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Ice shelves restrain flow from the Greenland and Antarctic ice sheets. Climate-ocean warming could force thinning or collapse of floating ice shelves and subsequently accelerate flow, increase ice discharge and raise global mean sea levels. Petermann Glacier (PG), northwest Greenland, recently lost large sections of its ice shelf, but its response to total ice shelf loss in the future remains uncertain. Here, we use the ice flow model Úa to assess the sensitivity of PG to changes in ice shelf extent, and to estimate the resultant loss of grounded ice and contribution to sea level rise. Our results have shown that under several scenarios of ice shelf thinning and retreat, removal of the shelf will not contribute substantially to global mean sea level (<1 mm). We hypothesize that grounded ice loss was limited by the stabilization of the grounding line at a topographic high ~12 km inland of its current grounding line position. Further inland, the likelihood of a narrow fjord that slopes seawards suggests that PG is likely to remain insensitive to terminus changes in the near future.
Glacial environments exhibit temporally variable microseismicity. To investigate how microseismicity influences event detection, we implement two noise-adaptive digital power detectors to process seismic data from Taylor Glacier, Antarctica. We add scaled icequake waveforms to the original data stream, run detectors on the hybrid data stream to estimate reliable detection magnitudes and compare analytical magnitudes predicted from an ice crack source model. We find that detection capability is influenced by environmental microseismicity for seismic events with source size comparable to thermal penetration depths. When event counts and minimum detectable event sizes change in the same direction (i.e. increase in event counts and minimum detectable event size), we interpret measured seismicity changes as ‘true’ seismicity changes rather than as changes in detection. Generally, one detector (two degree of freedom (2dof)) outperforms the other: it identifies more events, a more prominent summertime diurnal signal and maintains a higher detection capability. We conclude that real physical processes are responsible for the summertime diurnal inter-detector difference. One detector (3dof) identifies this process as environmental microseismicity; the other detector (2dof) identifies it as elevated waveform activity. Our analysis provides an example for minimizing detection biases and estimating source sizes when interpreting temporal seismicity patterns to better infer glacial seismogenic processes.
NICE guidelines advise to consider admission for patients with borderline personality disorder (BPD) for the management of crises involving significant risk to self or others. Furthermore, to consider structured psychological interventions of greater than three months’ duration and twice-weekly sessions according to patients’ needs and wishes.
We aimed to assess reasons for admission and access to psychological interventions in an acute inpatient BPD population.
Case notes of patients with a diagnosis of BPD (ICD-10 F60.3 and F60.31), discharged from four acute general adult wards in Sheffield during a period of twelve months were studied retrospectively, using a structured questionnaire based on BPD NICE guidance.
Of the 83 identified BPD patients, seventy-eight percent were female and 82% between 16–45 years old. Eleven patients had four or more admissions. Eighty percent reported suicidal ideation at admission, with 50% having acted on it (70% by overdose, 50% cutting, 10% hanging). Of this cohort, 58% reported they intended to die. Psychosocial factors at admission were identified in 59 cases, including relationship breakdown (47.5%), alcohol/drug use (30.5%) and accommodation issues (17%). Disturbed/aggressive behaviour was documented in 27.1% of these cases. Sixty-eight percent of patients had psychology input in the 5 years preadmission: 38% (21 patients) received structured therapy, whilst 62% received only one assessment or advise to teams.
Patients were mainly admitted for risk management. A high proportion received unstructured psychological interventions. Services offering structured psychological interventions should be supported, as hospitalisations only temporarily address BPD patients’ suicidality and psychosocial difficulties.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The original research by the Teotihuacan Mapping Project (TMP) identified a large number of obsidian workshops within Teotihuacan based on surface concentrations of production debris. Clark (1986b) questioned the validity of these identifications and called for subsurface excavation to confirm the presence of in situ workshop locales. This article summarizes the results from the excavation of one of the obsidian workshops identified in the Tlajinga district of Teotihuacan at Compound 17:S3E1 (Compound 17). We describe the excavations, discuss the lithic technology, and examine the subsurface contexts in terms of what they tell us about in situ obsidian craft activity. Excavations confirm that Compound 17 was a locus of large-scale obsidian craft production during the Classic period. While only a single test case, these results suggest that surface remains at Teotihuacan can be a useful guide in identifying craft production areas when they are confirmed through subsurface testing.
What explains state agency resistance to actions taken by their federal counterparts? And do sectional tensions make state bureaucratic nonacquiescence particularly likely in the U.S. South? We theorize that state resistance to federal administrative policy is more likely among Southern state bureaus due to administrative sectionalism. We argue that state agencies can and do resist federal administrative orders independent of other political constraints. This study is among the first to consider the policy consequences of sectionalism in state bureaucracies. We test our claims by employing a mixed methods approach that analyzes each instance of litigation and intervention by state bureaucrats in opposition to actions and orders by the Federal Energy Regulatory Commission (FERC) from 2010 to 2017. We find that, all else equal, state agency resistance to federal utility policy is about 3.75 times as likely among Southern utility regulators. This research has important normative implications for administrative politics as it suggests agencies with putatively apolitical policy jurisdiction have political preferences driven by sectional tension.
