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The cycling of carbon in riverine systems is a critical component of global carbon cycle research. However, the sources and performances of riverine carbon in the Qinling Mountains, a pivotal hydrological nexus in China, remain poorly understood. This study investigates the seasonal variations of dissolved organic carbon (DOC) concentration in the Tianyu River within the Qinling Mountains. By utilizing a combination of carbon isotopic signatures (Δ14C-δ13C) and the stepped-combustion method, we examined the sources of DOC and the contribution ratio of each end-member. Our findings reveal that: (1) the concentrations and dual carbon isotope ratios of DOC in the Tianyu River are influenced by regional climatic factors, exhibiting distinct seasonal patterns; (2) the 14C age of DOC in the Tianyu River is comparatively older than the global average for rivers but younger than that of China’s three major rivers (the Yellow, Yangtze, and Pearl Rivers); and (3) the DOC mainly comes from exogenous sources, with a proportion of about 85.8%–88.4%. Vegetation and riverine sediments are identified as primary contributors. These findings suggest that exemplary ecological preservation exists within the Qinling region while operating within an efficient carbon cycling system. This investigation provides initial insights into how regional climatic conditions influence riverine carbon cycles and enhances our understanding of biogeochemical processes related to carbon.
Maternal mental health represents a significant global health burden, not only in terms of maternal wellbeing, but also for the impact it has on child development. The relationship between maternal mental health and deleterious environmental exposures to the fetus is one mechanism of risk transmission. This study utilizes network analysis to a) explore how maternal mental health is associated with a wide array of fetal exposures, and b) examine how these exposures cluster together. A total of 485 pregnant women were recruited from the Mercy Hospital for Women in Melbourne, Australia between 2011–2017, as part of the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). The MPEWS includes measures of mental health diagnosis and symptoms, psychotropic medication, smoking, alcohol, substance use, and a wide range of lifestyle factors in the first and third trimesters of pregnancy. Regularized Partial Correlation Modelling was used to examine the network of relationships between maternal mental health and fetal exposures due to environmental factors, lifestyle and medications. For women diagnosed with mental health disorders there are relatively higher rates of exposure to smoking, anxiety and depression symptoms, psychotropic medications, pregnancy health conditions and less than optimal lifestyle factors. Factors such as physical exercise and folate supplementation show strong patterns of partial correlation. Trait anxiety emerged as the central variable in the network with the highest strength of relationship to all other exposure variables. The current study shows the value of approaching fetal exposures as a complex network of associated aspects of maternal lifestyle, mental health and environment. Viewing exposures together may assist clinical and public health interventions to target multiple associated risk factors, rather than the current focus on individual exposures. The preconception and perinatal periods offer important opportunities for the prevention of teratogenic fetal exposures and the promotion of a healthy start to life.
To evaluate potential modifications to the Centers for Disease Control and Prevention (CDC)’s Adult Sepsis Event (ASE) definition aimed at mitigating variable blood culturing practices, better-capturing cases where timely care may have prevented deterioration, and improving clinical credibility.
Design:
Retrospective observational study
Setting:
5 US hospitals
Patients:
Hospitalized adults, 2015–2022
Methods:
We assessed the impact of potential ASE modifications on community-onset sepsis incidence and mortality and reviewed 280 charts to assess positive predictive value (PPV) for clinical sepsis.
Results:
Among 1,101,252 hospitalized adults, 51,712 (4.7%) met community-onset ASE criteria (16.1% mortality). Expanding infection criteria to include present-on-admission infection codes when blood cultures were not drawn, non-blood clinical cultures, and discharge alive on antibiotic day three increased incidence by 15.0%, 12.2%, and 4.9%, respectively; all led to mild decreases in mortality rates. Expanding organ dysfunction criteria to include hypotension increased ASE incidence by 32.3% and decreased mortality by 18.5%. Broadening respiratory failure criteria to include noninvasive ventilation and high-flow oxygen had minimal impact. On chart review, original ASE criteria had 80% PPV for clinical sepsis. PPV was similar when identifying infection using present-on-admission infection codes instead of blood cultures and when including patients discharged alive on antibiotic day three. PPV decreased to 50% when using non-blood clinical cultures to identify infection, 17% when using single hypotension values alone to indicate organ dysfunction, and 30% when all ASE components occurred exactly 2 days vs within +/-1 day from the blood culture day.
