Synchronous Deglacial Overturning and Water Mass Source Changes

Understanding changes in ocean circulation during the last deglaciation is crucial to unraveling the dynamics of glacial-interglacial and millennial climate shifts. We used neodymium isotope measurements on postdepositional iron-manganese oxide coatings precipitated on planktonic foraminifera to reconstruct changes in the bottom water source of the deep western North Atlantic at the Bermuda Rise. Comparison of our deep water source record with overturning strength proxies shows that both the deep water mass source and the overturning rate shifted rapidly and synchronously during the last deglacial transition. In contrast, any freshwater perturbation caused by Heinrich event 1 could have only affected shallow overturning. These findings show how changes in upper-ocean overturning associated with millennial-scale events differ from those associated with whole-ocean deglacial climate events

Imager Evaluation of Diabetic Retinopathy at the Time of Imaging in a Telemedicine Program

Objective: To evaluate the ability of certified retinal imagers to identify presence versus absence of sight-threatening diabetic retinopathy (stDR) (moderate nonproliferative diabetic retinopathy or worse or diabetic macular edema) at the time of retinal imaging in a telemedicine program. Research Design and Methods: Diabetic patients in a primary care setting or specialty diabetes clinic received Joslin Vision Network protocol retinal imaging as part of their care. Trained nonphysician imagers graded the presence versus absence of stDR at the time of imaging. These gradings were compared with masked gradings of certified readers. Results: Of 158 patients (316 eyes) imaged, all cases of stDR (42 eyes [13%]) were identified by the imagers at the time of imaging. Six eyes with mild nonproliferative diabetic retinopathy were graded by the imagers to have stDR (sensitivity 1.00, 95% CI 0.90–1.00; specificity 0.97, 0.94–0.99). Conclusions: Appropriately trained imagers can accurately identify stDR at the time of imaging

High-resolution broadband spectroscopy using externally dispersed interferometry at the Hale telescope: Part 1, data analysis and results

High-resolution broadband spectroscopy at near-infrared wavelengths (950 to 2450 nm) has been performed using externally dispersed interferometry (EDI) at the Hale telescope at Mt. Palomar. Observations of stars were performed with the “TEDI” interferometer mounted within the central hole of the 200-in. primary mirror in series with the comounted TripleSpec near-infrared echelle spectrograph. These are the first multidelay EDI demonstrations on starlight, as earlier measurements used a single delay or laboratory sources. We demonstrate very high (10×) resolution boost, from original 2700 to 27,000 with current set of delays (up to 3 cm), well beyond the classical limits enforced by the slit width and detector pixel Nyquist limit. Significantly, the EDI used with multiple delays rather than a single delay as used previously yields an order of magnitude or more improvement in the stability against native spectrograph point spread function (PSF) drifts along the dispersion direction. We observe a dramatic (20×) reduction in sensitivity to PSF shift using our standard processing. A recently realized method of further reducing the PSF shift sensitivity to zero is described theoretically and demonstrated in a simple simulation which produces a 350× times reduction. We demonstrate superb rejection of fixed pattern noise due to bad detector pixels—EDI only responds to changes in pixel intensity synchronous to applied dithering. This part 1 describes data analysis, results, and instrument noise. A section on theoretical photon limited sensitivity is in a companion paper, part 2

Optimization of Drug Prescription and Medication Management in Older Adults with Cardiovascular Disease

Cardiovascular disease increases incrementally with age and elderly patients concomitantly sustain multimorbidities, with resultant prescription of multiple medications. Despite conforming with disease-specific cardiovascular clinical practice guidelines, this polypharmacy predisposes many elderly individuals with cardiovascular disease to adverse drug events and non-adherence. Patient-centered care requires that the clinician explore with each patient his or her goals of care and that this shared decision-making constitutes the basis for optimization of medication management. This approach to aligning therapies with patient preferences is likely to promote patient satisfaction, to limit morbidity, and to favorably affect healthcare costs

The deglacial history of 79N glacier and the Northeast Greenland Ice Stream

Acknowledgements This work was funded by NERC Standard Grant NE/N011228/1. We thank the Alfred Wegner Institute, and particularly Hicham Rafiq and Daniel Steinhage, for their significant logistic support through the iGRIFF project. Additional support was provided from Station Nord (Jørgen Skafte), Nordland Air, Air Greenland, the Joint Arctic Command and the Department of Geography, Durham University. Naalakkersuisut, Government of Greenland, provided Scientific Survey (VU-00121) and Export (046/2017) licences for this work. We would also like to thank our Field Ranger Isak (Nanu-Travel) and dog Ooni for keeping us safe in the field. TCN Sample preparation was carried out at the National Environmental Isotope Facility, Scottish Universities Environmental Research Centre under grant allocation 9185.0814. Chris Orton in the Cartographic Unit, Geography, Durham University edited several figures. This paper is dedicated to Mr Arnold Jones – a true Quaternarist.Peer reviewe

