Two glaciers and one sedimentary sink: the competing role of the Aare and the Valais glaciers in filling an overdeepened trough inferred from provenance analysis

The extent and distribution of glaciers on the Swiss Plateau during the Last Glacial Maximum (LGM) can be determined from the geological record. However, similar reconstructions for the glaciations that preceded the LGM are far more difficult to be made due to the destruction of suitable sedimentary records through recurring glaciations or due to the inaccessibility of preserved records. Here, we explored Quaternary sediments that were deposited during the Marine Isotope Stage (MIS) 8 glaciation at least around 250 ka, and which were recovered in a drilling that was sunk into an overdeepened bedrock trough west of Bern (Switzerland). We analyzed the sediment bulk chemical composition of the deposits to investigate the supply of the material to the area by either the Aare Glacier, the Saane Glacier, or the Valais Glacier, and we complement this investigation with the results of heavy mineral analyses and geochemical information from detrital garnet. The potential confluence of the Valais and the Aare glaciers in the Bern area makes this location ideal for such an analysis. We determined the sediment bulk chemical signal of the various lithological units in the central Swiss Alps where the glaciers originated, which we used as endmembers for our provenance analysis. We then combined the results of this fingerprinting with the existing information on the sedimentary succession and its deposition history. This sedimentary suite is composed of two sequences, Sequence A (lower) and Sequence B (upper), both of which comprise a basal till that is overlain by lacustrine sediments. The till at the base of Sequence A was formed by the Aare Glacier. The overlying lacustrine deposits of an ice-contact lake were mainly supplied by the Aare Glacier. The basal till in Sequence B was also formed by the Aare Glacier. For the lacustrine deposits in Sequence B, the heavy mineral and garnet geochemical data indicate that the sediment was supplied by the Aare and the Saane glaciers. We use these findings for a paleogeographic reconstruction. During the time when Sequence A and the basal till in Sequence B were deposited, the Aare Glacier dominated the area. This strongly contrasts with the situation during the LGM, when the Aare Glacier was deflected by the Valais Glacier towards the northeast. The Valais Glacier was probably less extensive during MIS 8, but it was potentially presentin the area, and it could have been essential for damming a lake in which the material supplied by the Aare and the Saane glaciers accumulated. In conclusion, combining provenance with sedimentological data, we could document how sediment was supplied to the investigated overdeepened basin during the MIS 8 glacial period and how glaciers were arranged in a way that was markedly different from the LGM

From glacial erosion to basin overfill: a 240 m-thick overdeepening–fill sequence in Bern, Switzerland

We drilled a 210 m-thick succession of Quaternary sediments and extended it 30 m upsection with information that we collected from an adjacent outcrop. In the 240 m-thick succession we identified 12 different lithofacies, grouped them into five facies assemblages, and distinguished two major sedimentary sequences. A sharp contact at 103 m depth cuts off cross-beds in sequence A and separates them from the overlying horizontal beds in sequence B. Although the lowermost facies assemblage of each sequence includes a till deposited during a period of ice cover, the two tills differ from each other. In particular, the till at the base of sequence A is dominated by large clasts derived from the underlying Molasse bedrock, whereas the till at the base of sequence B has no such Molasse components. Furthermore, the till in sequence A bears evidence of glaciotectonic deformation. Both tills are overlain by thick assemblages of subaqueous, most likely glaciolacustrine and lacustrine facies elements. The cross-bedded and steeply inclined sand, gravel, and diamictic beds of sequence A are interpreted as deposits of density currents in a subaqueous ice-contact fan system within a proglacial lake. In contrast, the lacustrine sediments in sequence B are considered to record a less energetic environment where the material was most likely deposited in a prodelta setting that gradually developed into a delta plain. Towards the top, sequence B evolves into a fluvial system recorded in sequence C, when large sediment fluxes of a possibly advancing glacier resulted in a widespread cover of the region by a thick gravel unit. Feldspar luminescence dating on two samples from a sand layer at the top of sequence B provided uncorrected ages of 250.3 ± 80.2 and 251.3 ± 59.8 ka. The combination of these ages with lithostratigraphic correlations of sedimentary sequences encountered in neighboring scientific drillings suggests that sequence B was deposited between Marine Isotope Stage 8 (MIS 8; 300–243 ka) and MIS 7 (243–191 ka). This depositional age marks the end of one stage of overdeepening–fill in the perialpine Aare Valley near Bern

