Abstract. Urban emissions impact aerosol-cloud interactions and thereby modify precipitation patterns, yet their absolute effects remain uncertain due to internal atmospheric variability and limitations of conventional analysis methods. This study aims to further quantify the influence of urban aerosol fields on convective precipitation through explicit chemistry-cloud coupling. Using the coupled COSMO-DCEP-MUSCAT modeling system, we simulate two convective events passing the city of Leipzig, Germany, with five-member ensemble experiments comparing total emissions to zero urban emission scenarios. Cloud droplet activation is calculated from prognostic three-dimensional aerosol fields, providing a physically consistent representation of aerosol–cloud interactions. We use backward trajectory analysis to directly trace urban air masses from convective clouds back to the region of urban emission sources, enabling objective sampling of individual clouds and isolation of local emission effects. The results reveal case-dependent responses. Under moderate atmospheric instability, urban aerosols locally modify the cloud microphysics and precipitation without altering the overall structure of the convective system. Under stronger initial instability, the urban emissions intensify the precipitation, leading to stronger downdrafts, causing a premature system decay and shorter lifetime compared to the zero urban emission scenario. Ensemble analysis demonstrates that emission-induced changes are comparable in amount to internal variability, highlighting the need for multiple realizations and significance testing. The results of this study reveal that urban aerosol effects are highly case-dependent, challenging assumptions about uniform impacts. The same air pollution source can either delay, enhance or suppress convection depending on prevailing atmospheric conditions.

While cities are facing increasing challenges of flood risk due to combined effects of climate change and socioeconomic development, understanding of the complexity of urban flood risk is still limited, hampering decision-making and urban adaptation planning. This study presents a qualitative system dynamics modelling framework to investigate urban flood risk and adaptation under climate change in a coupled socio-ecological system, the city of Hamburg. The developed integrated conceptual model provides a holistic understanding of key physical and socio-economic processes and the role of feedback loops underlying the urban system, and contributes to the understanding of vicious cycles of barriers that perpetuate and hinder adaptation processes within cities. The qualitative approach can help to break down silo-thinking in urban flood risk assessments. Decision-makers could use the framework to understand the complexity of interactions among multiple drivers of flood risk to overcome barriers and lock-in effects to adaptation in cities.

This study investigates the effects of significant activity changes on air pollutant concentrations across the three European cities Hamburg, Liège, and Marseille and focuses on the effects of COVID-19 lockdown measures as a case study for such significant activity changes. To identify such effects, this study utilizes urban-scale chemistry transport modeling, embedded in regional-scale Chemistry Transport simulations. The outcomes underscore the significance of considering local conditions and emissions sources, as variations between urban and regional simulations demonstrate. Notably, lockdown regulations yield the most substantial impact in Marseille due to its dense road traffic and port area, with Liège following suit, primarily influenced by regional air quality alterations. Conversely, Hamburg exhibits lower mean changes, attributed to its widespread urban structure. Analysis of modeled exceedances of limit values reveals significant reductions, particularly in areas of urban and road land use. These findings contribute valuable insights into the efficacy of significant activity changes, such as lockdown measures, in mitigating air pollution, underlining the importance of tailored strategies for emission reduction in urban environments.

Background: Adolescent idiopathic scoliosis (AIS) is often associated with thoracic hypokyphosis or even lordosis. Objectives: To analyze the influence of posterior correction and fusion in thoracic, structurally double-curved AIS. Material and methods: Out of 127 thoracic AIS (Lenke types 1 and 2) recorded prospectively, idiopathic double thoracic curve AIS were analyzed retrospectively. Surgery 2010-2019 with pedicle screw double rod systems in a scoliosis center. Followup (FU) at least 2 years. Frontal and sagittal angles (whole-spine radiographs, 2 planes): thoracic curve (MK), proximal-thoracic curve (PK) and lumbar curve (LK), thoracic kyphosis (TK), lumbar lordosis (LL). Statistical analysis: values as MW +/- SD, students t-test (significance a = 0.05), Pearson's correlation, sub-analysis with sagittal modifiers (-, N, +). Results: A total of 47 AIS-double thoracic curve were identified, mean FU 29.3 +/- 12.2 months, mean age 14 +/- 1.5 years. The mean correction (FU-preop) of MK was 67%, PK 53%, LK 73%, each significant, (p < 0.05). On average, TK (FU-preop) decreased by -6.5 +/- 11.6 degrees (p < 0.05), no significant change from FU (p = 0.6). TK (FU-preop) increased by 8.6 +/- 5.0 degrees (p < 0.05) in hypokyphotic cases, significantly decreased by -4.8 +/- 9.6 degrees in normokyphotic AIS and -25.3 +/- 11.1 degrees in hyperkyphotic cases, respectively (p < 0.05). In hypokyphosis: moderately strong correlation between correction PK (r= -0.5) and spontaneous correction LK (r= 0.8) (frontal plane) and change from pre-to postop TK (sagittal plane) (p < 0.05). Moderate correlation for hyperkyphosis: correction PK (r= -0.5) and postop TK (p < 0.05). No relevant correlations for normokyphosis. 17% had postop hypokyphosis, of which 0% had preop hypokyphosis. Rod diameter (5.5 mm vs. 6 mm) had no significant effect on TC.Conclusions: Posterior instrumented correction and fusion (pedicle screw dual rod systems) can significantly correct both lateral curves in idiopathic double thoracic curves, although it is associated with an increased risk of postop thoracic hypokyphosis, especially in preoperatively normokyphotic patients.