People with psychotic disorders face impairments in their global functioning and their quality of life (QoL). The relationship between the two outcomes has not been systematically investigated. Through a systematic review, we aim to explore the presence and extent of associations between global functioning and QoL and establish whether associations depend on the instruments employed.
In May 2016, ten electronic databases were searched using a two-phase process to identify articles in which associations between global functioning and QoL were assessed. Basic descriptive data and correlation coefficients between global functioning and QoL instruments were extracted, with the strength of the correlation assessed according to the specifications of Cohen 1988. Results were reported with reference to the Meta-analysis of Observational Studies in Epidemiology guidelines and PRISMA standards. A narrative synthesis was performed due to heterogeneity in methodological approaches.
Of an initial 15 183 non-duplicate articles identified, 756 were deemed potentially relevant, with 40 studies encompassing 42 articles included. Fourteen instruments for measuring global functioning and 22 instruments for measuring QoL were used. Twenty-nine articles reported linear associations while 19 assessed QoL predictors. Correlations between overall scores varied in strength, primarily dependent on the QoL instrument employed, and whether QoL was objectively or subjectively assessed. Correlations observed for objective QoL measures were consistently larger than those observed for subjective measures, as were correlations for an interviewer than self-assessed QoL. When correlations were assessed by domains of QoL, the highest correlations were found for social domains of QoL, for which most correlations were moderate or higher. Global functioning consistently predicted overall QoL as did depressive and negative symptoms.
This review is the first to explore the extent of associations between global functioning and QoL in people with psychotic disorders. We consistently found a positive association between global functioning and QoL. The strength of the association was dependent on the QoL instrument employed. QoL domains strongly associated with global functioning were highlighted. The review illustrates the extensive array of instruments used for the assessment of QoL and to a lesser extent global functioning in people with psychotic disorders and provides a framework to understand the different findings reported in the literature. The findings can also inform the future choice of instruments by researchers and/or clinicians. The observed associations reassure that interventions for improving global functioning will have a positive impact on the QoL of people living with a psychotic disorder.
The Pueblo population of Chaco Canyon during the Bonito Phase (AD 800–1130) employed agricultural strategies and water-management systems to enhance food cultivation in this unpredictable environment. Scepticism concerning the timing and effectiveness of this system, however, remains common. Using optically stimulated luminescence dating of sediments and LiDAR imaging, the authors located Bonito Phase canal features at the far west end of the canyon. Additional ED-XRF and strontium isotope (87Sr/86Sr) analyses confirm the diversion of waters from multiple sources during Chaco’s occupation. The extent of this water-management system raises new questions about social organisation and the role of ritual in facilitating responses to environmental unpredictability.
Herbicide resistance, and in particular multiple-herbicide resistance, poses an ever-increasing threat to food security. A biotype of junglerice [Echinochloa colona (L.) Link] with resistance to four herbicides, imazamox, fenoxaprop-P-ethyl, quinclorac, and propanil, each representing a different mechanism of action, was identified in Sunflower County, MS. Dose responses were performed on the resistant biotype and a biotype sensitive to all four herbicides to determine the level of resistance. Application of a cytochrome P450 inhibitor, malathion, with the herbicides imazamox and quinclorac resulted in increased susceptibility in the resistant biotype. Differential gene expression analysis of resistant and sensitive plants revealed that 170 transcripts were upregulated in resistant plants relative to sensitive plants and 160 transcripts were upregulated in sensitive plants. In addition, 507 transcripts were only expressed in resistant plants and 562 only in sensitive plants. A subset of these transcripts were investigated further using quantitative PCR (qPCR) to compare gene expression in resistant plants with expression in additional sensitive biotypes. The qPCR analysis identified two transcripts, a kinase and a glutathione S-transferase that were significantly upregulated in resistant plants compared with the sensitive plants. A third transcript, encoding an F-box protein, was downregulated in the resistant plants relative to the sensitive plants. As no cytochrome P450s were differentially expressed between the resistant and sensitive plants, a single-nucleotide polymorphism analysis was performed, revealing several nonsynonymous point mutations of interest. These candidate genes will require further study to elucidate the resistance mechanisms present in the resistant biotype.
