Prolonged Recovery Period Research Articles

Differences in the Time to Achieve Bromage Score (2) in Post-Spinal Anesthesia Caesarean Section Patients between the Use of Conventional Methods and Eracs

Pregnancy, labor, and delivery lead to significant physiological changes, and having accurate knowledge of these changes is crucial for an effective spinal anesthetic technique during a caesarean section. Optimizing the mother's health before, during, and after a caesarean section is the goal of the ERACS care method, which is a specialized approach to surgical procedures. Issues with lower limb mobility, anxiety, and dependence on others are some mental health problems that may arise from prolonged recovery periods. Spinal anesthesia patients are evaluated using the Bromage scale to determine if they are ready to be released from the post-anesthesia room. Researchers at Panglima Sebaya Hospital aimed to compare the time taken by standard operating room procedures and ERACS to reach a Bromage Score (2) after spinal anesthesia in caesarean section patients. This study employed a cross-sectional design based on observational analytical research, which is a non-experimental quantitative technique. Out of 84 patients, 47 were treated with standard SC techniques, and 47 were treated with ERACS SC. The findings indicated that the conventional method took 181–240 minutes (3–4 hours) to achieve a Bromage score (2), while the ERACS method only took 60–120 minutes (1–2 hours). A significance value of 0.000 (2-tailed) was determined based on the independent t-test results. The results showed that the ERACS method required less time than the conventional method to achieve Bromage Score (2) in CS patients post-spinal anesthesia.

Thyroid endocrine disruption effects of OBS in adult zebrafish and offspring after parental exposure at early life stage

As an alternative to perfluorooctane sulfonate, sodium p-perfluorous nonenoxybenzene sulfonate (OBS) has been widely used and caused ubiquitous water pollution. However, its toxicity to aquatic organisms is still not well known. Therefore, in this study, parental zebrafish were exposed to OBS at environmentally relevant concentrations from ∼ 2 h post-fertilization to 21 days post-fertilization (dpf) in order to investigate the thyroid disrupting effects in F0 adults and F1 offspring. Histopathological changes, such as hyperplasia of thyroid follicular epithelia and colloidal depletion, were observed in F0 adults at 180 dpf. In F0 females, thyroxine (T4) levels were significantly reduced in 30 and 300 μg/L exposure groups, while triiodothyronine (T3) levels were significantly increased in 3 μg/L exposure group. For F0 males, significant increases of T4 and T3 levels were observed, revealing the sex-specific differences after the OBS exposure. The transcription levels of some key genes related to the hypothalamic-pituitary-thyroid (HPT) axis were significantly disrupted, which induced the thyroid endocrine disruption effects in adult zebrafish even after a prolonged recovery period. For F1 offspring, the thyroid hormone (TH) homeostasis was also altered as T4 and T3 levels in embryos/larvae exhibited similar changes as F0 females. The transcription levels of some key genes related to the HPT axis were also significantly dysregulated, suggesting the transgenerational thyroid disrupting effects of OBS in F1 offspring. In addition, the decreased swirl-escape rate was observed in F1 larvae, which could be caused by disrupting gene expressions related to the central nervous system development and be associated with the TH dyshomeostasis. Therefore, parental OBS exposure at early life stage resulted in thyroid endocrine disruption effects in both F0 adult zebrafish and F1 offspring, and caused the developmental neurotoxicity in F1 larvae.

