Objective

To report a case of early pregnancy loss successfully managed by hysteroscopic resection, review the literature comparing hysteroscopic resection to dilation and curettage for retained products of conception, and review potential advantages of hysteroscopic resection over dilation and curettage for management of early pregnancy loss.

Design

Case report.

Setting

Private practice.

Patients

One woman with early pregnancy loss.

Interventions

Hysteroscopic resection using a mechanical morcellation device.

Main outcome measures

Complete uterine evacuation after hysteroscopic resection as demonstrated by a normal transvaginal ultrasound and cessation of bleeding 2 weeks after surgery.

Results

The hysteroscopic fluid deficit was 365 ml, with minimal blood loss. Products of conception were confirmed on pathologic examination. There were no intraoperative or postoperative complications. A saline infusion sonogram obtained 4 months after surgery demonstrated a normal endometrial cavity with no intrauterine adhesions.

Conclusions

Surgical management of early pregnancy loss may be complicated by retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Hysteroscopic resection of RPOC has been associated with fewer cases of intrauterine adhesions, more cases of complete tissue removal, and earlier time to conception compared with dilation and curettage. Early pregnancy loss can also be characterized as RPOC with potentially similar benefits from hysteroscopic resection. Thus, hysteroscopic resection can be considered as an alternative surgical technique for management of early pregnancy loss. This case report demonstrates the successful application of hysteroscopic resection in a case of early pregnancy loss.

Thaw and release of permafrost carbon (C) due to climate change is likely to offset increased vegetation C uptake in northern high-latitude (NHL) terrestrial ecosystems. Models project that this permafrost C feedback may act as a slow leak, in which case detection and attribution of the feedback may be difficult. The formation of talik, a subsurface layer of perennially thawed soil, can accelerate permafrost degradation and soil respiration, ultimately shifting the C balance of permafrost-affected ecosystems from long-term C sinks to long-term C sources. It is imperative to understand and characterize mechanistic links between talik, permafrost thaw, and respiration of deep soil C to detect and quantify the permafrost C feedback. Here, we use the Community Land Model (CLM) version 4.5, a permafrost and biogeochemistry model, in comparison to long-term deep borehole data along North American and Siberian transects, to investigate thaw-driven C sources in NHL ( > 55° N) from 2000 to 2300. Widespread talik at depth is projected across most of the NHL permafrost region (14 millionĝ€†km2) by 2300, 6.2 millionĝ€†km2 of which is projected to become a long-term C source, emitting 10 Pgĝ€†C by 2100, 50 Pgĝ€†C by 2200, and 120 Pgĝ€†C by 2300, with few signs of slowing. Roughly half of the projected C source region is in predominantly warm sub-Arctic permafrost following talik onset. This region emits only 20 Pgĝ€†C by 2300, but the CLM4.5 estimate may be biased low by not accounting for deep C in yedoma. Accelerated decomposition of deep soil C following talik onset shifts the ecosystem C balance away from surface dominant processes (photosynthesis and litter respiration), but sink-to-source transition dates are delayed by 20-200 years by high ecosystem productivity, such that talik peaks early ( ĝ1/4 2050s, although borehole data suggest sooner) and C source transition peaks late ( ĝ1/4 2150-2200). The remaining C source region in cold northern Arctic permafrost, which shifts to a net source early (late 21st century), emits 5 times more C (95 Pgĝ€†C) by 2300, and prior to talik formation due to the high decomposition rates of shallow, young C in organic-rich soils coupled with low productivity. Our results provide important clues signaling imminent talik onset and C source transition, including (1) late cold-season (January-February) soil warming at depth ( ĝ1/4 2 m), (2) increasing cold-season emissions (November-April), and (3) enhanced respiration of deep, old C in warm permafrost and young, shallow C in organic-rich cold permafrost soils. Our results suggest a mosaic of processes that govern carbon source-to-sink transitions at high latitudes and emphasize the urgency of monitoring soil thermal profiles, organic C age and content, cold-season CO2 emissions, and atmospheric 14CO2 as key indicators of the permafrost C feedback.

