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The Himalayan glaciers contribute significantly to regional water resources. However, limited field observations restrict our understanding of glacier dynamics and behaviour. Here, we investigated the long-term in situ mass balance, meteorology, ice velocity and discharge of the Chhota Shigri Glacier. The mean annual glacier-wide mass balance was negative, −0.46 ± 0.40 m w.e. a−1 for the period 2002–2019 corresponding to a cumulative wastage of −7.87 m w.e. Winter mass balance was 1.15 m w.e. a−1 and summer mass balance was −1.35 m w.e. a−1 over 2009–2019. Surface ice velocity has decreased on average by 25–42% in the lower and middle ablation zone (below 4700 m a.s.l.) since 2003; however, no substantial change was observed at higher altitudes. The decrease in velocity suggests that the glacier is adjusting its flow in response to negative mass balance. The summer discharge begins to rise from May and peaks in July, with a contribution of 43%, followed by 38% and 19% in August and September, respectively. The discharge pattern closely follows the air temperature. The long-term observation on the ‘Chhota Shigri – a benchmark glacier’, shows a mass wastage which corresponds to the slowdown of the glacier in the past two decades.
We present the first-ever mass-balance (MB) observation (2014–19), reconstruction (between 1978 and 2019) and sensitivity of debris-free Stok glacier (33.98°N, 77.45°E), Ladakh Region, India. In-situ MB was negative throughout the study period except in 2018/19 when the glacier witnessed a balanced condition. For MB modelling, three periods were considered based on the available data. Period I (1978–87, 1988/89) witnessed a near balance condition (−0.03 ± 0.35 m w.e. a−1) with five positive MB years. Whereas Period II (1998–2002, 2003–09) and III (2011–19) experienced high (−0.9 ± 0.35 m w.e. a−1) and moderate (−0.46 ± 0.35 m w.e. a−1) negative MBs, respectively. Glacier area for these periods was derived from the Corona, Landsat and PlanetScope imageries using a semi-automatic approach. The in-situ and modelled MBs were in good agreement with RMSE of 0.23 m w.e. a−1, R2 = 0.92, P < 0.05. The average mass loss was moderate (−0.47 ± 0.35 m w.e. a−1) over 28 hydrological years between 1978 and 2019. Sensitivity analysis showed that the glacier was more sensitive to summer temperature (−0.32 m w.e. a−1 °C−1) and winter precipitation (0.12 m w.e. a−1 for ± 10%). It was estimated that ~27% increase in precipitation is required on Stok glacier to compensate for the mass loss due to 1°C rise in temperature.
The production of a concise and user-friendly leaflet on fitness to drive with mental illness. The purpose of the leaflet is to help facilitate patient education and to provide them with a quick abridged reference and to assist practitioners’ in parting advice to patients.
Extraction and collation of vital information from the ‘At a glance Guide to the current medical standards of fitness to drive’ guideline by DVLA, UK. This information was reviewed by a panel of consultant psychiatrists and an advisory board in DVA, Northern Ireland. Prior to the leaflet construction an audit was undertaken to assess awareness and compliance with the guideline, duty of informing DVA and to gauge the frequency of advice sought and imparted regarding suitability to drive with mental illness and the necessity for a leaflet.
Most practitioners are aware of the guideline recommendation and the hierarchy of the duty to inform DVA. Doctors are often asked about driving with mental illness and they often advise their patients. Majority agree that a leaflet containing concise information would be valuable. Thence, a guidance leaflet on fitness to drive with mental illness was produced. It includes the legal obligation to inform DVA, the requirements to notify DVA of prevalent mental illnesses, of both acute episodes and chronic conditions, for cars, motorcycles and LGV. It also includes a brief section on substance misuse and psychotropic medications.
A leaflet on fitness to drive with mental illness was produced as it is beneficial to both patients and practitioners.
Diarrhoeal disease is one of the major causes of morbidity and mortality in children and is usually measured at individual level. Shared household attributes, such as improved water supply and sanitation, expose those living in the same household to these same risk factors for diarrhoea. The occurrence of diarrhoea in two or more children in the same household is termed ‘diarrhoea clustering’. The aim of this study was to examine the role of improved water supply and sanitation in the occurrence of diarrhoea, and the clustering of diarrhoea in households, among under-five children in India. Data were taken from the fourth round of the National Family and Health Survey (NFHS-4), a nationally representative survey which interviewed 699,686 women from 601,509 households in the country. If any child was reported to have diarrhoea in a household in the 2 weeks preceding the survey, the household was designated a diarrhoeal household. Household clustering of diarrhoea was defined the occurrence of diarrhoea in more than one child in households with two or more children. The analysis was done at the household level separately for diarrhoeal households and clustering of diarrhoea in households. The presence of clustering was tested using a chi-squared test. The overall prevalences of diarrhoea and clustering of diarrhoea were examined using exogenous variables. Odds ratios, standardized to allow comparison across categories, were computed. The household prevalence of diarrhoea was 12% and that of clustering of diarrhoea was 2.4%. About 6.5% of households contributed 12.6% of the total diarrhoeal cases. Access to safe water and sanitation was shown to have a great impact on reducing diarrhoeal prevalence and clustering across different household groups. Safe water alone had a greater impact on reducing the prevalence in the absence of improved sanitation when compared with the presence of improved sanitation. It may be possible to reduce the prevalence of diarrhoea in households by targeting those households with more than one child in the under-five age group with the provision of safe water and improved sanitation.
