Climate model response from the Geoengineering Model Intercomparison Project (GeoMIP)

Solar geoengineering - deliberate reduction in the amount of solar radiation retained by the Earth - has been proposed as a means of counteracting some of the climatic effects of anthropogenic greenhouse gas emissions. We present results from Experiment G1 of the Geoengineering Model Intercomparison Project, in which 12 climate models have simulated the climate response to an abrupt quadrupling of CO2 from preindustrial concentrations brought into radiative balance via a globally uniform reduction in insolation. Models show this reduction largely offsets global mean surface temperature increases due to quadrupled CO2 concentrations and prevents 97% of the Arctic sea ice loss that would otherwise occur under high CO2 levels but, compared to the preindustrial climate, leaves the tropics cooler (-0.3 K) and the poles warmer (+0.8 K). Annual mean precipitation minus evaporation anomalies for G1 are less than 0.2 mm day-1 in magnitude over 92% of the globe, but some tropical regions receive less precipitation, in part due to increased moist static stability and suppression of convection. Global average net primary productivity increases by 120% in G1 over simulated preindustrial levels, primarily from CO2 fertilization, but also in part due to reduced plant heat stress compared to a high CO2 world with no geoengineering. All models show that uniform solar geoengineering in G1 cannot simultaneously return regional and global temperature and hydrologic cycle intensity to preindustrial levels. Key Points Temperature reduction from uniform geoengineering is not uniform Geoengineering cannot offset both temperature and hydrology changes NPP increases mostly due to CO2 fertilization ©2013. American Geophysical Union. All Rights Reserved.BK is supported by the Fund for Innovative Climate and Energy Research. Simulations performed by BK were supported by the NASA High-End Computing (HEC) Program through the NASA Center for Climate Simulation (NCCS) at Goddard Space Flight Center. The Pacific Northwest National Laboratory is operated for the U.S. Department of Energy by Battelle Memorial Institute under contract DE-AC05-76RL01830. AR is supported by US National Science Foundation grant AGS-1157525. JMH and AJ were supported by the joint DECC/Defra Met Office Hadley Centre Climate Programme (GA01101). KA, DBK, JEK, UN, HS, and MS received funding from the European Union’s Seventh Framework Programme (FP7/ 2007–2013) under grant agreement 226567-IMPLICC. KA and JEK received support from the Norwegian Research Council’s Programme for Supercomputing (NOTUR) through a grant of computing time. Simulations with the IPSL-CM5 model were supported through HPC resources of [CCT/ TGCC/CINES/IDRIS] under the allocation 2012-t2012012201 made by GENCI (Grand Equipement National de Calcul Intensif). DJ and JCM thank all members of the BNU-ESM model group, as well as the Center of Information and Network Technology at Beijing Normal University for assistance in publishing the GeoMIP data set. The National Center for Atmospheric Research is funded by the National Science Foundation. SW was supported by the Innovative Program of Climate Change Projection for the 21st century, MEXT, Japan. Computer resources for PJR, BS, and JHY were provided by the National Energy Research Scientific Computing Center, which is supported by the Office of Science of the U.S. Department of Energy under contract DE-AC02-05CH11231