Current efforts by the International Maritime Organization (IMO) to decarbonize the shipping sector have gained momentum, although the exact path to achieve this goal is currently unclear. However, it can be safely assumed that alternative cleaner and zero-carbon fuels will be key components in the strategy. In this work, three ship emission scenarios for 2025, 2040, and 2050 were developed that cover the area of the North and Baltic Seas. They aim at a fundamental transition in the usage of marine fuels towards ammonia as the mainly used fuel in 2050, via an intermediate step in 2040 with liquefied natural gas as the main fuel. Additionally, expected trends and developments for the shipping sector were implemented, i.e., a fleet growth by vessel size and number. Efficiency improvements were included that are in accordance with the Energy Efficiency Design Index of the IMO. The scenarios were created using a novel method based on modifications to a virtual shipping fleet. The vessels in this fleet were subject to decommission and renewal cycles that adapt them to the scenario's target year. Emissions for this renewed shipping fleet were calculated with the Modular Ship Emission Modeling System (MoSES). With respect to ammonia engine technology, two cases were considered. The first case deals with compression ignition engines and marine gas oil as pilot fuel, while the second case treats spark ignition engines and hydrogen as the pilot fuel. The first case is considered more feasible until 2050. Reductions with the first case in 2050 compared to 2015 were 40% for CO2 emissions. However, CO2 equivalents were only reduced by 22%, with the difference mainly resulting from increased N2O emissions. NOX emissions were reduced by 39%, and different PM components and SO2 were between 73% and 84% for the same target year. The estimated NH3 slip from ammonia-fueled ships in the North and Baltic Seas was calculated to be 930 Gg in 2050. For the second ammonia engine technology that is considered more advanced, emission reductions were generally stronger and ammonia emissions smaller.

Adolescent idiopathic scoliosis (AIS) often correspond with hypo thoracic kyphosis (TK) or even lordosis. The aim of this study was to analyze the influence of posterior instrumentation in thoracic AIS. Analysis of prospectively collected AIS-data with structural thoracic curves (Lenke type 1 2), operated 2010–2019 with pedicle screw dual rod systems in one scoliosis center. Follow-up (FU) minimum 24 months. Coronal and sagittal angles measured based on standing long-cassette-X-rays: thoracic major (MC), proximal thoracic (PC) and lumbar curve (LC), TK, lumbar lordosis (LL). Statistical analysis: values as mean ± SD, differences by student’s t-test (significancy a = 0.05), Pearson’s correlation, sub-analysis with sagittal modifier (−, N, +). A total of 127 AIS could be identified (63

