Projected climate and land use change alter western blacklegged tick phenology, seasonal host-seeking suitability and human encounter risk in California.

Global environmental change is having profound effects on the ecology of infectious disease systems, which are widely anticipated to become more pronounced under future climate and land use change. Arthropod vectors of disease are particularly sensitive to changes in abiotic conditions such as temperature and moisture availability. Recent research has focused on shifting environmental suitability for, and geographic distribution of, vector species under projected climate change scenarios. However, shifts in seasonal activity patterns, or phenology, may also have dramatic consequences for human exposure risk, local vector abundance and pathogen transmission dynamics. Moreover, changes in land use are likely to alter human-vector contact rates in ways that models of changing climate suitability are unlikely to capture. Here we used climate and land use projections for California coupled with seasonal species distribution models to explore the response of the western blacklegged tick (Ixodes pacificus), the primary Lyme disease vector in western North America, to projected climate and land use change. Specifically, we investigated how environmental suitability for tick host-seeking changes seasonally, how the magnitude and direction of changing seasonal suitability differs regionally across California, and how land use change shifts human tick-encounter risk across the state. We found vector responses to changing climate and land use vary regionally within California under different future scenarios. Under a hotter, drier scenario and more extreme land use change, the duration and extent of seasonal host-seeking activity increases in northern California, but declines in the south. In contrast, under a hotter, wetter scenario seasonal host-seeking declines in northern California, but increases in the south. Notably, regardless of future scenario, projected increases in developed land adjacent to current human population centers substantially increase potential human-vector encounter risk across the state. These results highlight regional variability and potential nonlinearity in the response of disease vectors to environmental change.

The inception of plate tectonics: a record of failure.

The development of plate tectonics from a pre-plate tectonics regime requires both the initiation of subduction and the development of nascent subduction zones into long-lived contiguous features. Subduction itself has been shown to be sensitive to system parameters such as thermal state and the specific rheology. While generally it has been shown that cold-interior high-Rayleigh-number convection (such as on the Earth today) favours plates and subduction, due to the ability of the interior stresses to couple with the lid, a given system may or may not have plate tectonics depending on its initial conditions. This has led to the idea that there is a strong history dependence to tectonic evolution-and the details of tectonic transitions, including whether they even occur, may depend on the early history of a planet. However, intrinsic convective stresses are not the only dynamic drivers of early planetary evolution. Early planetary geological evolution is dominated by volcanic processes and impacting. These have rarely been considered in thermal evolution models. Recent models exploring the details of plate tectonic initiation have explored the effect of strong thermal plumes or large impacts on surface tectonism, and found that these 'primary drivers' can initiate subduction, and, in some cases, over-ride the initial state of the planet. The corollary of this, of course, is that, in the absence of such ongoing drivers, existing or incipient subduction systems under early Earth conditions might fail. The only detailed planetary record we have of this development comes from Earth, and is restricted by the limited geological record of its earliest history. Many recent estimates have suggested an origin of plate tectonics at approximately 3.0 Ga, inferring a monotonically increasing transition from pre-plates, through subduction initiation, to continuous subduction and a modern plate tectonic regime around that time. However, both numerical modelling and the geological record itself suggest a strong nonlinearity in the dynamics of the transition, and it has been noted that the early history of Archaean greenstone belts and trondhjemite-tonalite-granodiorite record many instances of failed subduction. Here, we explore the history of subduction failure on the early Earth, and couple these with insights from numerical models of the geodynamic regime at the time.This article is part of a discussion meeting issue 'Earth dynamics and the development of plate tectonics'.

Deep carbon export from a Southern Ocean iron-fertilized diatom bloom.