Induced P-wave Superfluidity in Asymmetric Fermi Gases

We show that two new intra-species P-wave superfluid phases appear in two-component asymmetric Fermi systems with short-range S-wave interactions. In the BEC limit, phonons of the molecular BEC induce P-wave superfluidity in the excess fermions. In the BCS limit, density fluctuations induce P-wave superfluidity in both the majority and the minority species. These phases may be realized in experiments with spin-polarized Fermi gases.Comment: published versio

Palynological investigations reveal Eemian interglacial vegetation dynamics at Spiezberg, Bernese Alps, Switzerland

Interglacial pollen records are valuable archives of past vegetation dynamics and provide important information about vegetation responses to different-than-today climates. Interglacial pollen archives pre-dating the Last Glacial Maximum (LGM) are scarce on the Swiss Plateau in contrast to the many available Late Glacial and Holocene records. This is mainly due to the rapidly changing palaeo- environmental conditions throughout the Quaternary and the low preservation potential of material suitable for palynological investigations. The Spiezberg site offers a palynological record situated most proximal to the Alps in Switzerland. Previous investigations tentatively assigned this record to the Eemian interglacial (MIS 5e). We have conducted additional pollen analytical investigations to increase the quantity of pollen information. Besides biostratigraphic interpretations, we use numerical methods such as distance analysis (distantia) and ordination techniques (PCA) to evaluate the similarities and differences between the Spiezberg record and its geographically and chronostratigraphically closest physically dated (U/Th, luminescence) analogues from the Eemian (MIS 5e) and Meikirch 3 (MIS 7a) interglacials. Our palynological investigations reveal the predominance of closed temperate forests with abundant fir (Abies) and spruce (Picea) as well as evergreen broad-leaved taxa (e.g. Hedera). The attri- bution to the Eemian interglacial relies on the observation of very rare beech (Fagus) occurrences, a phase with prominent yew (Taxus) and the unimportance of hornbeam (Carpinus), all of which are typical Eemian features on the Swiss Plateau. An Eemian age is supported by the numerical comparison with the Beerenmo€sli (MIS 5e) and Meikirch 3 (MIS 7a) reference records. Furthermore, the Picea, Taxus and Fagus dynamics observed on the Swiss Plateau during the Eemian are in excellent agreement with vegetational patterns observed elsewhere in Central Europe. Surprisingly, Carpinus was almost absent on the Swiss Plateau during the Eemian, whereas it was a major component of the forest at other European sites with a similar elevation as Spiezberg. We explain this by environmental conditions and the strong competition with Abies alba. In particular, considering the European Eemian vegetation history and the results of our reconstructions from the Swiss Plateau, we find that Abies alba was a highly competitive tree under natural warmer-than-today conditions. This finding provides further evidence that Abies alba may benefit from future climate warming

Insulin doseresponse curves for stimulation of splanchnic glucose uptake and suppression of endogenous glucose production differ in nondiabetic humans and are abnormal in people with type 2 diabetes.