Sentinel-1 SAR and deep learning for peatland fire detection in Ireland

Peatlands represent vital carbon reserves; however, once ignited, they release stored carbon, inflicting lasting environmental harm and necessitating prolonged recovery periods. An innovative method merging Sentinel-1 satellite imagery and deep learning (DL) is proposed to monitor peat fires across diverse regions of Ireland, regardless of weather conditions or time of day. A comprehensive dataset was assembled to train deep neural networks (DNN) using Sentinel-2 thermal band data and field measurement, resulting in 80% accuracy in detecting peat fire areas. This was achieved by incorporating inputs of both VV (vertical transmit, vertical receive) and VH (vertical transmit, horizontal receive) from Sentinel-1. Analysis of Sentinel-1 VV backscatter change time series for Wicklow Mountain in 2018 underscores the satellite's capacity to detect various phenomena, including snowfall and peat fire, evident prior to the peat fire event. Furthermore, scrutiny of peat fire occurrences in Wicklow Mountain from 2018 to 2023 via time series and mapping reveals a significant escalation, with the largest fire recorded in 2023 spanning over 40 km².

Time to recovery from severe community-acquired pneumonia and its determinants among older adults admitted to North Wollo hospitals: A multi-centred cohort study.

Severe community-acquired pneumonia presents a looming threat to older adults globally, often resulting in alarming mortality rates. Despite advancements in treatment, challenges persist, exacerbated by factors like increasing comorbidity. As age rises, so does the risk of mortality and prolonged recovery periods. Particularly in low-income countries such as Ethiopia, the burden of severe community-acquired pneumonia is staggering. Yet, research on the estimated time to recovery and its determinants among older adults in this region remains insufficient, demanding urgent attention. Hence, in this study we endeavour to uncover insights into the recovery time and contributing factors among older adults. We conducted a multi-centred retrospective cohort study among 422 older adults aged >65 years. We collected data using a structured checklist, and the final sample was meticulously selected using a systematic sampling technique. We computed Kaplan-Meier survival curves and log-rank tests to compare survival curves. We assessed multicollinearity using variance inflation factors. Further, we employed a Cox regression model to identify significant determinants, with model fitness evaluated using a Cox-Snell residual plot. Statistical significance was declared at a P ≤ 0.05. In this study, 79.3% (95% confidence interval (CI) = 75.58-83.29) of patients achieved recovery, with a median time to recovery from severe community-acquired pneumonia of 19 days. Age >75 years, diabetes mellitus, chronic obstructive pulmonary disease, elevated creatinine level and baseline white blood cells greater than 11.0 × 109/L were found to be significant determinants. On average, older adults take 19 days to recover from severe community-acquired pneumonia. Recovery times are notably longer for individuals aged >75 years, those with comorbidities, and those with elevated white blood cell and creatinine levels. Therefore, tailored interventions addressing these specific factors could potentially improve patient outcomes.

Transcriptome-Guided Characterization of the Environmental Toxicity of Metformin: Disruption of Energy Homeostasis and Inhibition of Embryonic Development of Zebrafish at Environmentally Relevant Concentrations.

Metformin has been widely detected in aquatic ecosystems, yet the knowledge of its impact on aquatic organisms, particularly at environmentally relevant concentrations, remains limited. In the present study, we characterized the developmental toxicity of metformin in zebrafish, utilizing a transcriptome-guided toxicological assessment framework. Transcriptomic analysis conducted at metformin concentrations within the μg/L range revealed significant disruptions in biological processes associated with nucleotide, hydrocarbon, and amino acid metabolism, suggesting a significant disturbance in energy homeostasis. This observation was corroborated by energy-targeted metabolomic analysis, wherein a considerable number of metabolites involved in purine metabolism, pyrimidine metabolism, and the citrate cycle displayed significant alterations. Notably, most intermediates in the citrate cycle such as acetyl-CoA exhibited remarkable decreases. Additionally, our study identified significant impediments in zebrafish embryonic development, including decreased yolk extension progress, spontaneous contraction and body length, and increased yolk sac area and yolk/while body lipid content ratio, at metformin concentrations as low as 0.12 μg/L. Furthermore, the disruption of energy homeostasis by metformin was observed to persist into adulthood even after a prolonged recovery period. The present findings highlighted the disruptive effects of metformin on energy homeostasis and embryonic development in teleost at environmentally relevant concentrations, thereby prompting a reevaluation of its environmental risk to nontarget aquatic organisms.

