Study Sites Research Articles

Local government policymaking environment for Health in All Policies: a case study research investigation

ABSTRACT The local level of government is identified as being well placed to address the determinants of health due to their flatter governance structure and proximity to the community. Research has identified multiple factors that influence local governments to act on these health determinants, although few have applied theories of the policy process to understand the policymaking environment. Using two Australian local government case study sites, we explored the policymaking environment regarding policy decisions to address health determinants using the lens of four theories of the policy process. We conducted 20 interviews and one focus group with elected members and staff in local government, along with an analysis of 12 policy documents and participation in a policy reference group. Following thematic analysis, 13 factors influencing policy addressing health determinants were identified, mostly confirming previous research from within Australia and globally. New themes have emerged regarding the limited range of policy actors involved and the lack of advocacy, particularly by community or media, who have an identified influence over decision-making in a local government context. Applying theories of the policy process also demonstrates how they can be used to add meaning to the interconnectedness of influences in unique local government policymaking environments.

Classification model for chlorophyll content using CNN and aerial images

Chlorophyll content is usually used as a quantitative measurement of plant health. The chlorophyll content is also a continuous number of data type, leading to a regression approach when developing the deep learning model. The regression model will predict the chlorophyll content in number format, which requires experts to analyse the outcome. Nevertheless, the analysis of the outcome could possibly lead to human error in diagnosing the plant’s health condition. Therefore, this study proposed a classification approach in developing a deep learning model to analyse the plant’s health condition without human intervention. The classification approach requires a discrete group for dependent variables instead of continuous numbers. When forming the chlorophyll content index groups in this study, which are low, optimum and high levels, two research studies were combined to form the groups, which were (1) the product of the standard range of nitrogen value in mango plant and (2) the correlation analysis between nitrogen value and chlorophyll content index. The classification model in this study used transfer learning algorithms, which were InceptionV3, DenseNet121 and ResNet50, with the canopy-scale level of mango plant RGB images with complex leaf structures in an uncontrolled and open area. Based on the findings, the classification model could classify the chlorophyll content index levels on both mango plant images, which were infected and not infected with black sooty mould. The finding also shows that a clearer distribution pattern of spectral information extracted from the mango plant images can influence the performance result of the classification model. Besides that, the starting point of the Digitization Footprint for this study site across the development stages of the classification model was 308.5756 MB/ha. Finally, the overall accuracy performances for the classification models that used the transfer learning algorithms, which were InceptionV3, DenseNet121, and ResNet50, and trained using the images of the mango plant infected with pest were 96.49 %, 92.98 %, and 89.47 %, respectively, and for using the images of the mango plant not infected with pest were 88.10 %, 78.57 %, and 69.05 %, respectively.

The Safety of Outpatient Health Care : Review of Electronic Health Records.

Despite considerable emphasis on delivering safe care, substantial patient harm occurs. Although most care occurs in the outpatient setting, knowledge of outpatient adverse events (AEs) remains limited. To measure AEs in the outpatient setting. Retrospective review of the electronic health record (EHR). 11 outpatient sites in Massachusetts in 2018. 3103 patients who received outpatient care. Using a trigger method, nurse reviewers identified possible AEs and physicians adjudicated them, ranked severity, and assessed preventability. Generalized estimating equations were used to assess the association of having at least 1 AE with age, sex, race, and primary insurance. Variation in AE rates was analyzed across sites. The 3103 patients (mean age, 52 years) were more often female (59.8%), White (75.1%), English speakers (90.8%), and privately insured (70.4%) and had a mean of 4 outpatient encounters in 2018. Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care-associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, -0.05 [CI, -0.09 to -0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially. Retrospective EHR review may miss AEs. Outpatient harm was relatively common and often serious. Adverse drug events were most frequent. Rates were higher among older adults. Interventions to curtail outpatient harm are urgently needed. Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions.