To determine whether the insulin dose-response curves for suppression of endogenous glucose production (EGP) and stimulation of splanchnic glucose uptake (SGU) differ in nondiabetic humans and are abnormal in type 2 diabetes, 14 nondiabetic and 12 diabetic subjects were studied. Glucose was clamped at ϳ9.5 mmol/l and endogenous hormone secretion inhibited by somatostatin, while glucagon and growth hormone were replaced by an exogenous infusion. Insulin was progressively increased from ϳ150 to ϳ350 and ϳ700 pmol/l by means of an exogenous insulin infusion, while EGP, SGU, and leg glucose uptake (LGU) were measured using the splanchnic and leg catheterization methods, combined with a [3-3 H]glucose infusion. In nondiabetic subjects, an increase in insulin from ϳ150 to ϳ350 pmol/l resulted in maximal suppression of EGP, whereas SGU continued to increase (P < 0.001) when insulin was increased to ϳ700 pmol/l. In contrast, EGP progressively decreased (P < 0.001) and SGU progressively increased (P < 0.001) in the diabetic subjects as insulin increased from ϳ150 to ϳ700 pmol/l. Although EGP was higher (P < 0.01) in the diabetic than nondiabetic subjects only at the lowest insulin concentration, SGU was lower (P < 0.01) in the diabetic subjects at all insulin concentrations tested. On the other hand, in contrast to LGU and overall glucose disposal, the increment in SGU in response to both increments in insulin did not differ in the diabetic and nondiabetic subjects, implying a right shifted but parallel dose-response curve. These data indicate that the dose-response curves for suppression of glucose production and stimulation of glucose uptake differ in nondiabetic subjects and are abnormal in people with type 2 diabetes. Taken together, these data also suggest that agents that enhance SGU in diabetic patients (e.g. glucokinase activators) are likely to improve glucose tolerance. Diabete

Concurrent validity and reliability of the Community Balance and Mobility scale in young-older adults

Background: With the growing number of young-older adults (baby-boomers), there is an increasing demand for assessment tools specific for this population, which are able to detect subtle balance and mobility deficits. Various balance and mobility tests already exist, but suffer from ceiling effects in higher functioning older adults. A reliable and valid challenging balance and mobility test is critical to determine a young-older adult’s balance and mobility performance and to timely initiate preventive interventions. The aim was to evaluate the concurrent validity, inter- and intrarater reliability, internal consistency, and ceiling effects of a challenging balance and mobility scale, the Community Balance and Mobility Scale (CBM), in young-older adults aged 60 to 70 years. Methods: Fifty-one participants aged 66.4 ± 2.7 years (range, 60–70 years) were assessed with the CBM. The Fullerton Advanced Balance scale (FAB), 3-Meter Tandem Walk (3MTW), 8-level balance scale, Timed-Up-and-Go (TUG), and 7-m habitual gait speed were used to estimate concurrent validity, examined by Spearman correlation coefficient (ρ). Inter- and intrarater reliability were calculated as Intra-class-correlations (ICC), and internal consistency by Cronbach alpha and item-total correlations (ρ). Ceiling effects were determined by obtaining the percentage of participants reaching the highest possible score. Results: The CBM significantly correlated with the FAB (ρ = 0.75; p < .001), 3MTW errors (ρ = − 0.61; p < .001), 3MTW time (ρ = − 0.35; p = .05), the 8-level balance scale (ρ = 0.35; p < .05), the TUG (ρ = − 0.42; p < .01), and 7-m habitual gait speed (ρ = 0.46, p < .001). Inter- (ICC2,k = 0.97), intrarater reliability (ICC3,k = 1.00) were excellent, and internal consistency (α = 0.88; ρ = 0.28–0.81) was good to satisfactory. The CBM did not show ceiling effects in contrast to other scales. Conclusions: Concurrent validity of the CBM was good when compared to the FAB and moderate to good when compared to other measures of balance and mobility. Based on this study, the CBM can be recommended to measure balance and mobility performance in the specific population of young-older adults. Trial registration Trial number: ISRCTN37750605 . (Registered on 21/04/2016)

Location, Location, Location: Where We Teach Primary Care Makes All the Difference

Creating a new model to train a high-quality primary care workforce is of great interest to American health care stakeholders. There is consensus that effective educational approaches need to be combined with a rewarding work environment, emphasize a good work/life balance, and a focus on achieving meaningful outcomes that center on patients and the public. Still, significant barriers limit the numbers of clinicians interested in pursuing careers in primary care, including low earning potential, heavy medical school debt, lack of respect from physician colleagues, and enormous burdens of record keeping. To enlarge and energize the pool of primary care trainees, we look especially at changes that focus on institutions and the practice environment. Students and residents need training environments where primary care clinicians and interdisciplinary teams play a crucially important role in patient care. For a variety of reasons, many academic medical centers cannot easily meet these standards. The authors propose that a major part of primary care education and training be re-located to settings in high-performing health systems built on comprehensive integrated care models where primary care clinicians play a principle role in leadership and care delivery

