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The Upper Hunter Valley is a major coal mining area in New South Wales (NSW), Australia. Due to the ongoing increase of mining activities, PM10 (air-borne particle with an aerodynamic diameter less than 10 micrometres) pollution has become a major air quality concern in local communities. The early part of this study identified two air quality subregions in the valley. This paper aims to provide a holistic summarisation of the relationships between elevated PM10 pollution in two subregions and the local- and synoptic-scale meteorological conditions for spring and summer, when PM10 pollution is relatively high. A catalogue of twelve synoptic types and a set of six local meteorological patterns have been quantitatively derived and linked to each other using the self-organising map (SOM) technique. The complex meteorology-air pollution relationships have been visualised/interpretated on the SOM planes for two representative locations. It was found that the influence of local meteorological patterns differed significantly for mean PM10 levels vs the occurrence of elevated pollution events and between air quality subregions. In contrast, synoptic types showed generally similar relationships with mean vs elevated PM10 pollution in the valley. Two local meteorological patterns, the hot-dry-northwesterly wind conditions and the hot-dry-calm conditions, were found most PM10 pollution conducive in the valley when combined with a set of synoptic counterparts. These synoptic types are featured with the influence of eastward migrating continental high pressure system and westerly troughs, or a ridge extending northwest towards coastal northern NSW or southern Queensland from the Tasman Sea. The method and results can be used in air quality research for other locations of NSW, or similar regions elsewhere.

The Upper Hunter Valley is a major coal mining area containing approximately 40% of the currently identified total coal reserves in New South Wales (NSW), Australia. Due to the ongoing increase of mining activities, PM10 (air-borne particle with an aerodynamic diameter less than 10 micrometres) pollution has become a major air quality concern in local communities. This paper summarises the spatial and temporal variability modes of PM10 pollution in the region, based on long-term multi-site monitoring data and the application of the rotated principal component analysis (RPCA) and wavelet analysis techniques. RPCA identified two distinct air quality clusters/subregions in the valley, one in the west/northwest, the other in the southeast. Wavelet analysis revealed the annual cycle to be most persistent temporal mode of PM10 variability in both subregions, with intermittent signals observed at time scales of around 120, 30~90 and under 30 days. How these variation modes are related to the effects of local PM10 emissions and the influence of meteorology at different time scales deserves further attention in future work. The findings will be used in air quality reporting and forecasting in NSW. The methodology and results can also be useful for air quality research in similar regions elsewhere.

The impact of interaction SS with MJO on rainfall along Java Island to East Nusa Tenggara has been studied using daily rainfall observation data from 2140 weather observation stations, which are also equipped with GSMaP, OLR, and ERA5 data. There were 61 SS events found, 17 during active MJO and 44 in inactive MJO. Rainfall increases more in the western study area when the active MJO and more in the eastern study area when the inactive MJO is due to SS. SS reduces rainfall in the Jakarta region, regardless of the activity or inactivity of the MJO. SS causes extreme rainfall to only occur in a small part of certain areas, so it tends to significantly reduce the possibility of extreme rainfall. In the southern part of the IMC, SS predominates over MJO in supporting increased water vapor transport. Large-scale synoptic circulations like the monsoon, SS, and MJO can interact with local land-sea wind circulation to produce spatiotemporal variability in rainfall on Java Island. Rainfall mostly increases in the afternoon and decreases in the morning when SS occurs, whether there is MJO or not. Convective instability analysis indicates that SS increases precipitation, most likely by lowering CIN and raising VIMFC.

Despite saltmarshes being considered as nature-based solutions (NbS) towards climate change mitigation, India’s saltmarsh ecosystems are least studied. This study quantifies the seasonal variation in carbon stocks mono-specific saltmarsh species (Porteresia coarctata) and its potential to play an important role in India’s climate change mitigation plans. Seasonal (pre-and post-monsoon) sampling of P. coarctata surface water, biomass and 30 cm sediment core was collected across four locations on the east coast of India to quantify sediment dry bulk density (DBD), organic matter (OM%), organic carbon (Corg%), Corg stocks of sediment and biomass, total carbon (C%) and nitrogen (N%) and stable isotopes of δ13C and δ15N. In general, the sediment DBD, OM and Corg of P. coarctata meadows was higher in post-monsoon and was influenced by salinity and pH changes. Isotope (δ¹³C) modelling of various sediment C sources suggested, particulate organic matter (POM) contribution was highest (0.04-0.79%) followed by P. coarctata (0.01–052%) and other macrophytes across our study locations. The seasonal variation of δ¹³C showed increased contribution of marine derived particulate and dissolved organic matter into P. coarctata meadows in post-monsoon season. Heavier δ¹⁵N values were observed in post-monsoon season suggesting anthropogenic input, that was utilized by P. coarctata to increase its above and below-ground biomass and shoot density. The combined ecosystem (30 cm sediment + biomass) Corg stocks of P. coarctata was 1.7-fold higher in post-monsoon (4021.20± 917 Mg C) compared to pre-monsoon (2297.36 ±647 Mg C) season among the four locations with a sediment Corg contribution >70%. Based on the International Panel for Climate Change Tier II assessment the P. coarctata meadows (443 ha) can help in avoiding the pre and post-monsoon emissions of 8431.34 and 14757.84 Mg CO₂ respectively. The combined price of the total CO₂ equivalent stored in P. coarctata meadows in pre- and post-monsoon is US$ 14.50 and US$ 25.38 million respectively. Further studies quantifying the NbS potential of P. coarctata mono-specific and mixed meadows of India’s coast is needed along with integration of saltmarsh ecosystems into India’s National Action Plan on Climate Change.

Aerosol-cloud interactions play a crucial role in shaping Earth’s climate and hydrological 1 cycle. Observing these interactions with high precision and accuracy is of the utmost importance 2 for improving climate models and predicting Earth’s climate. Over the past few decades, lidar 3 techniques have emerged as powerful tools for investigating aerosol-cloud interactions due to their 4 ability to provide detailed vertical profiles of aerosol particles and clouds with high spatial and 5 temporal resolutions. This review paper provides an overview of recent advancements in the study 6 of aerosol-cloud interactions using lidar techniques. The paper begins with a description of the 7 different cloud microphysical processes that are affected by the presence of the aerosol, and with 8 an outline of lidar remote sensing application in characterizing aerosol particles and clouds. The 9 subsequent sections delve into the key findings and insights gained from lidar-based studies of 10 aerosol-cloud interactions. This includes investigations into the role of aerosol particles in cloud 11 formation, evolution, and microphysical properties. Finally, the review concludes with an outlook 12 on future research. By reporting the latest findings and methodologies, this review aims to provide 13 valuable insights for researchers engaged in climate science and atmospheric research.

The COVID-19 pandemic has triggered seismic shifts in how we work, and organizations behave. It has caused many organizations to transition from an office-centric culture to more flexible ways of working. This shift is necessitated by health conditions and the need for controls. It is also driven by the assumption that remote work or working from home offer a certain assurance of safety for employees against the threat of infection in highly vulnerable office conditions. The shift to remote work has so far been mainly experimental as most businesses continue to learn about what works and what doesn’t. There is also the assumption that all that matters for the efficient operability of a remote work regime is the availability and effectiveness of computing technologies and internet connectivity. Thus, once those supplies are in place remote work is expected to be fully functional and without problems. As learning continues about what works and what doesn’t, it has also become increasingly clear that beyond the threat of covid-19 and the relative safety that individual homes may offer, there are other vulnerabilities which are ignored or underestimated in the process. In most instances, the home environment of the employee, the conditions under which employees operate from home and the health and safety such environments provide (or not) are either ignored or underestimated in discussions around remote work practices. This paper highlights remote work as an emergent practice while exploring associated, but ignored, health and safety issues in employee homes.

Off-grid electrification planning increasingly recognizes the importance of productive use of electricity (PUE) to promote community value creation and (financial) project sustainability. To ensure a sustainable and efficient integration in the community and energy system, PUE assets must carefully be evaluated to match both the community needs and the residential electricity demand patterns. We propose a novel methodology interlinking qualitative interviews, statistical analysis, and energy system modelling to optimize decision-making for PUE integration in off-grid energy systems in rural Madagascar by aligning relevant PUE effectively with anticipated residential electricity demand patterns based on socio-economic determinants of the community. We find that a possible contribution of the PUE to reducing the electricity costs depends signifi-cantly on three factors: 1. the residential electricity consumption patterns that are influenced by the socio-economic composition of the community, 2. the degree of flexibility of i) PUE assets and ii) operational preferences of the PUE user, and 3. the capacity of community members to finance and operate PUE assets. Our study demonstrates that significant cost reductions for PUE-integrated off-grid energy systems can be achieved by applying our proposed methodology. When matching PUE and residential consumption patterns, the integration of PUE assets in residential community energy system can reduce the financial risk of operators, provided the PUE enterprise operates reliably and sustainably. We highlight that the consideration of local value chains and co-creation approaches are essential to ensure the energy system is addressing the community’s needs, creates value for the community, enhances the project´s financial sustainability, and is achieving the overall objectives of decentralized energy system planning.

Combustion power plants emit carbon dioxide (CO₂), a major contributor to climate change. Direct emissions measurement is cost-prohibitive globally, while reporting varies in detail, recency, and granularity. To fill this gap and greatly increase the number of power plants worldwide with independent emissions monitoring, we developed and applied machine learning (ML) models using power plant plumes as proxy signals to estimate electric power generation and CO₂ emissions using Landsat 8, Sentinel-2, and PlanetScope imagery. Our ML models estimated power plant activity on each image snapshot, and then an aggregation model predicted plant utilization over a 30-day period. Lastly, emissions factors specific to region, fuel, and plant technology were used to convert estimated electricity generation to CO₂ emissions. Models were trained with reported hourly generation data in the US, Europe, and Australia and were validated with additional generation and emissions data from the US, Europe, Australia, Türkiye, and India. All results with sufficiently large sample sizes indicate that our models outperformed baseline approaches. In conducting external validation to compare modeled versus reported annual generation and emissions in the countries where available, we calculated the root mean square error overall for modeled countries with validation data as respectively 1.75 TWh (236 plants across 17 countries over 4 years) and 2.04 Mt CO₂ (207 plants across 17 countries over 4 years). Ultimately, we applied our ML method to plants that comprise 32% of global power plant CO₂ emissions averaged over 2015-2022. This dataset is the most comprehensive independent and free-of-cost global power plant point-source emissions monitoring system currently known to the authors and is publicly available at climatetrace.org to support global emissions reduction.

This article presents and discusses analytical data on the scientific publication record from 1910 to 2020 on two topics: "climate" and "climate change/global warming/climate emergency". The goal is to visualize how the publication record on these two topics has evolved over time, from different classification perspectives (year, country, source and organization). Three hypotheses are tested using data collected from Web of Science and various graphical representations of the data. It is found that research output related to the Earth’s contemporary changing climate overtook that of general climate research in 2011, and the publication ratio has been expanding in the last decade. There are significant differences in the publication countries and sources between the two topics, and conversely less significant differences in terms of organizations publishing these works. Differentiation factors that affect the level of research output and engagement on the climate challenge include: island versus landlocked nations, specialized versus general scientific journals, academic versus institutional organizations. The future of the publication records is discussed, such as the emergence of new terms to refer to the climate challenge, such as “climate emergency”.

In order to achieve global climate goals, it is necessary to estimate greenhouse gases (GHG) fluxes from ecosystems. To obtain a comprehensive assessment of CO2, СН4, N2O natural fluxes for the Russian Federation we used the "bottom-up" method according to [1]. We updated estimates for forest ecosystems based on State Forest Inventory data and satellite monitoring of forest disturbances. For grassland ecosystems, it was based on the correct distribution of areas between steppe and non-steppe zones. The estimated net uptake of natural ecosystems of Russia was 1.1 ± 1.8 billion tons of CO2-eq./year. The study shows that if only CO2 is taken into account, the net absorption of terrestrial ecosystems in Russia corresponds to more than -2.5 billion tons of CO2 (35% of forests’ contribution). However, given the emissions of non-CO2 GHGs, total net absorption in Russia’s natural ecosystems is reduced to about -1 billion tons of CO2-eq (with the forests’ contribution increasing to 80%). With regard to anthropogenic fluxes, the overall balance of GHGs in Russia corresponds to net-emissions of 1 billion tons of CO2-eq/year into the atmosphere. To improve reporting under the Paris Agreement, countries should aim to include only anthropogenic ("manageable") GHG fluxes on managed land.

Polar stratospheric clouds (PSCs) form in polar regions typically between 15 and 25 km, when the local temperature is sufficiently low. PSCs play an important role in the ozone chemistry and the dehydration and denitrification of the stratosphere. Lidars with a depolarization channel may be used to detect and classify different classes of PSCs. The main PSC classes are water ice, nitric acid trihydrate (NAT) and supercooled ternary solutions (STS), the latter being liquid droplets consisting of water, nitric acid and sulphuric acid. PSCs have been observed at the lidar observatory at Concordia Station from 2014 on. The harsh environmental conditions at Concordia during winter render successful lidar operation difficult. In order to facilitate the operation of the observatory several measures have been put in place to achieve an almost complete remote control of the system. PSC occurrence is strongly correlated with local temperatures and is affected by dynamics, as the PSC coverage during the observation season shows.

In this study, a basic study was performed to analyze the seasonal temperature status of a research room in the Global Environment Research Building where ceiling-embedded indoor units are installed to study the room temperature status of the building as well as to improve its thermal environment. In addition, a direction for improvement of the indoor thermal environment in the winter was proposed through a CFD (computational fluid dynamics) simulation and was proven by an additional experiment. Through the results of this study, it appeared that if the ceiling-embedded indoor unit was installed in the small indoor space without considering the thermal vulnerability of its perimeter boundary, the air temperature of the upper part was greatly different from that of the bottom part in the winter. Hence, in this study, as a means to improve it, convectors were installed to minimize the effect of the external thermal environment and angle-controllable air flowing fans were installed to mitigate the stratification distribution. With such result, it was intended to present the essential data for improvement of the thermal environment as well as conservation of heating energy in the winter for buildings by reviewing the use of the ceiling-embedded indoor unit in the future.

Critically ill patients treated in the intensive care unit (ICU) can present many abdominal conditions that need a prompt diagnosis and timely treatment because of their general frailty. Clinical evaluation and diagnostic tools like ultrasound or CT scan are not reliable or feasible in these patients. Bedside laparoscopy (BSL) is a minimally invasive procedure that allows surgeons to assess the abdominal cavity directly in the ICU, thus avoiding unnecessary exploratory laparotomy or incidence related to intra-hospital transfer. We conducted a review of the literature to summarize the state-of-the-art of BSL. Medline, The Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases were utilized to identify all relevant publications. Indications, contraindications, technical aspects, and outcomes are discussed. The procedure is safe, feasible, and effective. When other diagnostic tools fail to diagnose or exclude an intra-abdominal condition in ICU patients, BSL should be preferred over exploratory laparotomy.