Factors affecting the recovery of COVID-19 patients in Pakistan, with a focus on smoking: A comprehensive analysis

This research paper delves into the various factors influencing the recovery of COVID-19 patients in Pakistan, with a specific emphasis on the impact of tobacco smoking. To unravel these connections, we conducted a data collection campaign employing a custom-designed questionnaire, gathering responses from 170 individuals who had successfully recovered from the coronavirus. Subsequently, we employed the Ordinary Least Squares (OLS) method to examine the influence of socio-economic factors on the recovery process. Our findings revealed that patients within the age range of 36 to 46 years exhibited an extended recovery period, requiring an additional three days for recuperation compared to their younger counterparts aged 17 to 25 years. Furthermore, patients aged above 46 years experienced a more prolonged recovery period, with a delay of up to seven days. Residence played a pivotal role in recovery times, as urban-dwelling patients showed a noteworthy advantage, recuperating 1.5 days sooner than their rural counterparts. A conspicuous relationship emerged regarding smoking habits, as patients who smoked tobacco required an additional two days for recovery when compared to non-smokers. Similarly, patients classified as obese experienced 2.6 more days to regain their health compared to individuals with a normal Body Mass Index (BMI). Remarkably, our analysis revealed that factors such as income, gender, and education were insignificant in terms of the number of the days required for recovery. These results provide a comprehensive understanding of the dynamics at play in the recovery process of COVID-19 patients in Pakistan, offering valuable insights for healthcare professionals and policymakers.

Epidemiology of American Football-Related Fractures in the United States 2002-2021.

American football is the most popular sport in the United States, with over 5.6 million people >6 years old playing the sport. Fractures in American football athletes are significant, as they compromise an athlete's performance and can also lead to prolonged recovery periods, affecting team dynamics and player careers. Analyzing these injuries is critical to evaluate preventive measures and tailor rehabilitation strategies to ensure the well-being and sustained peak performance of football athletes on and off the field. To analyze the trend of American football fractures by body site, sex, and age in amateur athletes over a 20-year period between 2002 and 2021. Descriptive epidemiology study. The National Electronic Injury Surveillance System (NEISS) database was queried to characterize football-related fractures and injuries from 2002 to 2021 in patients aged 0-99 years old. National injury estimates were calculated using sample weights. Chi-square analysis and one-way ANOVA were performed to compare categorical variables. Of 56,809 cases of American football-related fractures over 20 years, patients aged 10 to 14 years had the highest incidence of fractures, composing 41.2% of all fractures (n = 23,389), and patients aged <18 years represented 88.8% of all fractures (n = 50,457). The median age of players when fractures occurred was 13 years. Upper extremity fractures (n = 41,863 [73.7%]) were the most common fracture reported compared with lower extremity and head, neck, and trunk fractures. Among upper extremity fractures, finger fractures had the highest prevalence (35.6%), followed by lower arm fractures (19.9%) and wrist fractures (13%). While most cases resulted in release after treatment (93.1%), 5.9% resulted in treatment and hospitalization. When analyzing trends in American football-related fractures over time, we observed the largest number of fractures in 2006 (n = 3664), while the smallest number of fractures occurred in 2020 (n = 1313). Also, a downward trend was found in American football-related fractures since 2006, with a mean of 101 fewer fractures each year. Our analysis showed that American football-related fractures diagnosed in the emergency department in the United States were most likely to occur in pediatric patients (10-18 years old). In addition, patients experiencing American football-related fractures were most likely to have an upper extremity fracture and not require hospitalization. The trend in American football-related fractures has been decreasing since 2006.

Changing the Mandibular Position in Rowing: A Brief Report of a World-Class Rower.