Thermal infrared shadow-hiding in GOES-R ABI imagery: snow and forest temperature observations from the SnowEx 2020 Grand Mesa field campaign

Abstract. The high temporal resolution of thermal infrared imagery from the Geostationary Operational Environmental Satellites R-series (GOES-R) presents an opportunity to observe mountain snow and forest temperatures over the full diurnal cycle. However, the off-nadir views of these imagers may impact or bias temperature observations, especially when viewing a surface composed of both snow and forests. We used GOES-16 and -17 thermal infrared brightness temperature observations of a flat snow- and forest-covered study site at Grand Mesa, Colorado, USA, to characterize how forest coverage and view angle impact these observations. These two geostationary satellites provided views of the study area from the southeast (134.1° azimuth, 33.5° elevation) and southwest (221.2° azimuth, 35.9° elevation), respectively. As part of the NASA SnowEx field campaign in February 2020, coincident brightness temperature observations from ground-based and airborne IR sensors were collected to compare with those from the geostationary satellites. Observations over the course of 2 cloud-free days spanned the entire study site. The brightness temperature observations from each dataset were compared to find their relative differences and how those differences may have varied over time and/or as a function of varying forest cover across the study area. GOES-16 and -17 brightness temperatures were found to match the diurnal cycle and temperature range within ∼ 1 h and ± 3 K of ground-based observations. GOES-16 and -17 were both biased warmer than nadir-looking airborne IR and ASTER observations. The warm biases were higher at times when the sun–satellite phase angle was near its daily minimum. The phase angle, the angle between the direction of incoming solar illumination and the direction from which the satellite is viewing, reached daily minimums in the morning for GOES-16 and afternoon for GOES-17. In morning observations, warm biases in GOES-16 brightness temperature were greater for pixels that contained more forest coverage. The observations suggest that a “thermal infrared shadow-hiding” effect may be occurring, where the geostationary satellites are preferentially seeing the warmer sunlit sides of trees at different times of day. These biases are important to understand for applications using GOES-R brightness temperatures or derived land surface temperatures (LSTs) over areas with surface roughness features, such as forests, that could exhibit a thermal infrared shadow-hiding effect.

A case of paleoseismic evidence of normal fault capable of triggering an M>8 earthquake − study on Sertengshan range-front fault, north margin of Hetao Basin, China

The Sertengshan Range-front Fault (SRF) and Langshan Range-front Fault (LRF) constitute a normal fault system on the northern boundary of the Linhe Depression in its northwest, and an investigation of the LRF–SRF is significant for understanding the seismic activities of normal faults. We set four trenches at three study sites to reveal paleo-earthquakes in the western segment of the SRF (W-SRF) in this system, and established 5 surface rupture events along W-SRF since the Late Pleistocene. By integrating paleoseismic data from 27 trenches on multiple fault segments, we reconstructed the paleoseismic sequence for the LRF–SRF region since 15 ka, and identified 10 paleoseismic events with corresponding rupture segments and magnitudes. The slip rates at the three study sites decreased gradually from the west to east on the W-SRF, by comparing with previous studies, further evidencing that the tectonic activities of the two faults have gradually synchronized. Besides, based on the timing of the latest paleoseismic event (1.88−2.03 ka BP), earthquakes of > M 8 surface ruptures of >200 km can occur in the northwestern Ordos Block and its seismic behavior revealed the seismogenic possibility of normal faults triggering an M > 8 earthquake.

Determinants of depressive and alcohol use disorders among female sex workers in Ethiopia: evidence from a national bio-behavioral survey, 2020

