Multiple transpolar auroral arcs reveal insight about coupling processes in the Earth's magnetotail.

A distinct class of aurora, called transpolar auroral arc (TPA) (in some cases called "theta" aurora), appears in the extremely high-latitude ionosphere of the Earth when interplanetary magnetic field (IMF) is northward. The formation and evolution of TPA offers clues about processes transferring energy and momentum from the solar wind to the magnetosphere and ionosphere during a northward IMF. However, their formation mechanisms remain poorly understood and controversial. We report a mechanism identified from multiple-instrument observations of unusually bright, multiple TPAs and simulations from a high-resolution three-dimensional (3D) global MagnetoHydroDynamics (MHD) model. The observations and simulations show an excellent agreement and reveal that these multiple TPAs are generated by precipitating energetic magnetospheric electrons within field-aligned current (FAC) sheets. These FAC sheets are generated by multiple-flow shear sheets in both the magnetospheric boundary produced by Kelvin-Helmholtz instability between supersonic solar wind flow and magnetosphere plasma, and the plasma sheet generated by the interactions between the enhanced earthward plasma flows from the distant tail (less than -100 RE) and the enhanced tailward flows from the near tail (about -20 RE). The study offers insight into the complex solar wind-magnetosphere-ionosphere coupling processes under a northward IMF condition, and it challenges existing paradigms of the dynamics of the Earth's magnetosphere.

Deaths and Severe Adverse Events after the use of Mifepristone as an Abortifacient from September 2000 to February 2019.

OBJECTIVES: Primary: Analyze the Adverse Events (AEs) reported to the Food and Drug Administration (FDA) after use of mifepristone as an abortifacient. Secondary: Analyze maternal intent after ongoing pregnancy and investigate hemorrhage after mifepristone alone. METHODS: Adverse Event Reports (AERs) for mifepristone used as an abortifacient, submitted to the FDA from September 2000 to February 2019, were analyzed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAEv3). RESULTS: The FDA provided 6158 pages of AERs. Duplicates, non-US, or AERs previously published (Gary, 2006) were excluded. Of the remaining, there were 3197 unique, US-only AERs of which there were 537 (16.80%) with insufficient information to determine clinical severity, leaving 2660 (83.20%) Codable US AERs. (Figure 1). Of these, 20 were Deaths, 529 were Life-threatening, 1957 were Severe, 151 were Moderate, and 3 were Mild.The deaths included: 9 (45.00%) sepsis, 4 (20.00%) drug toxicity/overdose, 1 (5.00%) ruptured ectopic pregnancy, 1 (5.00%) hemorrhage, 3 (15.00%) possible homicides, 1 (5.00%) suicide, 1 (5.00%) unknown. (Table 1).Retained products of conception and hemorrhage caused most morbidity. There were 75 ectopic pregnancies, including 26 ruptured ectopics (includes one death).There were 2243 surgeries including 2146 (95.68%) D&Cs of which only 853 (39.75%) were performed by abortion providers.Of 452 patients with ongoing pregnancies, 102 (22.57%) chose to keep their baby, 148 (32.74%) had terminations, 1 (0.22%) miscarried, and 201 (44.47%) had unknown outcomes.Hemorrhage occurred more often in those who took mifepristone and misoprostol (51.44%) than in those who took mifepristone alone (22.41%). CONCLUSIONS: Significant morbidity and mortality have occurred following the use of mifepristone as an abortifacient. A pre-abortion ultrasound should be required to rule out ectopic pregnancy and confirm gestational age. The FDA AER system is inadequate and significantly underestimates the adverse events from mifepristone.A mandatory registry of ongoing pregnancies is essential considering the number of ongoing pregnancies especially considering the known teratogenicity of misoprostol.The decision to prevent the FDA from enforcing REMS during the COVID-19 pandemic needs to be reversed and REMS must be strengthened.

Precipitation Modification by Ionization.

Rainfall is hypothesized to be influenced by droplet charge, which is related to the global circuit current flowing through clouds. This is tested through examining a major global circuit current increase following the release of artificial radioactivity. Significant changes occurred in daily rainfall distribution in the Shetland Islands, away from pollution. Daily rainfall changed by 24%, and local clouds optically thickened, within the nuclear weapons test period. This supports expectations of electrically induced microphysical changes in liquid water clouds from additional ionization.

Pilot study utilizing MRI 3D TGSE PASL (arterial spin labeling) differentiating clearance rates of labeled protons in the CNS of patients with early Alzheimer disease from normal subjects.

