Valuing investments in sustainable land management in the Upper Tana River basin, Kenya.

We analyze the impacts of investments in sustainable land use practices on ecosystem services in the Upper Tana basin, Kenya. This work supports implementation of the Upper Tana-Nairobi Water Fund, a public-private partnership to safeguard ecosystem service provision and food security. We apply an integrated modelling framework, building on local knowledge and previous field- and model-based studies, to link biophysical landscape changes at high temporal and spatial resolution to economic benefits for key actors in the basin. The primary contribution of this study is that it a) presents a comprehensive analysis for targeting interventions that takes into account stakeholder preferences, local environmental and socio-economic conditions, b) relies on detailed, process-based, biophysical models to demonstrate the biophysical return on those investments for a practical, decision-driven case, and c) in close collaboration with downstream water users, links those biophysical outputs to monetary metrics, including: reduced water treatment costs, increased hydropower production, and crop yield benefits for agricultural producers in the conservation area. This study highlights the benefits and trade-offs that come with conducting participatory research as part of a stakeholder engagement process: while results are more likely to be decision-relevant within the local context, navigating stakeholder expectations and data limitations present ongoing challenges.

Controlled Complete Suppression of Single-Atom Inelastic Spin and Orbital Cotunneling.

The inelastic portion of the tunnel current through an individual magnetic atom grants unique access to read out and change the atom's spin state, but it also provides a path for spontaneous relaxation and decoherence. Controlled closure of the inelastic channel would allow for the latter to be switched off at will, paving the way to coherent spin manipulation in single atoms. Here, we demonstrate complete closure of the inelastic channels for both spin and orbital transitions due to a controlled geometric modification of the atom's environment, using scanning tunneling microscopy (STM). The observed suppression of the excitation signal, which occurs for Co atoms assembled into chains on a Cu2N substrate, indicates a structural transition affecting the dz(2) orbital, effectively cutting off the STM tip from the spin-flip cotunneling path.

Projected effects of climate and development on California wildfire emissions through 2100.

Changing climatic conditions are influencing large wildfire frequency, a globally widespread disturbance that affects both human and natural systems. Understanding how climate change, population growth, and development patterns will affect the area burned by and emissions from wildfires and how populations will in turn be exposed to emissions is critical for climate change adaptation and mitigation planning. We quantified the effects of a range of population growth and development patterns in California on emission projections from large wildfires under six future climate scenarios. Here we show that end-of-century wildfire emissions are projected to increase by 19-101% (median increase 56%) above the baseline period (1961-1990) in California for a medium-high temperature scenario, with the largest emissions increases concentrated in northern California. In contrast to other measures of wildfire impacts previously studied (e.g., structural loss), projected population growth and development patterns are unlikely to substantially influence the amount of projected statewide wildfire emissions. However, increases in wildfire emissions due to climate change may have detrimental impacts on air quality and, combined with a growing population, may result in increased population exposure to unhealthy air pollutants.

Relative weights of the backpacks of elementary-aged children.

The purpose of the study was to describe the range of relative backpack weights of one group of elementary-aged children and the extent to which they exceeded recommended levels. A second purpose was to explore whether gender and age help predict the relative weight of children's backpacks. Ninety-five 8- to 12-year-old elementary school students (56% girls; 88% car or bus riders) participated. Their school backpacks were weighed, and their age, gender, and mode of transportation to school were recorded. Only 40% of the sample carried backpacks that were less than 10% of their body weights. Five percent of the students' backpacks exceeded 20% of their body weights. Neither age group nor gender significantly predicted relative backpack weight or relative weight levels. Recommendations are made for ways to reduce the weight these young children carry.

Patient Risk Factors Associated With Postoperative Complications After Common Hand Procedures.

