Temporally variable recurrence regimes of mega-tsunamis in the 6500 years prior to the 2004 Indian Ocean event

The analyses of cores retrieved from three sites near Port Blair (South Andaman) revealed out-of-sequence deposits at various depths. They are identified as previous episodes of tsunami by their sediment characteristics and microfossil content, using the 2004 event deposition as a template. These deposits have median ages of 601 cal. yr BP, 837 cal. yr BP, 1440 cal. yr BP, 3018 cal. yr BP, 3591 cal. yr BP, 4712 cal. yr BP, 5607 cal. yr BP, and 6357 cal. yr BP and are chronologically equivalent of those from the far-field locations in the Indian Ocean region. The distant deposits that are correlated with the South Andaman sites most likely owe their origin to the 2004-type events, as indicated by tsunami simulations in the study region. The long-term record presented here is characterized by an early phase of a quasiperiodic recurrence regime that transitions into a distinct interval of temporally clustered events. The quasiperiodic regime that appears around the mid-Holocene with an inter-event interval of 980 ± 385 years is followed by a sizable quiescent period of 1605 ± 245 years, before being succeeded by a regime of temporally clustered events. The chronology of nine tsunami events in the last 6500 years from the Indian Ocean region, thus implies a nonlinear pattern for the causative earthquakes. As demonstrated in the subduction zones elsewhere, the temporal variability of tsunamigenic great earthquakes is supported by the theoretical models espousing the characteristics of long-term stress recycling processes active within the subduction zones and transfer processes between the lower viscoelastic layer and the upper seismogenic crust

Castleman Disease with Endocrine Dysfunction

Castleman disease is a rare, non-clonal lymphoproliferative disorder predominantly affecting lymphoid tissues. This report presents the case of a 23-year-old male with a chronic left-sided neck swelling and gynecomastia. Surgical excision and Webster technique for gynecomastia were performed, and histopathological examination revealed features consistent with Castleman disease. The lymph node specimen displayed enlarged and reactive atretic germinal centers with an onion skin arrangement of lymphocytes and occasional atypical follicular dendritic cells. Additionally, the breast tissue showed proliferating ducts indicative of gynecomastia. Immunohistochemical analysis confirmed the diagnosis, revealing CD20-positive mantle zones, diffuse CD45 positivity, CD3 positivity in the paracortex and interfollicular area, and Ki-67 positivity in the germinal center. Castleman disease presents clinically as unicentric or multicentric forms and histologically as hyaline vascular, plasma cell, mixed cellular, or plasmablastic variants. Elevated levels of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) underscore the disease's inflammatory background. The disease's heterogeneity presents challenges in diagnosis, particularly the plasma cell variant, which can mimic Hodgkin lymphoma. Laboratory abnormalities, such as elevated ESR, LDH, CRP, and anemia, are seen in the multicentric variant. Associations with POEMS syndrome, Kaposi's sarcoma, and co-existing malignant lymphomas complicate the disease's clinical course. Recognition of this condition is crucial for timely intervention, as surgical excision is curative in unicentric cases, while multicentric forms often exhibit a rebound effect. Understanding the disease's diverse presentations and associated lymphomas is essential for accurate diagnosis and appropriate management

