A 120,000-year long climate record from a NW-Greenland deep ice core at ultra-high resolution.

We report high resolution measurements of the stable isotope ratios of ancient ice (δ18O, δD) from the North Greenland Eemian deep ice core (NEEM, 77.45° N, 51.06° E). The record covers the period 8-130 ky b2k (y before 2000) with a temporal resolution of ≈0.5 and 7 y at the top and the bottom of the core respectively and contains important climate events such as the 8.2 ky event, the last glacial termination and a series of glacial stadials and interstadials. At its bottom part the record contains ice from the Eemian interglacial. Isotope ratios are calibrated on the SMOW/SLAP scale and reported on the GICC05 (Greenland Ice Core Chronology 2005) and AICC2012 (Antarctic Ice Core Chronology 2012) time scales interpolated accordingly. We also provide estimates for measurement precision and accuracy for both δ18O and δD.

Resolving the controls of water vapour isotopes in the Atlantic sector.

Stable water isotopes are employed as hydrological tracers to quantify the diverse implications of atmospheric moisture for climate. They are widely used as proxies for studying past climate changes, e.g., in isotope records from ice cores and speleothems. Here, we present a new isotopic dataset of both near-surface vapour and ocean surface water from the North Pole to Antarctica, continuously measured from a research vessel throughout the Atlantic and Arctic Oceans during a period of two years. Our observations contribute to a better understanding and modelling of water isotopic composition. The observations reveal that the vapour deuterium excess within the atmospheric boundary layer is not modulated by wind speed, contrary to the commonly used theory, but controlled by relative humidity and sea surface temperature only. In sea ice covered regions, the sublimation of deposited snow on sea ice is a key process controlling the local water vapour isotopic composition.

A global database of water vapor isotopes measured with high temporal resolution infrared laser spectroscopy.

The isotopic composition of water vapour provides integrated perspectives on the hydrological histories of air masses and has been widely used for tracing physical processes in hydrological and climatic studies. Over the last two decades, the infrared laser spectroscopy technique has been used to measure the isotopic composition of water vapour near the Earth's surface. Here, we have assembled a global database of high temporal resolution stable water vapour isotope ratios (δ18O and δD) observed using this measurement technique. As of March 2018, the database includes data collected at 35 sites in 15 Köppen climate zones from the years 2004 to 2017. The key variables in each dataset are hourly values of δ18O and δD in atmospheric water vapour. To support interpretation of the isotopologue data, synchronized time series of standard meteorological variables from in situ observations and ERA5 reanalyses are also provided. This database is intended to serve as a centralized platform allowing researchers to share their vapour isotope datasets, thus facilitating investigations that transcend disciplinary and geographic boundaries.

Stable isotopes in the atmospheric marine boundary layer water vapour over the Atlantic Ocean, 2012-2015.

The water vapour isotopic composition (1H216O, H218O and 1H2H16O) of the Atlantic marine boundary layer has been measured from 5 research vessels between 2012 and 2015. Using laser spectroscopy analysers, measurements have been carried out continuously on samples collected 10-20 meter above sea level. All the datasets have been carefully calibrated against the international VSMOW-SLAP scale following the same protocol to build a homogeneous dataset covering the Atlantic Ocean between 4°S to 63°N. In addition, standard meteorological variables have been measured continuously, including sea surface temperatures using calibrated Thermo-Salinograph for most cruises. All calibrated observations are provided with 15-minute resolution. We also provide 6-hourly data to allow easier comparisons with simulations from the isotope-enabled Global Circulation Models. In addition, backwards trajectories from the HYSPLIT model are supplied every 6-hours for the position of our measurements.

Surface-atmosphere decoupling limits accumulation at Summit, Greenland.

