Incidence and Cost of Ankle Sprains in United States Emergency Departments

Ankle sprains represent a common injury in emergency departments, but little is known about common complications, procedures, and charges associated with ankle sprains in emergency departments

Response to: "Renal biopsies should be performed whenever treatment strategies depend on renal involvement"

We thank Chemouny et al for their letter and concur with their conclusions. As we state (1): “A positive biopsy for AAV is helpful when considering an initial diagnosis or recurrent disease.” In our view, renal biopsy is important to establish diagnosis and may also provide an indication of prognostic trajectory and although existing classification systems need further validation, changes like glomerular sclerosis have obvious adverse prognostic value for patients with AAV (2-4). The Delphi process, for the scope of the current recommendations, identified the role of biopsy at both diagnosis and follow-up as an important item for update. Histopathological evidence of vasculitis, such as pauci-immune glomerulonephritis or necrotising vasculitis in any organ, remains the gold standard for diagnostic purposes. The likely diagnostic yield varies and is dependent on the organ targeted and in patients with GPA with renal involvement can be as high as 91.5% from renal biopsy (5). As Chemouny and colleagues have demonstrated, a renal biopsy was definitive in determining their management decisions. However during follow-up when relapses occur, it may be prudent to consider judicious use of further kidney biopsy during suspected renal relapse since the cause for acute kidney injury may be due to another cause other than AAV (6). Kind regards, M Yates, C Mukhtyar and DR Jayne on behalf of co-authors

The pattern of northern hemisphere surface air temperature during prolonged periods of low solar output

We show that the reconstructed sensitivity of the sea level temperature to long term solar forcing in the Northern Hemisphere is in very good agreement with the empirical temperature pattern corresponding to changes of the North Annular Mode (NAM). This implies that long-term variations of solar output affect climate predominantly through the NAM that extends throughout the stratosphere and troposphere

Ultrathin Tropical Tropopause Clouds (UTTCs) : I. Cloud morphology and occurrence

Subvisible cirrus clouds (SVCs) may contribute to dehydration close to the tropical tropopause. The higher and colder SVCs and the larger their ice crystals, the more likely they represent the last efficient point of contact of the gas phase with the ice phase and, hence, the last dehydrating step, before the air enters the stratosphere. The first simultaneous in situ and remote sensing measurements of SVCs were taken during the APE-THESEO campaign in the western Indian ocean in February/March 1999. The observed clouds, termed Ultrathin Tropical Tropopause Clouds (UTTCs), belong to the geometrically and optically thinnest large-scale clouds in the Earth´s atmosphere. Individual UTTCs may exist for many hours as an only 200--300 m thick cloud layer just a few hundred meters below the tropical cold point tropopause, covering up to 105 km2. With temperatures as low as 181 K these clouds are prime representatives for defining the water mixing ratio of air entering the lower stratosphere

Arctic system on trajectory to new state

The Arctic system is moving toward a new state that falls outside the envelope of glacial-interglacial fluctuations that prevailed during recent Earth history. This future Arctic is likely to have dramatically less permanent ice than exists at present. At the present rate of change, a summer ice-free Arctic Ocean within a century is a real possibility, a state not witnessed for at least a million years. The change appears to be driven largely by feedback-enhanced global climate warming, and there seem to be few, if any processes or feedbacks within the Arctic system that are capable of altering the trajectory toward this “super interglacial” state

A mathematical framework for analysis of water tracers: Part 1: Development of theory and application to the preindustrial mean state

A new matrix operator framework is developed to analyze results from climate modeling studies that employ numerical water tracers (WTs), which track the movement of water in the aerial hydrological cycle from evaporation to precipitation. Model WT output is related to the fundamental equation of hydrology, and the moisture flux divergence is subdivided into the divergence of locally evaporated moisture and the convergence of remotely evaporated moisture. The formulation also separates locally and remotely sourced precipitation. The remote contribution (also the remote moisture convergence) may be further subdivided into zonal, meridional, intrabasin, and interbasin parts. This framework is applied to the preindustrial climate as simulated by a global climate model in which water has been tagged in 10° latitude bands in each of the major ocean basins, and in which each major land mass has been tagged separately. New insights from the method reveal fundamental differences between the major ocean basins in locally sourced precipitation, remotely sourced precipitation, and their relative partitioning. Per unit area, the subtropical Atlantic is the largest global moisture source, providing precipitable water to adjacent land areas and to the eastern Pacific tropics while retaining the least for in situ precipitation. Subtropical moisture is least divergent over the Pacific, which is the smallest moisture source (per unit area) for global land areas. Basins also differ in how subtropical moisture is partitioned between tropical, midlatitude, and land regions. Part II will apply this framework to hydrological cycle perturbations due to CO₂ doubling.Keywords: linear algebra, numerical water tracers, hydrologic cycle, big data analysis, matrix operatorKeywords: linear algebra, numerical water tracers, hydrologic cycle, big data analysis, matrix operato

Ecosystem fluxes of carbonyl sulfide in an old-growth forest: temporal dynamics and responses to diffuse radiation and heat waves

Carbonyl sulfide (OCS) has recently emerged as a tracer for terrestrial carbon uptake. While physiological studies relating OCS fluxes to leaf stomatal dynamics have been established at leaf and branch scales and incorporated into global carbon cycle models, the quantity of data from ecosystem-scale field studies remains limited. In this study, we employ established theoretical relationships to infer ecosystem-scale plant OCS uptake from mixing ratio measurements. OCS fluxes showed a pronounced diurnal cycle, with maximum uptake at midday. OCS uptake was found to scale with independent measurements of CO2 fluxes over a 60&thinsp;m tall old-growth forest in the Pacific Northwest of the US (45∘49′13.76′′&thinsp;N, 121∘57′06.88′′&thinsp;W) at daily and monthly timescales under mid–high light conditions across the growing season in 2015. OCS fluxes were strongly influenced by the fraction of downwelling diffuse light. Finally, we examine the effect of sequential heat waves on fluxes of OCS, CO2, and H2O. Our results bolster previous evidence that ecosystem OCS uptake is strongly related to stomatal dynamics, and measuring this gas improves constraints on estimating photosynthetic rates at the ecosystem scale.</p

Mediation in the Law Curriculum

Cited by Lord Neuberger in ‘Educating Future Mediators’ at the 4th Civil Mediation Council National Conference, May 201