Introduction: Atrial fibrillation (AF) is a common cardiac arrhythmia whose prevalence rises with age and is linked to increased morbidity and mortality due to the risk of thromboembolism. Management typically involves anticoagulation and rhythm control, but the treatment of elderly patients with multiple comorbidities requires careful consideration of drug side effects and interactions. Cibenzoline, a Vaughan-Williams class IA antiarrhythmic, is effective against AF but has risks of toxicity, especially in older people and those with renal impairment, due to its renal excretion and prolonged half-life in these populations. Discussion: This paper presents a case of an 80-year-old woman with paroxysmal AF who suffered cardiac arrest due to cibenzoline toxicity despite receiving standard adjusted dosages. The patient's cibenzoline blood concentration was significantly higher than the therapeutic range, leading to cardiotoxicity, which was exacerbated by drug interactions with bisoprolol and edoxaban, both metabolized by the CYP3A4 enzyme. Venoarterial extracorporeal membrane oxygenation (V-A ECMO) and intra-aortic balloon pump (IABP) successfully managed the cardiac arrest. This case emphasizes the unpredictable pharmacokinetics of cibenzoline in elderly patients with renal impairment and the need for vigilant therapeutic drug monitoring to avoid adverse events. Conclusions: Cibenzoline can pose a significant risk of severe toxicity in elderly patients with renal impairment, and drug interactions may potentiate this risk. The paper underscores the importance of careful dose adjustment and monitoring of drug levels in this population. In cases of cibenzoline-induced cardiac arrest, V-A ECMO and IABP are effective treatment modalities. The case study serves as a critical reminder for clinicians to remain vigilant for drug-induced complications and to apply aggressive supportive treatments when necessary.

(1) Background: A simple approach to map irrigated landcover has been introduced by using measures derived from optical spectral range as an alternative to thermal range. It has been demonstrated that substituting surface temperature (Ts, ‘thermal approach’) with SWIR transformed reflectance (STR, ‘optical approach’) to detect surface moisture is feasible with comparable results. (2) Methods: Using an iterative thresholding procedure to minimize within-class variance, the bilevel segmentation of variables derived from Landsat-8 representing surface moisture and vegetation cover was achieved for the 2020-21 summer for a key irrigation district in Australia. (3) Results: The results of irrigated landcover by optical approach found to be comparable with those by thermal approach. The classification accuracy was assessed using water delivery records at farm level. Though the overall accuracy is high in both cases, the optical approach (97.6%) performed slightly better than the thermal approach (93.9%). (4) Conclusions: The feasibility of using STR to map irrigated landcover has been confirmed by a high-level overall accuracy assessment. This has broader implications in terms of irrigated landcover assessment, as the use of satellite imagery in these applications may not necessarily be limited to microwave or thermal sensors.

Due to its high short-term global warming potential (GWP) compared to carbon dioxide, methane (CH₄) is a considerable agent of climate change. This research is aimed at analyzing data on methane gathered at the GAW (Global Atmosphere Watch) station of Lamezia Terme (Calabria, Southern Italy) spanning seven years of continuous measurements (2016-2022) and integrating the results with key meteorological data. Compared to previous studies on detected methane mole fractions at the same station, daily-to-yearly patterns have become more prominent thanks to the analysis of a much larger data set. Overall, the yearly increase of methane at the Lamezia Terme station is in general agreement with global measurements by NOAA, though local peaks are present, and an increase linked to Covid-19 is identified. Seasonal changes and trends have proved to be fully cyclic, with the daily cycles being largely driven by local wind circulation patterns and synoptic features. Outbreak events have been statistically evaluated depending on their weekday of occurrence to test possible correlations with anthropic activities. A cross analysis between methane peaks and specific wind directions has also proved that local sources may be deemed responsible for the highest mole fractions.

C. auris is a newly emerging yeast, raising public health concerns due to its outbreak potential, lack of protocols for decontamination and isolation of patients or contacts, increased resistance to common antifungals and associated high mortality. This research aimed to describe the challenges related to identifying the outbreak, limiting further contamination, and treating affected individuals. We retrospectively analysed all cases of C. auris detected between October 2022 and August 2023, but our investigation focused on a three-month-long outbreak in the department of cardio-vascular surgery and the related intensive care unit. Along with isolated cases in different wards, we identified 13 patients who became infected or colonized in the same area and time, even though the epidemiological link could be traced only in 10 patients, according to the epidemiological investigation. In conclusion, our study emphasizes the substantial challenge encountered in clinical practice when attempting to diagnose and limit the spread of an outbreak. Therefore, it is crucial to promptly apply contact precaution measures and appropriate environmental cleaning, from the first case detected positive.

Synchronous electrical cardioversion is a relatively common procedure in the emergency department (ED), often performed for unstable supraventricular tachycardia (SVT) or unstable ventricular tachycardia (VT). However, it is also used for stable cases resistant to drug therapy, which carry a risk of deterioration. In addition to the inherent risks linked with procedural sedation, there is a possibility of malignant arrhythmias or bradycardia, which could potentially result in cardiac arrest following this procedure. Here, we present a case of complete heart block unresponsive to transcutaneous pacing and positive inotropic and chronotropic drugs for 90 minutes, resulting in multiple cardiac arrests. The repositioning of the transcutaneous cardio-stimulation electrodes, one of them placed in the left latero-sternal position and the other at the level of the apex, led to immediate stabilization of the patient. Extubation of the patient was performed the following day, while full recovery and discharge within 7 days, after insertion of a permanent pacemaker.

German noise action plans aim to reduce negative health outcomes from noise exposure and identify quiet areas free of noise pollution. Quiet area identification in German noise action plans is based primarily on noise mapping and spatial analysis and not empirical or qualitative data about acoustic environments, thus leaving a gap in the understanding of the quality of formally recognized quiet areas in noise action plans. This work presents a comparative empirical case study in Dortmund, Germany, with the aim to describe the diurnal dB(A) and biophonic properties of quiet areas versus noise 'hot spots'. Sound observations were collected (n=282,764) in five different natural or recreational land use patch types larger than four acres within 33 proposed quiet areas in Dortmund (n=70) and 23 noise hot spots between April 27^th, 2022 and March 2^nd, 2023. We find that quiet areas are on average more than 20 dB(A) quieter than noise hot spots almost every hour of the day. Forests, managed tree stands, cemeteries, and agriculture diel patterns are dominated by dawn dusk chorus in spring and summer, whereas sport and recreation as well as noise hot spots are dominated by traffic and human noise. A novel composite biophony mapping procedure is presented that finds distinct temporal distribution of biophony in forested and agriculture peri-urban locations positively associated with patch size, distance away from LDEN > 55, proximity to water, and the number of vegetation layers in the plant community. Anthrophony distribution dominates urban land uses in all hours of the day, but expands during day and evening and contracts at night and in dusk hours. The procedures presented here illustrate how qualitative information regarding quiet areas can be integrated into German noise action planning.

Human induced climate change led to the recognition of Community-Based Adaptation (CBA) as one of the remedies in building adaptive capacity and resilience of communities. It recognizes the agency of communities in shaping the optimal strategy. CBA interventions are vital in addressing community needs and contextual specificities, enable participatory and inclusive engagement and thereby facilitate more profound adaptation impacts. Agent-based modelling (ABM) has the potential to be an invaluable approach in developing tailored adaptation strategies considering capacities, resources, skills, priorities, needs and the cultural context of local communities. ABM allows to capture the complex relationships among various components within community decision making on CBA actions, the CBA actions themselves and the environment, however available tools provide for various degrees of freedom in agent definition, sensitivity analysis, scalability, experiment design and output analysis to name a few. This article assesses all available ABM modelling and simulation tools for its application in the context of CBA. NetLogo emerges as the most suitable tool for incorporating and handling the special features of CBA. It is closely followed by GAMA and Envision. The article provides insights and guidance to researchers and practitioners in selecting ABM tools aligned with the specific requirements of their CBA simulations and projects.

Climate simulations in West Africa have been attributed with large uncertainties. Global climate projections are not consistent with changes in observations at the regional or local level of the Niger basin, making management of hydrological projects in the basin uncertain. This study evaluates the potential of using the quantile mapping bias correction to improve the Coupled Model Intercomparison Project (CMIP5) outputs for use in hydrology impact studies. Rainfall and temperature projections from 8 CMIP5 Global Climate Models (GCM) were bias corrected using the quantile mapping approach. Impacts of climate change was evaluated with bias corrected rainfall, temperature and potential evapotranspiration (PET). The IHACRES hydrological model was adapted to the Niger basin and used to simulate impacts of climate change on discharge under present and future conditions. Bias correction significantly improved the accuracy of rainfall and temperature simulations compared to observations. Nash coefficient (NSE) for monthly rainfall comparisons of 8 GCMs to the observed was improved by bias correction from 0.69 to 0.84. The standard deviations among the 8 GCM rainfall data were significantly reduced from 0.13 to 0.03. Increasing rainfall, temperature, PET and river discharge were projected for all GCMs used in this study under the RCP8.5 scenario. These results will help improving projections and contribute to the development of sustainable climate change adaptation strategies.

Fever control is essential in patients with severe traumatic brain injury (TBI). The efficacy of therapeutic hypothermia (TH) in severe TBI has been investigated over the last few decades; however, in contrast to experimental studies showing benefits, no evidence of efficacy has been demonstrated in clinical practice. In this review, the mechanisms and history of hypothermia were briefly outlined, while the results of major randomized controlled trials (RCTs) and meta-analyses investigating TH for adult TBI are introduced and discussed. The retrieved meta-analyses showed conflicting results, with a limited number of studies indicating benefits of TH. Some studies have shown benefits of long-term TH compared with short-term TH. Although TH is effective at lowering elevated intracranial pressure (ICP), reduced ICP does not lead to favorable outcomes. Low-quality RCTs overestimated the benefits of TH, while high-quality RCTs showed no difference or worse outcomes with TH. RCTs assessing standardized TH quality demonstrated the benefits of TH. As TBI has heterogeneous and complicated pathologies, applying a uniform treatment may not be ideal. A meta-analysis of young patients who underwent early cooling and hematoma removal showed better TH results. TH should not be abandoned, and its optimal should be advocated on an individual basis.

Introduction: Although aging is a natural phenomenon, in recent years it has accelerated. One key factor implicated in the aging process is oxidative stress. Oxidative stress play also role in frailty (frail) and metabolic syndrome (MetS). Methods: 66 elderly persons (65 years old and older) with no acute or severe chronic disorders were assessed: waist circumference (WC), arterial blood pressure, glycemia, glycated hemoglobin (HbA1c), plasma lipids and activity of erythrocyte superoxide dismutase (SOD-1). Patients were classified as NonMetS-Nonfrail (n=19), NonMetS-frail (n=20), MetS-Nonfrail (n=17), and MetS-frail (n=10). Results: There were no significant differences in superoxide dismutase activity among investigated elderly groups. However, the data suggests that MetS individuals, both frail and nonfrail, have higher risk factors for cardiovascular disease compared to NonMetS individuals. The correlations analyses of SOD-1 and other metabolic indices suggest that SOD-1 levels may be influenced by age, total cholesterol, HDL cholesterol, and fasting glucose levels in certain groups of seniors. Conclusions: Aging is associated with decreased antioxidant enzyme SOD-1 activity with glucose alteration in frailty syndrome as well as with lipids disturbances in metabolic syndrome.

Developing countries, including Small Island Developing States (SIDS) and Least Developed Countries (LDCs), are exceptionally vulnerable to climate change due to their distinct geographical and environmental characteristics. The impacts of climate change extend across their ecosystems, water resources, and vital economic sectors, such as food systems, health, education, and energy. Escalating sea levels and heightened salinity levels imperil freshwater reserves, while warmer ocean temperatures and acidification disrupt water demand, tourism, health services, and fisheries. Furthermore, developing countries bear the brunt of water shortages, flooding, and deteriorating water quality. Alarmingly, nearly two-thirds of the global population experience severe water scarcity for at least one month annually, with the majority residing in developing countries. By 2025, half of the world's population could inhabit areas grappling with water scarcity, predominantly concentrated in developing nations. In this context, innovative adaptation strategies, notably transformative wastewater projects, are imperative for fostering sustainability and resilience in these regions. However, significant barriers impede progress, creating a stark disparity between current financing capabilities and the imperative to fund water security initiatives. Compounding these challenges, developing countries find themselves ensnared in a burgeoning debt crisis, marked by escalating interest rates and inflation, which threatens to impede developmental progress and curtail investments in adaptation and mitigation endeavors. Consequently, there arises a critical necessity to harness innovative financial mechanisms to transform these debts into assets that facilitate climate action. This paper meticulously explores the potential of debt-for-climate swaps as a catalyst for advancing transformative wastewater projects, with a focused lens on their strategic deployment to underpin critical initiatives. Through rigorous examination of case studies and empirical evidence, the paper elucidates how debt-for-climate swaps can effectively bolster sustainable wastewater management systems in developing countries. Furthermore, it delineates best practices for leveraging these mechanisms to fortify environmental sustainability and resilience. Additionally, the paper delineates the roles and responsibilities of key stakeholders, including governments, policymakers, the private sector, communities, and climate financial institutions. By amalgamating theoretical insights with tangible examples, this paper furnishes a comprehensive framework for harnessing debt-for-climate swaps to enhance water security and resilience in developing countries. It endeavors to furnish actionable strategies for policymakers, practitioners, and stakeholders to navigate the complex terrain of climate change and engender sustainable development.

The extent of access to energy of displaced populations in settlements and camps in Africa is largely 14 unknown. A multitude of contextual factors, such as the location and the characteristics of housing, 15 the legal status, the socio-cultural background, and the availability of humanitarian and public ser- 16 vices impact the living conditions and the needed energy services. Limitations in accessing energy 17 services have direct, multilayered, and far-reaching implications, including impacts on health, nu- 18 trition, education, protection, and livelihood. The objective of this article is to contribute to a more 19 comprehensive overview of the current state of energy access in displacement contexts on the Afri- 20 can continent by identifying and utilizing existing data. After a screening of the vast and various 21 available information, setting up of a database, consolidating the gathered data as well as assessing 22 the quality through a quality assessment method, the currently available information is visualized 23 and discussed. Considerable differences in the access to electricity for displaced persons across the 24 countries are found. For both electricity and clean cooking, the availability for displaced persons 25 ranges from nearly no access at all up to an access rate of 100%. More strikingly, the results also 26 show that besides South Africa and countries in the Maghreb region, the access to both clean cook- 27 ing and electricity for displaced persons is very low. At the same time, the fragmented data availa- 28 bility, the poor data quality, and the questionable expediency of available data allows neither solid 29 theoretical conclusions nor planning of effective practical implementation measures. Novel inter- 30 disciplinary research, conceptual frameworks and indicators are needed for the purpose of compa- 31 rability and consistency. Future research has the potential to more comprehensively capture the 32 current state of access to energy in displacements contexts and in a next step to examine how energy 33 is interwoven in the lives of displaced people to derive a set of more detailed context-sensitive en- 34 ergy indicators. It is essential that the concerned persons, the displaced persons themselves are in- 35 cluded in the research in a meaningful way.

