Twenty-first century hydroclimate: A continually changing baseline, with more frequent extremes.

SignificanceTwenty-first century trends in hydroclimate are so large that future average conditions will, in most cases, fall into the range of what we would today consider extreme drought or pluvial states. Using large climate model ensembles, we remove the background trend and find that the risk of droughts and pluvials relative to that (changing) baseline is fairly similar to the 20th century risk. By continually adapting to long-term background changes, these risks could therefore perhaps be minimized. However, increases in the frequency of extremely wet and dry years are still present even after removing the trend, indicating that sustainably managing hydroclimate-driven risks in a warmer world will face increasingly difficult challenges.

Quantifying the influence of global warming on unprecedented extreme climate events.

Efforts to understand the influence of historical global warming on individual extreme climate events have increased over the past decade. However, despite substantial progress, events that are unprecedented in the local observational record remain a persistent challenge. Leveraging observations and a large climate model ensemble, we quantify uncertainty in the influence of global warming on the severity and probability of the historically hottest month, hottest day, driest year, and wettest 5-d period for different areas of the globe. We find that historical warming has increased the severity and probability of the hottest month and hottest day of the year at >80% of the available observational area. Our framework also suggests that the historical climate forcing has increased the probability of the driest year and wettest 5-d period at 57% and 41% of the observed area, respectively, although we note important caveats. For the most protracted hot and dry events, the strongest and most widespread contributions of anthropogenic climate forcing occur in the tropics, including increases in probability of at least a factor of 4 for the hottest month and at least a factor of 2 for the driest year. We also demonstrate the ability of our framework to systematically evaluate the role of dynamic and thermodynamic factors such as atmospheric circulation patterns and atmospheric water vapor, and find extremely high statistical confidence that anthropogenic forcing increased the probability of record-low Arctic sea ice extent.

Anthropogenic warming has increased drought risk in California.

California is currently in the midst of a record-setting drought. The drought began in 2012 and now includes the lowest calendar-year and 12-mo precipitation, the highest annual temperature, and the most extreme drought indicators on record. The extremely warm and dry conditions have led to acute water shortages, groundwater overdraft, critically low streamflow, and enhanced wildfire risk. Analyzing historical climate observations from California, we find that precipitation deficits in California were more than twice as likely to yield drought years if they occurred when conditions were warm. We find that although there has not been a substantial change in the probability of either negative or moderately negative precipitation anomalies in recent decades, the occurrence of drought years has been greater in the past two decades than in the preceding century. In addition, the probability that precipitation deficits co-occur with warm conditions and the probability that precipitation deficits produce drought have both increased. Climate model experiments with and without anthropogenic forcings reveal that human activities have increased the probability that dry precipitation years are also warm. Further, a large ensemble of climate model realizations reveals that additional global warming over the next few decades is very likely to create ∼ 100% probability that any annual-scale dry period is also extremely warm. We therefore conclude that anthropogenic warming is increasing the probability of co-occurring warm-dry conditions like those that have created the acute human and ecosystem impacts associated with the "exceptional" 2012-2014 drought in California.

Regional atmospheric CO2 inversion reveals seasonal and geographic differences in Amazon net biome exchange.

Understanding tropical rainforest carbon exchange and its response to heat and drought is critical for quantifying the effects of climate change on tropical ecosystems, including global climate-carbon feedbacks. Of particular importance for the global carbon budget is net biome exchange of CO2 with the atmosphere (NBE), which represents nonfire carbon fluxes into and out of biomass and soils. Subannual and sub-Basin Amazon NBE estimates have relied heavily on process-based biosphere models, despite lack of model agreement with plot-scale observations. We present a new analysis of airborne measurements that reveals monthly, regional-scale (~1-8 × 10(6)  km(2) ) NBE variations. We develop a regional atmospheric CO2 inversion that provides the first analysis of geographic and temporal variability in Amazon biosphere-atmosphere carbon exchange and that is minimally influenced by biosphere model-based first guesses of seasonal and annual mean fluxes. We find little evidence for a clear seasonal cycle in Amazon NBE but do find NBE sensitivity to aberrations from long-term mean climate. In particular, we observe increased NBE (more carbon emitted to the atmosphere) associated with heat and drought in 2010, and correlations between wet season NBE and precipitation (negative correlation) and temperature (positive correlation). In the eastern Amazon, pulses of increased NBE persisted through 2011, suggesting legacy effects of 2010 heat and drought. We also identify regional differences in postdrought NBE that appear related to long-term water availability. We examine satellite proxies and find evidence for higher gross primary productivity (GPP) during a pulse of increased carbon uptake in 2011, and lower GPP during a period of increased NBE in the 2010 dry season drought, but links between GPP and NBE changes are not conclusive. These results provide novel evidence of NBE sensitivity to short-term temperature and moisture extremes in the Amazon, where monthly and sub-Basin estimates have not been previously available.

