Use of δ18Oatm in dating a Tibetan ice core record of Holocene/Late Glacial climate.

Ice cores from the northwestern Tibetan Plateau (NWTP) contain long records of regional climate variability, but refrozen meltwater and dust in these cores has hampered development of robust timescales. Here, we introduce an approach to dating the ice via the isotopic composition of atmospheric O2 in air bubbles (δ18Oatm), along with annual layer counting and radiocarbon dating. We provide a robust chronology for water isotope records (δ18Oice and d-excess) from three ice cores from the Guliya ice cap in the NWTP. The measurement of δ18Oatm, although common in polar ice core timescales, has rarely been used on ice cores from low-latitude, high-altitude glaciers due to (1) low air pressure, (2) the common presence of refrozen melt that adds dissolved gases and reduces the amount of air available for analysis, and (3) the respiratory consumption of molecular oxygen (O2) by micro-organisms in the ice, which fractionates the δ18O of O2 from the atmospheric value. Here, we make corrections for melt and respiration to address these complications. The resulting records of water isotopes from the Guliya ice cores reveal climatic variations over the last 15,000 y, the timings of which correspond to those observed in independently dated lake and speleothem records and confirm that the Guliya ice cap existed before the Holocene. The millennial-scale drivers of δ18Oice are complex and temporally variable; however, Guliya δ18Oice values since the mid-20th century are the highest since the beginning of the Holocene and have increased with regional air temperature.

The moderating role of early-life parental adverse and positive factors in the genetic and environmental contributions to objectively assessed sleep duration in middle childhood.

Early-life positive and adverse parental factors, such as positive parent personality and parental stress, affect the environmental context in which children develop and may influence individual differences in children's sleep health. This study examined the moderating role of early-life parental factors in the heritability (i.e., the extent to which individual differences are due to genetic influences) of objectively assessed childhood sleep duration. A total of 351 families from the Arizona Twin Project were studied. Primary caregivers (95% mothers) reported on multiple dimensions of stress and facets of their own personality when the twins were 12 months old. Seven years later (Mage = 8.43 years, SD = 0.68), families completed a home visit, and twins (51% female; 57% White, 29% Hispanic; 30% monozygotic, 39% same-sex dizygotic, 31% other-sex dizygotic) wore actigraph watches to assess their sleep, with caregivers completing similar assessments on their personality attributes and stress. Early-life positive parent personality moderated the heritability of sleep duration (Δ-2LL [-2 log likelihood] = 2.54, Δdf = 2, p = .28), such that as positive parent personality increased, the heritability of duration decreased. Early-life parental stress also moderated the genetic contribution to sleep duration (Δ-2LL = 2.02, Δdf = 2, p = .36), such that as stress increased, the heritability of duration increased. Concurrent positive parent personality and parental stress composites showed similar patterns of findings. Results highlight the likely contribution of parent positive traits and adverse experiences to the etiology of children's sleep health, with genetic influences on children's sleep more prominent in "riskier" environments. Understanding how genetics and environments work together to influence the etiology of sleep may inform prevention programs.

Comparison of Delphi Consensus Criteria and Musculoskeletal Infection Society Outcome Reporting Tool Definitions of Successful Surgical Treatment of Periprosthetic Knee Infection.

BACKGROUND: Agreement on success following surgical treatment for periprosthetic joint infection (PJI) is important for comparing the efficacy of different surgical approaches with varying consequences and outcomes and setting patient expectations. We compared success rates following two-stage exchange arthroplasty for knee PJI using two expert-consensus definitions of success. METHODS: Prospectively documented data for 57 knees treated by a single surgeon at an academic tertiary care center were retrospectively reviewed. Treatment outcomes were quantified using the Delphi Consensus Criteria and the Musculoskeletal Infection Society Outcome Reporting Tool (MSIS ORT). RESULTS: Success rates were 81% using the Delphi Consensus Criteria and 56% using the MSIS ORT (P = .008). The MSIS ORT success rates increased to 76% when aseptic revisions and deaths unrelated to PJI were not penalized as failures of treatment. Predicted probabilities of successful treatment in a hypothetical case scenario were lowest based on the MSIS ORT and similarly higher using Delphi Consensus Criteria and MSIS ORT modified for both women (53.0, 90.8, and 88.7%) and men (29.1, 89.1, and 89.3%). CONCLUSIONS: Study observations underscore the need for a uniformly accepted single definition of surgical treatment success.