Abstract: Background and objective: Iliopsoas abscess (IPA) is a rare condition with varied symptomology and etiology. Less than one-third of patients with IPA present on the emergency department (ED) admission with the traditional triad of fever, back pain, and restricted hip motion (or limp), leading to delays in diagnosis and management. This case report aims to bring awareness among healthcare professionals regarding the atypical presentation and introduce a potential differential diagnosis when evaluating patients with fever and back pain. The intention is to provide insights into the signs and symptoms that may indicate the presence of an iliopsoas abscess and prompt additional investigations. Case report: Here, we describe a case of primary iliopsoas abscess associated with drug-induced acute liver failure in our ED. The patient complained of pain in the left lumbar region and fatigue that started two weeks before this presentation, claiming that, during the previous night, the pain suddenly worsened. She had a fever, pain at palpation in the right hypochondriac and left lumbar regions, accompanied by fever and vomiting, jaundiced skin, and sclera at the examination in ED. On abdominal ultrasonography, the diagnosis of acute cholangitis was suspected. The laboratory test shows leukocytosis with neutrophilia, thrombocytosis, hepatocytolysis syndrome, and hyperbilirubinemia with the predominance of indirect bilirubin. We performed then abdominal and pelvic computed tomography, which confirmed the diagnosis of cholelithiasis observed with the diameter of the bile duct within normal limits but also showed an abscess-like collection fused to the interfibrillar level of the left iliopsoas muscle; a diagnosis we most likely would have been missed. After that, the patient was hospitalized in the General Surgery Department, and surgery drainage of the abscess was performed. The patient's evolution was excellent; she was discharged after 11 days. Conclusions: The case presented here exemplifies how iliopsoas abscess, a rare cause of back pain, can quickly go unrecognized, especially in the emergency department. Our experiences will raise awareness among doctors in emergency departments about this uncommon but essential diagnosis. With advancements in diagnostic tools and techniques, we aspire that more cases of iliopsoas abscess will be accurately diagnosed.

Out-of-hospital cardiac arrest (OHCA) represents a significant global public health burden, characterized by low survival and few established diagnostic tools to guide intervention. OHCA presents with a wide variety of etiologies in a heterogeneous population, posing a clinical challenge to care teams. In this review, we describe evolving research focused on diagnostic approaches to OHCA following resuscitation, including electrocardiography, coronary angiography, computed tomography, ultrasonography, and serologic biomarker assessment. These diagnostic tools have been employed in post-resuscitative efforts for diagnosing ischemic and non-ischemic cardiac, respiratory, neurologic, vascular, traumatic, and metabolic causes of arrest.

This six-year multicentre study investigated acute intentional poisoning with substances of abuse in adolescents to identify changes and patterns in substance use. Data from 568 adolescents were collected from three paediatric poison centres in Romania between January 2017 and December 2022. The study analysed the epidemiological and sociodemographic characteristics of the adolescents, including age, gender, place of residence, history of substance abuse, psychiatric history, and history of institutionalized care. The findings revealed that cannabis and new psychoactive sub-stances (NPSs) are the most commonly implicated substances, each with distinct profiles among adolescents. Cannabis was involved in 45.6% of cases, with a significant association with urban residency. NPSs were identified as the second most prevalent substance, accounting for 38.9% of cases. These were more prevalent in rural areas and among patients with psychiatric disorders. Cannabis and NPSs were also the most commonly implicated substances in acute intentional poisoning cases with substances of abuse. These substances have distinct profiles among adolescents, including age, gender, residency area, history of substance abuse, psychiatric history, and institutional care. These findings underscore the necessity of targeted public health interventions and integrated care approaches to address substance use and related mental health issues in adolescents.

Purpose: The deterioration of oral function has been getting much attention as “Oral frailty”. This study evaluated the change in tongue pressure, one of the objective items of oral frailty, to examine the relationship between body position and tongue pressure. Methods: This study was prospective, observational study in a single-center. The participants were categorized by Clinical Frailty Scale (CFS). Tongue pressure was measured in the following positions: dorsal, sitting, and sitting with plantar grounding. Differences in tongue pressure between CFS and between body positions were statistically analyzed. Results: A significant decrease in tongue pressure was demonstrated in CFS4 compared to CFS3. Furthermore, in CFS5 and CFS6, tongue pressure decreased in the sitting po-sition compared to that in the dorsal position and recovered to the dorsal level with plantar grounding. Conclusions: Tongue pressure decreased as the progression of frailty. It decreased by sitting, and this decrease was alleviated by plantar grounding.

In the past two decades, several floods have affected people and their properties in Burkina Faso, with the unprecedented flooding occurring in Ouagadougou in September 2009. So far, most studies have focused on Ouagadougou and surrounding localities and have paid little attention to other flood-prone regions in Burkina Faso. Specifically, there is a data and knowledge gap about the flood risk in the Haut-Bassins region, which in turn hampers the development of mitigation strategies and risk reduction measures in communities. This study demonstrates how data collected at the household level can be used to understand flood risk and its components at the village level in this data-scarce region. Using an indicator-based method, we analyze both flood risk and flood risk perception at the village level. Moreover, we determine the factors influencing flood risk perception at the household level using an ordered logit model. We find that 12 out of the 14 villages considered, experience high levels of flood risk. The management of runoff from the nearest urban areas and poorly designed civil engineering infrastructures, such as roads, were highlighted by the households as significant factors that increase their vulnerability. Hence, dependencies in space and between urban and rural areas may play a substantial role in modifying risk. The perceived flood risk consistently exceeds the estimated flood risk, with an insignificant positive correlation between both risk indices. Regression results indicate that flood risk perception is mainly influenced by informational and behavioral factors of the households. The findings of this study can provide valuable information to municipal and regional authorities involved in disaster risk management in the study area. Moreover, the method is transferable to other data-scarce regions

The monitoring of coastal waters using satellite data, from sensors including Sentinel-3 OLCI, has become a vital tool in the management of these water environments; especially when it comes to improving our understanding of the effects of climate change on these regions. In this study, Level-2 water products derived from different OLCI Sentinel-3 processors were validated against a comprehensive in situ dataset from the NW Baltic Sea proper region. The products validated were those of the regionally adapted Case-2 Regional Coast Colour (C2RCC) OLCI processor (v1.0 and v2.1), as well as the latest standard Level-2 OLCI case 2 (Neural Network) products from Sentinel-3’s processing baseline: Baseline Collection 003 (BC003), including “CHL_NN”, “TSM_NN”, and “ADG443_NN”. Furthermore, the effect of the current EUMETSAT system vicarious calibration (SVC) on the Level-2 water products was also validated. Results showed that the system vicarious calibration (SVC) reduces the reliability of the Level-2 OLCI products. For example, the application of these SVC gains to the OLCI data for the regionally adapted v2.1 C2RCC products resulted in RMSD increases of 36% for “conc_tsm”; 118% for “conc_chl”; 33% for “iop_agelb”; 50% for “iop_adg”; and 10% for “kd_z90max” using a ±3h validation window. The findings indicate that the current EUMETSAT SVC gains should be applied and interpreted with caution in the region of study at present. A key outcome of the paper recommends the development of a regionally specific SVC against AERONET-OC data for the region.

Current trends in systemic risk literature provide new insights into multi-hazard risks that interact and compound with built environments, creating more significant impacts on socio-economic and human systems. Recurrent natural hazards and extreme weather events are more likely to compound and cascade into more impactful events, especially in vulnerable societies. In small-island communities (SICS), including large archipelagos and Small Island Developing States (SIDS), the long-term impact of multi-, compounding-, and cascading-hazards (MCC hazards) can result in persistent vulnerability and residual risks. This is due to delayed responses, limited resources, poverty, fewer evacuation options, and inadequate markets and infrastructure. Using Ternate, a densely populated small volcanic island in North Maluku, Indonesia, as a case study, this paper assesses the impacts of seven types of natural hazards: flash floods, landslides, extreme weather, extreme waves and abrasion, earthquakes, tsunamis, and volcanic eruptions. The research focuses on the multi-hazard impact on population, land use, and infrastructure exposures in 60 villages in Ternate. The findings highlight population density, land use, and infrastructure exposure to multi-hazard risks, providing valuable information on potential losses in future hazard events.

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by renal tubular cystic dilatations. The cysts can develop anywhere along the nephron and over time the cystic dilatation lead to kidney enlargement. On the other hand, the cysts begin to reduce the number of functional nephrons as a consequence of cystic expansion that further contributes to the decline in renal function over the years. The pressure exerted by the dilated cysts lead to compensatory mechanisms that further contribute to the decline in renal function. These structural changes are responsible of glomerular hyperfiltration states, albuminuria, proteinuria, and haematuria. However, the presentation of ADPKD varies in children from a completely asymptomatic child with incidental ultrasound detection of cysts to a rapidly progressive disease. There have been reports of early onset of ADPKD in children younger than 2 years that showed a more rapid decline in renal function. ADPKD is caused by mutation in PKD1 and PKD2 genes. Today, the PKD1 gene mutation seems to account for up to 85% of the cases worldwide, and it is associated with worse renal outcomes. Individuals with PKD2 gene mutation seem to present a milder form of the disease, with a more delayed onset of end stage kidney disease. The cardinal sign of ADPKD is the presence of renal cysts during renal ultrasound. The current guidelines provide the clinicians the recommendations for genetic testing in children with a positive family history. Given that the vast majority of children with ADPKD present with normal or supra normal kidney function we explored the glomerular filtration rates dynamics and the renal ultrasound adjusted percentiles. 14 out of 16 patients had kidney percentile over 90%. The gene mutations were equally distributed among our cohort. In addition, we compared the modified Schwartz formula to the quadratic equation after adjusting the serum creatinine measurements. It seems that even though children with ADPKD have enlarged kidneys, the renal function is more likely normal or near normal when the quadratic estimation of glomerular filtration rate is used (qGFR tended to be lower, 111.95 ± 12.43 ml/min/1.73m2 compared to Schwartz eGFR 126.28 ± 33.07ml/min/1.73m2, p=0.14). Also, when the quadratic equation was employed, not even a patient reached the glomerular hyperfiltration thresholds. The quadratic formula showed that glomerular filtration rates are linear or slightly decreasing after 1-year of follow-up (Quadratic ΔeGFR=0.32±5.78ml/min/1.73m2) as opposed to Schwartz formula that can falsely classify children in a hyperfiltration state ΔeGFR=7.51±19.46ml/min/1.73m2), p=0.019.

Understanding the dynamics of Organic Carbon mineralization is fundamental in forecasting biosphere to atmosphere Net Carbon Ecosystem Exchange (NEE). With this perspective, we developed 3D-CMCC-PSM, a new version of the hybrid Process Based Model 3D‐CMCC FEM where also heterotrophic respiration (R_h) is explicitly simulated. The aim was to quantify NEE as a forward problem, by subtracting Ecosystem Respiration (R_eco) to Gross Primary Productivity (GPP). To do so, we developed a simplification of the Soil Carbon dynamics routine proposed in DNDC [1]. The method calculates decomposition as a function of soil moisture, temperature, state of the organic compartments, and relative abundance of microbial pools. Given the pulse dynamics of soil respiration, we introduced modifications in some of the principal constitutive relations involved in phenology and littering sub-routines. We quantified the model structure related uncertainty in NEE, by running our training simulations over 1000 random parameter-sets extracted from parameters distributions expected from literature. 3D-CMCC-PSM predictability was tested on independent time series for 6 Fluxnet sites. The model resulted in daily and monthly estimations highly consistent with the observed time series. It showed lower predictability in Mediterranean ecosystems, suggesting that it may need further improvements in addressing evapotranspiration and water dynamics.

Incisional hernias have a particular dynamic related both to the repair method and to the absence or presence of a prosthetic material. The incidence of incisional hernias is estimated at 9.8% after 21 months and increases to 18.7% after ten years. This study presents a surgical method for the repair of recurrent incisional hernias, through open surgery and the use of existing mesh. The selection criteria regarding the use of this method are: the prosthesis is well integrated, without granulomas, suppurations, defect appearing on the same prosthetic abdominal area. The analyzed factors were the location of the incisional hernias, the duration of the operation, the duration of hospitalization, identified complications, the size of the parietal defect. The retrospective study carried out focused on recurrences of incisional hernias from a group of 631 patients operated on for incisional hernias in a general surgery department of Dr. Constantin Andreoiu County Emergency Hospital, Ploiești, Romania, during January 2018 - December 2022. Of the total of 18.22% relapses, 13.6% were relapsed eventrations after prosthetic procedures. Following the application of the selection criteria, several 8 patients with recurrent eventrations were operated by the open method using the existing mesh. In the case of recurrences after prosthetic procedures of incisional hernias, the recurrence can be solved by open surgery using the existing well-integrated prosthesis, without tension, absence of suppuration in the wound, and the peritoneal cavity. For the presented case, the return to daily activities occurred after 22 hours of hospitalization.

Heart failure is a global major healthcare problem with millions of hospitalizations annually and with a very high mortality. There is an increased interest in finding new and reliable biomarkers for the diagnostication, prognostication and therapeutical guidance of patients hospitalized for acute heart failure. There is data to sustain the role of CA 125, a worldwide used marker of ovarian cancer, in patients with heart failure. Several studies have shown links between CA 125 levels and congestion seen in acute heart failure, high mortality and readmission rates at 6 months follow up after discharge from acute heart failure and also a role of CA 125 in the guidance of heart failure therapy. There are also clinical trials that showed that several particularities of CA 125 make it even better than NTpro BNP ( a classical and more utilised marker of heart failure) in several scenarios of acute heart failure.

Federated learning is an effective approach for preserving data privacy and security, enabling machine learning to occur in a distributed environment and promoting its development. However, an urgent problem that needs to be addressed is how to encourage active client participation in federated learning. The Shapley Value, a classical concept in cooperative game theory, has been utilized for data valuation in machine learning services. Nevertheless, existing numerical evaluation schemes based on the Shapley Value are impractical as they necessitate additional model training, leading to increased communication overhead. Moreover, participants’ data may exhibit Non-IID characteristics, posing a significant challenge to evaluating participant contributions. Non-IID data weakens the marginal effects of participants, which in turn affects model accuracy and leads to underestimated contribution measurements. Current works often overlook the impact of heterogeneity on model aggregation. This paper presents a fair federated learning contribution measurement scheme that addresses the need for additional model computations. By introducing a noval aggregation weight, it enhances the accuracy of contribution measurement. Experiments on the MNIST dataset show that the proposed method can accurately compute the contributions of participants. Compared to existing baseline algorithms, the model accuracy is significantly improved, with a similar time cost.

