The partitioning of precipitation into frozen and liquid components influences snow-derived water resources and flood hazards in mountain environments. We used a 915-MHz Doppler radar wind profiler ...upstream of the northern Sierra Nevada to estimate the hourly elevation where snow melts to rain, or the snow level, during winter (December–February) precipitation events spanning water years (WY) 2008–2017. During this ten-year period, a Mann-Kendall test indicated a significant (p < 0.001) positive trend in snow level with a Thiel-Sen slope of 72 m year−1. We estimated total precipitation falling as snow (snow fraction) between WY1951 and 2017 using nine daily mid-elevation (1200–2000 m) climate stations and two hourly stations spanning WY2008–2017. The climate-station-based snow fraction estimates agreed well with snow-level radar values (R2 = 0.95, p < 0.01), indicating that snow fractions represent a reasonable method to estimate changes in frozen precipitation. Snow fraction significantly (p < 0.001) declined during WY2008–2017 at a rate of 0.035 (3.5%) year−1. Single-point correlations between detrended snow fraction and sea-surface temperatures (SST) suggested that positive SST anomalies along the California coast favor liquid phase precipitation during winter. Reanalysis-derived integrated moisture transported upstream of the northern Sierra Nevada was negatively correlated with snow fraction (R2 = 0.90, p < 0.01), with atmospheric rivers representing the likely circulation mechanism producing low-snow-fraction storms.
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.
Knowledge of brachial plexus anatomy is essential when performing upper-extremity regional anaesthesia. Anomalous brachial plexus anatomy has been reported in up to 35% of patients. Variants include ...anomalous course of the roots anterior to, or within, the scalene musculature and abnormal separation of the cords around the subclavian artery. These anomalies have been detected with ultrasound, a valuable tool for delineating anatomy and providing imaging guidance during regional anaesthesia. We report a previously undescribed course of the brachial plexus relative to the subclavian artery within the supraclavicular fossa identified by ultrasound prior to peripheral nerve blockade.
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.
Abstract Context Documentation of the emotional or psychological needs of seriously ill patients receiving specialty palliative care is endorsed by the “Measuring What Matters” project as a quality ...performance metric and recommended for use by hospice and palliative care programs for program improvement. Objectives The aim of this study was to increase the proportion of inpatient palliative care team encounters in which emotional or psychological needs of patients and family members were documented and to qualitatively enrich the nature of this documentation. Methods This is a mixed-methods retrospective study of 200 patient charts reviewed before and after implementation of a structured note template (SmartPhrase) for palliative care encounters. Patterns of documentation of emotional needs pre- and post-implementation were assessed quantitatively and qualitatively using thematic analysis. Results A total of 158 of 200 pre-intervention charts and 185 of 200 post-intervention charts included at least one note from the palliative care team. Documentation of emotional assessment increased after SmartPhrase implementation (63.9% 101 of 158 vs. 74.6% 138 of 185; P < 0.03). Qualitative analysis revealed a post-intervention reduction in the use of generic phrases (“emotional support provided”) and an increase in the breadth and depth of emotion-related documentation. Conclusion A structured note template with a prompt for emotional assessment increases the overall quantity and richness of documentation related to patient and family emotions. However, this documentation remains mostly descriptive. Additional prompting for documentation of recommendations to address identified emotional needs, and the use of screening tools for depression and anxiety, when appropriate, may be necessary for clinically meaningful quality improvements in patient care.
Megadroughts are not devoid of interannual precipitation variability. However, the frequency and magnitude of occasional wet years must be limited in order to be consistent with geologic evidence ...indicating terminal lake lowstands during past megadroughts. We present a series of hydrologic model simulations of Walker Lake, a western Great Basin terminal lake, where varying return intervals of increased cool-season (October–April) precipitation are superimposed upon a megadrought climate. Estimated megadrought lowstands are achieved with wetter years returning every 5–10 years. Total cool season moisture transport derived from the 20th Century Reanalysis between 1895 and 2012 A.D. was positively correlated with cool-season precipitation during the corresponding year (0.49, p < 0.01). Daily moisture transport exceeding the 95th percentile is used as a surrogate for atmospheric river events. Wetter (drier) years had a greater (lesser) fraction of total cool season transport occurring on atmospheric river days, indicating their important role in driving western Great Basin hydroclimate variability.
•Hydrologic modeling identifies frequency/magnitude of wet years during megadrought.•Wetter years can recur no more frequently than at 5–10 year intervals.•Atmospheric rivers important for western Great Basin hydroclimate variability.
While the Seminaries and Institutes of Religion (S&I) of The Church of Jesus Christ of Latter-day Saints expect supervisors of teachers to observe teachers regularly and provide feedback, they have ...not provided those supervisors with adequate training materials, or explained how these supervisors are expected to accomplish this. For this study, three administrators and three teachers were interviewed about their experiences with observation and feedback in S&I. Their responses provided clarification on the purposes of observation and feedback, revealed that a lack of supervisor training has resulted in teachers’ experiences with observation and feedback being different from administrator’s expectations in key ways, and identified some elements of observation and feedback that teachers and administrators agree are effective. Those elements include teachers’ autonomy, collaboration between supervisors, frequent observations designed to help teachers improve (rather than to judge teachers’ abilities), and providing feedback in a kind and constructive way, limiting suggestions for improve to one or two things that are based on principles for teaching that are widely-accepted throughout S&I. This study also reports how teachers and administrators might feel about the use of a standard observation form for teacher observation and feedback.
Macrophages reside in essentially all tissues of the body and play key roles in innate and adaptive immune responses. Distinct populations of tissue macrophages also acquire context-specific ...functions that are important for normal tissue homeostasis. To investigate mechanisms responsible for tissue-specific functions, we analyzed the transcriptomes and enhancer landscapes of brain microglia and resident macrophages of the peritoneal cavity. In addition, we exploited natural genetic variation as a genome-wide “mutagenesis” strategy to identify DNA recognition motifs for transcription factors that promote common or subset-specific binding of the macrophage lineage-determining factor PU.1. We find that distinct tissue environments drive divergent programs of gene expression by differentially activating a common enhancer repertoire and by inducing the expression of divergent secondary transcription factors that collaborate with PU.1 to establish tissue-specific enhancers. These findings provide insights into molecular mechanisms by which tissue environment influences macrophage phenotypes that are likely to be broadly applicable to other cell types.
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•Tissue environment is a major determinant of resident macrophage gene expression•Environment selectively activates common enhancers in different macrophage subsets•Environment primes and activates subset-specific enhancers and super-enhancers•Genetic variation enables discovery of subset-specific transcription factors
Genomic and genetic approaches reveal that distinct environmental factors activate shared enhancers and induce expression of population-restricted transcription factors that prime and activate subset-specific enhancers in tissue macrophages.
The HEATSOURCE 7.0 temperature model was modified to test whether hypothesized revegetation strategies could reduce water temperatures to 20°C along a portion of the Carson River in western Nevada. ...Modifications to the HEATSOURCE model made use of high-resolution LIDAR and image data of the study area to improve the representation of channel morphology and to better disaggregate parameters relating to energy balance. The model was modified to work with the Multi-Objective Complex global optimization algorithm. A simulation of riparian zone revegetation was performed by transplanting the vegetation attributes from a reach of substantial riparian tree cover to a sparsely vegetated 14 km long reach in the study area. Results showed that the maximum revegetation simulation produced measurable reductions in stream temperature. However, there were no days over the entire validation period when the maximum daily stream temperature would be expected to meet the 20°C threshold in the revegetated reach.
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