&lt;p&gt;Transport and the related economic sectors contribute significantly to climate change. Emissions from these sectors are continuously growing, challenging the achievement of the Paris agreement. These sectors also have detrimental impacts on air quality and noise pollution. None of the currently available emission inventories can consistently account for the emissions (gas, particles and noise) of all transport modes (land transport, aviation, and shipping), while also considering the emissions from transport-related energy production, industrial processes and infrastructures. Moreover, most of the available inventories do not include information at subsector level, for example, they neither distinguish among different vehicle types nor consider key transport-related quantities other than emissions. However, emission inventories at such a level of detail are essential for a reliable quantification of the impact of transport at global, regional and national scales. In addition, consistent emission inventories are required for the development of future emission scenarios to assess the effectiveness of climate policies and other measures to improve air quality and to reduce noise pollution. To master this challenging task, the new strategic impulse project ELK &amp;#8211; EmissionsLandKarte (en.: emission map) combines the interdisciplinary expertise of the German Aerospace Center (DLR) through a collaboration of 24 institutes and the Helmholtz-Zentrum Hereon. ELK aims to establish a primary source of information for different stakeholders and working groups, such as national policy makers, the scientific community dealing with climate, air quality and noise modelling, and the Intergovernmental Panel for Climate Change (IPCC). A collaborative and interdisciplinary approach is necessary in order to cover the wide spectrum of topics inherent to the compilation of emission inventories. This includes, for instance, transport demand, emission indices, and the development of models, together with dedicated methods for data visualization and management. The diversity of data sources and the heterogeneity of data formats from different sectors and data providers require the combination of different modelling tools and approaches, along with the use of measurements and satellite data. Available DLR data and data from external providers will be processed and used as input to quantify spatially and temporally resolved transport volumes and emission distributions. Based on already available inventories, precise criteria for the design of the ELK emission inventories will be defined and their quality and usability in real-world applications will be assessed. Finally, a database structure and user interface will be established to guarantee an easy and reliable access to the final products for both internal and external users. The ELK project links the aeronautics, space, transport and energy research programs of the DLR.&lt;/p&gt;

In surgical treatment of adolescent idiopathic scoliosis (AIS), only a few studies measure both, radiological parameters and PROMs and correlate them. Prospectively collected AIS-data of one scoliosis-center within a multicenter German-Spine-Society-Study. All patients underwent instrumented posterior spinal correction and fusion with pedicle-screw-dual-rod-systems from 05/2019 to 01/2021. The data were retrospectively analyzed. Inclusion criteria: age 11–17 years, follow-up (FU) at least 12 months. Clinical data, radiographic parameters, and PROMs (SRS-30-questionnaire) were collected. 100

The lockdown measures taken to prevent a rapid spreading of the coronavirus in Europe in spring 2020 led to large emission reductions, particularly in road traffic and aviation. Atmospheric concentrations of NO2 and PM2.5 were mostly reduced when compared to observations taken for the same time period in previous years; however, concentration reductions may not only be caused by emission reductions but also by specific weather situations. In order to identify the role of emission reductions and the meteorological situation for air quality improvements in central Europe, the meteorology chemistry transport model system COSMO-CLM/CMAQ was applied to Europe for the period 1 January to 30 June 2020. Emission data for 2020 were extrapolated from most recent reported emission data, and lockdown adjustment factors were computed from reported activity data changes, e.g. Google mobility reports. Meteorological factors were investigated through additional simulations with meteorological data from previous years. The results showed that lockdown effects varied significantly among countries and were most prominent for NO2 concentrations in urban areas with 2-week-average reductions up to 55 % in the second half of March. Ozone concentrations were less strongly influenced (up to ±15 %) and showed both increasing and decreasing concentrations due to lockdown measures. This depended strongly on the meteorological situation and on the NOx / VOC emission ratio. PM2.5 revealed 2 %–12 % reductions of 2-week-average concentrations in March and April, which is much less than a different weather situation could cause. Unusually low PM2.5 concentrations as observed in northern central Europe were only marginally caused by lockdown effects. The lockdown can be seen as a big experiment about air quality improvements that can be achieved through drastic traffic emission reductions. From this investigation, it can be concluded that NO2 concentrations can be largely reduced, but effects on annual average values are small when the measures last only a few weeks. Secondary pollutants like ozone and PM2.5 depend more strongly on weather conditions and show a limited response to emission changes in single sectors.

Die adoleszente idiopathische Skoliose (AIS) geht häufig mit einer thorakalen Hypokyphose oder sogar Lordose einher. Ziel war es, den Einfluss der dorsalen Korrekturspondylodese bei thorakalen, strukturell doppelbogigen AIS zu analysieren. Von insgesamt 127 prospektiv erfassten thorakalen AIS (Lenke-Typ 1 und 2) wurden die doppelbogigen thorakalen AIS retrospektiv analysiert. Operation 2010–2019 mit Pedikelschrauben-Doppelstab-Systemen in einem Skoliosezentrum. Nachuntersuchung (FU) mind. 2 Jahre. Frontale und sagittale Winkel (Ganzwirbelsäulen-Röntgenbilder, 2E): thorakale Krümmung (MK), proximal-thorakale Krümmung (PK) und lumbale Nebenkrümmung (LK), thorakale Kyphose (TK), Lendenlordose (LL). Statistische Analyse: Werte als MW ± SD, Students t‑Test (Signifikanz a = 0,05), Pearson’s Korrelation, Subanalyse mit sagittalen Modifiern (−, N, +). Insgesamt wurden 47 doppelbogige thorakale AIS identifiziert, mittlere FU 29,3 ± 12,2 Monate, mittleres Alter 14 ± 1,5 Jahre. Mittlere Korrektur (FU-präop) der MK betrug 67

