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Large uncertainties persist in estimates of soil–atmosphere exchange of important trace gases. One significant source of uncertainty is the combined effect of wind and pressure on these fluxes. Wind and pressure effects are mediated by surface topography: few surfaces are uniform and over scales of tenths of a metre to tens of metres, air pressure and wind speed at the ground surface may be very variable. In this paper we consider how such spatial variability in air pressure and wind speed affects fluxes of trace gases. We used a novel nested wind tunnel design comprising a toroidial wind tunnel, in which wind speed and pressure may be controlled, set within a larger, linear wind tunnel. The effects of both wind speed and pressure differentials on fluxes of CO2 and CH4 within three different ecosystems (forest, grassland, peat bog) were quantified. We find that trace gas fluxes are positively correlated with both wind speed and pressure differential near the surface boundary. We argue that wind speed is the better proxy for trace gas fluxes because of its stronger correlation and because wind speed is more easily measured and wind speed measurement methodology more easily standardized. Trace gas fluxes, whether into or out of the soil, increase with wind speed within the toroidal tunnel (+55 % flux per m s−1), while faster, localized surface winds that are external to the toroidal wind tunnel reduce trace gas fluxes (−13 % flux per m s−1). These results are consistent for both trace gases over all ecosystem soil types studied. Our findings support the need for a revised conceptualization of soil–atmosphere gas exchange. We propose a conceptual model of the soil profile that has a \"mixed layer\", with fluxes controlled by wind speed, wind duration, porosity, water table, and gas production and consumption.

Methyl halide gases are important sources of atmospheric inorganic halogen compounds, which in turn are central reactants in many stratospheric and tropospheric chemical processes. By observing emissions of methyl chloride, methyl bromide, and methyl iodide from flooded California rice fields, we estimate the impact of rice agriculture on the atmospheric budgets of these gases. Factors influencing methyl halide emissions are stage of rice growth, soil organic content, halide concentrations, and field-water management. Extrapolating our data implies that about 1 percent of atmospheric methyl bromide and 5 percent of methyl iodide arise from rice fields worldwide. Unplanted flooded fields emit as much methyl chloride as planted, flooded rice fields.

Das hier behandelte Problem ist nicht nur für die anwaltliche Praxis, sondern auch für die Gerichte aktuell. Im nächsten Heft wird deshalb ein Beitrag zur Spezialisierungsfrage aus der Sicht des Richters erscheinen.

Wearable fitness technologies, like the Oura Ring (Oura Health Oy), provide physiological metrics, like sleep and heart rate data, to a growing user base of young adults. However, these technologies and connected mobile apps do not measure young adults' alcohol use that contributes to these metrics. Personalized feedback on the impact of alcohol on sleep and heart rate may boost motivation to reduce drinking among young adults. For this pilot randomized controlled trial, we evaluated the acceptability, feasibility, and perceived effectiveness of a wearable personalized feedback intervention for alcohol reduction in young adults that integrated physiological and behavioral data. Recruitment took place offline and online via open access websites. Participants (N=60) wore the Oura Ring for 6 weeks and completed daily behavioral smartphone diaries. Only the feedback group (n=30) had full access to the Oura Ring app and personalized feedback reports every 2 weeks, received from the study team. The app included daily feedback on sleep and cardiovascular recovery. Feedback reports combined Oura Ring and diary data to show trends of alcohol use alongside sleep and cardiovascular data. We used artificial intelligence-driven convergent mixed methods to evaluate self-assessed exit surveys and face-to-face exit interviews, including natural language processing and researcher-coded qualitative analyses with interviews. Half of participants (30/60, 50%) were men, 81.6% (49/60) were White, and they had a mean age of 22.02 (SD 1.98) years. Across both groups, the overall program was described as highly acceptable, feasible, and effective. Wearing the Oura Ring was highly acceptable and feasible. The smartphone diaries were moderately acceptable, moderately-highly feasible, and highly effective. The feedback reports were highly acceptable, feasible, and effective. Among feedback group participants, the Oura Ring and app were moderately effective. The feedback group participants also had high adherence using the app daily, and 80% (48/60) read all 3 feedback reports. Per natural language processing, the most common topic in the feedback interviews related to their behavior change due to multiple intervention components (Ɵk=0.18). This contrasted with the most common topic from assessment group participants about prechange learning (Ɵk=0.22). During the researcher-coded qualitative analysis, we identified themes in 3 categories. Most participants described helpful aspects of the Oura Ring and app, smartphone diaries, and feedback report. Most felt that the report had the right amount of information, and a large group reported they learned about their sleep deficits. Curiosity was the most common reason participants joined the study. SMS text messages and usability kept them engaged, and almost none considered dropping out. Commercial fitness wearables that integrate behavioral data may be acceptable and feasible and promote readiness to change drinking in young adults who are generally unconcerned about risky behaviors.

