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In New York City, a multi-disciplinary Mass Casualty Consultation team is proposed to support prioritization of patients for coordinated inter-facility transfer after a large-scale mass casualty event. This study examines factors that influence consultation team prioritization decisions.
As part of a multi-hospital functional exercise, 2 teams prioritized the same set of 69 patient profiles. Prioritization decisions were compared between teams. Agreement between teams was assessed based on patient profile demographics and injury severity. An investigator interviewed team leaders to determine reasons for discordant transfer decisions.
The 2 teams differed significantly in the total number of transfers recommended (49 vs 36; P = 0.003). However, there was substantial agreement when recommending transfer to burn centers, with 85.5% agreement and inter-rater reliability of 0.67 (confidence interval: 0.49–0.85). There was better agreement for patients with a higher acuity of injuries. Based on interviews, the most common reason for discordance was insider knowledge of the local community hospital and its capabilities.
A multi-disciplinary Mass Casualty Consultation team was able to rapidly prioritize patients for coordinated secondary transfer using limited clinical information. Training for consultation teams should emphasize guidelines for transfer based on existing services at sending and receiving hospitals, as knowledge of local community hospital capabilities influence physician decision-making.
The chapter summarises the main findings from the SDG chapters (1–17) combined with the results from a workshop in 2018 to answer the following questions: How is Agenda 2030 likely to interact with forests and people? What are the possible synergies, trade-offs between goals and targets? What are the contextual conditions that shape the interactions between SDGs and targets and subsequent impacts on forests and people? Two broad groups of SDGs emerge. One includes SDGs that primarily focus on institutional, governance and social conditions. Those contribute to an enabling environment for inclusive forest management and conservation with associated livelihood benefits. A second group of SDGs affect land use directly and thus are expected to impact forests. Progress in the first group of SDGs results in synergistic interactions and positive outcomes for forests and peoples. Among the second group of SDGs, the potential for trade-offs is high, with important repercussions for forest and people. Understanding the potential for these trade-offs is essential in order to avoid implementation pathways that favour a small subset of these SDGs at the expense of the others.
The introductory chapter introduces the Agenda 2030 and its 17 SDGs and briefly presents the process that led to its adoption. It discusses the nature of the SDGs, recognising the great variation in the nature, scope and function of the SDGs and related targets, and drawing attention to the interlinkages among the goals and targets. Forests provide ecosystem services that are crucial for human welfare and for reaching the SDGs. The chapter gives a brief overview of the world’s forests and forests’ contributions to the SDGs. Forests are only mentioned in two SDGs (SDG 6 and SDG 15). However, due to the interrelated nature of the SDGs and targets, the implementation of the SDG agenda will inevitably influence forests and forest-related livelihoods and the possibilities to achieve the forest specific targets. Understanding the potential impacts of SDGs on forests, forest-related livelihoods and forest-based options to generate progress towards achieving the SDGs, as well as the related tradeoffs and synergies, is crucial for efforts undertaken to reach these goals. It is especially important for reducing potential negative impacts and to leverage opportunities to create synergies that will ultimately determine whether comprehensive progress towards the SDGs will be accomplished.
This chapter summarises the lessons learnt in the book, based on a reflection process amongst the editors and a joint workshop with the lead authors. The key messages are that 1) forests are a crucial base for sustainable development, and need to be fully considered in all related decision making, 2) the SDGs will impact forests and the people dependent on them in many ways, with the exact impact being highly dependant on the respective ecological and socio-economic context, 3) the SDGs include partially conflicting visions for forests and people, corresponding to distinct values and interests, involving the necessity to consider trade-offs and set priorities when implementing them, 4) there are fundamental values and principles that may guide sustainable development related to forests and people regardless of the context, including basic human rights but also forest-specific aspects and principles for how existing trade-offs can be managed, 5) that there is the necessity to continuously learn from, and adapt, the process of implementing the SDGs. The chapter concludes by addressing the urgency of creative and forward-looking human engagement at the forest–people interface, to make sure that sustainable development can benefit both forests and people.
