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The spatial scale over which seasonal precipitation is autocorrelated could impact both data set development and water resources management, but spatial and temporal variability in these relationships and their potential changes have not been systematically evaluated. Here, we quantify changes in the length scale of seasonal precipitation correlations using daily values from 19,786 precipitation gauges from 1950 to 2019 across the contiguous United States. Annual precipitation correlation distance (PCD) is shorter in the western than eastern U.S., and shorter in summer than winter. In summer, PCD significantly decreased by 0.37 km/yr over the 70‐year study period in the Northwest, Northern Rockies and Plains, and Upper Midwest regions. Declines were smaller in other seasons, and PCD had spatially variable climate dependencies. Decreases in PCD suggest an increase in seasonal precipitation spatial variability and a shift toward more convective dominating precipitation, and could challenge precipitation interpolation exercises in sparsely gauged areas.

The burnout syndrome is characterized by emotional exhaustion, depersonalization, and reduced personal achievement. Uncertainty exists about the prevalence of burnout among medical and surgical residents. Associations between burnout and gender, age, specialty, and geographical location of training are unclear. In this meta-analysis, we aimed to quantitatively summarize the global prevalence rates of burnout among residents, by specialty and its contributing factors. We searched PubMed, PsycINFO, Embase, and Web of Science to identify studies that examined the prevalence of burnout among residents from various specialties and countries. The primary outcome assessed was the aggregate prevalence of burnout among all residents. The random effects model was used to calculate the aggregate prevalence, and heterogeneity was assessed by I2 statistic and Cochran’s Q statistic. We also performed meta-regression and subgroup analysis. The aggregate prevalence of burnout was 51.0% (95% CI: 45.0–57.0%, I2 = 97%) in 22,778 residents. Meta-regression found that the mean age (β = 0.34, 95% CI: 0.28–0.40, p < 0.001) and the proportion of males (β = 0.4, 95% CI = 0.10–0.69, p = 0.009) were significant moderators. Subgroup analysis by specialty showed that radiology (77.16%, 95% CI: 5.99–99.45), neurology (71.93%, 95% CI: 65.78–77.39), and general surgery (58.39%, 95% CI: 45.72–70.04) were the top three specialties with the highest prevalence of burnout. In contrast, psychiatry (42.05%, 95% CI: 33.09–51.58), oncology (38.36%, 95% CI: 32.69–44.37), and family medicine (35.97%, 95% CI: 13.89–66.18) had the lowest prevalence of burnout. Subgroup analysis also found that the prevalence of burnout in several Asian countries was 57.18% (95% CI: 45.8–67.85); in several European countries it was 27.72% (95% CI: 17.4–41.11) and in North America it was 51.64% (46.96–56.28). Our findings suggest a high prevalence of burnout among medical and surgical residents. Older and male residents suffered more than their respective counterparts.

The impacts of large terrestrial volcanic eruptions are apparent from satellite monitoring and direct observations. However, more than three quarters of all volcanic outputs worldwide lie submerged beneath the ocean, and the risks they pose to people, infrastructure, and benthic ecosystems remain poorly understood due to inaccessibility and a lack of detailed observations before and after eruptions. Here, comparing data acquired between 2015 - 2017 and 3 months after the January 2022 eruption of Hunga Volcano, we document the far-reaching and diverse impacts of one of the most explosive volcanic eruptions ever recorded. Almost 10 km 3 of seafloor material was removed during the eruption, most of which we conclude was redeposited within 20 km of the caldera by long run-out seafloor density currents. These powerful currents damaged seafloor cables over a length of >100 km, reshaped the seafloor, and caused mass-mortality of seafloor life. Biological (mega-epifaunal invertebrate) seafloor communities only survived the eruption where local topography provided a physical barrier to density currents (e.g., on nearby seamounts). While the longer-term consequences of such a large eruption for human, ecological and climatic systems are emerging, we expect that these previously-undocumented refugia will play a key role in longer-term ecosystem recovery. During the 2022 Hunga Volcano eruption, 10 km 3 of seafloor material was removed, fueling long-run out seafloor density currents. These powerful currents damaged seafloor cables over a length of >100 km, reshaped the seafloor, and caused mass-mortality of seafloor life.

