Objectives The aim of this study was to determine the availability of quinidine throughout the world. Background Quinidine is the only oral medication that is effective for preventing ...life-threatening ventricular arrhythmias due to Brugada syndrome and idiopathic ventricular fibrillation. However, because of its low price and restricted indication, this medication is not marketed in many countries. Methods We conducted a survey of the availability of quinidine by contacting professional medical societies and arrhythmia specialists worldwide. Physicians were e-mailed questionnaires requesting information concerning the quinidine preparation available at their hospital. We also requested information concerning cases of adverse arrhythmic events resulting from unavailability of quinidine. Results A total of 273 physicians from 131 countries provided information regarding the availability of quinidine. Quinidine was readily available in 19 countries (14%), not accessible in 99 countries (76%), and available only through specific regulatory processes that require 4 to 90 days for completion in 13 countries (10%). We were able to gather information concerning 22 patients who had serious arrhythmias probably related (10 cases) or possibility related (12 cases) to the absence of quinidine, including 2 fatalities possibly attributable to the unavailability of quinidine. Conclusions The lack of accessibility of quinidine is a serious medical hazard at the global level.
Climate communication is a thriving research area spanning science, social science, and humanities. The field has grown explosively in recent years, necessitating increased efforts to synthesize and ...make sense of the resulting profusion of studies. To support scholars navigating this quickly evolving knowledge domain, we developed a knowledge map of the climate communication research landscape by applying network analysis and data visualization techniques to the metadata from 2995 publications on climate communication. The map reveals a dense web of connections among five distinct knowledge communities, indicating a tightly knit and intensely collaborative knowledge domain, and suggests new avenues for the application of climate communication knowledge, in particular to support climate services and co-production. The climate communication knowledge map answers the call for synoptic perspectives on areas of science communication while demonstrating a novel visual approach to knowledge synthesis for science communication domains.
Assessing regional hydrologic responses to past climate changes can offer a guide for how water resources might respond to ongoing and future climate change. Here we employed a coupled water balance ...and lake evaporation model to examine Walker Lake behaviors during the Medieval Climate Anomaly (MCA), a time of documented hydroclimatic extremes. Together, a 14C‐based shoreline elevation chronology, submerged subfossil tree stumps in the West Walker River, and regional paleoproxy evidence indicate a ~50 year pluvial episode that bridged two 140+ year droughts. We developed estimates of MCA climates to examine the transient lake behavior and evaluate watershed responses to climate change. Our findings suggest the importance of decadal climate persistence to elicit large lake‐level fluctuations. We also simulated the current 2012–2015 California‐Nevada drought and found that the current drought exceeds MCA droughts in mean severity but not duration.
Key Points
Model‐proxy comparisons in terminal lake basins contextualize past and present hydroclimates
Climate conditions require decadal persistence to elicit complete lake‐level oscillations
The current CA‐NV drought exceeds past droughts in mean severity but not duration
During the termination of the last glacial period the western U.S. experienced exceptionally wet conditions, driven by changes in location and strength of the mid-latitude winter storm track. The ...distribution of modern winter precipitation is frequently characterized by a north-south wet/dry dipole pattern, controlled by interaction of the storm track with ocean-atmosphere conditions over the Pacific and Atlantic Oceans. Here we show that a dipole pattern of similar geographic extent persisted and switched sign during millennial-scale abrupt climate changes of the last deglaciation, based on a new lake level reconstruction for pluvial Lake Chewaucan (northwestern U.S.), and a compilation of regional paleoclimate records. This suggests the dipole pattern is robust, and one mode may be favored for centuries, thereby creating persistent contrasting wet/dry conditions across the western U.S. The TraCE-21k climate model simulation shows an equatorward enhancement of winter storm track activity in the northeastern Pacific, favoring wet conditions in southwestern U.S. during the second half of Heinrich Stadial 1 (16.1-14.6 ka) and consistent with paleoclimate evidence. During the Bølling/Allerød (14.6-12.8 ka), the northeastern Pacific storm track contracted poleward, consistent with wetter conditions concentrated poleward toward the northwest U.S.
The degree to which warming of the planet will alter Asia's water resources is an important question for food, energy, and economic security. Here we present geological evidence, underpinned by ...radiometric dating and dendrochronology, and bolstered by hydrological modeling, indicating that wetter-than-present conditions characterized the core of the inner Asian desert belt during the Little Ice Age, the last major Northern Hemispheric cold spell of the Holocene. These wetter conditions accompanied northern mid-latitude cooling, glacier expansion, a strengthened/southward-shifted boreal jet, and weakened south Asian monsoons. We suggest that southward migration of grasslands in response to these wetter conditions aided the spread of Mongol Empire steppe pastoralists across Asian drylands. Conversely, net drying over the 20th century has led to drought that is unprecedented for the past ∼830 years, and that could intensify with further heating of the Asian continent.
•The Tarim Basin was wetter than today for most of the past 830 yrs.•Wet conditions correspond to Little Ice Age cooling.•Southward migration of rangelands facilitated spread of Mongol Empire.•Current warming could cause northward expansion of interior Asian deserts.