BACKGROUND: Carpal tunnel syndrome (CTS), trigger finger (TF), and De Quervain tenosynovitis (DQ) are 3 common pathologies of the hand often treated with relatively simple surgical procedures. However, outcomes from these procedures can be compromised by postoperative complications. The aim of this study was to evaluate the association between diabetes, tobacco use, and obesity and the incidence of postoperative complications. METHODS: We reviewed 597 patients treated surgically for CTS, TF, or DQ from 2010 to 2015. We used bivariate and multivariate analyses to assess independent associations between diabetes, tobacco use, obesity, and surgical complications and compared the incidences with healthier patients without these comorbidities. We also looked at patients with overlapping diagnoses of these comorbidities. RESULTS: Bivariate analysis showed that patients with diabetes and smokers were more likely to have a surgical complication. Multivariate analysis showed diabetes and tobacco use as independent predictors of complications. The disease states or combinations placing patients at the highest risk of a postoperative complication were the diabetic-smoker-obese, diabetic-smoker, diabetic-obese, diabetic, and smoker-obese groups. The diabetic-smoker-obese patient population had a 42.02% predicted rate of postoperative complications. CONCLUSIONS: Diabetes and tobacco use are independent risk factors for complications after operative treatment of CTS, TF, and DQ. Obesity when coexisting with diabetes mellitus (DM) and/or tobacco use increased the risk of complications. When the 3 patient factors evaluated, DM, obesity, and tobacco use, were present, the rate of complications was 42.02%. Careful assessment and discussion should occur before proceeding with operative treatment for simple hand conditions in patients with the risk factors studied.

A Case of Sarcoidosis Mimicking Lymphoma Confounded by Cognitive Decline.

Sarcoidosis is a disease with an unknown cause that affects multiple organ systems and has a varied clinical presentation. Often, its symptomatology mimics other disease processes, such as lymphoma, tuberculosis, and amyloidosis. The reticuloendothelial involvement and typical B symptoms of weight loss, fatigue, night sweats, and lymphadenopathy can make sarcoidosis often easily confused with lymphoma. Sarcoidosis has a myriad of central nervous system (CNS) effects, which are often not recognized as symptoms of the disease. These neuropsychiatric symptoms can include, but are not limited to, cognitive decline, headaches, and personality changes. In this report, we discuss a case of a patient who presented with symptoms consistent with indolent lymphoma but was eventually diagnosed with sarcoidosis with extrapulmonary manifestations.

Climate-informed hydrologic modeling and policy typology to guide managed aquifer recharge.

Harvesting floodwaters to recharge depleted groundwater aquifers can simultaneously reduce flood and drought risks and enhance groundwater sustainability. However, deployment of this multibeneficial adaptation option is fundamentally constrained by how much water is available for recharge (WAFR) at present and under future climate change. Here, we develop a climate-informed and policy-relevant framework to quantify WAFR, its uncertainty, and associated policy actions. Despite robust and widespread increases in future projected WAFR in our case study of California (for 56/80% of subbasins in 2070-2099 under RCP4.5/RCP8.5), strong nonlinear interactions between diversion infrastructure and policy uncertainties constrain how much WAFR can be captured. To tap future elevated recharge potential through infrastructure expansion under deep uncertainties, we outline a novel robustness-based policy typology to identify priority areas of investment needs. Our WAFR analysis can inform effective investment decisions to adapt to future climate-fueled drought and flood risk over depleted aquifers, in California and beyond.

Wernicke's Encephalopathy Presenting as Sensorineural Hearing Loss.

Sleeve gastrectomy is a restrictive-type weight loss surgery that can result in nutritional deficiencies, such as vitamin B1 (thiamine) deficiency. Although Wernicke's encephalopathy is a known complication following bariatric surgery, bilateral sensorineural hearing loss is a rare presenting symptom of this condition. We present a case of a patient two months postoperative following a sleeve gastrectomy whose chief complaint was hearing loss. While initial laboratory evaluation of her complaint showed elevated inflammatory markers, prompting an autoimmune workup, ultimately the diagnosis of Wernicke's encephalopathy was confirmed by a low thiamine level and magnetic resonance imaging findings. A correction of the patient's thiamine deficiency led to an improvement of her symptoms.

Anatomic Reconstruction of the Anterior Oblique and the Dorsoradial Ligaments for Painful Subluxating Carpometacarpal Joint of the Thumb.