Abstract Study Objectives Insomnia is common among adults with chronic heart failure (HF) and associated with daytime symptoms and decrements in function. The purpose of this randomized controlled trial (RCT) was to evaluate the sustained effects over one year of CBT-I (Healthy Sleep: HS) compared with HF self-management education (Healthy Hearts; attention control: HH) on insomnia severity, sleep characteristics, symptoms, and function among people with stable HF. The primary outcomes were insomnia severity, actigraph-recorded sleep efficiency, and fatigue. Methods We randomized adults with stable HF with preserved or reduced ejection fraction who had at least mild insomnia (Insomnia severity index >7) in groups to HS or HH (4 sessions/8 weeks). We obtained wrist actigraphy and measured insomnia severity, self-reported sleep characteristics, symptoms (fatigue, excessive daytime sleepiness, anxiety, depression), and six-minute walk distance at baseline, within one month of treatment, and at 6 and 12 months. We used general linear mixed models (GLMM) and generalized estimating equations (GEE) to evaluate the effects. Results The sample included 175 participants (M age = 63 ± 12.9 years; 43% women; 18% Black; 68% New York Heart Association Class II or II; 33%; LVEF < 45%) randomized to HS (n = 91) or HH (n = 84). HS had sustained effects on insomnia severity, sleep quality, self-reported sleep latency and efficiency, fatigue, excessive daytime sleepiness, and six-minute walk distance at 12 months. Conclusions CBT-I produced sustained improvements in insomnia, fatigue, daytime sleepiness, and objectively measured physical function among adults with chronic HF, compared with a robust HF self-management program that included sleep hygiene education. Clinical Trial Information Insomnia Self-Management in Heart Failure; https://clinicaltrials.gov/ct2/show/NCT02660385; NCT02660385.

BackgroundObstructive sleep apnoea (OSA) is a heterogeneous disorder, and improved understanding of physiologic phenotypes and their clinical implications is needed. We aimed to determine whether routine polysomnographic data can be used to identify OSA phenotypes (clusters) and to assess the associations between the phenotypes and cardiovascular outcomes.MethodsCross-sectional and longitudinal analyses of a multisite, observational US Veteran (n=1247) cohort were performed. Principal components-based clustering was used to identify polysomnographic features in OSA’s four pathophysiological domains (sleep architecture disturbance, autonomic dysregulation, breathing disturbance and hypoxia). Using these features, OSA phenotypes were identified by cluster analysis (K-means). Cox survival analysis was used to evaluate longitudinal relationships between clusters and the combined outcome of incident transient ischaemic attack, stroke, acute coronary syndrome or death.ResultsSeven patient clusters were identified based on distinguishing polysomnographic features: ‘mild’, ‘periodic limb movements of sleep (PLMS)’, ‘NREM and arousal’, ‘REM and hypoxia’, ‘hypopnoea and hypoxia’, ‘arousal and poor sleep’ and ‘combined severe’. In adjusted analyses, the risk (compared with ‘mild’) of the combined outcome (HR (95% CI)) was significantly increased for ‘PLMS’, (2.02 (1.32 to 3.08)), ‘hypopnoea and hypoxia’ (1.74 (1.02 to 2.99)) and ‘combined severe’ (1.69 (1.09 to 2.62)). Conventional apnoea–hypopnoea index (AHI) severity categories of moderate (15≤AHI<30) and severe (AHI ≥30), compared with mild/none category (AHI <15), were not associated with increased risk.ConclusionsAmong patients referred for OSA evaluation, routine polysomnographic data can identify physiological phenotypes that capture risk of adverse cardiovascular outcomes otherwise missed by conventional OSA severity classification.