We investigated the acute biophysical responses of changing the mandibular position during a rowing incremental protocol. A World-class 37-year-old male rower performed two 7 × 3 min ergometer rowing trials, once with no intraoral splint (control) and the other with a mandibular forward repositioning splint (splint condition). Ventilatory, kinematics and body electromyography were evaluated and compared between trials (paired samples t-test, p ≤ 0.05). Under the splint condition, oxygen uptake was lower, particularly at higher exercise intensities (67.3 ± 2.3 vs. 70.9 ± 1.5 mL·kg-1·min-1), and ventilation increased during specific rowing protocol steps (1st-4th and 6th). Wearing the splint condition led to changes in rowing technique, including a slower rowing frequency ([18-30] vs. [19-32] cycles·min-1) and a longer propulsive movement ([1.58-1.52] vs. [1.56-1.50] m) than the control condition. The splint condition also had a faster propulsive phase and a prolonged recovery period than the control condition. The splint reduced peak and mean upper body muscle activation, contrasting with an increase in lower body muscle activity, and generated an energetic benefit by reducing exercise cost and increasing rowing economy compared to the control condition. Changing the mandibular position benefited a World-class rower, supporting the potential of wearing an intraoral splint in high-level sports, particularly in rowing.

Assessing the Vulnerabilities: Cybersecurity Challenges in Power System Infrastructure in Nigeria

This study examined the Cyber security Challenges in Power System Infrastructure in Nigeria. Four research questions guided the study which employed a survey research design. The population of the study was 46 respondents comprising 23 Technical Units Heads and 23 Heads of Cyber security Units from the (23) power-generating plants in Nigeria. The entire population was used hence, there was no sampling. The instrument used for data collection was a structured questionnaire titled: Cyber security Challenges in Power System Infrastructure Questionnaire (CCPSIQ) developed by the researchers. A reliability index of 0.89 was obtained using the Cronbach Alpha reliability method. The mean statistic was used to answer the research questions. The findings of the study revealed that the primary cyber threats targeting power system infrastructure in Nigeria including network-based attacks, insider threats, supply chain vulnerabilities, advanced persistent threats (APTs), physical attacks, zero-day exploits, data breaches, and ransom ware/extortion; it further reveal that cyber-attacks on power grid infrastructure in Nigeria lead to significant service disruptions, financial losses, equipment damage, safety compromises, erosion of customer confidence, regulatory non-compliance, increased vulnerability to future incidents, reputation damage, and prolonged recovery periods, underscoring the multifaceted impact of cyber threats on operational efficiency. The study recommended that: Collaboration among stakeholders, including government agencies, industry partners, and cyber security experts, is paramount to effectively address emerging threats and enhance cyber security resilience. By implementing proactive measures and fostering a culture of cyber security awareness, Nigeria can strengthen its power system infrastructure against cyber threats, safeguarding the reliability and security of critical services for its citizens.

Risk-based dynamic inoperability input-output and non-linear optimisation models to analyse resilience in the construction industry

ABSTRACT Pakistan has faced significant economic losses due to catastrophes, specifically floods. This study aims to assess the ripple effects of the 2022 floods, focusing on the Construction Industry, which has been gaining importance in the national economy, and on the resilience of economic sectors absorbing the negative shocks from floods. The study uses the Asian Development Bank's (ADB) Input-Output database for Pakistan using the Dynamic Inoperability Input-Output Model (DIIM) with the Fuzzy Full Consistency Method (F-FUCOM). The analysis revealed that the Construction Industry’s weak resilience resulted in a prolonged recovery period and that the lack of flood risk mitigation infrastructure was identified as the most critical. The results suggest that policymakers prioritise such infrastructures, like dams, early warning systems, and transportation infrastructure, to enhance the resilience of the overall economy.

