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The state of California, in the United States of America, has a population of nearly 40 million people and is the 5th largest economy in the world. During the coronavirus disease 2019 (COVID-19) pandemic in 2020-2021, the state experienced a medical surge that stressed its sophisticated health-care and public health system. During this period, ventilators, oxygen, and other equipment necessary for providing ventilatory support became a scarce resource in many health-care settings. When demand overwhelms supply, creative solutions are required at all levels of disaster management and health care. This study describes the disaster response by the state of California to mitigate the emergency demands for oxygen delivery resources.
Cahokia is the largest documented urban settlement in the pre-Columbian United States. Archaeological evidence suggests that the city, located near what is now East St. Louis, Illinois, began to rapidly expand starting around AD 1050. At its height, Cahokia extended across 1000 ha and included large plazas, timber palisade walls, and hundreds of monumental earthen mounds. Following several centuries of occupation, the city experienced a period of gradual abandonment from about AD 1200 to 1400. Here, we present geochemical data from a 1500-year-old sediment core from nearby Horseshoe Lake that records watershed impacts associated with the growth and decline of Cahokia. Sedimentary analysis shows a distinctive 24-cm-thick, gray, fine-grained layer formed between AD 1150 and 1220 and characterized by low carbonate δ13C, elevated sorbed metal concentrations, and higher organic matter δ15N. The deposition of this layer is contemporaneous with archaeological evidence of increased agricultural activity, earthen mound construction, and higher populations surrounding the lake. We hypothesize that these human impacts increased soil erosion, producing new sediment sources from deeper soil horizons, and shifted dissolved transport to the lake, producing lower carbonate δ13C values, higher concentrations of lead, copper, potassium, and aluminum, and increased δ15N, likely due to contributions of enriched nitrogen from sewage.
Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.
We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive–behavioural therapy (G-CBT).
We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3–25). Predictors of treatment response were examined.
G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, t = −1.71, d.f. = 245, P = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t = 2.79, d.f. = 175, P = 0.006; t = 2.89, d.f. = 175, P = 0.004).
Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.
Declaration of interest
C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers’ honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
The long-term stability of mechanically exfoliated MoS2 flakes was compared for storage in the air and storage under vacuum. Significant changes in MoS2 flakes were observed for samples stored in the air, whereas similar flakes on samples stored in vacuum underwent no change. Small speckles were observed to appear on the surface of flakes stored in the air, followed by thinning and eventual decomposition of MoS2 flakes. The speckles are suspected to be formed by oxidation of MoS2 in the presence of atmospheric oxygen and water molecules, resulting in the formation of hydrated MoO3.
Peatlands have long been recognised as a high priority for protection under international and national wildlife laws and agreements. Over the last half century this protection has essentially been reactionary in the face of more widespread land management policy and market forces, which have encouraged damage to peatlands. This damage has been mainly to support the delivery of provisioning services, such as food, timber and pulp, or the widespread extraction of peat and oil. Across the world, peatlands of different types face a variety of pressures from land use and land-use change as well as pollution (e.g. atmospheric pollution on British blanket bogs), making them more susceptible to impacts of climate change. Within the general framework of international agreements on peatland conservation, each country has developed its own approach to tackling the threats with varying degrees of success. While established wildlife conservation policy has helped limit the extent of damage to peatlands in some countries, there is a need and opportunity for a stronger and more urgent public policy response to address the significant ongoing losses of peatland biodiversity and ecosystem services. The recognition of the multiple benefits that peatlands provide has presented new avenues to support sustainably managed peatlands, in addition to reducing peatland loss through active restoration (e.g. Bain et al. 2011; Joosten, Tapio-Biström and Tol 2012). This chapter presents an overview of the principal international and national policy drivers, with examples from selected countries across the world to highlight how new resources could be directed at wise use and conservation of peatlands.
Global overview of policy drivers for peatland conservation
While peatlands have been regarded as wastelands, and areas to be ‘improved’ for agriculture and forestry since the late eighteenth century (Chapter 2), they are now recognised for their wildlife and increasingly for their ecosystem services. Peatlands, therefore, feature in some of the world's highest-level environmental policies.
One of the earliest global agreements to recognise the importance of peatlands for protection was the Ramsar Convention (1971) that promoted the establishment and management of a network of protected wetlands. In 1996, it was reported that though peatlands represented 50% of the world's freshwater and terrestrial wetlands, less than 10% of the designated Ramsar sites had peatland as their dominant habitat (Chapter 15). Given continuing peatland loss and degradation, Contracting Parties set out guidelines to improve peatland protection (Ramsar 2003).
Many studies have demonstrated short-term behavioural responses by whales and dolphins in the presence of vessels, but the population-level implications of such changes are poorly understood (Lusseau, 2003, 2004; Bejder et al., 2006a; Lusseau & Bejder, 2007). One means for developing such an understanding is to use a modelling framework such as the Population Consequences of Acoustic Disturbance (PCAD) model. PCAD identifies four levels at which data can be collected, and allows for estimates of modelling parameters at one level to be based on measured data at another level (National Research Council, 2005).
The first level contains short-term behavioural responses, such as those that have been the typical focus of studies on effects of whale-watching. Effects vary within and between species, and include changes in respiration patterns, surface active behaviours, swimming velocity, vocal behaviour, activity state, inter-individual spacing, wake riding, approach and avoidance, and displacement from habitat. Collisions may result in injury or death (Wells & Scott, 1997; Laist et al., 2001). More detailed reviews of vessel effects can be found in Lien (2001) and Ritter (2003).
This book provides an overview of the research related to psychological assessment across South Africa. The thirty-six chapters provide a combination of psychometric theory and practical assessment applications in order to combine the currently disparate research that has been conducted locally in this field. Existing South African texts on psychological assessment are predominantly academic textbooks that explain psychometric theory and provide brief descriptions of a few testing instruments. Psychological Assessment in South Africa provides in-depth coverage of a range of areas within the broad field of psychological assessment, including research conducted with various psychological instruments. The chapters critically interrogate the current Eurocentric and Western cultural hegemonic practices that dominate the field of psychological assessment. The book therefore has the potential to function both as an academic text for graduate students, as well as a specialist resource for professionals, including psychologists, psychometrists, remedial teachers and human resource practitioners.
Bioenergy has a significant greenhouse gas (GHG) mitigation potential, provided that the resources are developed sustainably and that efficient bioenergy systems are used. Certain current systems and key future options including perennial cropping systems, use of biomass residues and wastes and advanced conversion systems are able to deliver 80 to 90% emission reductions compared to the fossil energy baseline. However, land use conversion and forest management that lead to a loss of carbon stocks (direct) in addition to indirect land use change (d+iLUC) effects can lessen, and in some cases more than neutralize, the net positive GHG mitigation impacts. Impacts of climate change through temperature increases, rainfall pattern changes and increased frequency of extreme events will influence and interact with biomass resource potential. This interaction is still poorly understood, but it is likely to exhibit strong regional differences. Climate change impacts on biomass feedstock production exist but if global temperature rise is limited to less than 2°C compared with the pre-industrial record, it may pose few constraints. Combining adaptation measures with biomass resource production can offer more sustainable opportunities for bioenergy and perennial cropping systems.
Biomass is a primary source of food, fodder and fibre and as a renewable energy (RE) source provided about 10.2% (50.3 EJ) of global total primary energy supply (TPES) in 2008. Traditional use of wood, straws, charcoal, dung and other manures for cooking, space heating and lighting by generally poorer populations in developing countries accounts for about 30.7 EJ, and another 20 to 40% occurs in unaccounted informal sectors including charcoal production and distribution.