Implant Position, Survivorship, and Patient-Reported Outcomes in Manual Medial Unicompartmental Knee Arthroplasty.

BACKGROUND: Two related recent reports described high error rates for implant positioning and reduced implant survivorship in manual unicompartmental knee arthroplasty (MUKA) compared to robotic-assisted unicompartmental knee arthroplasty (RUKA). The present study scientifically replicated these reports by comparing MUKAs similarly performed by an experienced high-volume surgeon in similar patients using the same study methods as these reports. METHODS: A total of 216 consecutive MUKAs were retrospectively evaluated radiographically for achievement of implant positioning targets. Achievement of targets was compared to the published MUKA and RUKA outcomes and correlated with revision rates and patient-reported outcome measures. RESULTS: There were 20% of study MUKAs compared to 88.1% of comparison MUKAs (P < .001) and 31.4% of comparison RUKAs (P < .048) that failed to meet all 7 implant positioning targets. The MUKA revision rates were significantly lower in the study sample than for comparison MUKAs (3.2% versus 14.2%, P < .001). Implant survivorship was 91.7% (95% confidence interval 84.9, 98.5%) at 8.9 years compared to 70.0% (95% confidence interval 56.0, 80.0%) at 10.2 years, respectively. Most patient-reported outcome measures did not differ based on achievement of implant positioning targets (P ≥ .072). CONCLUSIONS: Present study findings indicate that observations in the 2 recent reports may not be generalizable to all UKA surgeons. Additional data on the relationship between implant positioning and revision as well as functional outcomes are needed to identify appropriate robotic arthroplasty applications.

Medicaid Patients Travel Disproportionately Farther for Revision Total Joint Arthroplasty.

BACKGROUND: Access to high-quality care for revision total joint arthroplasty (rTJA) is poorly understood but may vary based on insurance type. This study investigated distance traveled for hip and knee rTJA based on insurance type. METHODS: A total of 317 revision hips and 431 revision knees performed between 2010 and 2020 were retrospectively reviewed. Cluster sampling was used to select primary hips and knees for comparison. Median driving distance was compared based upon procedure and insurance type. RESULTS: Revision hip and knee patients traveled 18.2 and 11.0 miles farther for surgery compared to primary hip and knee patients (P ≤ .001). For hip rTJA, Medicaid patients traveled farther than Medicare patients followed by commercially insured patients with median distances traveled of 98.4, 67.2, and 35.6 miles, respectively (P = .016). Primary hip patients traveled the same distance regardless of insurance type (P = .397). For knee rTJA, Medicaid patients traveled twice as far as Medicare and commercially insured patients (medians of 85.0, 43.5, and 42.2 miles respectively, P ≤ .046). Primary knee patients showed a similar pattern (P = .264). Age and ASA-PS classification did not indicate greater comorbidity in Medicaid patients. CONCLUSION: Insurance type may influence rTJA referrals, with disproportionate referral of Medicaid and Medicare patients to nonlocal care centers. In addition to patient burden, these patterns potentially present a financial burden to facilities accepting referrals. Strategies to improve equitable access to rTJA, while maintaining the highest and most economical standards of care for patients, providers, and hospitals, are encouraged.

Studying the Specificity of Research Reporting for Ayres Sensory Integration® Interventions in the Published Literature: A Scoping Review.