The Design of a Speech Recognition-Based Finger Training Rehabilitation Device: Mechanical and System Aspects

This research introduces a novel speech recognition-based control system for finger rehabilitation aimed at addressing the inefficiencies and prolonged recovery periods commonly associated with traditional stroke rehabilitation methods. The system enables stroke patients to engage in finger exercises while simultaneously providing real-time feedback on the finger's angle, speed, and position. This feedback is invaluable for rehabilitation physicians, offering critical data for assessing and refining rehabilitation strategies. The system architecture is composed of three main components: the hardware circuitry, a lower-level computer control system, and a voice recognition-based human-computer interaction system, all integrated with a finger movement perception system. Employing the Hidden Markov Model (HMM) for pattern recognition in the voice interaction component, the system has undergone simulation testing to verify its effectiveness. The findings confirm that the speech recognition-based rehabilitation training system meets all design expectations, providing a safe, reliable, and promising approach for enhancing finger rehabilitation practices.

Relationship between infection, physical and mental health and exercise habits of some Chinese residents after recovery from COVID-19

This study aimed to determine the infection status, exercise habits, anxiety levels, and sleep quality in Chinese residents who recovered from infection during the period of coronavirus disease 2019 (COVID-19) period. It also aimed to investigate the influencing factors of recovery status and aid in improving intervention measures for COVID-19 recovery. This study is a sub-study nested within a cross-sectional investigation of infection and physical and mental health among partially recovered residents in all 34 provincial areas of China during the COVID-19 pandemic. A total of 1 013 participants (374 males and 639 females) completed the study. Cardiopulmonary endurance was significantly lower after infection than before infection (p ​< ​0.001). Women (3.92 ​± ​4.97) exhibited higher levels of anxiety than men (3.33 ​± ​4.54, p ​= ​0.015). The sleep score was significantly higher after infection (8.27 ​± ​7.05) than before infection (4.17 ​± ​4.97, p ​< ​0.001). The active and regular exercise groups exhibited significantly shorter durations of fever than the sedentary and irregular groups (p ​= ​0.033; p ​= ​0.021). Additionally, the active group demonstrated significantly fewer recovery days ([7.32 ​± ​3.24] days) than the sedentary group ([7.66 ​± ​3.06] days, p ​= ​0.035). We found a correlation between age and the recovery time of symptoms after COVID-19. We noted that a greater number of symptoms corresponded to poorer cardiopulmonary fitness and sleep quality. Individuals who engage in sedentary lifestyles and irregular exercise regimens generally require prolonged recovery periods. Therefore, incorporating moderate exercise, psychological support, sleep hygiene and other health interventions into post-COVID-19 recovery measures is imperative.

Nutrition therapy in colorectal cancer patient with severe malnutrition: A case report

Background: Malnutrition in cancer patients generally, and in gastrointestinal cancer specifically, is common, that could be from the cancer itself or the treatment. Thus, it is necessary to follow special nutrition rules in patients with colorectal cancer. This study aims to see the progress of the nutritional status of cancer patients treated with special nutrition rules. Case Description: A 72-year-old man was brought to the ER with the chief complaint of weakness, felt since 1 week ago. Other complaints are loss of appetite and liquid stool. History of weight loss is 12 kg in the last 6 months. He was diagnosed with colorectal cancer 6 months ago. The patient looks pale, with conjunctiva pallor, loss of subcutaneous fat in arms, trunk, and feet, and loss of muscle in the face, ribs, and shoulder. He was then admitted to the ward with a diagnosis of colorectal cancer with severe malnutrition. Nutrition therapy has been given since the beginning. The total energy was 2,100 kkal, with 80gr protein, 280gr carbohydrate, and 70gr fat. The patient was treated for 10 days. Clinically improved: the conjunctiva was no more pallor, arm circumference increased to 19cm, he had gained his appetite, was no longer dripping with norepinephrine, and no longer needed O2 supplementation (SaO2 in room air: 98%). Conclusion: Cancer treatment causes side effects on nutrition status. It is essential to give special nutrition rules to patients with colorectal cancer. Cancer patients also suffer from inadequate food intake, reduced ability to digest food, and disturbed body homeostasis. Malnutrition, especially in cancer patients, could result in general weakening, lower immunity, prolonged recovery period, and lower tolerance to the side effects of cancer therapy. Early nutrition therapy has a good impact on the nutritional status of the cancer patient.