Estimation of airway obstruction using oximeter plethysmograph waveform data

BACKGROUND: Validated measures to assess the severity of airway obstruction in patients with obstructive airway disease are limited. Changes in the pulse oximeter plethysmograph waveform represent fluctuations in arterial flow. Analysis of these fluctuations might be useful clinically if they represent physiologic perturbations resulting from airway obstruction. We tested the hypothesis that the severity of airway obstruction could be estimated using plethysmograph waveform data. METHODS: Using a closed airway circuit with adjustable inspiratory and expiratory pressure relief valves, airway obstruction was induced in a prospective convenience sample of 31 healthy adult subjects. Maximal change in airway pressure at the mouthpiece was used as a surrogate measure of the degree of obstruction applied. Plethysmograph waveform data and mouthpiece airway pressure were acquired for 60 seconds at increasing levels of inspiratory and expiratory obstruction. At each level of applied obstruction, mean values for maximal change in waveform area under the curve and height as well as maximal change in mouth pressure were calculated for sequential 7.5 second intervals. Correlations of these waveform variables with mouth pressure values were then performed to determine if the magnitude of changes in these variables indicates the severity of airway obstruction. RESULTS: There were significant relationships between maximal change in area under the curve (P < .0001) or height (P < 0.0001) and mouth pressure. CONCLUSION: The findings suggest that mathematic interpretation of plethysmograph waveform data may estimate the severity of airway obstruction and be of clinical utility in objective assessment of patients with obstructive airway diseases

Sensitivity of IFN-γ Release Assay to Detect Latent Tuberculosis Infection Is Retained in HIV-Infected Patients but Dependent on HIV/AIDS Progression

BACKGROUND: Detection and treatment of latent TB infection (LTBI) in HIV infected individuals is strongly recommended to decrease morbidity and mortality in countries with high levels of HIV. OBJECTIVE: To assess the validity of a newly developed in-house ELISPOT interferon-gamma release assay (IGRA) for the detection of LTBI amongst HIV infected individuals, in comparison with the Tuberculin Skin Test (TST). METHODOLOGY/PRINCIPAL FINDINGS: ESAT6/CFP10 (EC) ELISPOT assays were performed, together with a TST, in 285 HIV infected individuals recruited in HIV clinics in Dakar, Senegal, who had no signs of active TB at time of enrolment. Thirty eight of the subjects (13.3%) failed to respond to PHA stimulation and were excluded from the analysis. In the 247 remaining patients, response to PHA did not vary according to CD4 cell count categories (p = 0.51). EC ELISPOT was positive in 125 (50.6%) subjects, while 53 (21.5%) had a positive TST. Concordance between EC ELISPOT and TST was observed in 151 patients (61.1%) (kappa = 0.23). The proportion of subjects with a positive response to the EC ELISPOT assay decreased with declining CD4 counts (p trend = 0.001), but were consistently higher than the proportion of TST responders. In multivariate analysis, the risk of being EC-ELISPOT positive in HIV infected individuals was associated with age, CD4 count and HIV-1 strain. CONCLUSION: Our study indicates that IGRAs using M. tuberculosis specific antigens are likely to retain their validity for the diagnosis of LTBI among HIV positive individuals, but may be impaired by T-cell anergy in severely immuno-suppressed individuals

Cross-National Analysis of the Associations among Mental Disorders and Suicidal Behavior: Findings from the WHO World Mental Health Surveys

Using data from over 100,000 individuals in 21 countries participating in the WHO World Mental Health Surveys, Matthew Nock and colleagues investigate which mental health disorders increase the odds of experiencing suicidal thoughts and actual suicide attempts, and how these relationships differ across developed and developing countries

Progression of duodenal adenomatosis in familial adenomatous polyposis: due to ageing of subjects and advances in technology

Familial adenomatous polyposis patients are at risk of duodenal cancer. Surveillance is indicated and the extent of duodenal polyposis is quantified by the Spigelman staging system. We noticed an impressive increase in high Spigelman stages over the years and therefore decided to investigate whether this increase might be due to the time-lapse since the inception of surveillance or related to improvements in endoscopic imaging and/or changes in dysplasia-reporting. Patients who were investigated by the same endoscopist since 1980 in at least 2 different episodes of technical improvements were eligible. The period 1980–2009 was divided into 4 episodes using the following landmarks: replacement of fibre-endoscopes by video-endoscopes in 1987, change in processors in 1995, change in image resolution in 2000, and change in dysplasia-reporting in 2006. An increase in Spigelman stages from low stages (0–II 100%) to high stages (III 28.1%, IV 43.8%) was seen (median follow-up: 19.5 years). In patients who progressed, a median of 4 years elapsed before progression by one stage occurred and 7 years to progress by two stages. In a mixed-model analysis, both time-lapse and technical improvements were determinant factors for duodenal disease progression. When both factors were introduced in the model, the time-lapse as well as the change in image resolution and dysplasia-ranking contributed consistently in increasing Spigelman scores and stages. The impressive increase in severity of duodenal polyposis is determined by time-lapse, technological advances and change in dysplasia-reporting. These results might call for a revised Spigelman classification