The aim of this study is to quantify the BIAS in air pollution (PM2.5, NO2) exposure estimates that arise from neglecting population activity under COVID-19 lockdown conditions. We applied mobility data as derived from different sources (Google, Eurostat, Automatic Identification System, etc.) to model the impact of (1) changing emissions and (2) the change in population activity patterns in a European multi-city (Hamburg, Liège, Marseille) exposure study. Our results show significant underestimations of exposure estimates when activity profiles are either neglected or not adjusted for lockdown conditions.

Summary This study aims to quantify the combined effect of changing emissions and population activity in the estimation of urban population during the first COVID19-lockdown measures in the beginning of the year 2020. While most studies focus on the impact of changing emissions in concentration reductions due to lockdown measures, we identified the additional change in population exposure for three different cities in Europe, when taking into account the change in population activity in a dynamic urban population exposure model. The results show that population exposure is underestimated by up to 8% for NO2 and by up to 29% for PM2.5 exposure, when neglecting the change in population activity. Introduction The lockdown response to the coronavirus disease 2019 (COVID-19) has caused an exceptional reduction in global economic and transport activity. Many recent measurement and modelling studies tested the hypothesis that this has reduced ground-level air pollution concentrations as well as the associated population exposure and health effects, especially in urban areas. Although Google and Apple mobility data is utilized in such air quality modelling studies to derive changes in emissions, the mobility data is not used to reflect changes in population activity patterns. Nevertheless, neglecting the mobility of populations in exposure estimates is known to introduce substantial BIAS; especially on urban-scales. Therefore, we identified the additional change in population exposure for three different cities in Europe (Hamburg - DE, Liège - BE, Marseille - FR), when taking into account the change in population activity in a dynamic urban population exposure model. Methods To model the impact of (1) changing emissions and (2) the change in population activity patterns in our multi-city exposure study, we applied mobility data as derived from different sources (Google, Eurostat, Automatic Identification System, etc.). The aim is to quantify the BIAS in air pollution (PM2.5, NO2) exposure estimates that arises from neglecting population activity under COVID-19 lockdown conditions. We applied the urban-scale chemistry transport model EPISODE-CityChem (Karl et. al 2019) and the urban dynamic exposure model UNDYNE (Ramacher et al. 2020) in the European cities Marseille (FR), Liège (BE) and Hamburg (DE) in the first six months of 2020. Based on flexible microenvironment definitions for different surroundings (based on the Copernicus UrbanAtlas) and modes of transport (based on OpenStreetMap), the UNDYNE model allows for a flexible application of population activity in European urban areas. This feature was used to evaluate and compare a set of emission and activity scenarios. Results Compared to non-lockdown conditions, the derived lockdown activity profiles showed substantial additional changes in the total exposure of the urban population in all cities with up to 8% for NO2 and by up to 29% for PM2.5. The analysis of estimated exposure in the different microenvironments home, work and transport reflects the changes in population activity with increasing exposure in the home environment and decreasing exposure in the work and transport environments. Due to the general high reduction of population exposure in transport activities, a significant change of exposure for different modes of transport was not observed.