BackgroundFemale sex workers (FSWs) face an elevated risk of developing mental health disorders and alcohol use disorders (AUD), which in turn increase their vulnerability to HIV and other sexually transmitted infections (STIs) and other negative outcomes. To effectively address both of these health issues, it is crucial to understand the shared key determinants underlying these illnesses, which is a substantial knowledge gap in Ethiopia and elsewhere in the world. Therefore, this study aimed to identify the common key determinants of depression and AUD among FSWs in Ethiopia using a bivariate multivariable ordinal logistic model.MethodsWe analyzed cross-sectional biobehavioral data collected in 2020 from 16 cities and major towns in Ethiopia using the respondent-driven sampling (RDS) technique, which involved a total of 6,085 FSWs. FSWs who had lived at the study sites for at least a month before the study period were deemed eligible for recruitment. Major depressive disorder (DD) and AUD were screened using the Patient Health Questionnaire (PHQ9) and alcohol use disorder identification test (AUDIT), respectively. We used descriptive statistics to summarize study population characteristics and bivariate multivariable ordinal logistic regression (BMOLR) to identify common determinants of DD and AUD combined and their nonnormal correlation.ResultsAmong 6085 FSWs screened for DD and AUD, 13.5% and 4.0% have met the criteria for moderate and severe depressive disorder, respectively, and 20.3% and 34.7% have met the AUDIT criteria for harmful or hazardous behavior and alcohol dependence, respectively. FSW with experience of inconsistent condom use, condom failure, violence, mobility, use of any drugs, non-paying partners, abortion, and selling sex for more than five years were associated with an increase in the severity of both disorders. A high average income from selling sex and the number of paying partners reduced the severity of depression and increased the level of alcohol dependence. Being HIV positive and ever having anal sex were associated only with an increase in depression.ConclusionMajor DD and AUD are prevalent among FSWs in Ethiopia. The findings revealed that common key determinants, which exacerbated the severity of both disorders, were also risk factors for HIV and other STIs. Consequently, integrated STI strategies are essential in the screening, referral, and treatment of depression and AUD. Intervention packages should encompass determinants of depression and AUD, including condom utilization, drug use, mobility between towns, abortion, violence, and counseling services. Additionally, strategies to ensure economic security should be incorporated.

Redbay (Persea borbonia L. Spreng) Seedling and Sapling Growth and Recruitment Near Trees with and without Putative Resistance to Laurel Wilt Disease

Laurel wilt, a fungal disease (Harringtonia lauricola T.C. Harr., Fraedrich and Aghayeva) spread by the Asian redbay ambrosia beetle [Xyleborus glabratus Eichhoff (Coleoptera: Curculionidae: Scolytinae)], presents an imminent threat to North American members of the Lauraceae family, having caused extensive mortality in several species, especially redbay (Persea borbonia L. Spreng). Varying levels of disease resistance have been recorded in redbay under controlled conditions. To investigate if previously monitored putatively resistant field redbays have influenced the regeneration and survival of conspecifics within the surrounding 0.08 ha, a survey was conducted in 2018-19 and compared to similar data collected years prior (2008-09, 2013) along the coasts of Florida, Georgia, and South Carolina, United States. Plots were originally established at six disease-infested study sites around large redbay (>7.5-cm diameter at breast height (1.37 m) (DBH)) that had survived the initial laurel wilt disease epidemic that began in approximately 2007. In 2018-19, a subset of 61 plots within 16 m of the original “survivor” redbay were recorded and compared to previous surveys. Among the original redbay selected for resistance, 22 of 61 (36%) survivors across all sites were alive in 2018 with survival rates varying from 0 to 70% between survey periods (average mortality 3.6%/year). Trees that died in years since 2008-09 had their plots reclassified as susceptible or “suscepts”. Changes in mean quadratic diameter at 1.37 m of redbay plots near survivors were significantly greater than those near suscepts, and in 2018-19, the average diameter of redbay near survivors was 7.62 cm vs. 4.90 cm for suscepts. The diameter distribution of dead and live redbay in the whole population showed a decrease in live individuals surviving past 8 cm DBH in 2018–2019, but 20 of 22 survivor candidate trees were larger than 8 cm DBH. Regeneration was occurring both clonally and sexually and tended to be greater near suscepts, but midstory resprouts per hectare and understory seedlings interacted significantly with the site and the latter differed between sites. These findings indicate that redbay is regenerating in these ecosystems, and disease resistance may allow for increased average tree size for some individuals, but an upper size threshold of around 8 cm DBH may still exist for much of the population. In addition, the importance of site variables in regeneration was apparent, making either local genetic or environmental effects an important topic for future research. Continuing to monitor these survivors while locating new candidates for disease screenings and breeding, preventing the introductions of new strains of H. lauricola, shedding light on the nature of resistance and its heritability, and initiating outplanting trials with resistant germplasm are instrumental steps in bringing redbay back to prominence in its historical range.