Thumb carpometacarpal osteoarthritis (CMC OA) is a common pathology of the hand that is characterized by pain, loss of grip and pinch strength, and deformity. Although conservative management is often preferred in earlier stage of CMC OA, surgical techniques can be used when symptoms are not fully relieved, especially with subluxation. We report a case series of 26 patients (32 operations) with Eaton stage I and II CMC OA who underwent a novel surgical technique that anatomically restores the CMC joint with autologous double ligament reconstruction. All cases were retrospectively reviewed as a prospective study and performed at a single regional health system from 2012 to 2016. Preoperative and postoperative radiographs, grip and pinch strength measurements, and DASH scores were collected to evaluate the outcomes. The mean CMC subluxation ratio decreased from 0.59±0.14 to 0.35±0.21 (P<0.0001). The mean grip strength increased from 44.34±17.36 pounds to 52.97±18.92 pounds (P=0.017), and the mean pinch strength increased from 10.16±4.59 pounds to 12.75±4.52 pounds (P=0.00027). The mean DASH scores decreased from 42.32±14.99 to 19.94±14.47 (P<0.0001). The average follow-up period was 39.44±14.94 months. Three patients had postoperative thumb stiffness that resolved with physical therapy. One patient had postoperative pain, attributed to carpal tunnel syndrome. One surgery required revision. All other patients (84.38%) reported significant improvement in pain and the ability to return to previous levels of work. This surgical technique is therefore a feasible option for patients with Eaton stage I or II CMC OA, and should be recommended for wider surgical use.

Global modeling of nature's contributions to people.

The magnitude and pace of global change demand rapid assessment of nature and its contributions to people. We present a fine-scale global modeling of current status and future scenarios for several contributions: water quality regulation, coastal risk reduction, and crop pollination. We find that where people's needs for nature are now greatest, nature's ability to meet those needs is declining. Up to 5 billion people face higher water pollution and insufficient pollination for nutrition under future scenarios of land use and climate change, particularly in Africa and South Asia. Hundreds of millions of people face heightened coastal risk across Africa, Eurasia, and the Americas. Continued loss of nature poses severe threats, yet these can be reduced 3- to 10-fold under a sustainable development scenario.

Life cycle assessment needs predictive spatial modelling for biodiversity and ecosystem services.

International corporations in an increasingly globalized economy exert a major influence on the planet's land use and resources through their product design and material sourcing decisions. Many companies use life cycle assessment (LCA) to evaluate their sustainability, yet commonly-used LCA methodologies lack the spatial resolution and predictive ecological information to reveal key impacts on climate, water and biodiversity. We present advances for LCA that integrate spatially explicit modelling of land change and ecosystem services in a Land-Use Change Improved (LUCI)-LCA. Comparing increased demand for bioplastics derived from two alternative feedstock-location scenarios for maize and sugarcane, we find that the LUCI-LCA approach yields results opposite to those of standard LCA for greenhouse gas emissions and water consumption, and of different magnitudes for soil erosion and biodiversity. This approach highlights the importance of including information about where and how land-use change and related impacts will occur in supply chain and innovation decisions.

Charge-order domain walls with enhanced conductivity in a layered manganite.

Interfaces and boundaries in condensed-matter systems often have electronic properties distinct from the bulk material and thus have become a topic of both fundamental scientific interest and technological importance. Here we identify, using microwave impedance microscopy, enhanced conductivity of charge-order domain walls in the layered manganite Pr(Sr0.1Ca0.9)2Mn2O7. We obtain a complete mesoscopic map of surface topography, crystalline orientation and electronic phase, and visualize the thermal phase transition between two charge-ordered phases. In both phases, charge-order domains occur with domain walls showing enhanced conductivity likely due to local lifting of the charge order. Finite element analysis shows that the resolved domain walls can be as narrow as few nanometres. The domain walls are stabilized by structural twins and have a strong history dependence, suggesting that they may be manipulated to create novel devices.

Delayed puberty but normal fertility in mice with selective deletion of insulin receptors from Kiss1 cells.

Pubertal onset only occurs in a favorable, anabolic hormonal environment. The neuropeptide kisspeptin, encoded by the Kiss1 gene, modifies GnRH neuronal activity to initiate puberty and maintain fertility, but the factors that regulate Kiss1 neurons and permit pubertal maturation remain to be clarified. The anabolic factor insulin may signal nutritional status to these neurons. To determine whether insulin sensing plays an important role in Kiss1 neuron function, we generated mice lacking insulin receptors in Kiss1 neurons (IR(ΔKiss) mice). IR(ΔKiss) females showed a delay in vaginal opening and in first estrus, whereas IR(ΔKiss) males also exhibited late sexual maturation. Correspondingly, LH levels in IR(ΔKiss) mice were reduced in early puberty in both sexes. Adult reproductive capacity, body weight, fat composition, food intake, and glucose regulation were comparable between the 2 groups. These data suggest that impaired insulin sensing by Kiss1 neurons delays the initiation of puberty but does not affect adult fertility. These studies provide insight into the mechanisms regulating pubertal timing in anabolic states.