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\"An examination of 100+ previously unstudied colonial-era Maya wills from the Yucatec town of Ixil. These testaments--some of the only surviving documentation of colonial inhabitation--offer unprecedented depictions of material and spiritual life from 1738 to 1779 and are rare and rich resources of Maya language\"--Provided by publisher.

The development of robust artificial intelligence models for echocardiography has been limited by the availability of annotated clinical data. Here, to address this challenge and improve the performance of cardiac imaging models, we developed EchoCLIP, a vision–language foundation model for echocardiography, that learns the relationship between cardiac ultrasound images and the interpretations of expert cardiologists across a wide range of patients and indications for imaging. After training on 1,032,975 cardiac ultrasound videos and corresponding expert text, EchoCLIP performs well on a diverse range of benchmarks for cardiac image interpretation, despite not having been explicitly trained for individual interpretation tasks. EchoCLIP can assess cardiac function (mean absolute error of 7.1% when predicting left ventricular ejection fraction in an external validation dataset) and identify implanted intracardiac devices (area under the curve (AUC) of 0.84, 0.92 and 0.97 for pacemakers, percutaneous mitral valve repair and artificial aortic valves, respectively). We also developed a long-context variant (EchoCLIP-R) using a custom tokenizer based on common echocardiography concepts. EchoCLIP-R accurately identified unique patients across multiple videos (AUC of 0.86), identified clinical transitions such as heart transplants (AUC of 0.79) and cardiac surgery (AUC 0.77) and enabled robust image-to-text search (mean cross-modal retrieval rank in the top 1% of candidate text reports). These capabilities represent a substantial step toward understanding and applying foundation models in cardiovascular imaging for preliminary interpretation of echocardiographic findings. A vision–language foundation model, trained on a dataset of more than 1 million echocardiogram video–text pairs, is able to assess various cardiac structural and functional parameters despite not having been directly trained on any specific image interpretation task.

Anthropogenic aerosols are hypothesized to enhance planetary albedo and offset some of the warming due to the buildup of greenhouse gases in Earth’s atmosphere. Aerosols can enhance the coverage, reflectance, and lifetime of warm low-level clouds. However, the relationship between cloud lifetime and aerosol concentration has been challenging to measure from polar orbiting satellites. We estimate two timescales relating to the formation and persistence of low-level clouds over 1° × 1° spatial domains using multiple years of geostationary satellite observations provided by the Clouds and Earth’s Radiant Energy System (CERES) Synoptic (SYN) product. Lagrangian trajectories spanning several days along the classic stratus-to-cumulus transition zone are stratified by aerosol optical depth and meteorology. Clouds forming in relatively polluted trajectories tend to have lighter precipitation rates, longer average lifetime, and higher cloud albedo and cloud fraction compared with unpolluted trajectories. While liquid water path differences are found to be negligible, we find direct evidence of increased planetary albedo primarily through increased drop concentration (Nd ) and cloud fraction, with the caveat that the aerosol influence on cloud fraction is positive only for stable atmospheric conditions. While the increase in cloud fraction can be large typically in the beginning of trajectories, the Twomey effect accounts for the bulk (roughly 3/4) of the total aerosol indirect radiative forcing estimate.

Cloud reflectivity is sensitive to atmospheric aerosol concentrations because aerosols provide the condensation nuclei on which water condenses 1 . Increased aerosol concentrations due to human activity affect droplet number concentration, liquid water and cloud fraction 2 , but these changes are subject to large uncertainties 3 . Ship tracks, long lines of polluted clouds that are visible in satellite images, are one of the main tools for quantifying aerosol–cloud interactions 4 . However, only a small fraction of the clouds polluted by shipping show ship tracks 5 , 6 . Here we show that even when no ship tracks are visible in satellite images, aerosol emissions change cloud properties substantially. We develop a new method to quantify the effect of shipping on all clouds, showing a cloud droplet number increase and a more positive liquid water response when there are no visible tracks. We directly detect shipping-induced cloud property changes in the trade cumulus regions of the Atlantic, which are known to display almost no visible tracks. Our results indicate that previous studies of ship tracks were suffering from selection biases by focusing only on visible tracks from satellite imagery. The strong liquid water path response we find translates to a larger aerosol cooling effect on the climate, potentially masking a higher climate sensitivity than observed temperature trends would otherwise suggest. Investigations of the effect of aerosol emissions from shipping on cloud properties when both visible and invisible ship tracks are considered implies a large negative radiative effect (and associated cooling) from liquid water path adjustments.