With rapid changes in climate and the seasonal amplitude of carbon dioxide (CO2) in the Arctic, it is critical that we detect and quantify the underlying processes controlling the changing amplitude of CO2 to better predict carbon cycle feedbacks in the Arctic climate system. We use satellite and airborne observations of atmospheric CO2 with climatically forced CO2 flux simulations to assess the detectability of Alaskan carbon cycle signals as future warming evolves. We find that current satellite remote sensing technologies can detect changing uptake accurately during the growing season but lack sufficient cold season coverage and near-surface sensitivity to constrain annual carbon balance changes at regional scale. Airborne strategies that target regular vertical profile measurements within continental interiors are more sensitive to regional flux deeper into the cold season but currently lack sufficient spatial coverage throughout the entire cold season. Thus, the current CO2 observing network is unlikely to detect potentially large CO2 sources associated with deep permafrost thaw and cold season respiration expected over the next 50 y. Although continuity of current observations is vital, strategies and technologies focused on cold season measurements (active remote sensing, aircraft, and tall towers) and systematic sampling of vertical profiles across continental interiors over the full annual cycle are required to detect the onset of carbon release from thawing permafrost.

We introduce a retrieval algorithm to estimate lower tropospheric methane (CH4) concentrations from the surface to 1 km with uncertainty estimates using Hyperspectral Thermal Emission Spectrometer (HyTES) airborne radiance measurements. After resampling, retrievals have a spatial resolution of 6 × 6 m2. The total error from a single retrieval is approximately 20 %, with the uncertainties determined primarily by noise and spectral interferences from air temperature, surface emissivity, and atmospheric water vapor. We demonstrate retrievals for a HyTES flight line over storage tanks near Kern River Oil Field (KROF), Kern County, California, and find an extended plume structure in the set of observations with elevated methane concentrations (3.0 ± 0.6 to 6.0 ± 1.2 ppm), well above mean concentrations (1.8 ± 0.4 ppm) observed for this scene. With typically a 20 % estimated uncertainty, plume enhancements with more than 1 ppm are distinguishable from the background values with its uncertainty. HyTES retrievals are consistent with simultaneous airborne and ground-based in situ CH4 mole fraction measurements within the reported accuracy of approximately 0.2 ppm (or ∼8 %), due to retrieval interferences related to air temperature, emissivity, and H2O.

Abstract: Chemical and biological composition of surface materials and physical structure and arrangement of those materials determine the intrinsic reflectance of Earth's land surface. The apparent reflectance—as measured by a spaceborne or airborne sensor that has been corrected for atmospheric attenuation—depends also on topography, surface roughness, and the atmosphere. Especially in Earth's mountains, estimating properties of scientific interest from remotely sensed data requires compensation for topography. Doing so requires information from digital elevation models (DEMs). Available DEMs with global coverage are derived from spaceborne interferometric radar and stereo‐photogrammetry at ∼30 m spatial resolution. Locally or regionally, lidar altimetry, interferometric radar, or stereo‐photogrammetry produces DEMs with finer resolutions. Characterization of their quality typically expresses the root‐mean‐square (RMS) error of the elevation, but the accuracy of remotely sensed retrievals is sensitive to uncertainties in topographic properties that affect incoming and reflected radiation and that are inadequately represented by the RMS error of the elevation. The most essential variables are the cosine of the local solar illumination angle on a slope, the shadows cast by neighboring terrain, and the view factor, the fraction of the overlying hemisphere open to the sky. Comparison of global DEMs with locally available fine‐scale DEMs shows that calculations with the global products consistently underestimate the cosine of the solar angle and underrepresent shadows. Analyzing imagery of Earth's mountains from current and future spaceborne missions requires addressing the uncertainty introduced by errors in DEMs on algorithms that analyze remotely sensed data to produce information about Earth's surface.