United States contributions to the Second International Indian Ocean Expedition (US IIOE-2)

From the Preface: The purpose of this document is to motivate and coordinate U.S. participation in the Second International Indian Ocean Expedition (IIOE-2) by outlining a core set of research priorities that will accelerate our understanding of geologic, oceanic, and atmospheric processes and their interactions in the Indian Ocean. These research priorities have been developed by the U.S. IIOE-2 Steering Committee based on the outcomes of an interdisciplinary Indian Ocean science workshop held at the Scripps Institution of Oceanography on September 11-13, 2017. The workshop was attended by 70 scientists with expertise spanning climate, atmospheric sciences, and multiple sub-disciplines of oceanography. Workshop participants were largely drawn from U.S. academic institutions and government agencies, with a few experts invited from India, China, and France to provide a broader perspective on international programs and activities and opportunities for collaboration. These research priorities also build upon the previously developed International IIOE-2 Science Plan and Implementation Strategy. Outcomes from the workshop are condensed into five scientific themes: Upwelling, inter-ocean exchanges, monsoon dynamics, inter-basin contrasts, marine geology and the deep ocean. Each theme is identified with priority questions that the U.S. research community would like to address and the measurements that need to be made in the Indian Ocean to address them.We thank the following organizations and programs for financial contributions, support and endorsement: the U.S. National Oceanic and Atmospheric Administration; the U.S. Ocean Carbon and Biogeochemistry program funded by the National Science Foundation and the National Aeronautics and Space Administration; the NASA Physical Oceanography Program; Scripps Institution of Oceanography; and the Indo-US Science and Technology Forum

The deglacial history of 79N glacier and the Northeast Greenland Ice Stream

The Northeast Greenland Ice Stream (NEGIS) is the main artery for ice discharge from the northeast sector of the Greenland Ice Sheet (GrIS) to the North Atlantic. Understanding the past, present and future stability of the NEGIS with respect to atmospheric and oceanic forcing is of global importance as it drains around 17% of the GrIS and has a sea-level equivalent of 1.6 m. This paper reconstructs the deglacial and Holocene history of Nioghalvfjerdsbræ (or 79N Glacier); a major outlet of the NEGIS. At high elevation (>900 m asl) autochthonous blockfield, a lack of glacially moulded bedrock and pre LGM exposure ages point to a complex exposure/burial history extending back over half a million years. However, post Marine Isotope Stage 12, enhanced glacial erosion led to fjord incision and plateaux abandonment. Between 900 and 600 m asl the terrain is largely unmodified by glacial scour but post LGM erratics indicate the advection of cold-based ice through the fjord. In contrast, below ∼600 m asl Nioghalvfjerdsfjorden exhibits a geomorphological signal indicative of a warm-based ice stream operating during the last glacial cycle. Dated ice marginal landforms and terrain along the fjord walls show initial thinning rates were slow between ∼23 and 10 ka, but post-10 ka it is evident that Nioghalvfjerdsfjorden deglaciated extremely quickly with complete fjord deglaciation below ∼500 m asl between 10.0 and 8.5 ka. Both increasing air and ocean temperatures were pivotal in driving surface lowering and submarine melt during deglaciation, but the final withdrawal of ice through Nioghalvfjerdsfjorden was facilitated by the action of marine ice sheet instability. Our estimates show that thinning and retreat rates reached a maximum of 5.29 ma−1 and 613 ma−1, respectively, as the ice margin withdrew westwards. This would place the Early Holocene disintegration of this outlet of the NEGIS at the upper bounds of contemporary thinning and retreat rates seen both in Greenland and Antarctica. Combined with recent evidence of ice stream shutdown during the Holocene, as well as predictions of changing ice flow dynamics within downstream sections of the NEGIS catchment, this suggests that significant re-organisation of the terminal zone of the ice stream is imminent over the next century

Expanding research to provide an evidence base for nutritional interventions for the management of inborn errors of metabolism