Fertilization of the ocean by adding iron compounds has induced diatom-dominated phytoplankton blooms accompanied by considerable carbon dioxide drawdown in the ocean surface layer. However, because the fate of bloom biomass could not be adequately resolved in these experiments, the timescales of carbon sequestration from the atmosphere are uncertain. Here we report the results of a five-week experiment carried out in the closed core of a vertically coherent, mesoscale eddy of the Antarctic Circumpolar Current, during which we tracked sinking particles from the surface to the deep-sea floor. A large diatom bloom peaked in the fourth week after fertilization. This was followed by mass mortality of several diatom species that formed rapidly sinking, mucilaginous aggregates of entangled cells and chains. Taken together, multiple lines of evidence-although each with important uncertainties-lead us to conclude that at least half the bloom biomass sank far below a depth of 1,000 metres and that a substantial portion is likely to have reached the sea floor. Thus, iron-fertilized diatom blooms may sequester carbon for timescales of centuries in ocean bottom water and for longer in the sediments.

Destabilization of deep oxidized mantle drove the Great Oxidation Event.

The rise of Earth's atmospheric O2 levels at ~2.4 Ga was driven by a shift between increasing sources and declining sinks of oxygen. Here, we compile recent evidence that the mantle shows a significant increase in oxidation state leading to the Great Oxidation Event (GOE), linked to sluggish upward mixing of a deep primordial oxidized layer. We simulate this scenario by implementing a new rheological model for this oxidized, bridgmanite-enriched viscous material and demonstrate slow mantle mixing in simulations of early Earth's mantle. The eventual homogenization of this layer may take ~2 Ga, in line with the timing of the observed mantle redox shift, and would result in the increase in upper mantle oxidation of >1 log(fO2) unit. Such a shift would alter the redox state of volcanic degassing products to more oxidized species, removing a major sink of atmospheric O2 and allowing oxygen levels to rise at ~2.4 Ga.

Constraining the response of continental-scale groundwater flow to climate change.

Numerical models of groundwater flow play a critical role for water management scenarios under climate extremes. Large-scale models play a key role in determining long range flow pathways from continental interiors to the oceans, yet struggle to simulate the local flow patterns offered by small-scale models. We have developed a highly scalable numerical framework to model continental groundwater flow which capture the intricate flow pathways between deep aquifers and the near-surface. The coupled thermal-hydraulic basin structure is inferred from hydraulic head measurements, recharge estimates from geochemical proxies, and borehole temperature data using a Bayesian framework. We use it to model the deep groundwater flow beneath the Sydney-Gunnedah-Bowen Basin, part of Australia's largest aquifer system. Coastal aquifers have flow rates of up to 0.3 m/day, and a corresponding groundwater residence time of just 2,000 years. In contrast, our model predicts slow flow rates of 0.005 m/day for inland aquifers, resulting in a groundwater residence time of [Formula: see text] 400,000 years. Perturbing the model to account for a drop in borehole water levels since 2000, we find that lengthened inland flow pathways depart significantly from pre-2000 streamlines as groundwater is drawn further from recharge zones in a drying climate. Our results illustrate that progressively increasing water extraction from inland aquifers may permanently alter long-range flow pathways. Our open-source modelling approach can be extended to any basin and may help inform policies on the sustainable management of groundwater.

Progressive seawater acidification on the Great Barrier Reef continental shelf.

Coral reefs are highly sensitive to ocean acidification due to rising atmospheric CO2 concentrations. We present 10 years of data (2009-2019) on the long-term trends and sources of variation in the carbon chemistry from two fixed stations in the Australian Great Barrier Reef. Data from the subtropical mid-shelf GBRWIS comprised 3-h instrument records, and those from the tropical coastal NRSYON were monthly seawater samples. Both stations recorded significant variation in seawater CO2 fugacity (fCO2), attributable to seasonal, daytime, temperature and salinity fluctuations. Superimposed over this variation, fCO2 progressively increased by > 2.0 ± 0.3 µatm year-1 at both stations. Seawater temperature and salinity also increased throughout the decade, whereas seawater pH and the saturation state of aragonite declined. The decadal upward fCO2 trend remained significant in temperature- and salinity-normalised data. Indeed, annual fCO2 minima are now higher than estimated fCO2 maxima in the early 1960s, with mean fCO2 now ~ 28% higher than 60 years ago. Our data indicate that carbonate dissolution from the seafloor is currently unable to buffer the Great Barrier Reef against ocean acidification. This is of great concern for the thousands of coral reefs and other diverse marine ecosystems located in this vast continental shelf system.