Despite rapid melting in the coastal regions of the Greenland Ice Sheet, a significant area (~40%) of the ice sheet rarely experiences surface melting. In these regions, the controls on annual accumulation are poorly constrained owing to surface conditions (for example, surface clouds, blowing snow, and surface inversions), which render moisture flux estimates from myriad approaches (that is, eddy covariance, remote sensing, and direct observations) highly uncertain. Accumulation is partially determined by the temperature dependence of saturation vapor pressure, which influences the maximum humidity of air parcels reaching the ice sheet interior. However, independent proxies for surface temperature and accumulation from ice cores show that the response of accumulation to temperature is variable and not generally consistent with a purely thermodynamic control. Using three years of stable water vapor isotope profiles from a high altitude site on the Greenland Ice Sheet, we show that as the boundary layer becomes increasingly stable, a decoupling between the ice sheet and atmosphere occurs. The limited interaction between the ice sheet surface and free tropospheric air reduces the capacity for surface condensation to achieve the rate set by the humidity of the air parcels reaching interior Greenland. The isolation of the surface also acts to recycle sublimated moisture by recondensing it onto fog particles, which returns the moisture back to the surface through gravitational settling. The observations highlight a unique mechanism by which ice sheet mass is conserved, which has implications for understanding both past and future changes in accumulation rate and the isotopic signal in ice cores from Greenland.

Stable isotopes in atmospheric water vapor and applications to the hydrologic cycle.

The measurement and simulation of water vapor isotopic composition has matured rapidly over the last decade, with long-term datasets and comprehensive modeling capabilities now available. Theories for water vapor isotopic composition have been developed by extending the theories that have been used for the isotopic composition of precipitation to include a more nuanced understanding of evaporation, large-scale mixing, deep convection, and kinetic fractionation. The technologies for in-situ and remote sensing measurements of water vapor isotopic composition have developed especially rapidly over the last decade, with discrete water vapor sampling methods, based on mass spectroscopy, giving way to laser spectroscopic methods and satellite- and ground-based infrared absorption techniques. The simulation of water vapor isotopic composition has evolved from General Circulation Model (GCM) methods for simulating precipitation isotopic composition to sophisticated isotope-enabled microphysics schemes using higher-order moments for water- and ice-size distributions. The incorporation of isotopes into GCMs has enabled more detailed diagnostics of the water cycle and has led to improvements in its simulation. The combination of improved measurement and modeling of water vapor isotopic composition opens the door to new advances in our understanding of the atmospheric water cycle, in processes ranging from the marine boundary layer, through deep convection and tropospheric mixing, and into the water cycle of the stratosphere. Finally, studies of the processes governing modern water vapor isotopic composition provide an improved framework for the interpretation of paleoclimate proxy records of the hydrological cycle.

Recurrence of Susac Syndrome following 23 Years of Remission.

Susac syndrome is an autoimmune microangiopathy affecting the brain, retina and inner ear (cochlea and semicircular canals), leading to encephalopathy, branch retinal artery occlusions (BRAOs) and asymmetric neurosensory hearing loss, respectively. The natural history and long-term prognosis are variable as the disease has been shown to be monophasic and self-limiting, polycyclic or chronic continuous. We describe a 35-year-old woman who presented with a sudden hearing loss in the left ear in the 37th week of her second pregnancy. She subsequently developed BRAO in the right eye 2.5 months after having given birth. MRI findings included round lesions in the corpus callosum which are pathognomonic for Susac syndrome. Previous patient records documented encephalopathy, sudden deafness of the right ear and visual field defects in the left eye at the age of 12, followed by permanent hearing and visual defects. We expand on the variability in the course of Susac syndrome as recurrence may occur after as long as 23 years. Cases of monophasic self-limiting Susac syndrome may in fact turn polycyclic with an interval of more than 2 decades between the bouts of the disease. In these cases, suspecting the development of exacerbation early is important in order to start the treatment promptly.

Cognitive behaviour therapy for hyperacusis: a randomized controlled trial.