Alcohol consumption in tertiary education students

Background Heavy alcohol consumption among adolescents and young adults is an issue of significant public concern. With approximately 50% of young people aged 18-24 attending tertiary education, there is an opportunity within these settings to implement programs that target risky drinking. The aim of the current study was to survey students and staff within a tertiary education institution to investigate patterns of alcohol use, alcohol-related problems, knowledge of current National Health and Medical Research Council (NHMRC) guidelines for alcohol consumption and intentions to seek help for alcohol problems. Methods Students of an Australian metropolitan university (with staff as a comparison group) participated in a telephone interview. Questions related to knowledge of NHMRC guidelines, drinking behaviour, alcohol-related problems and help-seeking intentions for alcohol problems. Level of psychological distress was also assessed. Results Of the completed interviews, 774 (65%) were students and 422 (35%) were staff. While staff were more likely to drink regularly, students were more likely to drink heavily. Alcohol consumption was significantly higher in students, in males and in those with a history of earlier onset drinking. In most cases, alcohol-related problems were more likely to occur in students. The majority of students and staff had accurate knowledge of the current NHMRC guidelines, but this was not associated with lower levels of risky drinking. Psychological distress was associated with patterns of risky drinking in students. Conclusions Our findings are consistent with previous studies of tertiary student populations, and highlight the disconnect between knowledge of relevant guidelines and actual behaviour. There is a clear need for interventions within tertiary education institutions that promote more effective means of coping with psychological distress and improve help-seeking for alcohol problems, particularly among young men

A web-based Alcohol Clinical Training (ACT) curriculum: Is in-person faculty development necessary to affect teaching?

<p>Abstract</p> <p>Background</p> <p>Physicians receive little education about unhealthy alcohol use and as a result patients often do not receive efficacious interventions. The objective of this study is to evaluate whether a free web-based alcohol curriculum would be used by physician educators and whether in-person faculty development would increase its use, confidence in teaching and teaching itself.</p> <p>Methods</p> <p>Subjects were physician educators who applied to attend a workshop on the use of a web-based curriculum about alcohol screening and brief intervention and cross-cultural efficacy. All physicians were provided the curriculum web address. Intervention subjects attended a 3-hour workshop including demonstration of the website, modeling of teaching, and development of a plan for using the curriculum. All subjects completed a survey prior to and 3 months after the workshop.</p> <p>Results</p> <p>Of 20 intervention and 13 control subjects, 19 (95%) and 10 (77%), respectively, completed follow-up. Compared to controls, intervention subjects had greater increases in confidence in teaching alcohol screening, and in the frequency of two teaching practices – teaching about screening and eliciting patient health beliefs. Teaching confidence and teaching practices improved significantly in 9 of 10 comparisons for intervention, and in 0 comparisons for control subjects. At follow-up 79% of intervention but only 50% of control subjects reported using any part of the curriculum (p = 0.20).</p> <p>Conclusion</p> <p>In-person training for physician educators on the use of a web-based alcohol curriculum can increase teaching confidence and practices. Although the web is frequently used for disemination, in-person training may be preferable to effect widespread teaching of clinical skills like alcohol screening and brief intervention.</p