Visual outcomes and optimal timing for repeat surgery in cases of postoperative hematoma following transsphenoidal surgery for pituitary neuroendocrine tumors: A retrospective cohort study.

To investigate the visual outcomes and optimal timing for repeat surgery in cases of postoperative hematoma following transsphenoidal surgery for pituitary neuroendocrine tumors (PitNETs). A retrospective study was conducted on 28 patients who developed evident postoperative hematoma out of a total of 9,010 patients. The hematomas were classified into three types based on their CT appearance. Type 1a - mild high density with no tension, Type 1b - thin-layer high density; Type 2a - solid high density with large empty cavities, Type 2b - solid high density with small empty cavities; Type 3 -solid high density with no cavity showing high tension. Patient data were collected for analysis. The study cohort comprised 10 female and 18 male patients, with a mean age of 51.5±11.9 years. Most patients presented with large adenomas (median diameter 36mm). Postoperative visual sight improved in 12 patients, remained stable in 11 patients, and worsened in 5 patients. Notably, no patients experienced worsened visual sight beyond twenty-four hours after the operation. Among the five patients with visual deterioration, four had CT type 3 hematoma (4/6, 66.7%), and one had CT type 2b hematoma (1/9, 11.1%). Patients in the type 3 CT group were significantly more prone to experience visual deterioration compared to those in the type 2 group (odds ratio [OR] 2.154 [95% CI 1.858-611.014], P=.027). Four patients underwent repeat surgery after visual deterioration, resulting in visual improvement following a prolonged recovery period. Postoperative hematoma had limited impact on pituitary dysfunction and hyponatremia. Our study reveals a significant association between postoperative hematoma CT types and visual deterioration. For patients with stable visual sight and type 1 or 2a hematoma, conservative strategies may be considered. Conversely, type 2b and 3 patients are at higher risk of visual deterioration, especially within the first 24 hours after the operation. Consequently, early reoperation before vision worsens may be a prudent approach to reduce risks and improve visual outcomes, particularly in type 3 patients.

Conservation energetics of beluga whales: using resting and swimming metabolism to understand threats to an endangered population.

The balance between energetic costs and acquisition in free-ranging species is essential for survival, and provides important insights regarding the physiological impact of anthropogenic disturbances on wild animals. For marine mammals such as beluga whales (Delphinapterus leucas), the first step in modeling this bioenergetic balance requires an examination of resting and active metabolic demands. Here, we used open-flow respirometry to measure oxygen consumption during surface rest and submerged swimming by trained beluga whales, and compared these measurements with those of a commonly studied odontocete, the Atlantic bottlenose dolphin (Tursiops truncatus). Both resting metabolic rate (3012±126.0 kJ h-1) and total cost of transport (1.4±0.1 J kg-1m-1) of beluga whales were consistent with predicted values for moderately sized marine mammals in temperate to cold-water environments, including dolphins measured in the present study. By coupling the rate of oxygen consumption during submerged swimming with locomotor metrics from animal-borne accelerometer tags, we developed predictive relationships for assessing energetic costs from swim speed, stroke rate and partial dynamic acceleration. Combining these energetic data with calculated aerobic dive limits for beluga whales (8.8 min), we found that high-speed responses to disturbance markedly reduce the whale's capacity for prolonged submergence, pushing the cetaceans to costly anaerobic performances that require prolonged recovery periods. Together, these species-specific energetic measurements for beluga whales provide two important metrics, gait-related locomotor costs and aerobic capacity limits, for identifying relative levels of physiological vulnerability to anthropogenic disturbances that have become increasingly pervasive in their Arctic habitats.

Bellwethers of change: population modelling of North Pacific humpback whales from 2002 through 2021 reveals shift from recovery to climate response.