Hyperacusis, defined as unusual intolerance to ordinary environmental sounds, is a common problem for which there are no controlled trials on psychological treatment. Given the avoidance strategies present in hyperacusis, and similarities with problems such as tinnitus and chronic pain, cognitive behaviour therapy (CBT) is hypothesized to be helpful for patients with hyperacusis. In this randomized controlled study of 60 patients with hyperacusis, CBT was compared with a waiting list control group using the Loudness Discomfort Level test (LDL), the Hyperacusis Questionnaire, the Hospital Anxiety and Depression Scales, the Quality of Life Inventory and an adapted version of the Tampa Scale of Kinesiophobia. There were significant between-group effects in favour of the CBT group on all measures except for the HADS anxiety scale. Between-group effect sizes were moderate to high, with Cohen's d = 0.67 and 0.69 per ear, respectively, for the primary measure LDL, and ranging from d = 0.32 to 1.36 for the secondary measures. The differences between groups ceased to exist when the waiting list group was treated later with CBT, and the treatment results were largely maintained after 12 months. In conclusion, CBT is a promising treatment for hyperacusis, although more research is necessary.

Internet-based cognitive behaviour therapy for tinnitus patients delivered in a regular clinical setting: outcome and analysis of treatment dropout.

Cognitive behaviour therapy (CBT) can reduce tinnitus distress but is not available for most patients. Therapist guided, internet-based CBT (ICBT) increase availability and has been shown to be effective. However, the initial positive results need to be replicated in larger samples, and treatment dropout has not been thoroughly studied. Moreover, it has not been evaluated if a low-intensity version of ICBT without therapist contact could be an alternative for patients who do not need or are able to manage the full ICBT-program. This study evaluated two parallel interventions delivered in regular care: ICBT for tinnitus distress (n = 293) and a low-intensity version of ICBT (n = 81) for patients with lower levels of tinnitus distress. We also explored predictors of dropout from ICBT and if dropout influences outcome. Tinnitus Reaction Questionnaire (Wilson, Henry, Bowen, & Haralambous, 1991) was used as the primary outcome. Secondary outcomes were measures of depression, anxiety, sleep, and sound sensitivity. Significant reductions following ICBT were found on all measures after treatment and also at a three-month follow-up. Patients receiving low-intensity ICBT showed a significant reduction in distress, even when they had low levels of distress initially. Treatment dropout was preceded by an increase in days spent at each treatment step but not by an increased distress. Early dropout was related to worse outcome. ICBT can be used in a regular clinical setting to reduce tinnitus distress. Early dropouts may need additional management. For help-seeking patients with lower distress, a low-intensity version of ICBT can be used.

Psychiatric comorbidity and personality traits in patients with hyperacusis.

OBJECTIVE: Hyperacusis, defined as unusual intolerance of ordinary environmental sounds, is a common problem. In spite of this, there is limited understanding of the underlying mechanisms. We hypothesized that individuals with hyperacusis would be prone to suffer from psychiatric disorders, related in particular to anxiety. Therefore, psychiatric morbidity and personality traits were investigated, along with different sociodemographic and clinical characteristics. DESIGN: Patients were assessed with a clinical interview related to symptoms of hyperacusis, the Mini-international neuropsychiatric interview (MINI), and the Swedish Universities scales of Personality (SSP) to study psychiatric disorders and personality traits. STUDY SAMPLE: A group of 62 Swedish patients with hyperacusis between 18 and 61 years (mean 40.2, SD 12.2) was included. RESULTS: Altogether 56% of the patients had at least one psychiatric disorder, and 47% had an anxiety disorder. Also, personality traits related to neuroticism were over-represented. A majority, 79%, suffered from comorbid tinnitus, and a similar proportion used measures to avoid noisy environments. CONCLUSIONS: The over-representation of anxiety disorders and anxiety-related personality traits in patients with hyperacusis suggests common or cooperating mechanisms. Cognitive behavioural treatment strategies, proven efficient in treating anxiety, may be indicated and are suggested for further studies.

Tibolone low dose (1.25 mg/d) therapy and postural balance in elderly women.