OBJECTIVE: To determine the feasibility of 3D TGSE PASL MRI with long inversion times to estimate CNS perfusion clearance, comparing normals to Alzheimer disease patients. METHODS: This pilot study used 3D TGSE PASL MRI with long TIs to estimate the signal clearance of labeled blood/ultra-filtrate (CSF) from brain signal averages of seven inversion times (TI) from six regions of the brain in 18 normal subjects of ages 18-70 years before and after exercise. Arterial pulse corrected signal average per TI versus TI was plotted. The slope (linear regression) indicated the clearance rate. Three subjects with mild Alzheimer disease (AD) were studied pre-exercise only. RESULTS: In normals, signal decay rate variance among brain regions, age groups and post-exercise failed to demonstrate statistical significance except in middle-age group pre- to post-exercise-dominant temporal lobe. We found highly statistically significant reduced signal clearance rate in the AD group. DISCUSSION: Signal decay in normal age groups correlates with decay of T1blood, thus CSF paravascular flow egresses and is inseparable from venous outflow. The AD group correlates with decay rate T1CSF, indicating a proportion of labeled blood ultra-filtered within the brain (paravascular fluid) is retained. This provides indirect evidence of reduced paravascular clearance in AD. Further development may produce an efficient biomarker identifying neurodegenerative diseases and future treatment efficacy.

Scenario analysis for biodiversity conservation: a social-ecological system approach in the Australian Alps.

Current policy interventions are having limited success in addressing the ongoing decline in global biodiversity. In part, this is attributable to insufficient attention being paid to the social and governance processes that drive decisions and can undermine their implementation. Scenario planning that draws on social-ecological systems (SES) analysis provides a useful means to systematically explore and anticipate future uncertainties regarding the interaction between humans and biodiversity outcomes. However, the effective application of SES models has been limited by the insufficient attention given to governance influences. Understanding the influence governance attributes have on the future trajectory of SES is likely to assist choice of effective interventions, as well as needs and opportunities for governance reform. In a case study in the Australian Alps, we explore the potential of joint SES and scenario analyses to identify how governance influences landscape-scale biodiversity outcomes. Novel aspects of our application of these methods were the specification of the focal system's governance attributes according to requirements for adaptive capacity, and constraining scenarios according to the current governance settings while varying key social and biophysical drivers. This approach allowed us to identify how current governance arrangements influence landscape-scale biodiversity outcomes, and establishes a baseline from which the potential benefits of governance reform can be assessed.

Divergent stakeholder views of corporate social responsibility in the Australian forest plantation sector.

Although the Australian forest plantation industry acknowledges that there is a role for corporate social responsibility (CSR) in forest management, there is confusion as to what this constitutes in practice. This paper describes the conflicts between internal and external stakeholder views on CSR in plantation forestry. We conducted in-depth interviews with key informants across three plantation management regions in Australia: Tasmania, the Green Triangle and south-west Western Australia. We interviewed a range of stakeholders including forest company employees, local councils, Indigenous representatives, and environmental non-government organisations. CSR-related initiatives that stakeholders believed were important for plantation management included the need for community engagement, accountability towards stakeholders, and contribution to community development and well-being. Although there was wide support for these initiatives, some stakeholders were not satisfied that forest companies were actively implementing them. Due to the perception that forest companies are not committed to CSR initiatives such as community engagement, some stakeholder expectations are not being satisfied.

Integrated Osteopathic-Neurologic Examinations With Musculoskeletal Treatment: The ONE Approach.

The global burden of neurologic disorders is a leading cause of disability and death worldwide and has increased the demand for treatments and rehabilitation. Our proposed integrated osteopathic-neurologic examination (ONE) provides the physician with expanded diagnostic and point-of-care treatment modalities while allowing the physician to make a more tangible effect in patient care. By incorporating the osteopathic structural somatic examination with the complete neurologic evaluation, somatic dysfunction, occurring as a consequence or independent of neurologic injury, can be identified and treated using osteopathic manipulative techniques at time of visit. Using the proposed integrated examination, the physician can determine the interplay between structural and neurologic findings to identify patterns of change that coincide with more specific diagnoses and the chronicity of a condition. Tangible benefits from the ONE approach translate to more accurate clinical assessment and enhanced patient and physician satisfaction.

A functional folate receptor is induced during macrophage activation and can be used to target drugs to activated macrophages.