Consumers prefer bright, cherry-red retail beef. Retailers often mark down the price of discolored beef for quick sale. However, following this practice could result in a net loss of revenue if consumer willingness to pay (WTP) for nondiscolored beef is negatively affected by the presence of discolored beef in the consumer choice set. Through a hypothetical online survey and a controlled in-person experiment, we determine that marketing discolored beef together with nondiscolored beef increases most consumers’ evaluation of, but not their WTP for, nondiscolored beef.
Laboratory identification of carbapenem-resistant Enterobacteriaceae (CRE) is a key step in controlling its spread. Our survey showed that most Veterans Affairs laboratories follow VA guidelines for initial CRE identification, whereas 55.0% use PCR to confirm carbapenemase production. Most respondents were knowledgeable about CRE guidelines. Barriers included staffing, training, and financial resources.
A hallmark of life is plasticity, which enables reproduction, evolution, and environmental adaptivity. It is natural to wonder if these remarkable features in nature and biology can be realized in the materials world and implemented in the emerging fields of autonomous systems, artificial intelligence, and animal–machine interfaces. First, we describe fundamental features of neurons and synapses in the brain that are responsible for information processing. Then we discuss mechanisms governing electronic plasticity in correlated electronic quantum materials that mimic organismic behavior. We give examples of learning networks and circuits designed using quantum materials that can be implemented for machine intelligence. We conclude with suggestions for future interdisciplinary research wherein synergistic interactions between orbital filling, defects, and strain could give rise to new functionality of relevance to sensory interfaces (e.g., haptics), neural information processing, and neuroscience.
Mobile phones can replace traditional self-monitoring tools through cell phone-based ecological momentary assessment (CEMA) of lifestyle behaviours and camera phone-based images of meals, i.e. photographic food records (PFR). Adherence to mobile self-monitoring needs to be evaluated in real-world treatment settings. Towards this goal, we examine CEMA and PFR adherence to the use of a mobile app designed to help mothers self-monitor lifestyle behaviours and stress.
In 2012, forty-two mothers recorded CEMA of diet quality, exercise, sleep, stress and mood four times daily and PFR during meals over 6 months in Los Angeles, California, USA.
A purposive sample of mothers from mixed ethnicities.
Adherence to recording CEMA at least once daily was higher compared with recording PFR at least once daily over the study period (74 v. 11 %); adherence to both types of reports decreased over time. Participants who recorded PFR for more than a day (n 31) were more likely to be obese v. normal- to overweight and to have higher blood pressure, on average (all P<0·05). Based on random-effects regression, CEMA and PFR adherence was highest during weekdays (both P<0·01). Additionally, PFR adherence was associated with older age (P=0·04). CEMA adherence was highest in the morning (P<0·01). PFR recordings occurred throughout the day.
Variations in population and temporal characteristics should be considered for mobile assessment schedules. Neither CEMA nor PFR alone is ideal over extended periods.
Infections caused by multidrug-resistant gram-negative organisms (MDRGNOs) have been increasing every year. The objective of this study was to describe the prevalence of MDRGNOs and factors associated with MDRGNOs in patients with spinal cord injury or disorder (SCI/D).
Retrospective cohort study.
Department of Veterans Affairs (VA) electronic health record data from 142 VA facilities were evaluated for 19,642 patients with SCI/D. Multivariable cluster-adjusted models were fit to identify factors associated with MDRGNO.
Gram-negative (GN) cultures occurred in 44% of patients with SCI/D receiving care at VA facilities, and 11,527 (41.3%) GN cultures had an MDRGNO. The most frequent GN organisms (GNOs) were Escherichia coli (28.5%), Klebsiella pneumoniae (17.0%), and Pseudomonas aeruginosa (16.0%). Two-thirds of GN cultures were from the outpatient setting, where MDRGNO prevalence was 37.6%. Significant geographic variation in the prevalence of MDRGNOs was identified (South, 44.7%; Northeast, 44.3%; West, 36.8%; Midwest, 34.4%). Other factors associated with an MDRGNO were older age, injury characteristics, comorbidities, specimen type, healthcare setting, and healthcare exposure. Black (odds ratio [OR], 1.58; 95% confidence interval [CI], 1.39–1.78) and Hispanic race (OR, 1.58; 95% CI, 1.28–1.95), polymicrobial culture (OR, 2.67; 95% CI, 2.46–2.90), and antibiotic use in the previous 90 days (OR, 1.62; 95% CI, 1.50–1.76) were also associated with having an MDRGNO.