A trans-National Institutes of Health initiative, Nutrition and Dietary Supplement Interventions for Inborn Errors of Metabolism (NDSI-IEM), was launched in 2010 to identify gaps in knowledge regarding the safety and utility of nutritional interventions for the management of inborn errors of metabolism (IEM) that need to be filled with evidence-based research. IEM include inherited biochemical disorders in which specific enzyme defects interfere with the normal metabolism of exogenous (dietary) or endogenous protein, carbohydrate, or fat. For some of these IEM, effective management depends primarily on nutritional interventions. Further research is needed to demonstrate the impact of nutritional interventions on individual health outcomes and on the psychosocial issues identified by patients and their families. A series of meetings and discussions were convened to explore the current United States’ funding and regulatory infrastructure and the challenges to the conduct of research for nutritional interventions for the management of IEM. Although the research and regulatory infrastructure are well-established, a collaborative pathway that includes the professional and advocacy rare disease community and federal regulatory and research agencies will be needed to overcome current barriers

Detector for advanced neutron capture experiments at LANSCE

The Detector for Advanced Neutron Capture Experiments (DANCE) is a 159-element 4x barium fluoride array designed to study neutron capture on small quantities, 1 mg or less, of radioactive nuclides. It is being built on a 20 m neutron flight path which views the 'upper tier' water moderator at the Manuel J. Lujan Jr. Neutron Scattering Center at the Los Alamos Neutron Science Center. The detector design is based on Monte Carlo calculations which have suggested ways to minimize backgrounds due to neutron scattering events. A data acquisition system based on fast transient digitizers is bcing implemente

Association of Radiotherapy Duration With Clinical Outcomes in Patients With Esophageal Cancer Treated in NRG Oncology Trials: A Secondary Analysis of NRG Oncology Randomized Clinical Trials

IMPORTANCE: For many types of epithelial malignant neoplasms that are treated with definitive radiotherapy (RT), treatment prolongation and interruptions have an adverse effect on outcomes. OBJECTIVE: To analyze the association between RT duration and outcomes in patients with esophageal cancer who were treated with definitive chemoradiotherapy (CRT). DESIGN, SETTING, AND PARTICIPANTS: This study was an unplanned, post hoc secondary analysis of 3 prospective, multi-institutional phase 3 randomized clinical trials (Radiation Therapy Oncology Group [RTOG] 8501, RTOG 9405, and RTOG 0436) of the National Cancer Institute-sponsored NRG Oncology (formerly the National Surgical Adjuvant Breast and Bowel Project, RTOG, and Gynecologic Oncology Group). Enrolled patients with nonmetastatic esophageal cancer underwent definitive CRT in the trials between 1986 and 2013, with follow-up occurring through 2014. Data analyses were conducted between March 2022 to February 2023. EXPOSURES: Treatment groups in the trials used standard-dose RT (50 Gy) and concurrent chemotherapy. MAIN OUTCOMES AND MEASURES: The outcomes were local-regional failure (LRF), distant failure, disease-free survival (DFS), and overall survival (OS). Multivariable models were used to examine the associations between these outcomes and both RT duration and interruptions. Radiotherapy duration was analyzed as a dichotomized variable using an X-Tile software to choose a cut point and its median value as a cut point, as well as a continuous variable. RESULTS: The analysis included 509 patients (median [IQR] age, 64 [57-70] years; 418 males [82%]; and 376 White individuals [74%]). The median (IQR) follow-up was 4.01 (2.93-4.92) years for surviving patients. The median cut point of RT duration was 39 days or less in 271 patients (53%) vs more than 39 days in 238 patients (47%), and the X-Tile software cut point was 45 days or less in 446 patients (88%) vs more than 45 days in 63 patients (12%). Radiotherapy interruptions occurred in 207 patients (41%). Female (vs male) sex and other (vs White) race and ethnicity were associated with longer RT duration and RT interruptions. In the multivariable models, RT duration longer than 45 days was associated with inferior DFS (hazard ratio [HR], 1.34; 95% CI, 1.01-1.77; P = .04). The HR for OS was 1.33, but the results were not statistically significant (95% CI, 0.99-1.77; P = .05). Radiotherapy duration longer than 39 days (vs ≤39 days) was associated with a higher risk of LRF (HR, 1.32; 95% CI, 1.06-1.65; P = .01). As a continuous variable, RT duration (per 1 week increase) was associated with DFS failure (HR, 1.14; 95% CI, 1.01-1.28; P = .03). The HR for LRF 1.13, but the result was not statistically significant (95% CI, 0.99-1.28; P = .07). CONCLUSIONS AND RELEVANCE: Results of this study indicated that in patients with esophageal cancer receiving definitive CRT, prolonged RT duration was associated with inferior outcomes; female patients and those with other (vs White) race and ethnicity were more likely to have longer RT duration and experience RT interruptions. Radiotherapy interruptions should be minimized to optimize outcomes