Conclusions:
Our findings inform modifications to ASE to optimize its utility for national epidemiologic monitoring and quality measurement.
Modern conflicts are characterized by wide-spread use of conventional explosive ordnance (EO), improvised explosive devices (IEDs), and other air-launched explosives. In contrast to advances in military medicine and high-income civilian trauma systems since the United States-led wars in Afghanistan and Iraq, the mortality rate among civilian EO casualties has not decreased in decades. Although humanitarian mine action (HMA) stakeholders have extensive presence and medical capabilities in EO-affected settings, coordination between HMA and health actors has not been leveraged systematically.
Methods:
Data from a prior systematic review of emergency care interventions feasible within the context of HMA activities and low-resource health care systems were used to model mortality reduction among EO victims. Interventions were categorized using the World Health Organization (WHO) Emergency Care System Framework sites of “scene,” “transport,” and “facility.” The cumulative impact of the interventions on EO-related mortality was estimated using pooled effect estimates and simulation modeling.
Results:
The meta-analysis included 16 reports from 13 countries, representing 127,505 injured persons. Pooled effect estimates across subcategories of emergency care interventions were 0.42 for layperson transportation (95%CI, 0.24-0.74), 0.79 for prehospital notification systems (95%CI, 0.51-1.19), 0.52 for prehospital trauma care training courses (95%CI, 0.46-0.59), 0.67 for facility-based trauma care training courses (95%CI, 0.48-0.92), and 0.66 for facility-based trauma team organization and activation protocols (95%CI, 0.45-0.97). A 68% reduction in mortality (95%UI, 57%-79%) was observed when implementing the full set of interventions in a region with no prior implemented interventions.
Conclusion:
Enhanced coordination between HMA and health actors to implement a structured set of emergency care interventions holds potential to significantly reduce preventable death among civilian EO casualties.
The site of Stublina, first excavated in 1956 by Milutin Garašanin of the Institute of Archaeology and Radoslav Galović of the National Museum Belgrade is located at the southeast outskirts of the Supska village near the town of Ćurpija, in Central Serbia. Its location on the edge of the flood plain of the Central Balkans’ major waterway, the Velika Morava River, places it on a major corridor extending south to north, linking southern Europe and the Aegean with the Pannonian plains in the north. Based on material finds, the site predominantly belongs to the Late Neolithic and is attributable to the so-called Vinča culture complex; however, sporadic finds of Early Neolithic Starčevo type pottery and Late Medieval burials were also reported. The results of the excavation were published in a single monograph in 1979, containing information on roughly half of the excavated area. However, radiocarbon dating was never performed on the site. The site of Stublina, containing evidence for the life span of the so-called Vinča culture complex in the Velika Morava River basin, one of the most important corridors during the entire Neolithic period of Southeast Europe, is a valuable chronological beacon based on its vast material record of pottery fragments, traditionally used to construct relative chronological sequences in the past. In this paper, we present the results of contextual radiocarbon dating using Bayesian chronological modeling with 28 new AMS 14C radiocarbon dates, selected from the material archive located in the depos of the National Museum of Serbia in Belgrade. The samples were chosen from stratigraphically well-defined contexts published in the 1979 Garašanin and Garašanin volume on Supska. These contexts provide secure chronological order of layers and features, representing the entire life span of the site in the Late Neolithic period. Our results provide strong validation for archival records originating from old archaeological excavations and breathe new life into their potential for contemporary archaeological research, using techniques and methods unavailable at the time of their creation.