Bushveld superplume drove Proterozoic magmatism and metallogenesis in Australia.

Large-scale mantle convective processes are commonly reflected in the emplacement of Large Igneous Provinces (LIPs). These are high-volume, short-duration magmatic events consisting mainly of extensive flood basalts and their associated plumbing systems. One of the most voluminous LIPs in the geological record is the ~ 2.06 billion-year-old Bushveld Igneous Complex of South Africa (BIC), one of the most mineralised magmatic complexes on Earth. Surprisingly, the known geographic envelope of magmatism related to the BIC is limited to a series of satellite intrusions in southern Africa and has not been traced further afield. This appears inconsistent with the inferred large size of the BIC event. Here, we present new radiometric ages for alkaline magmatism in the Archean Yilgarn Craton (Western Australia), which overlap the emplacement age of the BIC and indicate a much more extensive geographic footprint of the BIC magmatic event. To assess plume involvement at this distance, we present numerical simulations of mantle plume impingement at the base of the lithosphere, and constrain a relationship between the radial extent of volcanism versus time, excess temperature and plume size. These simulations suggest that the thermal influence of large plume events could extend for thousands of km within a few million years, and produce widespread alkaline magmatism, crustal extension potentially leading to continental break-up, and large ore deposits in distal sectors. Our results imply that superplumes may produce very extensive and diverse magmatic and metallogenic provinces, which may now be preserved in widely-dispersed continental blocks.

Surface ocean carbon dioxide variability in South Pacific boundary currents and Subantarctic waters.

To improve estimates of the long-term response of the marine carbon system to climate change a better understanding of the seasonal and interannual variability is needed. We use high-frequency multi-year data at three locations identified as climate change hotspots: two sites located close to South Pacific boundary currents and one in the Subantarctic Zone (SAZ). We investigate and identify the main drivers involved in the seasonal an interannual (2012-2016) variability of the carbon system. The seasonal variability at boundary current sites is temporally different and highly controlled by sea surface temperature. Advection processes also play a significant role on the monthly changes of the carbon system at the western boundary current site. The interannual variability at these sites most likely responds to long-term variability in oceanic circulation ultimately related to climatic indices such as the El Niño Southern Oscillation, the Pacific Decadal Oscillation and the Southern Annular Mode (SAM). In the SAZ, advection and entrainment processes drive most of the seasonality, augmented by the action of biological processes in spring. Given the relevance of advection and entrainment processes at SAZ, the interannual variability is most probably modulated by changes in the regional winds linked to the variability of the SAM.

Computer modeling of patient flow in a pediatric emergency department using discrete event simulation.

UNLABELLED: Increasing patient census and department overcrowding are universal concerns in pediatric emergency medicine. Accurate predictions of patient flow and resource utilization in the pediatric emergency department (PED) are important in determining what aspects of PED activity could be modified to improve patient flow, reduce patient waiting times, and increase staff efficiency and morale, and thus direct change more effectively. BACKGROUND: We report (1) the construction of a Patient Flow Model (PFM) using discrete event simulation to test simulated PED staffing scenarios that were designed to alleviate the pressures that result from increased census and overcrowding, and (2) a Physician Scheduling Analysis Tool to assist in physician scheduling. METHODS: Arena discrete event simulation modeling software was used to develop a model of PED patient flow after extensive interviews with PED staff and direct observation of patient flow in July 2005. A total of 517 patients were directly observed, and all modeled aspects of their interaction with PED staff and resources were recorded. Historical demographic patient arrival information was combined with observed patient flow data to provide simulated patient arrival rates for the PFM and was also used to construct the Physician Scheduling Analysis Tool. Validation of the PFM was performed by comparing annual simulated patient flow data with actual patient flow data. Previously determined staffing scenarios were applied to the simulation and the resulting performance indicator outputs examined. RESULTS: The PFM was validated on model-wide and process-specific levels, with excellent validation observed on high acuity-patient length of stay and for highly detailed processes such as triage and registration. Simulation of the addition of a hospital volunteer and a second triage nurse demonstrated reductions in pretriage waiting time and the proportion of patients waiting longer than 30 or 60 minutes for pretriage. Simulation of an extra physician shift to the staff schedule demonstrated reductions in length of stay for patients of all triage categories. CONCLUSIONS: The PFM accurately represents patient flow through the department and can provide simulated patient flow information on a variety of scenarios. It can effectively simulate changes to the model and its effects on patient flow.