(i) To investigate serum myostatin (absolute and normalized for total body lean mass (TBLM)) and IGF-1 as biomarkers of frailty and low relative appendicular skeletal muscle mass (RASM) in older adults, and; (ii)to examine gender differences in the association of serum myostatin and IGF-1 levels with frailty and low RASM. Cross-sectional study. The “Longitudinal Assessment of Biomarkers for characterization of early Sarcopenia and predicting frailty and functional decline in community-dwelling Asian older adults Study” (GERI-LABS) study in Singapore. 200 subjects aged 50 years and older residing in the community. Frailty was assessed using the modified Fried criteria. Low RASM was defined using cutoffs for height-adjusted appendicular skeletal muscle mass measured by dual-energy X-ray absorptiometry as recommended by the Asian Working Group for Sarcopenia. Comorbidities, cognitive and functional performance, physical activity and nutritional status were assessed. Blood samples collected included serum myostatin, insulin-like growth factor 1 (IGF-1) and markers of inflammation (total white cell count, CRP, IL-6 and TNFaR1). Subjects were classified into 4 groups: Frail/Prefrail with low RASM (Frail/Low RASM), Frail/Prefrail with normal RASM (Frail/Normal RASM), Robust with low RASM (Robust/Low RASM) and Robust with normal RASM (Robust/Normal RASM). 63 (32%) subjects were classified as Frail/Low RASM, 53 (27%) Frail/Normal RASM, 28 (14%) Robust/Low RASM and 56 (28%) Robust/Normal RASM respectively. Frail/Low RASM subjects were older and had lower BMI compared to Frail/Normal RASM and robust subjects. Mean (SE) normalized myostatin levels were higher in Frail/Low RASM compared to Frail/Normal RASM subjects (1.0 (0.04) versus 0.84 (0.05) ng/ml/kg, P=0.01). Median (IQR) IGF-1 level was lower amongst Frail/Low RASM subjects compared to Frail/Normal RASM subjects (102.3, (77.7, 102.5) vs 119.7 (82.7, 146.0) ng/ml, P=0.046). No differences in myostatin or IGF-1 were observed among robust individuals with or without low muscle mass. In adjusted multinomial logistic regression models with Robust/Normal RASM as the reference group, myostatin (P=0.05) and IGF-1 (P=0.043) were associated with Frail/Low RASM status in the whole cohort. When stratified by gender, myostatin was significantly associated with Frail/Low RASM status in men only (P=0.03). In women, serum IGF-1 was associated with Frail/Low RASM status (P=0.046), but not myostatin (P=0.53). Serum myostatin, normalized for TBLM in men and IGF-1 in women are potential biomarkers for frail individuals with low RASM, and may identify a target group for intervention.

Although risk factors related to chemotherapy-induced nausea and vomiting (CINV) have been identified in previous studies, only a few studies have evaluated the risk factors associated with contemporary antiemetic prophylaxis, including olanzapine/aprepitant- or NEPA-containing regimens. This study aimed to identify the risk factors associated with CINV development in Chinese breast cancer patients receiving doxorubicin and cyclophosphamide chemotherapy. Data from 304 patients enrolled in 3 previously reported prospective antiemetic studies were included. Multivariate logistic regression models were used to predict risk factors associated with CINV occurrence. Additionally, the likelihood of treatment failure in relation to the number of risk factors in individual patients was evaluated. Multivariate analysis of the entire study group revealed that obesity status (defined as body mass index/= 25.0 kg/m2) and the use of olanzapine/aprepitant- or NEPA-containing anti-emetic regimens were associated with a high likelihood, while a history of motion sickness was associated with a lower likelihood, complete response (CR), and \"no nausea\" in the overall phase. A history of vomiting during pregnancy was also associated with a lower likelihood of an overall CR. Patients with an increasing number of risk factors had a higher likelihood of treatment failure and shorter time to first vomiting. Those who did not achieve CR and \"no nausea\" in the first cycle were less likely to achieve these parameters in the subsequent cycle of chemotherapy. The present study confirmed previously reported risk factors for CINV in Chinese breast cancer patients receiving doxorubicin and cyclophosphamide. Further optimization of CINV control is required for patients with identifiable risk factors; olanzapine/aprepitant- or NEPA- containing prophylaxis are the preferred contemporary anti-emetics regimens for Chinese breast cancer patients undergoing doxorubicin and cyclophosphamide chemotherapy.