An urban heat island (UHI) effect is identified in Reno, Nevada by analyzing regional temperature trends calculated from seven long-term observation stations for the summer and winter seasons between ...1950 and 2014. The UHI is maximized during summer (June–August) and characterized by asymmetric increases in minimum (∼1.1 °C/decade, p < 0.01) versus maximum temperature (∼0.1 °C/decade, p < 0.01) trends in excess of trends from regional climate stations. Comparisons of historical Reno temperatures with an ensemble of 66 bias-corrected and downscaled global climate model (GCM) outputs spanning 1950–2014 demonstrates cold biases of 1.5–4.5 °C during summer with minimum temperature having the largest bias. We show that a secondary bias correction step utilizing the statistical downscaling method of quantile–quantile mapping (QQM) can reduce biases in future climate projections assuming no changes to the UHI. The QQM results in an additional total warming of ensemble mean temperatures by ∼3 °C for downscaled GCM output and ∼4 °C for re-gridded 1° grid resolution GCM output for 2030–2049 under the RCP8.5 emissions scenario. These temperature differences produce additional increases in summer potential evapotranspiration of 10% compared to non-QQM bias-corrected GCM output. It was shown that the QQM method represents a useful and computationally efficient method for bias correction of temperature projections for cities where UHI effects exist. Planning and impacts studies of urban water resources can benefit from these improved climate projections, particularly in regions where downscaled GCM output is unavailable.
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•An urban heat island effect (UHI) is identified in Reno, Nevada, USA.•Global climate models show cold temperatures biases in the urban area.•Projected temperature biases are efficiently reduced by a bias correction step.•Bias correction increases summer potential evapotranspiration rates by ∼10%.
Automatic methods for model calibration seek to take advantage of the speed and power of digital computers, while being objective and relatively easy to implement. However, they do not provide ...parameter estimates and hydrograph simulations that are considered acceptable by the hydrologists responsible for operational forecasting and have therefore not entered into widespread use. In contrast, the manual approach which has been developed and refined over the years to result in excellent model calibrations is complicated and highly labor‐intensive, and the expertise acquired by one individual with a specific model is not easily transferred to another person (or model). In this paper, we propose a hybrid approach that combines the strengths of each. A multicriteria formulation is used to “model” the evaluation techniques and strategies used in manual calibration, and the resulting optimization problem is solved by means of a computerized algorithm. The new approach provides a stronger test of model performance than methods that use a single overall statistic to aggregate model errors over a large range of hydrologie behaviors. The power of the new approach is illustrated by means of a case study using the Sacramento Soil Moisture Accounting model.
Food allergy is a chronic disease that affects individuals of all ages and is a significant public health problem globally. This narrative overview examines clinical management strategies for ...IgE-mediated food allergy in children around the world to understand variations in practice. Information was drawn from clinical practice guidelines, recent research, the websites of professional and governmental bodies with expertise in food allergy, and clinical experts from a broad cross-section of geographical regions. The structure and delivery of clinical services, allergen avoidance and food labeling, and resources to support the management of allergic reactions in the community are discussed in detail. The adoption of emerging food immunotherapies is also explored. Wide variations in clinical management of food allergy were apparent across the different countries. Common themes were continuing issues with access to specialist care and recognition of the need to balance risk reduction with dietary and social restrictions to avoid unnecessary detrimental impacts on the quality of life of food allergy sufferers. Findings highlight the need for standardized presentation of practice and priorities, and may assist clinicians and researchers when engaging with government and funding agencies to address gaps.
Shorelines that formed in closed watershed–lake systems record past climate conditions. A simple monthly water balance model was used to explore the link between past climates, paleoclimate proxies, ...and the hydrologic system response of a closed watershed–lake system in the Great Basin, USA. The model was applied at a high spatial resolution and calibrated with available modern hydroclimate and watershed data and then used with existing paleolake shoreline estimates to investigate how climate and hydrologic conditions in the late Pleistocene differed from modern conditions. A range of climate conditions, ∆T (0 to −8 °C) and ∆P (1.9–2.4) from the modern climate, resulted in steady model simulations of the late Pleistocene lake highstand. Modeling results also indicate the watershed–lake system response is much more sensitive to changes in precipitation than to changes in temperature, and that the range of possible combinations of these variables can be reduced significantly when the results are compared with an independent modeling study that inferred paleoclimate conditions from glacial moraines in the Wind River Range near the eastern portion of the Great Basin. The modeling effort also revealed that physiographic heterogeneities and seasonality play a significant role in how the watershed–lake system responds to changes in precipitation and temperature, highlighting the importance of simulating the system behavior with an appropriate degree of spatial resolution. The significance of model calibration and performance evaluation over the modern period was demonstrated through a comparison of the calibrated model results with those obtained using default parameter values with the original model.
The focus of this study is to assess the performance improvements of semidistributed applications of the U.S. National Weather Service Sacramento Soil Moisture Accounting model on a watershed using ...radar‐based remotely sensed precipitation data. Specifically, performance comparisons are made within an automated multicriteria calibration framework to evaluate the benefit of “spatial distribution” of the model input (precipitation), structural components (soil moisture and streamflow routing computations), and surface characteristics (parameters). A comparison of these results is made with those obtained through manual calibration. Results indicate that for the study watershed, there are performance improvements associated with semidistributed model applications when the watershed is partitioned into three subwatersheds; however, no additional benefit is gained from increasing the number of subwatersheds from three to eight. Improvements in model performance are demonstrably related to the spatial distribution of the model input and streamflow routing. Surprisingly, there is no improvement associated with the distribution of the surface characteristics (model parameters).
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