Osteochondral Allograft Donor-Host Matching by the Femoral Condyle Radius of Curvature.

BACKGROUND: Conventional osteochondral allograft (OCA) matching, requiring orthotopic, size-matched condyles, and narrow surgical time windows often prohibit timely transplantation. HYPOTHESIS: The femoral condyle radius of curvature (RoC) is an appropriate, isolated criterion for donor-host matching in fresh OCAs, potentially enhancing matching efficiency when compared with conventional matching techniques. STUDY DESIGN: Descriptive laboratory study. METHODS: In part 1 of this study, 3-dimensional digital reconstructions of 14 randomly selected, cadaveric distal femoral hemicondyles were performed. Each condyle was divided into anterior, middle, and posterior zones. A virtual best-fit grid was applied to each, and each zone's sagittal- and coronal-plane RoCs were determined. Seven nonorthotopic OCA transplantations were performed based on RoC matching with 1-mm tolerance, and the preoperative and postoperative surface geometry were quantified to assess the accuracy of articular surface restoration. Of note, each donor-host pair did not match by the conventional method. In part 2 of this study, 12 cadaveric distal femora were categorized by size and digitized in the aforementioned manner. Simulated circular defects measuring 20, 25, and 30 mm in diameter were introduced into each zone. OCA matches were determined based on donor and host RoCs, and the total number of potential matches (of 71 total comparisons) was recorded as a percentage for each simulated defect. Finally, the results of RoC matching were compared with the conventional method for simulated defects in all zones of both the medial and lateral femoral condyles. RESULTS: Part 1: The mean surface deviation after OCA transplantation was -0.09 mm, with a mean maximum protrusion at any point of 0.59 mm. Part 2: Using the RoC, 20-mm defects had a 100% chance of being matched. Defects of 25 and 30 mm had a 91% and 64% chance of being matched, respectively. Compared with the conventional method, the RoC method yielded a 3.2-fold greater match rate for lesions of the medial and lateral femoral condyles ( P = .02). CONCLUSION: This investigation shows that femoral condyle RoCs in the sagittal and coronal planes may be useful, alternative matching criteria, expanding on current standards. CLINICAL RELEVANCE: These matching criteria may increase the number of available matches, reduce wait times for patients, and reduce the number of wasted grafts.

On-field performance of national football league players after return from concussion.

BACKGROUND: There are few data examining the short-term effects of concussions on player performance upon return to play. This study examined changes in on-field performance and the influence of epidemiologic factors on performance and return to play. HYPOTHESIS: On-field performance is different in players who return within 7 days after concussion compared with players who miss at least 1 game. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Players in the National Football League who were active during the 2008 to 2012 seasons were considered for inclusion. Weekly injury reports identified concussed players. All players played in at least 4 games before and after the game of injury (sentinel game) within the year of injury (sentinel year). Players who had missed games secondary to another injury or had sustained a second concussion within the sentinel year were excluded. The players' league profiles were used to determine age, position, body mass index, career experience, and games missed. ProFootballFocus performance scores determined player ratings. Statistical analysis used 2-sided t tests and both univariate and multivariate logistic regression models. RESULTS: There were a total of 131 concussions in the 124 players who qualified for this study; 55% of these players missed no games. Defensive secondary, wide receiver, and offensive line were the most commonly affected positions. Players who missed at least 1 game were younger and less experienced. Preinjury ProFootballFocus performance scores were similar to postinjury performance in players without games missed (0.16 vs 0.33; P = .129) and players who missed at least 1 game (-0.06 vs 0.10; P = .219). Age, body mass index, experience, and previous concussion did not correlate with changes in postinjury scores (P > .05). Older, more experienced players and players with late-season concussions were more likely to return to play without missing games (P < .05). The odds of returning within 7 days increased by 18% for each career year and by 40% for each game before the sentinel game within the sentinel year; these same odds decreased by 85% after introduction of newer treatment guidelines in 2009. CONCLUSION: No difference in player performance after concussion was found whether the player did or did not miss games before return. Return without missing games may be associated with experience and timing of injury within a season and less likely after newer guidelines.