Stress perception, coping behaviors and work-privacy conflict of student midwives in times of COVID-19 pandemic: the “Healthy MidStudents” study in Germany

BackgroundStudent midwives deliver care for women under challenging job demands, which may affect their mental health– thus creating a high need for health promotion. Given the lack of research addressing this topic, the aim of this study is to examine the links between stress perception, coping behaviors, work-privacy conflict, and perception of COVID-19 pandemic impact on studies of student midwives in northern Germany.MethodsData were collected using a cross-sectional online-survey at nine midwifery study sites in northern Germany from October 2022 to January 2023. 342 student midwives (response rate: 61.3%) were surveyed on stress perception, coping behaviors, work-privacy conflict, and perceived impact of the COVID-19 pandemic on their studies. Descriptive, linear regression and moderation analyses were run to test explorative assumptions.ResultsResults revealed that higher levels of perceived stress were reported by 13.4% of student midwives. Social support (M = 13.76, SD = 2.19) and active stress coping (M = 10.72, SD = 2.01) were identified as most prevalent coping behaviors in the present sample. It was found that work-privacy conflict was positively associated with stress perception (ß = 0.53, p =.001) and maladaptive coping behaviors (alcohol and cigarette consumption: ß = 0.14, p =.015), and negatively associated with adaptive coping behaviors (positive thinking: ß = − 0.25, p =.001, social support: ß = − 0.23, p =.001). Students with children reported significantly lower levels of social support than students without children. 55.6% of student midwives perceived a negative impact of the COVID-19 pandemic on their studies (mostly on lectures, seminars, and contact with fellow students).ConclusionsKey findings highlighted moderate stress levels among student midwives during theoretical study stage. Based on current research, prevalence of high stress levels among student midwives remains unclear. Given the overall heterogeneous, limited research on student midwives’ stress perception, coping behaviors, work-privacy conflict and perceptions of COVID-19 pandemic impact on studies, implications for research are suggested, e.g. longitudinal studies at different time points and settings and interventional studies. Findings provide a starting point for implementation of workplace health promotion in theoretical and practical stages of midwifery science study programs, e.g. training courses on stress prevention and adaptive coping, and for improvement of working conditions.

Balanced Solution versus Normal Saline in Predicted Severe Acute Pancreatitis: A Stepped Wedge Cluster Randomized Trial.

To compare the effect of balanced multielectrolyte solutions(BMES) versus normal saline(NS) for intravenous fluid on chloride levels and clinical outcomes.in patients with predicted severe acute pancreatitis (pSAP). Isotonic crystalloids are recommended for initial fluid therapy in acute pancreatitis, but whether the use of BMES in preference to NS confers clinical benefits is unknown. In this multicenter, stepped-wedge, cluster-randomized trial, we enrolled patients with pSAP (APACHE II score ≥8 and C-reactive protein >150mg/L) admitted within 72 hours of the advent of symptoms. The study sites were randomly assigned to staggered start dates for one-way crossover from the NS phase (NS for intravenous fluid) to the BMES phase(Sterofudin for intravenous fluid). The primary endpoint was the serum chloride concentration on trial day3. Secondary endpoints included a composite of clinical and laboratory measures. Overall, 259 patients were enrolled from eleven sites to receive NS(n=147) or BMES(n=112). On trial day3, the mean chloride level was significantly lower in patients who received BMES(101.8mmol/L(SD4.8) versus 105.8mmol/L(SD5.9), difference -4.3mmol/L [95%CI -5.6 to -3.0mmol/L];P<0.001). For secondary endpoints, patients who received BMES had less systemic inflammatory response syndrome(19/112,17.0% versus 43/147,29.3%, P=0.024) and increased organ failure-free days (3.9d(SD2.7) versus 3.5days(SD2.7), P<0.001) by trial day7. They also spent more time alive and out of ICU(26.4d(SD5.2) versus 25.0days(SD6.4), P=0.009) and hospital(19.8d(SD6.1) versus16.3days(SD7.2), P<0.001) by trial day30. Among patients with pSAP, using BMES in preference to NS resulted in a significantly more physiological serum chloride level, which was associated with multiple clinical benefits(Trial registration number: ChiCTR2100044432).