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation

The 2012 Mw 8.6 Indian Ocean earthquake: Deep nucleation on a listric-like fault

The 2012 Mw 8.6 Indian Ocean earthquake, the largest instrumentally recorded strike-slip event, has been described as a westward rupture on orthogonal faults that are part of the original oceanic fabric of the region. Reported estimates of its depth vary from 10 to 45 km, while the maximum depth of its inferred rupture extends to ~50–60 km. The complexity of the earthquake is undeniable both in terms of fault geometry and rupture propagation, with debates on the geometry of the causative faults. Results from recent seismic surveys enable a fresh look at the earthquake fault geometry, nucleation depths, and lithospheric rheology. In the present study, these new findings are incorporated into 22 forward models using a revised velocity structure and N-S geometries that flatten with depth. The rupture initiation is modeled in the uppermost mantle (25–30 km) as well as in the upper mantle at ~45 km, the latter of which is 15–20 km below the commonly accepted values of maximum depth for frictional failure. Our study shows that the westward directionality of wave propagation is achieved for strike-slip failure on a listric-like fault, in contrast to subvertical geometries as previously suggested. This propagation is persistent for a strike-slip failure only for events nucleating at upper mantle depths (~45 km) rather than for those set to originate at depths between 25 and 30 km. However, for a dip-slip failure the westward propagation is found to be consistent at both nucleation depths on a listric-like fault. This study highlights a deep nucleation within the lithospheric mantle for the 2012 Mw 8.6 earthquake that could be due to strain localization induced by fluid-rock interaction and/or mineral transformation/crystallization near the 680 °C isotherm at ~45 km depth (≈1.4 GPa), which correlates with deep serpentinization on faults

Monthly resolved coral barium isotopes record increased riverine inputs during the South Asian summer monsoon

We present a monthly resolved stable Ba isotope record (δ138Bacoral) of a young fossil coral (Porites) from the eastern side of the Andaman Islands (NE Indian Ocean), which grew prior to the 19th century. This δ138Bacoral record complements 19-years of monthly resolved Ba/Cacoral, Sr/Cacoral, U/Cacoral, δ18Ocoral and δ13Ccoral data from the same colony that can serve as a baseline of environmental variability before the industrialised era. The δ138Bacoral record exhibits small but significant seasonal variability ranging from 0.16 to 0.27 ± 0.03‰ over two continuous annual cycles. The δ138Bacoral signature is generally low during the South Asian summer monsoon (SAM, June-September) and post-SAM seasons (October-January), which are characterised by high Ba/Cacoral and more depleted δ18OSW values. We suggest that Ba desorption from suspended fluvial sediments followed by lateral advection are the main causes of the low δ138Bacoral and elevated Ba/Cacoral values during the SAM and post-SAM. However, this promising Ba proxy behaviour is interrupted by pronounced spikes of low δ138Bacoral and high Ba/Cacoral signatures observed during the pre-SAM season (February-May) throughout the 19-year record. Possible explanations for these spikes observed during dry seasons are (1) Ba enrichment associated with decreased mixed layer depth or (2) Ba release from sediments trapped by local fringing mangroves. Surface seawater from the coral site sampled over an annual cycle exhibits a wide range of dissolved δ138BaSW and [Ba]SW values, with significantly lowered δ138BaSW of 0.29 ± 0.04‰ and high [Ba]SW of 66.03 nmol/kg during the SAM, which is broadly consistent with the coral skeletal signals. Our results establish a clear link between monsoon-driven freshening events and Ba isotope variability of surface waters and assess the utility of coral skeletal Ba isotopes to trace riverine inputs into tropical coastal oceans

CuO as a reactive and reusable reagent for the hydrogenation of nitroarenes

Copper oxide (CuO) is used as a reusable solid reagent for hydrogenation of nitroarenes to aminoarenes. The use of CuO resulted in 100 % conversion of 2.9 mmol of nitrobenzene to aniline in 45 s at room temperature using hydrazine hydrate as the reducing agent. During the reaction, CuO is converted to inactive metallic Cu which can be regenerated to active CuO by thermal oxidation. DFT simulations indicated facile formation of oxygen vacancies (EO,vac = −3.8 kJ/mol) on the surface of CuO (111) in reducing environment which is consistent with the XPS analysis. Oxygen vacancies facilitate stronger nitrobenzene binding (−148.5 kJ/mol) and reduced activation barrier (Ea = 36.4 kJ/mol) for N[sbnd]O dissociation. Motivated from this mechanistic insight -NO2 groups in various nitroarenes were selectively hydrogenated to [sbnd]NH2 groups using CuO