Influence of podiatry on orthopedic surgery at a level I trauma center.

Level I trauma centers frequently see trauma at or below the ankle, which requires consultation with the orthopedic surgery department. However, as podiatry programs begin to firmly establish themselves in more Level I trauma centers, their consultations increase, ultimately taking those once seen by orthopedic surgery. A review of the literature demonstrates that this paradigm shift has yet to be discussed. The purpose of this study was to determine how many, if any, lower extremity fracture consultations a newly developed podiatry program would take from the orthopedic surgery department. A retrospective review was performed of emergency department records from January 2007 to December 2011. Seventeen different emergency department diagnoses were used to search the database. Ultimately, each patient's emergency department course was researched. Several trends were noted. First, if trauma surgery was involved, only the orthopedic surgery department was consulted for any injuries at or below the ankle. Second, the emergency department tended to consult the podiatry program only between the hours of 8 am and 6 pm. Third, as the podiatry program became more established, their number of consultations increased yearly, and, coincidentally, the orthopedic surgery department's consultations decreased. Finally, high-energy traumas involved only the orthopedic surgery department. Whether the orthopedic surgery department or podiatry program is consulted regarding trauma surgery is likely hospital dependent.

Sports hernia in National Hockey League players: does surgery affect performance?

BACKGROUND: Athletic pubalgia is a complex injury that results in loss of play in competitive athletes, especially hockey players. The number of reported sports hernias has been increasing, and the importance of their management is vital. There are no studies reporting whether athletes can return to play at preinjury levels. PURPOSE: The focus of this study was to evaluate the productivity of professional hockey players before an established athletic pubalgia diagnosis contrasted with the productivity after sports hernia repair. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Professional National Hockey League (NHL) players who were reported to have a sports hernia and who underwent surgery from 2001 to 2008 were identified. Statistics were gathered on the players' previous 2 full seasons and compared with the statistics 2 full seasons after surgery. Data concerning games played, goals, average time on ice, time of productivity, and assists were gathered. Players were divided into 3 groups: group A incorporated all players, group B were players with 6 or fewer seasons of play, and group C consisted of players with 7 or more seasons of play. A control group was chosen to compare player deterioration or improvement over a career; each player selected for the study had a corresponding control player with the same tenure in his career and position during the same years. RESULTS: Forty-three hockey players were identified to have had sports hernia repairs from 2001 to 2008; ultimately, 80% would return to play 2 or more full seasons. Group A had statistically significant decreases in games played, goals scored, and assists. Versus the control group, the decreases in games played and assists were supported. Statistical analysis showed significant decreases in games played, goals scored, assists, and average time on ice the following 2 seasons in group C, which was also seen in comparison with the control group. Group B (16 players) showed only statistical significance in games played versus the control group. CONCLUSION: Players who undergo sports hernia surgeries return to play and often perform similar to their presurgery level. Players with over 7 full seasons return but with significant decreases in their overall performance levels. Less veteran players were able to return to play without any statistical decrease in performance and are likely the best candidates for repair once incurring injury.

Hemiarthroplasty in a patient with severe systemic sclerosis.

Systemic sclerosis (scleroderma) is a connective tissue disorder of unknown etiology. This rare, chronic, multisystem disorder encompasses a number of variations leading to focal and systemic classifications, which includes features such as skin thickening. The changes within the skin microstructure have led to numerous surgical complications. In a review of the orthopedic literature, we found no reports describing surgical outcomes or the success of skin closures in procedures related to the hip for patients with scleroderma. We present a case of a 74-year-old man with a history of scleroderma who underwent a bipolar hemiarthroplasty to repair a right transcervical femoral neck fracture. The risk factors associated with wound healing and effects of skin contractures in systemic sclerosis patients are reviewed.