Curriculum leadership in a rural indigenous high school in Taiwan implementing the 108 Curriculum Guidelines

AbstractThe 108 Curriculum Guidelines (108CG) were implemented in high schools in Taiwan in 2019 and have increased the flexibility of curriculum offerings. Schools must now offer diverse curricula, flexible options and self‐directed learning courses based on students' needs and teachers' expertise. This study explores how rural high schools in Taiwan promote curriculum leadership following the implementation of the 108CG. Using a case school in southern Taiwan as the study site, it examines the current implementation of the 108CG in rural high schools, the processes and strategies that school members employ in applying curriculum leadership and the challenges they encounter. Six participants from the case school were interviewed, from August 2021 to May 2022. We also conducted observations and document analyses. The results show that the principal and mid‐level leaders' collaborative efforts are integral to advancing the 108CG. However, the school faces challenges in implementing the 108CG due to its environmental context. The principal's major challenge stems from the differing curriculum interpretations by tribal chiefs and families in the community. Mid‐level leaders also grapple with students' passive learning attitudes and the need for preparedness among teachers for curriculum reform. Although the 108CG have been in operation for more than 4 years, rural high schools continue to face challenges in implementing them. Introducing collaborative lesson planning and using checklists during curriculum review meetings could help track curriculum progress.

Potential effects of the discharge of wastewater treatment plant (WWTP) effluents in benthic communities: evidence from three distinct WWTP systems.

Wastewater treatment plant (WWTP) effluents can be sources of environmental contamination. In this study, we aimed to understand whether effluents of three different WWTPs may have ecological effects in riverine recipient ecosystems. To achieve this, we assessed benthic phytobenthos and macroinvertebrate communities at three different locations relative to the effluent discharge: immediately upstream, immediately downstream and 500-m downstream the effluent discharge. Two approaches were employed: the ecological status classification as defined in the Water Framework Directive (WFD) based on biological indicators; constrained multivariate analysis to disentangle the environmental drivers (physicochemical variables and contaminants, namely metals, polycyclic aromatic hydrocarbons, pharmaceuticals, and personal care products) of ecological changes across the study sites. The results showed inconsistencies between the WFD approach and the multivariate approach, as well as between the responses of macroinvertebrates and diatoms. The WWTP effluents impacted benthic communities in a single case: macroinvertebrates were negatively affected by one of the WWTP effluents, likely by the transported pharmaceuticals (other stressors are essentially homogeneous among sites). Given the findings and the scarcity of consistent evidence on ecological impacts that WWTP effluents may have in recipient ecosystems, further research is needed towards more sustainable regulation and linked environmental protection measures.

Investigating and modeling motorcycle crash rates at urban unsignalized intersections in India

Objective The present study focuses on understanding the behavior of motorized 2-wheeler (MTW) riders at urban unsignalized intersections in India. In the Indian context, over 60% of road crash fatalities are attributed to vulnerable road users, with MTWs serving as the predominant contributors, accounting for 44% of total fatalities. Notably, unsignalized intersections have emerged as critical sites for accidents involving vulnerable road users. Methods Postencroachment time is used to assess traffic conflicts of MTW users. Furthermore, the study employs the exceedance property of extreme value theory to calculate crash probabilities. Tobit and grouped random parameters Tobit regression models are developed to model crash probabilities, incorporating variables such as traffic volume, traffic composition, gap acceptance time, intersection characteristics, and intersection conflict area at 4 urban unsignalized intersections in Surat, India. Results MTW riders have the lowest gap acceptance time among vehicles in the traffic stream. Cars and other heavy vehicles readily accept gaps when MTWs are in the conflicting stream at unsignalized intersections, which increases traffic conflicts. MTWs have the highest crash rates in the traffic stream. Among the developed models, the grouped random parameters Tobit regression captures the spatial unobserved heterogeneity of the study sites and outperforms the simple Tobit regression model. The results also indicate that MTW riders are exposed to a higher risk of crashes while turning at unsignalized intersections. The presence of a central traffic island has varied implications; it raises crash rates at 3-legged intersections but lowers them at 4-legged intersections for 2-wheelers. Conclusion The study concludes that MTW crash rates are influenced by traffic and intersectional factors. Increased gap acceptance time correlates with lower crash rates. Countermeasure selections require detailed investigations, because it was observed that the presence of central traffic islands has varied effects on crash rates at 3-legged and 4-legged unsignalized intersections.

GWAS of Folate Metabolism With Gene-environment Interaction Analysis Revealed the Possible Role of Lifestyles in the Control of Blood Folate Metabolites in Japanese: The J-MICC Study.