MDRGNOs were common in community and healthcare settings among veterans with SCI/D, with significant geographic variation. Health care and antibiotic exposures were significant factors associated with MDRGNOs. Priority should be given to controlling the spread of MDRGNOs in this special population, including a focus on judicious use of antibiotics.
Glacier mass balance and runoff are simulated from 1955 to 2014 for the catchment (46% glacier cover) containing Chhota Shigri Glacier (Western Himalaya) using gridded data from three regional climate models: (1) the Rossby Centre regional atmospheric climate model v.4 (RCA4); (2) the REgional atmosphere MOdel (REMO); and (3) the Weather Research and Forecasting Model (WRF). The input data are downscaled to the simulation grid (300 m) and calibrated with point measurements of temperature and precipitation. Additional input is daily potential global radiation calculated using a DEM at a resolution of 30 m. The mass-balance model calculates daily snow accumulation, melt and runoff. The model parameters are calibrated with available mass-balance measurements and results are validated with geodetic measurements, other mass-balance model results and run-off measurements. Simulated annual mass balances slightly decreased from −0.3 m w.e. a−1 (1955–99) to −0.6 m w.e. a−1 for 2000–14. For the same periods, mean runoff increased from 2.0 m3 s−1 (1955–99) to 2.4 m3 s−1 (2000–14) with glacier melt contributing about one-third to the runoff. Monthly runoff increases are greatest in July, due to both increased snow and glacier melt, whereas slightly decreased snowmelt in August and September was more than compensated by increased glacier melt.
Socioeconomic difficulties affect the cognitive and emotional development of children. However, the focus of prior studies has largely been on poverty and material hardship. This study expands on the existing literature by examining the impact of familial transient financial difficulties during infancy on long-term cognitive and behavioral outcomes.
The National Longitudinal Surveys of Youth (79) were used to assess the association between a transient drop in family income by 50% or more (called transient income decline or TID) during the first 3 years of life and later-life Peabody Individual Achievement Math and Reading scores and behavior problem index (BPI) scores (N = 8272–17 348; median assessment age = 9 years). A subsample of matched siblings (N = 2049–4238) was examined to tease out maternal and intra-familial effects.
Exposure to TID predicted increased total and externalizing BPI scores (std. coefficients of 0.10 and 0.09, respectively, p < 0.01) in the overall sample. Among matched siblings, exposure to TID predicted increased total, externalizing, and internalizing BPI scores (std. coefficients of 0.27, 0.25, and 0.23, respectively, p < 0.01).
Familial transient financial difficulties can have long-lasting behavioral effects for infants. The study identifies an early risk factor and at-risk children, thus providing insight into developing early intervention measures for infants to avoid long-term behavioral problems.
Refractory carbides possess metal-like electronic and catalytic properties, which make them interesting candidates for anodes in solid oxide fuel cells. However, significant challenges include phase instability due to electrochemical potential gradient driven oxidation. This requires an understanding of both the chemical thermodynamics in operating environments along with direct measurement of the catalytic activity in fuel mixtures. Here, we present an experimental study on nanostructured WC as an anode for solid oxide fuel cells operating at 300–500 °C. This is enabled by combining calculated thermochemical equilibria validated against experiments at the material level and in fuel cell devices combined with flow reactor studies on fuel-selective catalytic activity directly at working anode interfaces. With an optimized anode microstructure and hydrogen–methane fuel mixtures, WC anode-based solid oxide fuel cells are shown to achieve a near-ideal open circuit voltage of 1.1 V at 500 °C.