UNLABELLED: Most hip fractures occur in subjects without osteoporosis and are associated with a fall. Conventional menopausal hormone therapy (HT) improves postural balance, which might explain the rapid reduction in hip fracture risk. It is unclear whether tibolone improves postural balance, which might determine its effects on peripheral fracture risk. OBJECTIVE: To study the short-term effects of low-dose tibolone therapy on postural balance in elderly women. METHODS: Eighty healthy women (70 evaluable), aged 60 years or more, were recruited through advertising in the local media. They were randomly allocated to receive either tibolone (1.25 mg/d) or placebo for 6 months. Postural balance was assessed as sway velocity, using a force platform. RESULT(S): Baseline characteristics, including serum estradiol values and postural balance, were similar in the two study groups. On average, the overall dosing compliance was very high, over 97% in both groups. After 6 months, sway velocity had decreased (improved) by 7.6% (-0.97 cm/s; P=0.16 vs. baseline) in the tibolone arm and by 2.5% (-0.30 cm/s; P=0.59 vs. baseline) in the placebo group. The difference 0.67 cm/s was not statistically significant (95% CI -2.44, 1.10; P=0.45). Adjustments for age, serum estradiol level and variable value at baseline, revealed similar results. CONCLUSIONS: Short-term treatment with tibolone (1.25 mg/d), compared to placebo, did not significantly affect postural balance function in elderly women.

Internet versus group cognitive-behavioral treatment of distress associated with tinnitus: a randomized controlled trial.

Tinnitus distress can be reduced by means of cognitive-behavior therapy (CBT), and the treatment can be delivered in different ways. The most recent format is Internet-based self-help. The aim of this study was to compare this treatment (n= 26) with standard group-based CBT (n=25) in a randomized controlled trial. Outcomes on self-report inventories measuring tinnitus distress were evaluated immediately after and 1 year after treatment. Results showed that both groups had improved, and there were few differences between them. The effect size for the Internet treatment was d=0.73 (95% CI=0.16-1.30) and for the group treatment was d=0.64 (95% CI=0.07-1.21). The Internet treatment consumed less therapist time and was 1.7 times as cost-effective as the group treatment. At pretreatment patients rated the Internet treatment as less credible than the group treatment. In conclusion, Internet treatment for tinnitus distress merits further investigation, as the outcomes achieved are promising.

Use of a self-help book with weekly therapist contact to reduce tinnitus distress: a randomized controlled trial.

OBJECTIVE: Tinnitus distress can be reduced by means of cognitive-behavior therapy (CBT). To compensate for the shortage of CBT therapists, we aimed, in this study, to investigate the effects of a CBT-based self-help book guided by brief telephone support. METHODS: Seventy-two patients were randomized either to a self-help book and seven weekly phone calls or to a wait-list control condition, later on receiving the self-help book with less therapist support. The dropout rate was 7%. Follow-up data 1 year after completion of treatment were also collected (12% dropout). The Tinnitus Reaction Questionnaire (TRQ) was the main outcome measure, complemented with daily ratings of tinnitus and measures of insomnia, anxiety, and depression. RESULTS: On the TRQ, significant reductions were found in the treatment group both immediately following treatment and at 1-year follow-up. In the treatment group, 32% reached the criteria for clinical significance (at least 50% reduction of the TRQ) compared to 5% in the wait-list group. Directly after treatment, two out of five measures showed significant differences in favor of the treatment with more therapist support compared with the group who, after their waiting period, received little therapist support. The self-help treatment was estimated to be 2.6 (seven phone calls) and 4.8 (one phone call) times as cost-effective as regular CBT group treatment. CONCLUSIONS: Guided self-help can serve as an alternative way to administer CBT for tinnitus. Preliminary results cast some doubts on the importance of weekly therapist contact. The effect size was somewhat smaller than for regular CBT, but on the other hand, the self-help seems far more cost-effective. Future studies should compare treatment modalities directly and explore cost-effectiveness more thoroughly.

Hormone therapy and postural balance in elderly women.