For the 40 years after the end of commercial whaling in 1976, humpback whale populations in the North Pacific Ocean exhibited a prolonged period of recovery. Using mark-recapture methods on the largest individual photo-identification dataset ever assembled for a cetacean, we estimated annual ocean-basin-wide abundance for the species from 2002 through 2021. Trends in annual estimates describe strong post-whaling era population recovery from 16 875 (± 5955) in 2002 to a peak abundance estimate of 33 488 (± 4455) in 2012. An apparent 20% decline from 2012 to 2021, 33 488 (± 4455) to 26 662 (± 4192), suggests the population abruptly reached carrying capacity due to loss of prey resources. This was particularly evident for humpback whales wintering in Hawai'i, where, by 2021, estimated abundance had declined by 34% from a peak in 2013, down to abundance levels previously seen in 2006, and contrasted to an absence of decline in Mainland Mexico breeding humpbacks. The strongest marine heatwave recorded globally to date during the 2014-2016 period appeared to have altered the course of species recovery, with enduring effects. Extending this time series will allow humpback whales to serve as an indicator species for the ecosystem in the face of a changing climate.

2036 “I didn’t personally think it would change my life, but it has”: The experience following emergency laparotomy for older people

Abstract Introduction Older people living with frailty are at high risk of adverse clinical outcomes following emergency laparotomy, including early death, hospital readmission and functional decline. Despite this, there is a paucity of literature exploring patient experience of surgery in this group, particularly following hospital discharge. As a result, there is limited information to guide the development of service delivery models that support optimal post-operative recovery and improve overall experience. Methods Twenty older people, aged ≥65 years, with a Clinical Frailty Scale score of ≥ 4 and who had undergone emergency laparotomy were recruited from eight participating hospital sites. Participants were interviewed at 3 weeks following their surgery, or the earliest convenient date. Semi-structured interviews were undertaken either face to face or via telephone and explored the peri-operative and early recovery experience. Data were analysed using reflexive thematic analysis. Results Participants described physical, psychological, and social implications following emergency laparotomy which extended further than hospital discharge. Recovery was perceived to be an ongoing and slow process of returning to ‘normal self’ however participants displayed resilience towards achieving this by ‘knuckling down’ and ‘pushing forward’. The experience of hospital care was generally positive, but lack of access to discharge advice and community follow up left some participants feeling ‘abandoned’ and uncertain once they returned home. Many were reliant on family support during this period. Conclusions Older people living with frailty experience multifaceted consequences of emergency laparotomy that result in a prolonged recovery period. Multi-disciplinary post-operative care pathways are essential in addressing the holistic care needs of this group following surgery. The provision of robust discharge information and enhanced access to support in the community could improve patient experience and facilitate ongoing recovery at home.

Comprehensive evaluation of morphological and physiological responses of seventeen Crassulaceae species to waterlogging and drainage under temperate monsoon climate

Unpredictable rainfall frequently results in excess moisture, which is detrimental to the landscape because it interferes with the genetic, morphological, and physiological processes of plants, even though the majority of urban landscapes frequently experience moisture shortages. A study was conducted to analyze the effects of a 36-day waterlogging phase and a subsequent 12-day recovery period on the morpho-physiological responses of 17 Crassulaceae species with the goal of identifying those which were more tolerant of the conditions. Results revealed that waterlogging stress has an impact on all morpho-physiological parameters. Sensitive materials (S7, Hylotelephium telephium ‘Purple Emperor’ and S15, S. sexangulare) showed severe ornamental quality damage, mortality, decreases in total dry biomass, root-shoot ratio, and chlorophyll content, as well as higher MDA concentrations. Lower reductions in these parameters, along with improved antioxidant enzyme activities and greater recovery capabilities after drainage, were observed in the most tolerant materials S2 (H. spectabile ‘Brilliant’), S3 (H. spectabile ‘Carl’), and S5 (H. telephium ‘Autumn Joy’). Furthermore, with the exception of early death materials (S7 and S15), all materials showed varying intensities of adventitious root formation in response to waterlogging. The 17 species were divided into 4 clusters based on the comprehensive evaluation value. The first group included S1-S3, S5-S6, S8-S12, which were waterlogged tolerant with the highest values (0.63–0.82). S14 belongs to the intermediate waterlogging tolerant. S4, S13, S16, and S17 were clustered into the low waterlogging-tolerant group. S7 and S15 were the most susceptible to waterlogging. The survival and success of Crassulaceae species (especially, the first and second cluster), throughout this prolonged period of waterlogging (36 days) and recovery were attributed to a combination of physiological and morphological responses, indicating that they are an appealing species for the creation of rain gardens or obstructed drainage locations.