This chapter reviews normal aging-related changes in memory processes, including short-term or working memory and episodic and semantic long-term memory. Definitions of the boundaries of normal vs. pathological long-term memory changes with advancing age are provided, including Benign Senescent Forgetfulness, Age Associated Memory Impairment, and Mild Cognitive Impairment. Memory decline is contrasted with decline in other cognitive processes, including processing speed and spatial cognition. Aging-related decline is similar for verbal and visual long-term memory, including more traditional memory measures such as list-learning, and for tests that are designed to simulate everyday memory abilities such as name–face association. Aging-related decline in long-term memory appears to be a function of the amount initially learned, with little evidence of accelerated forgetting in association with normal advancing age. Recognition performance remains high and relatively stable over successive age cohorts. Last, the factor structure of measures of short- and long-term memory, as well as episodic and semantic memory, supports the differentiation of these constructs and shows stability of these unique domains across the adult age range.
The Minnesota Center for Twin and Family Research (MCTFR) comprises multiple longitudinal, community-representative investigations of twin and adoptive families that focus on psychological adjustment, personality, cognitive ability and brain function, with a special emphasis on substance use and related psychopathology. The MCTFR includes the Minnesota Twin Registry (MTR), a cohort of twins who have completed assessments in middle and older adulthood; the Minnesota Twin Family Study (MTFS) of twins assessed from childhood and adolescence into middle adulthood; the Enrichment Study (ES) of twins oversampled for high risk for substance-use disorders assessed from childhood into young adulthood; the Adolescent Brain (AdBrain) study, a neuroimaging study of adolescent twins; and the Siblings Interaction and Behavior Study (SIBS), a study of adoptive and nonadoptive families assessed from adolescence into young adulthood. Here we provide a brief overview of key features of these established studies and describe new MCTFR investigations that follow up and expand upon existing studies or recruit and assess new samples, including the MTR Study of Relationships, Personality, and Health (MTR-RPH); the Colorado-Minnesota (COMN) Marijuana Study; the Adolescent Brain Cognitive Development (ABCD) study; the Colorado Online Twins (CoTwins) study and the Children of Twins (CoT) study.
Forests provide vital ecosystem services crucial to human well-being and sustainable development, and have an important role to play in achieving the seventeen Sustainable Development Goals (SDGs) of the United Nations 2030 Agenda. Little attention, however, has yet focused on how efforts to achieve the SDGs will impact forests and forest-related livelihoods, and how these impacts may, in turn, enhance or undermine the contributions of forests to climate and development. This book discusses the conditions that influence how SDGs are implemented and prioritised, and provides a systematic, multidisciplinary global assessment of interlinkages among the SDGs and their targets, increasing understanding of potential synergies and unavoidable trade-offs between goals. Ideal for academic researchers, students and decision-makers interested in sustainable development in the context of forests, this book will provide invaluable knowledge for efforts undertaken to reach the SDGs. This title is available as Open Access via Cambridge Core.
Industrial heat treatment of milk results in protein glycation. A high protein glycation level has been suggested to compromise the post-prandial rise in plasma amino acid availability following protein ingestion. In the present study, we assessed the impact of glycation level of milk protein on post-prandial plasma amino acid responses in humans. Fifteen healthy, young men (age 26 (SEM 1) years, BMI 24 (SEM 1) kg/m2) participated in this randomised cross-over study and ingested milk protein powder with protein glycation levels of 3, 20 and 50 % blocked lysine. On each trial day, arterialised blood samples were collected at regular intervals during a 6-h post-prandial period to assess plasma amino acid concentrations using ultra-performance liquid chromatography. Plasma essential amino acid (EAA) concentrations increased following milk protein ingestion, with the 20 and 50 % glycated milk proteins showing lower overall EAA responses compared with the 3 % glycated milk protein (161 (SEM 7) and 142 (SEM 7) v. 178 (SEM 9) mmol/l × 6 h, respectively; P ≤ 0·011). The lower post-prandial plasma amino acid responses were fully attributed to an attenuated post-prandial rise in circulating plasma lysine concentrations. Plasma lysine responses (incremental AUC) following ingestion of the 20 and 50 % glycated milk proteins were 35 (SEM 4) and 92 (SEM 2) % lower compared with the 3 % glycated milk protein (21·3 (SEM 1·4) and 2·8 (SEM 0·7) v. 33·3 (SEM 1·7) mmol/l × 6 h, respectively; P < 0·001). Milk protein glycation lowers post-prandial plasma lysine availability in humans. The lower post-prandial availability of lysine following ingestion of proteins with a high glycation level may compromise the anabolic properties of a protein source.