Previous work has demonstrated that a subset of macrophages expresses a folate receptor (FR) that can mediate internalization of folate-linked molecules, including imaging and therapeutic agents. To characterize this subset, macrophages were collected from peritoneal cavities of mice injected with saline, thioglycolate, zymosan, heat-killed or live bacteria, and cell-surface markers that coexpress with FR were identified. Virtually no F4/80(+) peritoneal macrophages from saline-injected mice expressed FR, whereas numerous macrophages from mice injected with each inflammatory stimulus expressed FR. Examination of cell differentiation antigens that are up-regulated in FR(+) macrophages revealed markers characteristic of an activated state (CD80, CD86, Ly-6C/G), whereas macrophages lacking these activation markers expressed few or no FR. FR(+) macrophages also produced tumor necrosis factor-alpha (TNF-alpha) and reactive oxygen species, and production of reactive oxygen species correlated linearly with expression of FR. Synovial macrophages collected from arthritic patients were found to bind and internalize folate-linked dyes. Moreover, a folate-linked radioimaging agent was shown to image inflamed joints of rheumatoid arthritic patients. These results suggest that FR constitutes a marker for macrophage activation and that FR(+) macrophages can be targeted with folate-linked drugs without promoting drug uptake by nonactivated macrophages. This trial was registered at www.clinicaltrials.gov as #NCT00588393.

A space hurricane over the Earth's polar ionosphere.

In Earth's low atmosphere, hurricanes are destructive due to their great size, strong spiral winds with shears, and intense rain/precipitation. However, disturbances resembling hurricanes have not been detected in Earth's upper atmosphere. Here, we report a long-lasting space hurricane in the polar ionosphere and magnetosphere during low solar and otherwise low geomagnetic activity. This hurricane shows strong circular horizontal plasma flow with shears, a nearly zero-flow center, and a coincident cyclone-shaped aurora caused by strong electron precipitation associated with intense upward magnetic field-aligned currents. Near the center, precipitating electrons were substantially accelerated to ~10 keV. The hurricane imparted large energy and momentum deposition into the ionosphere despite otherwise extremely quiet conditions. The observations and simulations reveal that the space hurricane is generated by steady high-latitude lobe magnetic reconnection and current continuity during a several hour period of northward interplanetary magnetic field and very low solar wind density and speed.

Good governance for terrestrial protected areas: A framework, principles and performance outcomes.

Governing norms by which to steer traditional government functions are well established and understood; however, this is not the case for the new multi-level and collaborative approaches that characterize protected area governance. This is largely new territory that makes novel demands on governance institutions and policy. In this context, establishing and maintaining good governance across the diversity of ownership and responsibility arrangements is critical for the future effectiveness and acceptability of protected areas. Fulfilling the promise and avoiding the pitfalls inherent in contemporary protected area governance will require an understanding of what is meant by 'good governance' and development of associated mechanisms to assess performance and provide a basis for improvement. This paper's contribution lies in the guidance it provides for the hitherto under-developed area of governance quality assessment. I first present a framework that positions governance quality in relation to governance and management effectiveness. I then characterize good protected area governance according to a set of seven principles - legitimacy, transparency, accountability, inclusiveness, fairness, connectivity and resilience. Together, the framework, governance principles and related performance outcomes provide a platform for assessment of governance quality for an individual terrestrial protected area, a network of several protected areas, or a national protected area system.

Hourly weather observations from the Scottish Highlands (1883-1904) rescued by volunteer citizen scientists.

Weather observations taken every hour during the years 1883-1904 on the summit of Ben Nevis (1345 m above sea level) and in the town of Fort William in the Scottish Highlands have been transcribed from the original publications into digital form. More than 3,500 citizen scientist volunteers completed the digitization in less than 3 months using the http://WeatherRescue.org website. Over 1.5 million observations of atmospheric pressure, wet- and dry-bulb temperatures, precipitation and wind speed were recovered. These data have been quality controlled and are now made openly available, including hourly values of relative humidity derived from the digitized dry- and wet-bulb temperatures using modern hygrometric algorithms. These observations are one of the most detailed weather data collections available for anywhere in the UK in the Victorian era. In addition, 374 observations of aurora borealis seen by the meteorologists from the summit of Ben Nevis have been catalogued and this has improved the auroral record for studies of space weather.

Localization of multiple acoustic sources with small arrays using a coherence test.