Global shipping accounts for 13% of global emissions of SO₂, which, once oxidized to sulfate aerosol, acts to cool the planet both directly by scattering sunlight and indirectly by increasing the albedo of clouds. This cooling due to sulfate aerosol offsets some of the warming effect of greenhouse gasses and is the largest uncertainty in determining the change in the Earth’s radiative balance by human activity. Ship tracks—the visible manifestation of the indirect of effect of ship emissions on clouds as quasi-linear features—have long provided an opportunity to quantify these effects. However, they have been arduous to catalog and typically studied only in particular regions for short periods of time. Using a machine-learning algorithm to automate their detection we catalog more than 1 million ship tracks to provide a global climatology. We use this to investigate the effect of stringent fuel regulations introduced by the International Maritime Organization in 2020 on their global prevalence since then, while accounting for the disruption in global commerce caused by COVID-19. We find a marked, but clearly nonlinear, decline in ship tracks globally: An 80% reduction in SOₓ emissions causes only a 25% reduction in the number of tracks detected.

Introduction: Pectus excavatum (PEX) is the most common congenital chest wall deformity, characterized by posterior depression of the sternum and lower costal margin. While often asymptomatic, severe PEX can lead to compression of the heart and great vessels, potentially causing right ventricular dysfunction, syncope, and other cardiovascular symptoms. Syncope due to right ventricle compression in PEX is rare but can significantly impact quality of life and may require surgical intervention. Case Report: An 18-year-old female presented to the emergency department after an unwitnessed syncopal episode. The patient reported feeling lightheaded while showering, followed by collapse and brief loss of consciousness. Diagnostic testing revealed normal neurological and metabolic parameters including point-of-care glucose, electrocardiogram, serum troponin, electrolytes, and head computed tomography. Chest imaging showed severe PEX with concerns of right ventricular compression. Transthoracic echocardiography demonstrated normal cardiac function, and exercise stress testing showed no ischemic changes. Additional laboratory studies revealed iron deficiency anemia. Conclusion: This case underscores the potential for PEX to cause distorted cardiac morphology, including right ventricular compression, which can lead to syncope in severe cases. The absence of cardiac ischemia, arrhythmias, or metabolic derangement suggests postural changes compounded by undiagnosed anemia and underlying PEX as the most likely cause of this patient’s syncope. Given the patient’s symptoms and anatomical findings, referral for surgical evaluation was made to discuss definitive management options. This case highlights the importance of considering structural chest wall abnormalities in the differential diagnosis of syncopal events, particularly when standard causes are excluded.

Smartphones are increasingly integrated into everyday life, but frequency of use has not yet been objectively measured and compared to demographics, health information, and in particular, sleep quality. The aim of this study was to characterize smartphone use by measuring screen-time directly, determine factors that are associated with increased screen-time, and to test the hypothesis that increased screen-time is associated with poor sleep. We performed a cross-sectional analysis in a subset of 653 participants enrolled in the Health eHeart Study, an internet-based longitudinal cohort study open to any interested adult (≥ 18 years). Smartphone screen-time (the number of minutes in each hour the screen was on) was measured continuously via smartphone application. For each participant, total and average screen-time were computed over 30-day windows. Average screen-time specifically during self-reported bedtime hours and sleeping period was also computed. Demographics, medical information, and sleep habits (Pittsburgh Sleep Quality Index-PSQI) were obtained by survey. Linear regression was used to obtain effect estimates. Total screen-time over 30 days was a median 38.4 hours (IQR 21.4 to 61.3) and average screen-time over 30 days was a median 3.7 minutes per hour (IQR 2.2 to 5.5). Younger age, self-reported race/ethnicity of Black and \"Other\" were associated with longer average screen-time after adjustment for potential confounders. Longer average screen-time was associated with shorter sleep duration and worse sleep-efficiency. Longer average screen-times during bedtime and the sleeping period were associated with poor sleep quality, decreased sleep efficiency, and longer sleep onset latency. These findings on actual smartphone screen-time build upon prior work based on self-report and confirm that adults spend a substantial amount of time using their smartphones. Screen-time differs across age and race, but is similar across socio-economic strata suggesting that cultural factors may drive smartphone use. Screen-time is associated with poor sleep. These findings cannot support conclusions on causation. Effect-cause remains a possibility: poor sleep may lead to increased screen-time. However, exposure to smartphone screens, particularly around bedtime, may negatively impact sleep.