Real‐time forecasted ice information for large lakes, such as the Great Lakes, is critical for essential operations, such as ice breaking, commercial navigation, search and rescue, and oil spill response. Existing forecast products for large lake ice conditions are not available for medium‐range time horizons (5–16 days out), yet they could provide important information for decision making, particularly for ice breaking and spill responses. In addition, ice forecasts for Earth's largest lakes at these timescales could be important for Medium‐Range Weather (MRW) forecasting. However, the skill of existing operational products in predicting ice conditions at MRW timescales has not been studied. This work aims to determine how well ice forecasts from a coupled large lake hydrodynamic‐ice model perform for MRW forecast horizons. Simulations were carried out for the 2022 Great Lakes ice season, using 8 different 16‐day forecast periods. Forecast results were compared to observations of meteorology and ice conditions from the U.S. National Ice Center. Results show the MRW ice forecasts in the Great Lakes outperform persistence‐based forecasts. These findings could inform the development or extension of lake operational ice forecasting and the potential of coupling between atmospheric and large lake models at medium‐range forecast time scales. Plain Language Summary Ice information for large lakes is critical for essential operations, such as ice breaking, commercial navigation, search and rescue, and oil spill response. Ice forecasts are currently not available in the medium‐range (5–16 days out) time scale, yet they could provide valuable information for decision making. This information could also be important for medium‐range weather forecasts. The skill of existing Great Lakes ice forecast products at medium‐range time scales is currently unknown. Our work aims to determine how well ice forecasts from an atmosphere‐lake model perform for medium‐range time scales. Simulations were carried out for the 2022 Great Lakes ice season, using 8 different 16‐day forecast periods. The modeled forecasts were compared to observations from the National Ice Center and observed meteorological conditions. Results show that the modeled forecasts outperform persistence forecasts. These findings could inform the development or extension of ice forecasting and the potential of an atmosphere‐lake model at medium‐range time scales. Key Points Medium‐range (5‐ to 16‐day) ice forecasts show utility in the Great Lakes Model ice forecasts outperform ice persistence forecasts Air temperature bias in medium‐range weather forecasts is the likely greatest contributor to ice error

With considerable variation including potential sex-specific differential rate of skeletal muscle loss, identifying modifiable factors for sarcopenia will be pivotal to guide targeted interventions. This study seeks to identify clinical and biological correlates of sarcopenia in community-dwelling older adults, with emphasis on the role of anabolic and catabolic stimuli, and special reference to gender specificity. In this cross-sectional study involving 200 community-dwelling and functionally independent older adults aged ≥50 years, sarcopenia was defined using the Asian Working Group for Sarcopenia criteria. Comorbidities, cognitive and functional performance, physical activity and nutritional status were routinely assessed. Biochemical parameters included haematological indices, lipid panel, vitamin D level, anabolic hormones [insulin-like growth factor-1 (IGF-1), free testosterone (males only)] and catabolic markers [inflammatory markers (interleukin-6, C-reactive protein) and myostatin]. Multiple logistic regression was performed to identify independent predictors for sarcopenia. Age was associated with sarcopenia in both genders. Malnutrition conferred significantly higher odds for sarcopenia in women (OR = 5.71, 95 % CI 1.13–28.84.44, p  = 0.035) while higher but acceptable range serum triglyceride was protective in men (OR = 0.05, 95 % CI 0.00–0.52, p  = 0.012). Higher serum myostatin independently associated with higher odds for sarcopenia in men (OR = 1.11, 95 % CI 1.00–1.24, p  = 0.041). Serum IGF-1 was significantly lower amongst female sarcopenic subjects, with demonstrable trend for protective effect against sarcopenia in multiple regression models, such that each 1 ng/ml increase in IGF-1 was associated with 1 % decline in odds of sarcopenia in women ( p  = 0.095). Our findings support differential pathophysiological mechanisms for sarcopenia that, if corroborated, may have clinical utility in guiding sex-specific targeted interventions for community-dwelling older adults.