Assessment of environmental forensic indicator for anthropogenic groundwater contamination via target/suspect/nontarget analysis using HRMS techniques

This study compared target/suspect/nontarget analysis via liquid chromatography-high-resolution mass spectrometry (LC-HRMS) with traditional environmental forensic methods, specifically nitrate and its stable N isotope, in assessing groundwater pollution from livestock manure and agriculture. Using an in-house database of 1471 target and suspects, 35 contaminants (pesticides, veterinary drugs, surfactants) were identified, some uniquely linked to specific pollution sources, such as sulfamethazine and 4-formylaminoantipyrine in manure-affected areas. Pesticides were widespread, typically showing higher intensity in agricultural zones. On the other hand, the results of stable N isotope analysis (δ15N-NO3: 4.8 to 16.4‰) indicated the influence of human activities such as fertilizers, sewage, and manure in all sampling sites, including the control site far from the pollution sources and cannot differentiate the specific sources. The study underscores LC-HRMS's efficacy in different pollution sources, surpassing the limitations of stable N isotope analysis, and provides valuable insights for polluted groundwater source tracking strategies.

Effects of acute hypoxia and reoxygenation on histological structure, antioxidant response, and apoptosis in razor clam Sinonovacula constricta

Hypoxia is one of the major environmental problems limiting the healthy development of intensive aquaculture. Marine benthic shellfish are encountering heightened problems related to hypoxic stress as a result of ongoing human activities and aquaculture operations. Razor clam Sinonovacula constricta, a commercially valuable shellfish, has not yet been reported in studies on physiological changes caused by hypoxia and reoxygenation. To understand the negative effects of hypoxia and reoxygenation on the clams, we set up two low-oxygen concentration groups (DO 2.0 mg/L and DO 0.5 mg/L) and assessed multiple aspects of oxidative damage to their hepatopancreas and gills. After the hypoxic stress, the two tissues of the razor clam suffered varying degrees of damage, including cell degeneration and disruption of mitochondrial cristae. After reoxygenation, the 2.0 mg/L group recovered substantially, but the clams in the 0.5 mg/L group still unrecovered. The activities of antioxidant enzymes (MDA, T-AOC, SOD, GPX, and CAT) in clams were considerably altered by acute hypoxia and reoxygenation. Briefly, there was a growing and then declining trend in MDA, T-AOC, and SOD activities in the hepatopancreas, whereas GPX and CAT activities showed the converse trend. In the hepatopancreas and gills, the level of anti-apoptotic gene Bcl-2 transcripts gradually decreased with the duration of hypoxia and increased following reoxygenation. However, changes in the transcript level of the pro-apoptotic gene Bax were in contrast to that of Bcl-2. The TUNEL assay revealed that hypoxia caused apoptosis. Furthermore, at DO 0.5 mg/L, the degree of apoptosis was more significant than at DO 2.0 mg/L, and hepatopancreatic apoptosis was more severe than gill apoptosis. Collectively, our findings imply that hypoxia induces oxidative stress, histological damage, and apoptosis in razor clams in a concentration-dependent and tissue-specific manner. These consequences serve as a reminder that prolonged recovery periods may be required for razor clams to fully recover from oxidative damage resulting from hypoxia-reoxygenation episodes.