Direction finding of more sources than sensors is appealing in situations with small sensor arrays. Potential applications include surveillance, teleconferencing, and auditory scene analysis for hearing aids. A new technique for time-frequency-sparse sources, such as speech and vehicle sounds, uses a coherence test to identify low-rank time-frequency bins. These low-rank bins are processed in one of two ways: (1) narrowband spatial spectrum estimation at each bin followed by summation of directional spectra across time and frequency or (2) clustering low-rank covariance matrices, averaging covariance matrices within clusters, and narrowband spatial spectrum estimation of each cluster. Experimental results with omnidirectional microphones and colocated directional microphones demonstrate the algorithm's ability to localize 3-5 simultaneous speech sources over 4 s with 2-3 microphones to less than 1 degree of error, and the ability to localize simultaneously two moving military vehicles and small arms gunfire.

Observations of the step-like accelerating processes of cold ions in the reconnection layer at the dayside magnetopause.

Cold ions of plasmaspheric origin have been observed to abundantly appear in the magnetospheric side of the Earth's magnetopause. These cold ions could affect the magnetic reconnection processes at the magnetopause by changing the Alfvén velocity and the reconnection rate, while they could also be heated in the reconnection layer during the ongoing reconnections. We report in situ observations from a partially crossing of a reconnection layer near the subsolar magnetopause. During this crossing, step-like accelerating processes of the cold ions were clearly observed, suggesting that the inflow cold ions may be separately accelerated by the rotation discontinuity and slow shock inside the reconnection layer.

Innovative approach to teaching osteopathic manipulative medicine: the integration of ultrasonography.

CONTEXT: Noninvasive diagnostic methods and palpatory physical examination skills are especially important for osteopathic medical students intending to work in rural, underresourced, or underserved areas. The A.T. Still University-Kirksville College of Osteopathic Medicine integrates ultrasonography into the osteopathic manipulative medicine (OMM) courses required during the first 2 years of medical school, allowing students to learn the technology and to visualize anatomical structures and regions. OBJECTIVE: To assess the feasibility of integrating ultrasonography into the first-year and second-year OMM curriculum through the evaluation of students' success in demonstrating the technology and visualizing the anatomy. METHODS: As part of their OMM requirements at the A.T. Still University-Kirksville College of Osteopathic Medicine, all first- and second-year students in OMM courses were given ultrasonography assignments that required them to obtain images of musculoskeletal structures in different regions of the body. First-year students studied craniocervical structures and the thoracic, lumbar, and sacral regions. Second-year students studied the glenohumeral joint and the suprapatellar recess. The assignments focused on identifying structures of interest, making annotations, and measuring the structures of interest. Handouts with detailed instructions and a demonstration were provided before each assignment. RESULTS: A total of 183 first-year students and 165 second-year students participated. Of the first-year students, on average, 177 of 181 were able to successfully complete the assignments, with an average completion rate of 98%. The costotransverse joint assignment yielded the lowest completion rate (97%), and the craniocervical landmarks assignment had the highest completion rate (99%). Of the second-year students, 162 of 165 participants were able to successfully complete the assignments, with an average completion rate of 98%. Mean scores were the same for both second-year assignments. CONCLUSION: First-year and second-year osteopathic medical students successfully demonstrated their use and understanding of ultrasonography and found their assigned structures using live ultrasound imaging. The skills gained through these assignments added another dimension to students' understanding of normal and pathologic musculoskeletal anatomy and vasculature. The integration of ultrasonography into OMM courses may have created a foundation for learning ultrasound-guided injection techniques.

Feasibility of Using Ultrasonography to Establish Relationships Among Sacral Base Position, Sacral Sulcus Depth, Body Mass Index, and Sex.