IMPORTANCE: A contributing factor to the gap between research publication and clinical implementation is the lack of specificity used when reporting findings. OBJECTIVE: This scoping review used the Rehabilitation Treatment Specification System (RTSS) to determine which elements of specificity are most often present and omitted from research using Ayres Sensory Integration® (ASI). DATA SOURCES: The following databases were searched: PubMed, CINAHL, PsycINFO, Cochrane Library, and ERIC. STUDY SELECTION AND DATA COLLECTION: Eligible studies used ASI in an outpatient setting with children who had sensory integration or processing difficulties. Studies selected were quantitative (Level 1, 2, 3, or 4), available in full text, peer reviewed, and published in English within the past 20 yr. FINDINGS: Of the 22 studies that met inclusion criteria, 100% included ingredients (actions of the therapist), 63% included mechanisms of action (reasoning behind these actions), 86% included targets, and 23% described client progression. We also found that 49% of all ingredients were listed in conjunction with a target, 15% were listed in conjunction with a mechanism of action, and 11% were listed in conjunction with both a target and a mechanism of action. CONCLUSIONS AND RELEVANCE: Findings indicate that many studies list ingredients but often omit the mechanism of action. This omission makes replication of the intervention increasingly difficult and prevents a deeper understanding of the clinical reasoning process behind the intervention. Plain-Language Summary: Gaps identified in this scoping review highlight inconsistencies in the reporting of treatment specificity that may affect the replication and translation of Ayres Sensory Integration® (ASI) research into practice.

Frequency and Predictors of Falls Among Adults With Heart Failure: A Prospective Study.

OBJECTIVE: Adults with heart failure (HF) may be at high risk for falling due to age, comorbidities and frailty; however, few studies have examined falls in HF. The purpose of this study was to quantify the frequency and predictors of falls over 1 year among adults with HF. METHODS: We conducted a prospective study of adults with New York Heart Association (NYHA) functional class I-IV HF. After baseline assessment of physical frailty and clinical characteristics, participants self-reported falls every 3 months during 1 year. Comparative statistics were used to identify baseline differences between those who fell vs those who did not. A stepwise negative binomial regression model was used to identify predictors of fall rate over 1 year. RESULTS: The sample (n = 111) was 63.4 ± 15.7 years old, 48% were women, 28% had HF with preserved ejection fraction, and 41% were frail. Over 1 year, 43 (39%) of participants reported at least 1 fall and 28 (25%) of participants reported 2+ falls. Among those who fell, 29 (67%) reported injurious falls. Those who fell had significantly higher body mass indexes and were more likely to have NYHA class III/IV, type 2 diabetes and HF with preserved ejection fraction and to meet slowness and physical exhaustion criteria than those who did not fall. The fall rate was elevated among those with type 2 diabetes and those meeting the slowness and physical exhaustion criteria for physical frailty. CONCLUSIONS: Nearly 40% of adults with HF experienced a fall within 1 year. Screening for comorbidities, slowness and exhaustion may help to identify those at risk for a fall.

Environmental Fate of Cl-PFPECAs: Accumulation of Novel and Legacy Perfluoroalkyl Compounds in Real-World Vegetation and Subsoils.

Per- and polyfluoroalkyl substances (PFAS) are globally distributed and potentially toxic compounds. We report accumulation of chloroperfluoropolyethercarboxylates (Cl-PFPECAs) and perfluorocarboxylates (PFCAs) in vegetation and subsoils in New Jersey. Lower molecular weight Cl-PFPECAs, containing 7-10 fluorinated carbons, and PFCAs containing 3-6 fluorinated carbons were enriched in vegetation relative to surface soils. Subsoils were dominated by lower molecular weight Cl-PFPECAs, a divergence from surface soils. Contrastingly, PFCA homologue profiles in subsoils were similar to surface soils, likely reflecting temporal-use patterns. Accumulation factors (AFs) for vegetation and subsoils decreased with increasing CF2, 6-13 for vegetation and 8-13 in subsoils. In vegetation, for PFCAs having CF2 = 3-6, AFs diminished with increasing CF2 as a more sensitive function than for longer chains. Considering that PFAS manufacturing has transitioned from long-chain chemistry to short-chain, this elevated vegetative accumulation of short-chain PFAS suggests the potential for unanticipated PFAS exposure levels globally in human and/or wildlife populations. This inverse relationship between AFs and CF2-count in terrestrial vegetation is opposite the positive relationship reported in aquatic vegetation suggesting aquatic food webs may be preferentially enriched in long-chain PFAS. AFs normalized to soil-water concentrations increased with chain length for CF2 = 6-13 in vegetation but remained inversely related to chain length for CF2 = 3-6, reflecting a fundamental change in vegetation affinity for short chains compared to long.

Early atmospheric contamination on the top of the Himalayas since the onset of the European Industrial Revolution.