We report continuous surface observations of carbon dioxide (CO2) and methane (CH4) from the Los Angeles (LA) Megacity Carbon Project during 2015. We devised a calibration strategy, methods for selection of background air masses, calculation of urban enhancements, and a detailed algorithm for estimating uncertainties in urban-scale CO2 and CH4 measurements. These methods are essential for understanding carbon fluxes from the LA megacity and other complex urban environments globally. We estimate background mole fractions entering LA using observations from four "extra-urban" sites including two "marine" sites located south of LA in La Jolla (LJO) and offshore on San Clemente Island (SCI), one "continental" site located in Victorville (VIC), in the high desert northeast of LA, and one "continental/mid-troposphere" site located on Mount Wilson (MWO) in the San Gabriel Mountains. We find that a local marine background can be established to within ~1 ppm CO2 and ~10 ppb CH4 using these local measurement sites. Overall, atmospheric carbon dioxide and methane levels are highly variable across Los Angeles. "Urban" and "suburban" sites show moderate to large CO2 and CH4 enhancements relative to a marine background estimate. The USC (University of Southern California) site near downtown LA exhibits median hourly enhancements of ~20 ppm CO2 and ~150 ppb CH4 during 2015 as well as ~15 ppm CO2 and ~80 ppb CH4 during mid-afternoon hours (12:00-16:00 LT, local time), which is the typical period of focus for flux inversions. The estimated measurement uncertainty is typically better than 0.1 ppm CO2 and 1 ppb CH4 based on the repeated standard gas measurements from the LA sites during the last 2 years, similar to Andrews et al. (2014). The largest component of the measurement uncertainty is due to the single-point calibration method; however, the uncertainty in the background mole fraction is much larger than the measurement uncertainty. The background uncertainty for the marine background estimate is ~10 and ~15 % of the median mid-afternoon enhancement near downtown LA for CO2 and CH4, respectively. Overall, analytical and background uncertainties are small relative to the local CO2 and CH4 enhancements; however, our results suggest that reducing the uncertainty to less than 5 % of the median mid-afternoon enhancement will require detailed assessment of the impact of meteorology on background conditions.

Responses to COVID-19 have resulted in unintended reductions of city-scale carbon dioxide (CO₂) emissions. Here, we detect and estimate decreases in CO₂ emissions in Los Angeles and Washington DC/Baltimore during March and April 2020. We present three lines of evidence using methods that have increasing model dependency, including an inverse model to estimate relative emissions changes in 2020 compared to 2018 and 2019. The March decrease (25%) in Washington DC/Baltimore is largely supported by a drop in natural gas consumption associated with a warm spring whereas the decrease in April (33%) correlates with changes in gasoline fuel sales. In contrast, only a fraction of the March (17%) and April (34%) reduction in Los Angeles is explained by traffic declines. Methods and measurements used herein highlight the advantages of atmospheric CO₂ observations for providing timely insights into rapidly changing emissions patterns that can empower cities to course-correct CO₂ reduction activities efficiently.

Wetlands are the largest global natural methane (CH4/ source, and emissions between 50 and 70° N latitude contribute 10-30% to this source. Predictive capability of land models for northern wetland CH4 emissions is still low due to limited site measurements, strong spatial and temporal variability in emissions, and complex hydrological and biogeochemical dynamics. To explore this issue, we compare wetland CH4 emission predictions from the Community Land Model 4.5 (CLM4.5-BGC) with siteto regional-scale observations. A comparison of the CH4 fluxes with eddy flux data highlighted needed changes to the model's estimate of aerenchyma area, which we implemented and tested. The model modification substantially reduced biases in CH4 emissions when compared with CarbonTracker CH4 predictions. CLM4.5 CH4 emission predictions agree well with growing season (May-September) CarbonTracker Alaskan regional-level CH4 predictions and sitelevel observations. However, CLM4.5 underestimated CH4 emissions in the cold season (October-April). The monthly atmospheric CH4 mole fraction enhancements due to wetland emissions are also assessed using the Weather Research and Forecasting-Stochastic Time-Inverted Lagrangian Transport (WRF-STILT) model coupled with daily emissions from CLM4.5 and compared with aircraft CH4 mole fraction measurements from the Carbon in Arctic Reservoirs Vulnerability Experiment (CARVE) campaign. Both the tower and aircraft analyses confirm the underestimate of cold-season CH4 emissions by CLM4.5. The greatest uncertainties in predicting the seasonal CH4 cycle are from the wetland extent, coldseason CH4 production and CH4 transport processes. We recommend more cold-season experimental studies in highlatitude systems, which could improve the understanding and parameterization of ecosystem structure and function during this period. Predicted CH4 emissions remain uncertain, but we show here that benchmarking against observations across spatial scales can inform model structural and parameter improvements.