Background Clinical and genetic heterogeneity in monogenetic disorders represents a major diagnostic challenge. Although the presence of particular clinical features may aid in identifying a specific cause in some cases, the majority of patients remain undiagnosed. Here, we investigated the utility of whole-exome sequencing as a diagnostic approach for establishing a molecular diagnosis in a highly heterogeneous group of patients with varied intellectual disability and microcephaly. Methods Whole-exome sequencing was performed in 38 patients, including three sib-pairs, in addition to or in parallel with genetic analyses that were performed during the diagnostic work-up of the study participants. Results In ten out of these 35 families (29 %), we found mutations in genes already known to be related to a disorder in which microcephaly is a main feature. Two unrelated patients had mutations in the ASPM gene. In seven other patients we found mutations in RAB3GAP1 , RNASEH2B, KIF11 , ERCC8 , CASK , DYRK1A and BRCA2 . In one of the sib-pairs, mutations were found in the RTTN gene. Mutations were present in seven out of our ten families with an established etiological diagnosis with recessive inheritance. Conclusions We demonstrate that whole-exome sequencing is a powerful tool for the diagnostic evaluation of patients with highly heterogeneous neurodevelopmental disorders such as intellectual disability with microcephaly. Our results confirm that autosomal recessive disorders are highly prevalent among patients with microcephaly.

Lynch syndrome is caused by germline mutations in MSH2, MLH1, MSH6, and PMS2 mismatch-repair genes and leads to a high risk of colorectal and endometrial cancer. We previously showed that constitutional 3′ end deletions of EPCAM can cause Lynch syndrome through epigenetic silencing of MSH2 in EPCAM-expressing tissues, resulting in tissue-specific MSH2 deficiency. We aim to establish the risk of cancer associated with such EPCAM deletions. We obtained clinical data for 194 carriers of a 3′ end EPCAM deletion from 41 families known to us at the Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands and compared cancer risk with data from a previously described cohort of 473 carriers from 91 families with mutations in MLH1, MSH2, MSH6, or a combined EPCAM–MSH2 deletion. 93 of the 194 EPCAM deletion carriers were diagnosed with colorectal cancer; three of the 92 women with EPCAM deletions were diagnosed with endometrial cancer. Carriers of an EPCAM deletion had a 75% (95% CI 65–85) cumulative risk of colorectal cancer before the age of 70 years (mean age at diagnosis 43 years [SD 12]), which did not differ significantly from that of carriers of combined EPCAM–MSH2 deletion (69% [95% CI 47–91], p=0·8609) or mutations in MSH2 (77% [64–90], p=0·5892) or MLH1 (79% [68–90], p=0·5492), but was higher than noted for carriers of MSH6 mutation (50% [38–62], p<0·0001). By contrast, women with EPCAM deletions had a 12% [0–27] cumulative risk of endometrial cancer, which was lower than was that noted for carriers of a combined EPCAM–MSH2 deletion (55% [20–90], p<0·0001) or of a mutation in MSH2 (51% [33–69], p=0·0006) or MSH6 (34% [20–48], p=0·0309), but did not differ significantly from that noted for MLH1 (33% [15–51], p=0·1193) mutation carriers. This risk seems to be restricted to deletions that extend close to the MSH2 gene promoter. Of 194 carriers of an EPCAM deletion, three had duodenal cancer and four had pancreatic cancer. EPCAM deletion carriers have a high risk of colorectal cancer; only those with deletions extending close to the MSH2 promoter have an increased risk of endometrial cancer. These results underscore the effect of mosaic MSH2 deficiency, leading to variable cancer risks, and could form the basis of an optimised protocol for the recognition and targeted prevention of cancer in EPCAM deletion carriers. Sacha Swarttouw-Hijmans Foundation, Dutch Cancer Society, Deutsche Krebshilfe (German Cancer Aid), Hong Kong Cancer Fund, Hungarian Research Grant OTKA, Norwegian EEA Financial Mechanism (Hungarian National Institute of Oncology), and US National Cancer Institute.