Injury to the peritoneum during surgery is followed by a healing process that frequently results in the attachment of adjacent organs by a fibrous mass, referred to commonly as adhesions. Because injuries to the peritoneum during surgery are inevitable, one must understand the mechanisms of adhesion formation to prevent its occurrence. This requires a thorough understanding of the molecular sequence that results in the attachment of injured peritoneum and the development of fibrous tissue. Recent data show that fibroblasts from the injured peritoneum may play a critical role in forming adhesion tissues. Therefore, identifying changes in gene expression patterns in the peritoneal fibroblasts during the process may provide clues to the mechanisms by which adhesion develops. This review presents many papers discussing genes implied in peritoneal adhesion.

Subnational governments play a key role responding to climate change risks in terms of policy strategies and instruments. This article analyzes how Brazilian municipal and state governments have developed and implemented public policies to mitigate and to adapt to climate change risks. We surveyed all cities’ and states’ climate policies within the country. The methodological approach includes five main points of analysis: 1. mitigation targets and intentions; 2. adaptation actions; 3. stakeholders’ participation; 4. policy implementation; 5. participation in networks related to climate change. Our results suggest that even though subnational climate policies in Brazil are isolated initiatives within the national context, they play an important role responding to climate change risks in different scales and levels. The strongest Brazilian policies with both mitigation and adaptation actions counted on previous mobilization for the climate issue involving different stakeholders from several segments of the society. These governments have also participated in transnational cooperation networks related to climate change.

Background: In recent years, whole blood parameters and derivatives have been used as prognostic criteria in the course of the disease in various diseases. The prognostic nutritional index (PNI), the systemic immune-inflammation index (SII), the neutrophil-lymphocyte ratio (NLR) have been adapted as an indicator of inflammation and have been widely studied to define the severity of inflammation in some diseases. The aim of this study was to evaluate the relationship between parameters such as NLR, SII, PNI, controlling nutritional status (CONUT) score, nutritional risk index (NRI) and with immunonutrition status and disease activity in patients with ischemic stroke of small vessel, large vessel and other etiologies. Methods: We retrospectively evaluated the records of 1454 consecutive ischemic stroke patients hospitalized in the emergency department of Gaziosmanpasa Education and Research Hospital from 2019 to 2023. Results: Of the 1350 SVO patients included in the study, 58.8% had small vessel, 29.3% had large vessel and 11.9% had other etiologies. There was a significant difference between the 3 etiology groups for PNI and CONUT. The median PNI was 47.03 (41.33-52.85) in the other etiology group, 35.29 (33.69-37.25) in the small vessel group, and 34.11 (30.23-36.87) in the large vessel group. The CONUT median was 5(5-6) in the small vessel group, 5(4-6) in the large vessel group and 4(4-4) in the other etiology group. In addition, CONUT and PNI were also found to be independent risk factors for death. A negative significant correlation was observed between PNI and NLR (r:-0.692), SII (r:-0.591), CONUT (r:-0.685). Significant correlations were observed between CONUT and NLR (r:0.402), SII (r:0.312). Conclusion: PNI and SII were significantly associated with disease activity. PNI, CONUT and NRI as a more accurate prognostic indicator of nutritional status in patients with ischemic stroke of small vessel, large vessel and other etiologies. NLR and SII may be important predictive markers in the course and prognosis of stroke.

Introduction Emergency laparotomy is a surgical procedure associated with significantly higher mortality rates compared to elective surgeries. Awake laparotomy under neuraxial anaesthesia has recently emerged as a promising approach in abdominal surgery to improve patient outcomes. This study aims to evaluate the feasibility and potential benefits of using lumbar spinal anaesthesia as the primary anaesthetic technique in emergency laparotomies. Methods We conducted a case series involving 16 patients who underwent emergency laparotomy for bowel ischemia, perforation, or occlusion. Lumbar spinal anaesthesia was employed as the main anaes-thetic technique. We analysed patient demographics, clinical characteristics, intraoperative details, and postoperative outcomes. The primary outcome measures included the adequacy of postoper-ative pain control, the incidence of postoperative complications, and mortality rates. Results Among the 16 patients, adequate postoperative pain control was achieved, with only 2 patients requiring additional analgesia. Postoperative complications, including sepsis, wound dehiscence, and pneumonia, were observed in 7 patients (44%). The observed mortality rate was relatively low at 6% (1 patient). Notably, conversion to general anaesthesia was not necessary in any of the cases, and no early readmissions were reported. Discussion Our findings highlight the feasibility and potential benefits of using neuraxial anaesthesia in emergency laparotomies. The observed low mortality rate and the avoidance of conversion to general anaesthesia suggest that lumbar spinal anaesthesia may be a useful alternative in emer-gency settings. However, the occurrence of postoperative complications in 44% of patients indi-cates the need for cautious patient selection and close monitoring. Further research with larger sample sizes is warranted to fully elucidate the efficacy, safety, and potential impact of this tech-nique on patient outcomes in emergency laparotomies.

Introduction. Intra-abdominal cystic formations represent heterogeneous pathologies with varied localization and clinical manifestation. The first challenge of a giant intra-abdominal cystic lesion is identifying the organ of origin. The clinical presentation of intra-abdominal cystic lesions varies from acute manifestations to non-specific symptoms or accidental discovery. Case presentation: A 2-year-old girl presents to the emergency unit with a fever of 38.5 Celsius, loss of appetite, and apathy. The investigations showed a gigantic intra-abdominal mass whose organ belonging could not be specified. Postoperatively, a giant mesenteric lymphangioma was evident, which was completely excised. Discussions Giant cystic formations modify the anatomical reports and become space-replacing formations, and the starting point is even more challenging to assess preoperatively. Nevertheless, the careful evaluation of the characteristics of the formation, the effect on the adjacent organs, the age of the patient, and the clinical picture can provide elements of differential diagnosis.

Background and Objectives: Renal cell carcinomas and upper tract urothelial carcinomas are types of malignancies that originate in the kidneys. Each of these examples shows an increasing trend in the frequency and the mortality rate. This study aims to comprehensively define carcinomas by analysing clinical, paraclinical, and histological aspects to predict aggressiveness and mortality. Materials and Methods: We conducted a retrospective investigation on a group of patients suspected with kidney cancers. Results: We identified 188 cases. We observed a higher mortality rate and older age in individuals with urothelial carcinomas. Anemia, acute kidney injury, hematuria and perineural invasion were the main risk factors that predicted their mortality. Tumour size in renal cell carcinomas correlates with the presence of necrosis and sarcomatoid areas. Factors that indicate a higher rate of death are older age, exceeding of the renal capsule, the lesion that includes the entire kidney, lymphovascular invasion, acute kidney injury, and anemia. Conclusions: Even if they originate at the renal level, and the clinical-paraclinical picture is similar, the histopathological characteristics make the difference. In addition, to these are added the previously mentioned common parameters that can represent important prognostic factors. In conclusion, the characteristics commonly identified in one type of cancer may act as risk factors for the other tumor. The detected data include threshold values and risk factors, making a significant contribution to the existing literature.

Background and Objectives: High job strain is worsening the outcome in coronary artery disease, CAD. Severe dissatisfaction on workplace, imbalance between high demands , and low rewards, are affecting the quality of life, and diminishing the duration of life, especially in CAD patients. Our study included two samples : CAD patients (experimental group), and without CAD patients, but with traditional risk factors (control group). The main objective of the study was the role played by high sensitivity C reactive protein, hs CRP, and microalbuminuria, as mediators of job strain and CAD relationship. Secondary objectives were the following: identification of the most vulnerable patients( with significant job strain) and intervention towards this category, for cardiovascular events prevention (primary or secondary). Materials and Methods: The utilized methods were the following : clinical exam; electrocardiogram; echocardiogram; non contrast enhanced computed chest tomography; laboratory findings ( lipid profile, glycemia, hs CRP, microalbuminuria); type D scale, DS 14; depression questionnaire, PHQ-9; and satisfaction with work scale, SWWS. Results: The highest values for hs CRP and microalbuminuria were noticed in patients with the lowest Likert score, for both samples CAD, and without CAD patients. The highest job strain was noticed in females. More than half of CAD patients ,with low Likert scores, revealed myocardial infarction. Conclusions: Microalbuminuria and hs CRP were statistical significant in the study as intercessors, in job strain and CAD relationship. The most vulnerable patients for vascular events were females, in both groups : CAD and “CAD waiting desk”. In CAD sample, the vascular vulnerability was also increased by high job strain.

(1) Background: Cardiac resynchronization therapy (CRT) is essential for patients with heart failure and ventricular conduction abnormalities. Cardiomyopathy often includes left bundle branch block (LBBB) marked by delayed activation of the LV lateral wall and a widened QRS complex. Following CRT, patients with heart failure and LBBB have better outcomes and quality of life improvements. Various electrocardiographic and clinical parameters are thought to predict this improvement. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a reliable tool for measuring the quality of life in these patients. (2) Methods: We performed an observational prospective study over 69 individuals diagnosed with cardiac failure and dilatative cardiomyopathy with low FE and major LBBB and analyzed the correlations between patient outcomes after the procedure and the demographic, clinical, and electrocardiographic parameters, which include systolic blood pressure, ECG morphology elements, QRS duration, QRS area and associated comorbidities. (3) Results: Following our analysis a correlation between QRS area, intraprocedural systolic blood pressure, QRS duration and CRT outcomes assessed by the KCCQ score was observed which reflected that CRT has a hemodynamic impact and also affects the severity of ventricular asynchrony.; (4) Conclusions: The significant correlations observed with the KCCQ score show how CRT therapy impacts patients' quality of life, symptom burden, and functional status.

P-band radar remote sensing applied during the Airborne Microwave Observatory of Subcanopy and Subsurface (AirMOSS) mission has shown great potential for estimation of root zone soil moisture. When retrieving the soil moisture profile (SMP) from P-band radar, a mathematical function describing the vertical moisture distribution is required. Because only a limited number of observations are available, the number of free parameters of the mathematical model must not exceed the number of observed data. For example, a second order polynomial that contains 3 free parameters was presumed based on in-situ SMP data. The polynomial is currently parameterized based on 3 backscatter observations provided by AirMOSS (i.e. one frequency at three polarizations of HH, VV and HV). In this paper, a more realistic, physically-based SMP model containing 3 free parameters is derived based on a solution to Richards’ equation for unsaturated flow in soils. Evaluation of the new SMP model based on both numerical simulations and measured data revealed that it exhibits greater flexibility for fitting measured and simulated SMPs than the currently applied polynomial. It is also demonstrated that the new SMP model can be reduced to a second order polynomial at the expense of fitting accuracy.

Background and Objectives: The purpose of the study was to analyze the relationships between several clinical and biological factors, but also the tumor topography and surgical strategies used in patients with colorectal cancer. Materials and Methods: We designed an analytical, observational, retrospective study that included patients admitted to our emergency surgical department and diagnosed with colorectal cancer. The study group inclusion criteria were: patients admitted during 2020-2022; patients diagnosed with colorectal cancer (including the ileocecal valve); patients who benefited from a surgical procedure, either in emergency or elective. Results: In our study group, consisting of 153 patients, we accounted for 56.9% male patients and 43.1% female patients. The most common clinical manifestations were pain (73.2% of the study group), followed by abdominal distension (69.3% of the study group) and absence of intestinal transit (38.6% of the study group). A number of 69 patients were operated in emergency (45.1%), while 84 patients (54.9%) benefited from elective surgery. The most frequent topography of the tumor was the sigmoid colon, with 19.60% of the patients, followed by the colorectal junction, with 15.68% of the patients and superior rectum and inferior rectum, with 11.11% of the patients in each subcategory. The most frequent type of procedure was right hemicolectomy (21.6% of the study group), followed by rectosigmoid resection (20.9% of the study group). The surgical procedure was finished by performing an anastomosis in 49% of the patients, an ostomy in 43.1% of the patients, while for 7.8% of the patients, a tumoral biopsy was performed. Conclusions: Colorectal cancer remains one of the most frequent cancers in the world, with a heavy burden that involves high mortality, alterations in the quality of life of the patients and their families, and also the financial costs of the medical systems.

At the end of the dry season in early March to early April each year, extensive agricultural biomass waste burnings occur throughout insular mainland Southeast Asia. During this biomass burnings period, smoke aerosols blanket the whole regions and were transported and dispersed by predominant westerly and south westerly winds to southern China, Taiwan and as far southern Japan and the Philippines. The extensive and intense burnings coincided with some wildfires in the forests due to high temperature making the region one of the global hot spots of biomass fires. In this study, we focus on the effect of pollutants emitted from biomass burnings in March 2019 at the height of the burnings period to the exposed population and their health impact. The Weather Research Forecast- Chemistry (WRF-Chem) model was used to predict the PM2.5 concentration over the simulating domain and health impacts are then assessed on the exposed population in the four countries of Southeast Asia, namely Thailand, Laos, Cambodia and Vietnam. Using the health impact based on log-linear concentration response function and Integrated Exposure Response (IER), the results show that at the peak period of the burnings from 13 to 20 March 2019, Thailand experienced the highest impact, with an estimated 2170 premature deaths. Laos, Vietnam, and Cambodia followed, with estimated mortalities of 277, 565, and 314 deaths respectively. However, when considering the impact per head of population, Laos exhibited the highest impact, followed by Thailand, Cambodia, and Vietnam. The results highlight the significant health impact and associated economic cost of agricultural waste burnings in Southeast Asia at the end of the dry season. And hence policy makers should take these into account to design measures to reduce the negative impact of widespread burnings on exposed population in the region.

Climate change is a major development challenge to Ethiopia. Unless adaptation measures are widely implemented, climate change can set back development efforts and achievements by years. Recognizing this, the Government of Ethiopia (GoE) and civil society organizations have since recently been making considerable efforts to tackle the climate change problem. This paper documents the experience of CARE International in Ethiopia in facilitating bottom-up approaches to promote community-led disaster risk management and climate change adaptation planning through a participator scenario planning (PSP) methodology. PSP is a coordinated approach which leverages a variety of stakeholders' skills and mandates to explore potential climate change risks and their impacts, and then develop locally relevant and shared adaptation action plans that support livelihoods, social capital and ecosystem resilience. The approach has facilitated timely access to and communication of seasonal climate advisories which in turn is empowering communities to take advantage of opportunities that climate presents, which is a key part of adapting to climate change. The institutionalization of the approach by district and regional disaster prevention and food security coordination offices in the southern pastoral regions of Ethiopia encouraged integration of PSP into community livelihood adaptation and local government development planning, hence continuity of the process. Sustainability is expected to be fully achieved when local government planning processes recognize the importance of and provides resources for the participation of meteorological services and community forecasting experts to help refine plans on a seasonal basis, and for systems for dissemination of advisories. Key words: Climate Change, Disaster Risk Reduction, Adaptation, Pastoralism, Ethiopia,

The bioindicator potential of seagrass ecosystems in coastal trace metal monitoring is low for tropical island ecosystems. This study evaluated the bioindicator potential of six seagrass species exposed to anthropogenic trace metal pollution in the Andaman and Nicobar Islands (ANI) of India. Sediment and seagrass biomass, samples were analyzed for trace metals (Co, Cr, Cu, Fe, Mg, Mn, Ni, Pb, Zn) from four locations of ANI exposed to anthropogenic contamination. Geo accumulation Index values indicated moderate trace metal contamination in seagrass sediment. Seagrass trace metal accumulation from sediment was both species-specific and location- specific for ANI. Small seagrass species such as H. ovalis, H. beccarii and H. uninervis accumulated the maximum concentration of six trace metals (Cr, Cu, Fe, Ni, Pb, Zn) in their tissues compared to big seagrass species like T. hemprichii and E. acoroides of ANI. This study indicates leaves of small seagrass and roots of big seagrass species can serve as short- and long-term bioindicators respectively, of coastal trace metal contamination in tropical islands of ANI.