Core Outcomes for Colorectal Cancer Surgery: A Consensus Study

Background: Colorectal cancer (CRC) is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for evaluating surgery is within well-designed randomized controlled trials (RCTs); however, the impact of RCTs is diminished by a lack of coordinated outcome measurement and reporting. A solution to these issues is to develop an agreed standard “core” set of outcomes to be measured in all trials to facilitate cross-study comparisons, meta-analysis, and minimize outcome reporting bias. This study defines a core outcome set for CRC surgery. Methods and Findings: The scope of this COS includes clinical effectiveness trials of surgical interventions for colorectal cancer. Excluded were nonsurgical oncological interventions. Potential outcomes of importance to patients and professionals were identified through systematic literature reviews and patient interviews. All outcomes were transcribed verbatim and categorized into domains by two independent researchers. This informed a questionnaire survey that asked stakeholders (patients and professionals) from United Kingdom CRC centers to rate the importance of each domain. Respondents were resurveyed following group feedback (Delphi methods). Outcomes rated as less important were discarded after each survey round according to predefined criteria, and remaining outcomes were considered at three consensus meetings; two involving international professionals and a separate one with patients. A modified nominal group technique was used to gain the final consensus. Data sources identified 1,216 outcomes of CRC surgery that informed a 91 domain questionnaire. First round questionnaires were returned from 63 out of 81 (78%) centers, including 90 professionals, and 97 out of 267 (35%) patients. Second round response rates were high for all stakeholders (>80%). Analysis of responses lead to 45 and 23 outcome domains being retained after the first and second surveys, respectively. Consensus meetings generated agreement on a 12 domain COS. This constituted five perioperative outcome domains (including anastomotic leak), four quality of life outcome domains (including fecal urgency and incontinence), and three oncological outcome domains (including long-term survival). Conclusion: This study used robust consensus methodology to develop a core outcome set for use in colorectal cancer surgical trials. It is now necessary to validate the use of this set in research practice

A study of sertraline in dialysis (ASSertID) : a protocol for a pilot randomised controlled trial of drug treatment for depression in patients undergoing haemodialysis

© 2015 Friedli et al. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedBACKGROUND: The prevalence of depression in people receiving haemodialysis is high with estimates varying between 20 and 40 %. There is little research on the effectiveness of antidepressants in dialysis patients with the few clinical trials suffering significant methodological issues. We plan to carry out a study to evaluate the feasibility of conducting a randomised controlled trial in patients on haemodialysis who have diagnosed Major Depressive Disorder.METHODS/DESIGN: The study has two phases, a screening phase and the randomised controlled trial. Patients will be screened initially with the Beck Depression Inventory to estimate the number of patients who score 16 or above. These patients will be invited to an interview with a psychiatrist who will invite those with a diagnosis of Major Depressive Disorder to take part in the trial. Consenting patients will be randomised to either Sertraline or placebo. Patients will be followed-up for 6 months. Demographic and clinical data will be collected at screening interview, baseline interview and 2 weeks, and every month (up to 6 months) after baseline. The primary outcome is to evaluate the feasibility of conducting a randomised, double blind, placebo pilot trial in haemodialysis patients with depression. Secondary outcomes include estimation of the variability in the outcome measures for the treatment and placebo arms, which will allow for a future adequately powered definitive trial. Analysis will primarily be descriptive, including the number of patients eligible for the trial, drug exposure of Sertraline in haemodialysis patients and the patient experience of participating in this trial.DISCUSSION: There is an urgent need for this research in the dialysis population because of the dearth of good quality and adequately powered studies. Research with renal patients is particularly difficult as they often have complex medical needs. This research will therefore not only assess the outcome of anti-depressants in haemodialysis patients with depression but also the process of running a randomised controlled trial in this population. Hence, the outputs of this feasibility study will be used to inform the design and methodology of a definitive study, adequately powered to determine the efficacy of anti-depressants in patient on haemodialysis with depression.TRIAL REGISTRATION: ISRCTN registry ISRCTN06146268 and EudraCT reference: 2012-000547-27.Peer reviewedFinal Published versio