The present genome-wide association study (GWAS) aimed to reveal the genetic loci associated with folate metabolites, as well as to detect related gene-environment interactions in Japanese. We conducted the GWAS of plasma homocysteine (Hcy), folic acid (FA), and vitamin B12 (VB12) levels in the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study participants who joined from 2005 to 2012, and also estimated gene-environment interactions. In the replication phase, we used data from the Yakumo Study conducted in 2009. In the discovery phase, data of 2,263 participants from four independent study sites of the J-MICC Study were analyzed. In the replication phase, data of 573 participants from the Yakumo Study were analyzed. For Hcy, MTHFR locus on chr 1, NOX4 on chr 11, CHMP1A on chr 16, and DPEP1 on chr 16 reached genome-wide significance (P < 5 × 10-8). MTHFR also associated with FA, and FUT2 on chr 19 associated with VB12. We investigated gene-environment interactions in both studies and found significant interactions between MTHFR C677T and ever drinking, current drinking, and physical activity >33% on Hcy (β = 0.039, 0.038 and -0.054, P = 0.018, 0.021 and <0.001, respectively) and the interaction of MTHFR C677T with ever drinking on FA (β = 0.033, P = 0.048). The present GWAS revealed the folate metabolism-associated genetic loci and gene-environment interactions with drinking and physical activity in Japanese, suggesting the possibility of future personalized cardiovascular disease prevention.

New insights into biodiversity-disease relationships: the importance of the host community network characterization

Camera-trapping-based social network analysis (SNA) is a valuable tool to characterize communities and identify species with an outstanding role in pathogen maintenance. This study provides new insights into the contentious debate on the effect of biodiversity on disease risk by combining SNA with the assessment of host diversity indicators and pathogen richness in Spain. The apparent species richness detected by camera traps at each study site ranged from 10 to 33 species (mean ± standard error (SE): 20.73 ± 1.94) and their apparent diversity rates (i.e., Shannon index) ranged from 0.57 to 2.55 (mean ± SE: 1.97 ± 0.16). At the community level, vertebrate host diversity had a marginal dilution effect on the disease risk and was negatively correlated to pathogen richness. The exposure to multiple pathogens, as a proxy of disease risk, was negatively associated with apparent host diversity. The disease risk was driven by the interaction of apparent biodiversity with the presence of livestock and with the centrality of the indicator species (i.e., the wild boar). The maximum risk of co-exposure to pathogens was reached when the lowest apparent biodiversity rates coincided with the highest wild boar centrality in the host community or with the presence of livestock, respectively. The highest confluence of pathogens occurred at lower apparent diversity indexes, higher wild boar relative abundances and predominance of agricultural lands. Our results suggest that the diversity-disease relationship is not linear and depends on the environment and host community characteristics, thereby opening avenues for designing new prevention strategies.

Preoperative ketamine administration for prevention of postoperative neurocognitive disorders after major orthopedic surgery in elderly patients: A multicenter randomized blinded placebo-controlled trial.

Preventive anesthetic impact on the high rates of postoperative neurocognitive disorders in elderly patients is debated. The Prevention of postOperative Cognitive dysfunction by Ketamine (POCK) study aimed to assess the effect of ketamine on this condition. This is a multicenter, randomized, double-blind, interventional study. Patients ≥60 years undergoing major orthopedic surgery were randomly assigned in a 1:1 ratio to receive preoperative ketamine 0.5 mg/kg as an intravenous bolus (n = 152) or placebo (n = 149) in random blocks stratified according to the study site, preoperative cognitive status and age. The primary outcome was the proportion of objective delayed neurocognitive recovery (dNR) defined as a decline of one or more neuropsychological assessment standard deviations on postoperative day 7. Secondary outcomes included a three-month incidence of objective postoperative neurocognitive disorder (POND), as well as delirium, anxiety, and symptoms of depression seven days and three months after surgery. Among 301 patients included, 292 (97%) completed the trial. Objective dNR occurred in 50 (38.8%) patients in the ketamine group and 54 (40.9%) patients in the placebo group (OR [95% CI] 0.92 [0.56;1.51], p = 0.73) on postoperative day 7. Incidence of objective POND three months after surgery did not differ significantly between the two groups nor did incidence of delirium, anxiety, apathy, and fatigue. Symptoms of depression were less frequent in the ketamine group three months after surgery (OR [95%CI] 0.34 [0.13-0.86]). A single preoperative bolus of intravenous ketamine does not prevent the occurrence of dNR or POND in elderly patients scheduled for major orthopedic surgery. (Clinicaltrials.gov NCT02892916.).