The levels of aerosols in the atmosphere affect cloud reflectivity and the Earth’s radiative balance. A comprehensive analysis of satellite observations shows that thermodynamics and precipitation govern cloud responses to aerosols. Changes in aerosol concentrations affect cloud albedo and Earth’s radiative balance 1 . Aerosol radiative forcing from pre-industrial time to the present due to the effect of atmospheric aerosol levels on the micro- and macrophysics of clouds bears the largest uncertainty among external influences on climate change 1 . Of all cloud forms, low-level marine clouds exert the largest impact on the planet’s albedo 2 . For example, a 6% increase in the albedo of global marine stratiform clouds could offset the warming that would result from a doubling of atmospheric CO 2 concentrations 3 . Marine warm cloud properties are thought to depend on aerosol levels and large-scale dynamic or thermodynamic states 4 , 5 , 6 . Here we present a comprehensive analysis of multiple measurements from the A-Train constellation of Earth-observing satellites, to quantify the radiative forcing exerted by aerosols interacting with marine clouds. Specifically, we analyse observations of co-located aerosols and clouds over the world’s oceans for the period August 2006–April 2011, comprising over 7.3 million CloudSat single-layer marine warm cloud pixels. We find that thermodynamic conditions—that is, tropospheric stability and humidity in the free troposphere—and the state of precipitation act together to govern the cloud liquid water responses to the presence of aerosols and the strength of aerosol–cloud radiative forcing.

Increased concentrations of aerosol can enhance the albedo of warm low-level cloud. Accurately quantifying this relationship from space is challenging due in part to contamination of aerosol statistics near clouds. Aerosol retrievals near clouds can be influenced by stray cloud particles in areas assumed to be cloud-free, particle swelling by humidification, shadows and enhanced scattering into the aerosol field from (3-D radiative transfer) clouds. To screen for this contamination we have developed a new cloud–aerosol pairing algorithm (CAPA) to link cloud observations to the nearest aerosol retrieval within the satellite image. The distance between each aerosol retrieval and nearest cloud is also computed in CAPA. Results from two independent satellite imagers, the Advanced Along-Track Scanning Radiometer (AATSR) and Moderate Resolution Imaging Spectroradiometer (MODIS), show a marked reduction in the strength of the intrinsic aerosol indirect radiative forcing when selecting aerosol pairs that are located farther away from the clouds (−0.28±0.26 W m−2) compared to those including pairs that are within 15 km of the nearest cloud (−0.49±0.18 W m−2). The larger aerosol optical depths in closer proximity to cloud artificially enhance the relationship between aerosol-loading, cloud albedo, and cloud fraction. These results suggest that previous satellite-based radiative forcing estimates represented in key climate reports may be exaggerated due to the inclusion of retrieval artefacts in the aerosol located near clouds.

The impact of aerosols on cloud properties is one of the largest uncertainties in the anthropogenic radiative forcing of the climate. Significant progress has been made in constraining this forcing using observations, but uncertainty remains, particularly in the magnitude of cloud rapid adjustments to aerosol perturbations. Cloud liquid water path (LWP) is the leading control on liquid-cloud albedo, making it important to observationally constrain the aerosol impact on LWP. Previous modelling and observational studies have shown that multiple processes play a role in determining the LWP response to aerosol perturbations, but that the aerosol effect can be difficult to isolate. Following previous studies using mediating variables, this work investigates use of the relationship between cloud droplet number concentration (Nd) and LWP for constraining the role of aerosols. Using joint-probability histograms to account for the non-linear relationship, this work finds a relationship that is broadly consistent with previous studies. There is significant geographical variation in the relationship, partly due to role of meteorological factors (particularly relative humidity). The Nd–LWP relationship is negative in the majority of regions, suggesting that aerosol-induced LWP reductions could offset a significant fraction of the instantaneous radiative forcing from aerosol–cloud interactions (RFaci). However, variations in the Nd–LWP relationship in response to volcanic and shipping aerosol perturbations indicate that the Nd–LWP relationship overestimates the causal Nd impact on LWP due to the role of confounding factors. The weaker LWP reduction implied by these “natural experiments” means that this work provides an upper bound to the radiative forcing from aerosol-induced changes in the LWP.