Aktuell überwiegt der Anteil der Frauen in Studium und Weiterbildung, die fachspezifische Verteilung bis zur Führungsposition ist aber teilweise reziprok (Orthopädie/Chirurgie). Gibt es Unterschiede, die auf eine geschlechtsabhängige Umverteilung in Führungspositionen bereits in der Weiterbildungswahl hindeuten? Onlineumfrage mit Assistenzärzt/-innen der Orthopädie/Unfall(OUC)- und Neurochirurgie (NCH). Vergleich mit Gynäkologie (GYN). Statistische Auswertung, Mittelwert in Prozent, statistische Unterschiede mittels t‑ oder chi2-Test (Signifikanzniveau α = 0,05). Rückläufer Fragebogen = 277, vollständige Teilnahme = 250. Ärztinnen: OUC:52 %, NCH:57 %, GYN:85 %. Insgesamt 49 % wurde im Studium vermittelt, dass aus geschlechtsspezifischen Gründen ein Fach ungeeignet sei (w57–76 %, m10–33 %). Häufigster Grund für ein Fach: alle = „operative Tätigkeit“, zweithäufigster Grund: OUC-w = „gutes Arbeitsklima“, OUC-m = „Niederlassung“, NCH-w = „Karriere“ und „gutes Arbeitsklima“, NCH-m = „gutes Arbeitsklima“, GYN-w = „Niederlassung“, GYN-m = „Karriere“. Häufigster Grund dagegen: OUC/GYN = „kaum Niederlassungsmöglichkeit“, NCH = „negativer Führungsstil durch Vorgesetzte“. Bei Ärztinnen in OUC/NCH hatte Vereinbarkeit von Beruf/Familie geringsten Einfluss auf Fachgebietswahl. Deren subjektive Einschätzung über Vereinbarkeit war signifikant am schlechtesten und insgesamt (OUC/NCH) signifikant schlechter als in GYN. Zwar begründen Ärztinnen in NCH die Fachgebietswahl häufiger mit Karrierezielen, Ärzte in OUC/NCH streben aber eher eine höhere hierarchische Position an. Die Ergebnisse der Studie unterstreichen, dass die Fächer bereits im Studium eine geschlechtsspezifische Prägung erhalten, die deutliche Auswirkungen auf die Fachgebietswahl hat. Das diesbezügliche Image muss überdacht werden, da absehbar auch chirurgische Fächer auf mehr weibliches Fachpersonal werden zurückgreifen müssen.

Based on the Baltic Earth Assessment Reports of this thematic issue in Earth System Dynamics and recent peer-reviewed literature, current knowledge of the effects of global warming on past and future changes in climate of the Baltic Sea region is summarised and assessed. The study is an update of the Second Assessment of Climate Change (BACC II) published in 2015 and focuses on the atmosphere, land, cryosphere, ocean, sediments, and the terrestrial and marine biosphere. Based on the summaries of the recent knowledge gained in palaeo-, historical, and future regional climate research, we find that the main conclusions from earlier assessments still remain valid. However, new long-term, homogenous observational records, for example, for Scandinavian glacier inventories, sea-level-driven saltwater inflows, so-called Major Baltic Inflows, and phytoplankton species distribution, and new scenario simulations with improved models, for example, for glaciers, lake ice, and marine food web, have become available. In many cases, uncertainties can now be better estimated than before because more models were included in the ensembles, especially for the Baltic Sea. With the help of coupled models, feedbacks between several components of the Earth system have been studied, and multiple driver studies were performed, e.g. projections of the food web that include fisheries, eutrophication, and climate change. New datasets and projections have led to a revised understanding of changes in some variables such as salinity. Furthermore, it has become evident that natural variability, in particular for the ocean on multidecadal timescales, is greater than previously estimated, challenging our ability to detect observed and projected changes in climate. In this context, the first palaeoclimate simulations regionalised for the Baltic Sea region are instructive. Hence, estimated uncertainties for the projections of many variables increased. In addition to the well-known influence of the North Atlantic Oscillation, it was found that also other low-frequency modes of internal variability, such as the Atlantic Multidecadal Variability, have profound effects on the climate of the Baltic Sea region. Challenges were also identified, such as the systematic discrepancy between future cloudiness trends in global and regional models and the difficulty of confidently attributing large observed changes in marine ecosystems to climate change. Finally, we compare our results with other coastal sea assessments, such as the North Sea Region Climate Change Assessment (NOSCCA), and find that the effects of climate change on the Baltic Sea differ from those on the North Sea, since Baltic Sea oceanography and ecosystems are very different from other coastal seas such as the North Sea. While the North Sea dynamics are dominated by tides, the Baltic Sea is characterised by brackish water, a perennial vertical stratification in the southern subbasins, and a seasonal sea ice cover in the northern subbasins.

Study Design A retrospective single center cohort study with prospective collected data from an institutional spine registry. Objectives To determine whether restoration of lordosis L5/ S1 is possible with both anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF) and to find out which technique is superior to recreate lordosis in L5/S1