Cross-national epidemiology of DSM-IV major depressive episode

Background: Major depression is one of the leading causes of disability worldwide, yet epidemiologic data are not available for many countries, particularly low- to middle-income countries. In this paper, we present data on the prevalence, impairment and demographic correlates of depression from 18 high and low-to middle-income countries in the World Mental Health Survey Initiative. Methods: Major depressive episodes (MDE) as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DMS-IV) were evaluated in face-to-face interviews using the World Health Organization Composite International Diagnostic Interview (CIDI). Data from 18 countries were analyzed in this report (n = 89,037). All countries surveyed representative, population-based samples of adults. Results: The average lifetime and 12-month prevalence estimates of DSM-IV MDE were 14.6% and 5.5% in the ten high-income and 11.1% and 5.9% in the eight low- to middle-income countries. The average age of onset ascertained retrospectively was 25.7 in the high-income and 24.0 in low- to middle-income countries. Functional impairment was associated with recency of MDE. The female: male ratio was about 2: 1. In high-income countries, younger age was associated with higher 12-month prevalence; by contrast, in several low-to middle-income countries, older age was associated with greater likelihood of MDE. The strongest demographic correlate in high-income countries was being separated from a partner, and in low- to middle-income countries, was being divorced or widowed. Conclusions: MDE is a significant public-health concern across all regions of the world and is strongly linked to social conditions. Future research is needed to investigate the combination of demographic risk factors that are most strongly associated with MDE in the specific countries included in the WMH.(NIH/NIMH) United States National Institute of Mental Health[R01MH070884]John D. and Catherine T. MacArthur FoundationPfizer FoundationUSA Public Health Service[R13-MH066849]USA Public Health Service[R01-MH069864]USA Public Health Service[R01 DA016558](NIH) Fogarty International Center[FIRCA R03-TW006481]PAHO Pan American Health OrganizationEli Lilly & Company FoundationOrtho-McNeil Pharmaceutical, Inc.GlaxoSmithKlineSanofi-AventisBristol-Myers SquibbState of Brazil Research Foundation (FAPESP)[03/00204-3]Ministry of Social ProtectionEuropean Commission[QLG5-1999-01042]European Commission[SANCO 2004123]Piedmont Region (Italy)Fondo de Investigacion Sanitaria, Instituto de Salud Carlos III, Spain[FIS 00/0028]Spanish Ministerio de Ciencia y Tecnologia[SAF 2000-158-CE]Departament de Salut, Generalitat de Catalunya, SpainInstituto de Salud Carlos III[CIBER CB06/02/0046]Instituto de Salud Carlos III[RETICS RD06/0011 REM-TAP]Government of IndiaWHOMinistry of HealthIsrael National Institute for Health Policy and Health Services ResearchNational Insurance Institute of IsraelJapan Ministry of Health, Labour and Welfare[H13-Shogai-023]Japan Ministry of Health, Labour and Welfare[H14-Tokubetsu-026]Japan Ministry of Health, Labour and Welfare[H16-Kokoro-013]Lebanese Ministry of Public HealthWHO (Lebanon)(NIH) Fogarty International, anonymous private donations to IDRAAC, LebanonJanssen CilagEli LillyRocheNovartisNational Institute of Psychiatry Ramon de la Fuente[INPRFMDIES 4280]CNPq National Council on Science and Technology[CONACyT-G30544-H]PanAmerican Health Organization (PAHO)New Zealand Ministry of Health, Alcohol Advisory CouncilHealth Research Council(NIH/NIMH) USA National Institute of Mental Health[R01-MH059575](NIH/NIMH) USA National Institute of Mental Health[RO1-MH61905]National Institute of Drug AbuseSouth African Department of HealthUniversity of MichiganNational Institute of Mental Health (NIH/NIMH)[U01-MH60220]National Institute of Drug Abuse (NIDA)Substance Abuse and Mental Health Services Administration (SAMHSA)Robert Wood Johnson Foundation (RWJF)[044708]John W. Alden TrustsAnalysis Group Inc.Eli Lilly CompanyEPI-QJohnson & Johnson PharmaceuticalsOrtho-McNeil Janssen Scientific AffairsPfizer Inc.Shire USA, Inc