Drought monitoring and early detection have improved greatly in recent decades through the development and refinement of numerous indices and indicators. However, a lack of guidance, based on user experience, exists as to which drought monitoring tools are most appropriate in a given location. This review paper summarizes the results of targeted user engagement and the published literature to improve the understanding of drought across North America, and to enhance the utility of drought monitoring tools. Workshops and surveys were used to assess and make general conclusions about the perceived performance of drought indicators, indices and impacts information used for monitoring drought in the five main Köppen climate types (Tropical, Temperate, Continental, Polar Tundra, Dry) found across Canada, Mexico, and the United States. In Tropical, humid Temperate, and southerly Continental climates, droughts are perceived to be more short-term (less than 6 months) in duration rather than long-term (more than 6 months). In Polar Tundra climates, Dry climates, Temperate climates with dry warm seasons, and northerly Continental climates, droughts are perceived to be more long-term than short-term. In general, agricultural and hydrological droughts were considered to be the most important drought types. Drought impacts related to agriculture, water supply, ecosystem, and human health were rated to be of greatest importance. Users identified the most effective indices and indicators for monitoring drought across North America to be the U.S. Drought Monitor (USDM) and Standardized Precipitation Index (SPI) (or another measure of precipitation anomaly), followed by the Normalized Difference Vegetation Index (NDVI) (or another satellite-observed vegetation index), temperature anomalies, crop status, soil moisture, streamflow, reservoir storage, water use (demand), and reported drought impacts. Users also noted the importance of indices that measure evapotranspiration, evaporative demand, and snow water content. Drought indices and indicators were generally thought to perform equally well across seasons in Tropical and the colder Continental climates, but their performance was perceived to vary seasonally in Dry, Temperate, Polar Tundra, and the warmer Continental climates, with improved performance during warm and wet times of the year. The drought indices and indicators, in general, were not perceived to perform equally well across geographies. This review paper provides guidance on when (time of year) and where (climate zone) the more popular drought indices and indicators should be used. The paper concludes by noting the importance of understanding how drought, its impacts, and indicators are changing over time as the climate warms, and by recommending ways to strengthen the use of indices and indicators in drought decision-making.

To assess the usefulness of an attachable video laryngoscope (AVL) by attaching a camera and monitor to a conventional Macintosh laryngoscope (CML). Normal and tongue edema airway scenarios were simulated using a manikin. Twenty physicians performed tracheal intubations using CML, AVL, Pentax AWS® (AWS), and McGrath MAC® (MAC) in each scenario. Ten physicians with more than 10 cases of clinical experience with tracheal intubation using CML were included in the skilled group. Ten physicians with less than 10 cases of clinical experience with tracheal intubation using CML were included in the unskilled groups. The time required to intubate and the success rate were recorded. The degree of difficulty of use and glottic view assessment scored by participants. All 20 participants successfully completed the study. There was no difference in the success rate and time required for tracheal intubation in the normal airway scenarios. For the skilled group, in the tongue edema airway scenario, the AWS had the highest success rate (100%) followed by AVL (60%), MAC (60%), and CML (20%) (p = 0.001). The time required to intubate with the AWS was significantly shorter than with AVL (10.2 vs 22.3 s; p=0.002) or MAC (10.2 vs 23.7 s; p=0.001). There was no significant (p > 0.05) difference between AVL and MAC. The degree of Difficulty of Use for AVL was significantly lower than that for CML (7.8 vs 2.8; p < 0.001). There was no significant (p > 0.05) difference between AVL and other video laryngoscopes. AVL had a higher rate of successful tracheal intubation than CML in the tongue edema scenario. AVL showed a similar success rate and time of tracheal intubation to the MAC. Therefore, AVL may be a possible alternative video laryngoscope device.

Introduction: Lower respiratory tract infections, including pneumonia, are one of the leading causes of child mortality, especially in low-resource settings. Current guidelines rely on clinical signs for diagnosis, leading to over-prescription of antibiotics, which in turn contribute to antimicrobial resistance. Lung point of care ultrasound (L-POCUS) offers potential to improve diagnostic accuracy and reduce unnecessary antibiotic use, but lacks standardized guidelines for diagnosis and management of paediatric pneumonia. Methods and Analysis: This study utilizes a modified Delphi process to develop expert consensus guidelines for L-POCUS interpretation in paediatric pneumonia that would constitute a framework for effective guidelines for judicious antibiotic prescribing. The 5-stage iterative process includes: i) creation of a literature summary and conceptual framework, ii) first round of online surveys for expert feedback, iii) virtual meetings to discuss survey results and refine guidelines, iv) second round of online surveys, v) final analysis and development of consensus guidelines. A panel of 12-15 experts, chosen for their paediatric POCUS experience, geographic diversity, and gender balance, will participate. Consensus will be defined as ≥75% agreement. Ethics and Dissemination: Participation is voluntary, with consent obtained at the start and the option to withdraw at any time. The protocol was approved by the Ethics Commission of Bern, Switzerland. Findings will be disseminated through open access publication.

The incidence of diabetes mellitus (DM) continues to rise worldwide and one of the most serious microvascular complications is diabetic kidney disease (DKD), which is the leading cause of end-stage renal disease. Current bi-omarkers such as urinary albumin excretion rate have limitation for early detection of DKD. In our study we used ultra-high-performance liquid chromatography coupled with electrospray ionization-quadrupole-time of flight-mass spectrometry (UHPLC-QTOF-ESI+-MS) techniques to quantify previously analyzed metabolites, such as tryptophan, kynurenic acid, taurine, l-acetylcarnitine, glycine, and tiglylglycine. We performed the targeted analy-sis of metabolites from urine and serum samples, collected from 110 subjects. Of these, 90 patients with type 2 DM (T2DM) were divided according to the urinary albumin/creatinine ratio (UACR) into normoalbuminuria 300 mg/g groups, respectively, while 20 subjects were rep-resented by healthy controls. Through various validation methods, we identified several metabolites as potential biomarkers, such as kynurenic acid, glycine, and l-tryptophan in serum and l-acetylcarnitine, tiglylglycine, and tau-rine in urine.

Candida spp. is rarely found in the etiology of neonatal early-onset sepsis (EOS). However, candidemia is associated with increased mortality and morbidity, as in late-onset sepsis. Congenital candidiasis may present as mucocutaneous infection or, more rarely, as a systemic infection in term and preterm infants. Material and methods: Case reports of two cases of congenital systemic candidiasis (CSC) produced by Candida albicans and a review of the data in the literature. Results: Both neonates were male, born vaginally, with risk factors for congenital candidiasis. One of the infants was born at term and presented with an almost generalized maculopapular rash at birth; C. albicans grew in the blood culture sampled at 36 hours; parenteral fluconazole was started immediately, and no complications were noted. The other infant was born preterm, at 28 weeks of gestation, and presented signs of respiratory distress on the 4th day of life after initial successful treatment of the respiratory distress syndrome with surfactant and non-invasive respiratory support. C. albicans was present in the neonatal blood and gastric aspirate cultures, and in the maternal vaginal cultures (all sampled at birth); parenteral fluconazole therapy was administered for 30 days as investigations revealed both liver and renal involvement and the infant development bronchopulmonary dysplasia. Conclusion: As data in the literature suggests, despite occurring at any gestational age, CSC may present various clinical pictures, the rash may mimic many other neonatal conditions, and the systemic dissemination cannot be distinguished from bacterial EOS. Careful anamnesis and a high index of suspicion are important for the prompt recognition and treatment of CSC, optimizing the short- and long-term outcomes.

Traumatic pneumothorax (PTX) occurs in up to 50% of patients with severe polytrauma and chest injuries. Patients with traumatic PTX with clinical signs of tension physiology and hemodynamic instability are typically treated with an urgent decompressive thoracostomy, tube thoracostomy, or needle decompression. There is recent evidence that non-breathless patients with hemodynamically stable traumatic PTX can be managed conservatively through observation or a percutaneous pigtail catheter. We present here a 52-year-old woman who presented to the emergency department with 55 mm traumatic PTX. Following aspiration of 1500 ml of air, clinical improvement was immediately observed, allowing the patient to be discharged shortly thereafter. In hemodynamically stable patients with posttraumatic PTX, without specific risk factors or oxygen desaturation, observation or simple needle aspiration can be a reasonable approach. We aimed in this article to review the available literature on needle aspiration and conservative treatment of traumatic pneumothorax. A total of 12 studies were selected out of 190 articles on traumatic PTX, where conservative treatment versus chest tube decompression was compared. Our case report demonstrated that even a large PTX in a hemodynamically stable patient without other risk conditions, can be successfully treated conservatively with simple needle aspiration to avoid tube thoracostomy complications.

Assessment of extreme events and climate change on reservoir inflow is important for water and power stressed countries. Projected climate is subject to uncertainties related to climate change scenarios and Global Circulation Models (GCMs’). Extreme climatic events will increase with the rise in temperature as mentioned in the AR5 of the IPCC. This paper discusses the consequences of climate change that include extreme events on discharge. Historical climatic and gauging data were collected from different stations within a watershed. The observed flow data was used for calibration and validation of SWAT model. Downscaling was performed on future GCMs’ temperature and precipitation data, and plausible extreme events were generated. Corrected climatic data was applied to project the influence of climate change. Results showed a large uncertainty in discharge using different GCMs’ and different emissions scenarios. The annual tendency of the GCMs’ is bi-vocal: six GCMs’ projected a rise in annual flow, while one GCM projected a decrease in flow. The change in average seasonal flow is more as compared to annual variations. Changes in winter and spring discharge are mostly positive, even with the decrease in precipitation. The changes in flows are generally negative for summer and autumn due to early snowmelt from an increase in temperature. The change in average seasonal flows under RCPs’ 4.5 and 8.5 are projected to vary from -29.1 to 130.7% and -49.4 to 171%, respectively. In the medium range (RCP 4.5) impact scenario, the uncertainty range of average runoff is relatively low. While in the high range (RCP 8.5) impact scenario, this range is significantly larger. RCP 8.5 covered a wide range of uncertainties, while RCP 4.5 covered a short range of possibilities. These outcomes suggest that it is important to consider the influence of climate change on water resources to frame appropriate guidelines for planning and management.

Self-administered pre-participation screening for physical activity (PA) requires an instrument that should be easily used and identify individuals at high risk. The Physical Activity Readiness Questionnaire (PAR-Q+) has been used for many years. Its ease of use and ability to identify those not fit to undergo PA has not been assessed. This study was to determine the rates of the PAR-Q+ in identifying adults who may not be fit for moderate or intense PA and obtain feedback on the use of this tool. A public on-line voluntary survey on the PAR-Q+ was carried out obtaining participants’ bio-characteristics, them completing the PAR-Q+ form and providing feedback. With 1019 participants, about 57.8% engaged in at least 150 minutes of PA weekly. This decreased with increasing number of co-morbidities. Increasing age was associated with more co-morbidities. About 33.1% of the participants using the PARQ+ would have required further medical evaluation. Only 3 of the 7 main PAR-Q+ questions were easily understood. Difficulties were encountered with 39 of the 44 follow-up questions, especially amongst those with co-morbidities. The large number of technical terms was also a source of concern. The PAR-Q+ would need extensive simplification before it may be recommended for use.

The Energy Performance of Buildings Directive 2010 calls for the Nearly Zero Energy Standard for new buildings from 2021 onwards: Buildings using “almost no energy” are powered by renewable sources or energy produced by the building itself. For residential buildings, this ambitious new standard has already been reached. But for other building types this goal is still far away. The potential of these buildings to meet a Nearly Zero Energy Standard was investigated by analyzing ten case studies representing non-residential buildings with different uses. The analysis shows that the primary characteristics common to critical building types are a dense building context with a very high degree of technical installation (such as hospital, research and laboratory buildings). The large primary energy demand of these types of buildings cannot be compensated by building and property-related energy generation including off-site renewables. If the future Nearly Zero Energy Standard were to be defined with lower requirements because of this, the state related properties of Bavaria suggest that the real potential energy savings available in at least 85% of all new buildings would be insufficiently exploited. Therefore, it would be useful to instead individualize the legal energy verification process for new buildings to distinguish critical building types such as laboratories and hospitals.

Background We aimed to evaluate the effectiveness of the ALRYNGO channel-type video laryngoscope with an AI-based glottis guidance system in senior emergency medicine residents for endotracheal intubation. Methods We enrolled twenty patients would be adequate for each device (direct laryngoscope, Pentax-AWS, and ALRYNGO). Before intubation, six senior residents wore a personal protective equipment. To randomize the device in this clinical study, a sealed envelope containing a device-specific identification card was utilized. When intubation began, the person who measured the intubation time divided the total intubation time into three-time intervals. The primary outcome was the intubation time. The secondary outcomes were the glottis view using the Cormack-Lehane grade (C-L grade) and the glottis guidance performance of ALRYNGO’s artificial intelligence. Results In Pentax-AWS and ALRYNGO, all intubations were successful, but the intubation time was longer than with the direct laryngoscope. And among the three, the ALRYNGO and Pentax-AWS had the highest frequency of C-L grade I (easiest intubation) at 80%, and the direct laryngoscope had the lowest frequency of 10%. Conclusions Even if healthcare professionals without experience with the channel-type video laryngoscope improve their performance on airway mannequins after training, their intubation performance may differ when applied to actual patients.

This is a single tertiary center in southwest Romania, population-based, study. We retrospectively compared data obtained in two periods: January 2008 - December 2013 and January 2018 - De-cember 2023, respectively. The global incidence of transposition of great arteries (TGA) - the ter-minated cases added to the ones resulting in live-born pregnancies, remained almost constant. The live-born incidence of TGA decreased (0.34% to 0.013%). The prenatal detection rate increased slightly (71.42% to 87.5%). The median gestational age at the diagnosis decreased, from 29.3 ges-tational weeks (mean 25.4) to 13.4 weeks (mean 17.2). The proportion of terminated pregnancies significantly increased (14.28% to 75%, p = 0.019).