Taylor Glacier hosts an active englacial hydrologic system that feeds Blood Falls, a supraglacial outflow of iron-rich subglacial brine at the terminus, despite mean annual air temperatures of −17°C and limited surface melt. Taylor Glacier is an outlet glacier of the East Antarctic ice sheet that terminates in Lake Bonney, McMurdo Dry Valleys. To image and map the brine feeding Blood Falls, we used radio echo sounding to delineate a subhorizontal zone of englacial brine upstream from Blood Falls and elongated in the ice flow direction. We estimate volumetric brine content in excess of 13% within 2 m of the central axis of this zone, and likely much higher at its center. Brine content decreases, but remains detectable, up to 45 m away along some transects. Hence, we infer a network of subparallel basal crevasses allowing injection of pressurized subglacial brine into the ice. Subglacial brine is routed towards Blood Falls by hydraulic potential gradients associated with deeply incised supraglacial valleys. The brine remains liquid within the subglacial and englacial environments through latent heat of freezing coupled with elevated salt content. Our findings suggest that cold glaciers could support freshwater hydrologic systems through localized warming by latent heat alone.
The fertility and soil health of organic agroecosystems are determined in part by the size and turnover rate of soil carbon (C) and nitrogen (N) pools. Our research contrasts the effects of best management practices (BMP) (reduction in soil disturbance, addition of organic amendments) on C and N cycling in soils from two field sites representing five organic agroecosystems. Total soil organic C (SOC), a standard measure of soil health, contains equal amounts of biologically and non-biologically active C that is not associated with release of mineral N. A three-pool first-order model can be used to estimate the size and turnover rates of C pools but requires data from a long-term incubation. Our research highlights the use of two rapid C fractions, hydrolysable and permanganate (0.02 M) oxidizable C, to assess shifts in biologically active C. Adoption of BMP in organic management systems reduced the partitioning of C to the active pool while augmenting the slow pool C. These pools are associated with potentially mineralizable N supplied by residues, amendments and soil organic matter affecting the concentration and release of mineral N to crops. Our data show that minimizing disturbance (no tillage, pasture) and mixed compost additions have the potential to reduce carbon dioxide emissions while enhancing slow pool C and or its turnover, a reservoir of nutrients available to the soil biota. Use of these rapid, sensitive indicators of biological C activity will aid growers in determining whether a BMP fosters nutrient loss or retention prior to shifts in total SOC.
The spatial and temporal development of shear-induced overturning billows associated with breaking internal solitary waves is studied by means of a combined laboratory and numerical investigation. The waves are generated in the laboratory by a lock exchange mechanism and they are simulated numerically via a contour-advective semi-Lagrangian method. The properties of individual billows (maximum height attained, time of collapse, growth rate, speed, wavelength, Thorpe scale) are determined in each case, and the billow interaction processes are studied and classified. For broad flat waves, similar characteristics are seen to those in parallel shear flow, but, for waves not at the conjugate flow limit, billow characteristics are affected by the spatially varying wave-induced shear flow. Wave steepness and wave amplitude are shown to have a crucial influence on determining the type of interaction that occurs between billows and whether billow overturning can be arrested. Examples are given in which billows (i) evolve independently of one another, (ii) pair with one another, (iii) engulf/entrain one another and (iv) fail to completely overturn. It is shown that the vertical extent a billow can attain (and the associated Thorpe scale of the billow) is dependent on wave amplitude but that its value saturates once a given amplitude is reached. It is interesting to note that this amplitude is less than the conjugate flow limit amplitude. The number of billows that form on a wave is shown to be dependent on wavelength; shorter waves support fewer but larger billows than their long-wave counterparts for a given stratification.
Driving is an essential instrumental activity of daily living but becomes increasingly difficult to maintain with age-related comorbid medical conditions. Age-related physiologic changes can impact driving along with common medical conditions that have a high prevalence in advanced age. Polypharmacy and sedating medications can impair driving. A comprehensive assessment—including taking a driving history and a targeted physical exam, the Assessment of Driving-Related Skills (ADReS)—is recommended to identify older drivers at risk. Referrals to other health professionals (e.g., occupational therapists, physical therapists, social workers, neuropsychologists, etc.) may be quite helpful in determining driving risk and/or assisting with driving retirement and maintaining key driving destinations. Driving rehabilitation specialists (typically occupational therapists) can assist clinicans with comprehensive evaluations and performance-based road tests. Legal and ethical issues are related to reporting unsafe drivers, and clinicians are advised to seek local counsel in these matters and know their state laws.
Though the US civilian trauma care system plays a critical role in disaster response, there is currently no systems-based strategy that enables hospital emergency management and local and regional emergency planners to quantify, and potentially prepare for, surges in trauma care demand that accompany mass-casualty disasters.
A proof-of-concept model that estimates the geographic distributions of patients, trauma center resource usage, and mortality rates for varying disaster sizes, in and around the 25 largest US cities, is presented. The model was designed to be scalable, and its inputs can be modified depending on the planning assumptions of different locales and for different types of mass-casualty events.