OBJECTIVE: Most fractures occur in elderly individuals without osteoporosis, and more than 90% of all hip fractures are associated with a fall. It is unclear whether hormone therapy (HT) can improve postural balance when initiated in elderly women and the effect of endogenous estradiol (E2) levels. DESIGN: Forty healthy women (33 assessable), age 60 years or older, were recruited through advertising in the local media. They were randomly and blindly assigned to receive either estradiol patches (50 microg/24 h) combined with oral medroxyprogesterone acetate (2.5 mg/d) or placebo for 6 months. Postural balance was assessed as sway velocity using a force platform. RESULTS: Low serum E2 levels were associated with greater impairment of sway velocity during the study in the placebo group. After 6 months sway velocity had improved (decreased) in the HT group by 4.3% from baseline and increased in the placebo group by 6.2%. The difference was not significant (1.30 cm/s, 95% CI: -3.0 to 0.4; P = 0.13). However, among women with low serum E2 levels at baseline (less than the median, 35 pmol/L), sway velocity improved in the HT group and deteriorated in the placebo group with a difference of 23% (2.9 cm/s, 95% CI: 0.6-5.1; P = 0.013). There were similar results after adjustment for baseline sway velocity (P = 0.003) and in the intention-to-treat analysis (P = 0.023). There was also a significant interaction between the study group and baseline serum E2 levels with regard to changes in sway velocity (P = 0.014). CONCLUSIONS: In elderly women low endogenous serum E2 levels were associated with greater impairment of postural balance function during the study, whereas HT, as compared with placebo, improved postural balance in women with low serum E2 levels.

Early postmenopausal hormone therapy improves postural balance.

OBJECTIVE: Postmenopausal hormone therapy (HT) results in more substantial reductions in the risk of hip fracture when initiated sooner rather than later after menopause. We studied the effects of postmenopausal HT on the postural balance of postmenopausal women, with further assessment according to the time since they achieved menopause. DESIGN: One hundred women with a mean age of 52.5 years (91 evaluable) were randomly and blindly assigned to either a sequential estradiol-norethisterone acetate regimen or placebo for 3 months, after which all participants received open HT for a further 3 months. Postural balance was assessed as sway velocity using a force platform. RESULTS: After 3 months of HT, sway velocity had improved (decreased) from baseline by 7.0% (P = 0.007 vs baseline and P = 0.038 vs placebo). Continued HT for 6 months further improved sway velocity by 12% from baseline (P < 0.0001) to reach values similar to those historically found in younger women or in postmenopausal women after long-term HT. Closer proximity to menopause and more pronounced increases in serum estradiol values were associated with stronger improvements in sway velocity (P = 0.018 for interaction). HT also improved dizziness (P = 0.016 vs baseline and 0.022 vs placebo). (Nonparametric statistics are used throughout, except for analyses of interaction and dizziness.) CONCLUSIONS: Initiation of HT soon after menopause rapidly improved postural balance to levels normally seen in young women. We suggest that improved postural balance can contribute to the protection against fractures associated with HT and explain the more substantial reduction in hip fracture risk after HT initiated sooner, compared with later, after menopause. Further study is required to confirm these results.

Familial Ménière's disease in five generations.

OBJECTIVE: Clinical characterization of a Swedish family followed for five generations. Several members of each generation had Ménière's disease (MD). Possible modes of genetic transmission were assessed. STUDY DESIGN: Retrospective family survey. SETTING: University hospital. Tertiary referral center. PATIENTS: Members of a large family in which several members in each generation were affected by MD. INTERVENTIONS: Hearing levels were assessed, and the patients were asked to complete a questionnaire regarding age at onset, hearing loss, tinnitus, aural fullness, vertigo, and if MD was unilateral or bilateral. Glycerol tests were performed in a few cases. For deceased relatives, information was obtained from patient charts and interviews with relatives. Genetic studies with linkage analysis was performed for the loci DFNA 1, DFNA6/14, DFNA9, and DFNA15. RESULTS: One member of Generation I and, according to patient charts, two members of Generation II could have suffered from MD. In Generations III to V, 9 of 25 members developed inner ear dysfunction. Six of these individuals developed MD that was strictly in accordance with American Academy of Otolaryngology and Head and Neck Surgery, 1995 guidelines criteria, whereas three individuals had unilateral or bilateral hearing impairment, one in combination with benign paroxysmal positioning vertigo, which could represent an incomplete expression of the disease. The mean age at disease onset was 64.5 years in Generation III, 43 years in Generation IV, and 25 years in Generation V. In the genetic studies, none of the regions investigated showed linkage to the disease gene with a significant calculated log of odds ratio (LOD) score above three. CONCLUSION: The pattern of inheritance suggested that familial MD was autosomal dominant and exhibited incomplete expression of inner ear symptoms in some affected members. The decreasing age at onset of disease with succeeding generations could indicate anticipation. None of the hitherto-known DFNA loci, which has phenotypes bearing some resemblance to MD, had haplotypes in common with this large family affected by MD.

