Our understanding of how global climatic changes are translated into ice-sheet fluctuations and sea-level change is currently limited by a lack of knowledge of the configuration of ice sheets prior to the Last Glacial Maximum (LGM). Here, we compile a synthesis of empirical data and numerical modelling results related to pre-LGM ice sheets to produce new hypotheses regarding their extent in the Northern Hemisphere (NH) at 17 time-slices that span the Quaternary. Our reconstructions illustrate pronounced ice-sheet asymmetry within the last glacial cycle and significant variations in ice-marginal positions between older glacial cycles. We find support for a significant reduction in the extent of the Laurentide Ice Sheet (LIS) during MIS 3, implying that global sea levels may have been 30–40 m higher than most previous estimates. Our ice-sheet reconstructions illustrate the current state-of-the-art knowledge of pre-LGM ice sheets and provide a conceptual framework to interpret NH landscape evolution.

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Uptake of cardiovascular risk assessment and prescribing of statins in high risk patients was considerably lower than projected in the first year of NHS Health Checks programme. Targeting efforts to increase uptake and adherence to interventions in high risk populations and reinvesting resources into population wide strategies to reduce obesity, smoking and salt intake may prove more cost-effective in reducing the burden of cardiovascular disease in the UK.

No abstract

This study does not support the use of a referral-based targeted multifactorial intervention program to reduce subsequent falls or fall injuries in older people who present to an ED after a fall.

Background. The NHS Health Check programme aims to improve prevention, early diagnosis and management of cardiovascular disease (CVD) in England. High and equitable uptake is essential for the programme to effectively reduce the CVD burden. Objectives. Assessing the impact of a local financial incentive scheme on uptake and statin prescribing in the first 2 years of the programme.Methods. Cross-sectional study using data from electronic medical records of general practices in Hammersmith and Fulham, London on all patients aged 40-74 years. We assessed uptake of complete Health Check, exclusion of patients from the programme (exception reporting) and statin prescriptions in patients confirmed with high CVD risk.Results. The Health Check uptake was 32.7% in Year 1 and 20.0% in Year 2. Older patients had higher uptake of Health Check than younger (65-to 74-year-old patients: Year 1 adjusted odds ratio (AOR) 2.05 (1.67-2.52) & Year 2 AOR 2.79 (2.49-3.12) compared with 40-to 54-year-old patients). The percentage of confirmed high risk patients prescribed a statin was 17.7% before and 52.9% after the programme. There was a marked variation in Health Check uptake, exception reporting and statin prescribing between practices.Conclusions. Uptake of the Health Check was low in the first year in patients with estimated high risk despite financial incentives to general practices; although this matched the national required rate in second year. Further evaluations for cost and clinical effectiveness of the programme are needed to clarify whether this spending is appropriate, and to assess the impact of financial incentives on programme performance.

Glacial−interglacial variations in CO2 and methane in polar ice cores have been attributed, in part, to changes in global wetland extent, but the wetland distribution before the Last Glacial Maximum (LGM, 21 ka to 18 ka) remains virtually unknown. We present a study of global peatland extent and carbon (C) stocks through the last glacial cycle (130 ka to present) using a newly compiled database of 1,063 detailed stratigraphic records of peat deposits buried by mineral sediments, as well as a global peatland model. Quantitative agreement between modeling and observations shows extensive peat accumulation before the LGM in northern latitudes (>40°N), particularly during warmer periods including the last interglacial (130 ka to 116 ka, MIS 5e) and the interstadial (57 ka to 29 ka, MIS 3). During cooling periods of glacial advance and permafrost formation, the burial of northern peatlands by glaciers and mineral sediments decreased active peatland extent, thickness, and modeled C stocks by 70 to 90% from warmer times. Tropical peatland extent and C stocks show little temporal variation throughout the study period. While the increased burial of northern peats was correlated with cooling periods, the burial of tropical peat was predominately driven by changes in sea level and regional hydrology. Peat burial by mineral sediments represents a mechanism for long-term terrestrial C storage in the Earth system. These results show that northern peatlands accumulate significant C stocks during warmer times, indicating their potential for C sequestration during the warming Anthropocene.

Accurately reconstructing the paleogeography of the Laurentide Ice Sheet (LIS) during Marine Isotope Stage 3 (MIS 3; ca. 57,000 to ca. 29,000 yr B.P.) is critical for understanding glacial growth toward the Last Glacial Maximum (LGM), refining sealevel histories and studying the Earth system response to rapid climate change events. Here, we present a geochronological data set useful for testing hypotheses of global sea level and refining ice sheet configuration through this interval. Data (n = 735) span the entire MIS 3 interval and consist of 14 C determinations (n = 651), cosmogenic exposure ages (n = 52), and optically stimulated luminescence dates (n = 32). On that basis, we hypothesize that the central region of the LIS underwent a dramatic reduction in ice from ~52-40 ka.