To demonstrate the model’s potential application to real-life planning scenarios, sample disaster responses for 25 major US cities were investigated using a hybrid of geographic information systems and dynamic simulation-optimization. In each city, a simulated, fast-onset disaster epicenter, such as might occur with a bombing, was located randomly within one mile of its population center. Patients then were assigned and transported, in simulation, via the new model to Level 1, 2, and 3 trauma centers, in and around each city, over a 48-hour period for disaster scenario sizes of 100, 500, 5000, and 10,000 casualties.
Across all 25 cities, total mean mortality rates ranged from 26.3% in the smallest disaster scenario to 41.9% in the largest. Out-of-hospital mortality rates increased (from 21.3% to 38.5%) while in-hospital mortality rates decreased (from 5.0% to 3.4%) as disaster scenario sizes increased. The mean number of trauma centers involved ranged from 3.0 in the smallest disaster scenario to 63.4 in the largest. Cities that were less geographically isolated with more concentrated trauma centers in their surrounding regions had lower total and out-of-hospital mortality rates. The nine US cities listed as being the most likely targets of terrorist attacks involved, on average, more trauma centers and had lower mortality rates compared with the remaining 16 cities.
The disaster response simulation model discussed here may offer insights to emergency planners and health systems in more realistically planning for mass-casualty events. Longer wait and transport times needed to distribute high numbers of patients to distant trauma centers in fast-onset disasters may create predictable increases in mortality and trauma center resource consumption. The results of the modeled scenarios indicate the need for a systems-based approach to trauma care management during disasters, since the local trauma center network was often too small to provide adequate care for the projected patient surge. Simulation of out-of-hospital resources that might be called upon during disasters, as well as guidance in the appropriate execution of mutual aid agreements and prevention of over-response, could be of value to preparedness planners and emergency response leaders. Study assumptions and limitations are discussed.
A Geographic Simulation Model for the Treatment of Trauma Patients in Disasters. Prehosp Disaster Med.2016;31(4):413–421.
A panel of emergency medicine (EM) leaders endeavoured to define the key elements of leadership and its models, as well as to formulate consensus recommendations to build and strengthen academic leadership in the Canadian EM community in the areas of mentorship, education, and resources.
The expert panel comprised EM leaders from across Canada and met regularly by teleconference over the course of 9 months. From the breadth of backgrounds and experience, as well as a literature review and the development of a leadership video series, broad themes for recommendations around the building and strengthening of EM leadership were presented at the CAEP 2015 Academic Symposium held in Edmonton, Alberta. Feedback from the attendees (about 80 emergency physicians interested in leadership) was sought. Subsequently, draft recommendations were developed by the panel through attendee feedback, further review of the leadership video series, and expert opinion. The recommendations were distributed to the CAEP Academic Section for further feedback and updated by consensus of the expert panel.
The methods informed the panel who framed recommendations around four themes: 1) leadership preparation and training, 2) self-reflection/emotional intelligence, 3) academic leadership skills, and 4) gender balance in academic EM leadership. The recommendations aimed to support and nurture the next generation of academic EM leaders in Canada and included leadership mentors, availability of formal educational courses/programs in leadership, self-directed education of aspiring leaders, creation of a Canadian subgroup with the AACEM/SAEM Chair Development Program, and gender balance in leadership roles.
These recommendations serve as a roadmap for all EM leaders (and aspiring leaders) to build on their success, inspire their colleagues, and foster the next generation of Canadian EM academic leaders.
Boarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies.
A retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering.
A total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times.
Urban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576–582)
We aimed to characterize the geographic distribution of post-Hurricane Sandy emergency department use in administrative flood evacuation zones of New York City.
Using emergency claims data, we identified significant deviations in emergency department use after Hurricane Sandy. Using time-series analysis, we analyzed the frequency of visits for specific conditions and comorbidities to identify medically vulnerable populations who developed acute postdisaster medical needs.
We found statistically significant decreases in overall post-Sandy emergency department use in New York City but increased utilization in the most vulnerable evacuation zone. In addition to dialysis- and ventilator-dependent patients, we identified that patients who were elderly or homeless or who had diabetes, dementia, cardiac conditions, limitations in mobility, or drug dependence were more likely to visit emergency departments after Hurricane Sandy. Furthermore, patients were more likely to develop drug-resistant infections, require isolation, and present for hypothermia, environmental exposures, or administrative reasons.
Our study identified high-risk populations who developed acute medical and social needs in specific geographic areas after Hurricane Sandy. Our findings can inform coherent and targeted responses to disasters. Early identification of medically vulnerable populations can help to map “hot spots” requiring additional medical and social attention and prioritize resources for areas most impacted by disasters. (Disaster Med Public Health Preparedness. 2016;10:351–361)