CONTEXT: Identifying relationships among anatomical structures is key in diagnosing somatic dysfunction. Ultrasonography can be used to visualize anatomical structures, identify sacroiliac landmarks, and validate anatomical findings and measurements in relation to somatic dysfunction. As part of the osteopathic manipulative medicine course at A.T. Still University-Kirksville College of Osteopathic Medicine, first-year students are trained to use ultrasonography to establish relationships among musculoskeletal structures. OBJECTIVES: To determine the ability of first-year osteopathic medical students to establish sacral base position (SBP) and sacral sulcus depth (SSD) using ultrasonography and to identify the relationship of SBP and SSD to body mass index (BMI) and sex. METHODS: Students used ultrasonography to obtain the distance between the skin and the sacral base (the SBP) and the distance between the skin and the tip of the posterior superior iliac spine bilaterally. Next, students calculated the SSD (the distance between the tip of the posterior superior iliac spine and the SBP). Data were analyzed with respect to side of the body, BMI, sex, and age. The BMI data were subdivided into normal (18-25 mg/kg) and overweight (25-30 mg/kg) groups. RESULTS: Ultrasound images of 211 students were included in the study. The SBP was not significantly different between the left and right sides (36.5 mm vs 36.5 mm; P=.95) but was significantly different between normal and overweight BMI categories (33.0 mm vs 40.0 mm; P<.001) and between men and women (34.1 mm vs 39.0 mm; P<.001). The SSD was not significantly different between left and right sides (18.9 mm vs 19.8 mm; P=.08), normal and overweight BMI categories (18.9 mm vs 19.7 mm, P=.21), or men and women (19.7 mm vs 19.0 mm; P=.24). No significant relationship was identified between age and SBP (P=.46) or SSD (P=.39); however, the age range was narrow (21-33 years). CONCLUSION: The study yielded repeatable and reproducible results when establishing SBP and SSD using ultrasonography. The statistically significant relationship between SBP and higher BMI and between SBP and female sex may point to more soft tissue overlaying the sacrum in these groups. Further research is needed on the use of ultrasonography to establish criteria for somatic dysfunction.

Incidence of Somatic Dysfunction in Healthy Newborns.

CONTEXT: Recent evidence suggests that osteopathic manipulative treatment of somatic dysfunction in newborns may decrease complications and hospital length of stay. Such dysfunction may result from external forces related to the birth process, but its incidence is unknown. OBJECTIVE: To identify the incidence and patterns of somatic dysfunction in healthy newborns at least 6 hours after birth and to correlate those findings with maternal and labor history, gestational age, and findings of the initial newborn assessment performed immediately after birth. METHODS: Healthy newborns aged 6 to 72 hours were physically examined and assessed for somatic dysfunction, including asymmetry and motion restriction of the cranial, cervical, lumbar, and sacral regions. The total somatic dysfunction identified was summarized in a somatic dysfunction severity score (SDSS), calculated by assigning 1 point for each identified finding; the SDSS could range from 0 (no somatic dysfunction) to 34 (all somatic dysfunctions assessed present). Findings were correlated with maternal and newborn characteristics and labor history. Descriptive analyses were performed, and findings were compared between the initial newborn assessment and the research examination. RESULTS: One hundred newborns were examined (mean gestational age, 38.5 weeks). In 99 newborns (99%), at least 1 sphenobasilar synchondrosis strain pattern was present, with sidebending rotations being the most common (present in 63 newborns [63%]). Condylar compression was found in 95 newborns (95%), temporal bone restrictions in 85 (85%), motion restriction of at least 1 cervical vertebral segment in 91 (91%) and at least 1 lumbar vertebral segment in 94 (94%), and a posterior sacral base in 80 (80%). The SDSS was not associated with mode of delivery or labor augmentation (P=.49 and P=.54, respectively), but it was positively associated with the duration of labor; each 1-hour increase in labor increased the predicted SDSS by 0.12 points (P=.04). CONCLUSION: Somatic dysfunction of the cranial, cervical, lumbar, and sacral regions was common in healthy newborns, and the total somatic dysfunction (SDSS) was related to the length of labor. (ClinicalTrials.gov number NCT01496872).

Osteopathic manipulative treatment in prenatal care: a retrospective case control design study.

The use of osteopathic manipulative treatment (OMT) during pregnancy has a long tradition in osteopathic medicine. A retrospective study was designed to compare a group of women who received prenatal OMT with a matched group that did not receive prenatal OMT. The medical records of 160 women from four cities who received prenatal OMT were reviewed for the occurrence of meconium-stained amniotic fluid, preterm delivery, use of forceps, and cesarean delivery. The randomly selected records of 161 women who were from the same cities, but who did not receive prenatal OMT, were reviewed for the same outcomes. The results of a logistic regression analysis were statistically reliable, chi2 (4, N = 321) = 26.55; P < .001, indicating that the labor and delivery outcomes, as a set, were associated with whether OMT was administered during pregnancy. According to the Wald criterion, prenatal OMT was significantly associated with meconium-stained amniotic fluid (Z = 13.20, P < .001) and preterm delivery (Z = 9.91; P < .01), while the use of forceps was found to be marginally significant (Z = 3.28; P = .07). The case control study found evidence of improved outcomes in labor and delivery for women who received prenatal OMT, compared with women who did not. A prospective study is proposed as the next step in evaluating the effects of prenatal OMT.