Because few ice core records from the Himalayas exist, understanding of the onset and timing of the human impact on the atmosphere of the "roof of the world" remains poorly constrained. We report a continuous 500-y trace metal ice core record from the Dasuopu glacier (7,200 m, central Himalayas), the highest drilling site on Earth. We show that an early contamination from toxic trace metals, particularly Cd, Cr, Mo, Ni, Sb, and Zn, emerged at high elevation in the Himalayas at the onset of the European Industrial Revolution (∼1780 AD). This was amplified by the intensification of the snow accumulation (+50% at Dasuopu) likely linked to the meridional displacement of the winter westerlies from 1810 until 1880 AD. During this period, the flux and crustal enrichment factors of the toxic trace metals were augmented by factors of 2 to 4 and 2 to 6, respectively. We suggest this contamination was the consequence of the long-range transport and wet deposition of fly ash from the combustion of coal (likely from Western Europe where it was almost entirely produced and used during the 19th century) with a possible contribution from the synchronous increase in biomass burning emissions from deforestation in the Northern Hemisphere. The snow accumulation decreased and dry winters were reestablished in Dasuopu after 1880 AD when lower than expected toxic metal levels were recorded. This indicates that contamination on the top of the Himalayas depended primarily on multidecadal changes in atmospheric circulation and secondarily on variations in emission sources during the last 200 y.

Are Physical and Depressive Symptoms Different Between Women and Men With Heart Failure?: An Exploration Using Two Analytic Techniques.

BACKGROUND: Adults with heart failure (HF) experience a constellation of symptoms; however, understanding of gender differences in HF symptoms remain elusive. The aim of this study was to determine whether there are gender differences in physical and depressive symptoms and symptom patterns in HF using 2 different analytic techniques. METHODS: We performed a secondary analysis of combined data from 6 studies of adults with HF. Physical symptoms were measured with the HF Somatic Perception Scale, and depressive symptoms were measured with the Patient Health Questionnaire-9. First, we performed propensity matching with the nearest neighbor to examine the average treatment effect for HF Somatic Perception Scale and Patient Health Questionnaire-9 in the matched sample of women and men. Next, we used the entire data set in a latent class mixture model to determine patterns of symptoms. Finally, we calculated predictors of class membership with multinomial logistic regression. RESULTS: The sample (n = 524, 86.5% systolic HF) was 37% women with a mean age of 58.3 ± 13.9 years and mean number of years with HF of 6.9 ± 6.9. Three hundred sixty-six participants were matched on propensity scores; there were no significant gender differences in symptom scores between matched women (n = 183) and men (n = 183). Among all 524 participants, 4 distinct latent classes of symptom patterns indicate that many patients with HF are fatigued, some have more depressive symptoms, and others have significantly more edema or cough. Gender did not predict membership to any symptom pattern. CONCLUSIONS: There were significant gender differences in sociodemographics, health behaviors, and clinical characteristics, but not HF symptoms or symptom patterns, using either analytic technique.

Creating an Organizational Culture and Climate of Meaningful Recognition for Nurse Managers.

OBJECTIVES: To examine the current nurse manager (NM) recognition culture and climate in organizations and to develop a theoretical foundation for meaningful recognition. BACKGROUND: Nurse managers call for wider recognition, but the theoretical conceptualization and underpinnings of meaningful recognition are sparse in the literature. METHODS: A qualitative descriptive design was used utilizing individual interviews. The study participants included 30 individuals consisting of NMs, chief nursing officers, and chief nursing executives. Content analysis was conducted. RESULTS: A theoretical model with super-categories and supportive quotes was created to operationalize a culture and climate of meaningful recognition in the organizations represented by the sample. CONCLUSION: This qualitative descriptive study highlights the importance of recognizing the value of NMs for their contributions to nursing leadership and patient care. Implications of recognizing NMs are counteracting the feeling of being invisible and mitigating issues within the work environment.

Time Required for Planned and Unplanned Episodes of Care in Aseptic Hip and Knee Revision Arthroplasty.