Ideas about Artificial Intelligence appeared about half a century ago, but only now is it becoming an essential element of everyday life. The data provided is getting bigger and bigger and, in this case, we need artificial intelligence that helps us with superhuman powers. The interaction with medicine is getting closer and closer, medicine being a field that continues to be perfected. Machine learning, deep learning, neural networks, computer vision are some of the mechanisms that are already applied in medicine, becoming a trend in healthcare worldwide. Artificial intelligence will be the thing that will change contemporary medicine. Developed countries such as Japan, France, Germany have already implemented artificial intelligence in their medical systems. The help is in medical diagnosis, patient monitoring, personalized therapy, and workflow optimization. Artificial intelligence will help surgeons to perfect their skills, to standardize techniques, to choose the best surgical technique. The goal is to predict complications, reduce diagnostic time, diagnose complex pathologies, guide the surgeon intraoperatively and reduce medical errors. We are at the beginning but the potential is enormous.

Introduction Atherosclerotic disease is a major contributor to heart failure, stroke, and myocardial infarction, significantly lowering the quality of life and life expectancy, with a significant burden on healthcare. Not all lesions deemed non-significant are benign, and conversely, not all significant lesions are causative of ischemia. Fractional flow reserve (FFR) provides a functional assessment of coronary lesions, while optical coherence tomography (OCT) offers detailed imaging of plaque morphology, aiding in therapeutic decision-making. The objective of this study was to evaluate the utility of OCT and FFR as adjunctive tools in the catheterization laboratory for guiding therapeutic decisions in patients with multivessel disease for non-culprit vessels. Specifically, we aimed to assess how OCT and FFR influence therapeutic decision-making in patients with multi-vessel coronary artery disease. Methods 36 patients with acute coronary syndrome (ACS) and multivessel disease were randomized 1:1 into two groups: one guided by FFR alone, and the other by a combination of FFR and OCT. For the FFR group, revascularization decisions for non culprit lesions were based solely on FFR measurements. If the FFR was >0.8, the procedure concluded, and the patient received maximal medical treatment. If the FFR was ≤0.8, a stent was placed. For the FFR + OCT group, if the FFR was >0.8, the revascularization decision was based on OCT findings. If there were no vulnerable plaques (VP), the procedure concluded, and the patient received maximal medical treatment. If OCT imaging indicated VP, then the patient underwent revascularization. If the FFR was ≤0.8, the patient underwent revascularization regardless of OCT findings. Results OCT imaging altered the therapeutic decision in 11 cases where FFR measurements were above 0.8, but the lesions were characterized as VP. Analyzing the total change in the decision to stent, 4 cases in the FFR group and 15 cases in the FFR and OCT group (4 based on FFR and 11 on OCT) revealed a statistically significant difference (p = 0.0006; Relative Risk = 0.2556; 95% CI: 0.1013 to 0.5603). When analyzing the change in the total decision both to stent and not to stent, we observed a statistically significant difference, with Group 1 having 7 cases and Group 2 having 15 cases (p = 0.0153; Relative Risk = 0.4050; 95% CI: 0.2004 to 0.7698) Conclusion Based on the findings of this study, OCT significantly increases the percentage of stenting procedures by identifying vulnerable lesions. The use of intracoronary imaging facilitates the timely identification and treatment of these vulnerable lesions. This underscores the crucial role of OCT in enhancing the precision of coronary interventions by ensuring timely intervention for vulnerable lesions, thereby potentially improving patient outcomes Acknowledgment funding „This work was supported by the University of Medicine, Pharmacy, Science and Technology ,, George Emil Palade’’ of Targu Mures Research Grant number 510/14/17.01.2022”

The study of precipitation amount at different time scales constitutes an important issue in climate research and risk assessment. When dealing with daily totals, a frequent but sometimes underestimated problem is at what time the observation day begins. The choice of different starting times may lead to incompatibility between stations and incorrect identification of extreme events. In this work, the problem of temporal misalignment between precipitation datasets characterized by different starting time of the observation day is analyzed. The most widely used adjustment methods (1day and uniform shift) and two methods based on reanalysis (NOAA and ERA5) are evaluated in terms of temporal alignment, precipitation statistics and percentile distributions. As test series, the precipitation amount collected from 9 a.m. local time (09 LT) on the previous day to 09 LT on the target day (9-9 datasets) of the Padua and nearby stations in the period 1993-2022 have been selected. Results show that the reanalysis-based methods, in particular ERA5, outperform the others in temporal alignment, regardless the station. But, for the periods in which reanalysis data are not available, “1day” method, which shifts the daily amount back one calendar day, and “unif” method, which distributes uniformly the daily total from a 2-day moving window surrounding the target date, can be considered valid alternatives. On the other side, concerning the precipitation statistics, the reanalysis-based methods are not the best option, as they increase the precipitation frequency and reduce the mean value over wet days, NOAA much more than ERA5. Nevertheless, the uniform method provides a larger deviation from the original daily series. The use of the series of a station nearby the target one, which is mandatory in case of missing data, gives similar or better results than applying any adjustment method to the 9-9 series. General conclusions can hardly be drawn as they depend on the method and station. For the Padua dataset, the analysis was repeated at monthly and seasonal resolution. In general, the adjustment series show the most relevant changes in the precipitation statistics in summer and less temporal alignment with the original series in summer and autumn, the two seasons mainly affected by heavy rains in Padua. Finally, the percentiles distribution, analyzed for all the methods and stations, indicates that any adjustment method underestimates the percentile values, except ERA5. Only Legnaro, the station most correlated with Padua, gives results like ERA5.

The effects of climate change health impacts on urban health care systems and vulnerable populations are a researched topic with foundations on urban risk management, urban health methodologies, and sustainable urbanization. As climate change is a dynamic and transformative global issue the gap between adaptation and mitigation efforts and urban planning relies, among other things, in the limitations of previous studies of risk management structures tailored to the existing strategy to calculate the uncertainties and predict their influence on urban systems and subsystems. Moreover, as climate and health is a well-researched issue, it is also complex as the methodologies and strategic approach to minimize health risks of climate change is intrinsically contingent to risk methodologies and policy-making processes that are efficient with support of knowledge-based information. This paper emphasis the need for focusing on urban health risk management methods that serves to identify potential opportunities, and then manage and take action to prevent adverse health effects. It also emphasizes the probability of events and their consequences, which are measurable both qualitatively and quantitatively.

Athlete’s heart is characterised by structural, functional, and electrical remodelling. During an exercise session, the heart increases the use of oxygen, which is associated with decreased vascular resistance in the lungs’ circulation. Left ventricular hypertrophy is an echocardiographic modification especially met in endurance athlete’s heart. Moreover, left atrial dilatation represents another important characteristic of endurance athletes. Electrical modulation in the athletic heart induces neurological modifications leading to sinus arrhythmia, bradycardia, early repolarisation, and first-grade atrioventricular (AV) blocks. Athletes' nutritional status involves the assimilation of macronutrients such as proteins, carbohydrates, and fats. Depending on the duration of physical exercise, ATP can be obtained in aerobic or anaerobic conditions. This systematic review aims to find correlations between different evaluative methods of cardiac adaptation and present the metabolism in performance athletes.

The Vu Gia - Thu Bon River Basin (VG-TB) is confronting numerous challenges related to water security (WS), particularly in the face of the impacts of climate change. These challenges manifest in salinity intrusion, altered rainfall patterns, and reduced water supply in downstream areas. To assess the current state of water security in the basin, the study employed statistical analysis methods, Process Analysis Method (PAM), SMART, and Analytic Hierarchy Process (AHP) to develop a comprehensive Assessment Framework for Water Security (AFWS) in the VG-TB. The AFWS encompasses five key dimensions, 17 indicators, and 28 variables, aligning with the UN-Water definition of water security and addressing the Sustainable Development Goal 6 (SDG6) criteria for global water sustainability. It also adheres to the Asian Development Bank's (ADB) approach to water security assessment as outlined in the Asian Water Development Outlook (AWDO) reports. This allows for the computation of a comprehensive Water Security Index (WSI) for specific regions, serving as a foundation for decision-making and policy formulation aimed at enhancing water security in the context of climate change and facilitating sustainable basin development in the future.

This study assesses the predictive performance of six machine learning models in forecasting tumor dynamics within three months following Gamma Knife Radiosurgery (GKRS) in 77 brain metastasis (BM) patients. The analysis meticulously evaluates each model before and after hyperparameter tuning, utilizing accuracy, AUC and other metrics derived from confusion matrices. Initial findings highlighted that XGBoost significantly outperformed other models with an accuracy of 0.95 and an AUC of 0.95 before tuning. Post-tuning, the Support Vector Machine (SVM) demonstrated the most substantial improvement, achieving an accuracy of 0.98 and an AUC of 0.98. Conversely, XGBoost showed a decline in performance after tuning, indicating potential overfitting. The study also explores feature importance across models, noting that features like “control at one year”, “age of the patient”, and “beam on time for volume V1 treated”, were consistently influential across various models, albeit their impacts were interpreted differently depending on the model’s underlying mechanics. This comprehensive evaluation not only underscores the importance of model selection and hyperparameter tuning but also highlights the practical implications in medical diagnostic scenarios, where the accuracy of positive predictions can be crucial.

The agronomic characteristics of Cenchrus purpureus were assessed through a randomized block experimental design with seven accessions (Taiwan grass, King grass, Elephant grass, Merkeron, CT-115, Purpule grass and Maralfalfa) as treatments and four replications research was carried out at the Instituto Tecnológico Superior de Tantoyuca, in 2019 and 2020, under rainfed conditions. Sowing density was established at 36 tillers in 25 m2. Green and dry matter yield, daily rates of dry matter accumulation in leaves, leaf/stem ratio, height, leaf area index and cutting frequency were assessed. Rainfall amount, temperature, relative humidity and global radiation levels were recorded to assess their effect on the evaluated variables. One-way ANOVA and multivariate analysis techniques, such as multiple linear regression (MLR), Clustering, and Principal component analysis (PCA) with the Statistica V7 software, were used. The leaf area index was greatest (p < 0.05) on the dry season. Green and dry matter yield were greatest in Maralfalfa (p < 0.05). Variation in the results is attributed to weather phenomena; nonetheless, Elephant grass and Maralfalfa showed the highest yields. Quality parameters must be evaluated to identify those grasses with the best attributes.

Procedural Sedation and Analgesia (PSA) in the Emergency Department (ED) presents a crucial aspect of emergency medicine, enabling the execution of painful or distressing procedures with minimal patient discomfort. This narrative review delineates the pharmacological framework, methodologies, and clinical considerations integral to optimizing PSA, with a particular focus on pediatric and geriatric populations. Through a comprehensive review and analysis of current practices, this work evaluates the pharmacokinetics and pharmacodynamics of widely utilized sedatives and analgesics, including propofol, ketamine, dexmedetomidine, fentanyl, midazolam, etomidate, nitrous oxide, and remimazolam. Special attention is dedicated to the selection criteria based on patient-specific risk factors, procedural requirements, and the management of potential adverse effects. The manuscript also explores innovative sedation techniques and the integration of new pharmacological agents, emphasizing evidence-based approaches to enhance patient safety and outcome. Results underscore the significance of tailored sedation strategies, especially for vulnerable groups such as pediatric and geriatric patients, highlighting the need for meticulous pre-procedural assessment and monitoring to mitigate risks. Conclusions drawn advocate for a nuanced application of PSA, guided by current evidence and clinical guidelines, to improve the quality of care in emergency settings. This research reinforces the imperative for ongoing education, skill development, and adaptation of new evidence into clinical practice to advance procedural sedation and analgesia in the ED.

Although the influence of climate on the fire regime is unanimously recognized, most publications are studies on this influence are at the global scale. Therefore, this study aims to demonstrate the role of climate in the incidence of wildfires at the country and regional scale using statistical analysis and machine learning methods. Mainland Portugal was chosen as a case study due to its climate and because it is the European region most affected by wildfires. Results demonstrate the climate signature in the spatial and temporal distribution of the wildfire incidence. The conclusions of the study include (i) the existence of two pyro-regions, with different types of climate (Csb and Csa) composed of NUTS II regions: the northern region composed of the Norte and Centro regions and the southern region composed of Alentejo and Algarve; (ii) the intra-annual variability in the incidence of wildfires, characterized by two peaks, one in spring and the other in summer, are a consequence of the country's type of climate; and, (iii) how the annual cycle of wildfire incidence varies over the years depends on the weather conditions throughout each year. These results are of fundamental importance for wildfire managers, especially in the context of climate change.

Agriculture contributes towards South African economy, but this sector is highly vulnerable to risks imposed by climate change. Smallholder maize farmers are specifically susceptible to climate change impacts. Maize crop plays a crucial role in the country's food security as it is considered a stable food for households and source of feed for livestock. The study aimed to analyze the socio-economic factors influencing smallholder maize farmers’ willingness to adopt climate-smart agriculture. It was conducted in three different areas due to their specific agro-ecological zones. Multipurpose research design was used to gather data, and multistage random sampling to choose the study areas. Subsequently, 209 purposively selected farmers were interviewed face-to-face using structured questionnaires and focus discussion groups. Descriptive statistics and Double-hurdle regression model were used to analyze the data. Descriptive results indicated that 81%, 67%, and 63% farmers were willing to adopt CSA in Ga-Makanye, Gabaza, and Giyani, respectively. Empirical results from the first and second hurdles of the regression analysis showed that farmers’ education, crop diversification, information about CSA positively influenced the decision to adopt CSA while household size and agricultural experience negatively influenced the decision to adopt CSA. It is recommended that the Department of Agriculture, Land Reform, and Rural Development should provide CSA workshops and educational programs to farmers to enhance their knowledge and decision-making processes regarding adaptation strategies.

This study presents PlanteSaine, a novel mobile application powered by Artificial Intelligence (AI) models explicitly designed for maize, tomato, and onion farmers in Burkina Faso. Agriculture in Burkina Faso, like many developing nations, faces substantial challenges from plant pests and diseases, posing threats to both food security and economic stability. PlanteSaine addresses these challenges by offering a comprehensive solution that provides farmers with real-time identification of pests and diseases. Farmers capture images of affected plants with their smartphones, and PlanteSaine's AI system analyzes these images to provide accurate diagnoses. The application's offline functionality ensures accessibility even in remote areas with limited internet connectivity, while its messaging feature facilitates communication with agricultural authorities for guidance and support. Additionally, PlanteSaine includes an emergency alert mechanism to notify farmers about pest and disease outbreaks, enhancing their preparedness to deal with these threats. An AI-driven framework, featuring an image feature extraction phase with EfficientNetB3 and an artificial neural network (ANN) classifier, was developed and integrated into PlanteSaine. The evaluation of PlanteSaine demonstrates its superior performance compared to baseline models, showcasing its effectiveness in accurately detecting diseases and pests across maize, tomato, and onion crops. Overall, this study highlights the potential of PlanteSaine to revolutionize agricultural technology in Burkina Faso and beyond. Leveraging AI and mobile computing, PlanteSaine provides farmers with accessible and reliable pest and disease management tools, ultimately contributing to sustainable farming practices and enhancing food security. The success of PlanteSaine underscores the importance of interdisciplinary approaches in addressing pressing challenges in global agriculture

This paper, from the perspective of Mode 3 of knowledge production, takes the important carrier of knowledge, scientific research papers, as the research object. The mainstream databases (SCIE and SSCI) are chosen as the data sources. Firstly, bibliometric methods are applied to analyze the cooperation status among the main bodies of paper production, including authors and their affiliated institutions, countries, and disciplines; secondly, the Analytic Hierarchy Process (AHP) is used to construct a comprehensive evaluation model for the state of research cooperation in carbon neutrality. Based on the evaluation model, the cooperation characteristics of different disciplinary fields and the relationship between paper cooperation status and high-impact research papers are comparatively analyzed. At the same time, an analysis is conducted on the support from the government, the sponsorship from enterprises, and the participation of the public in the process of paper production. Finally, some suggestions are put forward on how to build an innovative ecosystem for carbon neutrality research from the perspective of Mode 3 of knowledge production.

Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS). Multiple noninvasive respiratory support modes are currently available in Romania, but little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). We aimed to identify the usage extent and clinical application of nHFOV in Romania. A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. The questionnaire was addressed to the leaders of all level III Romanian NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU’s size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10-17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%), heated, humidified high flow nasal cannula (HHHFNC) (61.9%), and nHFOV (11/21 units; 52.4%); 5/11 units reported frequent nHFOV use (in 2 or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). 10/11 units reported setting a mean airway pressure (MAP) equal to the CPAP level plus 1-2 cmH₂O on rescue nHFOV after CPAP failure. Both dedicated equipment (45.5%) and hybrid ventilators (63.6%) were used for nHFOV delivery, with face/nasal masks and short binasal prongs being the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV; none of the units mentioned pneumothorax as an adverse effect. Only 3 of the NICUs had a written protocol for nHFOV use. Initial, minimum, and maximum amplitude and initial and minimum MAP settings used were significantly higher with hybrid ventilators as compared to dedicated equipment (p<0.05). Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV. A need for training for nHFOV use was identified, and efforts are needed at the national level to develop courses and training sessions, including using simulation workshops, to offer more information on optimal nHFOV use in clinical practice.

This bibliographic study addresses key aspects related to fishing, product safety, and climate change in the Adriatic Sea region. The examination of product safety focuses on the assessment of contaminants originating from human activities such as industry, mining, agriculture, and household waste disposal. The contamination of the aquatic environment has emerged as a pressing global concern, extending to the Adriatic subbasin. Aquatic organisms, including fish, are prone to accumulating pollutants directly from polluted water sources and indirectly through the food web. The bio-accumulation of potentially hazardous substances, particularly heavy metals, pesticides, PCBs, PAHs, and antibiotic resistance in aquatic organisms, poses a significant threat to human health. Climate change effects will deplete our seafood supply in terms of quantity and safety owing to negative consequences such as higher levels of pollution, parasites, viruses, infections, acidification, and toxicities such as shellfish poisoning. Global food safety strategies should be developed to reduce greenhouse gas emissions and promote environmentally friendly technology, which indirectly affects seafood quality and microbiological safety, especially for Adriatic Sea, which is part of the Mediterranean Sea, characterized by the most polluted waters in the world.

Emergency Management has not developed in a cohesive or comprehensive manner. Differing terms are used to name identical concepts. A standard comprehensive doctrine for the important development of emergency management is needed. In this paper I explain a doctrinal framework for emergency management. The paper states a clear identification of the five dimensions, and each of their components, necessary to the informed practice of Emergency Management. Although emergencies vary in cause and severity, the process of Emergency Management necessary for optimal handling of these emergencies varies little. The “All Hazards Approach” to emergency management establishes and reinforces commonality in processes, procedures, planning templates and organizational structure. The three types of agencies associated with emergency management activities are discussed, including the subject matter agency, coordinating agency, and supporting agency. The four critical functions of emergency management are detailed, and include mitigation, preparedness, response, and recovery, often all carried out concurrently. The ten activities, and seven resources of emergency management are highlighted. There are many ways to represent the integration of these five dimensions, to ensure completeness, while ensuring clarity; the two most common are described. When experts in Emergency Management follow the doctrine, they can coordinate all those involved to be sure that all aspects of any hazard are considered, and that all organizations/agencies, functions, activities, and resources of Emergency Management are coordinated and optimally active. Following this process is the only way to ensure the best outcomes from any emergency.

We document for the first time epsilon waves on the electrocardiogram of a patient with Dravet syndrome (DS) who does not exhibit structural cardiac pathology. DS, a severe form of pediatric epilepsy, involves mutations in the SCN1A gene, which disrupt sodium ion flow and increase the risk of sudden unexpected death in epilepsy. The epsilon waves, typically associated with arrhythmogenic right ventricular dysplasia, may also suggest a link between neuronal and cardiac dysfunctions. In our case, the epsilon waves appear to originate from abnormalities in sodium channels rather than structural changes in the myocardium. This finding underscores the importance of assessing both neurological and cardiac manifestations in patients with severe epilepsy, opening new avenues for the research and treatment of these interactions in DS.

A case-crossover study examined how PM_2.5 from Asian Dust Storms (ADS) affects the number of emergency room (ER) admissions for cardiovascular diseases (CVDs) and respiratory diseases (RDs). Our data indicated that PM_2.5 concentration from ADS was highly correlated with ER visits for CVDs and RDs. The odds ratios (OR) increased by 2.92 (95% CI: 1.22-5.08) and 1.86 (95% CI: 1.30-2.91) per increase 10 µg/m³ in PM_2.5 levels, for CVDs and RDs, respectively. A 10 µg/m³ increase in PM_2.5 from ADSs was significantly associated with increase in ER visits for CVDs among those 65 years of age and older (an increase of 2.77 in OR) and for females (an increase of 3.09 in OR). In contrast, PM_2.5 levels had a significant impact on RD ER visits among those under 65 years of age (OR=1.77). The risk of ER visits for CVDs increased on the day when the ADS occurred in Taiwan and the day after (lag 0 and lag 1); the corresponding risk increase for RDs only increased on the fifth day after the ADS (lag 5). In Taiwan’s late winter and spring, the severity of ER visits for CVDs and RDs increases. Environmental protection agencies should employ an early warning system for ADS to reduce high-risk groups’ exposure to PM_2.5.

Background: With a rapid rise in our older adult population globally and due to their multimorbidities, our older adults are more likely to engage in the services provided in the emergency department at a higher rate than younger adults. The current emergency service delivery model may be ineffective against such an ageing phenomenon. Research reports most older adults having one or more co-morbidities including functional decline, dementia, and frailty. Studies have shown that older adults have been undertriaged with physicians not being able to comprehend their complex needs related to their presenting complaints in the emergency department. Geriatric emergency departments have incepted worldwide to better manage this care deficiency in the rapidly ageing society around the world. Data Sources: A search of published literature from 2010-2020 using (keywords) as described below was undertaken of which, relevant literature were selected for an informed review. Implications for Nursing: Understanding geriatric emergencies can enable healthcare workers to reduce undertriaging and provide appropriate care that improves patient's health outcomes currently and in the future in the emergency department. Further education in gerontology can also be a platform for our nurses to enhance their care and thought process, likewise upskilling themselves for the future geriatric population seeking treatment. Older healthcare workers will also be able to enhance their current job scope before retirement. In-house teachings from trained gerontologists or certified programs can shed light on the special care needs of our senior citizens globally. Conclusion: With our rapidly increasing population, we can expect an influx of our older patients both from home and long-term care facilities to present to the emergency department with a wide range of geriatric emergencies. By being able to create a geriatric screening process and tailored care models, healthcare workers will be able to understand their care process and in turn, improve patients' health outcomes and provide a quicker transition of care.

This study explores the near-surface dispersion mechanisms of contaminants in coastal waters, leveraging a comprehensive method that includes using dye and drifters as tracers, coupled with diverse observational platforms like drones, satellites, in-situ sampling, and HF radar. The aim is to deepen our understanding of surface currents' impact on contaminant dispersion, thereby improving predictive models for environmental incident management, including pollutant releases. Rhodamine WT dye, chosen for its significant fluorescent properties and detectability, along with drifter data, allowed us to investigate the dynamics of near-surface physical phenomena such as the Ekman current, Stokes drift, and wind-driven currents. Our research emphasizes the importance of integrating scalar tracers and Lagrangian markers in experimental designs, revealing differential dispersion behaviors due to near-surface vertical shear caused by the Ekman current and Stokes drift. The elongation direction of the dye patch aligns with the Ekman current direction during slow current conditions. Analytical calculations of vertical shear, based on the Ekman current and Stokes drift, closely matched those derived from tracer observations. Over a 7-hour experiment, the vertical diffusivity of near-surface water was observed at 2×10-4 m2/s, and the horizontal eddy diffusivity of the dye patch and drifters reached the order of 1 m2/s and at a 1000m length scale. Particle tracking models demonstrate that while HF radar currents can effectively predict the trajectories of tracers near the surface, incorporating near-surface currents, including Ekman current, Stokes drift, and windage, is essential for a more accurate prediction of the fate of surface floats.

Objective: Evaluation of patients with prosthetic valves who developed infective endocarditis by comparing treatment outcomes in both early- and late-onset IE episodes following prosthetic valve replacement surgery. This study sought to conduct a comprehensive assessment of the efficacy of these methodologies. The insights derived from this assessment will be utilized to enhance the quality of care for individuals with infective endocarditis who have received prosthetic valve replacement surgery. Results: During the period of investigation (January 2018 - December 2022), 78 patients diagnosed with infective endocarditis (IE) on prosthetic valve were admitted to the Infectious Diseases Department of the "Dr. Carol Davila" Central Military Emergency University Hospital in Bucharest. In 28 cases (35.8%), the onset of PVE occurred within 12 months of surgery (early onset), whereas in 50 patients (64.2%), the onset occurred more than 12 months after surgery (late onset). The mortality rate was 35.9% (53.6% among the early onset patients and 26% among the late-onset patients). Among patients who received surgical and medical therapy, the mortality rate was 29.6%, whereas among those who underwent only medical therapy, a 39.2% mortality rate was reported. According to the extracted data, antibiotic therapy was successful in 72.6% of patients. In contrast, a combination of surgical and drug-based approaches resulted in a cure in 76.1% of the patients. The most common etiological agent was Staphylococcus aureus (38.5%), followed by Enterococcus faecalis (26.9%), and Streptococcus mitis (10.3%). The mortality rate of patients with S. aureus was 29.2%, indicating the severity of this infectious agent. Conclusions: Prosthetic valve endocarditis (PVE) is a serious condition associated with a high mortality rate both in the short and long term. Regardless of the therapy used, the risk of death remains high. All patients with PVE who survived received effective early treatment, highlighting the need for prophylactic measures.

Background and Objective: Although possible risk factors associated with maternal postpartum depression (PPD) have been elucidated, it is still unknown how some newborns characteristics could influence the appearance of PPD. Our research aimed to unravel the impact of newborn’s characteristics on PPD. Methods: The study was conducted in the Obstetrics &amp; Gynecology Department, from our University Emergency County Hospital, between August 2019 and April 2021. We included women in the 2 nd day of the postpartum period (n=904), divided into 2 groups: women with PPD (n=236) and control (women without PPD, n=668), by using the Edinburg Postpartum Depression Scale. Characteristic information on newborns (i.e., the months in which they were born, premature delivery, birth weight, or gender) were assessed. Results: Our findings suggest that the winter season (i.e. December and January, p=0.01) births and male newborns (p=0.02) were associated with the appearance of depressive symptoms during postpartum. Conclusions: Therefore, our study showed that women who give birth to male newborns in winter are likely to develop PPD. This should be considered by all public health systems in order to prevent such manifestations in certain groups of women.

Museums are called to respond to contemporary challenges and contribute to the formation of more progressive societies. One of the major challenges of our time is climate change and museums could construct cocreated narratives around climate and implement targeted actions for the audiences through their sensorial and affective experiences. More specifically, Geology and Palaeontology museums are repositories of knowledge on geoheritage and geoconservation, recognized for their scientific, pedagogical, cultural and recreational values. The educational potential of geological and paleontological exhibits could be used in informal education activities regarding the climate emergency. Taking the above into consideration, this study focuses on both the creation and evaluation of an educational program for the Natural History Museum of Arsakeio Campus at Psychicko.

The Roma population constitutes the largest ethnic minority in Europe, however, data regarding the prevalence of non- communicable diseases are still scarce in the medical literature. The aim of this study was to assess the clinical and metabolic particularities of a Roma population with diabetes, in comparison with a group of Romanian Caucasians. We conducted an observational, transversal study and evaluated 808 adult patients with diabetes mellitus, from a tertiary hospital providing diabetes care, aged between 18 and 89 years old, of whom the majority were men (52.84%). Most of them had type 2 diabetes mellitus (T2DM), reaching 95.1% the Caucasian group and 87.8% among the Roma patients. 81.1% of the Caucasian patients had hypertension, approximately 15% higher than the Roma group, while more than half of the patients in both groups had obesity. There were no differences concerning myocardial infarction, however, the number of patients with history of stroke was 2.1 times higher in the Roma group compared to Caucasians. Chronic kidney disease was present in 22.1% of the Roma patients, 33.25% had retinopathy, and 72.7% presented polyneuropathy. The prevalence of cardiovascular risk factors, cardiovascular disease and microvascular complications among the study Roma population are quite significant, underscoring the importance of ethnic disparities in approaching healthcare management strategies.

(1) Background: better mechanistic understanding of desmosome disruption and acantholysis in Grover disease (GD) may improve management of this disease. Recent molecular studies highlighted promising pathways to be explored, by directly comparing GD and selected features of associated skin diseases. The association between GD and cutaneous keratinocyte carcinomas, the most prevalent non-melanoma skin cancers (NMSC), is not completely characterized. (2) Objective: To review the medical literature regarding GD-associated cutaneous keratinocyte cancers, focusing on molecular features, pathophysiological mechanisms and disease associations, to help guide future research and patient management. (3) Result: GD has been associated with a variety of skin conditions, but its association with skin cancers has been rarely reported. Between 1983 and 2024 only 9 scientific papers presented data supporting this association. Interestingly, we found that GD may mimic multiple NMSCs, as few authors reported GD cases misdiagnosed as multiple cutaneous squamous cell carcinomas for more than 4 years, or the presence of superficial basal cell carcinoma–like areas associated with focal acantholysis. (4) Conclusions: (a) GD may be an imitator of multiple NMSCs and (b) the relationship between GD and NMSCs may reveal promising pathways for the mechanistic understanding of desmosome disruption and acantholysis in GD and may even lead to its reclassification as a distinctive syndrome.

Background: Acute kidney disease (AKD) is a known risk factor for increased mortality and evolution towards chronic kidney disease (CKD) in adults. The data regarding children are scarce. The purpose of our study is to explore the risk factor for AKD and impact of AKD following an acute kidney injury (AKI) episode in children on mortality and new-onset CKD. Methods: We retrospectively evaluated 736 children with ages between 2 and 18 years old with AKI admitted in a tertiary care hospital from the west Romania over a 9 years period. Results: AKD incidence following AKI was 17%. Patients that developed AKD were older, with higher baseline serum creatinine values, urea, C reactive protein and lower proteins, haemoglobin and sodium. They were more often exposed to sepsis, critical illness and nephrotoxic medications and presented certain susceptibilities like CKD, neoplasia, anemia, heart failure, arterial hypertension, stem cell transplant and female gender. AKI causes that increased the risk of AKD were intrinsic ones. AKD increased the overall mortality by three times. The factors that independently increased the risk of evolution towards CKD were AKD, acute tubular necrosis and higher baseline serum creatinine values. Conclusions: AKD is an independent risk factor for mortality and new-onset CKD in children.