18F-Fluciclovine Uptake in an Incidentally Discovered Meningioma in a Patient With a History of Metastatic Prostate Cancer: A Case Report.

Meningiomas are common, benign tumors found in the dural layers of the central nervous system (CNS) that are often found incidentally. 18F-fluciclovine is an amino acid radiotracer that is used to monitor the recurrence of prostate cancer due to its high uptake in prostate cancer cells. This case report outlines a patient with a retinoblastoma tumor suppressor gene (RB1) mutation and prostate cancer metastasis to the bone incidentally noted to have an enhancing, extra-axial mass on a screening MRI. On prior scans, the mass displayed increased 18F-fluciclovine uptake. Because prostate cancer can metastasize to the meninges, especially in older patients with advanced disease, consideration was given to the progression of his oncological disease. However, additional imaging validated the existence and size of the mass, making a meningioma the final diagnosis. Meningeal metastases can be virtually indistinguishable from other CNS tumors, including meningiomas appearing as single or multiple dural-based, enhancing masses, and without prior imaging, further investigation is warranted.

Eating Disorders in U.S. Active Duty Military Members and Veterans: A Systematic Review.

INTRODUCTION: Feeding and eating disorders can be difficult to treat and frequently co-occur with other mental health conditions. The last systematic review of eating disorders in a military and veteran population was published in 2015. An updated review is warranted to re-examine the current literature on eating disorders in the active duty and veteran populations. MATERIALS AND METHODS: A systematic review that described the prevalence, co-occurrence of other disorders and/or events, and health care utilization of U.S. active duty members and veterans was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases and Medical Subject Headings (MeSH) terms used are listed in Appendix A. Each category of the literature was extracted and graded using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS: Twenty-one studies revealed prevalence estimates with varying rates based on demographic information. Trauma exposure is consistently associated with eating disorder development. Individuals diagnosed with eating disorders had greater health care utilization. CONCLUSIONS: Research on eating disorders in the military and veteran populations has expanded in recent years. Limitations of the evidence included in this review stem from the use of self-reported questionnaires, changes to medical record systems, and limited generalizability to the overall population of patients with eating disorders. Further research should investigate the impact of demographic factors and trauma exposure on the development of an eating disorder within the military and veteran populations.

Climate change increases risk of extreme rainfall following wildfire in the western United States.

Post-wildfire extreme rainfall events can have destructive impacts in the western United States. Using two climate model large ensembles, we assess the future risk of extreme fire weather events being followed by extreme rainfall in this region. By mid-21st century, in a high warming scenario (RCP8.5), we report large increases in the number of extreme fire weather events followed within 1 year by at least one extreme rainfall event. By 2100, the frequency of these compound events increases by 100% in California and 700% in the Pacific Northwest in the Community Earth System Model v1 Large Ensemble. We further project that more than 90% of extreme fire weather events in California, Colorado, and the Pacific Northwest will be followed by at least three spatially colocated extreme rainfall events within five years. Our results point to a future with substantially increased post-fire hydrologic risks across much of the western United States.

Human-driven greenhouse gas and aerosol emissions cause distinct regional impacts on extreme fire weather.

Attribution studies have identified a robust anthropogenic fingerprint in increased 21st century wildfire risk. However, the risks associated with individual aspects of anthropogenic aerosol and greenhouse gases (GHG) emissions, biomass burning and land use/land cover change remain unknown. Here, we use new climate model large ensembles isolating these influences to show that GHG-driven increases in extreme fire weather conditions have been balanced by aerosol-driven cooling throughout the 20th century. This compensation is projected to disappear due to future reductions in aerosol emissions, causing unprecedented increases in extreme fire weather risk in the 21st century as GHGs continue to rise. Changes to temperature and relative humidity drive the largest shifts in extreme fire weather conditions; this is particularly apparent over the Amazon, where GHGs cause a seven-fold increase by 2080. Our results allow increased understanding of the interacting roles of anthropogenic stressors in altering the regional expression of future wildfire risk.

Multidimensional risk in a nonstationary climate: Joint probability of increasingly severe warm and dry conditions.

We present a framework for quantifying the spatial and temporal co-occurrence of climate stresses in a nonstationary climate. We find that, globally, anthropogenic climate forcing has doubled the joint probability of years that are both warm and dry in the same location (relative to the 1961-1990 baseline). In addition, the joint probability that key crop and pasture regions simultaneously experience severely warm conditions in conjunction with dry years has also increased, including high statistical confidence that human influence has increased the probability of previously unprecedented co-occurring combinations. Further, we find that ambitious emissions mitigation, such as that in the United Nations Paris Agreement, substantially curbs increases in the probability that extremely hot years co-occur with low precipitation simultaneously in multiple regions. Our methodology can be applied to other climate variables, providing critical insight for a number of sectors that are accustomed to deploying resources based on historical probabilities.