A controlled trial of cognitive-behavior therapy combined with vestibular rehabilitation in the treatment of dizziness.

Dizziness is a common and often untreated symptom in the general population. The aim of this study was to investigate the effects of a combined cognitive-behavioral/vestibular rehabilitation (VR) program, using a randomized control design. A total of 29 participants were randomized to treatment consisting of psychoeducation, vestibular exercises, relaxation and cognitive interventions, or to serve as waiting list controls. Measures of dizziness-related handicap, dizziness-provoking movements, and daily diary registrations of dizziness symptoms at pre- and post-treatment showed statistically significant improvements in many domains, which translated to moderate effect sizes. These findings provide preliminary support for the combination of Cognitive-behavioral therapy (CBT) and VR methods in the treatment of dizziness.

Treatment of tinnitus in the elderly: a controlled trial of cognitive behavior therapy.

The aim of the study was to investigate the effects of cognitive behavioral therapy (CBT) in elderly people with tinnitus (<65 years). Thirty-seven patients were called in for a structured interview. Following exclusion, twenty-three participated in the trial. All participants underwent medical ear, nose, and throat (ENT) examination, audiometry, and tinnitus matchings. A randomized controlled design with a waiting list control group was used. A CBT treatment package was delivered in six weekly two hour group sessions. Outcome was measured using validated self-report inventories and daily diary ratings of annoyance, loudness and sleep quality for one week pretreatment, post-treatment. A three month follow-up was included at which time all participants had received treatment, but in a shorter format for the control group. Results showed statistically significant reductions of tinnitus-related distress. Thus, CBT was better than no treatment, but the particular aspects of CBT that contributed to the effects can not be established. In conclusion, the findings give some support for the use of group CBT for elderly people with tinnitus.

[Hyperacusis--an unexplored field. Cognitive behavior therapy can relieve problems in auditory intolerance, a condition with many questions]. / Hyperakusi--ett outforskat område. Kognitiv beteendeterapi kan lindra besvären vid ijudöverkänslighet, ett tillstånd med många frågetecken.

Hyperacusis is defined as unusual intolerance to ordinary environmental sounds, and is commonly reported in the general population and in association with a range of medical conditions. These include neurological deficits (e.g. migraine), psychiatric conditions (e.g. depression), and several ear, nose and throat diagnoses such as tinnitus, noise-induced hearing loss, and middle ear malfunctions. However, extreme sensitivity to noise has also been studied from a public health perspective, but with a focus on noise sensitivity in general. In this review a distinction is proposed between three different aspects of the experience of hyperacusis. The first is the sensitivity, with the pain sensations reported in association with sounds. The second is the annoyance, which can be unrelated to loudness, but still cause marked distress. The third aspect deals with the fear of being harmed by sounds, which promotes avoidance and the unmotivated use of ear protection. The natural course of hyperacusis is largely unknown and there are no published randomized outcome studies on the available treatment options for the condition. In this paper we propose that cognitive behavioral therapy, presented in a multidisciplinary setting, could be a useful treatment. This treatment includes relaxation methods, advice regarding sound, and gradual exposure to everyday sounds.