Dummy run for planning of isotoxic dose-escalated radiation therapy for glioblastoma used in the PRIDE trial (NOA-28; ARO-2024-01; AG-NRO-06)

BackgroundThe PRIDE trial (NOA-28; ARO-2024-01; AG-NRO-06; NCT05871021) is designed to determine whether a dose escalation with 75.0 Gy in 30 fractions can enhance the median overall survival (OS) in patients with methylguanine methyltransferase (MGMT) promotor unmethylated glioblastoma compared to historical median OS rates, while being isotoxic to historical cohorts through the addition of concurrent bevacizumab (BEV). To ensure protocol-compliant irradiation planning with all study centers, a dummy run was planned and the plan quality was evaluated. MethodsA suitable patient case was selected and the computed tomography (CT), magnetic resonance imaging (MRI) and O-(2-[18F]fluoroethyl)-L-tyrosine (FET) positron emission tomography (PET) contours were made available. Participants at the various intended study sites performed radiation planning according to the PRIDE clinical trial protocol. The treatment plans and dose grids were uploaded as Digital Imaging and Communications in Medicine (DICOM) files to a cloud-based platform. Plan quality and protocol adherence were analyzed using a standardized checklist, scorecards and indices such as Dice Score (DSC) and Hausdorff Distance (HD). ResultsMedian DSC was 0.89, 0.90, 0.88 for PTV60, PTV60ex (planning target volume receiving 60.0 Gy for the standard and the experimental plan, respectively) and PTV75 (PTV receiving 75.0 Gy in the experimental plan), respectively. Median HD values were 17.0 mm, 13.9 mm and 12.1 mm, respectively. These differences were also evident in the volumes: The PTV60 had a volume range of 219.1–391.3 cc (median: 261.9 cc) for the standard plans, while the PTV75 volumes for the experimental plans ranged from 71.5–142.7 cc (median: 92.3 cc). The structures with the largest deviations in Dice score were the pituitary gland (median 0.37, range 0.00–0.69) and the right lacrimal gland (median 0.59, range 0.42–0.78). ConclusionsThe deviations revealed the necessity of systematic trainings with appropriate feedback before the start of clinical trials in radiation oncology and the constant monitoring of protocol compliance throw-out the study. Trial registrationNCT05871021

Evaluating habitat-specific interference in automated radio telemetry systems: implications for animal movement studies

Automated radio telemetry systems have become a popular and invaluable tool in tracking the activity and movement of wild animals. However, many environmental conditions can hinder accuracy when tracking with this technology. For instance, study sites may contain multiple habitat types, each habitat uniquely affecting the signal strength received from tagged species. To investigate the influence of a structurally diverse study site on an automated radio telemetry system, we conducted this project at a restored and managed pine barren habitat that consisted of a mix of mature pitch pine, treated pitch pine, scrub oak, and hardwood forests. This site, Montague Plains Wildlife Management Area, Montague, Massachusetts, is also a known breeding ground for Eastern whip-poor-will (Antrostomus vociferus). To measure the relationship of radio signal strength with distance across each habitat, we used radio telemetry equipment manufactured by Cellular Tracking Technologies. We produced negative exponential decay functions measuring radio signal strength over distance and tested for differences among habitat types on radio signal strength (RSS). We found that decay function parameters significantly differed by habitat type, prompting us to investigate if accounting for these differences improved location estimate accuracy. To test this, we estimated known locations using trilateration methods with and without habitat calibration. Comparing these tests indicates that habitat-specific adjustments significantly improved location accuracy. Lastly, we visualized estimated RSS-based locations of 1 week of whip-poor-will data and compared them to GPS data generated from the same individual. Previous studies have accounted for types of environmental interference (like elevation) in the field but have avoided incorporating habitat-specific factors by working with node networks covering a relatively small area, but in this study, we examined the potential to scale up for larger areas and in more complex habitats.