American silk moth, Antheraea polyphemus Cramer 1775 (Lepidoptera: Saturniidae), native to North America, has potential significance in sericulture for food consumption and silk production. To date, the phylogenetic relationship and divergence time of A. polyphemus with its Asian relatives remain unknown. To end these issues, two mitochondrial genomes (mitogenomes) of A. polyphemus from the USA and Canada respectively were determined. The mitogenomes of A. polyphemus from the USA and Canada were 15,346 and 15,345 bp in size, respectively, with only two transitions and five indels. The two mitogenomes both encoded typical mitochondrial 37 genes. No tandem repeat elements were identified in the A+T-rich region of A. polyphemus. The mitogenome-based phylogenetic analyses supported the placement of A. polyphemus within the genus Antheraea, and revealed the presence of two clades for eight Antheraea species used: one included A. polyphemus, A. assamensis Helfer, A. formosana Sonan and the other contained A. mylitta Drury, A. frithi Bouvier, A. yamamai Guérin-Méneville, A. proylei Jolly, and A. pernyi Guérin-Méneville. Mitogenome-based divergence time estimation further suggested that the dispersal of A. polyphemus from Asia into North America might have occurred during the Miocene Epoch (18.18 million years ago) across the Berling land bridge. This study reports the mitogenome of A. polyphemus that provides new insights into the phylogenetic relationship among Antheraea species and the origin of A. polyphemus.
Targeted identification, effective triage, and rapid hemorrhage control are essential for optimal outcomes of mass-casualty incidents (MCIs). An important aspect of Emergency Medical Service (EMS) care is field triage, but this skill is difficult to teach, assess, and research.
Study Objective:
This study assessed triage efficacy and hemorrhage control of emergency responders from different professions who used the Sort, Assess, Life-Saving Treatment (SALT) triage algorithm in a virtual reality (VR) simulation of a terrorist subway bombing.
Methods:
After a brief just-in-time training session on the SALT triage algorithm, participants applied this learning in First VResponder, a high-fidelity VR simulator (Tactical Triage Technologies, LLC; Powell, Ohio USA). Participants encountered eleven virtual patients in a virtual scene of a subway station that had experienced an explosion. Patients represented individuals with injuries of varying severity. Metrics assessed included triage accuracy and treatment efficiency, including time to control life-threatening hemorrhage. Independent Mann-Whitney analyses were used to compare two professional groups on key performance variables.
Results:
The study assessed 282 participants from the ranks of EMS clinicians and medical trainees. Most (94%) participants correctly executed both global SALT sort commands. Participants triaged and treated the entire scene in a mean time of 7.8 decimal minutes, (95%CI, 7.6-8.1; SD = 1.9 decimal minutes) with a patient triage accuracy rate of 75.8% (95%CI, 74.0-77.6; SD = 15.0%). Approximately three-quarters (77%) of participants successfully controlled all life-threatening hemorrhage, within a mean time of 5.3 decimal minutes (95%CI, 5.1-5.5; SD = 1.7 decimal minutes). Mean time to hemorrhage control per patient was 0.349 decimal minutes (SD = 0.349 decimal minutes). Overall, EMS clinicians were more accurate with triage (P ≤ .001) and were faster at triage, total hemorrhage control (P < .01), and hemorrhage control per patient (P < .004) than medical trainees.
Conclusions:
Through assessments using VR simulation, it was observed that more experienced individuals from the paramedic (PM) workforce out-performed less experienced medical trainees. The study also observed that the medical trainees performed acceptably, even though their only formal training in SALT triage was a 30-minute, just-in-time lecture. Both of these findings are important for establishing evidence that VR can serve as a valid platform for assessing the complex skills of triage and treatment of an MCI, including the assessment of rapid hemorrhage control.
The Connecting People and Community for Living Well initiative recognizes that communities, specifically multisector community teams, are a critical part of the provision of programs and supports for those affected by dementia. Effective collaboration and building and supporting the collective well-being of these multisector community teams is key to their success and sustainability. This research sought to understand what supports the well-being of community teams. Focus groups were conducted with multisector community teams who support those impacted by dementia from across four rural communities. The research team used thematic analysis to identify patterns emerging within and across focus groups. The findings highlighted three areas of importance: the need for a resource to support teams to measure, monitor, and describe the impact of their actions; ongoing support from a system-level team; and the development of local and/or provincial policy and infrastructure that supports sustaining collaborative community-based work.