Introduction: The accurate interpretation of potential ST-segment elevations on electrocardiograms (ECGs) to diagnose acute myocardial infarction (MI) is a critical competency for emergency physicians (EPs) and cardiologists. There is conflicting evidence on the diagnostic accuracy of EPs and cardiologists interpreting potential STEMI ECGs. Methods: We conducted a web-based assessment of the diagnostic accuracy of potential STEMI ECGs of Canadian EPs and cardiologists. They were identified using the membership lists of the Canadian Association of Emergency Physicians and the academic departments of cardiology at Canadian medical schools. When provided with 20 ECGs of confirmed STEMI patients, EPs and cardiologists were asked to provide a binary Yes/No answer to the question, “In a patient with ischemic chest pain, does this ECG represent a STEMI?” EPs and cardiologists were blinded to the correct answers while completing the web-based assessment. Descriptive statistics were used to described frequencies and counts. Analysis using Rasch Measurement Theory was used to explore the relationship between correct interpretation of ECGs and predictive variables such as age, years in practice or type of practice. Results: Two hundred and fifty EPs and 30 cardiologists (n=280) responded to our survey (total response rate 25%). Average years in practice were 12.5 for EPs (SD 10.6; median 10) and 14.6 for cardiologists (SD 10.6; median 11); 52% of EPs and 93% of cardiologists practiced in an academic setting. Seven of the cardiologists were interventionalists, while 47.6% of EPs and 97% of cardiologists practiced at hospitals with 24-hour catheterization capability. The diagnostic accuracy of EPs for identifying STEMI ECGs was 75% (SD 15%); cardiologists’ accuracy was 76% (SD 15.5%). The ability to correctly interpret the ECGs was independent of age, years in practice, or type of practice (community vs academic). Conclusion: EPs and cardiologists display similar diagnostic accuracy for interpreting STEMI ECGs, regardless of age, years in practice or type of practice. The findings of our study suggest the need for focused ECG education for both EPs and cardiologists.
To describe the burden of extended-spectrum β-lactamase (ESBL) Enterobacteriaceae in veterans with spinal cord injury or disorder (SCI/D), to identify risk factors for ESBL acquisition, and to assess impact on clinical outcomes
Retrospective case-case-control study
PATIENTS AND SETTING
Veterans with SCI/D and utilization at a Veterans’ Affairs medical center from January 1, 2012, to December 31, 2013.
Patients with a positive culture for ESBL Klebsiella pneumoniae, Escherichia coli, or Proteus mirabilis were matched with patients with non-ESBL organisms by organism, facility, and level of care and to uninfected controls by facility and level of care. Inpatients were also matched by time at risk. Univariate and multivariate matched models were assessed for differences in risk factors and outcomes.
A total of 492 cases (62.6% outpatients) were matched 1:1 with each comparison group. Recent prior use of fluoroquinolones and prior use of third- and fourth-generation cephalosporins were independently associated with ESBL compared to the non-ESBL group (adjusted odds ratio [aOR], 2.61; 95% confidence interval [CI], 1.77–3.84; P<.001 for fluoroquinolones and aOR, 3.86; 95% CI, 2.06–7.25; P<.001 for third- and fourth-generation cephalosporins) and the control group (aOR, 2.10; 95% CI, 1.29–3.43; P = .003 for fluoroquinolones; and aOR, 3.31; 95% CI, 1.56–7.06; P=.002 for third- and fourth-generation cephalosporins). Although there were no differences in mortality rate, the ESBL group had a longer post-culture length of stay (LOS) than the non-ESBL group (incidence rate ratio, 1.36; 95% CI, 1.13–1.63; P=.001).
All SCI/D patients with ESBL were more likely to have had recent exposure to fluoroquinolones or third- and fourth-generation cephalosporins, and hospitalized patients were more likely to have increased post-culture LOS. Programs targeted toward reduced antibiotic use in SCI/D patients may prevent subsequent ESBL acquisition.
We report on healthcare worker use of a safe zone (outside a 3-foot perimeter around the patient’s bed) and personal protective equipment in 2 inpatient spinal cord injury/disorder units. Workers remained within the safe zone during 22% of observations but were less compliant with personal protective equipment inside the zone.
We present the updated glaciological mass balance (MB) of Chhota Shigri Glacier, the longest continuous annual MB record in the Hindu-Kush Karakoram Himalaya (HKH) region. Additionally, 4 years of seasonal MBs are presented and analyzed using the data acquired at an automatic weather station (AWS-M) installed in 2009 on a lateral moraine (4863ma.s.l.). The glaciological MB series since 2002 is first recalculated using an updated glacier hypsometry and then validated against geodetic MB derived from satellite stereo-imagery between 2005 (SPOT5) and 2014 (Pléiades). Chhota Shigri Glacier lost mass between 2002 and 2014 with a cumulative glaciological MB of –6.72mw.e. corresponding to a mean annual glacier-wide MB (Ba) of –0.56mw.e. a–1. Equilibrium-line altitude (ELA0) for the steady-state condition is calculated as ~4950ma.s.l., corresponding to an accumulation–area ratio (AAR0) of ~61%. Analysis of seasonal MBs between 2009 and 2013 with air temperature from AWS-M and precipitation from the nearest meteorological station at Bhuntar (1050ma.s.l.) suggests that the summer monsoon is the key season driving the interannual variability of Ba for this glacier. The intensity of summer snowfall events controls the Ba evolution via controlling summer glacier-wide MB (Bs).