BACKGROUND: Studies indicate aseptic revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) requires much more effort but is reimbursed less than primary procedures per minute work time. This study quantified planned and unplanned work performed by the surgeon and/or their team during the entire episode of care "reimbursement window" and compared it to allowed reimbursement times by Centers for Medicare and Medicaid Services (CMS). METHODS: Between October, 2010, and December, 2020, all unilateral aseptic rTHA and rTKA procedures performed by a single surgeon at a single institution were retrospectively reviewed. Time dedicated to planned work was calculated from surgery scheduling to 90 days postoperative. Impromptu patient inquiries and treatments after discharge but within the episode of care, involving the surgeon/surgeon team constituted unplanned work. Planned and unplanned work minutes were summed and divided by the number of patients reviewed to obtain average minutes of work per patient. Work time was compared to CMS allowable times for rTHA (617 minutes) and rTKA (520 minutes). RESULTS: There were 292 Aseptic rTKA and 63 aseptic rTHA procedures included. Based upon CMS allowable times per patient there were a mean of 4.4 hours (267 minutes) of uncompensated care time per rTKA patient and a mean of 2.4 hours (141 minutes) of uncompensated care time per rTHA patient. CONCLUSION: Aseptic revisions are substantially more complex than primaries, requiring work effort that is not commensurate with current reimbursements. Financially disincentivizing surgeons to care for patients requiring revision surgery could reduce patient access to care when high quality care is needed the most.

The Acknowledge-Normalize-Partner (ANP) Framework: A novel empathic communication tool for oncology nurses.

OBJECTIVE: To describe the development and implementation of a novel tool designed to enhance nurse-patient communication in a major academic cancer center, which nurses can learn quickly, incorporate into their primary palliative care practice, and broadly disseminate in order to improve the patient experience. METHOD: An evidence-based empathic communication tool and educational program were designed to provide essential skills to oncology nurses in having discussions with patients about their personal values. Evaluation included nurse focus groups, pre- and post-course evaluations and interviews, and patient questionnaires. RESULTS: Nurses were satisfied with the educational program and found the communication tool effective in a variety of clinical situations including discussions about personal values. Patients reported increased occurrences of these discussions when nurses utilized the framework (97% vs. 58%, p < 0.0001) and a higher quality of clinician communication (mean [SD] from 0 = very worst to 10 = very best: 7.18 [2.3] vs. 5.04 [2.9], p = 0.001). SIGNIFICANCE OF RESULTS: Skilled, empathic communication is an essential component of high-quality primary palliative care. Oncology nurses are well suited to lead communication and provide this care as part of an interprofessional team. The training and tool described here are targeted and efficient, and prepare nurses to respond skillfully to emotion while facilitating important discussions about patient values.

Background and Design of the Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure (BIOMES-HF) Study.

BACKGROUND: Symptoms, which often cluster together, are a significant problem in heart failure (HF). There is considerable heterogeneity in symptom burden, particularly in the vulnerable transition period after a hospitalization for HF, and the biological underpinnings of symptoms during transitions are unclear. The purpose of this article is to describe the background and design of a study that addresses these knowledge gaps, entitled Biological and Physiological Mechanisms of Symptom Clusters in Heart Failure (BIOMES-HF). METHODS AND RESULTS: BIOMES-HF is a prospective gender- and age-balanced longitudinal study of 240 adults during the 6-month transition period after a HF hospitalization. The aims are to (1) identify clusters of change in physical symptoms, (2) quantify longitudinal associations between biomarkers and physical symptoms, and (3) quantify longitudinal associations between physical frailty and physical symptoms among adults with HF. We will measure multiple symptoms, biomarkers, and physical frailty at discharge and then at 1 week and 1, 3, and 6 months after hospitalization. We will use growth mixture modeling and longitudinal mediation modeling to examine changes in symptoms, biomarkers, and physical frailty after HF hospitalization and associations therein. CONCLUSIONS: This innovative study will advance HF symptom science by using a multibiomarker panel and the physical frailty phenotype to capture the multifaceted nature of HF. Using advanced quantitative modeling, we will characterize heterogeneity and identify potential mechanisms of symptoms in HF. As a result, this research will pinpoint amenable targets for intervention to provide better, individualized treatment to improve symptom burden in HF. LAY SUMMARY: Adults with heart failure may have significant symptom burden. This study is designed to shed light on our understanding of the role of biological and physiological mechanisms in explaining heart failure symptoms, particularly groups of co-occurring symptoms, over time. We explore how symptoms, biomarkers, and physical frailty change after a heart failure hospitalization. The knowledge generated from this study will be used to guide the management and self-care for adults with heart failure.

