Abstract. Large uncertainties in land surface models (LSMs) simulations still arise from inaccurate forcing, poor description of land surface heterogeneity (soil and vegetation properties), incorrect model parameter values and incomplete representation of biogeochemical processes. The recent increase in the number and type of carbon cycle-related observations, including both in situ and remote sensing measurements, has opened a new road to optimize model parameters via robust statistical model–data integration techniques, in order to reduce the uncertainties of simulated carbon fluxes and stocks. In this study we present a carbon cycle data assimilation system that assimilates three major data streams, namely the Moderate Resolution Imaging Spectroradiometer (MODIS)-Normalized Difference Vegetation Index (NDVI) observations of vegetation activity, net ecosystem exchange (NEE) and latent heat (LE) flux measurements at more than 70 sites (FLUXNET), as well as atmospheric CO2 concentrations at 53 surface stations, in order to optimize the main parameters (around 180 parameters in total) of the Organizing Carbon and Hydrology in Dynamics Ecosystems (ORCHIDEE) LSM (version 1.9.5 used for the Coupled Model Intercomparison Project Phase 5 (CMIP5) simulations). The system relies on a stepwise approach that assimilates each data stream in turn, propagating the information gained on the parameters from one step to the next. Overall, the ORCHIDEE model is able to achieve a consistent fit to all three data streams, which suggests that current LSMs have reached the level of development to assimilate these observations. The assimilation of MODIS-NDVI (step 1) reduced the growing season length in ORCHIDEE for temperate and boreal ecosystems, thus decreasing the global mean annual gross primary production (GPP). Using FLUXNET data (step 2) led to large improvements in the seasonal cycle of the NEE and LE fluxes for all ecosystems (i.e., increased amplitude for temperate ecosystems). The assimilation of atmospheric CO2, using the general circulation model (GCM) of the Laboratoire de Météorologie Dynamique (LMDz; step 3), provides an overall constraint (i.e., constraint on large-scale net CO2 fluxes), resulting in an improvement of the fit to the observed atmospheric CO2 growth rate. Thus, the optimized model predicts a land C (carbon) sink of around 2.2 PgC yr−1 (for the 2000–2009 period), which is more compatible with current estimates from the Global Carbon Project (GCP) than the prior value. The consistency of the stepwise approach is evaluated with back-compatibility checks. The final optimized model (after step 3) does not significantly degrade the fit to MODIS-NDVI and FLUXNET data that were assimilated in the first two steps, suggesting that a stepwise approach can be used instead of the more “challenging” implementation of a simultaneous optimization in which all data streams are assimilated together. Most parameters, including the scalar of the initial soil carbon pool size, changed during the optimization with a large error reduction. This work opens new perspectives for better predictions of the land carbon budgets.

ObjectivesDespite the paucity of evidence verifying its efficacy and safety, traditional Chinese medicine (TCM) is expanding in popularity and political support. Decisions to include TCM diagnoses in the International Classification of Diseases 11th Revision and campaigns to integrate TCM into national healthcare systems have occurred while public perception and usage of TCM, especially in Europe, remains undetermined. Accordingly, this study investigates TCM’s popularity, usage and perceived scientific support, as well as its relationship to homeopathy and vaccinations.Design/SettingWe performed a cross-sectional survey of the Austrian population. Participants were either recruited on the street (in-person) or online (web-link) via a popular Austrian newspaper.Participants1382 individuals completed our survey. The sample was poststratified according to data derived from Austria’s Federal Statistical Office.Outcome measuresAssociations between sociodemographic factors, opinion towards TCM and usage of complementary medicine (CAM) were investigated using a Bayesian graphical model.ResultsWithin our poststratified sample, TCM was broadly known (89.9% of women, 90.6% of men), with 58.9% of women and 39.5% of men using TCM between 2016 and 2019. Moreover, 66.4% of women and 49.7% of men agreed with TCM being supported by science. We found a positive relationship between perceived scientific support for TCM and trust in TCM-certified medical doctors (ρ=0.59, 95% CI 0.46 to 0.73). Moreover, perceived scientific support for TCM was negatively correlated with proclivity to get vaccinated (ρ=−0.26, 95% CI −0.43 to –0.08). Additionally, our network model yielded associations between TCM-related, homeopathy-related and vaccination-related variables.ConclusionsTCM is widely known within the Austrian general population and used by a substantial proportion. However, a disparity exists between the commonly held public perception that TCM is scientific and findings from evidence-based studies. Emphasis should be placed on supporting the distribution of unbiased, science-driven information.

Introduction Despite the paucity of evidence verifying its efficacy and safety, traditional Chinese medicine (TCM) is expanding in popularity and political support. Decisions to include TCM diagnoses in the International Classification of Diseases 11th Revision (ICD-11) by the World Health Organization (WHO) and campaigns to integrate TCM into national healthcare systems have occurred whilst the public perception and usage of TCM, especially in Europe, remains undetermined. Accordingly, this study investigates the popularity, usage patterns, perception of scientific support for TCM, and its relationship to homeopathy. Methods A cross-sectional survey was performed in Austria and data from 1382 participants were analysed. A Bayesian network model retrieved partial correlations indicating distinct associations between sociodemographic determinants, complementary and alternative medicine (CAM) usage patterns, readiness to vaccinate, and TCM related variables. Results TCM was broadly known by the Austrian population (89.9% of women, 90.6% of men), with 58.9% of women and 39.5% of men using TCM between 2016 and 2019. 66.4% of women and 49.7% of men agreed with TCM being supported by science. We found a strong positive relationship between the perceived scientific support for TCM and trust in TCM-certified medical doctors. Moreover, perceived scientific support for TCM was negatively correlated with the proclivity to get vaccinated. Additionally, our Bayesian network model yielded distinct associations between TCM-, homeopathy-, and vaccination-related variables. Conclusion TCM is widely known within the Austrian general population and actively used by a substantial proportion. However, a crucial disparity exists between the commonly held public perception that TCM is scientific and findings from evidence-based studies. As public opinion towards TCM, and the proclivity to use it, are promoted through institutionalisation and official acknowledgement, it would be critical to sustain and support the distribution of unbiased, science-driven information by governmental institutions and policymakers to encourage informed patient-driven decision-making.