BackgroundGout is associated with non-alcoholic fatty liver disease (NAFLD), but neither the frequency nor severity of NAFLD in gout is well described. Elastography is a well-established ultrasonic method to evaluate both steatosis and fibrosis in the liver but has not been applied to evaluate gout patients.ObjectivesTo determine how common hepatic steatosis and fibrosis are in patients with gout using FibroScan technology?MethodsWe employed FibroScan technology, a validated transient elastography method, to evaluate patients with gout. Consecutive gout patients with insurance coverage were evaluated at one center from 11/1/2016 - 11/12021. We assessed the Fibrosis score (kPA) that measures liver stiffness (E score) and the controlled attenuation parameter dB/m (CAP) score that assesses steatosis. In addition, we assessed the four-factor fibrosis (FIB-4) Index formula that combines the patient’s age with aspartate aminotransferase (AST), alanine aminotransferase (ALT), and platelet count.Results47 gout patients (7 females, 14.9%; 40 males, 85.1%) were evaluated. The mean age was 59.8 years, and the mean BMI was 30.95 kg/m2. Tophi were present in 11 (26.2% of those with recorded information). The disease’s duration ranged from 0-49 years. Comorbidities included: dyslipidemia (86.7%), diabetes (31.1%), hypertension (63.6%), CHF (12.8%), CAD (12.8%), chronic kidney disease (19.15%), known liver disease (33.3%) and current alcohol consumption (46.8%). 53.7% (n=29) had hyperuricemia (serum urate (SU) >6.8 mg/dL) and 54.4% had elevations of either ALT or AST. Hepatic steatosis (CAP >238 dB/m) was found in 40 (85.1%) and was not significantly different in males or females (p=0.37) or those with CHF (p=0.87), CAD (p=0.94), hypertension (p=0.17), diabetes (p=0.68), dyslipidemia (p=0.59) or the presence of known liver diseases (p=0.37). CAP correlated with BMI (r=0.53, p=0.0001) but not age, SU, glucose, triglycerides, ALT, AST, FIB-4, or Fibrosis scores. By FibroScan, 9 (19.1%) had evidence of fibrosis (E score >7), including one with moderate and 8 with severe fibrosis (cirrhosis). Moderate or severe fibrosis was significantly associated with age (p=0.03) and known liver disease (p=0.003), but not ancestry, gender, BMI, triglycerides, HDL, glucose, gout duration, CHF, CAD, hypertension, dyslipidemia, or diabetes. SU was comparable in those with or without moderate or severe fibrosis (p=0.24). The Fib-4 score was significantly greater in those with severe or moderate fibrosis (3.77) versus those with no or mild fibrosis (1.59, p=0.0045). There was a significant correlation between the Fibrosis score and FIB-4 score (r2=0.24, p=0.0009) but not between the Fibrosis score and ALT (p=0.44) or AST(p=0.41).ConclusionHepatic steatosis and fibrosis are common in patients with gout but not associated with typical gout comorbidities. Screening for NAFLD with elastography should confirm the actual frequency of NAFLD in gout and provide a means to manage this comorbidity more effectively.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNaomi Schlesinger Consultant of: has been on advisory boards and consulting for Novartis, Horizon Pharma, SOBI, Protalix, and ANI., Ankoor Patel: None declared, Vinod Rustgi: None declared, Anthony Yeo: None declared, Peter Lipsky: None declared.

