, where antibiotic concentrations are quantified in different matrices including whole blood, plasma, urine, saliva, and exhaled breath condensate (EBC). The clearance and the temporal evaluation of antibiotic levels in EBC and plasma are demonstrated. Influence of matrix effects on measured drug concentrations is determined by comparing the plasma levels with those in noninvasive samples. The system's potential for blood-based POCT is further illustrated by tracking ss-lactam concentrations in untreated blood samples. Finally, multiplexing capabilities are explored successfully for multianalyte/sample analysis. By enabling a rapid, low-cost, sample-independent, and multiplexed on-site TDM, this system can shift the paradigm of "one-size-fits-all" strategy.ISSN:0935-9648ISSN:1521-409

Collaborative research across boundaries: Mangrove ecosystem services and poverty traps as a coupled natural-human system

Mangrove wetlands are one of the most threatened ecosystems in coastal zones, and are being degraded globally at a high rate due to human activities. Impoverished and vulnerable populations living in rural coastal areas in subtropical and tropical latitudes tend to be most directly dependent on ecosystem services and hence are directly affected by the degradation of mangrove wetlands and other coastal resources. We formed an interdisciplinary and international team of researchers, students, and professionals to understand the linkages between poverty traps and mangrove ecosystem services in coastal Tanzania, thus informing and contributing to institutional efforts to resolve and avoid these traps. This chapter analyzes the nature of this coupled natural-human system, assesses the challenges to implement an interdisciplinary research agenda as a team, and underscores the practical strategies to overcome those challenges

Identification of Borrelia Species after Creation of an In-House MALDI-TOF MS Database

Lyme borreliosis (LB) is a multisystemic disease caused by Borrelia burgdorferi sensu lato (sl) complex transmitted to humans by Ixodes ticks. B. burgdorferi sl complex, currently comprising at least 19 genospecies, includes the main pathogenic species responsible for human disease in Europe: B. burgdorferi sensu stricto (ss), B. afzelii, and B. garinii. In this study, for the first time, MALDI-TOF MS was applied to Borrelia spp., supplementing the existing database, limited to the species B. burgdorferi ss, B . spielmanii and B. garinii, with the species B. afzelii, in order to enable the identification of all the species potentially implicated in LB in Europe. Moreover, we supplemented the database also with B. hermsii, which is the primary cause of tick-borne relapsing fever in western North America, B. japonica, circulating in Asia, and another reference strain of B. burgdorferi ss (B31 strain). The dendrogram obtained by analyzing the protein profiles of the different Borrelia species reflected Borrelia taxonomy, showing that all the species included in the Borrelia sl complex clustered in a unique branch, while Borrelia hermsii clustered separately. In conclusion, in this study MALDI-TOF MS proved a useful tool suitable for identification of Borrelia spp. both for diagnostic purpose and epidemiological surveillance