A higher burden of multiple sclerosis genetic risk confers an earlier onset.

BACKGROUND: Age at onset of multiple sclerosis (MS) is an objective, influential predictor of the evolution of MS independent of disease duration. OBJECTIVES: Determine the influence of MS genetic predisposition on age of onset. METHODS: We conducted a comprehensive investigation of MS risk variants and age at onset in 3495 non-Latinx white individuals, including for combinations of HLA-DRB1*15:01 alleles and quintiles of an unweighted genetic risk score (GRS) for 198 of 200 autosomal MS risk variants that reside outside the major histocompatibility complex. RESULTS: The mean age at onset was 32 years, 29% were male, and 46% were HLA-DRB1*15:01 carriers. For those with the greatest genetic risk burden (the highest GRS quintile with two HLA-DRB1*15:01 alleles) were on average 5 years younger at onset (p = 0.002) than those with the lowest genetic risk burden (the lowest GRS quintile with no HLA-DRB1*15:01 alleles). There was a strong inverse relationship between the MS genetic risk burden and age at onset of MS (p < 5 × 10-8). CONCLUSION: We demonstrate a significant gradient between elevated MS genetic risk burden and an earlier onset of MS, suggesting that a higher MS genetic risk burden accelerates onset of the disease.

Making Vaccines Equitably Available to All Persons in Pima County, Arizona, 2020-2021.

We review the Pima County (Arizona) Health Department's efforts to achieve equitable COVID-19 vaccine distribution in a county with a social vulnerability index of 0.88. We expedited vaccine distribution, focusing on equitable distribution, implementing a multi-point of dispensing approach, and using a periurban and rural strategy. Pima County has one of the highest vaccine distribution percentages among the highest social vulnerability index quartiles and is more than 10 percentage points ahead of other large counties in Arizona in vaccine uptake. (Am J Public Health. 2022;112(11):1560-1563. https://doi.org/10.2105/AJPH.2022.307040).

Environmental Fate of Cl-PFPECAs: Predicting the Formation of PFAS Transformation Products in New Jersey Soils.

Although next-generation per- and polyfluorinated substances (PFAS) were designed and implemented as safer and environmentally degradable alternatives to "forever" legacy PFAS, there is little evidence to support the actual transformation of these compounds and less evidence of the safety of transformed products in the environment. Multiple congeners of one such PFAS alternative, the chloro-perfluoropolyether carboxylates (Cl-PFPECAs), have been found in New Jersey soils surrounding a manufacturing facility. These compounds are ideal candidates for investigating environmental transformation due to the existence of potential reaction centers including a chlorinated carbon and ether linkages. Transformation products of the chemical structures of this class of compounds were predicted based on analogous PFAS transformation pathways documented in peer-reviewed literature. Potential reaction products were used as the basis for high-resolution mass-spectrometric suspect screening of the soils. Suspected transformation products of multiple congeners, the Cl-PFPECAs, including H-PFPECAs, epox-PFPECAs, and diOH-PFPECAs, were tentatively observed in these screenings. Although ether linkages have been hypothesized as potential reaction centers under environmental conditions, to date, no documentation of ether scission has been identified. Despite exhaustive scrutiny of the high-resolution data for our Cl-PFPECA-laden soils, we found no evidence of ether scission.

Using a Virtual Platform for Conducting Grandfamily Research.