A late response of the sea-ice cover to Neoglacial cooling in the western Barents Sea

In high northern latitudes, the Middle to Late-Holocene was a time of orbitally-induced atmospheric cooling. This led to increased sea-ice production in the Arctic Ocean and its export southward, a decrease in sea surface temperatures (SST), and glacier advances at least since 5–4 ka BP. However, the response of the ocean-climate system to decreasing insolation was not uniform. Our research shows that the sea-ice cover in the northwestern Barents Sea experienced a late response to Neoglacial cooling. We analyzed dinoflagellate cyst assemblages from a sediment core from Storfjordrenna, south of Svalbard. We found that the area experienced ice-free conditions throughout most of the Mid- and Late-Holocene. It was only after 2.3 ka BP that the study site became covered with winter drift ice and primary productivity decreased subsequently. Other regional data support the decrease in SST, the expansion of the sea-ice cover, and the deterioration of the environmental conditions around that time. Our findings indicate that the sea-ice cover in the northwestern Barents Sea required a significant amount of time to respond to the general cooling trend in the region. These results have important implications for present-day environmental changes. Even if the current warming trend is revoked in the future, the observed sea-ice loss in the Barents Sea may be incredibly challenging to reverse.

Long-term, medium-term and acute stress response of urban populations of Eurasian red squirrels affected by different levels of human disturbance.

Animals in urban areas often encounter novel and potentially stressful conditions. It is important to understand how wildlife cope with anthropogenic disturbance. To investigate this specific adaptation we live-trapped squirrels in two study sites in Warsaw: a forest reserve and an urban park and we estimated stress responses at three levels: long-term and medium-term stress (the level of stress hormones, i.e. cortisol and cortisone concentrations, in hair and feces) and acute reaction to human-induced stress (measured during handling with the aid of the three indices: breath rate, struggle rate, and vocalization). According to GLMM models no difference in the stress hormones level was found between the two populations. The only differences in cortisol concentrations clearly depended on the season, i.e. being higher in autumn and winter comparying to other seasons. There was no influence of sex, or reproductive status on stress hormones. Forest squirrels had significantly higher breath rates, suggesting they were more stressed by handling. There was no difference in the struggle rate between study areas, this index was mostly affected by season (i.e. being highest in winter). First-trapped squirrels vocalized less than during the subsequent trappings. Assumingly, during the first, and more stressful trapping, squirrels used 'freezing' and/or little vocalization, while during next captures they used alarm calls to warn conspecifics. Overall, we showed that the two squirrel populations differed only in terms of their breath rate. This suggests that they did not differ in medium-term and long-term stress in general, but they can differ in acute response to handling. This also suggests that both populations were similarly affected by environmental factors. The lack of clear effects may also be due to population heterogeneity. Thus, in order to assess the effects of anthropogenic stressors a broader range of indicators and diverse analytical methods, including behavioral analyses, should be employed.

Fluviomorphic trajectories for dryland ephemeral stream channels following extreme flash floods

AbstractEphemeral alluvial streams pose globally significant flood hazards to human habitation in drylands, but sparse data for these regions limit understanding of the character and impacts of extreme flooding. In this study, we document decadal changes in dryland ephemeral channel patterns at two sites in the lower Colorado River Basin (southwestern United States) that were ravaged by extraordinary flash floods in the 1970s: Bronco Creek, Arizona (1971), and Eldorado Canyon, Nevada (1974). We refer to these two floods as ‘fluviomorphic erasure events’, because they produced blank slates for the channels that were gradually moulded by more frequent but much smaller flood events. We studied georectified aerial photos that span ~60 years at each site to show that both study sites recovered to their pre‐flood condition after ~25 years. We employ channel network metrics: stream‐link area (SLA), geometric braiding index and junction‐node density. Each metric decreased during the short‐duration extreme flood erasure events. Subsequently, a fluviomorphic trajectory at a decadal tempo returned the channels to pre‐flood values. The SLA decreased at rates of 3.6%–4.1% per year in the decade following the floods. The extreme flood events decreased the pre‐flood geometric braiding index at the two sites by 56%–68%, and it took 15–24 years for this index to recover to pre‐flood values. In contrast, it took 30–35 years for the channels to recover to a uniform pre‐flood channel form, as indicated by the spatial distribution of bars and junction nodes. Our results document baseline examples of ephemeral stream channel evolution trajectories, as future climatic change will likely accelerate increases in the magnitudes and frequencies of extreme floods and geomorphic erasure events.