The halobacteria are the only organisms that are tolerant of salinity at the molecular level. All other bacteria, all fungi, all plants, and all animals avoid the need for salt tolerance for most of their macromolecules by maintaining defined and conserved conditions in the cytoplasm. These conditions favour potassium over sodium, the limitation of total inorganic ion activity, and the supplementation of this where necessary with organic solutes which are metabolically neutral osmolytes that may also be osmoprotectant. The salt tolerance of an organism depends upon the range of external salinity over which it is able to sustain these conditions in the cytoplasm. There is substantial and increasing knowledge of the molecular biology and molecular genetics of the processes of ion and organic solute transport, solute synthesis, and compartmentation that underpin cell-based tolerance. Much of recent research focuses on the identification of genes and gene products that affect cell-based tolerance, commonly derived from single-cell models. There is commonly the implicit or explicit assumption that incorporation of these genes will benefit the salt tolerance of food crop species. While this essential experimental approach is giving enormous insight there should not be rash or premature expectations. The unique and overriding consideration for the salinity tolerance of terrestrial plants is the net flux of water due to transpiration and so resides at a higher level of organization. Processes that are advantageous to a single cell in an aqueous medium may be lethal to a cell in a leaf in the air. The likely impact of single structural-gene changes in ion and solute transport upon co-ordinated plant response is probably overestimated, and recent views consider regulatory processes and multiple gene transfers. While the tech nical ability for plant transformation increases daily, the practicality of using transgenic plants in complex breeding programmes seems rarely to be given enough thought. If intervention at the molecular level is to lead to salt-tolerant crop plants then it will be essential to view this in the contexts of whole plants and of plant breeding. Recent indications that a relatively small number of quantitative trait loci (QTL) may govern complex physiological characters offer the most hope for the future.

Frailty and intrinsic capacity (IC) are distinct but interrelated constructs. Uncertainty remains regarding how they are related and interact to influence health outcomes. We aim to understand the relationship between frailty and IC by identifying subgroups based on frailty criteria and IC domains and studying one-year outcomes. We studied 200 independent community-dwelling older adults (mean age 67.9±7.9 years, Modified Barthel Index (MBI) score 99±2.6). Frailty was defined by modified Fried criteria. Scores (range: 0–2) were assigned to individual IC domains (cognition, psychological, locomotion, and vitality) to yield a total IC score of 8. To identify subgroups, two-step cluster analysis was performed with age, frailty and IC domains. Cluster associations with one-year outcomes (frailty, muscle strength (grip strength, repeated chair stand test), physical performance (gait speed, Short Physical Performance Battery), function (MBI) and quality-of-life (EuroQol (EQ)-5D)) were examined using multiple linear regression adjusted for age, gender and education. Three distinct clusters were identified — Cluster 1: High IC/Robust (N=74, 37%); Cluster 2: Intermediate IC/Prefrail (N=73, 36.5%); and Cluster 3: Low IC/Prefrail-Frail (53, 26.5%). Comparing between clusters, IC domains, cognition, depressive symptoms, nutrition, strength and physical performance were least impaired in Cluster 1, intermediate in Cluster 2 and most impaired in Cluster 3. At one year, the proportion transitioning to frailty or remaining frail was highest in Cluster 3 compared to Cluster 2 and Cluster 1 (39% vs 6.9% vs 2.8%, P<0.001). Compared to Cluster 1, Cluster 3 experienced greatest declines in grip strength (β=−4.1, P<.001), MBI (β=−1.24, P=0.045) and EQ-5D utility scores (β=−0.053, P=0.005), with Cluster 2 intermediate between Cluster 1 and Cluster 3. Amongst independent community-dwelling older adults, IC is complementary to frailty measures through better risk-profiling of one-year outcomes amongst prefrail individuals into intermediate and high-risk groups. The intermediate group merits follow-up to ascertain longer-term prognosis.