This study examines the attitudes and practices of dentists and dental students towards envi-ronmental issues within their professional context. Data was selected based on their responses on a Google Forms e-questionnaire, designed specifically for the study. The sample consisted of 78 professional dentists and 75 dental students in Greece and their attitudes towards environmental protection, awareness of the environmental impact of dental practices, and factors influencing the adoption of environmentally friendly practices were assessed. Results reveal generally positive attitudes towards environmental protection, with students demonstrating higher levels of proper waste management practices. Dentists express awareness of their environmental impact but ex-hibit varying levels of engagement in eco-friendly practices. Factors such as moral consciousness and believing in the severity of climate change significantly influence environmental awareness in dental practice. Notably, dental students exhibit greater environmental awareness compared to practicing dentists. These findings emphasize the importance of integrating environmental edu-cation into dental curricula and continuing education programs to foster sustainable practices in dental care. Future research could explore interventions to enhance environmental consciousness among practicing dentists and assess the long-term impact of environmental education initiatives on dental care sustainability.

In this study the effects of three different main preparatory tillage operations [ploughing at 0.4 m (P40) and 0.20 m (P20) depth and minimum tillage at 0.20 m depth (MT) each of them carried out at two different soil water contents (WC) [low, 58% (LH) and high, 80% (HH) of field capacity] were investigated. The results obtained in this research show high values of soil strength in term of Penetration resistance (CI) and shear strength (SS) particularly in deeper soil layers at lower water content. Fossil-fuel energy requirements both for P40 LH and P20 LH were 25 and 35% higher with respect to the HH treatments and tractor slip were very high (P40 LH = 32.4%) with respect to the P40 HH treatment (16%). Therefore soil water content had significantly influenced tractor performance during soil ploughing, particularly at 0.40 m depth while MT was not influenced at all. A significant correlation between grain yield and soil penetration resistance was found highlighting how soil strength may be good indicator of its productivity. Obtained results during these field tests allowed considering MT and P20 treatments more suitable for this type of soil in climate change scenarios.

Although the dopamine hypothesis of schizophrenia explains the effects of all the available antipsychotics in clinical use, there is an increasing need for developing new drugs for the treatment of positive, negative, and cognitive symptoms of chronic psychoses. Xanomeline-trospium (KarXT) is a drug combination that is based on the essential role played by acetylcholine in the regulation of cognitive processes and the interactions between this neurotransmitter and other signaling pathways in the central nervous system, with a potential role in the onset of schizophrenia, Alzheimer’s disease, and substance use disorders. A systematic literature review that included four electronic databases (PubMed, Cochrane, Clarivate/Web of Science, and Google Scholar) and the US National Library of Medicine database for clinical trials detected 21 sources referring to 14 studies focused on KarXT, out of which only four have published results. Based on the results of these trials, the short-term efficacy and tolerability of xanomeline-trospium are good, but more data is needed before this drug combination may be recommended for clinical use. However, on a theoretical level, the exploration of KarXT is useful for increasing the interest of researchers in finding new, non-dopaminergic, antipsychotics that could be used either as monotherapy or as add-on drugs.

Chronic stress, culminating in burnout, evolves gradually and is notoriously difficult to detect due to vague symptoms and individuals' hesitance to acknowledge their struggles. To expedite the identification and recognition of this condition, enabling timely psychological intervention, the integration of Artificial Intelligence (AI) is increasingly considered. This research does not assert the feasibility of an AI system managing all aspects of chronic stress's impact. However, it highlights the capability of current technology to detect stress indicators based on quantifiable data like Heart Rate (HR) and organizational climate dimensions. Although other physiological markers such as oximetry, skin galvanic response, and EKG have been explored, they have not shown reliable differentiation between stress and joy. Focused on the unique context of school principals in the Bedouin regions of Israel, this study investigates the interplay between HR, organizational climate, and stress levels. It introduces a novel application of a fuzzy logic tool that combines HR and organizational climate metrics to aid in stress diagnosis. This tool incorporates the psychologist's expertise to provide real-time data crucial for developing effective coping strategies. While the AI-supported fuzzy system does not replace professional psychological intervention, it significantly enhances the speed of condition identification and intervention planning, thus shortening the response time to stress-related issues in educational leadership within culturally specific settings. The application of such AI-driven tools is pivotal for sustaining the well-being and effectiveness of educational leaders, thereby supporting the broader goal of educational sustainability.

Paediatric supraventricular tachycardia (SVT) is a common arrhythmia of great clinical significance. If not treated promptly, it can cause heart failure and cardiogenic shock. Depending on the patient’s condition SVT treatment involves vagal manoeuvres, pharmacological or direct current cardioversion. The goal of acute SVT management is to immediately convert SVT to normal sinus rhythm (NSR) and prevent its recurrence. Adenosine is recommended as first-line treatment for stable SVT by the European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines when vagal manoeuvres have proven ineffective. ERC and AHA guidelines recommend the intravenous route of administration. Intraosseous (IO) administration technique is also possible, but still relatively unknown. The aim of this paper is to describe a 3.5-year old child with SVT which was converted to NSR following IO administration of adenosine. Successful conversion was achieved in the second attempt with the adenosine dose. In the described case, there was no recurrence of SVT.

Accurate segmentation of the Left Ventricle (LV) in Echocardiogram (Echo) images is essential for cardiovascular analysis. Conventional techniques are labor-intensive and exhibit inter-observer variability. Deep learning has emerged as a powerful tool for automated medical image segmentation, offering advantages in speed and potentially superior accuracy. This study explores the efficacy of employing the YOLO (You Only Look Once) segmentation model for automated LV segmentation in Echo images. YOLO, a cutting-edge object detection model, achieves exceptional speed-accuracy balance through its well-designed architecture. It utilizes efficient dilated convolutional layers and bottleneck blocks for feature extraction, while incorporating innovations like path aggregation and spatial attention mechanisms. These attributes make YOLO a compelling candidate for adaptation to LV segmentation in Echo images. We posit that by fine-tuning a pre-trained YOLO based model on a well-annotated Echo image dataset, we can leverage the model's strengths in real-time processing and precise object localization to achieve robust LV segmentation. The proposed approach entails fine-tuning a pre-trained YOLO model on a rigorously labeled Echo image dataset. Model performance has been evaluated using established metrics such as mean Average Precision (mAP) at an Intersection over Union (IoU) threshold of 50% (mAP50) with 98.31%and across a range of IoU thresholds from 50% to 95% (mAP50:95) with 75.27%. Successful implementation of YOLO for LV segmentation has the potential to significantly expedite and standardize Echo image analysis. This advancement could translate to improved clinical decision-making and enhanced patient care.

Stress during a pandemic increased the risk of alcohol consumption, which may require pharmacological management. The characteristics of emergency calls for alcohol-related issues for patients pharmacologically treated, admitted to, or not admitted to the emergency department (ED) were analyzed. An observational single-center retrospective study was conducted from January 1, 2018 to December 31, 2021, and divided into 2-year periods (2018–2019 and 2020–2021). This study focused on calls to one of the EDs of seven hospitals in the Bari (Italy) metropolitan area for patients requiring emergency services (ES) who were either admitted or not admitted, due to their refusal. A 30% reduction in emergency calls for alcohol-related issues and a 41.17% reduction in calls for patients who refused to be admitted to the ED were observed during the pandemic. During the pandemic, a reduced rate of pharmacological treatment for calls coded green (non-critical), and an increase in calls coded yellow (fairly critical) and red (very critical) were recorded. Metadoxine was administered in almost all alcohol-related emergencies, primarily in conjunction with drugs acting on the gastrointestinal tract, irrespective of age, the period considered, and whether patients were admitted or not admitted to the ED. ES is the first and only out-of-hospital service encountered by numerous patients with alcohol-use disorders who refuse to be admitted to the ED. These patients should be directed by ES personnel to a multidisciplinary program to receive treatment for drinking, improve their quality of life, and reduce sanitation costs.

During the last decade, Bangladesh has been experienced a significant climatic anomalies which lead to an increase in magnitude and frequency of various climate relate extreme events. Climate scientists substantiate that global temperature and precipitation pattern is expected to change, which may result in consequential impact on agriculture, livelihood, and ecosystem. Bangladesh is therefore likely to face substantial challenges in the coming decades. In order to adequately understand this complex, dynamic phenomena, Analyzing historical Climate change scenarios as well as projecting its future trends is a great concern for researcher. This study aims to analyzes/ historical climatic data from (1901-2020), and predict future temperature and precipitation patterns in Bangladesh using CMIP6 data. Data used in this study (Observed data is from CRU TS 4.05 and future data is from CMIP6) have been acquired from WorldClim v2.1. Various methods including correlation, regression, standard deviation, correlation matrix, percentiles, cell statistics, and IDW interpolation were performed to analyze the trends, variability and spatial patterns of temperature and rainfall. This study revealed that Over the historical study period (1901-2020) Bangladesh has been experienced a significant warming trend with an average increase in temperature 2°C and with annual decline of the total precipitation 607.26 mm along with a shift towards drier conditions despite weak correlation with hotter years. Projected climate models represents that Bangladesh minimum temperature is expected to increase from 1°C to 4.4°C as well as maximum temperatures from 1°C to 4.1°C by 2100. Moreover, projected precipitation is expected to increase by 480.38 mm, with the biggest rises during monsoon months. Regional variations in temperature and precipitation are again expected, with the Southeast (SE) likely experiencing the most significant warming and the Northeast (NE) seeing the most substantial increase in precipitation.

The recent mountain pine beetle outbreaks have caused widespread mortality among lodgepole pine trees in western North America, resulting in a reduced population of surviving trees. While previous studies have focused on the cascading impacts of these outbreaks on the physiology and growth of the surviving trees, there remains a need for a comprehensive study into the interactions among various physiological traits and the growth in post-outbreak stands. Specifically, the relationship between chemical (primarily terpenes) and anatomical (mainly resin ducts) defences, as well as the allocation of non-structural carbohydrates (NSCs) to support these defence modalities, is poorly understood. To address these gaps, we conducted a field survey of surviving lodgepole pine trees in post-mountain pine beetle outbreak stands in western Canada. Our retrospective analysis targeted to determine correlations between the post-outbreak concentrations of monoterpenes, diterpenes, and NSCs in the phloem, and the historical resin duct characteristics and growth traits before and after the outbreak. We detected strong correlations between post-outbreak concentrations of monoterpenes and historical resin duct characteristics, suggesting a possible link between these two defence modalities. Additionally, we found a positive relationship between NSCs and the total concentrations of monoterpenes and diterpenes, suggesting that NSCs likely influence the production of these terpenes in lodgepole pine. Furthermore, historical tree growth patterns showed strong positive correlations with many individual monoterpenes and diterpenes. Interestingly, while surviving trees had enhanced anatomical defences after the outbreak, their growth patterns did not vary before and after the outbreak conditions. The complexity of these relationships emphasizes the dynamics of post-outbreak stand dynamics and resource allocation in lodgepole pine forests, highlighting the need for further research. These findings contribute to a broader understanding of conifer defenses and their coordinated responses to forest insect outbreaks, with implications for forest management and conservation strategies.

Currently, one of the main challenges is the mitigation of the effects of climate change on the agricultural sector. Conventional agriculture, with the intensive use of herbicides and pesticides to control weeds and pests, and the improper use of mineral fertilizers, contributes to climate change by causing increased greenhouse gases and groundwater pollution. Therefore, more innovative technologies must be used to overcome these problems. One possible solution is nanotechnology, which has the potential to revolutionize the conventional agricultural system. Active nanoparticles can be used both as a direct source of micronutrients and as a delivery platform for bioactive agrochemicals to improve crop growth, yield and quality. The use of nanoparticle formulations, including nanopesticides, nanoherbicides, nano-fertilizers and nano-emulsions, has been extensively studied to improve crop health and shelf life of agricultural products. Comprehensive knowledge of the interactions between plants and nanoparticles opens up new opportunities to improve cropping practices through the enhancement of properties such as disease resistance, crop yield, and nutrient use. The main objective of this review is to analyze the main effects of climate change on conventional agricultural practices, such as the use of pesticides, herbicides and fertilizers. It also focuses on how the introduction of nanoparticles into conventional practices can improve the efficiency of chemical pest control and crop nutrition. Finally, this review examines in depth the last 10 years (2014-2024) of scientific literature regarding the use of nanoparticles in agriculture to mitigate the effects of climate change.

The dawn of Artificial Intelligence (AI) in healthcare stands as a milestone in medical innovation. A plethora of different medical fields are heavily involved and pediatric emergency medicine is no exception. These new tools do not merely provide more advanced and efficient systems for patients’ diagnosis, management and treatment. They rather concern a strict shift from traditional methods based upon broad categories towards a more personalized healthcare. AI offers many promises in pediatric emergency medicine with a wide range of applications involving clinical decision making, patients’ flows management and prioritization. Main barriers to a widespread diffusion involve technological challenges but also ethical issues and the paucity of extensive datasets in pediatric contexts. We conducted a narrative review structured in two parts. The first part explores the theoretical principles of AI, providing all the necessary background to feel confident with these new state-of-the-art tools. The second part presents an informative analysis of AI models in pediatric emergencies, pointing out the actual applications and challenges until future feasible research perspectives.

(1) Background: LUS has emerged as a simple, rapid and non-invasive method for the dynamic assessment of pulmonary congestion, a major prognostic factor and a therapeutic target in AHF. (2) Methods: In the single-center prospective observational study, 42 patients hospitalized for AHF in the post-emergency polyvalent medicine department of CHU Grenoble were successively included between May 2021 and July 2022. Clinical examination, LUS and electrolyte panel results were collected daily. Vital status was assessed 30 days after the last LUS. The primary endpoint was the evolution of the number of B-lines according to the dose of diuretic administered ; (3) Results: We performed 188 LUS. Our patients were elderly (85.8 [SD 8.1]) and comorbid. The median number of B-lines decreased from 17 at admission to 7 in the middle of the hospital stay, then stagnated until discharge. Simultaneously, the median dose of diuretics, initially stable at a maximum of 40 mg/d IV, decreased to 20mg/d IV by the end of hospital stay. Patients with CKD had a higher mean number of B-lines at entry (24.2 [SD 11.6]) compared to those without CKD (8.2 [SD 8.8]). However, the evolution of B-lines number was independent of creatinine levels. 30-day all-causes mortality was significantly related to the number of B-lines at discharge (15.2 [SD 10.1] in deceased patients versus 3.9 [SD 5.4] in living patients, p