BACKGROUND: Because of the COVID-19 pandemic, our research team quickly pivoted from planned face-to-face interaction with participants to virtual interactions. During this transition, we discovered invaluable new practices for conducting research remotely, including collecting physiological data. OBJECTIVE: Our objective was to describe the methodological challenges we encountered when conducting this research virtually with grandparent-grandchild dyads and describe the strategies we developed to overcome those challenges. Of primary focus were procedures for finger-stick blood sample collection. Of secondary focus were procedures for conducting virtual-based research with older adults and across multiple generations. METHODS: During an observational study utilizing a virtual platform with 11 grandparent-grandchild dyads (mean age: 64.2 ± 5.0 years for grandparents and 9.3 ± 1.9 years for grandchildren), we documented lessons learned (based on the discussion within our team and feedback we have received from participants) that could be applicable for other, similar research endeavors. RESULTS: We found several challenges in collecting blood samples, including staff were unfamiliar with providing online instruction and participants needed to develop familiarity with the blood sample collection process (without having in-person assistance), and we had to develop methods for delivering blood sample collection kits to participants safely. We also found that it took longer than expected to run procedures-a challenge that might be encountered when conducting any type of dyadic research utilizing a virtual platform-particularly involving older adults and across multiple generations. In addition, it was challenging to keep child participants engaged in the virtual interactions. We document how we employed targeted strategies to overcome those obstacles. Recommendations for strategies from our team include to provide comprehensive and clear instruction/materials on blood sampling procedure, offer generous support throughout the blood collection process, be prepared to divide study visits into more than one session as needed, proactively anticipate potential roadblocks, and carefully consider the participants' developmental stages and attention span. DISCUSSION: The insights we gained will help inform future research with grandparent-grandchild dyads in remote or rural populations utilizing virtual platforms.

Disappearance of the last tropical glaciers in the Western Pacific Warm Pool (Papua, Indonesia) appears imminent.

The glaciers near Puncak Jaya in Papua, Indonesia, the highest peak between the Himalayas and the Andes, are the last remaining tropical glaciers in the West Pacific Warm Pool (WPWP). Here, we report the recent, rapid retreat of the glaciers near Puncak Jaya by quantifying the loss of ice coverage and reduction of ice thickness over the last 8 y. Photographs and measurements of a 30-m accumulation stake anchored to bedrock on the summit of one of these glaciers document a rapid pace in the loss of ice cover and a ∼5.4-fold increase in the thinning rate, which was augmented by the strong 2015-2016 El Niño. At the current rate of ice loss, these glaciers will likely disappear within the next decade. To further understand the mechanisms driving the observed retreat of these glaciers, 2 ∼32-m-long ice cores to bedrock recovered in mid-2010 are used to reconstruct the tropical Pacific climate variability over approximately the past half-century on a quasi-interannual timescale. The ice core oxygen isotopic ratios show a significant positive linear trend since 1964 CE (0.018 ± 0.008‰ per year; P < 0.03) and also suggest that the glaciers' retreat is augmented by El Niño-Southern Oscillation processes, such as convection and warming of the atmosphere and sea surface. These Papua glaciers provide the only tropical records of ice core-derived climate variability for the WPWP.

Relative Contribution of Outpatient Arthroplasty Risk Assessment Score Medical Comorbidities to Same-Day Discharge After Primary Total Joint Arthroplasty.

BACKGROUND: Selection of patients who can safely undergo outpatient total joint arthroplasty (TJA) is an increasing priority given the growth of ambulatory TJA. This study quantified the relative contribution and weight of 52 medical comorbidities comprising the Outpatient Arthroplasty Risk Assessment (OARA) score as predictors of safe same-day discharge (SDD). METHODS: The medical records of 2748 primary TJAs consecutively performed between 2014 and 2020 were reviewed to record the presence or absence of medical comorbidities in the OARA score. After controlling for patients not offered SDD due to OARA scores and patients who were offered but declined SDD, the final analysis sample consisted of 631 cases, 92.1% of whom achieved SDD and 7.9% of whom did not achieve SDD. Odds ratios were calculated to quantify the extent to which each comorbidity is associated with achieving SDD. RESULTS: Demographic characteristics of analysis cases were consistent with a high-volume TJA practice in a US metropolitan area. Among testable OARA comorbidities, 53% significantly decreased the likelihood of SDD by 2.3 (body mass index [BMI] ≥40 kg/m2) to 12 (history of post-operative confusion and pacemaker dependence) times. BMI between 30 and 39 kg/m2 did not affect the likelihood of SDD (P = .960), and BMI ≥40 kg/m2 had the smallest odds ratio in our study (2.28, 95% confidence interval 1.11-4.67, P = .025). CONCLUSION: Study findings contribute to the refinement of the OARA score as a successful predictor of safe SDD following primary TJA while maintaining low 90-day readmission rates.