Modeling of extreme freshwater outflow from the north-eastern Japanese river basins to western Pacific Ocean

This study demonstrates the importance of accurate extreme discharge input in hydrological and oceanographic combined modeling by introducing two extreme typhoon events. We investigated the effects of extreme freshwater outflow events from river mouths on sea surface salinity distribution (SSS) in the coastal zone of the north-eastern Japan. Previous studies have used observed discharge at the river mouth, as well as seasonally averaged inter-annual, annual, monthly or daily simulated data. Here, we reproduced the hourly peak discharge during two typhoon events for a targeted set of nine rivers and compared their impact on SSS in the coastal zone based on observed, climatological and simulated freshwater outflows in conjunction with verification of the results using satellite remote-sensing data. We created a set of hourly simulated freshwater outflow data from nine first-class Japanese river basins flowing to the western Pacific Ocean for the two targeted typhoon events (Chataan and Roke) and used it with the integrated hydrological (CDRMV3.1.1) and oceanographic (JCOPE-T) model, to compare the case using climatological mean monthly discharges as freshwater input from rivers with the case using our hydrological model simulated discharges. By using the CDRMV model optimized with the SCE-UA method, we successfully reproduced hindcasts for peak discharges of extreme typhoon events at the river mouths and could consider multiple river basin locations. Modeled SSS results were verified by comparison with Chlorophyll-a distribution, observed by satellite remote sensing. The projection of SSS in the coastal zone became more realistic than without including extreme freshwater outflow. These results suggest that our hydrological models with optimized model parameters calibrated to the Typhoon Roke and Chataan cases can be successfully used to predict runoff values from other extreme precipitation events with similar physical characteristics. Proper simulation of extreme typhoon events provides more realistic coastal SSS and may allow a different scenario analysis with various precipitation inputs for developing a nowcasting analysis in the future

Consensus on diagnosis and management of Cushing's disease: a guideline update

Cushing's disease requires accurate diagnosis, careful treatment selection, and long-term management to optimise patient outcomes. The Pituitary Society convened a consensus workshop comprising more than 50 academic researchers and clinical experts to discuss the application of recent evidence to clinical practice. In advance of the virtual meeting, data from 2015 to present about screening and diagnosis; surgery, medical, and radiation therapy; and disease-related and treatment-related complications of Cushing's disease summarised in recorded lectures were reviewed by all participants. During the meeting, concise summaries of the recorded lectures were presented, followed by small group breakout discussions. Consensus opinions from each group were collated into a draft document, which was reviewed and approved by all participants. Recommendations regarding use of laboratory tests, imaging, and treatment options are presented, along with algorithms for diagnosis of Cushing's syndrome and management of Cushing's disease. Topics considered most important to address in future research are also identified